Case-management of MDR-TB in children: a longitidinal study on 209 cases

Wide spreading of the drug resistance in the adult population makes the evolution of MDR-TB in children a challenge. The aim was to establish the peculiarities of the case-management in children diagnosed with MDR-TB in actual epidemiological conditions in R. Moldova (RM). It was performed a longitudinal study which included 209 children diagnosed with MDR-TB between 2009-2018 in RM. <b>Results:</b> two thirds of the sample-157(75%) were detected by active screening of high risk groups, although the majority-184(88%) were in a closed/family TB contact. Drug susceptibility testing (DST) confirmed drug resistance in 138(65%) children. MDR-TB was established in 71(35%) children using the DST results of the contact/source of infection. Conventional microscopy revealed AFB in 116(55%) cases. GeneXpert was performed in 68(32%) cases diagnosed after 2014 and was positive in 34(16%) cases. Chest X ray revealed mediastinal adenopathy in 77(38%), primary TB complex in 32(16%), infiltrative TB in 94(44%) and pleuresy in 6(3%) cases. General characteristics of the sample: male/female rate 1.1=1, age distribution : 0-4 years 11 months 29 days 53(26%), 5-13 years 11 months 29 days 61(29%) and 14-18 y.o. 92(45%) children. Risk factors identified were: lack of BCG vaccination in 15(7%) and social vulnerability in 63(31%). <b>Conclusions:</b> MDR-TB in children encounters difficulties in management due to low sensibility of microbiological test, high rate of extrapulmonary forms, barriers in healthcare seeking due to social vulnerability. The most affected were adolescents with lung involvement. Above factors were contributing to a raised epidemiological threaten of those children on the healthy community.