High burden of viral respiratory co-infections in a cohort of children with suspected pulmonary tuberculosis

Abstract

Background The presentation of pulmonary tuberculosis (PTB) in young children is often clinically indistinguishable from other common respiratory illnesses, which are frequently infections of viral aetiology. As little is known about the role of viruses in children with PTB, we investigated the prevalence of respiratory viruses in children with suspected PTB at presentation and follow-up. Methods In an observational cohort study, children < 13 years were routinely investigated for suspected PTB in Cape Town, South Africa between December 2015 and September 2017 and followed up for 24 weeks. Nasopharyngeal aspirates (NPAs) were tested for respiratory viruses using multiplex PCR at enrolment, week 4 and 8. Results Seventy-three children were enrolled [median age 22.0 months; (interquartile range 10.0–48.0); 56.2% male and 17.8% HIV-infected. Anti-tuberculosis treatment was initiated in 54.8%; of these 50.0% had bacteriologically confirmed TB. At enrolment, ≥1 virus were detected in 95.9% (70/73) children; most commonly human rhinovirus (HRV) (74.0%). HRV was more frequently detected in TB cases (85%) compared to ill controls (60.6%) (p = 0.02). Multiple viruses were detected in 71.2% of all children; 80% of TB cases and 60.6% of ill controls (p = 0.07). At follow-up, ≥1 respiratory virus was detected in 92.2% (47/51) at week 4, and 94.2% (49/52) at week 8. Conclusions We found a high prevalence of viral respiratory co-infections in children investigated for PTB, irrespective of final PTB diagnosis, which remained high during follow up. Future work should include investigating the whole respiratory ecosystem in combination with pathogen- specific immune responses.

Respiratory adenovirus infections in children: a focus on Africa

“…Although the highest rates of severe respiratory illness because of HAdV were seen in children less than 5 years of age, the rates of influenza-like illness because of HAdV were highest among individuals aged 5–24 years, indicating that HAdV impacts young people in addition to young children in Africa [ 17 ]. In another South African study, HAdV was detected in 55% of nasopharyngeal aspirates collected in children presenting with presumptive pulmonary tuberculosis [ 18 ].…”

Transcriptomics for child and adolescent tuberculosis*

“…Children and adolescents are infected with multiple pathogens during the first two decades. Consequently, TB-coinfections are common in high TB-prevalence regions, 35 and there is growing recognition that coinfections may influence TB susceptibility, natural history, and the performance of diagnostics. 36,37 Infection with a co-pathogen may provoke an immune response which may disrupt anti-mycobacterial immunological pathways important for controlling and containing Mtb infection.…”