Mycobacterium Tuberculosis Complex in Children Clinical, Radiological Features, Management, Outcome and Susceptibility Pattern

Abstract

Introduction Mycobacterium tuberculosis complex MTC is a major cause of morbidity and mortality globally. The Bacille Calmette-Guérin (BCG) vaccine is most commonly used worldwide. Disseminated BCG disease is one of the vaccine complications that may occur in immunocompromised children. Methods Retrospective study from January 2009 to December 2022. Results We evaluated 66 patients with microbiologically documented M. tuberculosis complex. Immunocompetent were 28 while 38 were immunocompromised. Our data include 46 patients with BCG-related infections. The majority of 26 patients were diagnosed with disseminated BCGiosis, and local BCGitis was found in 20 out of 46. Remaining 20 patients constitute non-BCG-related infections. Chest radiography done in 58 patients and 10.6% had abnormal findings specific for TB. Other image was mainly done for disseminated BCGiosis. The overall acid-fast bacillus AFB smear was positive in 42.4%, polymerase chain reaction (PCR) positive in 75.8% and positive cultures in 97%. Susceptibility of all samples showed high resistance of pyrazinamide 78.2%, and INH 57.8%, while low resistance to RIF and ethambutol. A further subanalysis of the non-BCG group only showed a drop of resistance to 30% for the related group; all strains were pyrazinamide resistant in the same line with the fact that BCG strain is intrinsically resistant to pyrazinamide, all our patients were 100% resistant. We observed four medications showed some advantage over three-drug regimens with respect to mortality in immunocompromised group. The overall outcome in all patients showed 10.6% mortality. Majority were in disseminated BCGiosis, in which 19.2% died. Conclusion: Our center is the main referral hospital in the kingdom with a large number of patients that will help in understanding local data more. Performance of smear and PCR showed variation in relation to different TB diagnoses and sensitivity patterns, giving us insight into different MTB complex strain characteristics that would help in treatment. Sensitivity pattern data will help in keeping updated treatment protocol locally. We recommend managing disseminated BCGiosis with at least four antimycobacterial agents.