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Abstract
To study Prevalence and Clinical spectrum of Tuberculosis in Paediatric HIV/AIDS.
Methods 320 children with HIV/AIDS enrolled in this study between September 2004 and September 2007. History, Examination, relevant investigations done and classified according to RNTCP, WHO and Immunological stages. SPSS soft ware and t-test used for statistical analysis.
Results Prevalence of tuberculosis is 18.12%(58) with Male:Female ratio of 1.22:1 among which unimmunised were 15%. Most common age group was 1–5 years (43.1%), and common presenting symptoms were fever (65.5%), cough (54.5%), FTT in 60%, head ache (20%),vomiting (15%). History of contact was available in 22%. All children weighed <50th percentile and 96.6% had <50th Percentile of height.53.44% had pulmonary, 20.68% CNS, 8.62% Disseminated, 5.17% Abdominal, 5.17% Milliary tuberculosis manifestations. Scrofuloderma and Lupus vulgaris 1 case each. ESR increased in 90%, Mantoux positive in 12.24%, gastric lavage for AFB 6%, Radiological evidence of pulmonary in 40%, CT scan evidence in 10.2%, Abnormalities of CSF in 14%, pleural and ascitic fluid 2% each noted. Severe immunosuppression in 60%. Treated under RNTCP category I in 92% and 6% in category III and 2% in category II. 29.48% children were on ART and 18.36 % expired.
Conclusion and recommendations -Tuberculosis is one of commonly prevalent infection in children with HIV with prevalence of 18.12% (49) with Male:Female ratio of 1.22:1 with most common age 1–5 years (43.1%)
–Pulmonary tuberculosis was commonest type followed by CNS tuberculosis with disseminated and extrapulmonary tuberculosis being more common with advanced immunosuppression
–Fever (65.5%), cough (54.5%), FTT(60%), head ache (20%),vomiting (15%),contact History (22%),unimmunized status (15%) and wasting (90%) are common at presentation. -Relation between Mantoux test positivity and severe immunosuppression was statistically significant. Contact history, Mantoux test and radiological examination with sputum microscopy can be used for diagnosis in resource-limited settings.
–Tuberculosis can occur in any CD4 count. Poor outcome were seen in severe immune suppression which was statistically significant.
–HIV disease category, severe immunosuppression with associated severe malnutrition at diagnosis were significantly associated with mortality
–All HIV positive children should be screened for tuberculosis at time of diagnosis of HIV and annually screened.
