Low paediatric tuberculosis case detection rate in Southern Mozambique

López-Varela, Elisa; Augusto, Orvalho; Guerra, Luis; Respeito, Durval; Sacoor, Charfudin; Sacarlal, Jahit; Migliori, Giovanni Battista; Sotgiu, Giovanni; Alonso, Pedro L.; García‐Basteiro, Alberto L.

doi:10.1183/13993003.01454-2015

Cited by 20 publications

(13 citation statements)

References 13 publications

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“…TB cases were classified according to the NIH classification [16]. This study showed that the incidence rate of TB among children aged less than 3 years was 470/100,000person-years, with a low estimated case detection rate of 40.8% (95% CI 36.6–45.1%)[6,15]. …”

Section: Methodsmentioning

confidence: 99%

“…However, underdetection is common [6], partially due to the inherent difficulties in obtaining respiratory samples in children, coupled to the paucibacillary nature of TB in this age group [5]. An additional layer of complexity is posed by the fact that NTM lung disease and tuberculosis (TB) have overlapping clinical and radiological manifestations.…”

Section: Introductionmentioning

confidence: 99%

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High Rates of Non-Tuberculous Mycobacteria Isolation in Mozambican Children with Presumptive Tuberculosis

et al. 2017

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IntroductionNon-tuberculous mycobacteria (NTM) can cause disease which can be clinically and radiologically undistinguishable from tuberculosis (TB), posing a diagnostic and therapeutic challenge in high TB settings. We aim to describe the prevalence of NTM isolation and its clinical characteristics in children from rural Mozambique.MethodsThis study was part of a community TB incidence study in children <3 years of age. Gastric aspirate and induced sputum sampling were performed in all presumptive TB cases and processed for smear testing using fluorochrome staining and LED Microscopy, liquid and solid culture, and molecular identification by GenoType® Mycobacterium CM/AS assays.ResultsNTM were isolated in 26.3% (204/775) of children. The most prevalent NTM species was M. intracellulare (N = 128), followed by M. scrofulaceum (N = 35) and M. fortuitum (N = 9). Children with NTM were significantly less symptomatic and less likely to present with an abnormal chest radiograph than those with M. tuberculosis. NTM were present in 21.6% of follow-up samples and 25 children had the same species isolated from ≥2 separate samples. All were considered clinically insignificant and none received specific treatment. Children with NTM isolates had equal all cause mortality and likelihood of TB treatment as those with negative culture although they were less likely to have TB ruled out.ConclusionsNTM isolation is frequent in presumptive TB cases but was not clinically significant in this patient cohort. However, it can contribute to TB misdiagnosis. Further studies are needed to understand the epidemiology and the clinical significance of NTM in children.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

High Rates of Non-Tuberculous Mycobacteria Isolation in Mozambican Children with Presumptive Tuberculosis

et al. 2017

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“…Mozambique with a population of 27 million people in 2014, has low case detection rate, below 50%[17], the estimated TB incidence is around 551 cases per 100,000 population; of these cases, an estimated 58% are HIV co-infected [18]. By 2014, 24 Xpert machines were operating in the country [1].…”

Section: Introductionmentioning

confidence: 99%

Do Xpert MTB/RIF Cycle Threshold Values Provide Information about Patient Delays for Tuberculosis Diagnosis?

et al. 2016

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IntroductionEarly diagnosis and initiation to appropriate treatment is vital for tuberculosis (TB) control. The XpertMTB/RIF (Xpert) assay offers rapid TB diagnosis and quantitative estimation of bacterial burden through Cycle threshold (Ct) values. We assessed whether the Xpert Ct value is associated with delayed TB diagnosis as a potential monitoring tool for TB control programme performance.Materials and MethodsThis analysis was nested in a prospective study under the routine TB surveillance procedures of the National TB Control Program in Manhiça district, Maputo province, Mozambique. Presumptive TB patients were tested using smear microscopy and Xpert. We explored the association between Xpert Ct values and self-reported delay of Xpert-positive TB patients as recorded at the time of diagnosis enrolment. Patients with >60 days of TB symptoms were considered to have long delays.ResultsOf 1,483 presumptive TB cases, 580 were diagnosed as TB of whom 505 (87.0%) were due to pulmonary TB and 302 (94.1%) were Xpert positive. Ct values (range, 9.7–46.4) showed a multimodal distribution. The median (IQR) delay was 30 (30–45) days. Ct values showed no correlation with delay (R2 = 0.001, p = 0.621), nor any association with long delays: adjusted odds ratios (AOR) (95% confidence interval [CI]) comparing to >28 cycles 0.99 (0.50–1.96; p = 0.987) for 23–28 cycles, 0.93 (0.50–1.74; p = 0.828) for 16–22 cycles; and 1.05 (0.47–2.36; p = 0.897) for <16 cycles. Being HIV-negative (AOR [95% CI]), 2.05 (1.19–3.51, p = 0.009) and rural residence 1.74 (1.08–2.81, p = 0.023), were independent predictors of long delays.ConclusionXpert Ct values were not associated with patient delay for TB diagnosis and cannot be used as an indicator of TB control program performance.

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“…25 This estimate was confirmed in a recent study conducted in Southern Mozambique where the TB case detection rate in children < 3 years of age was considered to be 40.8%. 36 The greatest case detection failure occurs in young children, and in a setting with poor epidemic control and little use of preventive therapy, children < 5 years are expected to account for at least half of all pediatric cases. The potential reporting gap of child TB cases is also emphasized by post-mortem examinations and by the yield of intensified case-finding (ICF) initiatives.…”

Section: Pediatric Tuberculosismentioning

confidence: 99%

The Epidemiology of Tuberculosis in Children

Khatami

Marais

2017

J Pediatr Infect Dis

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The epidemiology of tuberculosis, particularly in children, is highly intertwined with socio-political factors, such as poverty, access to healthcare, and migration. Growing evidence around the world shows that more children have tuberculosis (TB) than was previously thought, most of whom are undiagnosed and untreated, and that TB is a significant cause of morbidity and mortality in children in TB endemic areas. Since TB in young children results from recent transmission, the incidence of pediatric TB is a marker of epidemic control in a community and an indirect indicator of the effectiveness of TB control programs. It is estimated that pediatric TB represents between 4 and 21% of all TB cases, depending on the background prevalence in the country, and at least 10 to 20% of the total cases in areas with poor epidemic control. However, a precise estimate of the global burden of TB in children is difficult due to challenges in case ascertainment, diagnosis, and weak surveillance systems in many countries with a high burden of disease. Several recent estimates highlight these difficulties and provide a starting point to motivate further study. In addition, since drug-resistant TB in young children reflects transmission of resistant strains in the community and occurs with the same frequency as in treatment-naive adults, accurate monitoring of drug-susceptibility patterns in pediatric TB cases will inform optimal empiric treatment regimens in both adults and children, in the context of increasing rates of drug-resistant TB globally.

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Low paediatric tuberculosis case detection rate in Southern Mozambique

Cited by 20 publications

References 13 publications

High Rates of Non-Tuberculous Mycobacteria Isolation in Mozambican Children with Presumptive Tuberculosis

High Rates of Non-Tuberculous Mycobacteria Isolation in Mozambican Children with Presumptive Tuberculosis

Do Xpert MTB/RIF Cycle Threshold Values Provide Information about Patient Delays for Tuberculosis Diagnosis?

The Epidemiology of Tuberculosis in Children

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