Characteristics of drug resistant tuberculosis in children

Abstract

Introduction: Drug-resistant (DR) Mycobacterium tuberculosis (TB) infection represents a serious and growing problem. One of the greatest clinical challenges is the diagnosis and treatment of pediatric drug-resistant TB. There is a lack of diagnostic tools adapted to children, too little information on safe, effective treatment regimens and virtually no pediatric formulations of second line TB drugs available. Pediatric TB remains difficult to diagnose microbiologically, with the result that detection of drug-resistant TB in children is an ongoing challenge. Since children diagnosed with TB predominantly represent recently acquired TB infection, they provide an important indication of drug-resistant TB prevalence and transmission within their communities. Drug-resistant TB is essentially a man-made problem, which consumes large amounts of healthcare resources. Purpose and objectives: evaluation the clinical features of drug-resistant TB at children and to establish the risk factors in the development of drug-resistant TB at children, to ensure optimization of early detection and improvement of control drug-resistant TB cases in children. Methodology and materials: Retrospective study about 74 cases of drug-resistant TB at children, hospitalized at the Phthisiopneumology Hospital Chisinau, Moldova, between 2006-2011. Results: The most common diagnosis established was a form of secondary tuberculosis - pulmonary infiltrative TB - 47 (63.52%). Risk factors of DR TB at children are: contact with TB patients, poor living conditions, lack of chemoprophylaxis, associated diseases, non-vaccination or low-quality vaccination BCG. The way to detect drug - resistant TB children was passive in 45 cases (60,81%), by addressing the family doctor with characteristic clinical signs of tuberculosis. By the prophylactic examination of chil­dren with risk factors, particularly examination of contacts with TB patients, were found 29 children (39,18%). Among the children active detected, in 18 cases (24,32%) were found clinical signs present or long time, in 3 cases were even hemoptysis, but only after laboratory investigations of suspecting tuberculosis, appeared the “concern” of parents about health of children. Only 11(14,86%) children at the time of hospitalization had no acute clinical signs. The presence in family of an adult patient with pulmonary tuberculosis were found in 65 cases (87,83%) and 39 (60%) of these were already MDR confirmed, as a consequence of transmission of resistant strains from adults. By performing the tuberculin test with 2 TU were determined hyperergical reaction at 25 (33,78%) children with drug-resistant TB, in 36 (48,65%) cases determined normergical and at 13 (17.56%) children with drug-resistant TB TST Mantoux 2 TU were «negative.» The result of treatment in children with resistant forms of tuberculosis was always positive. Conclusions: Drug-resistance in children and teenagers frequently is primary, as a consequence of transmission of resistant strains from adults. TB drug resistance at children and teenagers require special attention and immediate action, because drug-resistance has a negative impact on TB treatment efficiency. MDR TB speaks of recent transmission in the community and therefore it is a failure of TB control program.