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Host and Microbial Predictors of Childhood Extrathoracic Tuberculosis and Tuberculosis Meningitis
Yun Pan1, Zhenhua Yang, Ruixi Liu
1From the *Department of Infectious Diseases, Children's Hospital of Chongqing Medical University, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China; †Epidemiology Department, School of Public Health, University of Michigan, Ann Arbor, Michigan.
Insights
Childhood tuberculosis (TB) is influenced by host factors like age and sex, and microbial factors such as Beijing lineage strains. Understanding these predictors is key for effective childhood TB control strategies.
Area of Science:
- Epidemiology
- Infectious Diseases
- Microbiology
Background:
- Childhood tuberculosis (TB) is a significant cause of child morbidity and mortality, historically receiving limited research attention.
- This study pioneers the characterization of childhood TB in China by integrating Mycobacterium tuberculosis genetic profiles with patient data.
Purpose of the Study:
- To identify host and microbial predictors associated with different forms of childhood TB, including extrathoracic TB, thoracic-extrathoracic TB, and TB meningitis (TBM).
- To characterize the genetic makeup of Mycobacterium tuberculosis strains involved in childhood TB cases in China.
Main Methods:
- Analysis of 331 culture-confirmed childhood TB cases and 158 Mycobacterium tuberculosis isolates.
- Application of univariate and multivariate logistic regression to determine predictors for extrathoracic TB, concurrent thoracic and extrathoracic TB, and TBM.
Main Results:
- Younger children (under 5 years) and females were more prone to extrathoracic TB alone.
- Rural residence was linked to thoracic-extrathoracic TB.
- Children under 5 years and infection with Beijing lineage strains showed significant associations with TB meningitis (TBM).
- Beijing lineage strains were prevalent (64%) and associated with both thoracic-extrathoracic TB and TBM.
Conclusions:
- Both host characteristics (age, sex, location) and microbial factors (Beijing lineage strains) significantly influence the clinical presentation and outcomes of childhood TB.
- Further research integrating host and pathogen data across diverse populations is crucial for advancing childhood TB control measures.
Background:
Childhood tuberculosis (TB) is a major infectious disease causing morbidity and mortality in children and yet has been largely ignored until recently. This study is the first study to characterize childhood TB in China incorporating both Mycobacterium tuberculosis genetic characteristics and patient data.
Methods:
We analyzed a total of 331 culture-confirmed childhood TB cases and 158 M. tuberculosis isolates from a subset of the study sample. Univariate and multivariate logistic regression analyses were performed to identify host and microbial predictors for having extrathoracic TB alone, concurrent thoracic and extrathoracic TB and TB meningitis (TBM), respectively.
Results:
Fifty-eight percent (192/331) of the study subjects had extrathoracic TB, and 139 (42.0%) cases had TBM. Both age of less than 5 years [adjusted odds ratio (OR): 4.52; 95% confidence interval (CI): 1.27-16.16] and female sex (adjusted OR: 2.72; 95% CI: 1.03-7.18) were significantly associated with extrathoracic TB alone, whereas living in rural area (adjusted OR: 2.35; 95% CI: 1.06-5.18) was significantly associated with thoracic-extrathoracic TB. Age of less than 5 years was also strongly associated with TBM (adjusted OR: 3.63; 95% CI: 1.64-8.05). Sixty-four percent (101/158) of the study isolates were Beijing lineage strains. Infection with Beijing lineage strains was significantly associated with thoracic-extrathoracic TB (adjusted OR: 2.39; 95% CI: 1.11-5.15) and TBM (adjusted OR: 2.25; 95% CI: 1.10-4.60).
Conclusions:
Both microbial and host factors can affect the outcome of M. tuberculosis infection in children. Future studies incorporating host and pathogen data from different populations are warranted to develop new strategies for childhood TB control.
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