Immunocompetent children and adolescents experienced deterioration linked to TB treatment

Thampi N. Pediatr Infect Dis J. 2011;doi:10.1097/INF.0b013e318239134c.

Unexplained deterioration occurred in nearly 15% of immunocompetent children with tuberculosis in a health center in Canada, according to study results.

Although many data exist for patients coinfected with HIV and TB, few data exist for immunocompetent children and adolescents who unexpectedly deteriorate clinically and/or radiographically during the course of TB treatment.

Researchers from one center in Toronto evaluated all HIV-negative children and adolescents treated for TB between January 2002 and July 2009. Findings from these patients were compared with those from patients who remained well during therapy.

Fourteen percent of 110 patients (n=15) deteriorated without explanation. All of these patients were receiving directly observed therapy. Deterioration occurred at a median of 80 days (range, 10-181 days).

Seven of the 15 patients experienced enlarging intrathoracic lymphadenopathy, often leading to severe airway compromise. Symptoms developed at sites remote from primary disease — including pericardial and pleural effusions and abdominal masses — occurred in four patients. Nine patients received corticosteroid therapy.

Deterioration was linked to multiple sites of disease at diagnosis (P=.02) and weight-for-age (defined as those in the <25th percentile; P=.03).

The researchers said these deteriorations may present months into treatment. “Many patients improve with corticosteroids, supporting an immunopathologic basis for many of these episodes,” they wrote. “These deteriorations can be difficult to distinguish from drug resistance, treatment failure or infection with other pathogens.”

Disclosure: The researchers report no relevant financial disclosures.

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