Tuberculosis in children and adolescents in the 1980s

Tuberculosis (TBC) continues to be a major health problem. Between January 1, 1980, and April 30, 1986, 211 children and adolescents presented with a positive tuberculin reaction or symptoms suggestive of tuberculosis. Active disease occurred in 35 (17%); 29 of these had primary infection, whereas 4 adolescents presented with cavitary pulmonary disease and 1 infant each had Pott's disease and cervical adenitis. The proportion of patients with active disease was greater in infants and toddlers; 2 of whom also had meningitis. Two children with active disease were infected with human immunodeficiency virus, 1 of whom died with cavitary tuberculosis. Only 43% of 211 patients were born in the United States. The ethnic distribution was Hispanic 45%, Oriental 30%, Black 18% and other 7%. Bacillus Calmette-Guérin vaccination was documented in 53 (25%) patients; 5 (9%) of these developed active disease. Despite vaccination and the availability of effective drugs, tuberculosis persists and appears to be increasing. Meeting the challenge of tuberculosis in the future will require more rapid diagnostic methods and recognition of the burden of infection in human immunodeficiency disease-infected children, together with revitalization of screening and follow-up programs, especially for toddlers and adolescents.