Tuberculosis (tb) Part 6

By Author: Ibrahim Machiwala
Total Articles: 463
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Tuberculosis in Children:
o TB in children is a sentinel event indicating recent transmission, and contacts should be evaluated to find the source case as soon as possible. Fortunately, children commonly do not infect other children because cough is rare and sputum production is scant.

o Diagnosis may be based on the presence of lymphadenopathy on chest radiographs. Most children can be treated with INH and reampin for 6 months, with pyrazinamide for the first 2 months if the culture from the source case is fully susceptible. Gastric aspirates or biopsies are not necessary if cultures can be obtained from the source case.

o In children younger than 5 years, the development of fatal military TB or meningeal TB is a significant concern. TB disease is uncommon in children aged 5 - 15 years (the golden age of childhood).

o INH tablets may be crushed and added to food. INH liquid without sorbitol should be used to avoid osmotic diarrhea, causing decreased food. If rifampin is not tolerated, it may be taken in divided doses 20 minutes after light meals.

o Ethambutol often is avoided in young ...
... children because of difficulties monitoring visual acuity and color perception. However, studies show that ethambutol (15 mg/kg) is well tolerated and can prevent further resistance if the child is infected with a resistant strain.

Human Immunodeficiency Virus:
o Patients with TB must be tested for HIV, and patients with HIV need periodic evaluation for TB with tuberculin skin testing and/or chest radiographs. Patients with HIV and a positive tuberculin skin test develop active TB at a rate of 3-16% per year.

o Patients with TB and HIV are more likely to have disseminated disease and less likely to have upper-lobe infiltrates or cavitary pulmonary disease. Patients with a CD4 count of less than 200 may mediastinal adenopathy with infiltrates.

o Treatment regimens for active or latent TB in patients with HIV are similar to the treatment of individuals who are HIV negative. The most significant differences involve the avoidance of rifampin in the patients who are on protease inhibitors or nonnucleoside reverse-transcriptase inhibitors. Rifabutin may
be used in place of rifampin in patients who are on indinavir, or efavirenz.

o Patients with HIV and may develop a paradoxical response when starting antiretroviral therapy. This response has been attributed to a stronger immune response to M Tuberculosis. Clinical findings include fever, worsening pulmonary infiltrates, and lymphadenopathy.