Scientific Letter
Description of an isoniazid-resistant tuberculosis outbreak in a block of apartments
Descripción de un brote de tuberculosis resistente a isoniacida en una comunidad de vecinos
Blanca Ruíz de Zárate, David Gomez-Pastrana
, Elvira Pérez-Escolano, Carmen Aragón Fernández, María Dolores López Prieto
Corresponding author
Unidad de Neumología Infantil, Hospital Materno Infantil Jerez, Jerez de la Frontera, Cádiz, Spain
Read
4887
Timeswas read the article
2092
Total PDF
2795
Total HTML
Share statistics
array:24 [ "pii" => "S2341287917301631" "issn" => "23412879" "doi" => "10.1016/j.anpede.2017.03.010" "estado" => "S300" "fechaPublicacion" => "2017-11-01" "aid" => "2234" "copyright" => "Asociación Española de Pediatría" "copyrightAnyo" => "2016" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "An Pediatr (Barc). 2017;87:292-3" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 1070 "formatos" => array:3 [ "EPUB" => 97 "HTML" => 636 "PDF" => 337 ] ] "Traduccion" => array:1 [ "es" => array:19 [ "pii" => "S1695403317301479" "issn" => "16954033" "doi" => "10.1016/j.anpedi.2017.03.002" "estado" => "S300" "fechaPublicacion" => "2017-11-01" "aid" => "2234" "copyright" => "Asociación Española de Pediatría" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "An Pediatr (Barc). 2017;87:292-3" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 2261 "formatos" => array:3 [ "EPUB" => 167 "HTML" => 1381 "PDF" => 713 ] ] "es" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">CARTA CIENTÍFICA</span>" "titulo" => "Descripción de un brote de tuberculosis resistente a isoniacida en una comunidad de vecinos" "tienePdf" => "es" "tieneTextoCompleto" => "es" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "292" "paginaFinal" => "293" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Description of an isoniazid-resistant tuberculosis outbreak in a block of apartments" ] ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Blanca Ruíz de Zárate, David Gomez-Pastrana, Elvira Pérez-Escolano, Carmen Aragón Fernández, María Dolores López Prieto" "autores" => array:5 [ 0 => array:2 [ "nombre" => "Blanca" "apellidos" => "Ruíz de Zárate" ] 1 => array:2 [ "nombre" => "David" "apellidos" => "Gomez-Pastrana" ] 2 => array:2 [ "nombre" => "Elvira" "apellidos" => "Pérez-Escolano" ] 3 => array:2 [ "nombre" => "Carmen" "apellidos" => "Aragón Fernández" ] 4 => array:2 [ "nombre" => "María Dolores" "apellidos" => "López Prieto" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2341287917301631" "doi" => "10.1016/j.anpede.2017.03.010" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2341287917301631?idApp=UINPBA00005H" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1695403317301479?idApp=UINPBA00005H" "url" => "/16954033/0000008700000005/v1_201710301212/S1695403317301479/v1_201710301212/es/main.assets" ] ] "itemSiguiente" => array:19 [ "pii" => "S234128791730162X" "issn" => "23412879" "doi" => "10.1016/j.anpede.2017.03.009" "estado" => "S300" "fechaPublicacion" => "2017-11-01" "aid" => "2238" "copyright" => "Asociación Española de Pediatría" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "An Pediatr (Barc). 2017;87:294.e1-8" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 4471 "formatos" => array:3 [ "EPUB" => 138 "HTML" => 3539 "PDF" => 794 ] ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Spanish Association of Paediatrics</span>" "titulo" => "Guidelines for prevention, detection and management of hyperbilirubinaemia in newborns of 35 or more weeks of gestation" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "294.e1" "paginaFinal" => "294.e8" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Recomendaciones para la prevención, la detección y el manejo de la hiperbilirrubinemia en los recién nacidos con 35 o más semanas de edad gestacional" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "fuente" => "<span class="elsevierStyleItalic">Source</span>: Adapted from the American Academy of Pediatrics.<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">7</span></a>" "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 462 "Ancho" => 1614 "Tamanyo" => 64441 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Indications for PT in newborns of 35 or more weeks’ gestation. These guidelines are based on limited evidence and the levels shown are approximations. Intensive PT should be used when the TBS concentration exceeds the level shown in the corresponding cell (values expressed in mg/dL). Patients at low risk: GA ≥38 weeks and well. Patients at medium risk: GA ≥38 weeks<span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span>risk factors for neurotoxicity, or GA of 35–37<span class="elsevierStyleSup">+6</span> weeks and well. Patients at high risk: GA of 35–37<span class="elsevierStyleSup">+6</span> weeks with risk factors for neurotoxicity. Risk factors for neurotoxicity: isoimmune haemolytic disease, G6PD deficiency, asphyxia, significant lethargy, temperature instability, sepsis, acidosis or albumin <3<span class="elsevierStyleHsp" style=""></span>g/dL. GA, gestational age; G6PD, glucose-6-phosphate dehydrogenase; PT, intensive phototherapy; TSB, total serum bilirubin.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "María Dolores Sánchez-Redondo Sánchez-Gabriel, José Luis Leante Castellanos, Isabel Benavente Fernández, Alejandro Pérez Muñuzuri, Segundo Rite Gracia, Cesar W. Ruiz Campillo, Ester Sanz López, Manuel Sánchez Luna" "autores" => array:9 [ 0 => array:2 [ "nombre" => "María Dolores" "apellidos" => "Sánchez-Redondo Sánchez-Gabriel" ] 1 => array:2 [ "nombre" => "José Luis" "apellidos" => "Leante Castellanos" ] 2 => array:2 [ "nombre" => "Isabel" "apellidos" => "Benavente Fernández" ] 3 => array:2 [ "nombre" => "Alejandro" "apellidos" => "Pérez Muñuzuri" ] 4 => array:2 [ "nombre" => "Segundo" "apellidos" => "Rite Gracia" ] 5 => array:2 [ "nombre" => "Cesar W." "apellidos" => "Ruiz Campillo" ] 6 => array:2 [ "nombre" => "Ester" "apellidos" => "Sanz López" ] 7 => array:2 [ "nombre" => "Manuel" "apellidos" => "Sánchez Luna" ] 8 => array:1 [ "colaborador" => "On behalf of the Comisión de Estándares de la Sociedad Española de Neonatología" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S1695403317301510" "doi" => "10.1016/j.anpedi.2017.03.006" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1695403317301510?idApp=UINPBA00005H" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S234128791730162X?idApp=UINPBA00005H" "url" => "/23412879/0000008700000005/v1_201710301006/S234128791730162X/v1_201710301006/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S2341287917301655" "issn" => "23412879" "doi" => "10.1016/j.anpede.2017.01.006" "estado" => "S300" "fechaPublicacion" => "2017-11-01" "aid" => "2209" "copyright" => "Asociación Española de Pediatría" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "An Pediatr (Barc). 2017;87:291-2" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 1539 "formatos" => array:3 [ "EPUB" => 119 "HTML" => 954 "PDF" => 466 ] ] "en" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Scientific Letter</span>" "titulo" => "Osteoarticular tuberculosis in paediatrics: A review of 20 years of cases in a tertiary hospital" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "291" "paginaFinal" => "292" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Tuberculosis osteoarticular en la edad pediátrica, revisión de casos en 20 años en un hospital terciario" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "María José Pérez Durán, Bárbara Moreno Sanz-Gadea, Teresa del Rosal Raves, María José Mellado Peña, Fernando Baquero-Artigao" "autores" => array:5 [ 0 => array:2 [ "nombre" => "María José" "apellidos" => "Pérez Durán" ] 1 => array:2 [ "nombre" => "Bárbara" "apellidos" => "Moreno Sanz-Gadea" ] 2 => array:2 [ "nombre" => "Teresa" "apellidos" => "del Rosal Raves" ] 3 => array:2 [ "nombre" => "María José" "apellidos" => "Mellado Peña" ] 4 => array:2 [ "nombre" => "Fernando" "apellidos" => "Baquero-Artigao" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S1695403317300334" "doi" => "10.1016/j.anpedi.2017.01.008" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1695403317300334?idApp=UINPBA00005H" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2341287917301655?idApp=UINPBA00005H" "url" => "/23412879/0000008700000005/v1_201710301006/S2341287917301655/v1_201710301006/en/main.assets" ] "en" => array:14 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Scientific Letter</span>" "titulo" => "Description of an isoniazid-resistant tuberculosis outbreak in a block of apartments" "tieneTextoCompleto" => true "saludo" => "Dear Editor:" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "292" "paginaFinal" => "293" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Blanca Ruíz de Zárate, David Gomez-Pastrana, Elvira Pérez-Escolano, Carmen Aragón Fernández, María Dolores López Prieto" "autores" => array:5 [ 0 => array:2 [ "nombre" => "Blanca" "apellidos" => "Ruíz de Zárate" ] 1 => array:4 [ "nombre" => "David" "apellidos" => "Gomez-Pastrana" "email" => array:1 [ 0 => "dgpastranad@gmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 2 => array:2 [ "nombre" => "Elvira" "apellidos" => "Pérez-Escolano" ] 3 => array:2 [ "nombre" => "Carmen" "apellidos" => "Aragón Fernández" ] 4 => array:2 [ "nombre" => "María Dolores" "apellidos" => "López Prieto" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Unidad de Neumología Infantil, Hospital Materno Infantil Jerez, Jerez de la Frontera, Cádiz, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Descripción de un brote de tuberculosis resistente a isoniacida en una comunidad de vecinos" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Drug resistance is an additional difficulty in the diagnosis and treatment of tuberculosis (TB). A rate of isoniazid (H) resistance of up to 9.6% has been reported in children in Spain.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">1</span></a> We present data on an outbreak of isoniazid-resistant TB, with emphasis on contact tracing and the diagnostic and treatment characteristics of paediatric cases.</p><p id="par0010" class="elsevierStylePara elsevierViewall">The index case was a man aged 39 years with active laryngeal TB and pulmonary cavitation that cared for children in an apartment block. He was isolated in the hospital from the moment of diagnosis and treated with H, rifampicin (R), pyrazinamide (Z) and ethambutol (E). Seven weeks later, resistance to H was confirmed (S315T mutation in the <span class="elsevierStyleItalic">katG</span> gene), so H was discontinued and streptomycin (S) and moxifloxacin added to the regimen. The patient suffered a tendon rupture that led to discontinuation of moxifloxacin, and eventually completed 12 months of treatment.</p><p id="par0015" class="elsevierStylePara elsevierViewall">The contact tracing involved performance of a tuberculin skin test (TST) that was repeated 2 months later in individuals with indurations of less than 5<span class="elsevierStyleHsp" style=""></span>mm. Children aged up to 14 years underwent a QuantiFERON<span class="elsevierStyleSup">®</span> test (Cellestis, Victoria, Australia) and chest radiograph (CXR). Contacts with a TST induration of 5<span class="elsevierStyleHsp" style=""></span>mm or greater and normal CXR underwent ultrasound examination of the mediastinum to assess for potential lymphadenopathies not visible in CXR. Lymph nodes greater than 1<span class="elsevierStyleHsp" style=""></span>cm considered abnormal.</p><p id="par0020" class="elsevierStylePara elsevierViewall">The investigation comprehended 16 adults and 15 children. None of the contacts were immigrants or had been vaccinated with BCG. Six children had indurations of 0<span class="elsevierStyleHsp" style=""></span>mm (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>) and were treated with H for primary chemoprophylaxis until the second TST, and this was negative in all of them.</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">Eight children with an induration of 5<span class="elsevierStyleHsp" style=""></span>mm or greater and a normal chest CXR received a diagnosis of latent tuberculosis infection (LTBI) and started HR treatment until resistance to H became known, eventually completing 6 months of R (6 R). One of them presented with subcarinal adenopathies of 2.3<span class="elsevierStyleHsp" style=""></span>cm in diameter on mediastinal ultrasound examination, but received a diagnosis of and treatment for LTBI per this study protocol. This patient remained asymptomatic and the lymphadenopathy was no longer visible on ultrasound after 4 months of treatment. One girl developed asymptomatic hypertransaminasaemia, which resolved with the discontinuation of treatment followed by its gradual reintroduction. One adolescent did not adhere to treatment repeatedly, and eventually completed 5 R.</p><p id="par0030" class="elsevierStylePara elsevierViewall">The QuantiFERON<span class="elsevierStyleSup">®</span> test was negative in children without infection and positive in children with LTBI, except for 1 girl aged 8 years with an induration of 17<span class="elsevierStyleHsp" style=""></span>mm in the TST and close contact with the index case.</p><p id="par0035" class="elsevierStylePara elsevierViewall">One boy aged 4 years with an induration of 20<span class="elsevierStyleHsp" style=""></span>mm and adenopathies on CXR received a diagnosis of tuberculosis disease (TBD) and started treatment with HRZE. His samples were negative, and after H resistance in the source case became known, completed 6 RZE. He was followed up at the clinic one year after he finished the treatment.</p><p id="par0040" class="elsevierStylePara elsevierViewall">Of the adults that were investigated, 10 had a positive result in the initial TST and 1 more had a positive result in the second test. All had normal CXR, received a diagnosis of LTBI and were treated with a 4 R regimen.</p><p id="par0045" class="elsevierStylePara elsevierViewall">The rate of isoniazid resistance in Spain is greater than 4%, so induction treatment of TBD should include 4 drugs unless it is known that the strain is sensitive to H.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">2</span></a> The recommended regimes for isoniazid resistant TB are 6–9 RZE, 2 RZES/7 RE or 2 RZE/7–10 RE, with the possible addition of a quinolone the first 2 months.<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">3,4</span></a> The boy with TBD in our study started treatment with 4 drugs and only completed 6 months of RZE, since Z was used throughout the treatment and due to the low bacillary population in the patient.</p><p id="par0050" class="elsevierStylePara elsevierViewall">In our unit, we use the 3 HR regimen for LTBI, which shortens the duration of treatment, improves adherence and covers the possibility of H resistance from the beginning of treatment. Cases with documented resistance to H require a 4–6 R regimen.<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">3,5</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">Six children were treated ineffectively with H for primary prophylaxis, as the resistance to H was unknown at the time, but fortunately the results of the second TST were negative in all.</p><p id="par0060" class="elsevierStylePara elsevierViewall">The delay in the diagnosis of drug resistance was 7 weeks. The GenoType MTBDRplus<span class="elsevierStyleSup">®</span> (Hains Life Science, Nehren, Germany) is a rapid assay that can be used to identify most of the mutations that confer resistance to R (<span class="elsevierStyleItalic">rpoB</span>) or H (<span class="elsevierStyleItalic">inh</span>A and <span class="elsevierStyleItalic">kat</span>G), facilitating the early detection of resistance.</p><p id="par0065" class="elsevierStylePara elsevierViewall">The agreement of the QuantiFERON<span class="elsevierStyleSup">®</span> test with the TST for the diagnosis of LTBI was good, although there was 1 false negative result with QuantiFERON<span class="elsevierStyleSup">®</span>. This technique can help diagnose LTBI, especially in patients that have received BCG vaccination or with immunosuppression, although it should not be used as a substitute for the TST.</p><p id="par0070" class="elsevierStylePara elsevierViewall">The asymptomatic patient with an induration of 23<span class="elsevierStyleHsp" style=""></span>mm in the TST and a normal CXR with evidence of adenopathies on mediastinal ultrasound was classified and treated as a case of LTBI as opposed to TBD in our study, with a favourable outcome in sonographic followup. Lymphadenopathies that can only be detected by computed tomography or ultrasound in asymptomatic children do not seem to be specific of tuberculosis disease.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">6</span></a></p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Ruíz de Zárate B, Gomez-Pastrana D, Pérez-Escolano E, Aragón Fernández C, López Prieto MD. Descripción de un brote de tuberculosis resistente a isoniacida en una comunidad de vecinos. An Pediatr (Barc). 2017;87:292–293.</p>" ] ] "multimedia" => array:1 [ 0 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">F, family; L, leisure; 1, close contact (more than 6<span class="elsevierStyleHsp" style=""></span>h a day); 2, daily contact (fewer than 6<span class="elsevierStyleHsp" style=""></span>h a day); 3, occasional contact (not daily).</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Relationship with index case and level of closeness \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Age (years) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Tuberculin skin test (induration in mm) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">QuantiFERON<span class="elsevierStyleSup">®</span> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Chest radiograph \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Diagnosis \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">L3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">14 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Negative \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Normal \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No infection \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">L2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">10 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">25 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Positive \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Normal \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">LTBI \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">L2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Negative \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Normal \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No infection \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">L1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">25 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Positive \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Normal (chest ultrasound: subcarinal lymphadenitis) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">LTBI \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">F3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Negative \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Normal \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No infection \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">F3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Negative \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Normal \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No infection \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">F3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Negative \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Normal \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No infection \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">F3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Negative \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Normal \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No infection \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">F2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">12 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">18 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Positive \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Normal \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">LTBI \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">F2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">17 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Negative \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Normal \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">LTBI \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">F1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">14 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">20 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Positive \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Normal \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">LTBI \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">F1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">22 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Positive \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Normal \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">LTBI \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">F1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">20 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Positive \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Normal \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">LTBI \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">F1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">20 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Positive \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Abnormal \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">TBD \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">F1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">10 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Positive \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Normal \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">LTBI \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1576341.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Epidemiologic, clinical and radiologic data for the children under study.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:6 [ 0 => array:3 [ "identificador" => "bib0035" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Pediatric drug-resistant tuberculosis in Madrid: family matters" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "B. Santiago" 1 => "F. Baquero-Artigao" 2 => "A. Mejías" 3 => "D. Blázquez" 4 => "M.S. Jiménez" 5 => "M.J. Mellado-Peña" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/INF.0000000000000111" "Revista" => array:6 [ "tituloSerie" => "Pediatr Infect Dis J" "fecha" => "2014" "volumen" => "33" "paginaInicial" => "345" "paginaFinal" => "350" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24622395" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0040" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:1 [ "titulo" => "Documento de consenso: plan para la prevención y control de la tuberculosis en España" ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.arbres.2009.01.001" "Revista" => array:6 [ "tituloSerie" => "Arch Bronconeumol" "fecha" => "2009" "volumen" => "45" "paginaInicial" => "139" "paginaFinal" => "144" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19251347" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0045" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Documento de consenso de la Sociedad Española de Infectología Pediátrica sobre la tuberculosis resistente a fármacos" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "M.J. Mellado Peña" 1 => "F. Baquero-Artigao" 2 => "D. Moreno-Perez" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "An Pediatría" "fecha" => "2009" "volumen" => "71" "paginaInicial" => "447" "paginaFinal" => "458" ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0050" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Tuberculosis (NICE clinical guideline 33)" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "L. Turnbull" 1 => "C. Bell" 2 => "F. Child" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1136/archdischild-2016-310870" "Revista" => array:2 [ "tituloSerie" => "Arch Dis Child-Educ Pract Ed" "fecha" => "2016" ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0055" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Rifampin preventive therapy for tuberculosis infection: experience with 157 adolescents" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M.E. Villarino" 1 => "R. Ridzon" 2 => "P.C. Weismuller" 3 => "M. Elcock" 4 => "R.M. Maxwell" 5 => "J. Meador" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1164/ajrccm.155.5.9154885" "Revista" => array:7 [ "tituloSerie" => "Am J Respir Crit Care Med" "fecha" => "1997" "volumen" => "155" "paginaInicial" => "1735" "paginaFinal" => "1738" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9154885" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S1473309916301906" "estado" => "S300" "issn" => "14733099" ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0060" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "¿Debe realizarse una tomografía computarizada torácica a los niños con infección tuberculosa sin enfermedad aparente?" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "D. Gómez-Pastrana" 1 => "A. Carceller-Blanchard" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "An Pediatr" "fecha" => "2007" "volumen" => "67" "paginaInicial" => "585" "paginaFinal" => "593" ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/23412879/0000008700000005/v1_201710301006/S2341287917301631/v1_201710301006/en/main.assets" "Apartado" => array:4 [ "identificador" => "38181" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Scientific letters" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/23412879/0000008700000005/v1_201710301006/S2341287917301631/v1_201710301006/en/main.pdf?idApp=UINPBA00005H&text.app=https://analesdepediatria.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2341287917301631?idApp=UINPBA00005H" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 10 | 7 | 17 |
| 2024 October | 27 | 28 | 55 |
| 2024 September | 50 | 35 | 85 |
| 2024 August | 52 | 44 | 96 |
| 2024 July | 36 | 33 | 69 |
| 2024 June | 40 | 34 | 74 |
| 2024 May | 56 | 36 | 92 |
| 2024 April | 40 | 34 | 74 |
| 2024 March | 44 | 33 | 77 |
| 2024 February | 43 | 26 | 69 |
| 2024 January | 43 | 13 | 56 |
| 2023 December | 47 | 22 | 69 |
| 2023 November | 42 | 17 | 59 |
| 2023 October | 34 | 22 | 56 |
| 2023 September | 35 | 18 | 53 |
| 2023 August | 41 | 17 | 58 |
| 2023 July | 37 | 31 | 68 |
| 2023 June | 41 | 23 | 64 |
| 2023 May | 38 | 18 | 56 |
| 2023 April | 26 | 18 | 44 |
| 2023 March | 35 | 26 | 61 |
| 2023 February | 31 | 18 | 49 |
| 2023 January | 34 | 16 | 50 |
| 2022 December | 38 | 32 | 70 |
| 2022 November | 57 | 27 | 84 |
| 2022 October | 55 | 60 | 115 |
| 2022 September | 24 | 34 | 58 |
| 2022 August | 39 | 84 | 123 |
| 2022 July | 39 | 68 | 107 |
| 2022 June | 31 | 35 | 66 |
| 2022 May | 40 | 35 | 75 |
| 2022 April | 34 | 27 | 61 |
| 2022 March | 60 | 47 | 107 |
| 2022 February | 43 | 29 | 72 |
| 2022 January | 37 | 34 | 71 |
| 2021 December | 31 | 39 | 70 |
| 2021 November | 44 | 47 | 91 |
| 2021 October | 50 | 68 | 118 |
| 2021 September | 31 | 35 | 66 |
| 2021 August | 49 | 40 | 89 |
| 2021 July | 31 | 24 | 55 |
| 2021 June | 32 | 54 | 86 |
| 2021 May | 31 | 36 | 67 |
| 2021 April | 70 | 49 | 119 |
| 2021 March | 52 | 32 | 84 |
| 2021 February | 23 | 18 | 41 |
| 2021 January | 36 | 19 | 55 |
| 2020 December | 32 | 25 | 57 |
| 2020 November | 26 | 18 | 44 |
| 2020 October | 18 | 27 | 45 |
| 2020 September | 37 | 25 | 62 |
| 2020 August | 17 | 19 | 36 |
| 2020 July | 27 | 13 | 40 |
| 2020 June | 28 | 12 | 40 |
| 2020 May | 32 | 20 | 52 |
| 2020 April | 25 | 10 | 35 |
| 2020 March | 42 | 29 | 71 |
| 2020 February | 27 | 25 | 52 |
| 2020 January | 20 | 16 | 36 |
| 2019 December | 33 | 19 | 52 |
| 2019 November | 17 | 6 | 23 |
| 2019 October | 12 | 11 | 23 |
| 2019 September | 15 | 12 | 27 |
| 2019 August | 33 | 16 | 49 |
| 2019 July | 24 | 17 | 41 |
| 2019 June | 23 | 17 | 40 |
| 2019 May | 19 | 26 | 45 |
| 2019 April | 69 | 29 | 98 |
| 2019 March | 21 | 17 | 38 |
| 2019 February | 31 | 23 | 54 |
| 2019 January | 21 | 21 | 42 |
| 2018 December | 29 | 29 | 58 |
| 2018 November | 39 | 28 | 67 |
| 2018 October | 54 | 16 | 70 |
| 2018 September | 29 | 11 | 40 |
| 2018 August | 3 | 0 | 3 |
| 2018 July | 6 | 0 | 6 |
| 2018 June | 5 | 0 | 5 |
| 2018 May | 16 | 0 | 16 |
| 2018 April | 28 | 0 | 28 |
| 2018 March | 31 | 0 | 31 |
| 2018 February | 12 | 0 | 12 |
| 2018 January | 18 | 0 | 18 |
| 2017 December | 17 | 0 | 17 |
| 2017 October | 0 | 13 | 13 |
Show all
