Clinical profile of drug resistant tuberculosis in children

Abstract

This Cross-sectional observational study was conducted to determine the clinical profile of drug-resistant tuberculosis in children. Patients were classified as monoresistant TB, polyresistant TB, multidrug resistant (MDR)-TB and extensively drug resistant (XDR - TB). We coined a term called as Partial XDR-TB when isolates of Mycobacterium tuberculosis were confirmed to be resistant in vitro to be MDR along with either a fluoroquinolone or an aminoglycoside resistance (apart from streptomycin). Of 500 children analysed, 34 (6.8%) had drug resistant TB. Mean age of presentation was 6.8 ± 3.2 years (Male: Female ratio 13:21). 18 (52.9%) children had been treated for tuberculosis in the past (1 defaulted), 7 patients had been in contact with an adult suffering from drug resistant TB and 3 patients (10.3%) were HIV co-infected. Fourteen children (41.2%) had MDR TB, 11 (32.4%) had Partial XDR, 1 each (2.9%) had polyresistant TB and XDR TB. Clinical features of DR-TB are similar in all age groups. Past history of TB with treatment with antitubercular agents, and contact with adults suffering with drug-resistant TB are important risk factors in development of drug-resistant -TB in children.

Pediatric Tuberculosis in Young Children in India: A Prospective Study

“…Therefore, laboratory contamination or infection with more than one bacterial strain cannot be entirely ruled out. A recent cross-sectional study by Shah and Chilkar from Mumbai (near Pune) reported that 7% of children (mean age 6.8 years) had DR-TB, of whom 41% was MDR [29]. Interestingly, they reported a much higher rate of DR-TB (65%) in patients with extra-pulmonary disease, consistent with our results, where a large proportion (46%) had extra-pulmonary disease.…”

Clinical Profile of Paediatric Drug Resistant Tuberculosis at a Tertiary Care Hospital in Mumbai, India- A Sanguine Study

“…Schaaf , et al reported a prevalence of 6.5% of MDR-TB in children aged less than 13 years (median age was 2.5 years) in 2003-2005 at children hospital, South Africa, 4 whereas Ira shah et al reported a prevalence of 6.8% of drug resistant TB in children (median age was 7 years) in 2007-2010. 5 Difficulty in procuring extra pulmonary sample for the diagnosis of DRTB in younger children might be a probable explanation for presentation of DR-TB in slightly older children in our study .There were more females (71.67%) than males (28.3%) in our study which is comparable with a study by Schaaf et al in which 63.6% were females and 36.4% were males. 4 This female preponderance may be secondary to their predominant role in household chores, which invariably renders them exposed to the index cases.…”

“…History of TB treatment in the past has been identified as a risk factor associated with DRTB in several studies. 5,10 The main mode of acquiring DRTB in children is primary transmission of the resistant bacilli as observed by Newton SM, et al 11 Drug resistance is rarely acquired in the paediatric population due to the paucibacillary nature of the disease. Overall incidence of Primary DRTB is 4.1%.…”

Setting priorities for a research agenda to combat drug-resistant tuberculosis in children

“…This was a result of including the convenience sample afforded by the workshop participants from across India, which is home to 25-30% of global childhood drug-resistant TB cases, 2,25,26 but where very few data are available on MDR-TB in children. 27 It is important to note that our survey was not designed to represent countries according to their relative disease burden. Our survey was designed to synthesise the opinions of individuals with expertise or interest specifically in childhood drug-resistant TB-many of whom have worked in multiple countries-who were willing to rank research gaps that presently impact children with drug-resistant TB.…”