Abstract
BackgroundThe presentation of pulmonary tuberculosis (PTB) in young children is often clinically indistinguishable from other common respiratory illnesses, which are frequently infections of viral aetiology. As little is known about the role of viruses in children with PTB, we investigated the prevalence of respiratory viruses in children with suspected PTB at presentation and follow-up.MethodsIn an observational cohort study, children < 13 years were routinely investigated for suspected PTB in Cape Town, South Africa between December 2015 and September 2017 and followed up for 24 weeks. Nasopharyngeal aspirates (NPAs) were tested for respiratory viruses using multiplex PCR at enrolment, week 4 and 8.ResultsSeventy-three children were enrolled [median age 22.0 months; (interquartile range 10.0–48.0); 56.2% male and 17.8% HIV-infected. Anti-tuberculosis treatment was initiated in 54.8%; of these 50.0% had bacteriologically confirmed TB. At enrolment, ≥1 virus were detected in 95.9% (70/73) children; most commonly human rhinovirus (HRV) (74.0%). HRV was more frequently detected in TB cases (85%) compared to ill controls (60.6%) (p = 0.02). Multiple viruses were detected in 71.2% of all children; 80% of TB cases and 60.6% of ill controls (p = 0.07). At follow-up, ≥1 respiratory virus was detected in 92.2% (47/51) at week 4, and 94.2% (49/52) at week 8.ConclusionsWe found a high prevalence of viral respiratory co-infections in children investigated for PTB, irrespective of final PTB diagnosis, which remained high during follow up. Future work should include investigating the whole respiratory ecosystem in combination with pathogen- specific immune responses.
Highlights
The presentation of pulmonary tuberculosis (PTB) in young children is often clinically indistinguishable from other common respiratory illnesses, which are frequently infections of viral aetiology
We considered that TB may present acutely, especially in young children, and included children with any duration of cough, if ≥1 of the following were present: 1) exposure to an identified TB source case in the past 12 months, 2) positive tuberculin skin test (TST) if previously negative or unknown, or 3) a chest radiograph (CXR) suggestive of TB as assessed by the study clinician
Children with confirmed TB had more frequent documented exposure to TB, a positive Tuberculin skin test (TST) result and a Chest X- ray (CXR) suggestive of PTB compared to unconfirmed TB cases and ill controls
Summary
The presentation of pulmonary tuberculosis (PTB) in young children is often clinically indistinguishable from other common respiratory illnesses, which are frequently infections of viral aetiology. As little is known about the role of viruses in children with PTB, we investigated the prevalence of respiratory viruses in children with suspected PTB at presentation and follow-up. After careful clinical investigation and follow up, many children that present with symptoms suggestive of PTB are found to have diagnoses other than TB. This group needs to be better characterised to help clinical decision making and reduce unnecessary treatment. Respiratory virus infections likely play a crucial role in the aetiology of disease in this group of children [8]. There is a clear need to improve our current understanding of the role of respiratory coinfections in the interaction between the developing immune system and Mycobacterium tuberculosis (M.tb)
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