Tuberculosis in human immunodeficiency virus-infected children. A family infection
S. S. Bakshi, D. Alvarez, C. L. Hilfer, E. M. Sordillo, R. Grover and R. Kairam
Department of Pediatrics, Columbia University College of Physicians and Surgeons, St Luke's Roosevelt Hospital Center, New York, NY.
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.
