TUBERCULOSIS: Paediatric cases difficult to diagnose

DURBAN, 2 June 2010 (PLUSNEWS) - The fight against tuberculosis (TB) has failed children: the share of paediatric TB is increasing, and children have not escaped the rising tide of drug-resistant strains, according to new research presented at the South African TB Conference. Dr Ntombi Mhlongo-Sigwebela, TB programme director at the University Research Company, a public health consultancy, told the conference in the port city of Durban that TB in children under four years of age now accounted for about nine percent of all national TB cases annually. Dr Kalpesh Rahevar, a World Health Organization (WHO) medical officer, said inconclusive conventional TB skin tests (to determine whether a patient has a latent TB infection) and the inability to get sputum samples from young children made paediatric TB more difficult to diagnose and treat than in adults. "This highlights the challenge of diagnosing children, especially at the primary care level ... there are differing abilities to accurately diagnose TB; where there is a paediatrician who takes an interest in TB, you see a higher number of cases diagnosed," Mhlongo-Sigwebela told IRIN/PlusNews. To make things worse, paediatric drug formulations and international treatment guidance for children were also inadequate, said Dr Ben Marais of University of Stellenbosch, in Western Cape Province. "The WHO only produced guidelines this year on optimal isoniazid [a drug used to treat TB] dosing for children," he told IRIN/PlusNews. "I think this speaks to how poorly we've served children ... [it has been] more than 60 years since the discovery of the drugs [and only now do] we have an optimal [paediatric] dosing." WHO has listed South Africa's TB epidemic among the world's worst, and research has indicated that about 70 percent of adult TB patients are co-infected with HIV [http://www.aidsmap.com/en/news/BEF8C8CE-BC45-4DD4-B859-00E42D5F9459.asp]. Marais said the key to preventing paediatric TB infections was halting adult TB, improving infection control, and access to isoniazid preventive TB therapy.