High burden of viral respiratory co-infections in a cohort of children with suspected pulmonary tuberculosis
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(2020) 20:924
RESEARCH ARTICLE
Open Access
High burden of viral respiratory coinfections in a cohort of children with suspected pulmonary tuberculosis M. M. van der Zalm1*, E. Walters1,2, M. Claassen3, M. Palmer1, J. A. Seddon1,4, A.M. Demers1, M. L. Shaw5,6, E. D. McCollum7,8,9, G. U. van Zyl3† and A. C. Hesseling1†
Abstract Background: The presentation of pulmonary tuberculosis (PTB) in young children is often clinically indistinguishable from other common respiratory illnesses, which are frequently infections of viral aetiology. As little is known about the role of viruses in children with PTB, we investigated the prevalence of respiratory viruses in children with suspected PTB at presentation and follow-up. Methods: In an observational cohort study, children < 13 years were routinely investigated for suspected PTB in Cape Town, South Africa between December 2015 and September 2017 and followed up for 24 weeks. Nasopharyngeal aspirates (NPAs) were tested for respiratory viruses using multiplex PCR at enrolment, week 4 and 8. Results: Seventy-three children were enrolled [median age 22.0 months; (interquartile range 10.0–48.0); 56.2% male and 17.8% HIV-infected. Anti-tuberculosis treatment was initiated in 54.8%; of these 50.0% had bacteriologically confirmed TB. At enrolment, ≥1 virus were detected in 95.9% (70/73) children; most commonly human rhinovirus (HRV) (74.0%). HRV was more frequently detected in TB cases (85%) compared to ill controls (60.6%) (p = 0.02). Multiple viruses were detected in 71.2% of all children; 80% of TB cases and 60.6% of ill controls (p = 0.07). At follow-up, ≥1 respiratory virus was detected in 92.2% (47/51) at week 4, and 94.2% (49/52) at week 8. Conclusions: We found a high prevalence of viral respiratory co-infections in children investigated for PTB, irrespective of final PTB diagnosis, which remained high during follow up. Future work should include investigating the whole respiratory ecosystem in combination with pathogen- specific immune responses. Keywords: Respiratory viruses, pulmonary tuberculosis, Paediatric
Background An estimated 1 million children < 15 years develop tuberculosis (TB) every year [1]. Pulmonary TB (PTB) contributes to approximately 75% of the TB disease burden in children, and is difficult to confirm given the paucibacillary nature of the disease and challenges in obtaining good * Correspondence: [email protected] † GU van Zyl and AC Hesseling are shared senior authors. 1 Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa Full list of author information is available at the end of the article
quality respiratory samples in young children [2]. Moreover, the clinical diagnosis of PTB in children is frequently complicated by non-specific clinical presentations, which overlap with other common respiratory illnesses [3]. This is especially true in young children living in developing countries, particularly in settings where human immunodeficie
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