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RECENTLY, WE REPORTED that cigarette smoking is associated with Mycobacterium tuberculosis infection in adults, (1) a finding confirmed in several other studies. (2-6) Few studies have investigated the association between [...], OBJECTIVE. Tuberculosis and smoking are both significant public health problems. The association between passive smoking and Mycabacterium tuberculosis infection is not well documented. The objective of this study was to examine the influence of passive smoking on M tuberculosis infection in children. METHODS. A community survey was conducted in 15% of addresses in 2 adjacent low-income suburbs in Cape Town, South Africa. All children ( RESULTS. Of 1344 children, 432 (32%) had a positive tuberculin skin test. Passive smoking was significantly associated with M tuberculosis infection in the unadjusted analyses but not in the adjusted analyses. In the 172 households with a patient with tuberculosis, passive smoking was significantly associated with a positive tuberculin skin test (but not in the 492 households without a patient with tuberculosis. CONCLUSIONS. Passive smoking is associated with M tuberculosis infection in children living in a household with a patient with tuberculosis. More studies are needed to confirm this observation, but the possible association is a cause of great concern, considering the high prevalence of smoking and tuberculosis in most developing countries. Key Words children, tuberculosis, infection, smoking

Tuberculosis (TB) contact tracing has produced a significant yield of new TB cases and newly infected patients in the past. (1) Children in close contact with drug-susceptible adult pulmonary TB [...], Setting. The Western Cape Province of South Africa, an area with a high tuberculosis (TB) incidence, where initial multidrug resistance (MDR) among adult TB cases was 1.1% during 1992-1993. Objective. To determine the long-term prevalence of TB infection and disease in children in household contact with adults with MDR pulmonary TB, and to establish the efficacy of chemoprophylaxis in preventing disease in these children. Method. Children Results. At the initial evaluation 125 children were seen, median age 27.5 months. Of these, 119 were followed up. Fourteen (12%) had disease, 61 (51%) were infected only, and 44 (37%) were noninfected. By 30-month follow-up, 29 (24%) had developed disease and 64 (54%) were infected only. Four adult-child pair Mycobacterium tuberculosis isolates were compared by DNA fingerprinting; 3 were identical. All children who developed TB disease were clinically cured. Two (5%) of 41 children who received appropriate chemoprophylaxis and 13 (20%) of 64 who did not, developed TB during follow-up (odds ratio: 4.97). Conclusion. The study confirms MDR TB transmission to childhood contacts. Seventy-eight percent of children were infected or developed disease. Appropriate chemoprophylaxis may prevent disease in these children. Pediatrics 2002;109:765-771; tuberculosis, multidrug-resistant, children, contacts, follow-up, chemoprophylaxis.

When people develop tuberculosis after being successfully treated for the disease, it is not always a reactivation of the previous disease. Researchers used DNA analysis to identify the bacterial strain that was infecting 16 patients who developed tuberculosis for a second time after being successfully treated during the first infection. In 12 of the patients, the DNA analysis revealed that they were infected with a different strain of bacteria than the strain that caused the first infection. This illustrates the importance of strict infection control procedures when people become infected with tuberculosis so the bacterium is not transmitted to other people.

URL: www.pediatrics.org/cgi/doi/10.1542/peds.2006-0519 Ben J. Marais, MRCP, FCP, MMed, PhD, Robert P. Gie, FCP, Anneke C. Hesseling, MBChB, MSc, H. Simon Schaaf, MMed, MD, Carl Lombard, PhD, Donald A. Enarson, MD, [...], BACKGROUND. Tuberculosis control programs place an almost exclusive emphasis on adults with sputum smear-positive tuberculosis, because they are most infectious. However, children contribute a significant proportion of the global tuberculosis caseload and experience considerable tuberculosis-related morbidity and mortality, but few children in endemic areas have access to antituberculosis treatment. The diagnostic difficulty experienced in endemic areas with limited resources has been identified as a major factor contributing to poor treatment access. In general, there is a sense of scepticism regarding the potential value of symptom-based diagnostic approaches, because current clinical diagnostic approaches are often poorly validated. The natural history of childhood tuberculosis demonstrates that symptoms may offer good diagnostic value if they are well defined and if appropriate risk stratification is applied. This study aimed to determine the value of well-defined symptoms to diagnose childhood pulmonary tuberculosis in a tuberculosis-endemic area. METHODS. A prospective, community-based study was conducted in Cape Town, South Africa. Specific well-defined symptoms were documented in all children 2 weeks' duration; study participants were thoroughly evaluated for tuberculosis. In addition, all of the children who received antituberculosis treatment during the study period were reviewed by the investigator, irrespective of study inclusion. This concurrent disease surveillance provided a comprehensive overview of all of the childhood tuberculosis cases, allowing accurate assessment of the possible disadvantages associated with this symptom-based diagnostic approach. In the absence of an acceptable gold standard test, optimal case definition is an important consideration. Children were categorized as 'bacteriologically confirmed tuberculosis,' 'radiologically certain tuberculosis,' 'probable tuberculosis,' or 'not tuberculosis.' Bacteriologically confirmed tuberculosis was defined as the presence of acid-fast bacilli on sputum microscopy and/or Mycobacterium tuberculosis cultured from a respiratory specimen. Radiologically certain tuberculosis was defined as agreement between both independent experts that the chest radiograph indicated certain tuberculosis in the absence of bacteriologic confirmation. Probable tuberculosis was defined as the presence of suggestive radiologic signs and good clinical response to antituberculosis treatment in the absence of bacteriologic confirmation or radiologic certainty. Good clinical response was defined as complete symptom resolution and weight gain of ≥ 10% of body weight at diagnosis, within 3 months of starting antituberculosis treatment. Not tuberculosis was defined as spontaneous symptom resolution or no response to antituberculosis therapy in the absence of bacteriologic confirmation or radiologic signs suggestive of tuberculosis. Pulmonary tuberculosis was defined as a symptomatic child with: (1) bacteriologically confirmed tuberculosis, (2) radiologically confirmed tuberculosis, or (3) probable tuberculosis (as defined), excluding isolated pleural effusion. RESULTS. In total, 1024 children were referred for evaluation. Resolving symptoms were reported in 596 children (58.2%); 428 (41.8%) children with persistent, nonremitting symptoms at evaluation were investigated for tuberculosis. Pulmonary tuberculosis was diagnosed in 197 children; 96 were categorized as bacteriologically confirmed tuberculosis, 75 as radiologically certain tuberculosis, and 26 as probable tuberculosis. Combining a persistent nonremitting cough of >2 weeks' duration, documented failure to thrive (in the preceding 3 months), and fatigue provided reasonable diagnostic accuracy in HIV-uninfected children (sensitivity: 62.6%; specificity: 89.8%; positive predictive value: 83.6%); the performance was better in the low-risk group (≥ 3 years; sensitivity: 82.3%; specificity: 90.2%; positive predictive value: 82.3%) than in the high-risk group ( DISCUSSION. The combined presence of 3 well-defined symptoms at presentation (persistent, nonremitting cough of >2 weeks' duration; objective weight loss [documented failure to thrive] during the preceding 3 months; and reported fatigue) provided good diagnostic accuracy in HIV-uninfected children ≥ 3 years of age, with clinical follow-up providing additional value. The approach performed less well in children CONCLUSIONS. Pulmonary tuberculosis can be diagnosed with a reasonable degree of accuracy in HIV-uninfected children using a simple symptom-based approach. This offers the exciting prospect of improving treatment access for children, particularly in resource-limited settings where current access to antituberculosis treatment is poor. KEY WORDS. symptom-based, diagnosis, tuberculosis, children.

Introduction As the HIV epidemic matures in sub?Saharan Africa, adolescents with undiagnosed HIV disease may present to health services. The majority of these HIV?infected youth have severe immunosuppression and a [...], Until recently, little attention has been given to chronic lung disease (CLD) in HIV?infected children. As the HIV epidemic matures in sub?Saharan Africa, adolescents who acquired HIV by vertical transmission are presenting to health services with chronic diseases. The most common is CLD, which is often debilitating. This review summarizes the limited data available on the epidemiology, pathophysiology, clinical picture, special investigations and management of CLD in HIV?infected adolescents. A number of associated conditions: lymphocytic interstitial pneumonitis, tuberculosis and bronchiectasis are well described. Other pathologies such as HIV?associated bronchiolitis obliterans resulting in non?reversible airway obstruction, has only recently been described. In this field, there are many areas of uncertainty needing urgent research. These areas include the definition of CLD, pathophysiological mechanisms and common pathologies responsible. Very limited data are available to formulate an effective plan of investigation and management.