Dilemma of managing asymptomatic children referred with 'culture-confirmed' drug-resistant tuberculosis.
Dilemma of managing asymptomatic children referred with 'culture-confirmed' drug-resistant tuberculosis.
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DOI：
10.1136/archdischild-2015-310186
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发表时间：
2016-07
影响因子：
5.2
通讯作者：
Brust JC
中科院分区：
文献类型：
--
作者：
Loveday M;Sunkari B;Marais BJ;Master I;Brust JC
The diagnosis of drug-resistant tuberculosis (DR-TB) in children is challenging and treatment is associated with many adverse effects. We aimed to assess if careful observation, without initiation of second-line treatment, is safe in asymptomatic children referred with “culture-confirmed” DR-TB. KwaZulu-Natal, South Africa - an area with high burdens of HIV, TB and DR-TB. We performed an outcome review of children with “culture-confirmed” DR-TB who were not initiated on second-line TB treatment, as they were asymptomatic with normal chest radiographs on examination at our specialist referral hospital. Children were followed up every other month for the first year, with a final outcome assessment at the end of the study. In total, 43 asymptomatic children with normal chest radiographs were reviewed. The median length of follow-up until final evaluation was 549 days (IQR 259-722 days); most (34; 83%) children were HIV-uninfected. Resistance patterns included 9 (21%) mono-resistant and 34 (79%) multidrug-resistant (MDR) strains. Fifteen children (35%) had been treated with first-line TB treatment, prior to presentation at our referral hospital. At the final evaluation 34 (80%) children were well, 7 (16%) were lost to follow up, 1 (2%) received MDR-TB treatment and 1 (2%) died of unknown causes. The child who received MDR-TB treatment developed new symptoms at the 12 month review and responded well to second-line treatment. Bacteriological evaluation should not be performed in the absence of any clinical indication. If drug-resistant M. tuberculosis is detected in an asymptomatic child with a normal chest radiograph close observation may be an appropriate strategy, especially in settings where potential laboratory error and poor record keeping are constant challenges.
