Tuberculosis in human immunodeficiency virus-infected and human immunodeficiency virus-exposed children in New York City

Thomas, Pauline; Bornschlegel, Katherine; Singh, Tejinder; Abrams, Elaine J.; Cervia, Joseph S.; Fikrig, Senih; Lambert, Genevieve; Mendez, Hermann; Kaye, Katherine; Bertolli, Jeanne

doi:10.1097/00006454-200008000-00006

Cited by 34 publications

(20 citation statements)

References 16 publications

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“…In one large paediatric HIV clinic in London, UK, there was an average of two children with HIV per year who presented with active TB over a 15 year period (18/328, 5.5% of HIV infected patients were treated for active TB) [22] and in a US cohort of nearly 1500 HIV infected children, TB disease was found 3%, with an incidence of 0.61 per 100 child-years [23]. In contrast, in high prevalence countries, the incidence of TB disease in HIV positive children is much higher.…”

Section: Epidemiology Of Paediatric Hiv/tb Diseasementioning

confidence: 99%

Tuberculosis and HIV co-infection in children

et al. 2014

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HIV is the top and tuberculosis is the second leading cause of death from infectious disease worldwide, with an estimated 8.7 million incident cases of tuberculosis and 2.5 million new HIV infections annually. The World Health Organization estimates that HIV prevalence among children with tuberculosis, in countries with moderate to high prevalence, ranges from 10 to 60%. The mechanisms promoting susceptibility of people with HIV to tuberculosis disease are incompletely understood, being likely caused by multifactorial processes.Paediatric tuberculosis and HIV have overlapping clinical manifestations, which could lead to missed or late diagnosis. Although every effort should be made to obtain a microbiologically-confirmed diagnosis in children with tuberculosis, in reality this may only be achieved in a minority, reflecting their paucibacillary nature and the difficulties in obtain samples. Rapid polymerase chain reaction tests, such as Xpert MTB/RIF assay, are increasingly used in children. The use of less or non invasive methods of sample collection, such as naso-pharyngeal aspirates and stool samples for a polymerase chain reaction-based diagnostic test tests and mycobacterial cultures is promising technique in HIV negative and HIV positive children. Anti-tuberculosis treatment should be started immediately at diagnosis with a four drug regimen, irrespective of the disease severity. Moreover, tuberculosis disease in an HIV infected child is considered to be a clinical indication for initiation of antiretroviral treatment. The World Health Organization recommends starting antiretroviral treatment in children as soon as anti-tuberculosis treatment is tolerated and within 2- 8 weeks after initiating it. The treatment of choice depends on the child’s age and availability of age-appropriate formulations, and potential drug interactions and resistance. Treatment of multi-drug resistant tuberculosis in HIV-infected children follows same principles as for HIV uninfected children. There are conflicting results on effectiveness of isoniazid preventive therapy in reducing incidence of tuberculosis disease in children with HIV.ConclusionData on HIV/TB co-infection in children are still lacking. There are on-going large clinical trials on the prevention and treatment of TB/HIV infection in children that hopefully will help to guide an evidence-based clinical practice in both resource-rich and resource-limited settings.

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Section: Epidemiology Of Paediatric Hiv/tb Diseasementioning

confidence: 99%

Tuberculosis and HIV co-infection in children

et al. 2014

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“…15,27-29,32-37 HIV-infected children have an increased risk of developing pulmonary TB and of complicated or disseminated disease compared to uninfected children. [32][33][34] Co-infection with M. tuberculosis and HIV results in more rapid deterioration of immune dysfunction, viral replication, and HIV progression, and more frequent, severe other infections. [35][36][37][38] Symptoms, and signs of TB may be chronic, and nonspecific, including weight loss, failure to thrive, fever or persistent respiratory symptoms.…”

Section: Mycobacterial Infectionsmentioning

confidence: 99%

Chronic lung disease in human immunodeficiency virus (HIV) infected children

Zar

2007

Pediatric Pulmonology

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The development of chronic lung disease is common in HIV‐infected children. The spectrum of chronic HIV‐associated lung disease includes lymphocytic interstitial pneumonia (LIP), chronic infections, immune reconstitution inflammatory syndrome (IRIS), bronchiectasis, malignancies, and interstitial pneumonitis. Chronic lung disease may result from recurrent or persistent pneumonia due to bacterial, mycobacterial, viral, fungal or mixed infections. In high tuberculosis (TB) prevalence areas, M. tuberculosis is an important cause of chronic respiratory illness. With increasing availability of highly active antiretroviral therapy (HAART) for children in developing countries, a rise in the incidence of IRIS due to mycobacterial or other infections is being reported. Diagnosis of chronic lung disease is based on chronic symptoms and persistent chest X‐ray changes but definitive diagnosis can be difficult as clinical and radiological findings may be non‐specific. Distinguishing LIP from miliary TB remains a difficult challenge in HIV‐infected children living in high TB prevalence areas. Treatment includes therapy for specific infections, pulmonary clearance techniques, corticosteroids for children with LIP who are hypoxic or who have airway compression from tuberculous nodes and HAART. Children who are taking TB therapy and HAART need adjustments in their drug regimes to minimize drug interactions and ensure efficacy. Preventative strategies include immunization, chemoprophylaxis, and micronutrient supplementation. Early use of HAART may prevent the development of chronic lung disease. Pediatr Pulmonol. 2008; 43:1–10. © 2007 Wiley‐Liss, Inc.

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“…Overall, two (6%) of 33 cases were co-infected with HIV; one of these was a previously reported (suspect) TB case, and the other was a confirmed case that had been undetected by alternative surveillance. Numerous studies have emphasized the benefits of sharing information between healthcare agencies, 11,26,27,32 but this strategy can be difficult to implement due to patient confidentiality. 27 Previous studies have demonstrated under-notification of TB, ranging from 12% to 94%, in patients with known HIV infection or AIDS.…”

Section: Discussionmentioning

confidence: 99%

“…4,8,9 The NYC DOH and the Centers for Disease Control and Prevention (CDC) have also sponsored two ongoing active surveillance programs to assess co-infection with HIV and TB in children: the Pediatric Spectrum of Disease and Pediatric AIDS Surveillance. 10,11 To assess the completeness of reporting of pediatric TB cases to the NYC DOH Bureau of TB Control from January 1993 to December 1995, hospital-based alternative surveillance was developed to detect previously unreported cases of TB in children in our targeted surveillance area. The TB and TB/HIV cases identified by alternative surveillance were compared with cases previously reported to the NYC DOH during the same time period.…”

mentioning

confidence: 99%

Completeness of pediatric TB reporting in New York City

Gabriel¹,

Saiman²,

Kaye³

et al. 2003

Public Health Reports

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SYNOPSISObjectives. Accurate surveillance of tuberculosis (TB) in children is critical because such cases represent recent transmission, but surveillance is difficult as only 10% to 50% of cases are culture-confirmed. Hospital-based sources were used to develop alternative surveillance to assess completeness of reporting for pediatric TB in northern Manhattan and Harlem from 1993 through 1995.Methods. Alternative surveillance sources included ICD-9-CM hospital discharge codes for active TB and gastric aspirate reports. Cases identified by alternative surveillance were compared with cases previously reported to the New York City Department of Health (NYC DOH).Results. Alternative surveillance detected 25 cases of possible pediatric TB, of which four (16%) had never been reported to the NYC DOH and three (12%) had been reported as suspect cases, but had not fulfilled the criteria for a reportable case of pediatric TB. Of these seven newly counted cases, three were detected by ICD-9-CM codes, three by a gastric aspirate log book, and one by both. In contrast, 13 other cases had been reported to the NYC DOH, but were undetected by our alternative surveillance; eight of these could be verified with available medical records. Thus, the demographic and clinical characteristics of the 25 detected and the eight undetected cases with available medical records were evaluated in this study.Conclusions. Alternative surveillance proved effective, was complementary to the NYC DOH surveillance efforts, and increased the number of pediatric TB cases identified during the study period by 21%.

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Tuberculosis in human immunodeficiency virus-infected and human immunodeficiency virus-exposed children in New York City

Cited by 34 publications

References 16 publications

Tuberculosis and HIV co-infection in children

Tuberculosis and HIV co-infection in children

Chronic lung disease in human immunodeficiency virus (HIV) infected children

Completeness of pediatric TB reporting in New York City

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