Extensively drug-resistant tuberculosis in children with human immunodeficiency virus in rural South Africa.

Abstract

SETTING:

Extensively drug-resistant tuberculosis (XDR-TB) has been documented worldwide, but reports of XDR-TB in children are extremely limited.

OBJECTIVE:

To report the characteristics of pediatric XDR-TB patients in rural South Africa.

DESIGN:

We retrospectively reviewed children with sputum culture-confirmed XDR-TB from Tugela Ferry, South Africa, from January 2006 to December 2007. Demographic, clinical and microbiologic data were abstracted from medical records.

RESULTS:

Four children aged 6-8 years with XDR-TB were reviewed. Two had previous histories of TB. All were human immunodeficiency virus (HIV) infected orphans; three received highly active antiretroviral therapy (HAART) before XDR-TB diagnosis. All had clinical and radiographic improvement and sputum culture conversion while on standardized XDR-TB treatment and HAART. Two tolerated concomitant XDR-TB and HIV treatment well. Two experienced neuropsychiatric side effects related to cycloserine. All have survived >24 months and all were cured. Prior to XDR-TB diagnosis, the children had resided in the hospital's pediatric ward for a median of 8 months (range 5-17), including a 3-month overlapping period.

CONCLUSIONS:

XDR-TB is a microbiologic diagnosis that, even with HIV co-infection, can be successfully identified. Concurrent XDR-TB and HIV therapy is feasible and effective in children, although more research is needed into potential overlapping toxicities. Nosocomial transmission is suggested, calling for infection control policies in pediatric wards.

• Authors: T A Thomas, S V Shenoi, S K Heysell, F J Eksteen, V B Sunkari, N R Gandhi, G Friedland, N S Shah
• Journal: The international journal of tuberculosis and lung disease : the official journal of the International Union against Tuberculosis and Lung Disease (Int J Tuberc Lung Dis) Vol. 14 Issue 10 Pg. 1244-51 (Oct 2010) ISSN: 1815-7920 [Electronic] France
• PMID: 20843414 (Publication Type: Journal Article, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't, Research Support, U.S. Gov't, Non-P.H.S.)

Chemical References

• Anti-HIV Agents
• Antitubercular Agents

Topics

• Anti-HIV Agents (therapeutic use)
• Antiretroviral Therapy, Highly Active
• Antitubercular Agents (adverse effects, therapeutic use)
• Child
• Extensively Drug-Resistant Tuberculosis (complications, diagnosis, drug therapy, microbiology)
• Female
• HIV Infections (complications, diagnosis, drug therapy)
• Humans
• Male
• Mycobacterium tuberculosis (isolation & purification)
• Radiography, Thoracic
• Remission Induction
• Retrospective Studies
• Rural Population
• South Africa
• Sputum (microbiology)
• Treatment Outcome