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Temporal trend of drug-resistant tuberculosis among Thai children during 2006-2021
Watsamon Jantarabenjakul1,2, Praon Supradish Na Ayudhya3, Piyarat Suntarattiwong3
1Department of Pediatrics, King Chulalongkorn Memorial Hospital, Bangkok, Thailand.
Insights
Drug-resistant tuberculosis (DR-TB) remains stable in Thai children, with isoniazid-resistant TB (Hr-TB) affecting one-tenth of cases. Pre-extensively drug-resistant TB (pre-XDR) cases require close monitoring.
Area of Science:
- Pediatrics
- Infectious Diseases
- Public Health
Background:
- Drug-resistant tuberculosis (DR-TB) prevalence in adults has plateaued globally.
- Limited data exists on DR-TB trends specifically in pediatric populations in Southeast Asia.
Purpose of the Study:
- To determine the prevalence and trends of DR-TB among children in Thailand from 2006 to 2021.
- To identify specific drug resistance patterns in pediatric TB cases.
Main Methods:
- A retrospective cohort study included children (<15 years) with confirmed Mycobacterium tuberculosis complex (MTB).
- Diagnostic methods included culture, PCR-MTB, and Xpert MTB/RIF.
- Drug susceptibility testing (DST) was performed using phenotypic and/or genotypic methods to assess resistance to key anti-TB drugs.
Main Results:
- Out of 163 confirmed TB cases, 21.6% had DR-TB. Isoniazid resistance (Hr-TB) was observed in 10.8% and rifampicin resistance (Rr/MDR-TB) in 2.9%.
- DR-TB rates remained stable across different time periods (2006-2013, 2014-2018, 2019-2021) with no significant changes (p > 0.05).
- Two cases of pre-extensively drug-resistant TB (pre-XDR) with fluoroquinolone resistance were identified after 2014.
Conclusions:
- DR-TB prevalence in Thai children is stable, but significant isoniazid resistance necessitates treatment regimen adjustments.
- The emergence of pre-XDR cases highlights the need for ongoing surveillance and monitoring in this vulnerable population.
Background:
The prevalence of drug-resistant tuberculosis (DR-TB) in adults has stabilized in the past decade. Our study aimed to describe the prevalence of DR-TB in Thai children between 2006 and 2021.
Materials And Methods:
Children younger than 15 years old who had culture-confirmed Mycobacterium tuberculosis complex (MTB), positive PCR-MTB, or positive Xpert MTB/RIF were included in this cohort. Drug susceptibility testing (DST) was performed using phenotypic and/or genotypic methods. The prevalence of DR-TB was compared using the chi-square test.
Results:
Among 163 confirmed TB cases (44% as pulmonary TB, 27% as extrapulmonary TB, and 29% with both), the median age (IQR) was 12.2 (7.3-14.2) years. DST was performed in 139 cases (85%), revealing prevalences of all DR-TB, isoniazid-resistant TB (Hr-TB), and rifampicin monoresistant/multidrug-resistant TB (Rr/MDR-TB) of 21.6% (95% CI 14.7-28.4), 10.8% (95% CI 5.6-16.0%), and 2.9% (95% CI 0.1-5.7%), respectively. The DR-TB rates did not differ significantly between 2006-2013, 2014-2018, and 2019-2021 (p > 0.05). Two pre-extensively DR-TB (pre-XDR) cases with fluoroquinolone resistance were detected after 2014.
Conclusion:
The prevalence of DR-TB in Thai children was stable. However, one-tenth of DR-TB cases confirmed with DST were Hr-TB, which required adjustment of the treatment regimen. The pre-XDR cases should be closely monitored.
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