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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.
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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