Tuberculosis and HIV
Features suggestive of infections such as Tuberculosis (TB).
Patients who have TB may also have co-existent infection with Human Immunodeficiency Virus [HIV].
Suspecting TB requires a thorough history to include questions about:
- Loss of weight, night sweats, chronic cough for more than 2-3 weeks, chronic abdominal distention, lethargy or reducing activity/energy levels; these may suggest disseminated TB.
- Social circumstances including history of overcrowding, poor ventilation, positive TB or symptomatic contacts that have primary, secondary or multi-drug resistant TB.
- Previous history of TB (and management thereof), on past medical history.
- Risk factors for HIV exposure (sexual, vertical transmission from mother, intravenous drug use, contaminated blood products), or confirmed HIV testing of the child and treatment thereof.
The high index of suspicion or diagnosis of TB is made from the history, clinical presentation, a positive mantoux or Tuberculin Skin Test and radiographic changes. Confirmation of diagnosis relies on culture of the organism from sputum, biopsy or fine needle aspirate from bone or synovial fluid.
In endemic regions, the immunosuppressed child or child on immunosuppressive therapy is prone to developing TB which can manifest in several ways: e.g., Poncet’s, Gibbus-Pott’s disease, arthritis, osteomyelitis or dactylitis.
More information is available about TB in the Investigation, Limping Child, and Arthritis modules of pmm.