title: Trends in childhood drug-resistant tuberculosis in South Africa: a window into the wider epidemic?
abstract: Childhood tuberculosis (TB) is a marker of TB transmission within a community. We present the fourth consecutive survey of children with culture-confirmed TB at a hospital in Cape Town, South Africa, from 2009 to 2011. In comparison to the previous survey, the rate of multidrug-resistant TB (MDR-TB) has stabilised and the human immunodeficiency virus infection rate has declined. We also report on the first systematic surveillance of resistance to second-line drugs. Two concerns following from this are the high rate (22%) of ofloxacin resistance in MDR-TB isolates, and the discordance between isolates with an inhA promoter region mutation, usually implying ethionamide (ETH) resistance, and phenotypic ETH results in these isolates showing ETH susceptibility.
authors.affiliation: <label>*</label>Department of Paediatrics and Child Health, Desmond Tutu TB Centre, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa.
authors.forename: H S
authors.initials: HS
authors.lastname: Schaaf
authors.affiliation: <label>*</label>Department of Paediatrics and Child Health, Desmond Tutu TB Centre, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa.
authors.forename: A C
authors.initials: AC
authors.lastname: Hesseling
authors.affiliation: <label><sup>‡</sup></label>National Health Laboratory Service, Tygerberg Academic Hospital, Tygerberg, South Africa.
authors.forename: C
authors.initials: C
authors.lastname: Rautenbach
authors.affiliation: <label>*</label>Department of Paediatrics and Child Health, Desmond Tutu TB Centre, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa.
authors.forename: J A
authors.initials: JA
authors.lastname: Seddon
mesh_terms: D000367:Age Factors; D000995:Antitubercular Agents / Q000494:pharmacology*; D001426:Bacterial Proteins; D002648:Child; D002675:Child, Preschool; D024901:Drug Resistance, Multiple, Bacterial; D005000:Ethionamide / Q000494:pharmacology; D005260:Female; D015658:HIV Infections / Q000453:epidemiology*; D006801:Humans; D007223:Infant; D008297:Male; D009169:Mycobacterium tuberculosis / Q000187:drug effects / Q000302:isolation & purification; D015242:Ofloxacin / Q000494:pharmacology; D010088:Oxidoreductases; D011401:Promoter Regions, Genetic; D013019:South Africa / Q000453:epidemiology; D018088:Tuberculosis, Multidrug-Resistant / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology
chemical_list: D000995:Antitubercular Agents; D001426:Bacterial Proteins; D015242:Ofloxacin; D010088:Oxidoreductases; C085257:InhA protein, Mycobacterium; D005000:Ethionamide