title: Epidemiology of drug-resistant tuberculosis among children and adolescents in South Africa, 2005-2010.
abstract: OBJECTIVE
  To describe the demographic and clinical characteristics of children and adolescents diagnosed with resistance to any anti-tuberculosis drug (drug-resistant tuberculosis; DR-TB) in South Africa.
  
  
  METHODS
  We retrospectively reviewed medical records of all children (<13 years) and adolescents (13 to <18 years) with DR-TB at specialty hospitals in four South African provinces from 2005 to 2010.
  
  
  RESULTS
  During the review period, 774 children and adolescents (median age 11.3 years) were diagnosed with DR-TB at selected facilities. A high proportion of patients had a history of previous TB treatment (285/631; 45.2%), human immunodeficiency virus (HIV) infection (375/685; 54.7%), contact with a TB case (347/454; 76.4%), and smear-positive (443/729; 60.8%), cavitary (253/680, 38.7%) disease. Eighty-two per cent of patients with HIV infection received antiretroviral therapy. Of 626 patients diagnosed with multidrug-resistant TB (MDR-TB), 561 (89.6%) received a regimen consistent with national guidelines; the median length of treatment was 22 months (IQR 16-25). Among 400 patients with any DR-TB and a known outcome, 20.3% died during treatment.
  
  
  CONCLUSIONS
  Pediatric DR-TB in these provinces is characterized by complex clinical features at diagnosis, with one in five children dying during treatment. History of previous treatment and contact with a TB patient indicate opportunities for earlier diagnosis and treatment to improve outcomes.
authors.affiliation: Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
authors.forename: B K
authors.initials: BK
authors.lastname: Moore
authors.affiliation: Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
authors.forename: E
authors.initials: E
authors.lastname: Anyalechi
authors.affiliation: South African Medical Research Council, Cape Town, South Africa.
authors.forename: M
authors.initials: M
authors.lastname: van der Walt
authors.affiliation: Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
authors.forename: S
authors.initials: S
authors.lastname: Smith
authors.affiliation: National Institute for Communicable Diseases, National Health Laboratory Service, Johannesburg, South Africa.
authors.forename: L
authors.initials: L
authors.lastname: Erasmus
authors.affiliation: South African Medical Research Council, Cape Town, South Africa.
authors.forename: J
authors.initials: J
authors.lastname: Lancaster
authors.affiliation: Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
authors.forename: S
authors.initials: S
authors.lastname: Morris
authors.affiliation: South Africa National Department of Health, Pretoria, South Africa.
authors.forename: N
authors.initials: N
authors.lastname: Ndjeka
authors.affiliation: Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
authors.forename: J
authors.initials: J
authors.lastname: Ershova
authors.affiliation: National Institute for Communicable Diseases, National Health Laboratory Service, Johannesburg, University of Pretoria, Pretoria, South Africa.
authors.forename: N
authors.initials: N
authors.lastname: Ismail
authors.affiliation: Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
authors.forename: D
authors.initials: D
authors.lastname: Burton
authors.affiliation: Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
authors.forename: H
authors.initials: H
authors.lastname: Menzies
mesh_terms: D000293:Adolescent; D017677:Age Distribution; D000367:Age Factors; D019380:Anti-HIV Agents / Q000627:therapeutic use; D000995:Antitubercular Agents / Q000627:therapeutic use; D002648:Child; D060085:Coinfection; D016358:Contact Tracing; D005260:Female; D015658:HIV Infections / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology; D006801:Humans; D008297:Male; D008499:Medical Records; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012307:Risk Factors; D013019:South Africa / Q000453:epidemiology; D013997:Time Factors; D016896:Treatment Outcome; D018088:Tuberculosis, Multidrug-Resistant / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology* / Q000401:mortality / Q000635:transmission
chemical_list: D019380:Anti-HIV Agents; D000995:Antitubercular Agents