Factors Affecting Outcome of Tuberculosis in Children in Italy: An Ecological Study.
Tuberculosis is a major problem in children depending on their families for management and a re-emerging disease in low incidence countries, where foreign-born cases account for a large proportion of cases.



We investigated socioeconomic features of families and their impact on management and outcome of children with tuberculosis disease seen at a tertiary care centre for paediatric infectious diseases in Italy.



Forty-nine Italian and 30 foreign-origin children were included. Children from foreign families had more complicated diseases (20 % vs 0 %; P = 0.002), harbored more drug resistant strains (20 % vs 2 %; P = 0.011), showed longer hospital stay (12 ± 13.1 vs 5.1 ± 6.5 days; P = 0.012) and higher proportion of missed medical visits (15.7 ± 16 vs 8.6 ± 9.6; P ≤ 0.042) than those from Italian families. Harboring drug resistant strains was an independent risk factor for complicated disease course (OR: 72.98; 95 %CI: 1.54-3468.58; P = 0.029), and this risk is higher in children from Eastern Europe (OR: 10.16; 95 %CI: 1.7-61.9; P = 0.012).



Children from immigrant families showed an increased risk of complicated course of tuberculosis due to a higher rate of resistant strains and raise problems in clinical management. Specific protocols are needed to support these populations ensuring easy access to health services and monitoring.
Department of Translational Medical Sciences, Section of Pediatrics, University of Naples Federico II, Naples, Italy.|Pediatric Hepatology, Gastroenterology and Transplantation, Hospital Papa Giovanni XXIII, Bergamo, Italy.
Emanuele
E
Nicastro
Department of Translational Medical Sciences, Section of Pediatrics, University of Naples Federico II, Naples, Italy.|Department of Clinical Medicine and Surgery, Section of Infectious Diseases, University of Naples Federico II, Naples, Italy.
Riccardo
R
Scotto
Department of Translational Medical Sciences, Section of Pediatrics, University of Naples Federico II, Naples, Italy.
Diana
D
Cerullo
Department of Translational Medical Sciences, Section of Pediatrics, University of Naples Federico II, Naples, Italy.
Maria Cristina
MC
Fedele
Department of Translational Medical Sciences, Section of Pediatrics, University of Naples Federico II, Naples, Italy.
Eugenia
E
Bruzzese
Department of Pediatrics, L. Sacco Hospital, University of Milan, Milan, Italy.
Vania
V
Giacomet
Department of Translational Medical Sciences, Section of Pediatrics, University of Naples Federico II, Naples, Italy.
Maria Immacolata
MI
Spagnuolo
Department of Translational Medical Sciences, Section of Pediatrics, University of Naples Federico II, Naples, Italy. alfguari@unina.it.
Alfredo
A
Guarino
Department of Translational Medical Sciences, Section of Pediatrics, University of Naples Federico II, Naples, Italy.
Andrea
A
Lo Vecchio
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D015994:Incidence; D007223:Infant; D007558:Italy / Q000453:epidemiology; D008297:Male; D009161:Mycobacterium / Q000145:classification / Q000235:genetics / Q000302:isolation & purification; D012189:Retrospective Studies; D014376:Tuberculosis / Q000175:diagnosis / Q000453:epidemiology* / Q000382:microbiology
Children; Foreign; Multiresistant; Tuberculosis