Determinants of tuberculosis infection and disease in paediatric patients in the Czech Republic after tuberculosis exposure

BACKGROUND: Mycobacterium tuberculosis is a transmissible pathogen most commonly acquired through contact with an infectious individual. Early initiation of tuberculosis (TB) preventive treatment (TPT) in high-risk populations can substantially reduce the risk of TB infection (TBI) and/or progression to active disease. Our objectives were to identify risk factors for children and adolescents developing TBI and TB after exposure and to evaluate the diagnostic utility of chest computed tomography (CT). METHODS: A 6.5-year retrospective cohort study was conducted at a single centre in the Czech Republic to assess risk factors for TBI and TB in children and adolescents (0-18 y). RESULTS: Of 335 children included in the study (median age 6.85 y), TBI was diagnosed in 83 (25%) and TB in 39 (12%). Chest CT in 45 high-risk contacts identified TB in an additional 13 participants. The key TB risk factor was index patients having smear-positive TB (odds ratio [OR] 11.35), while older age of contacts (OR 0.83) and non-household exposure (OR 0.23) had a lower risk of TB. TBI risk increased with age (OR 1.21), index smear-positive patients (OR 4.66) and when the father was the index patient (OR 2.91). Ukrainian refugee children had higher risks of TB (relative risk 3.4). Adherence to TPT in those who qualified was good. CONCLUSIONS: Risk factors for TBI and TB were identified, including children being from Ukraine. Chest CT may aid in early diagnosis of TB.