Abstract
Background: Paediatric multidrug-resistant tuberculosis (MDR-TB) necessitates a prolonged duration of treatment with an intensive treatment regimen. The chest X-ray patterns of pulmonary TB depend on a multiplicity of factors, including immune status, and therefore identifying the influence of HIV on the chest X-ray appearances of MDR-TB may assist with improving the diagnostic criteria. Objectives: To describe the demographic characteristics and chest X-ray patterns of children with pulmonary MDR-TB and to compare the chest X-ray patterns of pulmonary MDR-TB between children who are HIV-infected and HIV-uninfected.Method: Retrospective chart review of hospital notes and chest X-rays of children with pulmonary MDR-TB at King Dinuzulu Hospital, Durban. The chest X-rays were systematically reviewed for the presence of the following variables: hilar/mediastinal lymphadenopathy, bronchopneumonic opacification, segmental/lobar consolidation, cavities, miliary opacification and pleural effusion.Results: Forty-five children (mean age, 6.29 years; median age, 6.00 years) with pulmonary MDR-TB met the inclusion criteria. The most common chest X-ray finding was consolidation (53.5%), followed by lymphadenopathy (35.6%), bronchopneumonic opacification (33.3%) and cavities (31.1%). Cavities were more common (OR 6.1; 95% CI 1.52–24.66) in children who had been initiated on standard anti-TB treatment for the current TB episode. There were no statistically significant differences in any of the chest X-ray patterns in HIV-uninfected (n = 22) compared with HIV-infected (n = 20) children. Conclusion: The most common chest X-ray finding was consolidation, followed by lymphadenopathy, bronchopneumonic opacification and cavities. The finding of a significantly higher frequency of cavities in children who had received prior standard anti-TB treatment for the current TB episode could reflect poor disease containment and increased parenchymal damage, owing to a delay in the recognition of MDR-TB. The development of cavitation in chest X-rays of children with TB could raise concern for the possibility of MDR-TB, and prompt further testing.
Highlights
Paediatric tuberculosis (TB) remains an area of significant concern
A retrospective review of patient records was conducted at the paediatric ward and paediatric outpatients’ department of a referral multidrug-resistant TB (MDR-TB) facility in Durban (King Dinuzulu Hospital) for the period 01 January 2013 to 31 December 2013, to identify children diagnosed with pulmonary MDR-TB
55 children
Summary
Paediatric tuberculosis (TB) remains an area of significant concern. In 2012, the total estimated number of childhood notifications from all countries was 349 000.1 In the paediatric population, chest X-rays remain the initial investigation in the work-up of suspected pulmonary TB; overlapping clinical and chest X-ray features with other causes of acute pneumonia, and poor sensitivities for the tuberculin skin test (TST), make confirmation of TB difficult.[2]. In terms of the clinical outcome of paediatric MDR-TB, in a cohort study of children with culture-confirmed MDR-TB in the Western Cape, South Africa, the majority of children were treated successfully, with 82% having favourable outcomes (cured and treatment completed) in contrast to adult data.[3] the majority of children were treated successfully, a further study in this region, which documented four known deaths (10%), suggested that earlier recognition of drug resistance could probably have prevented a further two deaths and morbidity.[4] http://www.sajr.org.za Open Access This observation highlights the importance of early detection and treatment of MDR-TB. The chest X-ray patterns of pulmonary TB depend on a multiplicity of factors, including immune status, and identifying the influence of HIV on the chest X-ray appearances of MDR-TB may assist with improving the diagnostic criteria
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