Tuberculosis during infancy

SETTING: A worldwide re-emergence of tuberculosis has been observed during the last decade. However, few studies of infants with tuberculosis appear i n the literature. OBJECTIVE: To describe tuberculosis during infancy. DESIGN: The records of all infants diagnosed with tuberculosis at a tertiar y care hospital from 1982 to 1998 were reviewed. RESULTS: Thirty-nine infants with a median age of 10 months were identified , 59% of whom presented during the second half of the study period. Diagnos es included endothoracic tuberculosis (33 patients), meningitis (3), miliar y tuberculosis (2) and cervical lymphadenitis (1). Reasons for medical eval uation were the onset of symptoms (25 patients), contact investigation (12) and tuberculin skin test screening (2). Common signs and symptoms included fever (22 patients), cough (7), appetite loss (4) and wheezing/rales (4). Chest X-ray revealed hilar adenopathy (22 patients), infiltrates (16), atel ectases (3) and miliary pattern (2). Cultures were attempted in nine patien ts and were positive in seven. All patients responded promptly to treatment . No complications or deaths occurred. CONCLUSION: Tuberculosis in infants has been diagnosed increasingly during the last decade. Endothoracic tuberculosis predominates. One third of the p atients were diagnosed due to contact investigation. As early diagnosis and treatment appears to prevent complications and reduce mortality, pediatric ians should be alert for tuberculosis in an infant with an atypical picture suggestive of infection.