Nosocomial Infections in HIV-Infected and HIV-Uninfected children Hospitalized for Tuberculosis

Background : The interaction between tuberculosis and human immunodeficiency virus (HIV) infection is well known and is responsible for the increase in the incidence of tuberculosis (TB) in sub-Saharan Africa over the last decade. This places a considerable extra burden on health services. The Brooklyn Hospital for Chest Diseases (BCH) is a non-acute TB hospital for the City of Cape Town; South Africa. The hospital has 60 children's beds and approximately 140 paediatric admissions annually. This study; undertaken before the availability of antiretroviral drugs in the public sector in South Africa; documents the occurrence of nosocomial infections in HIV-infected and HIV-uninfected children at BCH. Methods : This retrospective case-control study evaluated the occurrence of nosocomial infections in human immunodeficiency virus (HIV)-infected children and age- and time of admission-matched HIV-uninfected children admitted to the BCH; Cape Town; South Africa between July 1999 and December 2001 for the treatment of tuberculosis (TB). Results : Forty-seven HIV-infected children (mean age 40 months) and 47 HIV-uninfected children (mean age 41 months) were studied. The HIV-infected children; who were not receiving antiretroviral therapy because it was not yet available in the public sector; experienced 109 episodes of nosocomial infections compared to 22 episodes amongst those not infected with HIV (p = 0.001). Twenty-five nosocomial infections (23)among the HIV-infected children; but only two (9) among the HIV-uninfected children; were serious enough to require transfer to a tertiary care hospital for management. Pneumonia was the commonest nosocomial infection and occurred in 26 (56) HIV-infected patients; of whom three died; but in only four (9 HIV-uninfected children; none of whom died. An outbreak of varicella affected 10 HIV-infected (21) and 9 HIV-uninfected children (19). One HIV-infected child died of varicella pneumonia. Other common nosocomial infections encountered in HIV-infected and HIV-uninfected children respectively were upper respiratory tract infections (pharyngitis; tonsillitis or rhinitis) affecting 21 and four; otitis media in five and one; oral candidiasis in seven and 0; urinary tract infection in four and one and acute gastroenteritis in five and zero children. Five HIV-infected children (11) died and four of the deaths were known to be due to nosocomial infection; only one HIV-uninfected child died from severe miliary TB. Conclusion : Nosocomial infections occurring in HIV-infected children are a serious cause of morbidity and mortality in children hospitalised for the treatment of tuberculosis. Their impact could be reduced by the earlier introduction of antiretroviral treatment and by immunisation against certain of the infecting agents. Post-exposure prophylaxis for varicella could prevent or alleviate disease

Preventing tuberculosis in childhood.

Almost half of the cases of tuberculosis requiring treatment may arise in children. The strategies to control tuberculosis in developing countries remain firmly focussed upon adults who are smear positive. The prevention of tuberculosis in childhood has two aspects: prevention of infection and management of infection once it has occurred. The steps for prevention of infection include early diagnosis of adults with tuberculosis who are culture positive but not yet smear positive. Use of ultraviolet lighting or at least large windows and ventilation in the area where patients are kept may reduce the infection rate. An appropriate regimen and supervised chemoprophylaxis to ensure good compliance may be an important step towards control of tuberculosis infection.