title: Pediatric tuberculosis-human immunodeficiency virus co-infection in the United Kingdom highlights the need for better therapy monitoring tools: a case report.
abstract: BACKGROUND
  Tuberculosis is an infection that requires at least 6 months of chemotherapy in order to clear the bacteria from the patient's lungs. Usually, therapeutic monitoring is dependent on smear microscopy where a decline in acid-fast bacilli is observed. However, this might not be indicative of the actual decline of bacterial load and thus other tools such as culture and molecular assays are required for patient management.
  
  
  METHODS
  Here, we report the case of a 12-year-old Black African boy co-infected with tuberculosis and human immunodeficiency virus who remained smear culture positive and liquid culture negative for a prolonged period of time following chemotherapy. In order to determine whether there was any live bacteria present in his specimens, we applied the newly developed molecular bacterial load assay that detects the presence of 16S ribosomal ribonucleic acid derived from the bacteria. Using this methodology, we were able to quantify his bacterial load and inform the management of his treatment in order to reduce the disease burden. Following this intervention he went on to make a complete recovery.
  
  
  CONCLUSIONS
  This case report highlights the value of improved biomarkers for monitoring the treatment of tuberculosis and the role of molecular assays such as the molecular bacterial load assay applied here. The molecular bacterial load assay detects bacterial ribonucleic acid which corresponds closely with the number of live bacilli as compared with polymerase chain reaction that detects deoxyribonucleic acid and may include dead bacteria.
authors.affiliation: Centre for Clinical Microbiology, University College London, London, NW3 2PF, UK. dimitrios.evangelopoulos@crick.ac.uk.|Present address: Laboratory of Mycobacterial Metabolism and Antibiotic Research, The Francis Crick Institute, London, NW1 1AT, UK. dimitrios.evangelopoulos@crick.ac.uk.
authors.forename: Dimitrios
authors.identifier: http://orcid.org/0000-0003-0472-7576
authors.initials: D
authors.lastname: Evangelopoulos
authors.affiliation: Department of Academic Paediatrics, Imperial College London, London, W2 1PG, UK.|Department of Paediatric Infectious Diseases, Great Ormond Street Hospital for Children, London, WC1N 3JH, UK.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Whittaker
authors.affiliation: Centre for Clinical Microbiology, University College London, London, NW3 2PF, UK.
authors.forename: Isobella
authors.initials: I
authors.lastname: Honeyborne
authors.affiliation: Centre for Clinical Microbiology, University College London, London, NW3 2PF, UK.
authors.forename: Timothy D
authors.initials: TD
authors.lastname: McHugh
authors.affiliation: Institute of Child Health and Great Ormond Street Hospital for Children, London, WC1N 3JH, UK.
authors.forename: Nigel
authors.initials: N
authors.lastname: Klein
authors.affiliation: Department of Paediatric Infectious Diseases, Great Ormond Street Hospital for Children, London, WC1N 3JH, UK.
authors.forename: Delane
authors.initials: D
authors.lastname: Shingadia
mesh_terms: D058491:Bacterial Load / Q000379:methods; D015415:Biomarkers / Q000032:analysis; D002648:Child; D060085:Coinfection; D015658:HIV Infections / Q000150:complications*; D006801:Humans; D008297:Male; D012336:RNA, Ribosomal, 16S; D011859:Radiography; D013183:Sputum / Q000382:microbiology*; D014397:Tuberculosis, Pulmonary / Q000150:complications* / Q000000981:diagnostic imaging / Q000382:microbiology; D006113:United Kingdom
chemical_list: D015415:Biomarkers; D012336:RNA, Ribosomal, 16S
keywords: Case report; Childhood tuberculosis; Clinical decisions; Molecular bacterial load; Rapid assay; Tuberculosis treatment monitoring