Since 2018, adolescents have been included as a target group for tuberculosis (TB) surveillance by the WHO. However, they are considered a neglected population, as there are considerable gaps in information about them. We aimed to analyze the risk factors for unfavorable TB treatment outcomes among adolescents in Rio de Janeiro, a Brazilian city with a high burden of TB. This is a retrospective study of adolescents (10-18 years) with TB notified in Rio de Janeiro, from four national database systems, covering 2014-2016. "Extreme vulnerability" was defined as adolescents who presented one of the following characteristics: homelessness, incarceration, tobacco use, illicit drug use, or alcohol abuse. Logistic regression analysis was used to identify factors associated with favorable (cure/completed treatment) and unfavorable outcomes (lost to follow-up, death, and treatment failure). A total of 725 adolescents with TB were included: 610 (84.1%) were cured, 94 (13%) were lost to follow-up, six (0.8%) died because of TB, 13 (1.8%) died because of other causes, and two (0.3%) failed treatment. Unfavorable outcomes were associated with retreatment (adjusted odds ratio [aOR]: 4

From 1989 onward a Down Syndrome (DS) outpatient clinic was started to focus all medical, cytogenetic and counselling aspects for DS patients and their families. Four hundred and sixty DS patients have been attending our hospital during this period ranging in age from birth to adolescence. Since our hospital is a paediatric referral centre in Rio de Janeiro (Brazil), most DS patients are among the paediatric range of individuals seen in our clinic. Furthermore, a specific clinical programme was established with the purpose of monitoring clinical complications, specially those occurring before one year of age.Among 145 DS patients investigated by abdominal ultrasound (US) scans, 16 (11%) biliary tract abnormalities were detected consisting of 10 asymptomatic biliary stones (radiolucence), 3 biliary sludge, and 3 intrinsic gallbladder abnormalities (transverse septum, fibrosis and irregular shape in one patient each). Most of these patients were white (n = 12), male (n = 9) and 14 of them diagnosed before one year of age. None had perinatal complications or total parenteral nutrition and 4 patients underwent surgery with no further complications. Congenital heart disease was present in 6 patients, consisting of isolated VSD (n = 2) combined either with ASD or PDA, isolated ASD (n = 1) and one PDA combined with congenital megacolon. Other abdominal US abnormalities were observed, mainly unilateral nonvisualized kidneys in 2 patients and renal hydronephrosis in 5 patients (one bilateral). On a prospective basis, another DS clinical programme at a paediatric Brazilian hospital at SFio Paulo state (Z. Mustacchi) had similar findings in their patients scanned by us.Therefore, it seems wise to perform at least one ultrasound scan in every DS patient, since a very unusual high frequency of previously unreported abdominal abnormalities can be found and detected at infant age.

Global efforts to eliminate tuberculosis (TB) must address the unique barriers that children (ages 0 through 9 years) and adolescents/young adults (AYA; ages 10 through 24 years) face in adhering to treatment for TB infection and disease. We conducted a narrative review to summarize current knowledge on the social determinants of treatment adherence among these age groups to guide efforts and policy to address their unique needs. Our findings revealed that research on TB treatment adherence among children and AYA is still in its nascent stage. The current literature revealed structural/community-, health system-, household-, and individual-level factors that influence treatment adherence and varied with developmental stage. There is a need to develop multilevel interventions to address the unique challenges that children and AYA face in adhering to TB treatment.

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