title: Rifampicin-monoresistant Mycobacterium tuberculosis disease among children in Cape Town, South Africa.
abstract: METHODS
  Tygerberg Children's Hospital (TCH) and Brooklyn Chest Hospital (BCH), South Africa.
  
  
  OBJECTIVE
  To describe paediatric cases of rifampicin (RMP) monoresistant tuberculosis (RMR-TB) disease.
  
  
  METHODS
  Records of children with culture-confirmed RMR-TB between 1 March 2003  and 28 February 2009 were identified from a prospectively recorded database of drug-resistant TB at TCH and BCH. Mutation analysis was performed on available specimens.
  
  
  RESULTS
  Eighteen children with a median age of 6.9 years (range 2 months-12.8 years) were identified. Nine (50%)  were human immunodeficiency virus (HIV) infected and four (22%) were HIV-exposed but non-infected. Eleven (61%) had had previous TB treatment or prophylaxis. Nine children (50%) had cavitary disease and five children (22%) had extra-pulmonary disease. Twelve (67%) had adult TB source cases,  including five (42%) adults with known RMR-TB. Primary transmission occurred among 11 children (61%) and acquisition of RMR-TB was possible in seven (39%) with prior RMP exposure. Median delay to specific RMR-TB treatment was 70 days (range 23-188). One child died from RMR-TB meningitis.  Gene mutations consistent with RMR-TB were confirmed in five available samples.
  
  
  CONCLUSIONS
  RMR-TB disease is increasingly encountered, particularly among HIV-infected and HIV-exposed non-infected children. Delay in commencing appropriate treatment for RMR-TB and high rates of cavitary  disease could be a source of RMR-TB transmission.
authors.affiliation: Department of Paediatrics and Child Health, Tygerberg Children's Hospital, Stellenbosch University, Cape Town, South Africa. dramowski@sun.ac.za
authors.forename: A
authors.initials: A
authors.lastname: Dramowski
authors.forename: M M
authors.initials: MM
authors.lastname: Morsheimer
authors.forename: A M
authors.initials: AM
authors.lastname: Jordaan
authors.forename: T C
authors.initials: TC
authors.lastname: Victor
authors.forename: P R
authors.initials: PR
authors.lastname: Donald
authors.forename: H S
authors.initials: HS
authors.lastname: Schaaf
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000453:epidemiology; D000293:Adolescent; D000367:Age Factors; D000904:Antibiotics, Antitubercular / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D060085:Coinfection / Q000453:epidemiology; D004252:DNA Mutational Analysis; D004269:DNA, Bacterial / Q000032:analysis; D024881:Drug Resistance, Bacterial / Q000235:genetics; D005260:Female; D015658:HIV Infections / Q000453:epidemiology; D006776:Hospitals, Pediatric; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008826:Microbial Sensitivity Tests; D008853:Microscopy; D009154:Mutation; D009169:Mycobacterium tuberculosis / Q000235:genetics / Q000302:isolation & purification*; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012293:Rifampin / Q000627:therapeutic use*; D013019:South Africa; D013183:Sputum / Q000382:microbiology; D016896:Treatment Outcome; D014397:Tuberculosis, Pulmonary / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology / Q000382:microbiology / Q000635:transmission
chemical_list: D000904:Antibiotics, Antitubercular; D004269:DNA, Bacterial; D012293:Rifampin