Characteristics of children treated for MDR-TB (n=149 unless otherwise stated)
| Characteristic | Variable | Number (%) unless otherwise indicated |
|---|---|---|
| Median age in months (IQR) | 36 (18–66) | |
| Male gender | 69 (46.3) | |
| Ethnicity | Xhosa | 90 (60.4) |
| Coloured | 59 (39.6) | |
| Source case | None identified | 20 (13.4) |
| MDR-TB | 111 (74.5) | |
| Defaulter | 2 (1.3) | |
| Died | 10 (6.7) | |
| DS* | 6 (4.0) | |
| Multiple source cases | 36 (24.2) | |
| Median delay in days from start of MDR-TB episode to MDR-TB treatment (IQR) | 14 (0–53) | |
| Positive TST (n=111) | 90 (81.1) | |
| Previous TB | 13 (8.7) | |
| Mean weight-for-age z score (SD; n=136)† | −0.98 (1.54) | |
| Mean height-for-age z score (SD; n=118)† | −1.05 (1.79) | |
| Mean weight-for-height z score (SD; n=64)† | −0.29 (1.4) | |
| Type of TB | Pulmonary alone | 120 (80.5) |
| Extrapulmonary alone | 12 (8.1) | |
| Both | 17 (11.4) | |
| Extrapulmonary involvement (more than one possible; n=29) | Miliary TB | 4 (10.3) |
| TB meningitis | 7 (17.9) | |
| Abdominal TB | 6 (15.4) | |
| Peripheral lymph node TB | 6 (15.4) | |
| Bone, joint or spinal TB | 8 (20.5) | |
| Other | 1 (2.6) | |
| Certainty of diagnosis of MDR-TB | Confirmed | 59 (39.6) |
| Probable | 82 (55.0) | |
| Possible‡ | 8 (5.4) | |
| Severity of disease | Non-severe | 104 (69.8) |
| Severe | 45 (30.2) | |
| Positive smear microscopy result for respiratory samples (n=46) | 23 (50.0) | |
| HIV positive (n=146) | 32 (21.9) | |
| WHO immunological stage (n=32) | Not significant | 5 (15.6) |
| Mild | 3 (9.4) | |
| Advanced | 11 (34.4) | |
| Severe | 13 (40.6) | |
| Timing of cART initiation (n=32) | cART started prior to MDR-TB episode | 11 (34.4) |
| cART started after start of MDR-TB episode but before MDR-TB treatment | 10 (31.3) | |
| cART started after MDR-TB treatment | 11 (34.4) | |
| Median time to start cART after MDR-TB treatment in days (IQR; n=11) | 17 (12–35) | |
| Drug resistance of isolate from child or from identified source case§ | Rifampicin (n=141) | 141 (100) |
| Isoniazid (n=141) | 125 (88.7) | |
| Ethambutol (n=92) | 23 (25.0) | |
| Ethionamide (n=102) | 5 (4.9) | |
| Amikacin (n=104)¶ | 16 (15.4) | |
| Ofloxacin (n=103)¶ | 14 (13.6) | |
| Chest radiograph features at start of MDR-TB treatment (more than one possible; n=148) | Normal | 16 (10.8) |
| Perihilar infiltrates | 32 (21.6) | |
| Hilar lymphadenopathy or airways compression | 81 (54.7) | |
| Lobar/segmental collapse or opacification | 69 (46.6) | |
| Pleural effusion | 10 (6.8) | |
| Cavities | 22 (14.9) | |
| Miliary picture | 4 (2.7) | |
| Widespread bronchopneumonic changes | 15 (10.1) | |
| Chest radiograph severity (n=148) | Non-severe | 72 (48.6) |
| Severe | 76 (51.4) |
*Source case identified with no risk factors for MDR-TB.
†At start of MDR-TB treatment.
‡All cases of possible MDR-TB diagnosed on basis of probable TB and failing first-line therapy.
§No DST to guide therapy in eight patients treated for failing first-line regimen with no identified source case.
¶Six children were treated for XDR-TB due to samples from them or their source case demonstrating resistance to amikacin and ofloxacin.
cART, combination antiretroviral therapy; DS, drug susceptible; DST, drug susceptibility testing; MDR, multidrug resistant; TB, tuberculosis; TST, tuberculin skin test; XDR, extensively drug resistant.