Pediatric tuberculosis in young children in India: a prospective study.

Abstract:

BACKGROUND:India has one of the highest tuberculosis (TB) burdens globally. However, few studies have focused on TB in young children, a vulnerable population, where lack of early diagnosis results in poor outcomes. METHODS:Young children (≤ 5 years) with suspected TB were prospectively enrolled at a tertiary hospital in Pune, India. Detailed clinical evaluation, HIV testing, mycobacterial cultures, and drug susceptibility testing were performed. RESULTS:223 children with suspected TB were enrolled. The median age was 31 months, 46% were female, 86% had received BCG, 57% were malnourished, and 10% were HIV positive. 12% had TB disease (definite or probable), 35% did not have TB, while TB could not be ruled out in 53%. Extrapulmonary disease was noted in 46%, which was predominantly meningeal. Tuberculin skin test (TST) was positive in 20% of children with TB. Four of 7 (57%) children with culture-confirmed TB harbored drug-resistant (DR) strains of whom 2 (50%) were multi-DR (MDR). In adjusted analyses, HIV infection, positive TST, and exposure to household smoke were found to be significantly associated with children with TB (P ≤ 0.04). Mortality (at 1 year) was 3 of 26 (12%) and 1 of 79 (1%), respectively, in children with TB and those without TB (P < 0.05). CONCLUSIONS:Diagnosis of TB is challenging in young children, with high rates of extra-pulmonary and meningeal disease. While the data on DR-TB are limited by the small sample size, they are however concerning, and additional studies are needed to more accurately define the prevalence of DR strains in this vulnerable population.

journal_name

Biomed Res Int

authors

Jain SK,Ordonez A,Kinikar A,Gupte N,Thakar M,Mave V,Jubulis J,Dharmshale S,Desai S,Hatolkar S,Kagal A,Lalvani A,Gupta A,Bharadwaj R

doi

10.1155/2013/783698

subject

Has Abstract

pub_date

2013-01-01 00:00:00

pages

783698

eissn

2314-6133

issn

2314-6141

journal_volume

2013

pub_type

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