Page 92 - HA Convention 2016 [Full Version]

HOSPITAL AUTHORITY CONVENTION 2016 Special Topics

T5.1 Latest Development of Tuberculosis Management 14:30 Theatre 2

Diagnosis and Management of Tuberculosis in Children
LI AM
Department of Paediatrics, The Chinese University of Hong Kong, Hong Kong

Childhood tuberculosis (TB) accounts for a significant proportion of the global tuberculosis disease burden. However, current
and previous efforts to develop better diagnostic, therapeutic, and preventive interventions have focused on smear-positive
cases, i.e. adults with the disease. Childhood TB, which is usually pauci-bacillary and smear negative remains neglected
for various reasons, namely the difficulty in collecting appropriate and adequate specimens and in making the diagnosis,
the largely unknown outcomes of children with TB, and the belief that childhood TB is not important for disease control and
that children contribute little to transmission. In this presentation, the presenter will address recent advances and current
scientific studies in the management of childhood TB.

Tuesday, 3 May

T5.2 Latest Development of Tuberculosis Management 14:30 Theatre 2

Rapid Diagnosis and Detection of Drug Resistance in Tuberculosis
Yam WC
Department of Microbiology, Queen Mary Hospital, The University of Hong Kong, Hong Kong

Tuberculosis (TB) has reemerged as a global public health concern with an annual mortality of 3 millions. The rising trend
of multidrug-resistant tuberculosis (MDR-TB) poses a threat to timely clinical management. A national surveillance of drug-
resistant TB in China reported that MDR-TB was identified in 5.7% of the newly diagnosed cases and 40% of those previously
treated cases, and about 9.0% of the patients with MDR-TB cases had extensively drug resistant (XDR) TB. Less than 50% of
the estimated MDR-TB cases were successfully diagnosed in 2014, causing the death of 190,000 people.

Prolonged laboratory diagnosis and phenotypic drug susceptibility testing (DST) due to slow growing Mycobacterium
tuberculosis makes treatment initiation delay of 8 to 80 days from first contact with medical care, transmission control and
risking poor clinical outcomes. Despite a higher running cost, commercial genotypic assays rapidly identify mycobacterial
species and drug resistant-associated mutations with a short turnaround time. Since 2013, we have been collaborating with
Hong Kong Government Tuberculosis and Chest Service to provide molecular diagnosis for rapid detection of Mycobacterium
tuberculosis and resistance determinants from respiratory specimens using our in-house real time PCR-based assays at a
lower cost with relatively high diagnostic sensitivity and specificity. Using PCR-sequencing, novel mutations associated with
rifampicin and Ofloxacin resistance were also identified among treatment experienced patients.

Current study on massive parallel targeted sequencing (MPTS) for simultaneous prediction of drug susceptibility in
Mycobacterium tuberculosis from respiratory specimens shows promising results. The cost-effectiveness of development,
introduction and availability of these methods for rapid diagnostics improves public health control and early initiation of anti-
tuberculosis therapy.

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