Pediatric tuberculosis in the metropolitan area of Rio de Janeiro

• Main Authors: Anna Cristina C. Carvalho, Pedro da Silva Martins, Claudete Aparecida Araújo Cardoso, Ana Lúcia Miceli, Terezinha Martire, Maria de Fátima B. Pombo Sant'Anna, Christiane Mello Schmidt, Luiza Martins Vieira, Selma Maria de Azevedo Sias, Ana Paula Quintanilha, Ana Paula Barbosa, Adriana da Silva Rezende Moreira, Carla Fernandes dos Santos Lara, Lorrayne Isidoro-Gonçalves, Rafaela Baroni Aurilio, Suzana Aparecida Greggi de Alcantara, André Luis Bezerra, Laura Saderi, Giovanni Sotgiu, Giovanni Battista Migliori, Afrânio L. Kritski, Clemax Couto Sant’Anna
• Format: Article
• Language: English
• Published: Elsevier 2020-09-01
• Series: International Journal of Infectious Diseases
• Online Access: http://www.sciencedirect.com/science/article/pii/S1201971220305051

Aim: To evaluate the clinical characteristics, diagnostic approach, and treatment outcomes of tuberculosis (TB) in children living in a high-burden metropolitan area. Methods: 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. Results: 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). Conclusions: 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.