Evaluation of young children in household contact with adult multidrug-resistant pulmonary tuberculosis cases

Background. The prevention and management of multidrug-resistant (MDR) tube rculosis has received much attention, but little attention has been given t o children with MDR tuberculosis or children in contact with adults with MD R tuberculosis. The aim of this study was to determine the prevalence of tu berculous infection and disease in childhood contacts of adults with MDR pu lmonary tuberculosis. Method. All children <5 years of age in household contact with 75 recently diagnosed adults with MDR pulmonary tuberculosis were evaluated. Evaluation included clinical examination, tuberculin skin test, chest radiography and culture for Mycobacterium tuberculosis from gastric aspirates. Results, One hundred twenty-eight children, median age 27 months, were eval uated. Fifty children had recent contact with other adult tuberculosis case s. Sixty-six children previously had chemoprophylaxis or treatment of whom 36 defaulted treatment or received insufficient chemoprophylaxis. One child had HIV infection. Forty-seven children were classified as noninfected, 66 were considered infected only (Mantoux test, greater than or equal to 15 m m) and 15 had disease. Three children, who had not previously received anti tuberculosis drugs, had positive cultures for M. tuberculosis; all R-ere mu ltidrug-resistant. Conclusion. This study documents the transmission of multidrug-resistant M. tuberculosis to childhood contacts, the development of disease in these co ntacts and the importance of knowing the index case's M. tuberculosis susce ptibility pattern in choosing a proper treatment regimen for the childhood contact.