Tuberculosis in infants less than 3 months of age of Risaralda, Colombia

Dear Editor,

We eagerly read a brief original study by Rosal Rabes et al.,¹ who reviewed the cases of tuberculosis (TB) in infants under 3 months of age from 1978 to 2014 at Hospital Universitario de La Paz in Madrid, Spain, and found 8 cases in a total of 555 children under 14 years of age (1.4%). We agree with the interesting and important aspects of the study, and we would like to take advantage of the opportunity to present what is occurring in a department (greater territorial unit) of Colombia, specifically Risaralda, with respect to TB in infants under 3 months of age.

Risaralda is a department in western Colombia with 946,626 inhabitants as of 2014, 1.62% (15,290) of whom are under one year of age. TB is a significant public health problem in this department, with an overall incidence of approximately 25 cases per 100,000 inhabitants (2010).² When the registry of cases of TB in infants under 3 months of age diagnosed with TB in the department of Risaralda between 1 January 2008 and 31 December 2013 was reviewed, it was found that 209 cases of TB had been diagnosed in children under 14 years of age. Among them, 7 were infants under 3 months of age. These accounted for 3.34% of paediatric cases of TB (Table 1).

Table 1.

Characteristics of the infants under 3 months of age with tuberculosis in Risaralda, Colombia, from 2008 to 2013.

Case	Year	Age (days)	Gender	Ethnicity	Time to seek care (days)^a	TB type	BCG scar	Symptoms^b	Culture	Radiographic diagnosis^c	Index case
1	2008	58	Male	Indigenous	25	Meningeal	Yes	Yes	Positive	No	Unknown
2	2011	58	Female	Mixed	0	Pulmonary	Yes	Yes	Not performed	No	Unknown
3	2011	58	Female	Mixed	0	Pulmonary	Yes	Yes	Not performed	Yes	Family/home
4	2012	29	Male	Mixed	1	Meningeal	Yes	Yes	Positive	No	Unknown
5	2013	1	Female	Mixed	0	Pulmonary	No	No	Not performed	Yes	Mother
6	2013	29	Male	Mixed	0	Pulmonary	No	Yes	Positive	Yes	Community
7	2013	58	Male	Indigenous	28	Pulmonary	Yes	Yes	Not performed	No	Family/home

a

Time elapsed between the date on which symptoms started and the date on which care was sought.

b

Symptoms suggestive of TB (fever, cough and respiratory difficulty).

c

Changes suggestive of TB, chest X-ray.

The mean age at the time of diagnosis was 58 days (interquartile range: 29–58 days); 4 were male and one was just one day old (potentially congenital TB). Two were indigenous children, and 4 were from Pueblo Rico, the city with the highest indigenous population in the department. Just one patient was asymptomatic. The time from the onset of symptoms to diagnosis in these cases ranged from 0 to 28 days. Two patients had meningeal TB, and the rest had pulmonary TB (Table 1).

In Colombia, in this population, the tuberculin test has little diagnostic value, as the BCG vaccine is administered at birth. In this series, only 2 of the patients did not have a BCG scar. In 3 cases, culture (gastric aspirate) was performed and found to be positive. In 3 of them, radiographic findings consistent with TB (lymphadenopathy and infiltrates) were found (Table 1). All of them received standard treatment, according to the Colombian national TB management programme³—isoniazid, rifampicin and pyrazinamide (6 months overall, with an initial intensive phase with these 3 drugs daily and then a second biweekly phase with H [isoniazid] and R [rifampicin])—with good tolerance.³ All patients progressed favourably and none died.

As Rosal Rabes et al.¹ affirmed, TB is uncommon in infants under 3 months of age, but potentially very serious, and in many cases, not considered or suspected in newborns. We would like to thank the authors for publishing the study which inspired us to review the subject in question and to think about future more in-depth and prospective studies in this regard, since despite its seriousness, there are few series on TB in newborns and young infants in the literature and in Colombia, and previously no such series in Risaralda.^4,5

Funding

The authors declare that they did not receive any funding to complete this study.

Conflicts of interest

The authors declare that they have no conflicts of interest.