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Clinical manifestation and outcome of tuberculosis in children with acquired immunodeficiency syndrome

CHAN, SIU PUN MBBS; BIRNBAUM, JEFFREY MD, MPH; RAO, MADU MD; STEINER, PHILLIP MD

The Pediatric Infectious Disease Journal: May 1996 - Volume 15 - Issue 5 - p 443-447
Original Studies

Background Atypical clinical manifestations and rapid progression of tuberculous disease (TB) are well-recognized in adults with the acquired immunodeficiency syndrome (AIDS). There are few reports of children with AIDS and TB. We report the manifestations, clinical course and outcome of 12 pediatric patients with AIDS and TB.

Methods The charts of all children admitted to our institution, from 1989 through 1994, with the diagnoses of AIDS and culture-proved TB were reviewed.

Results Twelve children between the ages of 2 months and 13 years fit the criteria. The mean time between the diagnosis of AIDS and TB was 20 months. The most frequent presenting symptoms were fever (75%) and tachypnea (33%). All had negative Mantoux tests (5 tuberculin units of purified protein derivative). Extrapulmonary TB was present in 3 (25%). A source case was identified for 4 (33%). Previous pulmonary disease was present in 7 (58%). Chest roentgenograms were abnormal in 11 (91%), with diffuse interstitial infiltration the most common finding. Susceptibility tests were performed on 10 strains, 3 of which were resistant to 1 or more antituberculosis drugs. Three patients (25%) died of TB, 1 of whom was appropriately treated with antituberculosis drugs but had a strain resistant to isoniazid and rifampin.

Conclusion Children with AIDS and TB most frequently present with atypical manifestations of TB. A high index of suspicion is needed to correctly diagnose TB in this group of children. Early diagnosis is important because most respond well when treated appropriately.

From the Pediatric Pulmonology Service, Staten Island University Hospital, Staten Island, NY (SPC), and the Department of Pediatrics, State University of New York Health Science Center at Brooklyn, Brooklyn, NY (JB, MR, PS).

Accepted for publication Feb. 15, 1996.

Address for reprints: Dr. Siu Pun Chan, Department of Pediatrics, Staten Island University Hospital, 475 Seaview Avenue, Staten Island, NY 10305. Fax 718-270-4785.

© Williams & Wilkins 1996. All Rights Reserved.