High prevalence of childhood multi-drug resistant tuberculosis in Johannesburg, South Africa: a cross sectional study

<p>Abstract</p> <p>Background</p> <p>There are limited data on the prevalence of multi-drug resistant tuberculosis (MDR-TB), estimated at 0.6-6.7%, in African children with tuberculosis. We undertook a retrospective analysis of the prevalence of MDR-TB in children with <it>Mycobacterium tuberculosis </it>(MTB) at two hospitals in Johannesburg, South Africa.</p> <p>Methods</p> <p>Culture-confirmed cases of MTB in children under 14 years, attending two academic hospitals in Johannesburg, South Africa during 2008 were identified and hospital records of children diagnosed with drug-resistant TB were reviewed, including clinical and radiological outcomes at 6 and 12 months post-diagnosis. Culture of <it>Mycobacterium tuberculosis </it>complex (MTB) was performed using the automated liquid broth MGIT™ 960 method. Drug susceptibility testing (DST) was performed using the MGIT™ 960 method for both first and second-line anti-TB drugs.</p> <p>Results</p> <p>1317 children were treated for tuberculosis in 2008 between the two hospitals where the study was conducted. Drug susceptibility testing was undertaken in 148 (72.5%) of the 204 children who had culture-confirmed tuberculosis. The prevalence of isoniazid-resistance was 14.2% (n = 21) (95%CI, 9.0-20.9%) and the prevalence of MDR-TB 8.8% (n = 13) (95%CI, 4.8-14.6%). The prevalence of HIV co-infection was 52.1% in children with drug susceptible-TB and 53.9% in children with MDR-TB. Ten (76.9%) of the 13 children with MDR-TB received appropriate treatment and four (30.8%) died at a median of 2.8 months (range 0.1-4.0 months) after the date of tuberculosis investigation.</p> <p>Conclusions</p> <p>There is a high prevalence of drug-resistant tuberculosis in children in Johannesburg in a setting with a high prevalence of HIV co-infection, although no association between HIV infection and MDR-TB was found in this study. Routine HIV and drug-susceptibility testing is warranted to optimize the management of childhood tuberculosis in settings such as ours.</p

Temporal Association in Hospitalizations for Tuberculosis, Invasive Pneumococcal Disease and Influenza Virus Illness in South African Children

<div><p>Introduction</p><p>The seasonal variability in hospitalization for tuberculosis may in part relate to super-imposed bacterial or predisposing respiratory viral infections. We aimed to study the temporal association between hospitalization for culture-confirmed pulmonary tuberculosis (PTB), invasive pneumococcal disease (IPD) and influenza virus epidemics in South African children.</p><p>Methods</p><p>We undertook a retrospective analysis which examined seasonal trends, from 2005 to 2008, for hospitalization for culture-confirmed PTB and IPD among children in relation to the influenza epidemics in Soweto, South Africa. Original time-series of the influenza virus epidemics and hospitalization rates for PTB and IPD were decomposed into three components: a trend cycle component, a seasonal component and an irregular component using the X-11 seasonal adjustment method. To compare the seasonality amongst the three series, the trend and irregular components were removed and only seasonal components examined.</p><p>Results</p><p>Across the study period, the influenza virus epidemics peaked during May to July (winter) months, which was closely followed by an increase in the incidence of hospitalization for IPD (August to October) and PTB (August to November).</p><p>Discussion</p><p>Within- and between-year temporal changes associated with childhood TB hospitalization may in part be driven by factors which influence temporal changes in pneumococcal disease, including potential variability in the severity of influenza virus epidemics in temperate climates. The dynamics of the interplay between the host and these infectious agents appears to be complex and multifactorial.</p></div

Seasonality of FLU, IPD and PTB in HIV-uninfected children.

<p>Seasonal factors of influenza (FLU) virus overall circulation and association to hospitalization for invasive pneumococcal disease (IPD) and culture-confirmed pulmonary tuberculosis (PTB) in HIV-uninfected children. The axis for seasonal factors for influenza is on the left and for IPD and PTB is on the right.</p

Seasonality of FLU, IPD and PTB in All children.

<p>Seasonal factors of influenza (FLU) virus overall circulation and association to hospitalization for invasive pneumococcal disease (IPD) and culture-confirmed pulmonary tuberculosis (PTB) in children. The axis for seasonal factors for influenza is on the left and for IPD and PTB is on the right.</p

Seasonality of FLU, IPD and PTB in HIV-infected children.

<p>Seasonal factors of influenza (FLU) virus overall circulation and association to hospitalization for invasive pneumococcal disease (IPD) and culture-confirmed pulmonary tuberculosis (PTB) in HIV-infected children. The axis for seasonal factors for influenza is on the left and for IPD and PTB is on the right.</p

Demographic information on children hospitalized with culture-confirmed pulmonary tuberculosis (PTB) and invasive pneumococcal disease (IPD).

<p>Demographic information on children hospitalized with culture-confirmed pulmonary tuberculosis (PTB) and invasive pneumococcal disease (IPD).</p