Lung function in South African children following pulmonary tuberculosis or lower respiratory tract infection

Résumé fourni par la source

Introduction: Pulmonary tuberculosis (PTB) may lead to long term lung health impairment in adults, but data is limited in children despite the high burden of PTB in low- and middle-income countries. Aim: To investigate the impact of PTB on lung function and compare this to non-TB LRTI up to 12 months post-TB diagnosis. Methods: Children hospitalised from 2015 to 2024 with suspected PTB were enrolled. Microbiological testing included 2 induced sputa for culture and Xpert Ultra. Participants were classified into 3 groups: confirmed TB (microbiologically positive); unconfirmed TB (clinical diagnosis);non-TB LRTI. Lung function measurements were done at enrolment and follow-up visits: 1 and 3 months for all participants; 6 and 12 months for confirmed or unconfirmed TB. Measures included pre- and post- bronchodilator (BDR) oscillometry and spirometry. Linear mixed effects models were used to explore the association of TB category with lung function z-scores over time. Results: Of 276 children included:112 (41%) had confirmed TB, 113 (41%) unconfirmed TB and 51 (18%) non-TB LRTI; median (IQR) age 8.3 (5.7-11.1) years, 51% female. Children with confirmed TB had lower pre-BDR resistance at 6 Hz z-score (β=-0.54, 95% CI [-0.96, -0.12], p=0.011); lower post BDR z-scores for FEV1 (-0.53 [-1.05, -0.01],p=0.047) and FVC (-0.56 [-1.11, -0.01],p=0.045) compared to non-TB LRTI at 3 months. Lower post-BD FEV1 and FEV1/FVC persisted through 12 months in children with confirmed compared to unconfirmed PTB. Conclusion PTB impacts long term lung function, potentially setting children on a trajectory of impaired health for life, highlighting the need for stronger preventive interventions and follow-up.

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