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

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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.
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Keywords: HIV/TB; co-infection; drug-resistant tuberculosis; extensively drug-resistant tuberculosis; pediatrics; tuberculosis

Document Type: Regular Paper

Affiliations: 1: Tugela Ferry Care and Research Collaboration, Tugela Ferry, KwaZulu-Natal, South Africa; and AIDS Program, Section of Infectious Diseases, Yale University School of Medicine, New Haven, Connecticut, USA 2: Tugela Ferry Care and Research Collaboration, Tugela Ferry, KwaZulu-Natal, South Africa; and Church of Scotland Hospital and Philanjalo Care Centre, Tugela Ferry, KwaZulu-Natal, South Africa 3: Department of Paediatrics, King George V Hospital, Durban, South Africa 4: Tugela Ferry Care and Research Collaboration, Tugela Ferry, KwaZulu-Natal, South Africa; and Department of Medicine, Albert Einstein College of Medicine, Bronx, New York, New York, USA

Publication date: 01 October 2010

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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.

    Certain IJTLD articles are selected for translation into French, Spanish, Chinese or Russian. They are available on the Union website

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