Free Content Rifampicin-monoresistant Mycobacterium tuberculosis disease among children in Cape Town, South Africa

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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.

Keywords: HIV; TB; drug-resistant TB; rifampicin; rifampicin monoresistance

Document Type: Research Article


Affiliations: 1: Department of Paediatrics and Child Health, Tygerberg Children's Hospital, Stellenbosch University, Cape Town, South Africa 2: Department of Pediatrics, University of California, San Francisco, California, USA 3: Medical Research Council/National Research Foundation Centre of Excellence, Department of Biomedical Sciences, Stellenbosch University, Tygerberg, South Africa 4: Department of Paediatrics and Child Health, Tygerberg Children's Hospital, Stellenbosch University, Cape Town, South Africa; and Desmond Tutu Tuberculosis Centre, Stellenbosch University, Cape Town, South Africa

Publication date: January 1, 2012

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  • The International Journal of Tuberculosis and Lung Disease publishes articles on all aspects of lung health, including public health-related issues such as training programmes, cost-benefit analysis, legislation, epidemiology, intervention studies and health systems research. The IJTLD is dedicated to the continuing education of physicians and health personnel and the dissemination of information on tuberculosis and lung health world-wide.

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