Nelson LJ, Talbot EA, Dennis AM, Guillebaud CS, Masunge J, Jibril H, Dimiti AI, Kurup S, Kilmarx PH, Samandari T, Wells CD; International Conference on AIDS (15th : 2004 : Bangkok, Thailand).

Int Conf AIDS. 2004 Jul 11-16; 15: abstract no. MoPeB3200.

Division of TB Elimination, National Center for HIV, STD, and TB Prevention, CDC, Atlanta, United States

Background: Botswana has one of the highest rates of HIV and tuberculosis (TB) in the world, although the burden of TB and other respiratory diseases among children is unknown. Methods: Hospitalized children<15 years with persistent cough or fever >/= 2 weeks or failure to thrive (FTT) >/=3 months were evaluated for TB at 2 referral centers in Botswana using sputum and gastric aspirate for smear and culture, chest radiograph (CXR), tuberculin skin testing (TST), mycobacterial blood cultures, HIV testing (ELISA, DNA and RNA PCR), and CD4 count. Children were assessed at 2 month follow-up. Cases with bacteriologic evidence of TB were classified as confirmed; those with >/= 2 of the following were classified as clinical cases: TST+,TB contact, response to TB therapy, CXR consistent with TB. Results: During 8/03-12/03, we evaluated 107 children for TB; median age was 15 months (range 2 mths-12 yrs), 60 (56%) were male. Among 93 with known HIV test results, 65 (70%) were HIV+; of these, 24/58 (41%) had CD4<15%, and 10/65 (15%) were on anti-retroviral therapy at enrolment. Forty-two (39%) reported exposure to a TB case, of which 33/42 (79%) was in the household. Most (92/107, 86%) had persistent cough; 60 (56%) had FTT, 48 (45%) had fever, and 6 (6%) were TST+. Among 94 with CXR performed, 91 (97%) had abnormalities. None had positive blood cultures. Among 43/65 (66%) HIV+ who have died or completed follow-up to date, 16 (37%) had TB (all clinical), 16 (37%) died, and additional clinical diagnoses were common: bacterial pneumonia (67%), Pneumocystis jiroveci pneumonia (28%), and lymphocytic interstitial pneumonitis (16%). Among 20/28 (71%) HIV- who died or completed follow-up, 7 (35%) had TB (4 confirmed + 3 clinical), 3 (18%) died, and 13 (65%) also had bacterial pneumonia. Conclusions: Despite intensive lab investigations, none of the HIV+ children and only 14% of the HIV- children had a definitive diagnosis. Improved rapid diagnostic tests and algorithms are urgently needed for children with TB and other pathogens.

Publication Types:

• Meeting Abstracts

Keywords:

• Acquired Immunodeficiency Syndrome
• Botswana
• Child
• HIV Infections
• HIV Seropositivity
• Humans
• Male
• Sputum
• Tuberculosis
• diagnosis

Other ID:

• GWAIDS0035288

UI: 102279504

From Meeting Abstracts