Three boys with a history of closed contacts to tuberculosis (Page 1/1)

Prepared by...
Peninnah Oberdorfer, M.D., PhD
Alisara Damrongmanee , M.D.
Virat Sirisanthana, M.D.
Department of Pediatrics, Chiang Mai University, Thailand
Chief compliant: 3 boys presented at the tuberculosis clinic for contact investigations.
 
Present illness:about 3 months ago, the grandfather of the boys developed hemoptysis with low grade fever. He was diagnosed as having pulmonary tubeculosis with a positive sputum for AFB. He was treated with the 4 drug-regimen. Due to the Global-funded project to search for the closed contact cases of tuberculosis, we sent the letter to the family and asked them to take the children less than 15 years for physical check up and the investigations. Three boys presented at the clinic with their father and mother. The characteristics, history of closed contacts and their clinical manifestations are presented in table1.
Past history: the mother of those boys was diagnosed as having pulmonary tuberculosis with pleural effusion about half a year ago. She had been treated at the private hospital and now she takes 2 drugs (INH and Rifampicin). The father also had a clinical symptoms of low grade fever and coughing. He was just diagnosed as having pulmonary tuberculosis with a sputum positive a week ago. The family live with grandfather. The grandmother has not yet investigated for a tuberculosis.
 
 
Physical examination: as shown in table 2
 
 
Investigations: Based on the guidelines of contact investigations, the two boys (7 and 6 years old) have been tested for the tuberculin test and all have the chest radiology done. The results of the investigation as shown in Table 3.
 

 
Management: Based on the contact investigation guidelines, 3 boys were treated as shown in Table 4
 
   
Lessons learned:
1.
 Close contact investigations are important for the Thai setting since the prevalence of tuberculous infection is high.(ref 1)
2.
 The therapy for latent tuberculous infection among children, the efficacy approaches 100% with appropriate adherence to therapy.(ref 2)
3.
 The criteria for tuberculin positivity as shown in Table 5
4.
 The guidelines for contact investigations and managements as shown in Flowchart 1.
 
   
 
 
 
 
 
References:
1. กองระบาดวิทยา สำนักงานปลัดกระทรวงสาธารณสุข. สถานการณ์วัณโรคประเทศไทย พ.ศ.2538. รายงานการเฝ้าระวังโรคประจำสัปดาห์ 1997; 28: 313-26.
2. American Academy of Pediatrics. In: Pickering LK, ed. Red book: 2003 Report of the Committee on Infectious Diseases. 26th ed. Elk Grove Village, IL: American Academy of Pediatrics; 2003: 642-660.
3. Centers for Disease Control and Prevention. Screening for tuberculosis and tuberculosis infection in high-risk populations: recommendations of the Advisory Council for the Elimination of Tuberculosis. M.M.W.R. 1995; 44(No.RR-11): 19-34.
4. American Thoracic Society. Targeted tuberculin testing and treatment of latent tuberculosis infection. Am J Respir Crit Care Med, 2000; 161: s221-s247.
5. สรุปการประชุมของคณะกรรมการ สมาคมปราบวัณโรคแห่งประเทศไทย การทดสอบทุเบอร์คุลินและการรักษาภาวะติดเชื้อวัณโรค วารสารวัณโรค โรคทรวงอกและเวชบำบัดวิกฤต 2546; 24(2):87-93.
6. สมาคมปราบวัณโรคแห่งประเทศไทย กรมควบคุมโรคติดต่อ สมาคมอุรเวชช์แห่งประเทศไทย. แนวทางการวินิจฉัยและการรักษาวัณโรคในประเทศไทย พิมพ์ครั้งที่ 2 (ฉบับปรับปรุง) กุมภาพันธ์ 2543 (หนังสือ)

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