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Int J Tuberc Lung Dis ; 16(1): 76-81, 2012 Jan.
Article in English | MEDLINE | ID: mdl-22236850

ABSTRACT

SETTING: Tygerberg Children's Hospital (TCH) and Brooklyn Chest Hospital (BCH), South Africa. OBJECTIVES: To describe paediatric cases of rifampicin (RMP) monoresistant tuberculosis (RMR-TB) disease. DESIGN: Records of children with culture-confirmed RMR-TB between 1 March 2003 and 28 February 2009 were identified from a prospectively recorded database of drug-resistant TB at TCH and BCH. Mutation analysis was performed on available specimens. RESULTS: Eighteen children with a median age of 6.9 years (range 2 months-12.8 years) were identified. Nine (50%) were human immunodeficiency virus (HIV) infected and four (22%) were HIV-exposed but non-infected. Eleven (61%) had had previous TB treatment or prophylaxis. Nine children (50%) had cavitary disease and five children (22%) had extra-pulmonary disease. Twelve (67%) had adult TB source cases, including five (42%) adults with known RMR-TB. Primary transmission occurred among 11 children (61%) and acquisition of RMR-TB was possible in seven (39%) with prior RMP exposure. Median delay to specific RMR-TB treatment was 70 days (range 23-188). One child died from RMR-TB meningitis. Gene mutations consistent with RMR-TB were confirmed in five available samples. CONCLUSION: RMR-TB disease is increasingly encountered, particularly among HIV-infected and HIV-exposed non-infected children. Delay in commencing appropriate treatment for RMR-TB and high rates of cavitary disease could be a source of RMR-TB transmission.


Subject(s)
Antibiotics, Antitubercular/therapeutic use , Drug Resistance, Bacterial , Mycobacterium tuberculosis/isolation & purification , Rifampin/therapeutic use , Tuberculosis, Pulmonary/drug therapy , AIDS-Related Opportunistic Infections/epidemiology , Adolescent , Age Factors , Child , Child, Preschool , Coinfection/epidemiology , DNA Mutational Analysis , DNA, Bacterial/analysis , Drug Resistance, Bacterial/genetics , Female , HIV Infections/epidemiology , Hospitals, Pediatric , Humans , Infant , Infant, Newborn , Male , Microbial Sensitivity Tests , Microscopy , Mutation , Mycobacterium tuberculosis/genetics , Predictive Value of Tests , Retrospective Studies , South Africa , Sputum/microbiology , Treatment Outcome , Tuberculosis, Pulmonary/diagnosis , Tuberculosis, Pulmonary/epidemiology , Tuberculosis, Pulmonary/microbiology , Tuberculosis, Pulmonary/transmission
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