Children may be at risk of acquiring multidrug-resistant TB (MDR-TB) in hospitals in South Africa and more resources should be directed at preventing and controlling infection spread in hospitals, according to research published at the Fourth South African AIDS Conference in Durban.
TB is the leading cause of death in HIV sufferers in South Africa. Of the nine million reported global cases, almost 10% occur in children.
Attempts to treat TB in recent years have resulted in some strains becoming multidrug-resistant.
A variety of studies have been conducted on the transmission of TB multidrug resistance in adults; however, comparatively few studies have been conducted on multidrug resistance in children who, for many biological and behavioural reasons, frequently have different demographics, clinical characteristics and outcomes to adults.
A Yale research group conducted a study to increase the understanding of multidrug resistance in children by investigating three HIV-infected children who were admitted to a paediatric hospital in rural South Africa.
Each of the children studied was malnourished at the time of hospital admission and two of them, both diagnosed with TB, were also found to be suffering from kwashiorkor. Anti-TB treatment was given to both children but only one responded, leaving researchers to conclude it was a case of multidrug-resistant TB. The third child was found to be free of TB.
Within eleven months both the child free of TB and the child infected with drug-susceptible TB acquired multidrug-resistant strains. Scrutiny of hospital records revealed that the children had all overlapped in the ward by four months. At the time of diagnosis, two of the three had been receiving antiretroviral therapy.
The period of hospital overlap suggested strongly that multidrug-resistant TB had passed in a chain-like manner between each child.
Following the diagnosis, each youngster was subjected to individual drug-susceptibility testing followed by an aggressive, tailor-made antibiotic treatment regimen. In each case the children responded well to antibiotics and recovered.
The researchers caution that the sample size examined was not statistically significant and call for more extensive research into the problem.
The preliminary findings suggest, however, that children may be at risk of infection by multidrug-resistant TB in a hospital setting, particularly if they remain in close proximity to one another for many months. Performing drug-susceptibility tests on a case-by-case basis may help to treat children when drug resistance has developed.
The researchers conclude that more time and money should be invested into understanding, preventing and treating the spread of multidrug-resistant TB in South African paediatric hospitals.
Thomas T et al. Successful treatment of extensively drug-resistant tuberculosis in children with HIV from rural South Africa. Fourth South African AIDS conference, Durban, South Africa, abstract 360, 2009.