Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2026
Asymptomatic Tuberculosis in Children With Household Exposure to Mycobacterium tuberculosis.
СтатьяПоддержка NIH: внешняя программаНазвание и аннотация: Перевод в очереди
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Mulenga Humphrey, Shenje Justin, Mendelsohn Simon C, Luabeya Angelique K K, Tameris Michele, Tredoux Enid N, Nemes Elisa, Bilek Nicole, Beyers Elisabeth, Ivacik-Goncalves Dejana, Andrews Jason R, Hawn Thomas R, Dobos Karen M, Altin John A, Musvosvi Munyaradzi, Scriba Thomas J, Hatherill Mark
Аннотация
BACKGROUND: Asymptomatic tuberculosis (TB) is common in adult community prevalence surveys. Evidence to inform our understanding of asymptomatic TB in children is lacking, because diagnostic algorithms typically include only symptomatic children.
METHODS: Children aged 2-60 months, without human immunodeficiency virus (HIV), with household exposure to an adult TB patient in the last year, were enrolled in South Africa. Symptom screening, chest radiography (CXR) and induced sputum were performed. Confirmed TB (requiring positive Xpert Ultra and/or MGIT culture) and unconfirmed TB (requiring 2 of TB exposure, compatible symptoms, or compatible CXR) were defined by application of a consensus case definition for classification of childhood TB. Asymptomatic TB was defined as Confirmed or Unconfirmed TB without reported symptoms.
RESULTS: In brief, 430 TB-exposed children, median age 25.9 (interquartile range [IQR] 13.5-40.0) months, were enrolled. And 154 (35.8%) children met TB diagnostic criteria, including 21 (4.9%) Confirmed and 133 (30.9%) Unconfirmed cases. Fifty-five (35.7%) of all TB cases were asymptomatic, including 17/21 (81.0%) Confirmed and 38/133 (28.6%) Unconfirmed cases. CXR was compatible with TB in 30/41 (73.2%) asymptomatic versus 15/47 (31.9%) symptomatic cases who underwent CXR (P < .001). TB treatment was started in 44/55 (80%) asymptomatic versus 34/99 (34.3%) symptomatic cases (P < .001). Factors associated with asymptomatic compared to symptomatic TB included microbiological confirmation (adjusted odds ratio [aOR] = 3.73; 95% confidence interval [CI]: 1.08-12.88).
CONCLUSIONS: Asymptomatic TB that meets the consensus case definitions for both Confirmed and Unconfirmed disease is common in TB-exposed children. All child household contacts should be actively investigated for TB, regardless of symptoms, before a decision is made on curative or preventive therapy.
METHODS: Children aged 2-60 months, without human immunodeficiency virus (HIV), with household exposure to an adult TB patient in the last year, were enrolled in South Africa. Symptom screening, chest radiography (CXR) and induced sputum were performed. Confirmed TB (requiring positive Xpert Ultra and/or MGIT culture) and unconfirmed TB (requiring 2 of TB exposure, compatible symptoms, or compatible CXR) were defined by application of a consensus case definition for classification of childhood TB. Asymptomatic TB was defined as Confirmed or Unconfirmed TB without reported symptoms.
RESULTS: In brief, 430 TB-exposed children, median age 25.9 (interquartile range [IQR] 13.5-40.0) months, were enrolled. And 154 (35.8%) children met TB diagnostic criteria, including 21 (4.9%) Confirmed and 133 (30.9%) Unconfirmed cases. Fifty-five (35.7%) of all TB cases were asymptomatic, including 17/21 (81.0%) Confirmed and 38/133 (28.6%) Unconfirmed cases. CXR was compatible with TB in 30/41 (73.2%) asymptomatic versus 15/47 (31.9%) symptomatic cases who underwent CXR (P < .001). TB treatment was started in 44/55 (80%) asymptomatic versus 34/99 (34.3%) symptomatic cases (P < .001). Factors associated with asymptomatic compared to symptomatic TB included microbiological confirmation (adjusted odds ratio [aOR] = 3.73; 95% confidence interval [CI]: 1.08-12.88).
CONCLUSIONS: Asymptomatic TB that meets the consensus case definitions for both Confirmed and Unconfirmed disease is common in TB-exposed children. All child household contacts should be actively investigated for TB, regardless of symptoms, before a decision is made on curative or preventive therapy.