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Fate or missed opportunities - challenges in diagnosing paediatric drug resistant tuberculosis in Germany

Hannah Schäfer, Michael Barker, Peter Follmann, Annette Günther, Petra Kaiser-Labusch, Sebastian Kerzen, Christian Schmidt, Katharina Schütz, Florian Stehling, Nina Timmesfeld, Paul Vöhringer, Folke Brinkmann
European Respiratory Journal 2021 58: PA3149; DOI: 10.1183/13993003.congress-2021.PA3149
Hannah Schäfer
1Ruhr University Bochum, St.Josef-Hospital, University Hospital of Paediatrics and Adolescent Medicine, Department of Paediatric Pulmonology, Bochum, Germany
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  • For correspondence: Hannah-lena.schaefer@rub.de
Michael Barker
2Children’s Hospital, Lungenklinik Heckeshorn, Helios Klinikum Emil von Behring, Berlin, Germany
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Peter Follmann
3Klinik für Kinder- und Jugendmedizin, Westpfalz-Klinikum, Kaiserslautern, Germany
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Annette Günther
2Children’s Hospital, Lungenklinik Heckeshorn, Helios Klinikum Emil von Behring, Berlin, Germany
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Petra Kaiser-Labusch
4Professor-Hess-Children’s Hospital, Bremen, Germany
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Sebastian Kerzen
5Department of Paediatric Pneumology and Allergy, University Children`s Hospital Regensburg, Campus St. Hedwig, Regensburg, Germany
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Christian Schmidt
6Children`s Hospital, St. Vinzenz-Hospital, Dinslaken, Germany
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Katharina Schütz
7Klinik für Pädiatrische Pneumologie, Allergologie und Neonatologie, Medizinische Hochschule Hannover, Hannover, Germany
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Florian Stehling
8University Hospital Essen, Centre for Pediatrics, Essen, Germany
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Nina Timmesfeld
9Abteilung für Medizinische Informatik, Biometrie und Epidemiologie, Ruhr-Universität Bochum, Bochum, Germany
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Paul Vöhringer
10Franz-Lust-Klinik Children`s Hospital, Städt. Klinikum Karlsruhe, Karlsruhe, Germany
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Folke Brinkmann
1Ruhr University Bochum, St.Josef-Hospital, University Hospital of Paediatrics and Adolescent Medicine, Department of Paediatric Pulmonology, Bochum, Germany
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Abstract

Background: Diagnosis and treatment of paediatric tuberculosis resistant to both isoniazid and rifampicin (MDR-pTB) remain challenging due to paucibacillary disease, low sensitivity and specificity of diagnostic tools and frequently changing guidelines

Aims and objective: This study aimed to describe epidemiology, clinical characteristics and outcome of MDR-TB among children and adolescents in Germany.

Methods: We collected all cases of MDR-pTB registered in Germany from 2010 to 2020 and compared their data to an adequate control sample with drug-sensitive TB.

Results: 52 subjects with MDR-pTB (24 active MDR-TB, 28 MDR-LTBI) and 56 controls were included. The annual incidence of MDR-TB rose from two in 2010 to nine in 2020. Time to diagnosis was longer in MDR-pTB compared to drug-sensitive TB (43 vs. 8 days, p <0.001) and did not change during the observational period while the time to diagnose drug-sensitive TB decreased. Most children with MDR-TB were born in countries of the former Soviet Union (48% vs. 8%, p <0.001) and have an index with drug-resistant-TB (97.7% vs. 2.8%, p <0.001). Most patients (85%) recovered, but 20% of MDR patients suffered from long-term side effects.

Conclusions: Early diagnosis, identification of potential MDR index, appropriate treatment and follow-up are essential in MDR-pTB. Therefore, better cooperation between clinics and public health care is required in Germany. In children with an MDR-TB index case or in those born in a MDR high-incidence country, bacteriological confirmation including PCR-based susceptibility testing should always be initiated. The individual drug regimen has to be adapted to the patients’ or index’ susceptibility testing results.

  • Children
  • MDR-TB (multidrug-resistant tuberculosis)
  • Adolescents

Footnotes

Cite this article as: European Respiratory Journal 2021; 58: Suppl. 65, PA3149.

This abstract was presented at the 2021 ERS International Congress, in session “Prediction of exacerbations in patients with COPD”.

This is an ERS International Congress abstract. No full-text version is available. Further material to accompany this abstract may be available at www.ers-education.org (ERS member access only).

  • Copyright ©the authors 2021
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Fate or missed opportunities - challenges in diagnosing paediatric drug resistant tuberculosis in Germany
Hannah Schäfer, Michael Barker, Peter Follmann, Annette Günther, Petra Kaiser-Labusch, Sebastian Kerzen, Christian Schmidt, Katharina Schütz, Florian Stehling, Nina Timmesfeld, Paul Vöhringer, Folke Brinkmann
European Respiratory Journal Sep 2021, 58 (suppl 65) PA3149; DOI: 10.1183/13993003.congress-2021.PA3149

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Fate or missed opportunities - challenges in diagnosing paediatric drug resistant tuberculosis in Germany
Hannah Schäfer, Michael Barker, Peter Follmann, Annette Günther, Petra Kaiser-Labusch, Sebastian Kerzen, Christian Schmidt, Katharina Schütz, Florian Stehling, Nina Timmesfeld, Paul Vöhringer, Folke Brinkmann
European Respiratory Journal Sep 2021, 58 (suppl 65) PA3149; DOI: 10.1183/13993003.congress-2021.PA3149
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