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