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Published on: September 5, 2017
Pediatric tuberculosis in young children in India: a prospective study
Sanjay K Jain1, Alvaro Ordonez1, Aarti Kinikar2
1Department of Pediatrics, Johns Hopkins University School of Medicine, 1550 Orleans Street, CRB-II, Room 1.09, Baltimore, MD 21287, USA ; Center for Tuberculosis Research, Johns Hopkins University School of Medicine, 1550 Orleans Street, CRB-II, Room 1.09, Baltimore, MD 21287, USA ; Center for Infection and Inflammation Imaging Research, Johns Hopkins University School of Medicine, 1550 Orleans Street, CRB-II, Room 1.09, Baltimore, MD 21287, USA.
Insights
Diagnosing tuberculosis (TB) in young children is challenging, with a high incidence of extrapulmonary and drug-resistant TB. Early diagnosis and treatment are crucial for better outcomes in this vulnerable population.
Area of Science:
- Pediatrics
- Infectious Diseases
- Public Health
Background:
- India faces a significant global burden of tuberculosis (TB).
- Research on TB in young children (≤ 5 years) is limited, despite their vulnerability.
- Delayed diagnosis in children often leads to poorer health outcomes.
Purpose of the Study:
- To investigate the clinical characteristics and outcomes of suspected tuberculosis in young children in India.
- To identify factors associated with TB in this pediatric population.
- To assess the prevalence of drug-resistant TB (DR-TB) in young children.
Main Methods:
- Prospective enrollment of 223 children (≤ 5 years) with suspected TB at a tertiary hospital in Pune, India.
- Comprehensive evaluation including clinical assessment, HIV testing, mycobacterial cultures, and drug susceptibility testing.
- Follow-up for mortality at one year.
Main Results:
- 12% of children had confirmed or probable TB; 46% had extrapulmonary disease, predominantly meningeal.
- HIV infection, positive tuberculin skin test (TST), and household smoke exposure were associated with TB.
- Drug-resistant TB (DR-TB) was found in 57% of culture-confirmed cases, with 50% being multi-drug resistant (MDR).
- Mortality was significantly higher in children with TB (12%) compared to those without (1%).
Conclusions:
- Diagnosing TB in young children presents challenges, often involving extrapulmonary and meningeal disease.
- The observed prevalence of DR-TB, though based on limited data, is concerning.
- Further research is essential to accurately determine the burden of DR-TB in this vulnerable pediatric group.
Background:
India has one of the highest tuberculosis (TB) burdens globally. However, few studies have focused on TB in young children, a vulnerable population, where lack of early diagnosis results in poor outcomes.
Methods:
Young children (≤ 5 years) with suspected TB were prospectively enrolled at a tertiary hospital in Pune, India. Detailed clinical evaluation, HIV testing, mycobacterial cultures, and drug susceptibility testing were performed.
Results:
223 children with suspected TB were enrolled. The median age was 31 months, 46% were female, 86% had received BCG, 57% were malnourished, and 10% were HIV positive. 12% had TB disease (definite or probable), 35% did not have TB, while TB could not be ruled out in 53%. Extrapulmonary disease was noted in 46%, which was predominantly meningeal. Tuberculin skin test (TST) was positive in 20% of children with TB. Four of 7 (57%) children with culture-confirmed TB harbored drug-resistant (DR) strains of whom 2 (50%) were multi-DR (MDR). In adjusted analyses, HIV infection, positive TST, and exposure to household smoke were found to be significantly associated with children with TB (P ≤ 0.04). Mortality (at 1 year) was 3 of 26 (12%) and 1 of 79 (1%), respectively, in children with TB and those without TB (P < 0.05).
Conclusions:
Diagnosis of TB is challenging in young children, with high rates of extra-pulmonary and meningeal disease. While the data on DR-TB are limited by the small sample size, they are however concerning, and additional studies are needed to more accurately define the prevalence of DR strains in this vulnerable population.
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