The impact of drug resistance on the risk of tuberculosis infection and disease in child household contacts: a cross sectional study

BMC Infectious Diseases

Research Article

Kathryn Snow¹  Vera Golla²  H. Simon Schaaf²  Karen Du Preez²  Anneke C. Hesseling²  James A. Seddon³  Anna M. Mandalakas⁴ 

[1] Department of Paediatrics, University of Melbourne, Melbourne, Australia;Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, PO Box 241, 8000, Cape Town, South Africa;Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, PO Box 241, 8000, Cape Town, South Africa;Centre for International Child Health, Department of Paediatrics, Imperial College London, Norfolk Place, W2 1PG, London, UK;Global TB Program, Department of Pediatrics, Baylor College of Medicine, Houston, USA;

关键词: Tuberculosis;    Children;    Resistance;    Infection;    Disease;   

DOI  :  10.1186/s12879-017-2668-2

 received in 2016-12-13, accepted in 2017-08-03,  发布年份 2017

来源: Springer

【 摘 要 】

BackgroundThe relative fitness of organisms causing drug-susceptible (DS) and multidrug-resistant (MDR) tuberculosis (TB) is unclear. We compared the risk of TB infection and TB disease in young child household contacts of adults with confirmed DS-TB and MDR-TB.MethodsIn this cross-sectional analysis we included data from two community-based contact cohort investigation studies conducted in parallel in Cape Town, South Africa. Children <5 years of age with household exposure to an infectious TB case were included between August 2008 to June 2011. Children completed investigation for TB infection (tuberculin skin test) and TB disease (symptom evaluation, chest radiograph, bacteriology) in both studies using standard approaches. The impact of MDR-TB exposure on each covariate of TB infection and TB disease was assessed using univariable and multivariable logistic regression.ResultsOf 538 children included, 312 had DS-TB and 226 had MDR-TB exposure. 107 children with DS-TB exposure had TB infection (34.3%) vs. 101 (44.7%) of children with MDR-TB exposure (adjusted Odds Ratio [aOR]: 2.05; 95% confidence interval [CI]: 1.34–3.12). A total of 15 (6.6%) MDR-TB vs. 27 (8.7%) DS-TB child contacts had TB disease at enrolment (aOR: 0.43; 95% CI: 0.19–0.97).ConclusionsOur results suggest a higher risk of TB infection in child contacts with household MDR-TB vs. DS-TB exposure, but a lower risk of TB disease. Although potentially affected by residual confounding or selection bias, our results are consistent with the hypothesis of impaired virulence in MDR-TB strains in this setting.

【 授权许可】

CC BY   
© The Author(s). 2017