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Int J Tuberc Lung Dis. 2016 Aug;20(8):1060-4. doi: 10.5588/ijtld.15.0602.

Source case identification in HIV-exposed infants and tuberculosis diagnosis in an isoniazid prevention study.

Author information

1
Children's Infectious Diseases Clinical Research Unit, Department of Paediatrics & Child Health, Stellenbosch University, Cape Town, South Africa; Swiss Children's Hospital, Liestal, Switzerland.
2
Center for Biostatistics in AIDS Research, Harvard School of Public Health, Boston, Massachusetts, USA.
3
Leonard M Miller School of Medicine, University of Miami, Miami, Florida, USA; Respiratory and Meningeal Pathogens Research Unit, Medical Research Council, and Department of Science & Technology, National Research Foundation, University of the Witwatersrand, Johannesburg, South Africa.
4
Department of Paediatrics, University of KwaZulu-Natal, Durban, South Africa.
5
Perinatal HIV Research Unit, University of the Witwatersrand, Johannesburg, South Africa.
6
Botswana-Harvard School of Public Health AIDS Institute, Gaborone, Botswana.
7
Department of Paediatrics & Child Health, Desmond Tutu TB Centre, Stellenbosch University, Cape Town, South Africa.
8
Children's Infectious Diseases Clinical Research Unit, Department of Paediatrics & Child Health, Stellenbosch University, Cape Town, South Africa.

Abstract

BACKGROUND:

Identifying source cases of children exposed to tuberculosis (TB) is challenging. We examined the time-point of obtaining contact information of TB source cases in human immunodeficiency virus (HIV) infected and HIV-exposed uninfected (HEU) children in a randomised, placebo-controlled trial of pre-exposure to isoniazid prophylaxis.

METHODS:

A total of 543 HIV-infected and 808 HEU infants without TB exposure aged 3-4 months were enrolled between 2004 and 2008. At 3-monthly follow-up, infants were evaluated for TB and care givers were asked about new TB exposure.

RESULTS:

In total, 128 cases of TB disease and 40 deaths were recorded among 19% (105/543) of the HIV-infected and 8% (63/808) of the HEU children; 229 TB contact occasions were reported in 205/1351 (15%) children, of which 83% (189/229) were in the household. Of the 189 household contacts, 108 (53%) underwent microbiological evaluations; 81% (87/108) were positive. HIV-infected and HEU infants had similar frequencies of TB contact: in 48% of infants with definite TB, 58% with probable TB and 43% with possible TB. Of 128 children diagnosed with TB, a TB contact was identified for 59. Of these, 29/59 (49%) were identified at or after the child's TB diagnosis.

CONCLUSION:

TB source cases are often identified at or after a child's TB diagnosis. More effort is required for earlier detection.

PMID:
27393540
PMCID:
PMC5066391
DOI:
10.5588/ijtld.15.0602
[Indexed for MEDLINE]
Free PMC Article

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