CULTURE-POSITIVE TUBERCULOSIS IN HUMAN-IMMUNODEFICIENCY-VIRUS TYPE 1-INFECTED CHILDREN

Background Adults infected by HIV have increased susceptibility to Myc obacterium 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, speci al 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 HN inf ection and culture-proved TB were reviewed, Results, Fourteen (10.4%) of 135 children with vertically transmitted HIV infection, 93% <2 year s of age, fit the criteria. Nonresolving pneumonia (4) and otorrhoea ( 6) were common complaints. A Mantoux test was positive (greater than o r equal to 15 mm) in 6 of 11 children. Extrapulmonary TB was present i n 5 cases. Ear swabs were the source of M. tuberculosis culture in 3, Chest radiographs were abnormal in all with hilar and paratracheal lym phadenopathy present in 7, A source case with pulmonary TB was identif ied for 10, Susceptibility tests were done on 9 strains of which 1 was drug-resistant, Four children were culture-positive 4 to 10 months af ter initiation of TB treatment. Mortality was 21% and 3 were lost to f ollow-up. Conclusions. In HIV-infected children the Mantoux skin test remains useful and culture specimens should be obtained from all sourc es. Response to treatment is unpredictable, and for this reason repeat ed cultures should be taken during treatment and a g-month course of t reatment considered.