Presentation and outcome of culture-confirmed isoniazid-resistant rifampicin-susceptible tuberculosis in children

Garcia-Prats, Anthony J. ; Du Plessis, L. ; Draper, H. R. ; Burger, A. ; Seddon, J. A. ; Zimri, K. ; Hesseling, Anneke C. ; Schaaf, H. Simon (2016)

CITATION: Garcia-Prats, A. J., et al. 2016. Presentation and outcome of culture-confirmed isoniazid-resistant rifampicin-susceptible tuberculosis in children. The International Journal of Tuberculosis and Lung Disease, 20(11):1469-1476(8), doi:10.5588/ijtld.16.0293.

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Setting: Isoniazid-resistant rifampicin-susceptible (HRRS) tuberculosis (TB) is the most prevalent form of drug-resistant TB globally, and may be a risk factor for poor outcomes. HRRS-TB in children has been poorly described. Objective: To characterize the clinical presentation, treatment, and clinical and microbiological outcomes, and factors associated with poor outcomes among children with culture-confirmed HRRS-TB. Design: Retrospective hospital-based cohort study. Results: Of the 72 children included, median age 50.1 months (IQR 21.5-102.5), 42% were male. Forty-four (51%) had a potential source case; only 13 were confirmed HRRS-TB. Twelve of 66 tested (17%) were HIV-infected, and 36 of 60 (60%) with pulmonary TB had severe disease. Seventy had treatment data; median total duration was 11.3 months (IQR 9-12.3); 25 (36%) initiated treatment with a 3-drug intensive phase; 52 (74%) received a fluoroquinolone. Of 63 with known outcome, 55 (88%) had a favourable outcome; 1 died and 3 had treatment failure. Ten had positive follow-up cultures at ≥2 months after starting treatment (17% of all PTB and 27% of those with follow-up culture data); older age (p=0.008), previous TB treatment (p=0.023) and severe PTB (p=0.018) were associated with failure to culture-convert at ≥2 months. Conclusions: Although overall outcomes were good, prolonged culture positivity and cases of treatment failure emphasize the need for additional attention to clinical management of children with HRRS-TB.

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