Tuberculosis in children 10 years of age and younger: three decades of experience during the chemotherapeutic era.

The 863 patients, aged 10 years and younger, treated at the Children's Chest Clinic of Bellevue Hospital during three decades (1953 through 1981) clearly indicated the success of antituberculosis therapy. There were no deaths from tuberculosis. Early treatment is associated with a reduction in the serious forms of disease, eg, meningitis, miliary disease, and bone infections, and with preventing death. Medication was well tolerated: only 1.1% of the patients had adverse reactions, all of which were reversible. Consistent compliance with medication of only 62% of patients is a challenge to the medical profession. Only 22.5% of mycobacterial cultures were positive. Long-term follow-up of patients was rewarding: seven pregnancies with healthy mothers and babies, and no reactivation of tuberculosis by later infections, even those such as measles or pneumonia. The severity of disease was related largely to patient's age (3 years and younger) and intimacy of contact, the highest rate being when the mother was the contact. The long-term experiences emphasizes the value of early identification, therapeutic compliance, and comprehensive contact, tracing in the future elimination of tuberculosis. Prophylactic therapy and close observation should be considered for contacts, especially those exposed to human immunodeficiency virus infections and addicted to drugs.

Tuberculosis in children and adolescents in the 1980s.

Tuberculosis (TBC) continues to be a major health problem. Between January 1, 1980, and April 30, 1986, 211 children and adolescents presented with a positive tuberculin reaction or symptoms suggestive of tuberculosis. Active disease occurred in 35 (17%); 29 of these had primary infection, whereas 4 adolescents presented with cavitary pulmonary disease and 1 infant each had Pott's disease and cervical adenitis. The proportion of patients with active disease was greater in infants and toddlers; 2 of whom also had meningitis. Two children with active disease were infected with human immunodeficiency virus, 1 of whom died with cavitary tuberculosis. Only 43% of 211 patients were born in the United States. The ethnic distribution was Hispanic 45%, Oriental 30%, Black 18% and other 7%. Bacillus Calmette-Guérin vaccination was documented in 53 (25%) patients; 5 (9%) of these developed active disease. Despite vaccination and the availability of effective drugs, tuberculosis persists and appears to be increasing. Meeting the challenge of tuberculosis in the future will require more rapid diagnostic methods and recognition of the burden of infection in human immunodeficiency disease-infected children, together with revitalization of screening and follow-up programs, especially for toddlers and adolescents.

Perspectives in adolescent tuberculosis: three decades of experience.

Three hundred seventy-one adolescents and young adults, 10 to 20 years of age, were treated for tuberculosis during a 29-year period. There were 258 patients tuberculin positive without disease, 37 with calcifications on chest roentgenographs, and 76 with active tuberculous disease. All patients received chemotherapy. Active tuberculosis was more common in the 10- to 12-year-old patients. The greater number of tuberculin reactors in this age group suggests that endocrine factors related to the onset of puberty may play a role in conversion. No significant sex difference was apparent. Drug toxicity was rarely a problem. Pregnancy subsequent to therapy was not associated with progression or reactivation of disease. Two (possibly three) patients who were properly treated and compliant with the drug regimen had reactivation disease 4 to 14 years later. Cavitary pulmonary disease occurred in the two compliant patients. Meningitis, believed to be tuberculous, occurred in the suspected case. Two of these received isoniazid prophylaxis for skin test conversion only. In one patient, treated with two drugs for primary tuberculosis in the past, tuberculous pneumonia developed later. All three recovered. Although reactivation does occur, it is rare. Because most tuberculin reactors were discovered in the 10- to 12-year age group when screened routinely in high school, this procedure should not be abandoned.

Congenital tuberculosis. Review and diagnostic guidelines.

A review of congenital tuberculosis was prompted by the successful treatment of this disease in a unique patient. She was followed up for 27 years, and gave birth to two normal, uninfected newborns despite calcifications throughout her abdomen and elsewhere. Tuberculosis of the newborn, whether acquired congenitally or postnatally, is preventable. Recommendations for diagnosis of congenital tuberculosis are given. Determination of the mother's tuberculin status or suitable testing should be done early in pregnancy. Endometritis is cited as an unrecognized source of fetal infection.

Management of tuberculin reactors in children and adolescents previously vaccinated with BCG.

Between 1960 and 1981, 142 Bacillus Calmette-Guérin (BCG)-vaccinated children and adolescents were evaluated in the Children's Chest Clinic, Bellevue Hospital. These patients came from 28 countries and had positive tuberculin reactions and/or exposure to active tuberculosis. Antituberculous therapy was given to 8 with active tuberculosis, to 8 with calcified pulmonary primary lesions and to 105 positive tuberculin reactors without disease. In a 1 1/2- to 16-year follow-up no tuberculous disease occurred, and two patients with previously negative roentgenograms developed calcified pulmonary lesions. Guidelines are given for the management of patients previously vaccinated with BCG with special reference to the value of prophylactic isoniazid therapy for those considered infected by Mycobacterium tuberculosis but without evidence of disease.

Extensive sclerosis of the base of the skull due to primary nasal tuberculosis.

An 8 year old black male is presented as a primary nasal tuberculous granuloma whose roentgenograms of the skull revealed extensive sclerosis of the periorbital region involving the frontal, sphenoid, and petrous bones. The tuberculous meningitis and the osseous sclerosis at the base of the skull were cured with anti-tuberculous therapy.