Table 1.
Demographic and clinical description of children and adolescents with drug-resistant tuberculosis from three provinces, South Africa, 2005–2008.
| Total N=423 |
HIV− n=185 |
HIV+ n=238 |
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|---|---|---|---|---|---|---|---|
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| Demographic | n | (%) | n | (%) | n | (%) | P valuea |
| Age in years, median (IQR) | 10.7 | (5.5–15.3) | 14.8 | (8.7–16.6) | 8.7 | (5.0–11.8) | <0.001 |
| Age Categories | <0.001 | ||||||
| 0–1 | 45 | (10.6) | 23 | (12.4) | 22 | (9.2) | |
| 2–7 | 106 | (25.1) | 18 | (9.7) | 88 | (37.0) | |
| 8–12 | 113 | (26.7) | 29 | (15.7) | 84 | (35.3) | |
| 13–17 | 159 | (37.6) | 115 | (62.2) | 44 | (18.5) | |
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| Sex | 0.007 | ||||||
| Male | 177 | (41.9) | 64 | (34.6) | 113 | (47.7) | |
| Female | 245 | (58.1) | 121 | (65.4) | 124 | (52.3) | |
| Missing | 1 | ||||||
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| Province | <0.001 | ||||||
| Eastern Cape | 78 | (18.4) | 52 | (28.1) | 26 | (10.9) | |
| Gauteng | 93 | (22.0) | 40 | (21.6) | 53 | (22.3) | |
| KwaZulu-Natal | 252 | (59.6) | 93 | (50.3) | 159 | (66.8) | |
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| Year of TB Diagnosis | <0.001 | ||||||
| 2005 | 64 | (15.1) | 26 | (14.1) | 38 | (16.0) | |
| 2006 | 79 | (18.7) | 24 | (13.0) | 55 | (23.1) | |
| 2007 | 138 | (33.6) | 54 | (29.2) | 84 | (35.3) | |
| 2008 | 142 | (33.6) | 81 | (43.8) | 61 | (25.6) | |
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| Clinical | |||||||
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| Weight known | 397 | (93.9) | 175 | (94.6) | 222 | (93.3) | 0.6 |
| Normal weight | 184 | (46.4) | 100 | (57.1) | 84 | (37.7) | |
| Underweightb | 97 | (24.4) | 45 | (25.7) | 52 | (23.4) | |
| Severely underweightc | 116 | (29.2) | 30 | (17.1) | 86 | (38.7) | <0.001 |
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| Documented TB contact history | 249 | (58.9) | 106 | (57.3) | 143 | (60.1) | 0.6 |
| Previous contact with a TB case | 198 | (79.5) | 89 | (84.0) | 109 | (76.2) | 0.1 |
| Previous contact with MDR/XDR TB case | 44 | (17.7) | 24 | (22.6) | 20 | (14.0) | 0.08 |
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| Documented TB treatment history | 341 | (80.6) | 140 | (75.7) | 201 | (84.5) | 0.02 |
| Retreatment | 169 | (49.6) | 51 | (36.4) | 118 | (58.7) | <0.001 |
| One previous TB episode | 149 | (88.2) | 46 | (90.2) | 103 | (87.3) | |
| Two previous TB episodes | 16 | (9.5) | 4 | (7.8) | 12 | (10.2) | |
| Three previous TB episodes | 4 | (2.4) | 1 | (2.0) | 3 | (2.5) | 0.09 |
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| Known anatomic site of TB | 408 | (96.5) | 177 | (95.7) | 231 | (97.1) | 0.4 |
| Pulmonary only | 316 | (77.5) | 161 | (91.0) | 155 | (67.1) | |
| Extrapulmonary (EP) only | 13 | (3.2) | 7 | (4.0) | 6 | (2.6) | |
| Pulmonary and EP | 79 | (19.4) | 9 | (5.1) | 70 | (30.3) | <0.001 |
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| Documented chest x-ray result | 389 | (92.0) | 165 | (89.2) | 224 | (94.1) | 0.06 |
| Abnormal chest x-ray result | 378 | (97.2) | 161 | (97.6) | 217 | (96.9) | 0.8 |
| Cavity lesions | 145 | (38.4) | 84 | (52.2) | 61 | (28.1) | 0.06 |
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| Number of complaints/symptoms | |||||||
| Asymptomatic | 17 | (4.0) | 10 | (5.4) | 7 | (2.9) | |
| 1–2 | 170 | (40.2) | 76 | (41.1) | 94 | (39.5) | |
| 3–4 | 143 | (33.8) | 60 | (32.4) | 83 | (34.9) | |
| >4 | 93 | (22.0) | 39 | (21.1) | 54 | (22.7) | 0.6 |
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| Presenting symptoms | |||||||
| Cough longer than 2 weeks | 269 | (63.6) | 114 | (61.6) | 155 | (65.1) | 0.5 |
| Low weight or failure to thrive | 200 | (47.3) | 86 | (46.5) | 114 | (47.9) | 0.8 |
| Fever | 87 | (20.6) | 39 | (20.5) | 49 | (20.6) | 1.0 |
| Sweats | 92 | (21.8) | 50 | (27.0) | 42 | (17.7) | 0.02 |
| Lack of appetite | 89 | (21.0) | 44 | (23.8) | 45 | (18.9) | 0.2 |
| Pulmonary TB not responding to anti-TB treatment | 162 | (38.3) | 72 | (38.9) | 90 | (37.8) | 0.8 |
| EP TB not responding to anti-TB treatment | 12 | (2.8) | 1 | (0.5) | 11 | (4.6) | 0.01 |
| Mass (e.g. adenopathy) | 22 | (5.2) | 3 | (1.6) | 19 | (8.0) | 0.004 |
| Neurological complaints | 19 | (4.5) | 5 | (2.7) | 14 | (5.9) | 0.1 |
| Non-specific complaints | 67 | (15.8) | 12 | (6.5) | 55 | (23.1) | <0.001 |
| Other Complaints | 259 | (61.2) | 111 | (60.0) | 148 | (62.2) | 0.6 |
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| Mycobacteriology | |||||||
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| TB culture performed | 419 | (99.1) | 184 | (99.5) | 235 | (98.7) | 0.6 |
| Positive culture | 398 | (95.0) | 173 | (94.0) | 225 | (95.7) | 0.4 |
| Smear microscopy performed | 409 | (96.7) | 176 | (95.1) | 233 | (97.9) | 0.1 |
| At least one positive smear | 258 | (63.1) | 120 | (68.2) | 138 | (59.2) | 0.06 |
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| Drug susceptibility test performed | 391 | (92.4) | 172 | (93.0) | 219 | (92.0) | 0.7 |
| Resistance profile | |||||||
| XDR TBd | 38 | (9.7) | 22 | (12.8) | 16 | (7.3) | |
| PreXDR TBe | 22 | (5.6) | 13 | (7.6) | 9 | (4.1) | |
| MDR TBf | 302 | (77.2) | 131 | (76.2) | 171 | (78.1) | |
| RIF mono-resistant TBg | 4 | (1.0) | 1 | (0.6) | 3 | (1.4) | |
| INH mono-resistant TBh | 7 | (1.8) | 1 | (0.6) | 6 | (2.8) | |
| Poly-resistant TBi | 10 | (2.6) | 2 | (1.2) | 8 | (3.7) | |
| None/Other | 8 | (2.1) | 2 | (1.2) | 6 | (2.7) | 0.07 |
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| Patient received DR TB treatment | 422 | (99.8) | 185 | (100) | 237 | (99.6) | >0.99 |
| Any toxicity reported | 42 | (9.9) | 17 | (9.2) | 25 | (10.5) | 0.7 |
| Recorded date of TB diagnosis and initiation of DR TB treatment | 410 | (96.9) | 181 | (97.8) | 229 | (96.2) | 0.3 |
| Treatment started before DX | 61 | (14.8) | 20 | (11.1) | 41 | (17.9) | |
| Treatment started with or after DX | 349 | (85.1) | 161 | (89.0) | 188 | (82.1) | 0.053 |
| 0–30 days after diagnosis | 210 | (60.2) | 91 | (56.5) | 119 | (63.3) | |
| >30 days and <1 year after diagnosis | 134 | (38.4) | 67 | (41.6) | 67 | (35.6) | |
| >1 year after diagnosis | 5 | (1.4) | 3 | (1.86) | 2 | (1.1) | 0.4 |
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| Outcomes | |||||||
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| Cure/Complete | 245 | (57.9) | 114 | (61.6) | 131 | (55.0) | |
| Died | 69 | (16.3) | 20 | (10.8) | 49 | (20.6) | |
| Failed | 3 | (0.7) | 1 | (0.5) | 2 | (0.8) | |
| Lost to Follow up | 36 | (8.5) | 22 | (11.9) | 14 | (5.9) | |
| Unknown/On Treatment/Transfer | 70 | (16.6) | 28 | (15.1) | 42 | (17.7) | 0.02 |
Abbreviations: HIV, human immunodeficiency virus; TB, tuberculosis; MDR, multidrug resistant; XDR, extensively drug resistant; LN, lymph node; MDR, multidrug resistant; RIF, rifampicin; INH, isoniazid; DX, laboratory-confirmed diagnosis.
For continuous variable (age), p value was calculated with a Wilcoxon-Mann-Whitney test. For categorical variables, p values were calculated using a Pearson’s chi square test or Fisher’s exact test where appropriate.
Weight for age adjusted Z-score >2 standard deviations below the mean.
Weight for age adjusted Z-score >3 standard deviations below the mean.
In addition to MDR, resistant to any fluoroquinolone and at least one of three second-line injectable drugs (capreomycin, kanamycin and amikacin).
In addition to MDR, resistant to any fluoroquinolone or at least one of three second-line injectable drugs (capreomycin, kanamycin and amikacin).
Resistant to both isoniazid and rifampicin.
Resistant to rifampicin only.
Resistant to isoniazid only.
Resistant to more than one first-line anti-TB drug, other than both isoniazid and rifampicin.