Paediatric tuberculosis in a low burden setting of Saudi Arabia: Drug and multidrug resistance patterns

In this study, the infection of young children with Mycobacterium tuberculosis and drug-resistant M. tuberculosis in a mass gathering area in Al-Madinah Al-Munawwarah, was investigated and discussed. All the children, 15 years old and younger, who were referred to the central tuberculosis laboratory in Al-Madinah between January 2012 and December 2014 were included in this study. Among a total of 622 registered new cases, 68 (10.9%) were children, males were 40 (58.8%) while 28 (41.2 %) were females. All the children were vaccinated with Bacillus Calmette-Guerin (BCG) within their first week of birth. Sixty (88.2%) children were infected with M. tuberculosis, whereas 8 (11.8%) had non tuberculous mycobacteria (NTM). Clinically, pulmonary tuberculosis was confirmed in 20 (29.4%) cases, whereas the remaining 48 (70.6%) had extra pulmonary tuberculosis. Multidrug-resistant M. tuberculosis (MDR) was isolated from 3 (4.4%) cases, all of whom were younger than five years; one with pulmonary and two with extrapulmonary tuberculosis. All the isolated MDR organisms belonged to the M. tuberculosis complex. The rates of mono-resistance to isoniazid (H), streptomycin (S), ethambutol (E) and pyrazinamide (Z) were 5.9, 1.5, 5.9 and 8.8%, respectively. No case was registered as mono-resistant to rifampin (R). The prevalence of childhood tuberculosis in the current study area is higher than the globally estimated rate. Since all the cases were new, MDR-TB was mostly due to infection with originally MDR strains.   Key words: Mycobacteria, polymerase chain reaction, resistance, antibiotics, antimicrobials.