Teens most at risk of severe TB in low-burden country

Adolescents appear to be the most vulnerable to severe tuberculosis (TB) in a low-burden setting, results of a study have shown.

The authors analysed children (aged <18 years) admitted with TB disease to the Robert Debré University Hospital in Paris, France, between 1992 and 2015 to better describe paediatric TB severity in a low-incidence country. They classified patients by TB severity based on the original classification of Wiseman et al. Risk factors associated with severity were also assessed.

Of the 304 patients (median age, 9.9 years; interquartile range, 3.3–13.3; male to female ratio, 1.04), 280 (92 percent) were classified: 168 (55 percent) with severe TB and 112 (37 percent) with nonsevere TB.  Central nervous system disease was prevalent among patients aged <2 years than those aged 2–17 years (5/54 [9 percent] vs 5/229 [2 percent]; p=0.024).

Univariate analysis revealed that being born abroad (p=0.011) and age ≥10 years (p=0.001) both correlated with disease severity. In multivariate analysis, diagnosis through symptom-based screening independently correlated with severity (odds ratio, 7.1, 95 percent confidence interval, 3.9–12.9; p<0.0001).

“In high-income countries, few paediatric studies have described the clinical expression of TB according to age, and their results are discordant,” the authors said. “Patients <2 years of age are usually considered to be at higher risk for severe disease than older children.”