Seddon James A, Hesseling Anneke C, Godfrey-Faussett Peter, Fielding Katherine, Schaaf H Simon
Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Clinical Building, Room 0085, P, O, Box 19063, Tygerberg, South Africa.
BMC Infect Dis. 2013 Aug 26;13:392. doi: 10.1186/1471-2334-13-392.
Young children exposed to Mycobacterium tuberculosis have a high risk of disease progression following infection. This study aimed to determine risk factors for M. tuberculosis infection and disease in children following exposure to adults with multidrug-resistant (MDR) tuberculosis (TB).
Cross-sectional study; all children aged < 5 years, routinely referred per local guidelines to the provincial specialist MDR-TB clinic, Western Cape Province, South Africa, following identification as contacts of adult MDR-TB source cases, were eligible for enrolment from May 2010 through April 2011. Demographic, clinical and social characteristics were collected. All children underwent HIV and tuberculin skin testing.
Of 228 children enrolled (median age: 30 months), 102 (44.7%) were classified as infected. Of these, 15 (14.7%) had TB disease at enrolment. Of 217 children tested for HIV, 8 (3.7%) were positive. In adjusted analysis, child's age (AOR: 1.43; 95% CI: 1.13-1.91; p = 0.002) and previous TB treatment history (AOR: 2.51; 95% CI: 1.22-5.17; p = 0.01) were independent risk factors for infection. Increasing age of the MDR-TB source case (AOR: 0.67; 95% CI: 0.45-1.00; p = 0.05) was protective and source case alcohol use (AOR: 2.59; 95% CI: 1.29-5.22; p = 0.007) was associated with increased odds of infection in adjusted analysis. Decreasing age of the child (p = 0.01) and positive HIV status (AOR: 25.3; 95% CI: 1.63-393; p = 0.01) were associated with prevalent TB disease.
A high proportion of children exposed to MDR-TB are infected or diseased. Early contact tracing might provide opportunities to prevent the progression to TB disease in children identified as having been exposed to MDR-TB.
接触结核分枝杆菌的幼儿在感染后疾病进展风险较高。本研究旨在确定接触耐多药（MDR）结核病（TB）成人的儿童感染结核分枝杆菌及发病的风险因素。
横断面研究；2010年5月至2011年4月期间，所有年龄小于5岁、根据当地指南在被确定为成人MDR-TB源病例的接触者后按常规转诊至南非西开普省省级MDR-TB专科诊所的儿童均符合纳入标准。收集人口统计学、临床和社会特征。所有儿童均接受HIV和结核菌素皮肤试验。
在纳入的228名儿童（中位年龄：30个月）中，102名（44.7%）被分类为感染。其中，15名（14.7%）在入组时患有结核病。在217名接受HIV检测的儿童中，8名（3.7%）呈阳性。在多因素分析中，儿童年龄（比值比：1.43；95%置信区间：1.13-1.91；p=0.002）和既往结核病治疗史（比值比：2.51；95%置信区间：1.22-5.17；p=0.01）是感染的独立危险因素。MDR-TB源病例年龄增加（比值比：0.67；95%置信区间：0.45-1.00；p=0.05）具有保护作用，且在多因素分析中源病例饮酒（比值比：2.59；95%置信区间：1.29-5.22；p=0.007）与感染几率增加相关。儿童年龄减小（p=0.01）和HIV阳性状态（比值比：25.3；95%置信区间：1.63-393；p=0.01）与现患结核病相关。
接触MDR-TB的儿童中很大一部分受到感染或患病。早期接触者追踪可能为预防被确定为接触过MDR-TB的儿童发展为结核病提供机会。
