Tuberculosis and AIDS co-morbidity in children: linkage of surveillance databases from Espírito Santo State, Brazil
A. Miranda1, R. Dietze1, T. Prado1, A. Caus1, M. Marques1, J. Golub2
1Universidade Federal do Espírito Santo, Medicina Social, Vitoria, Brazil, 2Johns Hopkins University, School of Medicine, Baltimore, United States
Background: HIV infection is a known risk factor for progression to TB disease in children, untreated co-infected persons progressing to TB more quickly than HIV-negative persons. We assessed the prevalence of AIDS among children diagnosed with active TB in Espírito Santo State, Brazil.
Methods: TB and AIDS surveillance system databases in Brazil between 2000 and 2006 were linked using Reclink software and SPSS support. Databases were compared using patient name, mother's name and date of birth with a probability of 92% for names and 90% for dates. State surveillance data for children < 15 years of age were included.
Results: Among 411 pediatric TB cases between 2001 and 2006, 27 (7%) were co-infected with AIDS. The mode of transmission for HIV in all but one child was perinatal; the other was infected through sexual transmission (homosexual practice). The median age for all the TB children was 4 (IQR (interquartile rage) 1-9), though co-infected children were younger (median=2 (IQR=1-5) than TB cases (4; IQR=1-10,p=0.006). Co-infected patients were more likely to have both pulmonary and extrapulmonary disease compared to TB patients with no HIV (30% vs. 9%) who were more likely to only have pulmonary disease. Most children (71%) were unable to provide a sputum specimen, though among those that did, co-infected patients were more likely to be smear negative for acid fast bacilli (83% vs. 46%;p=0.07) and culture positive for Mycobacterium tuberculosis (44% vs.19%;p< 0.001). Over half (57%) of co-infected patients did not react to TST compared to 17% of TB patients (p< 0.001).
Conclusions: Current diagnostics are not adequate for diagnosing TB in children, often leading to delays in appropriate treatment, and HIV co-infection greatly augments this problem.
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