MULTIDRUG RESISTANT TUBERCULOSIS IN CHILDREN IN THE DEMOCRATIC REPUBLIC OF CONGO: FIRST EXPERIENCE WITH A SHORT TREATMENT COURSE IN A UNIVERSITY HOSPITAL

Abstract

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.