Background Childhood tuberculosis causes significant morbidity and mortality in Southeast Asia, yet little is known about the epidemiology and clinical characteristics of this disease in Viet Nam. Objectives To determine the demographics, clinical presentations, radiographic and microbiologic findings, treatment regimens, and outcomes of children admitted with tuberculosis (TB) to a national referral hospital in Viet Nam. Methods We conducted a retrospective case series study of children ≤ 15 years old with bacteriologically confirmed or clinically diagnosed TB admitted to a national referral hospital in Ha Noi, Viet Nam from January through December 2007. Results One hundred three children were identified: median age 5 years (IQR 2-10), 44% female, 99% Kinh ethnicity, 27% residing in Ha Noi, 88% with BCG vaccination, 27% with known TB contact, and 38% malnourished. Intrathoracic TB was present in 62%, extrathoracic in 52%, both intra and extrathoracic in 19%, and undetermined site in 5%. The most common extrathoracic manifestation was peripheral lymphadenitis, and children under 5 were more likely to have miliary TB or both intra and extrathoracic TB. Fever and failure to thrive were common presenting symptoms among all participants (65% and 56%, respectively), 66% of those with intrathoracic TB presented with cough, and 92% of those with TB meningitis presented with severe neurologic impairment. Acid-fast bacilli smears and mycobacterial cultures were positive in 18% and 21% of children tested, and histopathology was positive in 88% of those biopsied. There were no adverse drug reactions necessitating change in therapy, and no inpatient mortality. Conclusions Extrathoracic TB was common, treatment well tolerated and clinical outcomes excellent. Culture confirmation rates were low and emphasize the need for improved diagnostics.
Marais BJ, Gie RP, Schaaf HS, Hesseling AC, Obihara CC, et al. (2004) The natural history of childhood intra-thoracic tuberculosis: a critical review of literature from the pre-chemotherapy era. Int J Tuberc Lung Dis 8: 392–402.
Hoa NB, Cobelens FG, Sy DN, Nhung NV, Borgdorff MW, et al. (2013) First national tuberculin survey in Viet Nam: characteristics and association with tuberculosis prevalence. Int J Tuberc Lung Dis 17: 738–744. doi: 10.5588/ijtld.12.0200
Nelson LJ, Schneider E, Wells CD, Moore M (2004) Epidemiology of childhood tuberculosis in the United States, 1993–2001: the need for continued vigilance. Pediatrics 114: 333–341. doi: 10.1542/peds.114.2.333
Zar HJ, Hanslo D, Apolles P, Swingler G, Hussey G (2005) Induced sputum versus gastric lavage for microbiological confirmation of pulmonary tuberculosis in infants and young children: a prospective study. Lancet 365: 130–134. doi: 10.1016/s0140-6736(05)17702-2
Rachow A, Clowes P, Saathoff E, Mtafya B, Michael E, et al. (2012) Increased and expedited case detection by Xpert MTB/RIF assay in childhood tuberculosis: a prospective cohort study. Clin Infect Dis 54: 1388–1396. doi: 10.1093/cid/cis190
Nicol MP, Workman L, Isaacs W, Munro J, Black F, et al. (2011) Accuracy of the Xpert MTB/RIF test for the diagnosis of pulmonary tuberculosis in children admitted to hospital in Cape Town, South Africa: a descriptive study. Lancet Infect Dis 11: 819–824.
Bates M, O'Grady J, Maeurer M, Tembo J, Chilukutu L, et al. (2013) Assessment of the Xpert MTB/RIF assay for diagnosis of tuberculosis with gastric lavage aspirates in children in Sub-Saharan Africa: a prospective descriptive study. Lancet Infect Dis 13: 36–42. doi: 10.1016/s1473-3099(12)70245-1
Stop TB Partnership Childhood TB Subgroup World Health Organization (2006) Guidance for national tuberculosis programmes on the management of tuberculosis in children. Chapter 1: introduction and diagnosis of tuberculosis in children. Int J Tuberc Lung Dis 10: 1091–1097.
Stop TB Partnership Childhood TB Subgroup, World Health Organization (2006) Guidance for national tuberculosis programmes on the management of tuberculosis in children. Chapter 2: anti-tuberculosis treatment in children. Int J Tuberc Lung Dis 10: 1205–1211.
United Nations Population Fund (2011) Ethnic groups in Viet Nam: an analysis of key indicators from the 2009 Viet Nam population and housing census. Available: http://unfpa.org/webdav/site/vietnam/sha？red/Publications%202011/Ethnic_Group_ENG？.pdf. Accessed 06 February 2014.
Buonsenso D, Lancella L, Delogu G, Krzysztofiak A, Testa A, et al. (2012) A twenty-year retrospective study of pediatric tuberculosis in two tertiary hospitals in Rome. Pediatr Infect Dis J 31: 1022–1026. doi: 10.1097/inf.0b013e3182615270
Fox GJ, Nhung NV, Sy DN, Lien LT, Cuong NK, et al. (2012) Contact investigation in households of patients with tuberculosis in Hanoi, Vietnam: a prospective cohort study. PLoS One 7: e49880. doi: 10.1371/journal.pone.0049880
Lolekha R, Anuwatnonthakate A, Nateniyom S, Sumnapun S, Yamada N, et al. (2008) Childhood TB epidemiology and treatment outcomes in Thailand: a TB active surveillance network, 2004 to 2006. BMC Infect Dis 8: 94–2334-8-94. doi: 10.1186/1471-2334-8-94
Phongsamart W, Kitai I, Gardam M, Wang J, Khan K (2009) A population-based study of tuberculosis in children and adolescents in Ontario. Pediatr Infect Dis J 28: 416–419. doi: 10.1097/inf.0b013e3181920d4d
Hoa NB, Wei C, Sokun C, Lauritsen JM, Rieder HL (2011) Characteristics of tuberculosis patients at intake in Cambodia, two provinces in China, and Viet Nam. BMC Public Health 11: 367–2458-11-367. doi: 10.1186/1471-2458-11-367
Ministry of Health, Viet Nam Administration of HIV/AIDS Control (2009) Viet Nam HIV/AIDS estimates and projections, 2007-2012. Available: http://www.ilo.org/wcmsp5/groups/public/？---ed_protect/---protrav/---ilo_aids/doc？uments/legaldocument/wcms_174609.pdf. Accessed 06 February 2014.
Thanh DH, Sy DN, Linh ND, Hoan TM, Dien HT, et al. (2010) HIV infection among tuberculosis patients in Vietnam: prevalence and impact on tuberculosis notification rates. Int J Tuberc Lung Dis 14: 986–993.
Chemtob D, Weiler-Ravell D, Leventhal A, Bibi H (2006) Epidemiologic characteristics of pediatric active tuberculosis among immigrants from high to low tuberculosis-endemic countries: the Israeli experience. Isr Med Assoc J 8: 21–26.
Tran ST, Renschler JP, Le HT, Dang HT, Dao TM, et al. (2013) Diagnostic accuracy of microscopic observation drug susceptibility (MODS) assay for pediatric tuberculosis in Hanoi, Vietnam. PLoS One 8: e72100. doi: 10.1371/journal.pone.0072100
Hatherill M, Hawkridge T, Zar HJ, Whitelaw A, Tameris M, et al. (2009) Induced sputum or gastric lavage for community-based diagnosis of childhood pulmonary tuberculosis? Arch Dis Child 94: 195–201. doi: 10.1136/adc.2007.136929
Toppet M, Malfroot A, Hofman B, Casimir G, Cantraine F, et al. (1991) Tuberculosis in children: a 13-year follow up of 1714 patients in a Belgian home care centre. Eur J Pediatr 150: 331–335. doi: 10.1007/bf01955934