Among a cohort of children living in contact with sputum smear-positive adult tuberculosis (TB) patients on Directly Observed Treatment Short Course (DOTS), roughly half the children were suffering from tuberculosis or tubercular infection, according to a follow-up study published in BMC Infectious Diseases. During 9 months of follow-up, 22 unaffected children developed disease and 43 acquired infection.
Children in this study were aged less than 15 years and were grouped as either less than 6 years of age or 6-14 years of age and further split up into subgroups based on symptoms, tuberculin reaction, and chest X-ray features. A total of 152 children living with 59 adult TB patients on DOTS were recruited; in total, 51% boys and 67% had a bacillus Calmette-Guerin scar.
At the time of recruitment, 30 children (23.4%) had tubercular infection (tuberculin skin test positive), and the prevalence was 7 times higher in children aged 6-14 years compared with those aged less than 6 years (36.9% vs 5.5%). During 9 months of follow-up, only 1 child aged less than 6 years was infected. Children aged 6-14 years continued to acquire infections, with 18, 18, and 6 infections found at 3, 6, and 9 months of follow-up, respectively. Nine children were lost to follow-up.
At the time of recruitment, 32 children (21.1%) had developed TB, and 21 children aged 6-14 continued to develop TB over a period of 9 months, with 5, 6, and 10 infections found at 3, 6, and 9 months of follow-up, respectively. Only 1 child aged less than 6 years developed tuberculosis at 9 months. In total, 54 of 143 children developed TB during the study. Of the children infected, 29 had pulmonary TB, 23 had cervical lymphadenopathy, and 1 child each had tubercular meningitis and abdominal TB.
Investigators note several study limitations including sputum/gastric aspirate for acid fast bacilli was not taken in all children, socioeconomic status and nutritional factors were not correlated, and 24 children could not be tested at recruitment.
“[O]ur study confirms that [a] large number of children (21.1%) living with adult sputum smear-positive TB patients suffer from active disease and almost equal number of child contacts (23.4%) harbor latent infection of TB,” study authors concluded. During the study, children were continually exposed, and the prevalence of active disease and TB infection rose to 37.7% and 74.5%, respectively.
Srivastava G, Faridi MMA, Gupta SS. Tubercular infection in children living with adults receiving Directly Observed Treatment Short Course (DOTS): a follow up study. BMC Infect Dis. 2020;20(1):720.