DOI: http://dx.doi.org/10.18203/2349-3291.ijcp20192778

Incidence of rifampicin resistance, HIV status and efficacy of fluid analysis among tuberculosis suspect pediatric cases

Deepmala Pandey, Ankur Yadav

Abstract


Background: Body fluids are commonly used for diagnosis as sputum is not reliable in children. Hence it is essential to study efficacy of body fluids in comparison to GeneXpert which is a new diagnostic modality. Objectives of this study was to incidence of rifampicin resistance, HIV status and efficacy of fluid analysis among tuberculosis suspect pediatric cases.

Methods: Present study was hospital based cross sectional study carried out over a period of two years at Department of Pediatrics, ACPM Medical College and Hospital from February 2016 to January 2018 among children with suspected tuberculosis. Rifampicin resistance was determined by using GeneXpert. Body fluids like CSF, pleural fluid, gastric aspirate etc were analyzed and compared with GeneXpert results.

Results: Rifampicin resistance was present in 5 cases i.e. 3.3%. 15.15% Patients were HIV positive and in them 12 were GeneXpert positive with 1 Rif resistance. Different Fluid analysis showed maximum positivity with pleural fluid >TB Lymphadenitis >TBM. GeneXpert done on different body fluids showed extra case detection in different fluid analysis negative patients i.e. 28.6% extra case detection in CSF (2 cases), 87.9% in gastric aspirate (25 cases), 85.4% in induced sputum (35 cases), 14.3% in Lymph node aspirate (1 case), 50% in pleural fluid (2 case).

Conclusions: : Rifampicin resistance found in present study is alarming. Among body fluids, FNAC, CSF and pleural fluids can be used reliably for diagnosis of tuberculosis where GeneXpert is not available.


Keywords


Body fluids, Diagnosis, FNAC, HIV status, Resistance, Tuberculosis

Full Text:

PDF

References


Kabra SK, Lodha R, Seth V. Some current concepts on childhood tuberculosis. Indian J Med Res. 2004;120(4):387-97.

Schaaf HS, Marais BJ, Hesseling AC, Gie RP, Beyers N, Donald PR. Childhood drug-resistant tuberculosis in the Western Cape Province of South Africa. Acta Paediatr. 2006;95(5):523-8.

Marais BJ, Gie RP, Schaaf HS, Hesseling AC, Enarson DA, Beyers N. The spectrum of disease in children treated for tuberculosis in a highly endemic area. Int J Tuberc Lung Dis. 2006;10(7):732-8.

Hesseling AC, Cotton MF, Fordham von Reyn C, Graham SM, Gie RP, Hussey GD. Consensus statement on the revised World Health Organization recommendations for BCG vaccination in HIV-infected infants. Int J Tuberc Lung Dis. 2008;12(12):1376-9.

Marais BJ, Graham SM, Cotton MF, Beyers N. Diagnostic and management challenges for childhood tuberculosis in the era of HIV. J Infect Dis. 2007;196 (Suppl 1):S76- 85.

Grant LR, Hammitt LL, Murdoch DR, O'Brien KL, Scott JA. Procedures for collection of induced sputum specimens from children. Clin Infect Dis. 2012;54 (Suppl 2):S140-5.

Shah I, Chilkar S. Clinical profile of drug resistant tuberculosis in children. Indian Pediatr. 2012;49(9):741-4.

Seddon JA, Hesseling AC, Marais BJ, Jordaan A, Victor T, Schaaf HS. The evolving epidemic of drug-resistant tuberculosis among children in Cape Town, South Africa. Int J Tuberc Lung Dis. 2012;16(7):928-33.

Lapphra K, Sutthipong C, Foongladda S, Vanprapar N, Phongsamart W, Wittawatmongkol O, et al. Drug-resistant tuberculosis in children in Thailand. Int J Tuberc Lung Dis. 2013;17(10):1279-84.

Panigatti P, Ratageri V, Shivanand I, Madhu PK, Shepur TA. Profile and Outcome of Childhood Tuberculosis Treated with DOTS-An Observational Study. Indian J Pediatr. 2014;81(1):9-14.

Chadha VK, Kumar P, Satyanarayanan AV, Chauhan LS, Gupta J, Singh S, et al. Annual risk of tuberculosis infection in Andhra Pradesh, India. Indian J Tuberc. 2007;54(4):177-83.

Ray M, Kumar L, Prasad B. Plasma zinc status in Indian childhood tuberculosis: Impact of anti-tuberculosis therapy. Int J Tuberc Lung Dis. 1998;2(9):719-25.

Huong NT, Duong BD, Co NV, Quy HT, Tung LB, Broekmans JF, et al. Tuberculosis epidemiology in six provinces of Vietnam after the introduction of the DOTS strategy. Int J Tuberc Lung Dis. 2006;10(9):963-9.