Lorrayne Isidoro-Gonçalves

Fundação Oswaldo Cruz

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Adriana da Silva Rezende Moreira

Universidade Federal do Rio de Janeiro

Rafaela Baroni Aurílio

Universidade Federal do Rio de Janeiro

Ana Lúcia Miceli

Secretaria da Saúde

Claudete Aparecida Araújo Cardoso

Universidade Federal Fluminense

André Luis Bezerra

Universidade Federal do Rio de Janeiro

Selma Maria de Azevedo Sias

Universidade Federal Fluminense

Pedro da Silva Martins

Instituto Evandro Chagas

Ana Paula Quintanilha

Secretaria da Saúde

Afrânio Lineu Kritski

Universidade Federal do Rio de Janeiro

Giovanni Battista Migliori

Istituti Clinici Scientifici Maugeri

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Universidade Federal do Rio de Janeiro

Universidade do Estado do Rio de Janeiro

Universidade Federal Fluminense

Istituti Clinici Scientifici Maugeri

Secretaria de Agricultura e Abastecimento

Secretaria da Saúde

Secretaria Municipal de Saúde

National Education and Research Network

Ministério da Saúde

Universidade Federal do Estado do Rio de Janeiro

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Pediatric tuberculosis in the metropolitan area of Rio de Janeiro

International Journal of Infectious Diseases (2020)

Anna Cristina Calçada Carvalho Pedro da Silva Martins Claudete Aparecida Araújo Cardoso Ana Lúcia Miceli Terezinha Martire

To evaluate the clinical characteristics, diagnostic approach, and treatment outcomes of tuberculosis (TB) in children living in a high-burden metropolitan area.This was a retrospective study, based on a medical chart review, involving children under 15 years old treated for TB between 2007 and 2016, in four primary health units (PHU) and three reference centers (RC) in five cities of Rio de Janeiro metropolitan area. Factors associated with TB treatment setting, microbiological diagnosis, and treatment outcomes were evaluated.A total of 544 children were enrolled; 71% were treated in PHU, 36% were under 5 years old, and 72% had pulmonary TB (PTB). The HIV prevalence was 10% (31/322). Fifty-three percent had at least one microbiological test for TB, 68% of them (196/287) had TB confirmed. Among 222 children with previous TB contact, information on LTBI was available for 78 (35%), and only 17% (13/78) were treated. Extrapulmonary TB (56% vs 32%), microbiologically confirmed TB (77% vs 60%), and HIV positivity (18.5% vs 4.0%) were significantly more frequent in RC. Treatment in RC (odds ratio (OR) 3.08, 95% confidence interval (CI) 1.74-5.44) and PTB (OR 2.47, 95% CI 1.34-4.56) were independently associated with a microbiological diagnosis of TB. The treatment success rate was 85%. In the logistic regression analysis, HIV-infected children had a 2.5-fold higher risk of an unfavorable outcome (OR 2.53, 95% CI 1.0-6.38; p = 0.05).Opportunities for TB prevention and early TB treatment are missed due to suboptimal close contact screening. Microbiological diagnosis of TB and drug susceptibility testing in children should be made available through more sensitive and accessible tests.

10.1016/j.ijid.2020.06.070

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