A prospective study of the prevalence of tuberculosis and bacteraemia in Bangladeshi children with severe malnutrition and pneumonia including an evaluation of Xpert MTB/RIF assay.
BACKGROUND
Severe malnutrition is a risk factor for pneumonia due to a wide range of pathogens but aetiological data are limited and the role of Mycobacterium tuberculosis is uncertain.


METHODS
We prospectively investigated severely malnourished young children (<5 years) with radiological pneumonia admitted over a 15-month period. Investigations included blood culture, sputa for microscopy and mycobacterial culture. Xpert MTB/RIF assay was introduced during the study. Study children were followed for 12 weeks following their discharge from the hospital.


RESULTS
405 eligible children were enrolled, with a median age of 10 months. Bacterial pathogens were isolated from blood culture in 18 (4.4%) children, of which 72% were Gram negatives. Tuberculosis was confirmed microbiologically in 7% (27/396) of children that provided sputum - 10 by culture, 21 by Xpert MTB/RIF assay, and 4 by both tests. The diagnostic yield from induced sputum was 6% compared to 3.5% from gastric aspirate. Sixty (16%) additional children had tuberculosis diagnosed clinically that was not microbiologically confirmed. Most confirmed tuberculosis cases did not have a positive contact history or positive tuberculin test. The sensitivity and specificity of Xpert MTB/RIF assay compared to culture was 67% (95% CI: 24-94) and 92% (95% CI: 87-95) respectively. Overall case-fatality rate was 17% and half of the deaths occurred in home following discharge from the hospital.


CONCLUSIONS
TB was common in severely malnourished Bangladeshi children with pneumonia. X-pert MTB/RIF assay provided higher case detection rate compared to sputum microscopy and culture. The high mortality among the study children underscores the need for further research aimed at improved case detection and management for better outcomes.
International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh; Centre for International Child Health, The University of Melbourne Department of Paediatrics and Murdoch Childrens Research Institute, Royal Children's Hospital, Melbourne, Australia.
Mohammod Jobayer
MJ
Chisti
Centre for International Child Health, The University of Melbourne Department of Paediatrics and Murdoch Childrens Research Institute, Royal Children's Hospital, Melbourne, Australia; International Union Against Tuberculosis and Lung Disease, Paris, France.
Stephen M
SM
Graham
Centre for International Child Health, The University of Melbourne Department of Paediatrics and Murdoch Childrens Research Institute, Royal Children's Hospital, Melbourne, Australia.
Trevor
T
Duke
International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh.
Tahmeed
T
Ahmed
International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh.
Hasan
H
Ashraf
International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh.
Abu Syed Golam
AS
Faruque
Centre for International Child Health, The University of Melbourne Department of Paediatrics and Murdoch Childrens Research Institute, Royal Children's Hospital, Melbourne, Australia.
Sophie
S
La Vincente
International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh.
Sayera
S
Banu
International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh.
Rubhana
R
Raqib
International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh.
Mohammed Abdus
MA
Salam
D016470:Bacteremia / Q000175:diagnosis / Q000453:epidemiology* / Q000382:microbiology; D001459:Bangladesh / Q000453:epidemiology; D002675:Child, Preschool; D015897:Comorbidity; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D044342:Malnutrition / Q000453:epidemiology*; D025202:Molecular Diagnostic Techniques; D011014:Pneumonia / Q000453:epidemiology*; D015995:Prevalence; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D013183:Sputum / Q000382:microbiology; D014376:Tuberculosis / Q000175:diagnosis / Q000453:epidemiology* / Q000382:microbiology