Tuberculosis in children with severe acute malnutrition

ABSTRACT

Introduction

With growing attention globally to the childhood tuberculosis epidemic after decades of neglect, and with the burden of severe acute malnutrition (SAM) remaining unacceptably high worldwide, the collision of these two diseases is an important focus for improving child health.

Areas covered

This review describes the clinical and public health implications of the interplay between tuberculosis and SAM, particularly for children under the age of five, and identifies priority areas for improved programmatic implementation and future research. We reviewed the literature on PubMed and other evidence known to the authors published until August 2021 relevant to this topic.

Expert opinion

To achieve the World Health Organization’s goal of eliminating deaths from childhood tuberculosis and to improve the abysmal outcomes for children with SAM, further research is needed to 1) better understand the epidemiologic connections between child tuberculosis and SAM, 2) improve case finding of tuberculosis in children with SAM, 3) assess unique treatment considerations for tuberculosis when children also have SAM, and 4) ensure tuberculosis and SAM are strongly addressed in decentralized, integrated models of providing primary healthcare to children.

KEYWORDS:

• Childhood tuberculosis
• tuberculosis
• severe acute malnutrition

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Supplementary material

Supplemental data for this article can be accessed https://doi.org/10.1080/17476348.2022.2043747

Article highlights

• Understanding the association between childhood tuberculosis (TB) and severe acute malnutrition (SAM), and improved management of co-occurring disease, is important for improving child health globally.

• TB is common in children with SAM, and vice-versa, with mortality tending to increase when these two diseases co-occur.

• Diagnosis of TB in young children is a major challenge globally, and TB case-finding strategies targeted at children with SAM may be high-yield, though diagnosis of TB in children with SAM has unique considerations that are described.

• The pharmacokinetics and pharmacodynamics of antituberculosis drugs in children with SAM may be significantly different compared to nourished children, and understanding these differences is essential for optimizing treatment of TB in children with SAM.

Policy-level and implementation research is needed to shift paradigms and optimize integrated models of health care that address TB and SAM in children.

Declaration of interests

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded. BJV is supported by the National Institute of Allergy and Infectious Diseases of the National Institutes of Health under Award Number T32AI055397. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.