A new study has shown children and adolescents with immunocompromise who contract tuberculosis (TB) experience increased rates of non-respiratory TB and more severe forms of the disease, leading to a higher incidence of associated long-term health complications.
The study also revealed that standard immune-based TB detection tests are not accurate in immunocompromised children and therefore the researchers highlight a need to design prevention and management plans for these children who contract TB to minimise later health issues.
The researchers conducted a retrospective, multicentre, case-control study within the Pediatric Tuberculosis Network (pTBnet) European Trials Group. All participants were aged under 18 and had been treated for or diagnosed with TB at a European centre between 2000 and 2020.
Of the 417 TB cases included, 139 were immunocompromised, including those with human immunodeficiency virus, inborn errors of immunity, drug-induced immunosuppression and other immunocompromising conditions. A control group of 278 non-immunocompromised patients with TB was also included. All data was sourced from the pTBnet database.
Increased rates of non-respiratory TB were found in immunocompromised children compared to controls (32.4% vs 21.2%), and these patients had an increased likelihood of presenting with severe disease (57.6% vs 38.5%).
These children also had significantly higher rates of false-negative tuberculin skin test (31.9% vs 6.0%) and QuantiFERON-TB Gold assay (30.0% vs 7.3%) results at diagnosis. However, the microbiological confirmation rate was similar in immunocompromised and control cases (58.3% vs 49.3%).
Overall, the mortality rate of immunocompromised children was low (<1%), but the rate of long-term health complications resulting from the TB infection was significantly higher in immunocompromised children versus children in the control group (14.8% vs 6.1%).
To improve the long-term health outcomes and decrease the severity of the infection for immunocompromised children, the researchers suggest that future studies focus on better immune-based tests to diagnose TB in these children effectively.
In addition, the researchers emphasise the need for a better understanding of why immunocompromised children have an increased rate of associated long-term health so these children can be better managed at diagnosis and prevention strategies can be put in place to improve outcomes.
Reference
Rodríguez-Molino, P et al. Tuberculosis Disease in Immunocompromised Children and Adolescents: A Pediatric Tuberculosis Network European Trials Group Multicenter Case-control Study. Clinical Infectious Diseases 2024; Jul 15: doi.org/10.1093/cid/ciae158.
