Profile of Paediatric TB Cases in a large East London NHS Trus

Abstract

Objectives To describe baseline characteristics and clinical profile of children presenting with TB disease to a large NHS Trust in East London. Methods Retrospective review of hospital records including demographic data, clinical presentations, laboratory results, management, and outcomes of children (<=16 years) treated for TB disease (January 2018 to December 2022). Patients were identified through the microbiology and clinical coding departments. Descriptive statistics were performed. Results Twenty-eight children were identified with a median age of 13 years (IQR 9 - 15). Most (n=20, 71%) were female and of Asian ethnicity (18/28, 64%). A nadir of cases was seen in 2020 (n=3, 11%). Most with known vaccination status (11/14, 79%) had received BCG. The most common clinical phenotype was pulmonary (20/28, 71%). Of those with pulmonary TB (n=20), the most common presenting symptoms were cough 18/20 (90%), weight loss 17/20 (85%), night sweats 11/18 (61%) and fever 11/20 (55%). Most children (11/20, 55%) with pulmonary TB had unilateral findings on chest imaging, mostly involving the left lung (8/11, 73%). Of the 16 tested sputum samples, 7 (44%) were acid fact bacilli (AFB) positive and 13 (81%) were positive on TB culture, with a discordant rate of 38%. All negative sputum samples were also AFB negative. Overall, Mantoux and IGRA were positive in 17/20 (85%) and 15/17 (88%) children respectively, with a positive concordance rate of 73% (11/15). The two children with a discordant result (IGRA negative, Mantoux positive) were < 3 years and had TB lymphadenopathy. The median time to commencing treatment from presentation (n=21) was 6 days (IQR 5 - 19). Overall, four children (14%) developed drug induced liver injury after a median of 12 days (IQR 9 - 20) from start of treatment, necessitating a pause in treatment. The median time to restarting treatment was 13 days (IQR 11 - 16). Four children with uncomplicated pulmonary or lymph node TB received 6 months of treatment. These would meet the SHINE trial1 criteria for shortened treatment (i.e. 4 months). No deaths were recorded in our cohort. Conclusion In our predominantly Asian cohort, a female predominance was seen. The low number of cases seen in 2020 possibly reflects reduced transmission due to the COVID-19 00000000 .