| Tuberculosis in Children:o TB in children is a sentinel | | | | resistance if the child is infected with a resistant |
| event indicating recent transmission, and contacts | | | | strain. |
| should be evaluated to find the source case as soon | | | | Human Immunodeficiency Virus:o Patients with TB |
| as possible. Fortunately, children commonly do not | | | | must be tested for HIV, and patients with HIV need |
| infect other children because cough is rare and | | | | periodic evaluation for TB with tuberculin skin testing |
| sputum production is scant.o Diagnosis may be based | | | | and/or chest radiographs. Patients with HIV and a |
| on the presence of lymphadenopathy on chest | | | | positive tuberculin skin test develop active TB at a |
| radiographs. Most children can be treated with INH | | | | rate of 3-16% per year.o Patients with TB and HIV |
| and reampin for 6 months, with pyrazinamide for the | | | | are more likely to have disseminated disease and less |
| first 2 months if the culture from the source case is | | | | likely to have upper-lobe infiltrates or cavitary |
| fully susceptible. Gastric aspirates or biopsies are not | | | | pulmonary disease. Patients with a CD4 count of less |
| necessary if cultures can be obtained from the | | | | than 200 may mediastinal adenopathy with |
| source case.o In children younger than 5 years, the | | | | infiltrates.o Treatment regimens for active or latent |
| development of fatal military TB or meningeal TB is a | | | | TB in patients with HIV are similar to the treatment |
| significant concern. TB disease is uncommon in | | | | of individuals who are HIV negative. The most |
| children aged 5 - 15 years (the golden age of | | | | significant differences involve the avoidance of |
| childhood).o INH tablets may be crushed and added | | | | rifampin in the patients who are on protease inhibitors |
| to food. INH liquid without sorbitol should be used to | | | | or nonnucleoside reverse-transcriptase inhibitors. |
| avoid osmotic diarrhea, causing decreased food. If | | | | Rifabutin maybe used in place of rifampin in patients |
| rifampin is not tolerated, it may be taken in divided | | | | who are on indinavir, or efavirenz.o Patients with HIV |
| doses 20 minutes after light meals.o Ethambutol | | | | and may develop a paradoxical response when |
| often is avoided in young children because of | | | | starting antiretroviral therapy. This response has been |
| difficulties monitoring visual acuity and color | | | | attributed to a stronger immune response to M |
| perception. However, studies show that ethambutol | | | | Tuberculosis. Clinical findings include fever, worsening |
| (15 mg/kg) is well tolerated and can prevent further | | | | pulmonary infiltrates, and lymphadenopathy. |