Pediatric tuberculosis in the metropolitan area of Rio de Janeiro

Abstract

To evaluate the clinical characteristics, diagnostic approach, and treatment outcomes of tuberculosis (TB) in children living in a high-burden metropolitan area. Methods: This was a retrospective study, based on a medical chart review, involving children under 15 years old treated for TB between 2007 and 2016, in four primary health units (PHU) and three reference centers (RC) in five cities of Rio de Janeiro metropolitan area. Factors associated with TB treatment setting, microbiological diagnosis, and treatment outcomes were evaluated. Results: A total of 544 children were enrolled; 71% were treated in PHU, 36% were under 5 years old, and 72% had pulmonary TB (PTB). The HIV prevalence was 10% (31/322). Fifty-three percent had at least one microbiological test for TB, 68% of them (196/287) had TB confirmed. Among 222 children with previous TB contact, information on LTBI was available for 78 (35%), and only 17% (13/78) were treated. Extrapulmonary TB (56% vs 32%), microbiologically confirmed TB (77% vs 60%), and HIV positivity (18.5% vs 4.0%) were significantly more frequent in RC. Treatment in RC (odds ratio (OR) 3.08, 95% confidence interval (CI) 1.74-5.44) and PTB (OR 2.47, 95% CI 1.34-4.56) were independently associated with a microbiological diagnosis of TB. The treatment success rate was 85%. In the logistic regression analysis, HIV-infected children had a 2.5-fold higher risk of an unfavorable outcome (OR 2.53, 95% CI 1.0-6.38; p = 0.05). Conclusions: Opportunities for TB prevention and early TB treatment are missed due to suboptimal close contact screening. Microbiological diagnosis of TB and drug susceptibility testing in children should be made available through more sensitive and accessible tests.

Treatment outcome of pediatric tuberculosis in eastern Ethiopia

“…In the current study, Pleural effusion was the second most common EPTB (25.5%). This result was in line with the study findings reported from Athens, Greece (26.5%) ( 15 ) and Rio de Janeiro Brazil (27%)( 12 ). The above differences might be due to the different diagnostic skills of health professionals, laboratory diagnostic tools, and the child's clinical presentation.…”

“…In this study, those with HIV positive sero status were less likely to have a successful treatment outcome. This was similar to studies conducted in Addis Ababa, Ethiopia ( 9 ), Cote d'Ivore ( 31 ) Malawi ( 30 ), and the metropolitan area of Rio de Janeiro, Brazil ( 12 ). Those HIV positive individuals might have low immunity status, which can be co-infected with a number of pathogens with varying clinical manifestations.…”

“…The overall EPTB findings were comparable to Arsi, Ethiopia (33.1%) ( 8 ), and Rio de Janeiro Brazil (28.1%) ( 12 ). But lower than compared to the report from Addis Ababa, Ethiopia (47.4%) ( 9 ).…”

“…This was comparable to the finding reported from Greece (47%) ( 15 ). But higher than reports from Colombia (40.6%)( 16 ), Tehran Iran (7%) ( 17 ), Italy, Rome (15.4%) ( 18 ) and Rio de Janeiro Brazil (40.3 %) ( 12 ). In the current study, Pleural effusion was the second most common EPTB (25.5%).…”

“…In Brazil, the percentage of children lost to follow-up was 9% and seven children (1%) died because of TB (including the child with MDR-TB). Among these children one child had TB meningitis ( 12 ).…”