Kumar Alok, Upadhyay Sanjay, Kumari Geeta
School of Clinical Medicine and Research, University of the West Indies, West Indies.
Curr HIV Res. 2007 Sep;5(5):499-504. doi: 10.2174/157016207781662434.
We studied the clinical presentation, diagnosis, treatment outcome and survival in children with HIV and Tuberculosis (TB) co-infection.
All HIV infected children with symptoms or signs consistent with tuberculosis were screened. We studied 24 cases of culture confirmed TB from among a cohort of 213 HIV infected children. All these children were on HAART for their HIV infection. Information on TB was collected by retrospective chart review of these children.
In a cohort of 213 children with vertically transmitted HIV infection, a total of 76 (36%) children suspected to have tuberculosis based on their clinical presentation together with either a positive Mantoux test or AFB positivity and treated for TB. Twenty four children had culture positive TB. The median age at diagnosis of TB was 16 months. Over half of these children had some immunodeficiency. Common presentations were fever (87%), history of contact with an open case of TB (79%), cough for more than 2 weeks (75%), malnutrition (71%), hepatosplenomegaly (71%), chronic diarrhea (67%) and generalized lymphadenopathy (58%). Mantoux test result was positive in 12 (50%) patients. Chest roentgenograms were abnormal in all the children, with hilar and/or Para tracheal node (62%) and lobar or segmental opacification (57%). Twenty one (87%) children had pulmonary TB at the time of their diagnosis. One or more sites of Extrapulmonary TB were confirmed in 10 (41%) patients. After six months of ATT, the cure rate was 64%. Three patients had documented drug-resistant. Five children (20%) died.
TB is a common co-infection in HIV infected children and children often present with un-resolving pneumonia. It carries significant mortality despite the HAART and adequate anti-tuberculosis treatment in these children.
我们研究了感染人类免疫缺陷病毒（HIV）和结核病（TB）的儿童的临床表现、诊断、治疗结果及生存率。
对所有有与结核病相符的症状或体征的HIV感染儿童进行筛查。我们从213名HIV感染儿童队列中研究了24例经培养确诊为结核病的病例。所有这些儿童均接受抗逆转录病毒治疗（HAART）以治疗其HIV感染。通过对这些儿童的病历进行回顾性查阅来收集结核病相关信息。
在213例垂直传播的HIV感染儿童队列中，共有76例（36%）儿童根据其临床表现以及结核菌素试验阳性或抗酸杆菌阳性而疑似患有结核病并接受了结核病治疗。24例儿童结核病培养呈阳性。结核病诊断时的中位年龄为16个月。这些儿童中超过一半存在某种免疫缺陷。常见表现包括发热（87%）、有结核病开放性病例接触史（79%）、咳嗽超过2周（75%）、营养不良（71%）、肝脾肿大（71%）、慢性腹泻（67%）和全身淋巴结肿大（58%）。12例（50%）患者结核菌素试验结果呈阳性。所有儿童胸部X线片均异常，肺门和/或气管旁淋巴结肿大（62%）以及肺叶或肺段实变（57%）。21例（87%）儿童在诊断时患有肺结核。10例（41%）患者确诊有一个或多个肺外结核部位。抗结核治疗6个月后，治愈率为64%。3例有耐药记录。5例儿童（20%）死亡。
结核病是HIV感染儿童中常见的合并感染，儿童常表现为迁延不愈的肺炎。尽管对这些儿童进行了HAART和充分的抗结核治疗，但结核病仍具有显著的死亡率。
