Abstract

Background

Multidrug-resistant (MDR) tuberculosis (TB) treatment requires long and potentially toxic drug regimens. In children, TB is hampered by sampling difficulties and few studies report data on MDR-TB in low incidence countries.

Aim

We describe the epidemiology, clinical presentation and outcome of pediatric MDR-TB in Belgium.

Methods

This retrospective multicentric study included all children ≤15 years with confirmed MDR-TB in Belgium from 2001 to 2016. Patients were identified from a national database (BELTA-TBnet registry) and data were abstracted retrospectively from medical records.

Results

Out of 249 cases of MDR-TB recorded in Belgium, 9 were children (3,6%), representing 0,8% of belgian pediatric TB diseases. Median age at diagnosis was 6,6 years (range 1,3-14,6). There were 5 boys and 4 girls. All children had a foreign origin and no child was infected with HIV. Three children (30%) had a history of treated TB and one a history of MDR contact. Five patients presented with pulmonary and 4 with extrapulmonary disease (miliary, meningitis, sub-cutaneous and osteoarticular TB). The oldest patient had an extensively drug-resistant (XDR) strain and a 18 months-old child a pre-XDR one. Patients were treated with different 2nd-line medications according to available guidelines and individual DST results. One child (11% of this group) died from TB meningitis with massive intracranial haemorrhage. Out of 8 children who completed treatment, 5 children (62.5%) who received aminoglycosides developed sensorineural hearing loss and one (12.5%) a peripheral neuropathy.

Conclusion

MDR-TB is a rare condition in children in Belgium and treatment is associated with high rates of adverse reactions.