Understanding the interaction between cytomegalovirus and tuberculosis in children: The way forward

Olbrich, Laura; Stockdale, Lisa; Basu Roy, Robindra; Song, Rinn; Cicin-Sain, Luka; Whittaker, Elizabeth; Prendergast, Andrew J.; Fletcher, Helen und Seddon, James A. (2021): Understanding the interaction between cytomegalovirus and tuberculosis in children: The way forward.
In: PLOS Pathogens 17(12), e1010061

Abstract

Author summaryOver 1 million children develop tuberculosis (TB) each year, and a quarter of a million children die from this disease. It is increasingly recognised that cytomegalovirus (CMV), a virus that is very common in young children, especially in communities living in poverty, disrupts the immune response to the bacteria that cause TB and increases the chance that a child will develop TB disease. CMV may also change the way that TB manifests in children, how easily TB is diagnosed, and influence the outcome of children with TB. Current research on the interaction between TB and CMV in children is impeded by inconsistent research approaches and laboratory techniques. In this article, we describe what is known about TB, CMV, and about how the 2 pathogens interact in children. We then outline the research gaps that currently exist and make suggestions about the potential studies that might answer these questions. We believe that a better understanding of the interaction between these 2 pathogens could have a substantial impact on child health globally. Over 1 million children develop tuberculosis (TB) each year, with a quarter dying. Multiple factors impact the risk of a child being exposed to Mycobacterium tuberculosis (Mtb), the risk of progressing to TB disease, and the risk of dying. However, an emerging body of evidence suggests that coinfection with cytomegalovirus (CMV), a ubiquitous herpes virus, impacts the host response to Mtb, potentially influencing the probability of disease progression, type of TB disease, performance of TB diagnostics, and disease outcome. It is also likely that infection with Mtb impacts CMV pathogenesis. Our current understanding of the burden of these 2 diseases in children, their immunological interactions, and the clinical consequence of coinfection is incomplete. It is also unclear how potential interventions might affect disease progression and outcome for TB or CMV. This article reviews the epidemiological, clinical, and immunological literature on CMV and TB in children and explores how the 2 pathogens interact, while also considering the impact of HIV on this relationship. It outlines areas of research uncertainty and makes practical suggestions as to potential studies that might address these gaps. Current research is hampered by inconsistent definitions, study designs, and laboratory practices, and more consistency and collaboration between researchers would lead to greater clarity. The ambitious targets outlined in the World Health Organization End TB Strategy will only be met through a better understanding of all aspects of child TB, including the substantial impact of coinfections.

• Dokumententyp: Zeitschriftenartikel
• Fakultät: Medizin
• Themengebiete: 600 Technik, Medizin, angewandte Wissenschaften > 610 Medizin und Gesundheit
• ISSN: 1553-7366
• Sprache: Englisch