Department of Pulmonary Medicine, Amala Institute of Medical Sciences, Thrissur, India.
Amala Institute of Medical Sciences, Thrissur, India.
Indian J Tuberc. 2023;70 Suppl 1:S39-S48. doi: 10.1016/j.ijtb.2023.09.006. Epub 2023 Sep 17.
Tuberculosis and malignancy are major public health problems in developing countries like India and causes significant morbidity and mortality. Mycobacterium tuberculosis is an aerobic acid-fast bacilli which is an important pathogen especially complicating clinical status of paediatric oncology patients and treatment of infection with this bacilli is challenging in this subpopulation of patients because of ongoing immunosuppression and relative lack of published guidelines. Atypical presentations of tuberculosis in children also complicate the diagnosis and management. All the more, in tuberculosis endemic area lung cancer may be mistakenly diagnosed as tuberculosis or vice versa and this wrong diagnosis increases the burden on country's health status. It is noted that tuberculosis prevalence is high in children with haematological malignancy and head and neck tumours compared to other solid organ tumours. Moreover, it is found that morbidity and mortality from tuberculosis is more in children from WHO listed high TB burden countries who undergo hematopoietic stem cell and solid organ transplantation. Use of immune checkpoint inhibitors as novel therapy in treatment of childhood malignancies has led to modification of the body's immunological response and has resulted in increased latent tuberculosis infection reactivation as one immune-related infectious consequence. Latent TB infection screening is important concept in management of paediatric oncology patients. Currently, the tests employed as screening diagnostics for LTBI are interferon-gamma release assay (IGRA) blood test and the tuberculin skin test (TST). Various regimens have been suggested for the treatment of LTBI. But, after a positive IGRA or TST and prior to latent TB treatment, active tuberculosis should be ruled out by detailed history taking, examination and appropriate investigations so as to minimize the risk of drug resistance with anti-tuberculosis monotherapy used in LTBI treatment. To add on to literature, Non tuberculous mycobacteria are universally present environmental organisms. However, in immunocompromised children especially in subpopulation of malignancy, NTM is known to cause infections which needs protocol based management. Also importance has to given to implementation of adequate preventive and corrective measures to prevent such opportunistic infection in paediatric oncology subpopulation. In this review, we provide an overview of tuberculosis in paediatric oncology patients and summarize the expansive body of literature on the tuberculosis mimicking carcinoma, tuberculosis burden in transplantation patients and those receiving immune check point inhibitors, latent TB infection screening and management, and NTM infection in children with malignancy.
结核和恶性肿瘤是印度等发展中国家的主要公共卫生问题，导致了严重的发病率和死亡率。结核分枝杆菌是一种需氧的抗酸杆菌，是一种重要的病原体，特别是在儿科肿瘤患者的临床状况中变得复杂，并且由于持续的免疫抑制和相对缺乏已发表的指南，感染这种杆菌的治疗具有挑战性。儿童中结核的不典型表现也使诊断和管理变得复杂。更重要的是，在结核流行地区，肺癌可能被误诊为结核，反之亦然，这种错误诊断增加了国家的健康负担。值得注意的是，与其他实体器官肿瘤相比，血液恶性肿瘤和头颈部肿瘤患儿的结核患病率较高。此外，研究发现，来自世界卫生组织列出的高结核负担国家的接受造血干细胞和实体器官移植的儿童，其结核发病率和死亡率更高。免疫检查点抑制剂作为儿童恶性肿瘤治疗的新疗法的使用导致了机体免疫反应的改变，并导致潜伏性结核感染的再激活，作为一种免疫相关的传染性后果。潜伏性结核感染的筛查是儿科肿瘤患者管理的重要概念。目前，用于 LTBI 筛查诊断的检测方法是干扰素-γ释放检测（IGRA）血液检测和结核菌素皮肤试验（TST）。已经提出了各种治疗 LTBI 的方案。但是，在进行 IGRA 或 TST 阳性且在进行潜伏性结核病治疗之前，应通过详细的病史采集、检查和适当的检查来排除活动性结核病，以尽量减少使用 LTBI 治疗中抗结核单药治疗的耐药风险。除文献外，非结核分枝杆菌是普遍存在的环境生物体。然而，在免疫功能低下的儿童中，特别是在恶性肿瘤亚群中，已经知道 NTM 会引起感染，需要基于方案的管理。还必须重视实施充分的预防和纠正措施，以防止儿科肿瘤亚群发生这种机会性感染。在这篇综述中，我们提供了儿科肿瘤患者结核的概述，并总结了大量关于结核模拟癌、移植患者和接受免疫检查点抑制剂治疗患者的结核负担、潜伏性结核感染筛查和管理以及恶性肿瘤儿童 NTM 感染的文献。
