Items in AFP with MESH term: Tuberculosis, Pulmonary
ABSTRACT: The management of infants whose mothers are infected with the human immunodeficiency virus (HIV) involves minimizing the risk of vertical transmission of HIV, recognizing neonatal HIV infection early, preventing opportunistic infections, and addressing psychosocial issues. Maternal antiretroviral drug therapy during pregnancy and labor, followed by six weeks of neonatal zidovudine therapy, can significantly decrease the risk of vertical transmission. Additional antiretroviral drugs may be needed in some high-risk newborns. Elective cesarean section also may prevent vertical transmission of HIV. Virologic tests allow early diagnosis of HIV infection, facilitating the timely initiation of aggressive treatment and the prevention of opportunistic infections. Even when tests are negative, infants must be closely monitored until age 18 months to completely rule out HIV infection. Prophylaxis for Pneumocystis carinii pneumonia should be initiated when HIV-exposed infants are six weeks old and should be continued for at least four months, regardless of negative virologic tests, because P. carinii pneumonia is often the initial presentation of HIV infection in infants. Laboratory monitoring, screening for perinatal infections, appropriate social support, and other modifications of standard infant care are also necessary.
Management of Active Tuberculosis - Article
ABSTRACT: Although the overall incidence of tuberculosis has been declining in the United States, it remains an important public health concern, particularly among immigrants, homeless persons, and persons infected with human immunodeficiency virus. Patients who present with symptoms of active tuberculosis (e.g., cough, weight loss, or malaise with known exposure to the disease) should be evaluated. Three induced sputum samples for acid-fast bacillus smear and culture should be obtained from patients with findings of tuberculosis or suspicion for active disease. If the patient has manifestations of extrapulmonary tuberculosis, smears and cultures should be obtained from these sites. Most patients with active tuberculosis should be treated initially with isoniazid, rifampin, pyrazinamide, and ethambutol for eight weeks, followed by 18 weeks of treatment with isoniazid and rifampin if needed. Repeat cultures should be performed after the initial eight-week treatment.
Primary Care of International Adoptees - Article
ABSTRACT: International adoptees are presenting to family physicians with increasing frequency. U.S. citizens have adopted over 100,000 international children since 1979. Prospective parents may seek advice from their physician during the adoptive process. If available at all, medical information on the child is often scanty. History and physical examination alone are often insufficient for diagnosis of common problems in this population. Adoptive parents may have concerns about growth and development, and appropriate immunizations. In addition, bacterial, viral and parasitic infections endemic in countries of origin create unusual challenges for the U.S. primary care physician. A basic understanding of the process of international adoption, a skillful evaluation of the child and selected laboratory studies enable the family physician to support the prospective parents and assist in a smooth transition of the child into a new family.
ATS Adopts Diagnostic Standards for Tuberculosis - Practice Guidelines
CDC Calls for Tuberculosis Screening and Treatment for All Patients with HIV Infection - Special Medical Reports
Clinical Briefs - Clinical Briefs