title: Pediatric tuberculosis in young children in India: a prospective study.
abstract: BACKGROUND
  India has one of the highest tuberculosis (TB) burdens globally. However, few studies have focused on TB in young children, a vulnerable population, where lack of early diagnosis results in poor outcomes.
  
  
  METHODS
  Young children (≤ 5 years) with suspected TB were prospectively enrolled at a tertiary hospital in Pune, India. Detailed clinical evaluation, HIV testing, mycobacterial cultures, and drug susceptibility testing were performed.
  
  
  RESULTS
  223 children with suspected TB were enrolled. The median age was 31 months, 46% were female, 86% had received BCG, 57% were malnourished, and 10% were HIV positive. 12% had TB disease (definite or probable), 35% did not have TB, while TB could not be ruled out in 53%. Extrapulmonary disease was noted in 46%, which was predominantly meningeal. Tuberculin skin test (TST) was positive in 20% of children with TB. Four of 7 (57%) children with culture-confirmed TB harbored drug-resistant (DR) strains of whom 2 (50%) were multi-DR (MDR). In adjusted analyses, HIV infection, positive TST, and exposure to household smoke were found to be significantly associated with children with TB (P ≤ 0.04). Mortality (at 1 year) was 3 of 26 (12%) and 1 of 79 (1%), respectively, in children with TB and those without TB (P < 0.05).
  
  
  CONCLUSIONS
  Diagnosis of TB is challenging in young children, with high rates of extra-pulmonary and meningeal disease. While the data on DR-TB are limited by the small sample size, they are however concerning, and additional studies are needed to more accurately define the prevalence of DR strains in this vulnerable population.
authors.affiliation: Department of Pediatrics, Johns Hopkins University School of Medicine, 1550 Orleans Street, CRB-II, Room 1.09, Baltimore, MD 21287, USA ; Center for Tuberculosis Research, Johns Hopkins University School of Medicine, 1550 Orleans Street, CRB-II, Room 1.09, Baltimore, MD 21287, USA ; Center for Infection and Inflammation Imaging Research, Johns Hopkins University School of Medicine, 1550 Orleans Street, CRB-II, Room 1.09, Baltimore, MD 21287, USA.
authors.forename: Sanjay K
authors.initials: SK
authors.lastname: Jain
authors.affiliation: Department of Pediatrics, Johns Hopkins University School of Medicine, 1550 Orleans Street, CRB-II, Room 1.09, Baltimore, MD 21287, USA ; Center for Tuberculosis Research, Johns Hopkins University School of Medicine, 1550 Orleans Street, CRB-II, Room 1.09, Baltimore, MD 21287, USA ; Center for Infection and Inflammation Imaging Research, Johns Hopkins University School of Medicine, 1550 Orleans Street, CRB-II, Room 1.09, Baltimore, MD 21287, USA.
authors.forename: Alvaro
authors.initials: A
authors.lastname: Ordonez
authors.affiliation: Byramjee Jeejeebhoy Government Medical College, Pune, India.
authors.forename: Aarti
authors.initials: A
authors.lastname: Kinikar
authors.affiliation: Byramjee Jeejeebhoy Government Medical College, Pune, India ; Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA.
authors.forename: Nikhil
authors.initials: N
authors.lastname: Gupte
authors.affiliation: National AIDS Research Institute, Pune, India.
authors.forename: Madhuri
authors.initials: M
authors.lastname: Thakar
authors.affiliation: Byramjee Jeejeebhoy Government Medical College, Pune, India ; Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA.
authors.forename: Vidya
authors.initials: V
authors.lastname: Mave
authors.affiliation: Department of Pediatrics, Johns Hopkins University School of Medicine, 1550 Orleans Street, CRB-II, Room 1.09, Baltimore, MD 21287, USA.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Jubulis
authors.affiliation: Byramjee Jeejeebhoy Government Medical College, Pune, India.
authors.forename: Sujata
authors.initials: S
authors.lastname: Dharmshale
authors.affiliation: Byramjee Jeejeebhoy Government Medical College, Pune, India.
authors.forename: Shailaja
authors.initials: S
authors.lastname: Desai
authors.affiliation: Byramjee Jeejeebhoy Government Medical College, Pune, India.
authors.forename: Swarupa
authors.initials: S
authors.lastname: Hatolkar
authors.affiliation: Byramjee Jeejeebhoy Government Medical College, Pune, India.
authors.forename: Anju
authors.initials: A
authors.lastname: Kagal
authors.affiliation: Imperial College London, London, UK.
authors.forename: Ajit
authors.initials: A
authors.lastname: Lalvani
authors.affiliation: Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA.
authors.forename: Amita
authors.initials: A
authors.lastname: Gupta
authors.affiliation: Byramjee Jeejeebhoy Government Medical College, Pune, India.
authors.forename: Renu
authors.initials: R
authors.lastname: Bharadwaj
mesh_terms: D002675:Child, Preschool; D018572:Disease-Free Survival; D005260:Female; D015658:HIV Infections / Q000175:diagnosis / Q000453:epidemiology / Q000382:microbiology / Q000401:mortality / Q000628:therapy; D006801:Humans; D007194:India / Q000453:epidemiology; D007223:Infant; D008297:Male; D015995:Prevalence; D011446:Prospective Studies; D015996:Survival Rate; D062606:Tertiary Care Centers; D014374:Tuberculin Test; D014390:Tuberculosis, Meningeal / Q000175:diagnosis / Q000453:epidemiology / Q000401:mortality / Q000628:therapy; D018088:Tuberculosis, Multidrug-Resistant / Q000175:diagnosis / Q000401:mortality / Q000628:therapy