MULTIDRUG RESISTANT TUBERCULOSIS IN CHILDREN IN THE DEMOCRATIC REPUBLIC OF CONGO: FIRST EXPERIENCE WITH A SHORT TREATMENT COURSE IN A UNIVERSITY HOSPITAL
Background: A short treatment course for multidrug-resistant tuberculosis (MR-TB) is not yet well codified in children in the Democratic Republic of Congo (DRC). The objective of this study was to evaluate a short MR-TB treatment course in children.
Methods: A prospective study was performed from April 2015 (corresponding to the inclusion) through April 2017 (and the later initiation time point was April 2016) in the University Clinics of Kinshasa. Enrolled children were aged 0 to 15 years. The treatment duration was in general for 9 months, with 4 months of intensive phase treatment with Kanamycin, Levofloxacin, Isoniazid, Pyrazinamide, Prothionamide, Clofazimine and Ethambutol, and 5 months of continuous phase treatment with Levofloxacin, Pyrazinamide, Clofazimine and Ethambutol. Frequencies were reported for significant results.
Results: A total of 21 children had MDR-TB (11 males and 10 females). Fifteen (71.43%) were bacteriological confirmed cases (by Xpert/MTB), and 6 (28.57%) were clinically diagnosed (MDR-TB contact with suggestive radiologic lesions); 2 patients were coinfected with HIV, 15 cases had pulmonary TB, and 6 had extrapulmonary TB. The main radiologic findings included TB cavity (3 cases), pleural effusion (5 cases), alveolar syndrome (8 cases), adenopathy (7 cases), and interstitial infiltration, fibrosis and miliary (2 cases each). The Ziehl control was negative before 4 months of treatment in the majority of the cases. Overall, 11 patients were cured, 7 completed the treatment, 2 died and 1 was lost to follow up.
Conclusions: MDR-TB remains a challenge in children. A more comfortable, short treatment course is feasible in children in the DRC. It is necessary to verify this observation with a larger cohort of MDR-TB patients in pediatrics.
Keywords: Multidrug-resistant tuberculosis; children; short treatment course; Africa; Kinshasa; treatment outcomes.
 Donald P R. Childhood tuberculosis: out of control? Curr Opin Pulm Med 2002; 8:178â€“182.
 Yuen CM, Rodriguez CA, Keshavjee S, Becerra MC. Map the gap: missing children with drug-resistant tuberculosis. PHA 2015; 5(1):45â€“58.
 World Health Organization. Guidelines for the programmatic management of drug-resistant tuberculosis. Emergency update 2008. WHO/HTM/TB/2008.402. Geneva, Switzerland: WHO, 2008. http://whqlibdoc.who.int/publications/2008/ 9789241547581 _eng.pdf. Accessed April 2015.
 The Sentinel Project for Pediatric Drug-Resistant Tuberculosis. Management of multidrug-resistant tuberculosis in children: a field guide. Boston, MA, USA: The Sentinel Project for Pediatric Drug-Resistant Tuberculosis, 2012. http://sentinelproject.files.wordpress.com/2012/11/sentinel_project_field guide 2012. pdf. Accessed April 2015.
 Moodley R, Godec TR. Short-course treatment for multidrug-resistant tuberculosis: the STREAM trials. Eur Respir Rev 2016; 25:29-35. DOI: 10.1183/16000617.0080-2015
 TrÃ©bucq A, Schwoebel V, Kuaban C, et al. Expanding shortened MDR-TB treatment: the West African experience. Int J Tuberc Lung Dis 2014; 18: Suppl. 1, S15.
 Aung KJM, Van Deun A, Declercq E, et al. Successful â€œ9-month Bangladesh regimenâ€ for multidrug-resistant tuberculosis among over 500 consecutive patients. Int J Tuberc Lung Dis 2014; 18:1180-1187.
 Achar J, Berry C, Herboczek K, et al. Multidrug-resistant tuberculosis in child successfully treated with 9-month drug regimen. Emer Infec Dis 2015; 21(11):2105-6.
 World Health Organization. Guidance for national tuberculosis programmes on the management of tuberculosis in children: Second edition. Geneva; 2014.
 Marais BJ, Hesseling AC, Gie RP, Schaaf HS, Beyers N. The burden of childhood tuberculosis and the accuracy of community-based surveillance data. Int J Tuberc Lung Dis 2006; 10(3):259-263.
 Du Cros P, Swaminathan A, Bobokhojaev OI, Sharifovna ZD, Martin C, Herboczek K. Challenges and solutions to implementing drug-resistant tuberculosis programmes for children in Central Asia. PHA 2015; 5(2):99-102.
 Schaaf HS, Garcia-Prats AJ, Hesseling AC, Seddon JA. Managing multidrug-resistant tuberculosis in children: review of recent developments. Curr Opin Infect Dis 2014; 27 (3): 211-9. Doi: 10.1097/QCO.0000000000000062.
 Aketi L, Shiku DJ, Kashongwe Z, Nkabikueni G, Kayembe KP, Kayembe J-M. Maternal knowledge of tuberculosis and Bacillus Calmette GuÃ©rin vaccination in pediatric health services in Kinshasa. JTR 2017; 5:30-43. ISSN online: 2329-8448.
 Santiago B, Baquero-Artigao F, Mejias A, et al. Pediatric Drug-resistant Tuberculosis in Madrid: Family Matters. Pediatrc Infect Dis J. 2014; 33(4):345-350.
 Guo Q, Pan Y, Yang Z, et al. Epidemiology and clinical characteristics of pediatric drug-resistant tuberculosis in Chongqing, China.PLoS 2016; 11(3):e0151303. Doi:10.1371/journal.pone.0151303
 AlcaÃ¯s A, Fieschi C, Abel L, Casanova J-L. Tuberculosis in children and adults two distinct genetic diseases. J Exp Med 2005; 202 (2):1617-1621. PMID: 16365144
 Yadav S, Rawal G. Primary extrapulmonary multi-drug-resistant tuberculosis in an immunocompetent child presenting with pleural effusion. Transl Pediatr 2017; 6(1):72-75.
 World Health Organization. Guidelines for the Programmatic Management of Drug-resistant Tuberculosis: 2011 Update. Geneva, WHO 2011.
 Ahuja SD, Ashkin D, Avendano M et al. Multidrug resistant pulmonary tuberculosis treatment regimens and patient outcomes: an individual patient data meta-analysis of 9,153 patients. PLoS Med 2012; 9: e1001300.
 Van Deun A, Maug AKJ, Salim MAH, et al. Short, highly effective, and inexpensive standardized treatment of multidrug-resistant tuberculosis. Am J Respir Crit Care Med 2010; 182:684-692.
 Piubello A, Harouna SH, Souleymane MB, et al. High cure rate with standardised short-course multidrug-resistant tuberculosis treatment in Niger: no relapses. Int J Tuberc Lung Dis 2014; 18:1188-1194.
 Kuaban C, Noeske J, Rieder HL, et al. High effectiveness of 12-month regimen for MDR-TB patients in Cameroon. Int J Tuberc Lung Dis 2015; 19: 517-524.
 Stephen HG. The role of moxifloxacin in tuberculosis therapy. Eur Respir Rev 2016; 25:19-28. Doi: 10.1183/16000617.0085-2015
 Johnson JL, Hadad DJ, Boom WH, et al. Early and extended early bactericidal activity of levofloxacin, gatifloxacin and moxifloxacin in pulmonary tuberculosis. Int J Tuberc Dis 2006; 10:605-612.
 Fiseha D, Kumssa H, Tefera M, Tesfaye A, Klinkenberg E, Yimer G. Ambulatory care for multidrug-resistant tuberculosis: lessons learned in Addis Ababa, Ethiopia. PHA 2014; 4(3): S37-S41. doi: 10.5588/pha.14.0058
 Velayutham B, Nair D, Ramalingam S, Perez-Velez CM, Becerra MC, Swaminathan S. Setting priorities for a research agenda to combat drug-resistant tuberculosis in children. PHA 2015; 5(4):222-235.
 Cox HS, Furin JF, Mitnick CD, Daniels C, Cox V, Goemaere E. The need to accelerate access to new drugs for multidrug-resistant tuberculosis. Bull World Health Organ 2015; 93:491â€“497. doi: http://dx.doi.org/10.2471/BLT.14.138925
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