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Open Access Highly Accessed Research article

High prevalence of childhood multi-drug resistant tuberculosis in Johannesburg, South Africa: a cross sectional study

Lee Fairlie125*, Natalie C Beylis3, Gary Reubenson14, David P Moore15 and Shabir A Madhi156

Author Affiliations

1 Faculty of Health Sciences, University of the Witwatersrand, 6 York Street, Parktown, Johannesburg, 2193, South Africa

2 WHI (Wits Institute for Sexual & Reproductive Health, HIV and Related Diseases), Hospital Street, Chris Hani Baragwanath Hospital, Old Potch Road, Soweto, Johannesburg, 1864, South Africa

3 National Health Laboratory Service (NHLS), Mycobacteriology Referral Laboratory, Corner de Korte and Hospital Streets, Braamfontein, Johannesburg, 2000, South Africa

4 Department of Paediatrics Rahima Moosa Mother and Child Hospital, Corner Fuel and Oudshoorn Roads, Newclare, Johannesburg, 2000, South Africa

5 Department of Paediatrics and Child Health, Metabolic Unit, Chris Hani Baragwanath Hospital, Old Potch Road, Soweto, Johannesburg, 1864, South Africa

6 Medical Research Council Respiratory and Meningeal Pathogens Research Unit & Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases; 11th floor Nurses Home, Chris Hani Baragwanath Hospital, Old Potch Road, Soweto, Johannesburg, 1864, South Africa

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BMC Infectious Diseases 2011, 11:28  doi:10.1186/1471-2334-11-28

Published: 26 January 2011

Abstract

Background

There are limited data on the prevalence of multi-drug resistant tuberculosis (MDR-TB), estimated at 0.6-6.7%, in African children with tuberculosis. We undertook a retrospective analysis of the prevalence of MDR-TB in children with Mycobacterium tuberculosis (MTB) at two hospitals in Johannesburg, South Africa.

Methods

Culture-confirmed cases of MTB in children under 14 years, attending two academic hospitals in Johannesburg, South Africa during 2008 were identified and hospital records of children diagnosed with drug-resistant TB were reviewed, including clinical and radiological outcomes at 6 and 12 months post-diagnosis. Culture of Mycobacterium tuberculosis complex (MTB) was performed using the automated liquid broth MGIT™ 960 method. Drug susceptibility testing (DST) was performed using the MGIT™ 960 method for both first and second-line anti-TB drugs.

Results

1317 children were treated for tuberculosis in 2008 between the two hospitals where the study was conducted. Drug susceptibility testing was undertaken in 148 (72.5%) of the 204 children who had culture-confirmed tuberculosis. The prevalence of isoniazid-resistance was 14.2% (n = 21) (95%CI, 9.0-20.9%) and the prevalence of MDR-TB 8.8% (n = 13) (95%CI, 4.8-14.6%). The prevalence of HIV co-infection was 52.1% in children with drug susceptible-TB and 53.9% in children with MDR-TB. Ten (76.9%) of the 13 children with MDR-TB received appropriate treatment and four (30.8%) died at a median of 2.8 months (range 0.1-4.0 months) after the date of tuberculosis investigation.

Conclusions

There is a high prevalence of drug-resistant tuberculosis in children in Johannesburg in a setting with a high prevalence of HIV co-infection, although no association between HIV infection and MDR-TB was found in this study. Routine HIV and drug-susceptibility testing is warranted to optimize the management of childhood tuberculosis in settings such as ours.