Pediatric tuberculosis in the metropolitan area of Rio de Janeiro

Abstract Purpose to evaluate clinical characteristics, diagnostic approach and treatment outcome of tuberculosis (TB) in children living in a high burden metropolitan area. Methods a retrospective study, based on medical chart review, involving children under 15 years old treated for TB from 2007 to 2016, in four primary health units (PHU) and three reference centers (RC) in five cities of Rio de Janeiro metropolitan area. Factors associated with TB treatment setting, microbiological diagnosis and treatment outcome were evaluated. Results 544 children were enrolled; 71% were treated at PHU, 36% were under 5 years old and 72% had pulmonary TB (PTB). HIV prevalence was 10% (31/322). Fifty-three percent had at least one microbiological test for TB, 68% of them (196/287) had TB confirmed. Among 222 children with previous TB contact, information on LTBI was available for 78 (35%), and only 17% (13/78) were treated. Extrapulmonary TB (56% vs. 32%), microbiological confirmed TB (77% vs. 60%) and HIV positivity (18.5% vs. 4.0%) were significantly more frequent in RC. Treatment at RC (OR = 3.08; 95% CI 1.74-5.44) and PTB (OR = 2.47; 95% CI 1.34-4.56) were independently associated with microbiological diagnosis of TB. Treatment success rate was 85%. In the logistic regression, HIV-infected children had a 2.5-fold higher risk of unfavorable outcome (OR = 2.53; 95% CI: 1.0-6.38; p = 0.05). Conclusion opportunities of TB prevention and early TB treatment are missed due to suboptimal close contact screening. Microbiological diagnosis of TB and susceptibility drug testing in children should be made available through more sensitive and accessible tests.