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