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Outcome of Children With Presumptive Tuberculosis in Mbarara, Rural Uganda

Bonnet, Maryline MD*†; Nansumba, Margaret MD, MSc; Bastard, Mathieu MSc; Orikiriza, Patrick MSc; Kyomugasho, Naomi MD; Nansera, Denis MD, MSc§; Boum, Yap PHD†¶; de Beaudrap, Pierre MD†‖; Kiwanuka, Julius MD; Kumbakumba, Elias MD

The Pediatric Infectious Disease Journal: February 2018 - Volume 37 - Issue 2 - p 147–152
doi: 10.1097/INF.0000000000001727
Original Studies

Background: Mortality among children with presumptive tuberculosis (TB) empiric TB treatment can be high. We describe the predictors of death among children with presumptive TB, and the relation between treatment and mortality.

Methods: A prospective cohort of children with presumptive TB who underwent clinical assessment, chest radiograph, tuberculin skin test and sputum bacterial tests for TB was followed up for 3 months. TB diagnosis was based on mycobacterial, clinical and radiologic findings. Predictors of deaths were determined using cox regression model.

Results: Of 360 children included in the analysis, 31.4% were younger than 2 years; 31.6% were HIV infected and 11.3% were severely malnourished. One hundred forty (38.9%) were diagnosed with TB, 18 (13%) of whom were bacteriologically confirmed. At 3 months of follow up, 25 of 360 (6.9%) children had died: 15 of 140 (10.7%) were receiving TB treatment versus 10 of 220 (4.5%) were not receiving treatment (P = 0.025). Severely malnourished children [adjusted hazard ratio (aHR), 9.86; 95% confidence interval (CI): 3.11–31.23] and those with chest radiographs suggestive of TB (aHR, 4.20; 95% CI: 0.93–19.01) were more likely to die. Children receiving empiric TB treatment had an increased risk of death (aHR, 2.37; 95% CI: 1.01–5.55) compared with children without treatment after adjustment for age, sex, HIV status and Bacillus Calmette-Guérin (BCG) vaccination.

Conclusions: The high mortality in children receiving empirically TB treatment highlights the difficulty in diagnosing childhood TB, the increased likelihood of starting treatment in critically ill children and in children with chronic disease, and the possibility of misdiagnosis. It strengthens the need to invest further in early TB detection and diagnosing nonsevere illness.

Supplemental Digital Content is available in the text.

From the *IRD UMI233/ INSERM U1175/ Université de Montpellier, Montpellier, France; Epicentre Mbarara Research Centre, Mbarara, Uganda; Epicentre Paris, Paris, France; §Mbarara Regional Reference Hospital, Mbarara, Uganda; Mbarara University of Science and Technology, Mbarara, Uganda; and IRD UMR196/CEPED, Paris, France.

Accepted for publication July 10, 2017.

Supported by Medecins Sans Frontieres.

The authors have no conflicts of interest to disclose.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website (www.pidj.com).

Address for correspondence: Maryline Bonnet, MD, Epicentre Mbarara Research Centre, P.O. Box 1956, Mbarara, Uganda. E-mail: maryline.bonnet@epicentre.msf.org.

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