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A Family Infection

Saroj S. Bakshi, MD; Dora Alvarez, MD; Carol L. Hilfer, MD; Emilia M. Sordillo, MD, PhD; Ranjeet Grover, MD; Ram Kairam, MD

Am J Dis Child. 1993;147(3):320-324.

Abstract
• Objective.
—To study the epidemiologic and clinical features of infection with Mycobacterium tuberculosis in human immunodeficiency virus (HIV)–infected children and their families.

Patients and Clinical Setting.
—Sixty families of children with HIV infection, children of HIV indeterminate status, and seroreverters underwent follow-up in a comprehensive multidisciplinary program for children and families.

Methods.
—Infection with M tuberculosis was diagnosed based on a positive Mantoux test result or a positive culture.

Results.
—Mycobacterium tuberculosis infection was diagnosed in seven children (three infected with HIV, three seroreverters, and one uninfected sibling of an infected child) from four families (6%). All infections were detected in the period from March 1990 through January 1992. Six of seven children had a history of exposure to M tuberculosis in an HIV-infected adult (parent) who was an intravenous drug user, homeless, and/or noncompliant with the medical regimen. All HIV-infected children and one seroreverter had pulmonary tuberculosis. One child died of complications of tuberculosis and HIV infection. The M tuberculosis isolated from this child was resistant to isoniazid, rifampin, and streptomycin sulfate.

Conclusions.
—Tuberculosis is a growing problem among inner-city children born to HIV-infected parents. Children infected with HIV in this study had symptomatic and severe disease with tuberculosis, which reflected the drug susceptibility pattern of M tuberculosis seen in our community.

(AJDC. 1993;147:320-324)

Author Affiliations
From the Departments of Pediatrics (Drs Bakshi, Alvarez, Grover, and Kairam), Radiology (Dr Hilfer), and Pathology (Dr Sordillo),Columbia University College of Physicians and Surgeons, St Luke's Roosevelt Hospital Center, New York, NY. Dr Bakshi is currently with North Shore University Hospital—Cornell University Medical College, Manhasset, NY.

Footnotes
Accepted for publication September 16, 1992.

Reprint requests to Department of Pediatrics, Division of Allergy and Immunology, North Shore University Hospital, 300 Community Dr, Manhasset, NY 11030 (Dr Bakshi).

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