Backgrounds:

In adults, there is a high risk of recurrent TB after successful treatment, however limited data is available in children. The aim of this study was to determine burden and risk factors of TB recurrence in children.

Methods

Retrospective descriptive study of TB recurrence in children aged 0-13 years presenting with presumptive pulmonary TB in Cape Town, South Africa from March 2012 to November 2017. Recurrent TB is defined as >1 episode TB treatment (both confirmed or clinically diagnosed disease).

Results:

Data of 608 children were reviewed for TB recurrence, the median age was 16.7 months (interquartile range, IQR: 9.5-33.3), 324 male (53.3%) and 72 living with HIV (LHIV, 11.8%).

A total of 52/608 (8.4%) of all children had reported previous treatment for TB. Of these, 28 were treated again as TB cases, and 2 were excluded due to misdiagnosis of TB at previous episode. Recurrent TB was thus seen in 26/281 (9.3%) of current TB cases.

8/26 (30.8%) of children had the same TB contact as the previous episode. Current TB episode was confirmed in 11/26 (42.3%) with median time-lapsed since previous episode of 21 months (IQR: 16.3-45). Underlying comorbidities were seen in 19/26 (73.1%) of the children, all HIV infected and some with malnutrition (8/26) and chronic lung disease (3/26). Two thirds of children LHIV reported poor adherence to antiretrovirals (84.2%) and low CD4 counts.

Conclusions/Learning Points:

Recurrent TB was common in this young cohort of children with PTB. Children LHIV are at significantly higher risk for recurrent TB. More data is needed to identify other risk factors for recurrent TB and long-term follow up for repeated recurrence and post TB lung disease.

Figure 1: Identification of children with recurrent TB