Tuberculosis in Children 10 Years of Age and Younger: Three Decades of Experience During the Chemotherapeutic Era

The 863 patients, aged 10 years and younger, treated at the Children's Chest Clinic of Bellevue Hospital during three decades (1953 through 1981) clearly indicated the success of antituberculosis therapy. There were no deaths from tuberculosis. Early treatment is associated with a reduction in the serious forms of disease, eg, meningitis, miliary disease, and bone infections, and with preventing death. Medication was well tolerated: only 1.1% of the patients had adverse reactions, all of which were reversible. Consistent compliance with medication of only 62% of patients is a challenge to the medical profession. Only 22.5% of mycobacterial cultures were positive. Long-term follow-up of patients was rewarding: seven pregnancies with healthy mothers and babies, and no reactivation of tuberculosis by later infections, even those such as measles or pneumonia. The severity of disease was related largely to patient's age (3 years and younger) and intimacy of contact, the highest rate being when the mother was the contact. The long-term experience emphasizes the value of early identification, therapeutic compliance, and comprehensive contact tracing in the future elimination of tuberculosis. Prophylactic therapy and close observation should be considered for contacts, especially those exposed to human immunodeficiency virus infections and addicted to drugs.