Pediatric and adolescent tuberculosis in Latvia, 2011-2014: case detection, diagnosis and treatment.

OBJECTIVE: To perform a comprehensive analysis of case detection, diagnosis and treatment of tuberculosis (TB) in children and adolescents in Latvia, and to evaluate the utility of the current approach. DESIGN: A retrospective study of all Latvian children and adolescents diagnosed with TB from 1 January 2011 to 31 December 2014. RESULTS: Of 3081 patients diagnosed with TB during 2011-2014, 250 (8%) were aged <18 years, and 80% were identified through contact investigation. Pulmonary TB was diagnosed in 77% of the patients. TB was confirmed bacteriologically in 21% of patients; chest X-ray (CXR) was consistent with TB in 42% of study participants, while 58% of cases were diagnosed with subclinical TB using low-dose computed tomography (CT) after being missed by CXR. Patients with visible abnormalities on CXR had a higher rate of bacteriological confirmation and were more often clinically symptomatic, which indicates active disease. Early diagnosis had a treatment success rate of 100% for drug-resistant and 99% for drug-susceptible TB. CONCLUSION: TB case detection through contact investigation provided early diagnosis and excellent treatment outcomes in children and adolescents in Latvia. CT was able to identify pathology consistent with subclinical TB in children with a history of exposure.

Multi- and extensively drug-resistant tuberculosis in Latvia: trends, characteristics and treatment outcomes.

SETTING: Drug-resistant tuberculosis (TB) is an important public health problem in Latvia. OBJECTIVE: To document trends, characteristics and treatment outcomes of registered patients with multi-drug-resistant (MDR-) and extensively drug-resistant (XDR-) TB in Latvia from 2000 to 2010. DESIGN: A retrospective national cohort study. RESULTS: Of 1779 patients, 1646 (92%) had MDR- and 133 (8%) XDR-TB. Over 11 years, the proportion of XDR-TB among MDR-TB patients increased from 2% to 18%. Compared to MDR-TB patients, those with XDR-TB were significantly more likely to have failed MDR-TB treatment (OR 8.4, 95%CI 4.3-16.2), have human immunodeficiency virus infection (OR 3.2, 95%CI 1.8-5.7), be illegal drug users (OR 5.7, 95%CI 2.6-11.6) or have had contact with MDR-TB patients (OR 1.9, 95%CI 1.3-2.8). Cure rates for XDR-TB were 50%. Compared with MDR-TB patients, those with XDR-TB had a higher risk of treatment failure (29% vs. 8%, respectively, P < 0.001). Unfavourable treatment outcomes were significantly associated with being male; having smear-positive disease; pulmonary cavities; failure, default or relapse after previous MDR-TB treatment; and a history of incarceration. CONCLUSION: More MDR-TB in Latvia is now also XDR-TB. This study identified several risk factors for XDR-TB and, for unfavourable treatment outcomes, highlighting the importance of early diagnosis and appropriate management of MDR-/XDR-TB.

[Primary respiratory tuberculosis in children: Hyperdiagnosis or hypodiagnosis].

The diagnosis of bacteriologically negative tuberculosis (TB) in children is traditionally based on clinical criteria, such as a history of contact with a patient with TB, a positive tuberculin test suggesting TB infection and radiological TB changes. To improve the early diagnosis of TB, the authors applied computed tomography (CT) to 284 children with suspected TB (a study group) who had negative bacterial tests and normal chest X-ray films. To identify individual diagnostic criteria, the study group was divided into 4 subgroups: 1) 119 patients with positive tuberculin tests (> or = 10 mm induration) and a known contact with a TB patient; 2) 100 patients with positive tuberculin tests (> or = 10 mm induration) without known contact with a TB patient; 3) 33 patients with negative tuberculin tests (> or = 10 mm induration) and a known contact with a TB patient; 4) 32 patients with negative tuberculin tests (> or = 10 mm induration) without known contact with a TB patient. A control comprised 29 children with bacteriologically verified TB and normal chest X-ray films. Conventionally radiological studies revealed undiagnosed lung parenchymal abnormalities in 35 (29.4%), 16 (16.0%), 4 (12.1%), and 5 (15.6%) children in Subgroups 1, 2, 3, and 4, respectively, and in 11 (37.9%) children in the control group. Intrathoracic lymph nodes of > or = 5 mm were rarely diagnosed in all the groups of patients, including children with bacteriologically verified TB. Calcified lymph nodes were visualized in 62 (52.1%), 40 (40.0%), 18 (54.5%), and 7 (21.9%) children in Subgroups 1, 2, 3, and 4, respectively, and in 15 (51.7%) children in the control group. CT revealed an active TB process in 49 (41.2%), 23 (23.0%), 12 (35.4%) and 1 (3.1%) children in Subgroups 1, 2, 3, and 4, respectively. The findings demonstrated the hypodiagnosis of active TB in the infected children contacting a TB patient when CT is not applied.