Page updated 30 April 2007
Tuberculosis in Children, Staff, and AIDS Patients
Tuberculosis in Children
Children with primary pulmonary tuberculosis are usually not infectious. If primary lesions are discharging (e.g. lymph nodes or osteomyelitis), source isolate the child for the first 14 days of treatment.
Be aware of the possibility that visiting relatives may have open tuberculosis. Large outbreaks have occurred on children's wards from infectious mothers and other relatives. It is the responsibility of the Medical Staff to ensure that close relatives of children with tuberculosis do not have open tuberculosis, usually through formal notification but also by direct questioning. Please ensure that the Infection Control Team are informed. Visitors who are clearly unwell and may have an infectious disease should anyway not be allowed on the wards.
Tuberculosis in Staff Members
Staff members who are ill must consult their general practitioners and report to Occupational Health. If there is any doubt, a review in the Chest Clinic to exclude active pulmonary tuberculosis is essential to reduce risk of transmission to patients. Staff with tuberculosis will stay off work until deemed non-infectious by chest physicians. Common symptoms of tuberculosis include malaise, unexplained weight loss, fever and night sweats, dry cough, cough with sputum and blood.
Tuberculosis in AIDS Patients
Several episodes of transmission of tuberculosis have been documented on AIDS units because these patients appear to be very prone to catching the infection. Multi-drug resistant tuberculosis is now being identified in London. The major problem with instituting a sensible preventive programme is that diagnosis is delayed. Sputum positive for acid-fast bacilli may contain Mycobacterium avium-intracellulare complex (MAC) which does not warrant Source Isolation. Cultures will take several weeks. The following guidelines have therefore been drawn up to reduce the risks of nosocomial tuberculosis to patients and staff with HIV.
- Tuberculosis will be considered in any patient with HIV and respiratory disease. Finding another pathogen such as Pneumocystis jirovecii does not exclude the possibility of tuberculosis.
- Risk will be assessed in the context of history of exposure (ward, friends, racial predisposition, travel, past history of TB).
- Initial treatment of mycobacterial disease should include drugs effective against both TB and Mycobacterium avium-intracellulare complex.
- Patients with TB (whether or not resistant) should not mix with other HIV positive people.
- Special protective masks (not ordinary surgical masks) must be available for staff performing risky procedures (eg bronchoscopy, induced sputum, tracheal aspiration (ICU) and surgery).
Note: "Induced sputum" is excellent for obtaining deep cough specimens for the diagnosis of tuberculosis but dangerous because an aerosol is generated deliberately. This procedure must be done in a room with proper ventilation away from susceptible patients.
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