Clinical manifestations and epidemiology of adolescent tuberculosis in Ukraine

Abstract

Background: During adolescence, childhood and adult forms of tuberculosis (TB) overlap, resulting in diverse disease manifestations. Knowing which patient characteristics are associated with which manifestations may facilitate diagnosis and enhance understanding of TB pathophysiology.

Methods: In this cross-sectional study, we included 10-19-year-olds in Ukraine's national TB registry who started TB treatment between 2015 and 2018. Using multivariable regression, we estimated associations between patient characteristics and four presentations of TB: pleural, extrathoracic, cavitary and rifampicin-resistant (RR). We also described the epidemiology of adolescent TB in Ukraine.

Results: Among 2491 adolescent TB cases, 88.4% were microbiologically confirmed. RR-TB was confirmed in 16.9% of new and 29.7% of recurrent cases. Of 88 HIV-infected adolescents, 59.1% were not on antiretroviral therapy at TB diagnosis. Among 10-14-year-olds, boys had more pleural disease (adjusted OR (aOR) 2.12, 95% CI: 1.08-4.37). Extrathoracic TB was associated with age 15-19 years (aOR 0.26, 95% CI: 0.18-0.37) and HIV (aOR 3.25, 95% CI: 1.55-6.61 in 10-14-year-olds; aOR 8.18, 95% CI: 3.58-17.31 in 15-19-year-olds). Cavitary TB was more common in migrants (aOR 3.53, 95% CI: 1.66-7.61) and 15-19-year-olds (aOR 4.10, 95% CI: 3.00-5.73); among 15-19-year-olds, it was inversely associated with HIV (aOR 0.32, 95% CI: 0.13-0.70). RR-TB was associated with recurrent disease (aOR 1.87, 95% CI: 1.08-3.13), urban residence (aOR 1.27, 95% CI: 1.01-1.62) and cavitation (aOR 2.98, 95% CI: 2.35-3.78).

Conclusions: Age, sex, HIV and social factors impact the presentation of adolescent TB. Preventive, diagnostic and treatment activities should take these factors into consideration.

FIGURE 1

Average annual tuberculosis notification rates in adolescents, stratified by age and sex, Ukraine, 2015–2017. Confidence intervals are omitted from this figure as we are presenting the actual notification rate rather than drawing inferences. Data from 2018 were excluded from this figure because there may be a delay of up to 3 months for entering cases into eTB Manager. As a result, even though the data for this analysis were downloaded from eTB Manager in November 2018, the number of notified adolescent TB cases in 2018 cannot be estimated with confidence. Of note, due to the lack of age- and sex-specific data on adolescent HIV prevalence in Ukraine, we could not stratify this analysis by HIV status.

FIGURE 2

Frequency of extrathoracic sites involved in a) exclusively extrathoracic adolescent tuberculosis cases (n=151) and b) cases with both intra- and extrathoracic involvement (n=61), Ukraine, 2015–2018. There are no data on the site from which the specimen was obtained for microbiological confirmation (i.e. specimen could have been obtained from the respiratory tract or the extrathoracic site). Only one reported case involved >1 extrathoracic site, the abdomen and bones and/or joints.