Case characteristics and trends in pediatric tuberculosis, Maryland, 1986-1993

To identify case characteristics and trends in the incidence of pediatric tuberculosis (TB) in Maryland during the national resurgence of the disease.

The authors conducted a retrospective review of the 248 cases of TB in children ages 19 and younger reported to the state registry between 1986 and 1993.

The incidence of pediatric TB in Maryland, while showing a downward trend between 1986 and 1993, was characterized by a bimodal pattern, with one peak in children younger than age 5 and another peak in adolescents. Certain case characteristics differed significantly according to age: adolescents with TB were more likely to have positive AFB smears, positive cultures, and cavitary X-rays than children in the 0-4 age group. On the other hand, PPD results did not differ significantly by age. Children with TB came from households in zip code areas for which the median family income was lower and the rate of unemployment was higher than comparable statewide figures.

Study findings indicate that (a) the general decline in adult TB in Maryland was accompanied by a decline among children; (b) age-specific case characteristics continue to be useful in clinical decision making for children with suspected TB; and (c) a state TB registry may prove useful not only in tracking disease trends and monitoring statewide control efforts but also in confirming case characteristics, all of which are important disease control issues in a time of fiscal downsizing.