Culture-positive tuberculosis in human immunodeficiency virus type 1-infected children.
BACKGROUND
Adults infected by HIV have increased susceptibility to Mycobacterium tuberculosis and progress more rapidly to disease. HIV and tuberculosis (TB) coinfection in children has been reported but often lacks bacterial confirmation. We report on the clinical picture, special investigations, clinical course and outcome of 14 children with HIV infection and culture-confirmed TB from a developing country.


METHODS
The clinical records of all children, from 1992 to 1997, with HIV infection and culture-proved TB were reviewed.


RESULTS
Fourteen (10.4%) of 135 children with vertically transmitted HIV infection, 93% <2 years of age, fit the criteria. Nonresolving pneumonia (4) and otorrhoea (6) were common complaints. A Mantoux test was positive (> or =15 mm) in 6 of 11 children. Extrapulmonary TB was present in 5 cases. Ear swabs were the source of M. tuberculosis culture in 3. Chest radiographs were abnormal in all with hilar and paratracheal lymphadenopathy present in 7. A source case with pulmonary TB was identified for 10. Susceptibility tests were done on 9 strains of which 1 was drug-resistant. Four children were culture-positive 4 to 10 months after initiation of TB treatment. Mortality was 21% and 3 were lost to follow-up.


CONCLUSIONS
In HIV-infected children the Mantoux skin test remains useful and culture specimens should be obtained from all sources. Response to treatment is unpredictable, and for this reason repeated cultures should be taken during treatment and a 9-month course of treatment considered.
Department of Paediatrics and Child Health, University of Stellenbosch and Tygerberg Hospital, South Africa.
H S
HS
Schaaf
A
A
Geldenduys
R P
RP
Gie
M F
MF
Cotton
D000995:Antitubercular Agents / Q000627:therapeutic use; D003906:Developing Countries; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000151:congenital*; D015497:HIV-1; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D009169:Mycobacterium tuberculosis / Q000302:isolation & purification; D012189:Retrospective Studies; D014374:Tuberculin Test; D014376:Tuberculosis / Q000150:complications* / Q000175:diagnosis* / Q000188:drug therapy
D000995:Antitubercular Agents