title: DRUG-RESISTANT TUBERCULOSIS AMONG URBAN THAI CHILDREN: A 10-YEAR REVIEW.
abstract: Drug-resistant tuberculosis (DR-TB) has become an increasing public health concern. We conducted this retrospective chart review to determine the risk factors, susceptibility patterns, and clinical outcomes of children with DR-TB treated at the Queen Sirikit National Institute of Child Health, Bangkok, Thailand. Susceptibility results were available for 78 of the 91 patients (85.7%) with positive cultures for M. tuberculosis. Sensitivity of tuberculin skin testing for overall culture-confirmed tuberculosis with a cut-off point of 10 mm for human immunodeficiency virus (HIV)-uninfected cases was 76.9%. Using a 5-mm induration cut-off-point for tuberculin skin testing for HIV-infected cases, sensitivity was only 14.3%. Resistance to at least one anti-tubercular drug was found in 22 cases (28.2%), with streptomycin resistance being the most common (21.7%), followed by isoniazid (11.5%), rifampicin (5.1%), and ethambutol (5.1%). Multi-drug resistance (MDR) was observed in 3 cases (3.8%). A history of previous TB treatment and bone and joint involvement were associated with a significantly higher percentage of DR-TB: 18.2% vs 1.8% (p = 0.0078) and 22.7 vs 1.8% (p = 0.0018), respectively. Case fatality rates were 1.7% and 4.5% for drug-susceptible and DR-TB, respectively. Due to the high rate of resistance, streptomycin is not recommended as first time treatment of childhood tuberculosis in Thailand.
authors: Warunee Punpanich
authors: WP
authors: Vandepittel
authors: Rattirot
authors: R
authors: Rattanasataporn
authors: Vipa
authors: V
authors: Treeratweeraphong
mesh_terms: D000293:Adolescent; D000995:Antitubercular Agents / Q000494:pharmacology*; D002648:Child; D002675:Child, Preschool; D004198:Disease Susceptibility / Q000453:epidemiology / Q000382:microbiology / Q000401:mortality; D024901:Drug Resistance, Multiple, Bacterial; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D009169:Mycobacterium tuberculosis / Q000187:drug effects* / Q000502:physiology*; D012189:Retrospective Studies; D012307:Risk Factors; D013785:Thailand; D014374:Tuberculin Test; D018088:Tuberculosis, Multidrug-Resistant / Q000453:epidemiology* / Q000382:microbiology / Q000401:mortality; D014504:Urban Health
chemical_list: D000995:Antitubercular Agents