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