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Mycobacterium tuberculosis Bacteremia Among Acutely Febrile Children in Western Kenya
Patricia B Pavlinac1, Jaqueline M Naulikha2, Grace C John-Stewart2
1Department of Global Health, University of Washington, Seattle, Washington; Department of Pediatrics, University of Washington, Seattle, Washington; Department of Epidemiology, University of Washington, Seattle, Washington; Department of Medicine, University of Washington, Seattle, Washington; Kenya Medical Research Institute, Centre for Clinical Research, Nairobi, Kenya; Kenya Medical Research Institute (KEMRI)/CGHR Centre for Global Health Research, Kisumu, Kenya; Department of Pediatrics, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, Georgia ppav@u.washington.edu.
Insights
In a Kenyan study of febrile children, Mycobacterium tuberculosis bacteremia was not detected despite risk factors like household TB exposure and malnutrition. This finding supports other pediatric research on tuberculosis in children.
Area of Science:
- Pediatrics
- Infectious Diseases
- Public Health
Background:
- Mycobacterium tuberculosis (M. tuberculosis) dissemination is common in children, often presenting with non-specific symptoms like fever.
- Nyanza, Kenya, has high rates of human immunodeficiency virus (HIV) and M. tuberculosis, making it a critical region for pediatric infectious disease research.
Purpose of the Study:
- To determine the prevalence of M. tuberculosis bacteremia in febrile children presenting to hospitals in Nyanza, Kenya.
- To investigate the association between M. tuberculosis bacteremia and risk factors such as HIV exposure and malnutrition in this pediatric population.
Main Methods:
- A cohort of 148 children aged 6 months to 5 years with fever and no recent antibiotic use were enrolled between March 2013 and February 2014.
- Blood samples were analyzed using standard bacterial and mycobacterial culture methods.
- Data on household TB contacts, HIV status, nutritional status (stunting, wasting), and BCG vaccination scar were collected.
Main Results:
- None of the 134 viable blood cultures yielded Mycobacterium isolates (95% confidence interval: 0-2.7%).
- Children in the cohort exhibited significant risk factors including household TB exposure (10.3%), malnutrition (17% stunted, 18.6% wasted), and HIV exposure (2.7% infected, 14.2% uninfected).
- 11.5% of children presented with one or more clinical signs suggestive of tuberculosis (TB).
Conclusions:
- M. tuberculosis bacteremia was not detected in this cohort of febrile children in Nyanza, Kenya, even in the presence of known risk factors.
- This finding aligns with previous pediatric studies and suggests that M. tuberculosis bacteremia may be infrequent in febrile children in this high-prevalence setting.
- Further research may be needed to understand the pathogenesis and diagnostic challenges of childhood tuberculosis in resource-limited settings.
Abstract:
In children, Mycobacterium tuberculosis (M. tuberculosis) frequently disseminates systemically, presenting with nonspecific signs including fever. We determined prevalence of M. tuberculosis bacteremia among febrile children presenting to hospitals in Nyanza, Kenya (a region with high human immunodeficiency virus (HIV) and M. tuberculosis prevalence). Between March 2013 and February 2014, we enrolled children aged 6 months to 5 years presenting with fever (axillary temperature ≥ 37.5°C) and no recent antibiotic use. Blood samples were collected for bacterial and mycobacterial culture using standard methods. Among 148 children enrolled, median age was 3.1 years (interquartile range: 1.8-4.1 years); 10.3% of children were living with a household member diagnosed with M. tuberculosis in the last year. Seventeen percent of children were stunted (height-for-age z-score < -2), 18.6% wasted (weight-for-height z-score < -2), 2.7% were HIV-infected, and 14.2% were HIV-exposed uninfected. Seventeen children (11.5%) had one or more signs of tuberculosis (TB). All children had a Bacille Calmette-Guerin vaccination scar. Among 134 viable blood cultures, none (95% confidence interval: 0-2.7%) had Mycobacterium isolated. Despite exposure to household TB contacts, HIV exposure, and malnutrition, M. tuberculosis bacteremia was not detected in this pediatric febrile cohort, a finding consistent with other pediatric studies.
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