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France's Cruelty To Kids
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Let's throw children suffering from infectious diseases out into the city streets – does that sound like a good idea to you?
That's what authorities are doing to kids in Marseille, France's second largest city, apparently unconcerned by the brutal immorality of what they're doing, let alone the public health issues.
To understand this breakdown in human decency, let's focus on one case, that of a teenage boy we'll call "R."
Born in West Africa, R. Ended up in Marseille, where initially he was able to stay in emergency accommodation in February 2021. There, he waited for an all-important age assessment, that is, whether the regional authorities in the French department of Bouches-du-Rhône considered him a child or an adult.
While housed there, he was diagnosed with tuberculosis by the national tuberculosis control center. Now, tuberculosis is preventable and curable, but it can be fatal without treatment. In fact, after COVID-19, tuberculosis is the second leading infectious killer globally today.
Naturally, then, the national tuberculosis control center told the departmental authorities about R.'s diagnosis and requested he be sent to their facilities for treatment. However, despite numerous reminders to the department over several months, R. Was never redirected to receive that treatment.
Instead, in April 2021, his age assessment declared him not a child, and he was turned out on the streets with no anti-tuberculosis treatment nor follow-up care.
These age assessments in France are often pivotal like this, but the decisions are super dodgy. In nearly 75 percent of cases, the assessments are overturned on appeal. Unfortunately, this review by the courts can take months, even years. In the meantime, children are ineligible for emergency accommodation – that is, they're often forced to live homeless, on the streets.
They also can't access services, such as education, legal assistance, the appointment of a guardian, and universal health protection.
Which brings us back to the teenage boy, R. Untreated, his tuberculosis spread to his bones and spinal cord. In November 2021, R. Abruptly lost sensation in both his legs. Doctors performed an emergency arthrodesis – a joint fusion – and inserted metal plates in his vertebrae.
To this day, R. Continues to experience severe physical pain, he's lost 60 percent of his mobility, and there are movements he will never simply be able to do again. His nightmare could have been avoided had the authorities acted ten months earlier, when R. Had his initial diagnosis.
The mean-spiritedness, the shamefulness, the shortsightedness of the authorities' actions are appalling, but what's even worse is that R.'s case is not unusual.
A new report documents how the French department of Bouches-du-Rhône, which includes Marseille, is failing to provide unaccompanied migrant children the protections they need and to which they are entitled.
They force children to sleep in the streets for days or weeks with tuberculosis, HIV, post-traumatic stress, or undetected pregnancies while they wait for their age assessment appeals – which, again, are successful in three out of four cases.
Officials should stop trying to hide behind the too-often bogus bureaucracy of age assessments. They should assume these folks are kids – because most of them are – and treat them humanely, not throw them out on the streets.
Tuberculosis Prevention: Health Disparities And Ethnic Populations
Unlike the flu, tuberculosis does not affect all people equally. The risk of infection is often dependent on where you live, your ethnicity, and your access to preventive measures, explained Carmen Sierra, DNP, RN, MBA, CCTN, a current PhD student at University of Miami, Florida.
Despite efforts to eliminate the disease, 13 million Americans are living with latent tuberculosis infection (LTBI), according to the most recent statistics from the National Health and Nutrition Examination Survey (NHANES). These include health care professionals who may have been exposed to Mycobacterium tuberculosis while at work. "Patients with latent TB can't spread the bacteria from person to person but [the disease] can advance to active TB without treatment," Dr Sierra said during a presentation at the DNPs of Color annual meeting in Washington, DC. Health care personnel with untreated latent TB infection should receive an annual TB symptom screen.
The prevalence of latent TB infection varies, with over 80% of US TB cases resulting from untreated latent infection. Among the 13 million cases, 8.9 million have untreated latent infection. Patients with latent TB are asymptomatic and noncontagious but show positive skin or blood tests and normal chest radiographs.
Although there is a vaccine, the Bacille Calmette- Guérin (BCG) vaccine is not widely used in the US, according to the Centers for Disease Control and Prevention. "In the United States, BCG is only considered for people who meet specific criteria and in consultation with a TB expert. Health care providers can consult their state or local TB control program for questions about BCG vaccination for their patients," said the CDC website.
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Among foreign born immigrants, the incidence of TB is higher in areas with large immigrant populations and ports of entry such as California (22% of cases), Texas (13% of cases), New York (9% of cases), and Florida (6% of cases).
Active infections have become rare among native-born Americans but rates are increasing, with 8331 reported new cases of TB in the United States in 2022 (a rate of 2.5 per 100,000 persons). Symptoms include persistent cough, hemoptysis, chest pain, weakness, no appetite, weight loss, chills, fever, and night sweats. "Approximately two-thirds of new cases of TB and 85% of multidrug-resistant TB are among non-US born persons," Dr Sierra said.
In the US, TB is more common in Asian, Hispanic, and Black populations. In 2021, TB affected 2834 Asian persons (36% of new cases), 2410 Hispanic or Latino persons (31%), and 1420 Black or African American people (18%), Dr Sierra reported. It is more prevalent in correctional institutes, the unhoused population, and international travelers to places where TB is endemic. The incidence of TB is also higher in California, in the southern states, and among major cities, including Baltimore, Chicago, District of Columbia, New York City, and Philadelphia. (Figure 1)
Among foreign born immigrants, the incidence of TB is higher in areas with large immigrant populations and ports of entry such as California (22% of cases), Texas (13% of cases), New York (9% of cases), and Florida (6% of cases). (Figure 2)
Dr Sierra advocates for enhanced screening with interferon gamma release assays (IGRAs), target interventions, and addressing disparities through improved access to care, treatment adherence, and identifying high-risk populations.
To find out where TB is active, visit World Atlas of TB.
What To Know About Genitourinary Tuberculosis
Genitourinary tuberculosis (GUTB) is a type of tuberculosis that affects the urinary system, genital organs, or both. It can lead to symptoms such as pain, blood in urine, or increased urinary frequency.
GUTB usually results from an Mycobacterium tuberculosis infection in the lungs that spreads to the genitourinary tract via the blood.
Treatment usually involves 6 months of antituberculosis medication. The cure rate is around 90%, with early detection and drug compliance.
Keep reading to learn more about GUTB, including the causes, symptoms, diagnosis, treatment, and outlook.
GUTB is when tuberculosis affects the genitals or urinary tract.
While tuberculosis can affect any organ, it most often involves the lungs, known as pulmonary tuberculosis. However, about 5–45% of cases affect other body parts. Of these, 30–40% involve one or more components of the urinary tract or genitals.
Learn more
Find out more about the genitourinary tract, including:
The microbe that usually leads to GUTB is M. Tuberculosis. However, other bacteria can also cause it. These include:
In rare cases, the tuberculosis vaccine bacillus Calmette-Guérin can lead to GUTB.
The most frequent cause involves the spread of pulmonary tuberculosis through the blood to the urogenital tract during the initial infection. The infection can remain inactive — or latent — but becomes active if a person develops immune system suppression.
Less commonly, a person can acquire the infection through the lymphatic system — part of the body's immune system — or via sexual transmission.
Risk factorsAside from having a weakened immune system, risk factors that increase the likelihood of a latent GUTB infection becoming active include:
A 2021 review notes that when GUTB affects a kidney, it does not often produce symptoms but can heavily damage the organ. Symptoms generally start when the infection involves the bladder.
These may include:
GUTB can affect the ureter and cause severe narrowing — strictures — that can lead to kidney damage due to obstruction. The ureter is the narrow tube that carries urine from the bladder to the outside of the body.
Other symptoms may entail an ulcer in the penis or a mass in the scrotum or epididymis in males. They may also include pelvic pain and irregularities in the menstrual cycle in females.
According to a 2021 review, GUTB poses a diagnostic challenge as it can affect any part of the genitourinary system, and symptoms vary broadly.
Diagnostic tools include:
The gold standard for diagnosis entails detecting M. Tuberculosis in body samples, such as:
Options for treating GUTB include:
MedicationsMedications are the usual treatment. This typically consists of a 6-month medication regimen, starting with 2 months of:
Following this, the treatment entails 4 months of rifampicin and isoniazid.
The 2021 review above cites a 2016 case study that discusses the use of corticosteroids. It states that in people with tuberculosis of the urinary tract, strictures of the ureter can deteriorate and cause an obstruction during treatment. Therefore, doctors may prescribe concurrent treatment with the corticosteroid prednisolone (Orapred, Orapred ODT, Prelone). This may help prevent the worsening of a stricture.
SurgeryMore than 50% of people with GUBT need surgery. As the condition can affect individuals differently, there is no standard for the type or timing of surgery.
In instances involving complications of a blockage or narrowing of the ureters, either of two surgical options may be necessary:
In some circumstances — such as in kidney cancer or extensive kidney damage — surgical removal of a kidney may be necessary.
For a person with GUTB and kidney damage, renal transplantation may be an option for those who are receiving or have received antituberculosis therapy.
Is it curable?With early detection and prompt standard medication treatment, the cure rate for GUTB is around 90%.
A 2018 review notes that M. Tuberculosis is usually eradicated within 2 weeks of treatment.
The outlook is excellent with early detection and good adherence to drug treatment. However, relapses occur in 6.3% of cases after an average of 5.3 years following treatment.
Genitourinary tuberculosis occurs when pulmonary tuberculosis travels through the bloodstream to one of the organs in the genitourinary tract.
Symptoms may include urinary frequency, blood in urine, difficulty urinating, and pain in the abdomen.
The gold standard of diagnosis involves detecting M. Tuberculosis in samples, such as blood culture, urine, or a biopsy.
Treatment usually entails a 6-month course of various antituberculosis medications. Surgery is sometimes necessary. The cure rate is around 90%. Although the outlook is excellent if caught early, relapses may still occur.
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