Day 1 :
- Track 1: General Pediatrics
Track 3: Pediatric Immunology and Infectious Diseases
Chair
Guillermo Godoy
University of Alabama and DCH Health System, USA
Co-Chair
Scott A Siegel
American Board of Oral and Maxillofacial Surgery, USA
Session Introduction
Guillermo Godoy
University of Alabama and DCH, USA
Title: Introduction to Pediatrics Bioethics
Time : 11:25-11:40
Biography:
Guillermo Godoy graduated from San Carlos University in Guatemala, the only Medical School at that time in Guatemala. He did a residency in Pediatrics at Roosevelt Hospital and again when he came to United States of America, he repeated a Pediatrics residency at The University of Arkansas Medical Sciences/Arkansas Children's Hospital from 1980 to 1982. Then he did his Perinatal Medicine-Neonatology fellowship at The University of Alabama in Birmingham from 1982 to 1985 and stayed on the Neonatology staff for one year. He is in Tuscaloosa, Alabama at the DCH Health System NICU's since 1986. He is an Associate Professor of Pediatrics and Obstetrics at The University of Alabama, Tuscaloosa. He was Chairman of the Pediatrics Department and the Chief of Medical Staff. He helped to establish the Ethics Committee at the DCH Health System Hospitals in 1987. He published many manuscripts, especially in the areas of neonatal infections and cardiopulmonary pathophysiology. He have been invited to lecture about these topics in several institutions. He is actively involved in the development of CPOE/EMR and electronic progress notes at his institution.
Abstract:
Before we tackle the specific clinical problems and situations in the neonatal population, I will highlight the principles and most common thoughts to deal with them in an appropriate, systematic and standardized manner. The Ethical problems in the Neonatal Intensive Care setting have increased as the therapies and procedures have become more invasive, more technical and more expensive. The ethical dilemmas vary depending on the population studied. We will discuss these factors that individualize how we make decisions in the NICU.
Mary Beth Bodin
DCH Health System, USA
Title: Topical nystatin for the prevention of Catheter-Associated candidiasis in ELBW infants
Time : 11:40-11:55
Biography:
Abstract:
BACKGROUND: Catheter-associated Candida bloodstream infections are a common and serious problem in Newborn Intensive Care Units (NICU). Several prophylactic regimens have been developed including oral administration of non-absorbable antifungals and intravenous infusions. No reports to date have employed a topical regimen. PURPOSE: To evaluate the effectiveness of topical nystatin cream in reducing catheter-associated Candida sepsis. STUDY DESIGN: A retrospective descriptive design was used to determine the incidence of Candida sepsis in Extremely Low Birth Weight (ELBW, <1000 grams at birth) infants who were treated with topical nystatin cream for Candida bloodstream infection prophylaxis between January 1, 2000 and December 31, 2010. The electronic medical records of all infants less than 1,000 grams admitted to the study NICU were reviewed to establish the incidence of Candida sepsis. RESULT: 464 ELBW infants were admitted to the NICU during the study period. Three infants (0.65%) developed Candida sepsis. CONCLUSIONS: These data demonstrate that a topical nystatin cream protocol is associated with a very low rate of Candida sepsis in ELBW infants with central catheters. Use of this protocol may contribute to a decrease in the morbidity and mortality associated with catheter-associated Candida infections in ELBW infants.
Andrea M Cevasco-Trotter
University of Alabama, USA
Title: Developmental music therapy programming for extremely low and low birth weight premature infants
Time : 11:55-12:10
Biography:
Andrea Cevasco-Trotter is the Director of Music Therapy and an Associate Professor at The University of Alabama. She researches the effects of developmental music therapy interventions on premature infants’ physiological and behavioral parameters. Dr. Cevasco’s work has been published in the Journal of Music Therapy, Music Therapy Perspectives, and Pediatric Nursing; recently, she has published several textbook chapters. She serves as a member of the Editorial Committee for the Journal of Music Therapy and Music Therapy Perspectives as well as on the Board of Directors for the Certification Board for Music Therapists.
Abstract:
Premature infants in the Neonatal Intensive Care Unit (NICU) are exposed to loud noises, bright lights, and medical procedures that inhibit necessary sleep for neurological growth and development. Since the 1990s, researchers found that music assists in pacifying infants. The purpose of this presentation is two-fold: 1) to describe evidence-based music therapy protocols that are designed to meet the developmental needs of premature infants in the NICU and provide positive outcomes, and 2) to describe the outcomes of a research study involving a developmental music therapy program, based on existing protocols, to enhance and expand music therapy services for infants in the NICU. This study was especially novel in that infants as young as 25 weeks post corrected age (PCA) received live music, recorded music was utilized once infants were 30 weeks and older, and music and multimodal stimulation (MMS) was implemented for infants once they were 32 weeks and older. Infants in the experimental group went home earlier 3.6 days sooner than infants in the control group; experimental infants weighing less than 1500 gram went home 13 days earlier than those in the control group. Analysis of oxygen saturation levels and heart rate prior to, during, and post music therapy indicate positive trends. Special emphasis will be placed on how music therapist can meet the needs of very low and extremely low birth weight infants.
Stormy Leigh O’Bryant
DCH Health System, USA
Title: Advancements in neonatal surfactants
Time : 12:10-12:25
Biography:
Abstract:
Background: Respiratory distress syndrome (RDS) is the major cause of neonatal respiratory distress. RDS results from lung immaturity in pre-term infants as a result of surfactant deficiency and is associated with increased morbidity and mortality among this population. Purpose: Update neonatal providers on advancements in surfactants for the management of RDS. Objectives: Review latest primary literature for natural and synthetic surfactants indicated for the management of RDS. Discuss efficacy and safety data for the pipeline surfactants, aerosolized KL4 surfactant (AEROSURF®) and lyophilized KL4 surfactant (SURFAXIN LS™), currently in early phase clinical trials. Discuss the variances in delivery methods and neonatal tolerance among natural and synthetic surfactants and possible advantages offered by these pipeline surfactants.
Biography:
Ann Misra has a passion for the role she plays in healthcare. She recently received her hospital’s prestigious Excellence Award which the administrator presents to one nurse at her hospital every six months after being nominated by their peers.! ! Ann graduated with her nursing degree from Georgia Southwestern State University in 1991. A member of the Gamma Beta Phi Honor Society she served as President of the college’s chapter of the National Student Nurses Association and Student Representative at Faculty Meetings. Upon graduation she received both the Faculty Award and the Best All-Around Nursing Student Award.! By choice, Ann has always worked night shift with neonates. She received her certification in Neonatal Intensive Care Nursing in 2000, has served on a transport team, been a NRP Instructor, charge nurse, preceptor, mentor and chaired the journal club which she initiated in her unit.! ! Ann is eager to share her perspective on bedside nursing in her Level 3 NICU located in west central Alabama. She will share tips and suggestions which can make your interactions with bedside nurses more productive and meaningful.!
Abstract:
Neonatal Nurse bedside approach to the sick neonate: Physical Examination: Systems review and monitoring: Signs and symptoms. Coordination of multidisciplinary teams care: RT, Radiology, PT/OT, Child Life and consultations. Laboratories and procedures coordination. Neurodevelopmental: Enviroment. Stimulation. Feedings. Cluster Care. Kangooro Care. Social issues: Parents, guardians bonding. Breast feeding. Siblings. Teaching. Identification of social, family problems, issues. Social services coordination and plan development.
Anita D Berry
Advocate Children’s Hospital Downers Grove, USA
Title: Implementing an early childhood developmental screening and surveillance program in primary care settings: Lessons learned from Enhancing Developmentally Oriented Primary Care (EDOPC)
Time : 13:30-13:55
Biography:
Anita Berry received her Masters Degree in Advance Practice Nursing from DePaul University a certificate in Infant Mental Health from Erikson Institute, a certification as a Pediatric Nurse Practitioner from RUSH University, and has a Certification in Pediatric Primary Care Mental Health from the Pediatric Nursing Certification Board. She is the director of the Healthy Steps Program at Advocate Children’s Hospital, the largest network provider of pediatric services in Illinois and among the top 10 in the nation. She has spoken at numerous national conferences and published articles in several journals.
Abstract:
A project called Enhancing Developmentally Oriented Primary Care, with the goal of increasing the financing and delivery of preventive developmental services for children birth to age 3 years in the state of Illinois, provided training and technical assistance to primary care providers throughout the state of Illinois. Primary care providers have opportunities to screen and observe infants and toddlers and their caregivers more than any other professional, because they see them up to 13 times in the first 3 years of life for well-child visits. The project used a 1-hour, on-site training for primary care providers and their entire office staff as the method of increasing knowledge. Training focused on intent to change practice and implement validated routine early childhood developmental screening, and early referrals to Early Intervention or other community resources. Although many primary care providers routinely use only developmental surveillance in their practices, clinical practice guidelines recommend routine use of standardized developmental screening, using validated developmental screening tools. This presentation will share lessons learned and recommendations based on clinical practice guidelines and experiences of the team members during implementation of the EDOPC project and others. Primary care providers are critical to this process because children with developmental disorders have the best long-term outcomes and opportunities for improved family functioning with early detection, diagnosis, and treatment. J Pediatr Health Care. (2014) -,
Patricia Mack
Advocate Children’s Hospital Downers Grove, USA
Title: Implementing an early childhood developmental screening and surveillance program in primary care settings: Lessons learned from Enhancing Developmentally Oriented Primary Care (EDOPC)
Time : 13:30-13:55
Biography:
Patty Mack has been a nurse for over 30 years and in addition is a Licensed Marriage and Family Therapist and infant Mental Health Specialist. She is a Healthy Steps Specialist for the Advocate Children’s Hospital –Park Ridge Pediatric Residency Program. She trained pediatric providers, residents and staff across Illinois in developmental screening and referral for over 10 years as part of the Enhancing Developmentally Oriented Primary Care project. She provides therapy for individuals and families at the Chrysallis Center for Individual and Family Development. Patty presents at state and national conferences on child and family developmental issues.
Abstract:
A project called Enhancing Developmentally Oriented Primary Care, with the goal of increasing the financing and delivery of preventive developmental services for children birth to age 3 years in the state of Illinois, provided training and technical assistance to primary care providers throughout the state of Illinois. Primary care providers have opportunities to screen and observe infants and toddlers and their caregivers more than any other professional, because they see them up to 13 times in the first 3 years of life for well-child visits. The project used a 1-hour, on-site training for primary care providers and their entire office staff as the method of increasing knowledge. Training focused on intent to change practice and implement validated routine early childhood developmental screening, and early referrals to Early Intervention or other community resources. Although many primary care providers routinely use only developmental surveillance in their practices, clinical practice guidelines recommend routine use of standardized developmental screening, using validated developmental screening tools. This presentation will share lessons learned and recommendations based on clinical practice guidelines and experiences of the team members during implementation of the EDOPC project and others. Primary care providers are critical to this process because children with developmental disorders have the best long-term outcomes and opportunities for improved family functioning with early detection, diagnosis, and treatment. J Pediatr Health Care. (2014) -,
Alicia Kodsi
Maimonides Medical Centre, USA
Title: Respiratory viral infection status is not an accurate clinical determinant in distinguishing SBI risk in febrile neonates
Time : 13:55-14:20
Biography:
Dr. Alicia Kodsi received her Doctor of Medicine degree from St. George’s University, School of Medicine in June 2014. She is currently doing her pediatric residency at Maimonides Infant and Children’s Hospital in Brooklyn, NY, where she is involved in multiple clinical research studies, particularly in her field of interest, Pediatric Emergency Medicine. Dr. Kodsi was a tutor in Toronto for children with learning disabilities, where she continued to tutor up until she began her medical training.
Abstract:
Objectives: To analyze a large group of febrile neonates < 28 days of age who received outpatient sepsis evaluation and nasopharyngeal aspirate antigen testing [NPAT] for respiratory syncytial viral [RSV] infection to determine whether there is a clinically-significant association between viral study results and risk for serious bacterial infection [SBI: bacterial meningitis, bacteremia, urinary tract infection, bacterial enteritis]. Methods: We evaluated consecutive febrile neonates < 28 days of age presenting to our urban pediatric emergency department [MMC] during a 6-year period, all of whom received a sepsis evaluation [CSF, blood, urine cultures] and RSV NPAT testing. To achieve adequate power [80%], the MMC data was combined with similar data reported from a prior prospective PEM-CRC study1 of like-aged febrile neonates who received similar evaluation. Results: From the MMC data of consecutively evaluated cases, the prevalence rate of +RSV in 387 febrile neonates was 6%. Of these, 378 [98%] received both a sepsis evaluation and RSV NPAT; +SBI occurred in 4/22 [18.1%] with +RSV vs 58/356 [16.2%] with -RSV [p = 0.77]. Combined with the PEM-CRC1 cohort of 411 febrile neonates < 28 days of age who received similar evaluation, a total of 789 cases were analyzed using meta-analysis. Overall, there were 117 cases of +SBI [14.8%]; and 104 cases of +RSV [13.2%]. The rate of +SBI was 11.5% in those with +RSV vs 15.3% in those with –RSV. Meta-analysis performed showed no significant difference in rates of +SBI between those with and without +RSV [OR = 0.78, 95% CI 0.41 – 1.50; p = 0.46]. Conclusion: Rates of +SBI are not significantly different between febrile neonates < 28 days of age with and without +RSV. Respiratory viral infection status is not an accurate clinical determinant in distinguishing SBI risk in febrile neonates.
Maite Hartwig
Pediatric Pain Center Hamberg, Germany
Title: Nutritional behaviour and one-point-(laser) acupuncture in the treatment of children with chronic headache.
Time : 14:45-15:10
Biography:
Maite Hartwig MD has completed her study of medicine at the “Free University of Berlin” 2003. Internship was done at the children`s hospital of Greifswald. Since 2007 she has been working at the Dept. for Paediatric Haematology/Oncology at the University Hospital Hamburg. Four years ago she also started working at the Paediatric Pain Center Hamburg, where children of all ages with bride variety of chronic pain are treated.
Abstract:
The increasing number of pupils suffering from headache as well as the limited longterm power of drugs forced us to think about non-pharmacological solutions. We wanted to find possible answers for children suffering on headaches specially in combination with high muscle tension and/or allergic comorbidity. Knowing that children with migraine react on special food and additives (Egger et al 1983), we started to look for a oligoantigenic diet. Procedure-A: History of the family situation, life events, the child's troubles and strains, school-situation and nutritional habits were examined. After a run-in phase of 4 weeks headache documentation the children were randomized into two groups (RCT): one with an oral one-hour counselling, the other was only handled over a brochure with the necessary dietary informations. A diet was provided avoiding artificial additives, coffein, milk and fast food for 12 weeks. Results-A: 117 school children suffering from migraine or tension-type headache were recruited. 58% oft he pupils reduced their headache significantly. Results for migraine were even better. There was no significant difference between the two treatment groups. Procedure-B: Pupils with tension-type headache have been examined concerning their upper cervical function (C1/2). Approximately 95% oft hem showed a unilateral reduced rotation of at least 10º. A 1-point scalp Laser-acupuncture at the frontal B-zone according to Yamamoto was performed with approximatly 2 Joule. Directly afterwards and one month later cervical function was controlled. Results-B: Nearly all patients showed an improvement of their cervical function directly after the 1-point-acupuncture intervention. About one third of endurance during the following month till the next date including significant improvement of headache parameters could be documented. Conclusion: Dietary regimes in chronic pediatric headaches and migräne seems to be a valid regime specially in children with a comorbidity of allergies. 1-point-Laser-acupuncture seems to be as effective as ostheopathic interventions. This method could be well integrated in a multimodal program.
Corena de Beer
Stellenbosch University, South Africa
Title: Laboratory investigations in cases of Sudden and Unexpected Death in Infancy (SUDI) in the Tygerberg Medico-legal Mortuary, Cape Town, South Africa
Time : 15:10-15:35
Biography:
Corena de Beer has completed her PhD in 2004 and holds the position of Senior Medical Scientist and Senior Lecturer in the Division of Medical Virology of Stellenbosch University, Cape Town, South Africa. She started research on SUDI cases in collaboration with Forensic Pathology in 2009. She has published 32 papers, of which 3 were on SUDI. She has successfully supervised 18 postgraduate students and is currently supervising 2 PhD, 2 MSc and 1 Honours BSc students. She serves on the Editorial Board of Annals of Forensic Research and Analysis and on several national review boards.
Abstract:
Sudden and unexpected death in infancy (SUDI) is an under-researched field in South Africa. Identifying causes of death remains challenging despite full medico-legal investigations inclusive of autopsy, scene visit and ancillary studies. Viral and bacterial infections have been implicated repeatedly as risk factors for SUDI, but no standard laboratory investigation protocol exist in South Africa. A total of 148 SUDI cases from the Tygerberg Medico-legal Mortuary were collected over a one year period and investigated for respiratory viruses. Samples were collected from the lungs for viral and bacterial culture as part of the institutional SUDI investigation protocol. Two additional molecular assays were performed on nucleic acids extracted from lung tissue to screen for respiratory viruses and individual results were compared with routine histology on lung sections. Agreement between positive viral results and severe interstitial pneumonitis in a small number of cases suggested infection as the cause of death. Disagreement between viral results and histology occurred often and caused doubt on the cause of death in many cases. Demographic information confirmed several risk factors that correspond with the literature. Molecular assays produced higher positive yields for respiratory viruses than routine shell vial culture, but the agreement with interstitial pneumonitis was still suboptimal. Careful interpretation of molecular assays is necessary, due to latent or non-pathogenic viral loads of identified viruses. Agreement between molecular assays was also not significant and reconfirmed the need for different approaches in order to formulate an optimal screening protocol in determining the cause of death in SUDI cases.
Carmen Liliana Barbacariu
Gr. T. Popa University, Europe
Title: Parents refusal to vaccinate their children: An increasing social phenomenon which threatens public health
Time : 15:55-16:20
Biography:
Carmen Liliana Barbacariu, MD, PhD, is a teaching assistant at “Grigore T. Popa” University of Medicine and Pharmacy, Iasi, Romania. She is specialized in general practice and pediatrics and holds a PhD reflecting extensive research regarding childhood developmental disorders. Her main research interest is promoting child health and development through a range of early intervention strategies that address families with young children. She is a founding member of AREPMF (Romanian Association for Pediatric Education amongst General Practitioners) willing to perfect primary care for children at a national level. She has over 50 scientific publications and co-authorships in scientific articles, textbooks, and monographs.
Abstract:
Over the last few years, many controversies related to immunization safety have arisen, leading to an increasing number of parents who refuse to vaccinate their children. We performed a qualitative research study to investigate the reasons behind child immunization safety concerns. Our results reflected a decrease in vaccination coverage, a tendency also observed in the statistics reports of the Romanian National Centre for Infectious Disease Control and Prevention. As in many other countries, in Romania, the anti-vaccination movement had a negative impact on parents’ immunization behaviour. Nowadays, parents with young children do not have personal experience with vaccine-preventable diseases and they perceive low potential health risks from getting these infectious diseases. Disagreement among the medical experts is a frustrating concern for many parents, because even if they know that vaccination is supported by most of the medical community, they also recognize the expertise of researchers (immunologists, virologists, or microbiologists) who suggest a risk of severe long-term adverse events following immunization. The numerous controversies and statements surrounding immunization side effects caused an erosion of public trust in the efficiency and safety of vaccination programs. Therefore, the researchers along with the government must evaluate claims against vaccines and create new health policies presenting unambiguous information regarding the safety and importance of vaccination. Whether vaccination is voluntary or compulsory, each option faces complex ethical challenges because humans depend on each other in infectious diseases matter.
Juan Pablo Rojas Hernández
Universidad El Bosque, Colombia, South America.
Universidad Libre Seccional Cali, Colombia, South America
Title: Ecthyma gangrenosum in pediatrics
Time : 16:20-16:45
Biography:
Dr. Rojas is a medical doctor with actually training in Pediatric Infectious Diseases Fellowship Program in the Universidad El Bosque, Bogotá, Colombia and ample experience in Research of infectious diseases. He completed him M.D. degree from the Faculty of Ciencias de la Salud, Universidad Libre, Cali, Colombia followed by a postgraduate degree of Pediatrician from the Universidad Libre, Cali, Colombia. He has extensive experience in clinical and epidemiological research in areas such as Infectious Diseases, Bacterial Resistance, Dengue, as well as experience in training/teaching in the fields of clinical and epidemiological research. He has published over 20 articles on Pediatrics, epidemiology and control of infectious diseases. Recognition of the Colombian Society of Pediatrics, Resident Featured at 2013, in the 28th Colombian Congress of Pediatrics, done in the city of Cartagena, Colombia on 13 and 15 June 2013.
Abstract:
Ecthyma gangrenosum (EG) is a rare infection of the skin, known as a characteristic lesion caused by Pseudomoma aeruginosa, but also can occur from other types of bacteria like Staphylococcus aureus or beta hemolytic group, among others. This condition is often associated with primary and secondary immunodeficiencies. The lesions present clinically as scaly, erythematous violacious macules that rapidly evolve into papule-vesicles, bleeding and crusty blisters leaving a deep punch ulcer with a necrotic base. Mortality is high, between 40% and 75% of immunologically compromised individuals. We describe the case of a girl of 5 years of age who initially presented chickenpox and then superinfection with Staphylococcus aureus, causing a clinical picture of EG. The diagnosis was reached based on symptoms, cultures and skin biopsies. Management was achieved with acyclovir, intravenous clindamycin and cefepime, with a good and quick response by the patient.
Biography:
Ashok Kapse is consulting Pediatrician practicing in the city of Surat in the Gujrat state of India, besides owning a private pediatric hospital he is also head of the pediatric department at a prestigious Mahavir super specialty hospital. He has special interest and skill in infectious diseases. Working along with CDC Atlanta he evolved simple clinical approach for diagnosis and management of Dengue illnesses particularly in resource limited situations. Recipient of many oration awards he is a popular and sought after speaker, he has delivered hundreds of lectures on Dengue, Malaria, Typhoid and antibiotic uses across the India. He has published more than 10 articles in reputed national & international journals also has contributed chapters in prestigious books.
Abstract:
Child presenting with rash is common occurrence in pediatrics. Rash presenting with fever provides you material for microbiological evaluation, offers you unique opportunity to make clinical diagnosis, and gives clinician vital leads towards severity markers. A case could be approached in different ways however rash based approach is the easiest way for clinical evaluation. Classification and evaluation of rash as erythematous, maculopapular, papulovesicular, petechial, blisterous and so on leads clinician to correct diagnosis and proper management. Correct typing of rash directs clinician towards a careful wait and watch approach in certain clinical situation while dictates him to act emergently in others. I intend to provide an easy clinico-pictorial approach for a case presenting with rash in day to day practice.
Mir N Anwar
Stanger Hospital, South Africa
Title: Childhood TB in HIV Era- in Sub Saharan Africa
Time : 17:10-17:35
Biography:
Mir Anwar graduated Medicine from Bangladesh in 1975 He did his post-graduation in Pediatrics from Ireland in 1982. He did his MPH concentration Maternity and Child Health from University of Massachusetts, USA in 2003. Then he joins in UN/ WHO and worked as a Pediatric Consultant & Public Health Specialist, around the world including Asia, Japan, Middle East, Africa, Pacific Island, Ireland and USA. Since 2007 he has been working in South Africa in different provinces of South Africa with the Department of Health. Presently he is working as a Clinical Medical Manager in Richmond Chest Hospital, KZN. South Africa. Presently His main interest is in Childhood TB and HIV in Sub-Saharan Africa. In his long carrier in Pediatric and Public Health he had attended several International Congress, Conferences, and Seminars and presented his original work. Some of them were published in International Journal Including American Child Neurology Journal, Japan Pediatric Neurology Journal, Pakistan Pediatric Journal, Bangladesh Child Medical Journal , Nigerian Journal of Obstratics and Gynecology Etc. For his work he is honored by American Academy of Pediatrics, Royal College of Health, UK, and International College of Pediatrics. Etc. His Biography was published in Who’s Who in Medicine Cambridge, UK in 1985.
Abstract:
Background- TB is surging much of the Africa because of HIV epidemic, it is observed that TB rate is much higher then what is reported it in public health system. In South Africa out of all TB case 16% are amongst children. Objective- Childhood mortality is increasingly higher in sub-Saharan Africa. To know the reason of child mortality- is it because of TB or HIV or both? Method – TB & HIV infection in children in retrospective study was in our mind In 2010, 8.8 million new TB cases globally, 1.1 million deaths (excluding HIV). 1.1 Million new HIV associated TB cases, 82% living in Sub Saharan-Africa. About 26 % of all HIV patients when start with ART, had TB in their life time.TB is number one cause of death, in HIV infected patients. Results- Deaths Worldwide, HIV: 6000/day, TB: 5000/day South Africa,-TB case Incidence: 4 th in the world, Childhood TB- 16% of all TB cases. Co-infection of TB&HIV – Globally- 13%, South Africa- are around 25- 60% of amongst children. WHO endorsed in 2010 new diagnostic tool to confirm TB, like Gene Xpert MDR/RIP, PCR based test even in children. Presently it is not widely available in Sub Saharan Africa because of high cost. South Africa lucky to have Gene XPRT test kit available even in district hospital. It is observed that the patterns of TB symptoms are also changing then that of traditional one. Conclusion- Problem persists still on diagnosis of TB as 87% of the TB patients shows smear negative even with fluorescent microscope. It shows that smear negative TB patients have high mortality even with proper TB treatment. It also observed that HIV patients have low TB organism in sputum even with low CD4 count.TB is a multisystem diseases. TB and HIV are correlated with each other; if we can decrease the incidence of HIV we can decrease the incidence of TB both in morbidity and mortality, I will discuss all these issue and facts in this topic.