Higher Risk of Active Tuberculosis Infection in Children Living With Infected Adults

Mother taking care of sick daughter with oxygen mask and teddy bear
Study authors assessed the relationship between children living in contact with sputum smear-positive tuberculosis patients on DOTS and children getting infected with tuberculosis or tubercular infection.

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.


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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.

Reference

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.