Multidrug Resistant Tuberculosis in Children in Port Harcourt – A Worrisome Trend

Abstract

Background: Drug-resistant tuberculosis and multidrug-resistant tuberculosis (MDR-TB) in particular represent a major threat to the fight against tuberculosis globally. MDR-TB presents with similar features and is transmitted in the same way as drug sensitive TB but its progression is rapid and its treatment, associated drug toxicity and monitoring constitute a heavy burden to the patients and the health system. MDR-TB affect people of all age groups but very little is known about the magnitude of this problem in children.
 Aims/Objectives: To determine the prevalence of multidrug resistant tuberculosis among children in Port Harcourt.
 Materials and Methods: Information on Paediatric tuberculosis was retrieved from the patients’ case notes, TB registers at the directly observed treatment short course (DOTs) clinic and the Multidrug resistant tuberculosis (MDR-TB) treatment center of the University of Port Harcourt Teaching Hospital from January 2018 to June 2019. Obtained data was analysed and presented in prose and tables. 
 Results: There was a total of 1,860 patients records of which 37 were Paediatrics cases giving a prevalence of Paediatric tuberculosis cases of 2.0% Out of these 37cases, four were multidrug resistant tuberculosis cases giving a prevalence of MDR-TB cases of 10.8%. There were three males and one female giving a male female ratio of 3: 1. and their ages ranged from 3months to 24months. All belonged to social class 5. Common presentation was chronic cough, prolonged fever, weight loss and lymph node swellings. Three (75%) had no prior treatment for tuberculosis while one (25%) completed 6months of anti TB drugs. All had BCG immunization within one week of delivery. One (25%) child had extra-pulmonary TB while 3(75%) children had pulmonary tuberculosis. Xpert MTB/RIF assay for all (100%) showed MTB detected, RIF resistant detected. Three (75%) of the mothers had MDRTB and the medications for their children was based on the drug sensitivity testing (DST) of their mothers. One (25%) of the children and his mother were HIV positive and the mother had died while still on the intensive phase of second line antiTB drugs. Three (75%) had completed the intensive phase of the conventional therapy with second line antiTB drugs and are closely followed up weekly on the continuation phase while one child is still on admission.
 Conclusions: The prevalence of MDR-TB in children in PH is high. All childhood TB (whether drug susceptible or drug resistant) is usually traced to an adult, thus effectively diagnosing and treating all adults as well as a high index of suspicion in presumptive cases is required to curb MDR-TB.
 Recommendations: We recommend strict use of the DOTs strategy in TB management to ensure drug adherence. Also, proper contact tracing, investigation and treatment of children of infected parents to reduce cases of MDR-TB is advocated.

Rifampicin-resistant tuberculosis in a toddler: A report of a rare paediatric case in obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria

“… 10 in Addis Ababa and Ide et al . 13 in Port Harcourt, they found the prevalence levels of 7.9% and 10.8%, respectively, in their studied children population. Drug-resistant TB is rarely reported among toddlers in Nigeria.…”

“… 13 reported four cases of MDR-TB among children whose ages ranged from 3 months to 24 months; the authors observed positive history of contact in all the patients who belong to low socioeconomic class. Previous treatment for TB is the strongest risk factor for the development of MDR-TB; 5 10 12 13 14 this is partly due to acquired drug resistance which emanates from poor compliance to dose and duration of treatment, substandard drugs, and the absence of infection control measures in hospitals. Resistance to anti-TB medications is due to mutations in the drug target genes of the bacterial chromosome before the strains are exposed to the drugs.…”

“…Similar to drug-susceptible TB, common features of DR-TB include chronic cough, prolonged fever, weight loss, and enlarged lymph nodes. 13 Features of disseminated disease and severe malnutrition may also occur. Undernutrition, which manifests as severe wasting and stunting in this reported case, tends to impair innate and adaptive immune responses needed to fight Mycobacterium tuberculosis.…”