Abstract
OBJECTIVE: To identify case characteristics and trends in the incidence of pediatric tuberculosis (TB) in Maryland during the national resurgence of the disease. METHODS: The authors conducted a retrospective review of the 248 cases of TB in children ages 19 and younger reported to the state registry between 1986 and 1993. RESULTS: The incidence of pediatric TB in Maryland, while showing a downward trend between 1986 and 1993, was characterized by a bimodal pattern, with one peak in children younger than age 5 and another peak in adolescents. Certain case characteristics differed significantly according to age: adolescents with TB were more likely to have positive AFB smears, positive cultures, and cavitary X-rays than children in the 0-4 age group. On the other hand, PPD results did not differ significantly by age. Children with TB came from households in zip code areas for which the median family income was lower and the rate of unemployment was higher than comparable statewide figures. CONCLUSIONS: Study findings indicate that (a) the general decline in adult TB in Maryland was accompanied by a decline among children; (b) age-specific case characteristics continue to be useful in clinical decision making for children with suspected TB; and (c) a state TB registry may prove useful not only in tracking disease trends and monitoring statewide control efforts but also in confirming case characteristics, all of which are important disease control issues in a time of fiscal downsizing.
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Selected References
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- Amodio J., Abramson S., Berdon W. Primary pulmonary tuberculosis in infancy: a resurgent disease in the urban United States. Pediatr Radiol. 1986;16(3):185–189. doi: 10.1007/BF02456283. [DOI] [PubMed] [Google Scholar]
- Bhaskar A., Pradhan P., Chaturvedi P., Basak A., Lodam A., Narang P., Harinath B. C. Immunodiagnosis of childhood pulmonary and extrapulmonary tuberculosis using Mycobacterium tuberculosis ES antigen by penicillinase ELISA. Ann Trop Paediatr. 1994;14(1):25–30. doi: 10.1080/02724936.1994.11747688. [DOI] [PubMed] [Google Scholar]
- Chaulk C. P., Chaisson R. E., Lewis J. N., Rizzo R. T. Treating multidrug-resistant tuberculosis: compliance and side effects. JAMA. 1994 Jan 12;271(2):103–105. [PubMed] [Google Scholar]
- Chaulk C. P., Moore-Rice K., Rizzo R., Chaisson R. E. Eleven years of community-based directly observed therapy for tuberculosis. JAMA. 1995 Sep 27;274(12):945–951. [PubMed] [Google Scholar]
- Cundall D. B. The diagnosis of pulmonary tuberculosis in malnourished Kenyan children. Ann Trop Paediatr. 1986 Dec;6(4):249–255. doi: 10.1080/02724936.1986.11748450. [DOI] [PubMed] [Google Scholar]
- D'Angelo L. J., Getson P. R., Luban N. L., Gayle H. D. Human immunodeficiency virus infection in urban adolescents: can we predict who is at risk? Pediatrics. 1991 Nov;88(5):982–986. [PubMed] [Google Scholar]
- Delacourt C., Gobin J., Gaillard J. L., de Blic J., Veron M., Scheinmann P. Value of ELISA using antigen 60 for the diagnosis of tuberculosis in children. Chest. 1993 Aug;104(2):393–398. doi: 10.1378/chest.104.2.393. [DOI] [PubMed] [Google Scholar]
- Fossett J. W., Perloff J. D., Kletke P. R., Peterson J. A. Medicaid and access to child health care in Chicago. J Health Polit Policy Law. 1992 Summer;17(2):273–298. doi: 10.1215/03616878-17-2-273. [DOI] [PubMed] [Google Scholar]
- Ghidey Y., Habte D. Tuberculosis in childhood: an analysis of 412 cases. Ethiop Med J. 1983 Jul;21(3):161–167. [PubMed] [Google Scholar]
- Kibel M. A., Hussey G. Problems in the diagnosis of childhood tuberculosis. S Afr Med J. 1990 Apr 21;77(8):379–380. [PubMed] [Google Scholar]
- LINCOLN E. M., HARRIS L. C., BOVORNKITTI S., CARRETERO R. W. Endobronchial tuberculosis in children, a study of 156 patients. Am Rev Tuberc. 1958 Jan;77(1):39–61. doi: 10.1164/artpd.1958.77.1.39. [DOI] [PubMed] [Google Scholar]
- Migliori G. B., Borghesi A., Rossanigo P., Adriko C., Neri M., Santini S., Bartoloni A., Paradisi F., Acocella G. Proposal of an improved score method for the diagnosis of pulmonary tuberculosis in childhood in developing countries. Tuber Lung Dis. 1992 Jun;73(3):145–149. doi: 10.1016/0962-8479(92)90148-D. [DOI] [PubMed] [Google Scholar]
- Nemir R. L. Perspectives in adolescent tuberculosis: three decades of experience. Pediatrics. 1986 Sep;78(3):399–405. [PubMed] [Google Scholar]
- Pierre C., Olivier C., Lecossier D., Boussougant Y., Yeni P., Hance A. J. Diagnosis of primary tuberculosis in children by amplification and detection of mycobacterial DNA. Am Rev Respir Dis. 1993 Feb;147(2):420–424. doi: 10.1164/ajrccm/147.2.420. [DOI] [PubMed] [Google Scholar]
- Smith M. H. Tuberculosis in children and adolescents. Clin Chest Med. 1989 Sep;10(3):381–395. [PubMed] [Google Scholar]
- Snider D. E., Jr, Rieder H. L., Combs D., Bloch A. B., Hayden C. H., Smith M. H. Tuberculosis in children. Pediatr Infect Dis J. 1988 Apr;7(4):271–278. doi: 10.1097/00006454-198804000-00008. [DOI] [PubMed] [Google Scholar]
- St Louis M. E., Conway G. A., Hayman C. R., Miller C., Petersen L. R., Dondero T. J. Human immunodeficiency virus infection in disadvantaged adolescents. Findings from the US Job Corps. JAMA. 1991 Nov 6;266(17):2387–2391. [PubMed] [Google Scholar]
- Starfield B. Primary care and health. A cross-national comparison. JAMA. 1991 Oct 23;266(16):2268–2271. [PubMed] [Google Scholar]
- Starke J. R., Jacobs R. F., Jereb J. Resurgence of tuberculosis in children. J Pediatr. 1992 Jun;120(6):839–855. doi: 10.1016/s0022-3476(05)81949-3. [DOI] [PubMed] [Google Scholar]
- Starke J. R. Modern approach to the diagnosis and treatment of tuberculosis in children. Pediatr Clin North Am. 1988 Jun;35(3):441–464. doi: 10.1016/s0031-3955(16)36465-3. [DOI] [PubMed] [Google Scholar]
- Starke J. R., Taylor-Watts K. T. Tuberculosis in the pediatric population of Houston, Texas. Pediatrics. 1989 Jul;84(1):28–35. [PubMed] [Google Scholar]
- Stegen G., Jones K., Kaplan P. Criteria for guidance in the diagnosis of tuberculosis. Pediatrics. 1969 Feb;43(2):260–263. [PubMed] [Google Scholar]
- Stoltz A. P., Donald P. R., Strebel P. M., Talent J. M. Criteria for the notification of childhood tuberculosis in a high-incidence area of the western Cape Province. S Afr Med J. 1990 Apr 21;77(8):385–386. [PubMed] [Google Scholar]