HIV and TB

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HIV and TB

Author: Pediatric Oncall

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A 5 years old boy was detected to have endobronchial TB at the age of 2 years and was on antituberculous therapy {ATT} for the past 3 years that included intermittent Streptomycin and Amikacin injections. Currently, he now had pneumonia along with otitis media and molluscum contagiosum. Thus an HIV ELISA was done which was positive. CD4 count was 509 {23 percent} cells/cumm. Both parents were also subsequently screened and were also HIV infected. A CT chest was done that showed multiple minimally enlarged non-necrotic axillary lymph nodes with necrotic enlarged subcarinal lymph node {2.5 x 1.9 cm} with patchy consolidation in the posterior segment of the right upper lobe with collapse consolidation. Nodules were seen in the apicoposterior segment of left upper lobe, the superior segment of left lower lobe and right lower lobe showing the endobronchial spread of disease. The child was started on first line ATT as well as ART and bronchoalveolar lavage {BAL} was sent for TB Bactec culture. The patient was subsequently lost to follow up for the next 6 months. He again presented with molluscum and chest X-Ray showed the same picture.

How should this child be managed?

Answer Discussion :

S

sebastian beshk

0

Fever

5 years ago

F

Fouad Abd Elsamad

0

Diarrea

5 years ago

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Answer 1

The child needs to be counseled regarding adherence. A repeat BAL or GL should be done to rule out DR-TB. In addition, other lung pathology such as LIP and PCP should also be ruled out in this child. The child's HIV viral load should be done and the child should be initially kept on the same ART. A repeat viral load should be done after 3 months to check the response to therapy as well as check adherence.

HIV and TB

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