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Published on: July 28, 2023
Pediatric tuberculosis in the metropolitan area of Rio de Janeiro
Anna Cristina C Carvalho1, Pedro da Silva Martins2, Claudete Aparecida Araújo Cardoso3
1Laboratório de Inovações em Terapias, Ensino e Bioprodutos (LITEB), Instituto Oswaldo Cruz, Fiocruz, Rio de Janeiro, RJ, Brazil; Programa Acadêmico de Tuberculose, Faculdade de Medicina da Universidade Federal do Rio de Janeiro (UFRJ), RJ, Brazil.
Insights
Missed opportunities for tuberculosis (TB) prevention in children highlight the need for better contact screening. Accessible, sensitive tests are crucial for diagnosing childhood TB and ensuring effective treatment outcomes.
Area of Science:
- Pediatrics
- Infectious Diseases
- Public Health
Background:
- Tuberculosis (TB) remains a significant global health challenge, particularly in high-burden metropolitan areas.
- Childhood TB presents unique diagnostic and management complexities.
- Effective TB control strategies require understanding disease patterns in vulnerable populations.
Purpose of the Study:
- To investigate the clinical features, diagnostic methods, and treatment results of TB in children.
- To identify factors influencing TB diagnosis and outcomes in a metropolitan setting.
- To evaluate the effectiveness of current TB management approaches in pediatric populations.
Main Methods:
- Retrospective chart review of children under 15 years old treated for TB between 2007 and 2016.
- Study conducted across primary health units and reference centers in the Rio de Janeiro metropolitan area.
- Analysis of factors associated with TB treatment setting, microbiological diagnosis, and treatment outcomes.
Main Results:
- A total of 544 children were included; 72% had pulmonary TB (PTB), and 10% were HIV-positive.
- Microbiological confirmation was achieved in 68% of tested children.
- Reference centers saw higher rates of extrapulmonary TB, microbiologically confirmed TB, and HIV positivity.
- HIV-infected children faced a 2.5-fold higher risk of unfavorable outcomes.
- Treatment success rate was 85%.
Conclusions:
- Suboptimal screening of close contacts leads to missed opportunities for TB prevention and early treatment in children.
- There is a critical need for more sensitive and accessible microbiological diagnostic tests and drug susceptibility testing for childhood TB.
- Improving contact tracing and diagnostic accessibility is essential for better TB control in pediatric populations.
Aim:
To evaluate the clinical characteristics, diagnostic approach, and treatment outcomes of tuberculosis (TB) in children living in a high-burden metropolitan area.
Methods:
This was a retrospective study, based on a medical chart review, involving children under 15 years old treated for TB between 2007 and 2016, in four primary health units (PHU) and three reference centers (RC) in five cities of Rio de Janeiro metropolitan area. Factors associated with TB treatment setting, microbiological diagnosis, and treatment outcomes were evaluated.
Results:
A total of 544 children were enrolled; 71% were treated in PHU, 36% were under 5 years old, and 72% had pulmonary TB (PTB). The HIV prevalence was 10% (31/322). Fifty-three percent had at least one microbiological test for TB, 68% of them (196/287) had TB confirmed. Among 222 children with previous TB contact, information on LTBI was available for 78 (35%), and only 17% (13/78) were treated. Extrapulmonary TB (56% vs 32%), microbiologically confirmed TB (77% vs 60%), and HIV positivity (18.5% vs 4.0%) were significantly more frequent in RC. Treatment in RC (odds ratio (OR) 3.08, 95% confidence interval (CI) 1.74-5.44) and PTB (OR 2.47, 95% CI 1.34-4.56) were independently associated with a microbiological diagnosis of TB. The treatment success rate was 85%. In the logistic regression analysis, HIV-infected children had a 2.5-fold higher risk of an unfavorable outcome (OR 2.53, 95% CI 1.0-6.38; p = 0.05).
Conclusions:
Opportunities for TB prevention and early TB treatment are missed due to suboptimal close contact screening. Microbiological diagnosis of TB and drug susceptibility testing in children should be made available through more sensitive and accessible tests.
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