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Volume 25, Number 3—March 2019

CME ACTIVITY - Synopsis

Treatment Outcomes in Global Systematic Review and Patient Meta-Analysis of Children with Extensively Drug-Resistant Tuberculosis

Muhammad OsmanComments to Author , Elizabeth P. Harausz, Anthony J. Garcia-Prats, H. Simon Schaaf, Brittany K. Moore, Robert M. Hicks1, Jay Achar, Farhana Amanullah, Pennan Barry, Mercedes Becerra, Domnica I. Chiotan, Peter C. Drobac2, Jennifer Flood, Jennifer Furin, Medea Gegia, Petros Isaakidis, Andrei Mariandyshev, Iveta Ozere, N. Sarita Shah3, Alena Skrahina, Elena Yablokova, James A. Seddon4, Anneke C. Hesseling4, and for The Collaborative Group for Meta-Analysis of Paediatric Individual Patient Data in MDR TB
Author affiliations: Stellenbosch University, Cape Town, South Africa (M. Osman, A.J. Garcia-Prats, H.S. Schaaf, J.A. Seddon, A.C. Hesseling); State University of New York Upstate Medical University, Syracuse, New York, USA (E.P. Harausz); Centers for Disease Control and Prevention, Atlanta, Georgia, USA (B.K. Moore); University of California, San Francisco, California, USA (R.M. Hicks); Médecins Sans Frontières, London, UK (J. Achar); Indus Hospital, Karachi, Pakistan (F. Amanullah); California Department of Public Health, Richmond, California, USA (P. Barry, J. Flood); Harvard Medical School, Boston, Massachusetts, USA (M. Becerra, P.C. Drobac, J. Furin); Romanian National TB Program, Bucharest, Romania (D.I. Chiotan); World Health Organization, Geneva, Switzerland (M. Gegia); Médecins Sans Frontières, Mumbai, India (P. Isaakidis); Northern State Medical University, Arkhangelsk, Russia (A. Mariandyshev, E. Yablokova); Riga Eastern Clinical University Hospital, Riga, Latvia (I. Ozere); Albert Einstein College of Medicine, Bronx, New York, USA (N.S. Shah); Republican Research and Practical Centre for Pulmonology and TB, Minsk, Belarus (A. Skrahina); Imperial College London, London (J.A. Seddon)

Main Article

Table 2

Demographic and clinical characteristics of 37 children with bacteriologically confirmed extensively drug-resistant tuberculosis*

Characteristic No. (%)
Age, y, median 11 y (IQR 6.0–13.1 y)
<2 6 (16)
2–4 3 (8)
5–9 y 6 (16)
10–14 y 22 (60)
Sex
F 23 (62)
M 14 (38)
Site of disease
PTB 32 (86)
EPTB† 2 (5)
PTB and EPTB‡ 3 (8)
Severe TB disease by chest radiography, n = 31§
No 11 (35)
Yes 20 (65)
Documented adult TB source case, n = 28
No 8 (29)
Yes 20 (71)
HIV status
Uninfected 22 (59)
Infected 7 (19)
Unknown 8 (22)
Antiretroviral treatment
Receiving treatment¶ 7 (100)
Malnutrition, n = 30#
No 18 (60)
Yes 12 (40)
Admitted to hospital for TB treatment, n = 29
No 4 (14)
Yes 25 (86)
WHO TB treatment outcome
Cured 23 (62)
Completed 7 (19)
Failed 1 (3)
Died 4 (11)
Loss to follow-up 2 (5)
Clinical outcome
Favorable** 30 (81)
Unfavorable†† 7 (19)

*EPTB, extrapulmonary tuberculosis; IQR, interquartile range; PTB, pulmonary tuberculosis; TB, tuberculosis; WHO, World Health Organization.
†Two cases of EPTB, 1 site specified as urogenital and 1 unspecified.
‡Three cases of PTB and EPTB. Sites of EPTB were peripheral lymph nodes and pleural TB in 1 child and abdominal TB in 2 children.
§Severity of TB based on grading of chest radiograph reports available only for 31 children; 2 children had EPTB only and no chest radiograph and 4 children had no chest radiograph despite documented PTB..
¶Six children were receiving antiretroviral therapy at the start of TB treatment and 1 child started antiretroviral therapy during the course of TB treatment.
#Underweight for age (weight-for-age z-score <–2) or as per treating clinician’s report.
**Includes all children who were cured or completed treatment.
††Includes all children who failed treatment, died, or were lost to follow-up during treatment.

Main Article

1Current affiliation: University of California, San Francisco, California, USA.

2Current affiliation: Oxford University, Oxford, UK.

3Current affiliation: Centers for Disease Control and Prevention, Atlanta, Georgia, USA.

4These senior authors contributed equally to this article.

Page created: February 19, 2019
Page updated: February 19, 2019
Page reviewed: February 19, 2019
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