High prevalence of childhood multi-drug resistant tuberculosis in Johannesburg, South Africa: a cross sectional study

Lee Fairlie,Gary Reubenson,Natalie C Beylis,David P Moore,Shabir A Madhi

doi:10.1186/1471-2334-11-28

Abstract

BackgroundThere are limited data on the prevalence of multi-drug resistant tuberculosis (MDR-TB), estimated at 0.6-6.7%, in African children with tuberculosis. We undertook a retrospective analysis of the prevalence of MDR-TB in children with Mycobacterium tuberculosis (MTB) at two hospitals in Johannesburg, South Africa.MethodsCulture-confirmed cases of MTB in children under 14 years, attending two academic hospitals in Johannesburg, South Africa during 2008 were identified and hospital records of children diagnosed with drug-resistant TB were reviewed, including clinical and radiological outcomes at 6 and 12 months post-diagnosis. Culture of Mycobacterium tuberculosis complex (MTB) was performed using the automated liquid broth MGIT™ 960 method. Drug susceptibility testing (DST) was performed using the MGIT™ 960 method for both first and second-line anti-TB drugs.Results1317 children were treated for tuberculosis in 2008 between the two hospitals where the study was conducted. Drug susceptibility testing was undertaken in 148 (72.5%) of the 204 children who had culture-confirmed tuberculosis. The prevalence of isoniazid-resistance was 14.2% (n = 21) (95%CI, 9.0-20.9%) and the prevalence of MDR-TB 8.8% (n = 13) (95%CI, 4.8-14.6%). The prevalence of HIV co-infection was 52.1% in children with drug susceptible-TB and 53.9% in children with MDR-TB. Ten (76.9%) of the 13 children with MDR-TB received appropriate treatment and four (30.8%) died at a median of 2.8 months (range 0.1-4.0 months) after the date of tuberculosis investigation.ConclusionsThere is a high prevalence of drug-resistant tuberculosis in children in Johannesburg in a setting with a high prevalence of HIV co-infection, although no association between HIV infection and MDR-TB was found in this study. Routine HIV and drug-susceptibility testing is warranted to optimize the management of childhood tuberculosis in settings such as ours.

Highlights

There are limited data on the prevalence of multi-drug resistant tuberculosis (MDR-TB), estimated at 0.6-6.7%, in African children with tuberculosis
Drug susceptibility testing In 2008, 1317 children were treated for tuberculosis between the two hospitals based on information accessed through an electronic register which is maintained at both facilities’ TB Focal Points
As it was not possible to ascertain retrospectively whether isolates obtained from lymph node aspirates were BCG in all cases, children in whom Mycobacterium tuberculosis (MTB) complex was only identified from lymph node aspirate samples were excluded from further analysis as bias may have been introduced by including these cases: ages were not available for all children, and the location of lymph node aspiration was not available for drug-sensitive cases. (Figure 1)

Summary

Introduction

There are limited data on the prevalence of multi-drug resistant tuberculosis (MDR-TB), estimated at 0.6-6.7%, in African children with tuberculosis. Most of the 2.1 million HIV-infected children live in sub-Saharan Africa including 10% in South Africa [1]. An estimated 10% of the 2.9 million new cases of tuberculosis in sub-Saharan Africa during 2007 occurred in children: 38% of all incident tuberculosis cases in sub-Saharan Africa (regardless of age group) were HIV-infected in 2007 [2]. There are limited data on the prevalence of drug-resistance in African children with tuberculosis. In Cape Town, South Africa, between 2005 and 2007 the prevalence rates of MTB isoniazid resistance were 14.4% and 6.7% of isolates had MDR-TB [4]. These prevalence rates had increased compared to one decade previously when the prevalence of isoniazid resistance was 6.9% (95% CI, 1.1-3.6) and MDR-TB 2.3% (95% CI, 0.9-6.6) [5]

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