DOI: http://dx.doi.org/10.18203/2349-3291.ijcp20172669

Study of tuberculosis in HIV positive children in a tertiary care hospital of Odisha

Ajaya Kumar Gahan, Jyoti Ranjan Champatiray, Saroj Kumar Satpathy

Abstract


Background: Tuberculosis and HIV have been closely linked since the emergence of AIDS. Worldwide, TB is the most common opportunistic infection affecting HIV seropositive individuals and it remains the most common cause of death in patients with AIDS. HIV infection has contributed to a significant increase in the worldwide incidence of TB. So, an attempt was made in the present study to know the magnitude/extent of tuberculosis, associated clinical patterns, epidemiological factors and outcomes in HIV positive children attending the ART Centre of SCB medical college and hospital, Cuttack.

Methods: A tertiary care hospital based prospective study was carried out in 50 children between 6 months to 14 years of age for a period of 2 years.

Results: Most of the cases were less than 6 years old. TB was more common in male children than in females. Most cases were from rural areas. Majority belong to Class IV (Upper Lower) and Class V(Lower) socio-economic class. Most had Grade II and Grade III malnutrition as per IAP classification. Definite history of contact and recent infection was present in most. Majority (75%) had pulmonary tuberculosis. Pleural variant was predominant in extra-pulmonary form followed by TB lymphadenitis and disseminated forms. 5% had both PTB and EPTB. Most cases were un vaccinated. Common clinical features were fever, cough, FTT, chronic diarrhoea. Disseminated TB was common in unvaccinated group. Recovery pattern was almost similar in vaccinated and unvaccinated groups. Most of the PTB cases were cured of the disease with only 2 deaths in this group whereas the number of deaths, children going LAMA and development of MDR-TB was more in disseminated forms.

Conclusions: Occurrence of TB is high in HIV positive cases. EPTB is common in unvaccinated cases. TB is common in rural and underprivileged children. Drug compliance is poor in disseminated forms. Mortality is high in disseminated forms. Sequele is more in disseminated forms of TB. 


Keywords


Co-infection, HIV, Tuberculosis

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References


Tuberculosis and HIV, HIV insight knowledge base chapter, Annie Lutemeya, lisa goose, University of California, San Francisco; 2013

Shah I. Multidrug resistant Tuberculosis in Children. Pediatr Infect Dis J. 2012;31(9):970-2.

Shah I, Bansal N. Poly-resistant Tb in an HIV infected child. J Fam Med Prim Care. 2012;1(2):153-4.

Golden MP. Extra pulmonary Tb- An overview AAFP. Yale university school of med and hosp. of saint Raphael. Am FAM physician. 2005;72(9): 1761-8.

WHO Guidance for national tb programmes on the mgt. of Tb in children. Available from; WHO/HTM/TB/2006.371, Geneva, Switzerland, WHO; 2006.

Ramachandran RS, Purnayyan S. Tuberculosis in children. Indian Pediatr.1966;3:218-23.

Ramachandran RS. Tuberculosis in children: experience with 1284 cases. Indian Pediatr. 1968;5(12):564-71.

Ramachandran P, Nagaraja D. Three chemotherapeutic studies of tubercular meningitis in children. Tubercle. 1986;67:17.

Sarma OA, Shantakumari C, A review of 150 cases of tuberculosis in children. Indian Pediatr. 1976;13:143.

Mukadi YD, Wiktor SZ, Coulibaly IM, Coulibaly D, Mbengue A, Folquet AM, et al, Impact of HIV infection on the development, clinical presentation, and outcome of tuberculosis among children in Abidjan, Côte d'Ivoire. AIDS. 1997;11(9):1151-8.

Mehera S, Ghosal S, Tuberculosis infection and disease in apparently healthy school going children near Delhi. Indian J Med Res. 1979;70:697.

Deshmukh MD. Review of tuberculosis work done in last 25 years. J Ass Phy Ind. 1970;18:105.

Murty M. Tuberculous lymphadenitis in Children. Ind Pediatr. 1976;13:533.

Sheikh MM, Ansari Z. Tuberculosis lymphadenopathy in children. Ind Ped. 1981;18:293.

Sheikh AH, Singh SD. Prevalance of tuberculosis infection and disease among children under 8 years. Ind Pediatr. 1982;19:991.

Mathur GP, Mathur S. Tuberculosis infection in children with reference to their immunisation status. A Hospital based study. Ind Pediatr. 1991;28: 569.

Raju SC, Shah PR, Desai AB. Diagnosis of tuberculosis in children. Med Surg. 1983;23:17.

Madhi S, Gray G,,Huebner RE,et al.Correlation between CD4 count ,concurrent antigen skin test and tuberculin skin test reactivity in HIV 1 infected and uninfected children with tuberculosis. Pediatr Inft Dis. 1999;18:800-5.

Marais BJ, Schaaf HS. Tuberculosis in children. 2014. doi 10.1101/cshperspect.a017855cold spring harb perspect med 2014

Hesseling AC, Rabie H, Marais BJ. BCG vaccine induced complications and HIV infection in children. Clin Infect dis. 2006;42:548-58.

Mukherjee A, Lodha R. Changing trends in childhood tuberculosis. Indian J Paediatr. 2010;78(3) 328-333.

Rajasekaran S, Jeyaseelan L, Raja K, Ravichandran N, Demographic and clinical profile of HIV infected children accessing care at Tambaram, Chennai, India. Indian J Med Res. 2009;129(1):42-9.

Jeena PM. Impact of HIV 1 co infection on presentation and hospital related mortality in children with culture proven pulmonary tuberculosis in Durban, south Africa. Int J Tuberc Lung Dis. 2002;6;672-8.

Sheikh MM, Ansari Z. Tuberculosis lymphadenopathy in children. Ind Ped. 1981;18:293.

Shah PR, Ramakrishnan B. Pulmonary tuberculosis in Ahmedabad. Epidemiology, diagnosis and chemotherapy. Ind J Ped. 1992;59:435.

Bhakoo ON, Gupte SP. Tuberculosis in children. IJP. 1969;36:65.

Magotra M, Andurkar GP. Primary pulmonary tuberculosis in children (A review of 300 cases). Indian Pediatr. 1974;11:529.

Chandra P. Tuberculosis in BCG vaccinated and unvaccinated children. IJP. 1975;12:424.

Chandra P, Harilal KT. Factors affecting efficacy of BCG vaccination. IJP. 1977;14:535.

Udani PM, Tuberculosis in childhood. Paediatric clin. India 1968;3:163.

Udani PM, Parikh UC. BCG test in tuberculosis. Ind Pediatr. 1971;8:143.

Udani PM, Parikh UC. Neurological and related syndromes of CNS tuberculosis, clinical features and pathogenesis. J Neuro. 1971;14:341.

Udani PM, Parikh UC. Neurological and related syndromes of neuro tuberculosis in children. Further observations in tuberculosis of the nervous system monograph on the proceedings of the symposium, Bombay, India. 1974:37-49.

Udani PM, Bhast S. Problems of tuberculosis in children in India. Epidemiology, morbidity, mortality and control programme. Indian Pediatr. 1976;13: 891.

Udani PM, Bhava SY. CNS Tuberculosis with clinical picture modified by BCG Vaccination and/or drug therapy. JJ Group of hospital and Grant medical college. 1979;24;3.

Udani PM. Evaluation of tuberculin test in paediatric practice. Indian Pediatr. 1982;19:469.

Udani PM. Tuberculosis in children in India. A major health hazard. Ped Clin India. 1983;18:11.

Udani PM. Tuberculosis in children, Epidemiology, clinical aspects, diagnosis and management in various practical situations. Bombay Hospital J. 1987;29;31.

Udani PM. Neurotuberculosis in tuberculosis in children. 1st edition Ind Ped, New Delhi;1991:143.

Asch S, Knowles L. Relationship of isoniazid resistance to HIV infection in patient with tuberculosis. Am J Respir Crit Care Med. 1996;153:1708-10.

Spellman CW, Matty KJ, Weis SE. A survey of drug resistance Mycobacterium tuberculosis and its relationship with HIV infection. AIDS. 1998;12:191-5.

Starke JR, Taylor Watts KT. Tuberculosis in the paediatric population of Houston, Texas, Pediatrics. 1989;84:28.