Multidrug-resistant TB in children with HIV infection in Romania

A retrospective study on a group of 417 children with TB and HIV/AIDS; 165 among these have had (+) culture for TB; MDR-TB - diagnosed to 73 children – 32,12%. Results: Mean age – 14,5 years; Sex – M: 50,94%; F: 49%; TST positive > 5 mm – 51,5%; negative – 49,5%; associated clinical symptoms: fever, weight loss, irritability – 100%; pain throat 75%, haemoptysia 50%. Rx abnormalities: parenchymal infiltration – 36,4%; cavitary lesions – 37%, hilar opacities – 11,3%; miliary – 7,5% bronchopneumonic opacities – 7,5%. Extrapulmonary TB – pleural effusion – 10,6,%; meningitis – 19,43%. Decreased CD4 – value <200 cells/mm3 – 32%, <100 cells/mm3 – 58,49%, <50 cells/mm3 – 9,43%. The cultures (+) in the sputum – 42,5%; gastric aspiration – 28,3%; LCR - 9,4%. BAAR presence: in sputum – 45,2%; LCR – 9,4%; gastric aspiration – 28,3%; pleural liquid – 3%, ganglionar aspiration – 13,1%. Chemo resistant forms: primary – 18,9%; secondary – 81,1%. Other resistances associated to H, R: SM – 29,5%; PZM – 24,3%; EMB – 18,9%; Km – 13,5%; CS – 8,1%; Q – 5,4%. Used treatment protocol 18-24 months; 4-5 antiTB drugs. Antiretroviral treatment received – 157% children. Side effects of treatment: hepatic cytolytic syndrome – 35,1%; jaundice – 18,9%; hadeache – 16,2%; personality disorders – 16,2%; thrombocytopenia – 13,5%. Bacteriological situation of discharge last BK examination BK cultures negative – 71,4%; positive – 28,86%. Conclusions: The MDR-TB prevalence is increased in the HIV/AIDS infected children; more frequent in the children with multiple hospitals admittance with previously antituberculous treatments, history of inappropriate regimes drugs,preventive therapies,treatment interruptions, treatment with two drugs.