[Retrospective study of 61 cases of multifocal tuberculosis in children in Brazzaville, Congo]

The spread of HIV infection has changed several aspects of tuberculosis notably with regard to disseminated and multifocal forms that have become increasingly common. The purpose of this study was to evaluate epidemiologic, clinical, and prognostic factors associated with multifocal tuberculosis and to assess the impact of HIV infection. The files of children admitted for multifocal tuberculosis to the paediatric department of the Brazzaville University Hospital Centre in Congo were retrospectively reviewed. Patients that were not followed throughout treatment were not included. Multifocal tuberculosis was defined as the presence of at least two extrapulmonary sites. All patients over 18 months old were screened for HIV infection. From January 1995 to December 2005, a total of 61 children with a mean age of 7.2 years (range, 8 months to 15 years) were enrolled according to these inclusion criteria. Multifocal tuberculosis was bifocal (n=15), trifocal (n=44), and quadrifocal (n=2) for a total of 170 sites. To assess the impact of HIV infection, patients over the age of 18 months divided into two groups based on positive versus negative screening tests. The time delay for seeking care was comparable for the 38 HIV-positive children (all infected with HIV-1) and the 20 HIV-negative children. However HIV-positive children exhibited a higher rate of malnutrition, more tuberculosis sites (both quadrifocal patients), and increased mortality (10/38 versus 2/20). These differences were not statistically significant probably due to the small patient population. Multifocal tuberculosis is a major problem for paediatric departments in the Congo. Its unusually high incidence and special severity is linked mainly to HIV infection. Given the high incidence of co-infection, routine screening for HIV is recommended for paediatric patients with multifocal tuberculosis.