Pediatric tuberculosis in the metropolitan area of Rio de Janeiro

•Tuberculosis in childhood was until recently considered a neglected disease and many cases are not identified.•TB screening of children who are close contacts of pulmonary TB cases is recommended by international guidelines.•TB diagnosis in children is hampered by the lack of sensitive and accessib...

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Published in:	International journal of infectious diseases Vol. 98; pp. 299 - 304
Main Authors:	Carvalho, Anna Cristina C., da Silva Martins, Pedro, Cardoso, Claudete Aparecida Araújo, Miceli, Ana Lúcia, Martire, Terezinha, Sant'Anna, Maria de Fátima B. Pombo, Schmidt, Christiane Mello, Vieira, Luiza Martins, de Azevedo Sias, Selma Maria, Quintanilha, Ana Paula, Barbosa, Ana Paula, Moreira, Adriana da Silva Rezende, Lara, Carla Fernandes dos Santos, Isidoro-Gonçalves, Lorrayne, Aurilio, Rafaela Baroni, de Alcantara, Suzana Aparecida Greggi, Bezerra, André Luis, Saderi, Laura, Sotgiu, Giovanni, Migliori, Giovanni Battista, Kritski, Afrânio L., Sant’Anna, Clemax Couto
Format:	Journal Article
Language:	English
Published:	Elsevier Ltd 01-09-2020 Elsevier
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Summary:	•Tuberculosis in childhood was until recently considered a neglected disease and many cases are not identified.•TB screening of children who are close contacts of pulmonary TB cases is recommended by international guidelines.•TB diagnosis in children is hampered by the lack of sensitive and accessible diagnostic methods.•This appears to be the largest cohort of children with TB in Brazil ever to be published.•Rio de Janeiro is the state with the second highest TB incidence rate and the highest mortality rate in Brazil. To evaluate the clinical characteristics, diagnostic approach, and treatment outcomes of tuberculosis (TB) in children living in a high-burden metropolitan area. This was a retrospective study, based on a medical chart review, involving children under 15 years old treated for TB between 2007 and 2016, in four primary health units (PHU) and three reference centers (RC) in five cities of Rio de Janeiro metropolitan area. Factors associated with TB treatment setting, microbiological diagnosis, and treatment outcomes were evaluated. A total of 544 children were enrolled; 71% were treated in PHU, 36% were under 5 years old, and 72% had pulmonary TB (PTB). The HIV prevalence was 10% (31/322). Fifty-three percent had at least one microbiological test for TB, 68% of them (196/287) had TB confirmed. Among 222 children with previous TB contact, information on LTBI was available for 78 (35%), and only 17% (13/78) were treated. Extrapulmonary TB (56% vs 32%), microbiologically confirmed TB (77% vs 60%), and HIV positivity (18.5% vs 4.0%) were significantly more frequent in RC. Treatment in RC (odds ratio (OR) 3.08, 95% confidence interval (CI) 1.74–5.44) and PTB (OR 2.47, 95% CI 1.34–4.56) were independently associated with a microbiological diagnosis of TB. The treatment success rate was 85%. In the logistic regression analysis, HIV-infected children had a 2.5-fold higher risk of an unfavorable outcome (OR 2.53, 95% CI 1.0–6.38; p = 0.05). Opportunities for TB prevention and early TB treatment are missed due to suboptimal close contact screening. Microbiological diagnosis of TB and drug susceptibility testing in children should be made available through more sensitive and accessible tests.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	1201-9712 1878-3511
DOI:	10.1016/j.ijid.2020.06.070