Diagnostic Dilemma

HIV and TB

A 5 years old boy was detected to have endobronchial TB at age of 2 years and was on antituberculous therapy {ATT} for 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 lymphnodes with necrotic enlarged subcarinal lymphnode {2.5 x 1.9 cm} with patchy consolidation in posterior segment of right upper lobe with collapse consolidation. Nodules were seen in apicoposterior segment of left upper lobe, superior segment of left lower lobe and right lower lobe showing endobronchial spread of disease. Child was started on Category 2 of ATT and bronchoalveolar lavage {BAL} was sent for TB Bactec culture. Patient was subsequently lost to follow up for next 6 months. He again presented with molluscum and chest X-Ray showed same picture.

How should this child be managed_?
Answer Discussion :
Edsel Peter
He would need a BAL. Adherence will have to be ensured before he is put on any second line anti TB drugs or even HIV medicines.
12 years ago

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