Pediatric tuberculosis and human immunodeficiency virus infection in Palm Beach County, Florida
D. S. Jones, J. M. Malecki, W. J. Bigler, J. J. Witte and M. J. Oxtoby
Division of HIV/AIDS, National Center for Infectious Diseases, Centers for Disease Control, Atlanta, GA 30333.
OBJECTIVE--To describe the factors underlying an increasing incidence of
tuberculosis in children. DESIGN--Descriptive case review. SETTING--Palm
Beach County, Fla. PARTICIPANTS--Forty-four children with suspected and
confirmed pediatric tuberculosis from 1985 through 1989.
INTERVENTIONS--None. MEASUREMENTS/MAIN RESULTS--From 1988 through 1989,
tuberculosis was confirmed in 15 children and suspected in another 16
compared with data from 1985 through 1987 in which the disease was
confirmed in nine children and suspected in four. Pediatric tuberculosis
occurred primarily in blacks younger than 5 years; the increase in the
number of cases reported in 1988 and 1989 occurred only in blacks. One
child in whom tuberculosis was confirmed during the recent period was
infected with the human immunodeficiency virus (HIV); however, among
children with suspected tuberculosis, four of the nine children tested were
seropositive for HIV. There was no evidence of increased transmission of
tuberculosis to children by HIV-seropositive adults compared with
transmission by HIV-seronegative adults with TB. New adult tuberculosis
cases in the county increased annually, from 92 cases in 1986 to 169 in
1989, of whom at least 36% were infected with HIV. CONCLUSIONS--The largest
effect of the HIV epidemic on tuberculosis in children appeared to be
indirect, through an increase in the number of adults with active
tuberculosis serving as potential sources of tuberculosis infection for
children. A direct effect of HIV infection in the progression of
tuberculous disease in children is likely, but was not detected in this
investigation. Case-finding for tuberculosis among children will need to
increase, particularly in areas heavily affected by acquired
immunodeficiency syndrome, but may be complicated by the difficulty of
diagnosing tuberculosis in HIV-infected children.
