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Pediatric Tuberculosis in Stockholm: A Mirror to the World

Nejat, Sahar MD*; Buxbaum, Charlotte MD*; Eriksson, Margareta MD*; Pergert, Mats MSc; Bennet, Rutger MD*

The Pediatric Infectious Disease Journal: March 2012 - Volume 31 - Issue 3 - p 224–227
doi: 10.1097/INF.0b013e31823d923c
Original Studies

Background: Increasing international migration has changed the epidemiology of tuberculosis (TB) in Europe. Little is published on clinical manifestations and epidemiology in children in this new era.

Methods: Clinical and laboratory data on all children with TB in Stockholm between 2000 and 2009 were entered into a database and retrospectively completed with information from case records. Population data, including parents' country of birth, were obtained from Statistics Sweden.

Results: TB was diagnosed in 147 children <18 years of age (78 confirmed, 12 probable, 57 possible). Fifty-six children (38%) presented clinically, and 91 were identified by screening procedures. Ninety children (61%) were born in high-endemic countries and 38 in Sweden to parents from such countries. The incidence was 451/100,000 person years among children born in Somalia, 44 among those born in other high-endemic countries, and 13 among Swedish-born children with parents from high-endemic countries. All but 1 of the 19 Swedish-born children with Swedish parents belonged to a single outbreak. Median age was 12 years. Severe, adult-type TB was predominantly observed in adolescents, whereas young children presented mild, primary disease that was diagnosed at the time of screening. The 78 positive cultures were traced back to 67 strains. Resistance to any first-line drug was present in 25% of the strains, of which 4 were multidrug resistant.

Conclusions: Active TB in Stockholm is common in children born in high-endemic countries, especially Somalia. The most severe cases are seen in adolescents. The high prevalence of antimicrobial resistance is a cause for concern.

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From the *Departments of Emergency Pediatrics & Infectious Disease and Pulmonology, Disease, Astrid Lindgren Children's Hospital, Stockholm, Sweden; and †Stockholm County Department of Communicable Disease Prevention and Control, Stockholm, Sweden.

Accepted for publication October 17, 2011.

The authors have no funding or conflicts of interest to disclose.

Address for correspondence: Rutger Bennet, MD, Department of Emergency Pediatrics & Infectious Disease, Astrid Lindgren Children's Hospital, Q8:00, SE-171 76 Stockholm, Sweden. E-mail:

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© 2012 by Lippincott Williams & Wilkins, Inc.