Demographic and Clinical Characteristics of Mortality Among Children with Tuberculosis in Malaysia

Introduction: Diagnosing tuberculosis in children is challenging; detection of M. tuberculosis in sputum is difficult, x-ray evidence is often non-specific, and tuberculin skin test is less sensitive than in adults. The risk of progression from primary infection is higher, and more rapid, compared to adults1. Therefore, early recognition enables timely diagnosis and treatment of TB among children and prevents mortality. Our objective is to describe the characteristics of children who succumbed from TB in Malaysia. Materials and Methods: This is a retrospective study. Cases were identified through TB Surveillance System Malaysia (TBSS). This study includes children aged 16 years old and below who passed away from TB from 1st January 2018 to 31st December 2020. Results: Eighty-five cases from all over the country were included in this study. Majority were from Sabah (43.5%), Selangor (16.4%) and Wilayah Persekutuan Kuala Lumpur (8.2%). Most of Non-Malaysia nationality TB deaths were from Sabah (n = 26, 72.2%). Median age of death was 8.9 years old (0.4 – 15.9). Duration of death from TB diagnosis was 8.5 days. Majority diseases were pulmonary TB (n = 45, 53%). Extrapulmonary TB (n = 40, 47%) includes meninges, colon, peritoneum and the pharynx. Smear positive TB was only found in 31 children (36.5%). 80% of the mortality was HIV negative, and 12% had unknown retroviral status. Discussion: Almost half of children succumbed had extra-pulmonary TB (EPTB), and median duration from diagnosis to death is less than ten days. This is suggestive of extensive TB disease with late diagnosis. 8.2% were detected via contact screening. Fifty-one (60%) cases had chest x-rays (CXR) done and all had abnormal findings. Acid-fast bacilli test from respiratory secretion were tested positive in 40.3% of those who had it done, and 84% of them were above 5 years old. For children, collection of respiratory secretion for AFB stain is challenging, as they can’t cough out their sputum. There were no records from TBSS on whether or not patients had Tuberculin Skin Test (TST) performed. BCG scar was seen in about 65% of cases. This may reflect poor coverage of immunization among non-Malaysian in Sabah. The percentage of children with unknown HIV status indicates that some children did not have HIV status investigated. EPTB is defined as TB of organs other than the lungs2. Out of all 40 patients with EPTB, about 43% did not have CXR performed. Early diagnosis of TB among children is important to prevent progression of the disease and mortality. This study highlighted the importance of early TB diagnosis and treatment among children in Malaysia. Awareness of the potential difficulty in diagnosing childhood TB is crucial to increase the index of suspicion among attending doctors. Conclusion: Most TB mortality among children in Malaysia were related to late diagnosis and advanced state of the disease. Immediate measures are required to improve the mortality rate.This poster was submitted to the 14th National Conference for Clinical Research (NCCR) on August 18-20 2021. https://nccrconference.com.my