Demographic and Clinical Trends in Pediatric Drug-resistant Tuberculosis in Mumbai, India from 2020-2023
Dhruv Gandhi, Ramsha Ansari, Ira ShahAbstract
Background
Pediatric drug-resistant tuberculosis (DR-TB) is a growing public health problem in India, with significant morbidity and mortality. The prevalence of DR-TB, demographic and clinical characteristics of pediatric DR-TB patients has shifted over the years. There is a need to recognise these shifting trends to prioritize public health prevention and treatment efforts. The aim of this study is to analyze trends in demographic, clinical and resistance profiles of DR-TB patients at a pediatric DR-TB clinic in Mumbai, India.
Methods
This retrospective observational study was conducted at the pediatric DR-TB clinic of a tertiary children’s hospital. We included children less than 18 years diagnosed with DR-TB between 2020 and 2023. Demographic variables analyzed include age at presentation and the sex. Clinical variables analyzed include the site of TB disease (pulmonary (PTB), extrapulmonary (EPTB) and disseminated) and the type of DR-TB (multidrug resistant (MDR), pre-extensively drug resistant (preXDR), XDR, and polyresistant). Individual drug resistance determined by Xpert MTB/Rif, line probe assay or phenotypic drug susceptibility testing was also recorded. These variables were compared over the years.
Results
From 2020 to 2023, we reported 527 (31.22%) DR-TB patients out of 1688 TB patients overall, of which we included 484 (91.84%) patients. Mean age was 10.55±4.20 years, with a male-to-female ratio of 153:331 (0.46:1). The overall prevalence of PTB, EPTB and disseminated TB was almost similar over the years (32.85% vs 32.02% vs 35.12%, respectively). Among PTB, primary TB (76.14%) is the most common presentation, and among EPTB, lymph node TB (51.38%) is the most common presentation, followed by abdominal (20%) and CNS-TB (19.69%). MDR-TB (60.12%) still remains the most common type followed by preXDR-TB (33.06%). From 2020-2023, the prevalence of DR-TB has doubled in children <5 years (8.45-16.47%; p=0.046) and the prevalence in males is increasing (23.94-43.53%; p=0.002). PTB prevalence has decreased (43.66-25.88%) and EPTB prevalence has increased (26.06-36.47%), although these are not statistically significant (p=0.08). The resistance to levofloxacin has increased (31.63-62.79%; p=0.001) and that of high-dose moxifloxacin has also increased (28.57-60.47%; p=0.001). The resistance to pyrazinamide has decreased (47.96-20.93%; p=0.004). In children <5 years, we found a high likelihood of primary PTB (Odds ratio: 2.22) and CNS-TB (Odds ratio: 2.14).
Conclusion
There has been a change in the trend of DR-TB patients between 2020 and 2023, with a higher prevalence among young children and males. In addition, fluroquinolone resistance has been increasing over the years while pyrazinamide resistance has been decreasing.