Evidence for tuberculous infection in Romanian HIV-positive children by enzyme-linked immunosorbent assay.
The pandemic spread of tuberculosis (TB) and human immunodeficiency virus (HIV) represents a serious world problem. The diagnosis of TB in developing countries remains difficult, particularly in patients with concomitant HIV infection. Anergia to tuberculin frequently occurs in HIV-positive patients with pulmonary or extrapulmonary disease, and radiographic images are atypical or nondiagnostic. Children are often in an even more unfavorable situation: they cannot expectorate, and the biological samples required for bacteriological examination and culture are more difficult to obtain. We present in this work the correlation between the presence of serum antimycobacterial antibodies [as demonstrated by an in-house enzyme-linked immunosorbent assay (ELISA)] in 41 out of 279 HIV-infected children, and clinical, bacteriological, radiological, and pathological data that support the diagnosis of TB in these children. The prevalence of antimycobacterial antibodies in our group of HIV-positive children was 23.3%. In only 4 of the total cases investigated could the diagnosis of TB not be supported by the results of standard tests for TB. The control group showed an insignificant interference from bacillus Calmette-Guerin (BCG) vaccination.