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Prevalence and Clinical Characteristics of Children With Nonsevere Tuberculosis in Spain
Alicia Hernanz-Lobo1,2,3,4, Antoni Noguera-Julian4,5,6,7,8, Laura Minguell9
1From the Pediatric Infectious Diseases Department, Gregorio Marañón University Hospital, Madrid, Spain.
Insights
Two-thirds of pediatric tuberculosis (TB) cases in Spain were nonsevere, often asymptomatic and diagnosed through contact tracing. These children experienced fewer sequelae and no deaths, suggesting they may benefit from shorter treatment regimens.
Area of Science:
- Pediatrics
- Infectious Diseases
- Public Health
Background:
- Tuberculosis (TB) remains a significant global health challenge, particularly in pediatric populations.
- Recent evidence suggests nonsevere pediatric TB can be effectively treated with a 4-month regimen, offering advantages over the traditional 6-month course.
- Understanding the prevalence and characteristics of nonsevere TB in children is crucial for optimizing treatment strategies.
Purpose of the Study:
- To determine the prevalence and clinical features of nonsevere tuberculosis (TB) in children within Spain.
- To compare the characteristics and outcomes of nonsevere TB versus severe TB in pediatric patients.
- To inform treatment guidelines for pediatric TB based on disease severity.
Main Methods:
- A retrospective cohort study was conducted involving children aged 16 years or younger diagnosed with TB.
- Nonsevere TB was defined by specific criteria including smear-negative respiratory TB confined to one lobe, absence of significant airway obstruction, and no miliary disease or complex pleural effusion.
- Children not meeting these criteria for nonsevere TB were classified as having severe TB. Clinical characteristics and outcomes were compared between the two groups.
Main Results:
- Out of 780 children with TB, 61.1% (477) had nonsevere disease. Nonsevere TB was less common in infants (<1 year) and adolescents (>14 years).
- Cases of nonsevere TB were more frequently identified through contact tracing (60.4%) and often presented asymptomatically (38.3%).
- Confirmation of TB was less frequent via culture and molecular tests in nonsevere cases. Sequelae were significantly less common in children with nonsevere TB (1.7% vs. 5.4%), and no deaths occurred in this group.
Conclusions:
- The majority of pediatric TB cases in Spain (two-thirds) were classified as nonsevere.
- Nonsevere pediatric TB typically presents with a benign clinical course and often has negative microbiological results.
- Findings support the potential benefit of short-course TB regimens for most children with nonsevere disease, especially in low-burden settings.
Background:
To assess the prevalence and characteristics of nonsevere TB among children in Spain. It has been recently demonstrated that these children can be treated with a 4-month regimen instead of the classical 6-month treatment regimen, with the same effectivity and outcomes, decreasing toxicity and improving adherence.
Methods:
We conducted a retrospective cohort study in a cohort of children ≤16 years of age with TB. Nonsevere TB cases included smear-negative children with respiratory TB confined to 1 lobe, with no significant airway obstruction, no complex pleural effusion, no cavities and no signs of miliary disease, or with peripheral lymph-node disease. The remaining children were considered to have severe TB. We estimated the prevalence of nonsevere TB and compared the clinical characteristics and outcomes between children with nonsevere and severe TB.
Results:
A total of 780 patients were included [46.9% males, median age 5.5 years (IQR: 2.6-11.1)], 477 (61.1%) of whom had nonsevere TB. Nonsevere TB was less frequent in children <1 year (33% vs 67%; P < 0.001), and >14 years of age (35% vs 65%; P = 0.002), mostly diagnosed in contact tracing studies (60.4% vs 29.2%; P < 0.001) and more frequently asymptomatic (38.3% vs 17.7%; P < 0.001). TB confirmation in nonsevere disease was less frequent by culture (27.0% vs 57.1%; P < 0.001) and by molecular tests (18.2% vs 48.8%; P < 0.001). Sequelae were less frequent in children with nonsevere disease (1.7 vs 5.4%; P < 0.001). No child with nonsevere disease died.
Conclusions:
Two-thirds of children had nonsevere TB, mostly with benign clinical presentation and negative microbiologic results. In low-burden countries, most children with TB might benefit from short-course regimens.
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