Risk factors for latent tuberculosis in children who had close contact to households with pulmonary tuberculosis

Dong Hoon Min; Hwa Hyun Wy; Jae Won Shim; Duk Soo Kim; Hye Lim Jung; Moon Soo Park; Jung Yeon Shim

doi:10.4168/aard.2017.5.2.105

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Min, Wy, Shim, Kim, Jung, Park, and Shim: Risk factors for latent tuberculosis in children who had close contact to households with pulmonary tuberculosis

Original Article

Allergy Asthma Respir Dis 2017;5(2):105-110.

Published online: 5 March 2017

DOI: https://doi.org/10.4168/aard.2017.5.2.105

Risk factors for latent tuberculosis in children who had close contact to households with pulmonary tuberculosis

Dong Hoon Min, Hwa Hyun Wy, Jae Won Shim, Duk Soo Kim, Hye Lim Jung, Moon Soo Park, Jung Yeon Shim

Department of Pediatrics, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea

Correspondence to: Jung Yeon Shim http://orcid.org/0000-0001-9367-2233 Department of Pediatrics, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, 29 Saemunan-ro, Jongno-gu, Seoul 03181, Korea Tel: +82-2-2001-2200, Fax: +82-2-2001-2199, E-mail: jy7.shim@samsung.com

Received 8 August 201624 September 2016 Accepted 27 September 2016

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

Tuberculosis (TB) is a common and possibly fatal infectious disease, and its incidence and prevalence is quite high in Korea compared to other Organization for Economic Co-operation and Development countries. Patients who have active TB can cause latent tuberculosis infection (LTBI) in children, which may progress to reactivated tuberculosis. This study was performed to analyze the risk of adult TB that affects children's LTBI.

Methods

From June 2013 to May 2014, 60 children (32 boys, 28 girls) who came into close contact with adult patients diagnosed with pulmonary TB underwent LTBI tests. The children were divided into the 2 groups: the first group was finally diagnosed to LTBI, and the second group was proven not to have LTBI. We compared the risk of adult patients with pulmonary TB between children with LTBI and those without through a medical record review.

Results

The number of adult patients with TB was 36 (father 68%, mother 23%, grandparents 8%). The patients who came into close contact with the LTBI group were older (47.0±12.8 years vs. 41.3±6.6 years) and had higher erythrocyte sedimentation rate (ESR) levels than those of the second group. The rate of negative acid-fast-bacilli smear with positive culture results in patients who came into contact with the LBTI group was higher than in the second group. The cutoff value of ESR for the diagnosis of LTBI was 31 mm/ hr with a sensitivity of 0.75 and a specificity of 0.85 (area under curve=0.748).

Conclusion

Adult pulmonary TB patients who are older and have higher ESR levels may be risk factors for LTBI in children coming into close contact with them.

Keywords: Tuberculosis, Latent infection, Risk factor, Erythrocyte sedimentation rate, Child

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Fig. 1.

Receiver operating characteristic (ROC) analysis for erythrocyte sedimentation rate (ESR) of infection source in the diagnosis of latent tuberculosis in children who were household contacts of an adult with pulmonary tuberculosis. Blood ESR levels of adults with pulmonary tuberculosis exhibited an ability (area under curve=0.748) in distingushing latent tuberculosis in children. The optimal cutoff was 31 mm/hr, and the sensitivity and and specificity were 75.0% and 85.0%, respectively.

Table 1.

Characteristics of the study subjects (n=60)

Characteristic	No. (%)
Male sex	32 (53.3)
Age (yr)
<2	7 (11.7)
2–5	10 (16.7)
>5	43 (71.7)
Latent tuberculosis	25 (41.7)
1st≥10 mm	16 (26.6)
Positive conversion	9 (15.0)
Positive IGRA	4/10 (40)
Latent tuberculosis treatment	25 (41.7)
Adverse effect	1 (1.6)
Infection source
Father	41 (68.3)
Mother	14 (23.3)
Grandparents	5 (8.3)

IGRA, interferon gamma release assay.

Table 2.

Clinical characteristics of infection source (n=36)

Infection source	Value
Age (yr)	43 (27–76)
Male sex	24 (66.7)
Symptom (+)	19 (52.8)
Sputum TB stain (+)	17 (47.2)
Sputum TB culture (+)	26 (72.2)
Sputum TB PCR (+)	27 (75)
Bronchoalveolar lavage (+)	2/3 (67)
IGRA	5/5 (100)
Follow-up sputum TB culture (+)	3 (8.3)
Mycobacterium tuberculosis (+)	26/26 (100)
Isoniazid resistant	1/26 (3.8)
Cavity	7 (19.4)
Tree in bud	6 (16.7)
Centrilobular nodule	29 (80.6)
Consolidation	6 (16.7
Location
Right upper lobe	25 (69.4)
Right middle lobe	6 (16.7)
Right lower lobe	6 (16.7)
Left upper lobe	16 (41.7)
Left lower lobe	4 (11.1)
Number of lobes
1	26 (72.2)
≥2	10 (27.8)
TB pleurisy (+)	7 (19.4)

Values are presented as mean (range) or number (%).

TB, tuberculosis; PCR, polymerase chain reaction; IGRA, Interferon gamma release assay.

Table 3.

Comparison of factors in infection source between children with and without latent tuberculosis

Variable	Latent TB (-) (n=35)	Latent TB (+) (n=25)	P-value	Odd ratio	95% CI
Age (yr)	41.3±6.6	47.0±12.8	0.03	1.067	1.001–1.137
Sex	22 (62.8)	19 (82.6)	0.11	0.356	0.099–1.278
Positive sputum TB stain	10 (30.3)	7 (28.0)	0.85	0.894	0.284–2.813
Positive sputum TB culture	13 (39.4)	14 (56.0)	0.21	1.958	0.682–5.618
Positive sputum TB PCR	18 (54.5)	12 (48.0)	0.61	0.769	0.271–2.180
Negative sputum AFB stain with positive culture	3 (9.1)	7 (28.0)	0.05	3.888	0.891–16.970
WBC (×10⁹/L)	6.597±1.963	7.217±3.563	0.40	1.000	0.999–1.000
Hb (g/dL)	14.0±2.2	14.3±1.4	0.62	1.217	0.900–1.646
CRP (mg/dL)	1.5±0.5	3.6±1.6	0.06	1.173	0.971–1.416
ESR (mm/hr)	18.8±3.9	45.1±9.6	0.01	1.045	1.006–1.087
Symptom	17 (48.6)	16 (64.0)	0.24	1.882	0.657–5.388
TB pleurisy	4 (12.5)	6 (21.4)	0.35	2.963	0.633–13.868
Cavity	7 (20.0)	4 (16.0)	0.69	0.762	0.197–2.946
Tree in bud	6 (17.1)	3 (12.0)	0.58	0.659	0.148–2.932
Centrilobular nodule	27 (77.1)	24 (96.0)	0.04	7.111	0.828–61.068
Consolidation	6 (17.1)	4 (16.0)	0.91	0.921	0.231–3.675
No. of lobes			0.14	0.219	0.024–1.959
1	25 (78.1)	24 (85.7)
≥2	7 (21.9)	4 (14.3)
Contact households			0.06	1.182	0.531–2.629
Father	23 (65.7)	18 (72.0)
Mother	11 (31.4)	3 (12.0)
Grandparents	1 (2.9)	4 (16.0)

Values are presented as mean±standard deviation or number (%).

TB, tuberculosis, CI, confidence interval; PCR, polymerase chain reaction; AFB, acid-fast bacilli; WBC, white blood cell; Hb, hemoglobin; CRP, C-reactive protein; ESR, erythrocyte sedimentation rate.

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