432. FACTORS ASSOCIATED WITH PEDIATRIC CENTRAL NERVOUS SYSTEM (CNS) TUBERCULOSIS (TB) IN CALIFORNIA, 19932011
Session: Poster Abstract Session: Pediatric Infections
Thursday, October 3, 2013
Room: The Moscone Center: Poster Hall C
Posters
  • CNS TB poster.pdf (1.0 MB)
  • Background:

    CNS TB has higher morbidity and mortality rates than other forms of TB and frequently affects children. A previous analysis showed an increase in the proportion of California pediatric TB cases involving the CNS. We sought to identify factors associated with CNS TB among children with TB, and describe their outcomes.

    Methods:

    We analyzed California TB registry data for persons aged 0–18 years diagnosed with TB during 1993–2011. CNS TB cases included cases with a CNS site of disease or a positive culture from the CNS. All other cases were non-CNS TB cases. Bivariate and multivariate analyses of clinical and demographic characteristics were performed.

    Results:

    Of 6,193 cases of pediatric TB in California, 200 (3.2%) were CNS TB. Cases occurred in 23 of 46 jurisdictions reporting pediatric TB, with 63.5% reported by 3 counties in southern California.  CNS TB cases were more likely 0–4 years old (72% versus 44%, p<.0001), Hispanic (75% versus 63%, p=.0006) and U.S.-born (82% versus 58%, p<.0001). Tuberculin Skin Test (TST) positivity (≥5mm) was lower in CNS TB cases (62% versus 94%, p<.0001). Factors associated with CNS TB in multivariate analysis included age <5 years (versus 15–18 years; odds ratio [OR] 2.6; 95%-confidence interval [CI] 1.6–4.2), Hispanic ethnicity (versus non-Hispanic white; OR 2.5; CI 1.0–6.3), U.S.-birth (OR 1.9; CI 1.3–2.9) and TST positivity (OR 0.1; CI 0.1–0.2). Mortality was high in CNS TB cases (4.5% versus 0.4%, p<.0001). After adjusting for demographics and provider type, TST positivity (OR 0.1; CI 0.03–0.3), culture positivity (OR 4.5; 1.6–12.4), and CNS TB (OR 5.1; CI 1.8–14.1) were associated with death among children with TB.

    Conclusion:

    Among children with TB in California, younger age, Hispanic ethnicity and U.S.-birth are associated with CNS TB. TST should not be used to rule out CNS TB. Because nearly all foreign-born children were born in countries where Bacille-Calmette Guerin (BCG) vaccine is given at birth and BCG can result in TST positivity, these results could reflect a protective effect of BCG.

    Alexandra Duque-Silva, MD1, Katherine Robsky, MPH2, Jennifer Flood, MD, MPH3 and Pennan Barry, MD, MPH2, (1)Infectious Diseases, Children's Hospital and Research Center Oakland, Oakland, CA, (2)Tuberculosis Control Branch, California Department of Public Health, Richmond, CA, (3)California Department of Public Health, Tuberculosis Control Branch, Richmond, CA

    Disclosures:

    A. Duque-Silva, None

    K. Robsky, None

    J. Flood, None

    P. Barry, None

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