TUBERCULOSIS IN URBAN CHILDREN 1979–1985

Abstract

Even with the availability of effective chemoprophylaxis, tuberculosis (Tb) continues to be a problem in children. From 1979 to 1985, 76 cases of Tb in children were reported to the Department of Public Health (Boston). 7 were incorrectly classified; 9 records were incomplete. We reviewed the remaining 60 cases that occurred in children aged birth to 18 years of age, all residents of Boston. Tb was diagnosed in children who had a positive culture or whose clinical presentation was consistent with Tb. 29 of the 60 children were born in the US, 28 in Haiti, Asia, or Cape Verde, and 3 unknown. The mean age was 8.1 years with 30% of children under age 3. The indications for Tb screening were as follows: routine screening (19), known contact (20), clinical suspicion (17), and unknown (4). The PPD was positive in all 60 children. 31 of the children were symptomatic - including cough, recurrent fever, anorexia, weight loss and night sweats. The chest x-ray was abnormal at the time of diagnosis in 52 of 53 children with pulmonary Tb. (28 pulmonary infiltrates, 8 infiltrates and adenopathy, 8 adenopathy, 3 scars, 5 pleural disease, 1 mediastinal mass). 6 of the 7 children with extrapulmonary Tb (4 cervical adenitis, 1 miliary, 1 meningitis, 1 renal) had abnormal x-rays. We conclude: (1) 50% of pediatric Tb cases in Boston occurred in children born outside of the US; (2) active Tb in the home, pulmonary symptoms, and abnormal chest x-rays were common; (3) 48% of tne cases occurred in children with no symptoms; (4) in all of our cases the PPD was positive. Based on these findings vigilant screening of certain high risk populations is essential.