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Previous Volume 341:1491-1495 November 11, 1999 Number 20 Next

	Full Text PDF Editorial by Miller, L. C. Letters Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited PubMed Citation

ABSTRACT

Background and Methods Young children rarely transmit tuberculosis. In July 1998, infectious tuberculosis was identified in a nine-year-old boy in North Dakota who was screened because extrapulmonary tuberculosis had been diagnosed in his female guardian. The child, who had come from the Republic of the Marshall Islands in 1996, had bilateral cavitary tuberculosis. Because he was the only known possible source for his female guardian's tuberculosis, an investigation of the child's contacts was undertaken. We identified family, school, day-care, and other social contacts and notified these people of their exposure. We asked the contacts to complete a questionnaire and performed tuberculin skin tests.

Results Of the 276 contacts of the child whom we tested, 56 (20 percent) had a positive tuberculin skin test (induration of at least 10 mm), including 3 of the child's 4 household members, 16 of his 24 classroom contacts, 10 of 32 school-bus riders, and 9 of 61 day-care contacts. A total of 118 persons received preventive therapy, including 56 young children who were prescribed preventive therapy until skin tests performed at least 12 weeks after exposure were negative. The one additional case identified was in the twin brother of the nine-year-old patient. The twin was not considered infectious on the basis of a sputum smear that was negative on microscopical examination.

Conclusions This investigation shows that a young child can transmit Mycobacterium tuberculosis to a large number of contacts. Children with tuberculosis, especially cavitary or laryngeal tuberculosis, should be considered potentially infectious, and screening of their contacts for infection with M. tuberculosis or active tuberculosis may be required.

Source Information

From the Epidemic Intelligence Service, Epidemiology Program Office (A.B.C.), and the Division of Tuberculosis Elimination, National Center for HIV, STD, and TB Prevention (A.B.C., R.R., S.V., I.M.O.), Centers for Disease Control and Prevention, Atlanta; the North Dakota Department of Health, Bismarck (R.V., S.M.); Altru Health Care Systems, Grand Forks, N.D. (J.H.); and the Nelson–Griggs District Health Unit, McVille, N.D. (J.F.).

Address reprint requests to Dr. Curtis at the Division of Tuberculosis Elimination, Mailstop E-10, Centers for Disease Control and Prevention, 1600 Clifton Rd., Atlanta, GA 30333.

Full Text of this Article

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Tuberculosis in a Child in North Dakota
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N Engl J Med 2000; 342:1918-1919, Jun 22, 2000. Correspondence

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