Culture-confirmed childhood tuberculosis in Cape Town, South Africa: a review of 596 cases.
BACKGROUND
The clinical, radiological and microbiological features of culture-confirmed childhood tuberculosis diagnosed at two referral hospitals are described.


METHODS
Cultures of Mycobacterium tuberculosis from children less than 13 years of age at Tygerberg and Red Cross Children's Hospitals, Cape Town, South Africa, were collected from March 2003 through February 2005. Folder review and chest radiography were performed and drug susceptibility tests done.


RESULTS
Of 596 children (median age 31 months), 330 (55.4%) were males. Of all children, 281 (47.1%) were HIV-uninfected, 133 (22.3%) HIV-infected and 182 (30.5%) not tested. Contact with infectious tuberculosis adults was recorded in 295 (49.5%) children. Missed opportunities for chemoprophylaxis were present in 117/182 (64.3%) children less than 5 years of age. Extrathoracic TB was less common in HIV-infected than in HIV-uninfected children (49/133 vs. 156/281; odds ratio 0.50, 95% confidence interval 0.32-0.78). Alveolar opacification (84/126 vs. 128/274; OR 1.85, 95%CI 1.08-3.19) and cavitation (33/126 vs. 44/274; OR 2.28, 95%CI 1.44-3.63) were more common in HIV-infected than in HIV-uninfected children. Microscopy for acid-fast bacilli on gastric aspirates and sputum was positive in 29/142 (20.4%) and 40/125 (32.0%) children, respectively. Sixty-seven of 592 (11.3%) children's isolates showed resistance to isoniazid and/or rifampicin; 43 (7.3%) were isoniazid-monoresistant, 2 (0.3%) rifampicin-monoresistant and 22 (3.7%) multidrug-resistant. Death in 41 children (6.9%) was more common in HIV-infected children and very young infants.


CONCLUSIONS
HIV infection and missed opportunities for chemoprophylaxis were common in children with culture-confirmed TB. With cavitating disease and sputum or gastric aspirates positive for acid-fast bacilli, children may be infectious. Transmission of drug-resistant TB is high in this setting.
Schaaf
H Simon
HS
Desmond Tutu Tuberculosis Centre, Department of Paediatrics and Child Health, Stellenbosch University, Cape Town, South Africa. hss@sun.ac.za
Marais
Ben J
BJ
Whitelaw
Andrew
A
Hesseling
Anneke C
AC
Eley
Brian
B
Hussey
Gregory D
GD
Donald
Peter R
PR
D000293:Adolescent; D000995:Antitubercular Agents / Q000494:pharmacology / Q000627:therapeutic use; D001431:Bacteriological Techniques; D002648:Child; D002675:Child, Preschool; D003470:Culture Media; D024881:Drug Resistance, Bacterial; D005260:Female; D015658:HIV Infections / Q000150:complications*; D006776:Hospitals, Pediatric; D006801:Humans; D008297:Male; D009169:Mycobacterium tuberculosis / Q000187:drug effects / Q000302:isolation & purification*; D011859:Radiography; D013019:South Africa / Q000453:epidemiology; D013183:Sputum / Q000382:microbiology; D018088:Tuberculosis, Multidrug-Resistant / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000382:microbiology; D014397:Tuberculosis, Pulmonary / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000382:microbiology
D000995:Antitubercular Agents; D003470:Culture Media