Screening for Latent and Active Tuberculosis in Paediatric Contacts of Tuberculosis Patients: A Cross-sectional Study

Abstract

Introduction: Globally, World Health Organisation (WHO) estimate suggests that, one million cases of Tuberculosis (TB) occur among children (approximate 10% of the total 9.6 million TB cases). As per Revised National Tuberculosis Control Programme (RNTCP), high importance and priority is given to the household contacts and paediatric age group (especially <6 years). Since, transmission can happen at any time from index case to the contact (before diagnosis or during treatment), all contacts of TB patients should be screened. Aim: To focus on the screening of paediatric contacts of TB positive patients by Mantoux test and to find out active and latent TB. Materials and Methods: A cross-sectional study was conducted in the Department of Paediatrics at Sri Guru Ram Das Institute of Medical Sciences and Research, Amritsar, Punjab, India. The duration of the study was 16 months, from February 2020 to June 2021. Participants, who were proven cases, either sputum positive or clinically diagnosed and were less than 18 years of age were included. Contacts in whom Isoniazid Preventive Therapy (IPT) had been started were excluded. The candidates who tested Mantoux positive and had symptoms of TB were further screened by following test chest X-ray, Ultrasonography (USG) abdomen, Microscopy for Acid Fast Bacilli (AFB), Cartridge Based Nucliec Acid Amplification Test (CBNAAT), Cerebrospinal Fluid (CSF) analysis and contrast Magnetic Resonance Imaging (MRI). The data collected was analysed statistically with Statistical Package for Social Sciences (SPSS) version 26.0 and the level of significance was determined p-value <0.05 as insignificant, p-value >0.05 as significant and p-value <0.001 as highly significant. Results: A total of 82 contacts were included. Out of these, 60 children had no organ system involvement, whilst 11 had lymphadenopathy, five had respiratory involvement and six had abdominal involvement. Out of 82 contacts, 23 children tested Mantoux positive and 59 tested negative. Out of 23 Mantoux positive contacts 16 (19.51%) had latent TB and only 1 (2.44%) had active TB. Conclusion: A significant number of children in contact with TB positive patients were found to have latent TB, and it is possible that, there can be activation from latent to active TB later on in these children.