Open Access Highly Accessed Research article

Culture-confirmed childhood tuberculosis in Cape Town, South Africa: a review of 596 cases

H Simon Schaaf12*, Ben J Marais12, Andrew Whitelaw34, Anneke C Hesseling15, Brian Eley67, Gregory D Hussey8 and Peter R Donald12

Author Affiliations

1 Desmond Tutu Tuberculosis Centre, Department of Paediatrics and Child Health, Stellenbosch University, Cape Town, South Africa

2 Tygerberg Children's Hospital, Cape Town, South Africa

3 National Health Laboratory Service, Groote Schuur and Red Cross Children's Hospital, Cape Town, South Africa

4 Department of Clinical Laboratory Sciences, University of Cape Town, Cape Town, South Africa

5 Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK

6 Red Cross Children's Hospital, Cape Town, South Africa

7 School of Child and Adolescent Health, University of Cape Town, Cape Town, South Africa

8 Institute of Infectious Diseases and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa

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BMC Infectious Diseases 2007, 7:140  doi:10.1186/1471-2334-7-140

Published: 29 November 2007

Abstract

Background

The clinical, radiological and microbiological features of culture-confirmed childhood tuberculosis diagnosed at two referral hospitals are described.

Methods

Cultures of Mycobacterium tuberculosis from children less than 13 years of age at Tygerberg and Red Cross Children's Hospitals, Cape Town, South Africa, were collected from March 2003 through February 2005. Folder review and chest radiography were performed and drug susceptibility tests done.

Results

Of 596 children (median age 31 months), 330 (55.4%) were males. Of all children, 281 (47.1%) were HIV-uninfected, 133 (22.3%) HIV-infected and 182 (30.5%) not tested. Contact with infectious tuberculosis adults was recorded in 295 (49.5%) children. Missed opportunities for chemoprophylaxis were present in 117/182 (64.3%) children less than 5 years of age.

Extrathoracic TB was less common in HIV-infected than in HIV-uninfected children (49/133 vs. 156/281; odds ratio 0.50, 95% confidence interval 0.32–0.78). Alveolar opacification (84/126 vs. 128/274; OR 1.85, 95%CI 1.08–3.19) and cavitation (33/126 vs. 44/274; OR 2.28, 95%CI 1.44–3.63) were more common in HIV-infected than in HIV-uninfected children. Microscopy for acid-fast bacilli on gastric aspirates and sputum was positive in 29/142 (20.4%) and 40/125 (32.0%) children, respectively. Sixty-seven of 592 (11.3%) children's isolates showed resistance to isoniazid and/or rifampicin; 43 (7.3%) were isoniazid-monoresistant, 2 (0.3%) rifampicin-monoresistant and 22 (3.7%) multidrug-resistant. Death in 41 children (6.9%) was more common in HIV-infected children and very young infants.

Conclusion

HIV infection and missed opportunities for chemoprophylaxis were common in children with culture-confirmed TB. With cavitating disease and sputum or gastric aspirates positive for acid-fast bacilli, children may be infectious. Transmission of drug-resistant TB is high in this setting.