High prevalence of childhood multi-drug resistant tuberculosis in Johannesburg, South Africa: a cross sectional study

Abstract

BackgroundThere are limited data on the prevalence of multi-drug resistant tuberculosis (MDR-TB), estimated at 0.6-6.7%, in African children with tuberculosis. We undertook a retrospective analysis of the prevalence of MDR-TB in children with Mycobacterium tuberculosis (MTB) at two hospitals in Johannesburg, South Africa.MethodsCulture-confirmed cases of MTB in children under 14 years, attending two academic hospitals in Johannesburg, South Africa during 2008 were identified and hospital records of children diagnosed with drug-resistant TB were reviewed, including clinical and radiological outcomes at 6 and 12 months post-diagnosis. Culture of Mycobacterium tuberculosis complex (MTB) was performed using the automated liquid broth MGIT™ 960 method. Drug susceptibility testing (DST) was performed using the MGIT™ 960 method for both first and second-line anti-TB drugs.Results1317 children were treated for tuberculosis in 2008 between the two hospitals where the study was conducted. Drug susceptibility testing was undertaken in 148 (72.5%) of the 204 children who had culture-confirmed tuberculosis. The prevalence of isoniazid-resistance was 14.2% (n = 21) (95%CI, 9.0-20.9%) and the prevalence of MDR-TB 8.8% (n = 13) (95%CI, 4.8-14.6%). The prevalence of HIV co-infection was 52.1% in children with drug susceptible-TB and 53.9% in children with MDR-TB. Ten (76.9%) of the 13 children with MDR-TB received appropriate treatment and four (30.8%) died at a median of 2.8 months (range 0.1-4.0 months) after the date of tuberculosis investigation.ConclusionsThere is a high prevalence of drug-resistant tuberculosis in children in Johannesburg in a setting with a high prevalence of HIV co-infection, although no association between HIV infection and MDR-TB was found in this study. Routine HIV and drug-susceptibility testing is warranted to optimize the management of childhood tuberculosis in settings such as ours.

Treatment outcomes for children with multidrug-resistant tuberculosis: a systematic review and meta-analysis

“…The median age of children ranged from 25 months 25 to 132 months 20 and HIV seropositivity ranged from 0% 22 to 54% (table 1). 25 In four studies, most children were reported to have been in contact with an adult with MDR tuberculosis (table 1).…”

“…The median age of children ranged from 25 months 25 to 132 months 20 and HIV seropositivity ranged from 0% 22 to 54% (table 1). 25 In four studies, most children were reported to have been in contact with an adult with MDR tuberculosis (table 1). 7,[20][21][22] The proportion of previously treated patients ranged from 0% 21 to 87% 20 (table 1).Duration of treatment ranged from 6 months to 34 months, 22 and in most studies treatment was provided for a minimum of 18 months, which is consistent with WHO recommendations (table 2).…”

“…For most patients, treatment was initiated in hospital (table 2). 7,20,21,[23][24][25] Insuffi cient data were available for outcomes for treatment with extensively drug-resistant tuberculosis to be included in this review.…”

“…The eight studies included in our analysis (fi gure 1) came from individual treatment programmes from fi ve countries (Peru, 20 Spain, 21 the USA, 22,23 South Africa, 7,24,25 and Latvia 26 ) and reported on treatment outcomes for a range of eight patients 21 to 111 patients. 24 One study was a conference abstract; 26 the rest were published as full text articles.…”

“…7 Time to appropriate treatment varied from 2 days 7 to 46 months. 20 All studies provided individualised treatment regimens guided by DST and reported high rates of treatment completion, and most studies 7,[20][21][22][24][25][26] provided injectable drugs to most patients (table 2). For most patients, treatment was initiated in hospital (table 2).…”