Evaluation and Management of Childhood Contacts to Infectious Pulmonary Tuberculosis

September 2006 (REVISED November 22, 2006)

Source Case:

A 31 year old male was admitted to the hospital after experiencing gross hemoptysis. He had a 2 month history of productive cough, a 25 pound weight loss, night sweats, and fatigue. A chest x-ray (CXR) revealed bilateral cavitary infiltrates. The initial sputum specimen was 4+ positive for acid fast bacilli (AFB) and a genetic probe assay confirmed Mycobacterium tuberculosis. A culture was positive for M. tuberculosis which was later reported to be resistant to INH and streptomycin. The patient has a history of heavy alcohol and drug use, is HIV negative but Hepatitis B and C positive. He has a long history of cigarette use and a chronic smoker's cough. The patient resides with his wife and 3 children (2 are stepchildren).

General Information on Contact's History

In the course of the contact investigation, eleven children were identified to have had exposure to the source case. All were tested by tuberculin skin test (TST). Of the eleven children, six had positive TSTs (range 11mm to 25mm). One of four children under the age of 5 years tested positive.

Contact #1; High Priority Contact: Active TB

The source's 13 month old niece had a positive TST with 25mm induration. Her chest x-ray had a question of an early infiltrate and adenopathy. These findings were both confirmed by a CT scan of the chest. The child was asymptomatic and was initially started on a daily regimen of INH, rifampin (RIF) and pyrazinamide (PZA). When the susceptibility results on the source case showed resistance to INH, her treatment was changed to RIF, PZA, and ethambutol (EMB).

Contact #2; High Priority Contact: Exposed, No Evidence of Disease

The youngest contact, a 7 week old infant, was TST negative (0mm). Her initial CXR was inconclusive and she had a one week history of cough. The physical exam was normal. Because of her persistent cough, initial abnormal CXR and young age, she was admitted to the hospital for a repeat CXR and CT scan of the chest. These were negative, so no further testing was done. She was started on window period prophylaxis with INH. A repeat TST was planned at 8-10 weeks post-exposure and another at age 6 months. She has since been changed to RIF. Both young children are on directly observed therapy (DOT) due to their young age and increased risk for developing life-threatening forms of TB disease.

Teaching Points


American Academy of Pediatrics. "Tuberculosis" Red Book: Report of the Committee on Infectious Diseases, 27th ed., 2006.

MMWR. Guidelines for the Investigation of Contacts of Persons with Infectious Tuberculosis. December 16, 2005, Volume 54(15): p. 14-15.

Nelson, L. J., Schneider, E., Wells, C.D. and Moore, M. "Epidemiology of Childhood Tuberculosis in the United States, 1993-2001: The Need for Continued Vigilance." Pediatrics August 2004, Volume 114, Number 2, p. 333-340.

Starke, Jeffrey R., "Tuberculosis in Infants & Children" in Tuberculosis & Nontuberculous Mycobacterial Infections., 5th ed. New York: McGraw Hill, Medical Publishing Division, 2006.

Heartland National TB Center
2303 SE Military Drive
San Antonio, Texas 78223
Phone: 1 (800) TEX-LUNG
Fax: (210) 531-4590