Rifampicin-monoresistant Mycobacterium tuberculosis disease among children in Cape Town, South Africa
OBJECTIVES: To describe paediatric cases of rifampicin (RMP) monoresistant tuberculosis (RMR-TB) disease.
DESIGN: Records of children with culture-confirmed RMR-TB between 1 March 2003 and 28 February 2009 were identified from a prospectively recorded database of drug-resistant TB at TCH and BCH. Mutation analysis was performed on available specimens.
RESULTS: Eighteen children with a median age of 6.9 years (range 2 months–12.8 years) were identified. Nine (50%) were human immunodeficiency virus (HIV) infected and four (22%) were HIV-exposed but non-infected. Eleven (61%) had had previous TB treatment or prophylaxis. Nine children (50%) had cavitary disease and five children (22%) had extra-pulmonary disease. Twelve (67%) had adult TB source cases, including five (42%) adults with known RMR-TB. Primary transmission occurred among 11 children (61%) and acquisition of RMR-TB was possible in seven (39%) with prior RMP exposure. Median delay to specific RMR-TB treatment was 70 days (range 23–188). One child died from RMR-TB meningitis. Gene mutations consistent with RMR-TB were confirmed in five available samples.
CONCLUSION: RMR-TB disease is increasingly encountered, particularly among HIV-infected and HIV-exposed non-infected children. Delay in commencing appropriate treatment for RMR-TB and high rates of cavitary disease could be a source of RMR-TB transmission.
Keywords: HIV; TB; drug-resistant TB; rifampicin; rifampicin monoresistance
Document Type: Research Article
Affiliations: 1: Department of Paediatrics and Child Health, Tygerberg Children's Hospital, Stellenbosch University, Cape Town, South Africa 2: Department of Pediatrics, University of California, San Francisco, California, USA 3: Medical Research Council/National Research Foundation Centre of Excellence, Department of Biomedical Sciences, Stellenbosch University, Tygerberg, South Africa 4: Department of Paediatrics and Child Health, Tygerberg Children's Hospital, Stellenbosch University, Cape Town, South Africa; and Desmond Tutu Tuberculosis Centre, Stellenbosch University, Cape Town, South Africa
Publication date: 01 January 2012
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