The evolving epidemic of drug-resistant tuberculosis among children in Cape Town, South Africa
OBJECTIVE: To determine the prevalence and trend of drug resistance and human immunodeficiency virus (HIV) co-infection among children with culture-confirmed tuberculosis (TB).
METHOD: Prospective surveillance from March 2007 to February 2009, compared to three previous surveys (1994–1998, 2003–2005, 2005–2007). Drug susceptibility testing (DST) against isoniazid (INH) and rifampicin (RMP) was performed using genotypic and phenotypic testing. If multidrug-resistant TB (MDR-TB) was detected, further DST against ethambutol (EMB) and second-line drugs was performed.
RESULTS: A total of 294 children with a median age of 26 months (range 3 days–13 years) were diagnosed with culture-confirmed TB. DST results were available for 292 (99.3%); 41 (14%) were INH-resistant, including 26 (8.9%) with MDR-TB. Four children (1.4%) had RMP monoresistance. EMB resistance was present in 12/24 (50%) MDR-TB cases tested. Two isolates were resistant to ofloxacin; none had extensively drug-resistant TB. Of those tested, 29% (63/217) were HIV-infected. Any resistance to RMP increased between 1994 and 2009 (P < 0.001), as did RMP monoresistance (P = 0.009) and MDR-TB (P < 0.001). Sensitivity was 87.5% and specificity 100% for genotypic compared to phenotypic testing for INH resistance.
CONCLUSIONS: RMP, and consequently multidrug, resistance is increasing among children with TB in this setting. EMB resistance is common among children with resistance to RMP and INH.
Document Type: Research Article
Affiliations: 1: Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Health Sciences, Stellenbosch University, Cape Town, South Africa; Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK 2: Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Health Sciences, Stellenbosch University, Cape Town, South Africa 3: The Children's Hospital at Westmead, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia; The Sydney Institute for Emerging Infectious Diseases and Biosecurity, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia 4: Division of Molecular Biology and Human Genetics, Department of Biomedical Science; Faculty of Health Sciences, Department of Science and Technology/National Research Foundation Centre of Excellence for Biomedical Tuberculosis, Research/Medical Research Council Centre for Molecular and Cellular Biology, Stellenbosch University, Tygerberg, South Africa 5: Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Health Sciences, Stellenbosch University, Cape Town, South Africa; and Tygerberg Children's Hospital, Cape Town, South Africa
Publication date: 01 July 2012
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