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Mycobacterium tuberculosis in children with human immunodeficiency virus type 1 infection
Y F Khouri1, M T Mastrucci, C Hutto
1Department of Pediatrics D4-4, University of Miami School of Medicine, FL 33101.
Insights
Children with vertically acquired human immunodeficiency virus type 1 infection and tuberculosis face a higher risk of extrapulmonary disease. Multidrug-resistant tuberculosis is a growing concern in this vulnerable population.
Area of Science:
- Pediatrics
- Infectious Diseases
- Immunology
Background:
- Vertically acquired human immunodeficiency virus type 1 (HIV-1) infection poses significant health challenges in children.
- Tuberculosis (TB) is a major opportunistic infection in individuals with HIV-1.
- Understanding the natural history of TB in vertically HIV-1-infected children is crucial for timely diagnosis and management.
Purpose of the Study:
- To evaluate the natural history of Mycobacterium tuberculosis infection in children with vertically acquired HIV-1 infection.
- To identify common presenting symptoms and disease patterns.
- To assess the impact of drug resistance on treatment outcomes and survival.
Main Methods:
- Retrospective study design.
- Analysis of medical records of nine children with vertically acquired HIV-1 and TB.
- Review of clinical presentation, diagnostic findings, treatment, and outcomes.
Main Results:
- Common symptoms included prolonged fever, cough, and anorexia.
- Five patients had pulmonary TB, three had pulmonary and extrapulmonary TB, and one had extrapulmonary TB.
- Isolates cultured after January 1989 showed resistance to multiple antituberculosis drugs, unlike earlier isolates.
- Median survival time after TB diagnosis was 20 months.
Conclusions:
- Children with vertically acquired HIV-1 and TB have an increased risk of extrapulmonary disease.
- A high index of suspicion for TB is warranted in HIV-1-infected children with persistent fever and respiratory symptoms.
- Empirical therapy with a broader drug panel may be necessary in areas with multidrug-resistant TB.
Abstract:
A retrospective study was conducted at the Childrens Hospital Center at Jackson Memorial Hospital in Miami, FL, to evaluate the natural history of Mycobacterium tuberculosis infection in nine children with vertically acquired human immunodeficiency virus type 1 infection. The patients' ages ranged from 6 months to 7 years (median age, 42 months). Common presenting symptoms included prolonged fever, cough and anorexia. Only one patient had a positive tuberculin test. Five patients evidenced only pulmonary disease, three patients had pulmonary and extrapulmonary disease and one patient developed extrapulmonary tuberculosis (mastoiditis) and pulmonary interstitial disease that could not be attributed to mycobacterial infection because of lack of information. Organisms isolated before January, 1989, were susceptible to isoniazid and rifampin whereas isolates from three patients cultured after that time were resistant to multiple antituberculosis drugs. The median survival time after M. tuberculosis diagnosis for all children was 20 months. Our study suggests that children with human immunodeficiency virus type 1 infection who have tuberculosis have an increased risk for extrapulmonary disease. A high index of suspicion for the diagnosis of M. tuberculosis should be maintained in human immunodeficiency virus type 1-infected children with prolonged fever and respiratory symptoms. In areas of high endemicity of multidrug-resistant organisms, therapy with a broader panel of drugs may need to be instituted until susceptibility testing becomes available.