6411 Profile of paediatric TB cases in a large East London NHS Trust

Objectives To describe baseline characteristics and clinical profile of children presenting with TB disease to a large NHS Trust in East London. Methods Retrospective review of hospital records including demographic data, clinical presentations, laboratory results, management, and outcomes of children (≤16 years) treated for TB disease (January 2018 to December 2022). Patients were identified through the microbiology and clinical coding departments. Descriptive statistics were performed. Results Twenty-eight children were identified with a median age of 13 years (IQR 9 – 15). Most (n=20, 71%) were female and of Asian ethnicity (18/28, 64%). A nadir of cases was seen in 2020 (n=3, 11%). Most with known vaccination status (11/14, 79%) had received BCG. The most common clinical phenotype was pulmonary (20/28, 71%). Of those with pulmonary TB (n=20), the most common presenting symptoms were cough 18/20 (90%), weight loss 17/20 (85%), night sweats 11/18 (61%) and fever 11/20 (55%). Most children (11/20, 55%) with pulmonary TB had unilateral findings on chest imaging, mostly involving the left lung (8/11, 73%). Of the 16 tested sputum samples, 7 (44%) were acid fact bacilli (AFB) positive and 13 (81%) were positive on TB culture, with a discordant rate of 38%. All negative sputum samples were also AFB negative. Overall, Mantoux and IGRA were positive in 17/20 (85%) and 15/17 (88%) children respectively, with a positive concordance rate of 73% (11/15). The two children with a discordant result (IGRA negative, Mantoux positive) were 1 criteria for shortened treatment (i.e. 4 months). No deaths were recorded in our cohort. Conclusion In our predominantly Asian cohort, a female predominance was seen. The low number of cases seen in 2020 possibly reflects reduced transmission due to the COVID-19 pandemic lockdown measures. Implementing the findings of the SHINE trial (i.e. shorter treatment for minimal TB disease) in the real world is likely to be cost saving and may improve treatment compliance and patient experience. Reference Turkova A, et al. Shorter treatment for nonsevere tuberculosis in African and Indian children. N. Engl. J. Med 2022;386:911– 922. https://doi.org/10.1056/NEJMoa2104535