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This Article Full Text Full Text (PDF) Take the CME quiz: Vol. 18 No. 2, February 1997 Rapid Responses: Submit a response Alert me when this article is cited Alert me when Rapid Responses are posted Alert me if a correction is posted Citation Map Services E-mail this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to My File Cabinet Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via CrossRef Citing Articles via Google Scholar Google Scholar Articles by Abernathy, R. S. Search for Related Content PubMed PubMed Citation Articles by Abernathy, R. S. Related Collections Infectious Diseases

(Pediatrics in Review. 1997;18:50-58.)
© 1997 American Academy of Pediatrics

Tuberculosis: An Update

	IMPORTANT POINTS

 

1. The majority of tuberculosis cases in children are from high-risk populations, that is, African-Americans, Hispanics, immigrants, and those living in poverty and in the inner cities.
   
2. The only acceptable tuberculin skin test is the intradermal Mantoux test with purified protein derivative (PPD), and three levels of positivity now are accepted. Children exposed to active disease who have findings suggestive of tuberculosis or who have human immunodeficiency virus (HIV) infection are positive at 5 to 9 mm; other high-risk groups are positive at 10 mm.
   
3. Diagnosis of childhood tuberculosis depends on a high index of suspicion coupled with suggestive epidemiologic data, tuberculin skin test results, and chest radiographic findings. Cultures are not routinely positive, and results are available only after treatment must be started.
   
4. Treatment is a uniform 6-month course of isoniazid, rifampin, and pyrazinamide for 2 months followed by 4 months of isoniazid and rifampin daily or twice weekly. Additional drugs are needed in cases of drug resistance.
   
5. Chemoprophylaxis for all children who have a positive tuberculin reaction will prevent future disease.
   

Despite the availability of effective antituberculosis drugs since 1952, tuberculosis remains an important cause of morbidity, mortality, and health care cost in the United States. Tuberculosis case rates declined at a rate of 6% annually for more than 20 years until 1985 when they leveled off (Fig. 1 ). Factors responsible for this include human immunodeficiency virus (HIV) infection; immigration of individuals from countries where tuberculosis rates are 10 to 30 times that of the United States; transmission of disease in hospitals, homeless shelters, and prisons; and poverty, overcrowded living, and poor access to medical care. While all this was occurring, funds for tuberculosis control by public health programs declined. Fortunately, the number of cases reported annually has decreased by 8.7% in the past 2 years, probably due . . . [Full Text of this Article]

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