Abstract
BackgroundYoung children exposed to Mycobacterium tuberculosis have a high risk of disease progression following infection. This study aimed to determine risk factors for M. tuberculosis infection and disease in children following exposure to adults with multidrug-resistant (MDR) tuberculosis (TB).MethodsCross-sectional study; all children aged < 5 years, routinely referred per local guidelines to the provincial specialist MDR-TB clinic, Western Cape Province, South Africa, following identification as contacts of adult MDR-TB source cases, were eligible for enrolment from May 2010 through April 2011. Demographic, clinical and social characteristics were collected. All children underwent HIV and tuberculin skin testing.ResultsOf 228 children enrolled (median age: 30 months), 102 (44.7%) were classified as infected. Of these, 15 (14.7%) had TB disease at enrolment. Of 217 children tested for HIV, 8 (3.7%) were positive. In adjusted analysis, child’s age (AOR: 1.43; 95% CI: 1.13-1.91; p = 0.002) and previous TB treatment history (AOR: 2.51; 95% CI: 1.22-5.17; p = 0.01) were independent risk factors for infection. Increasing age of the MDR-TB source case (AOR: 0.67; 95% CI: 0.45-1.00; p = 0.05) was protective and source case alcohol use (AOR: 2.59; 95% CI: 1.29-5.22; p = 0.007) was associated with increased odds of infection in adjusted analysis. Decreasing age of the child (p = 0.01) and positive HIV status (AOR: 25.3; 95% CI: 1.63-393; p = 0.01) were associated with prevalent TB disease.ConclusionA high proportion of children exposed to MDR-TB are infected or diseased. Early contact tracing might provide opportunities to prevent the progression to TB disease in children identified as having been exposed to MDR-TB.
Highlights
Young children exposed to Mycobacterium tuberculosis have a high risk of disease progression following infection
A number of children did not meet the eligibility criteria for the study: the source case did not have MDR-TB (n = 27), the child was older than five years (n = 56), the intensity of contact was not judged to be significant by the clinical team (n = 11) or a TST result was not available in the presence of an asymptomatic child (n = 2)
The remaining 53 children were not brought to the clinic by a parent or legal guardian who could provide informed consent (n = 31), the parents did not consent to the study (n = 3) or the families left the clinic before the research team could speak to them (n = 19)
Summary
Young children exposed to Mycobacterium tuberculosis have a high risk of disease progression following infection. This study aimed to determine risk factors for M. tuberculosis infection and disease in children following exposure to adults with multidrug-resistant (MDR) tuberculosis (TB). The development of tuberculosis (TB) requires exposure to Mycobacterium tuberculosis, subsequent infection, and progression to disease [1]. The diagnosis of M. tuberculosis infection and disease in children is challenging as available tests have limitations. As childhood TB results from recent infection and subsequent disease development, children serve as a sentinel marker of ongoing M. tuberculosis transmission and failing TB control within a community [5]. Identifying risk factors for infection and disease in children is important in understanding the broader epidemic
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