Clinical features and outcome in children admitted to a TB hospital in the Western Cape : the influence of HIV infection and drug resistance
Date
2005-08
Authors
Soeters, M.
De Vries, Anne Martien
Kimpen, Jan L. L.
Donald, Peter R.
Schaaf, H. Simon
Journal Title
Journal ISSN
Volume Title
Publisher
SAMJ
Abstract
Background. The Western Cape has a high incidence of tuberculosis (TB) and a rising prevalence of HIV infection. Children form 15-20% of this TB burden. Objective. To document the clinical features and outcome of TB among children admitted to a regional TB hospital. Method. A retrospective, descriptive study was undertaken of children under 15 years of age admitted to Brooklyn Hospital for Chest Diseases from January 2000 to December 2001. Demographic and clinical details of children were recorded routinely in a register that formed the basis of this review. Results. Two hundred and thirty-eight of the 250 children admitted had TB, of whom 120 (50.4%) were boys. The median age was 25 months. Reasons for admission were disease severity in 99 cases, social reasons in 36, and a combination in 103. Adult source cases were identified in 138 instances; 9 had drug-resistant TB, 31 drug-susceptible TB and in 98 cases susceptibility was unknown. TB was confirmed by culture in 119 children. Of 79 in whom susceptibility testing was done, 10 had isoniazid-resistant TB and 8 multidrug-resistant TB. HIV serology was positive in 43 of 138 children tested (31%). Previous antituberculosis treatment, severe malnutrition and weight under the 3rd percentile for age, a negative Mantoux test, and mortality were significantly more common in the HIV-infected children. Twenty-two of 41 previously negative Mantoux tests (< 5 mm induration) were positive on retesting. Conclusions. HIV infection is common in children with TB and malnutrition, and mortality in this group is high. Repeat Mantoux tests may show an increased number of positive results.
Description
Keywords
Ethambutol, Ethionamide, Isoniazid, Pyrazinamide, Rifampicin, Tuberculin, Tuberculostatic agents, Adolescents, Antibiotic resistance, Antibiotic sensitivity, Bacterium culture, Body weight, Childhood mortality, Comorbidity, Computer assisted tomography, Disease severity, Disease transmission, Drug eruption, Enzyme linked immunosorbent assay, Extrapulmonary tuberculosis, Health care facilities, Hospital admission, Human immunodeficiency virus, Human immunodeficiency virus infection, Jaundice, Lung tuberculosis, Malnutrition, Multidrug resistance, Mycobacterium tuberculosis, Polymerase chain reaction, Serology, Sputum smear, Thorax radiography, Tuberculin test, Tuberculosis, Tuberculous meningitis, Tuberculosis, Multidrug-Resistant, Tuberculosis, Pulmonary, Severity of Illness index, Mycobacterium tuberculosis, Microbial Sensitivity Tests, Hospitals, Special, Developing countries, AIDS-related opportunistic infections, Antitubercular agents, Tuberculosis in children -- Hospital treament -- South Africa -- Western Cape
Citation
Soeters, M, De Vries, AM, Kimpen, JLL. Donald, PR & Schaaf, HS 2005, 'Clinical features and outcome in children admitted to a TB hospital in the Western Cape - The influence of HIV infection and drug resistance', South African Medical Journal, vol. 95, no. 8, pp. 602-606.