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Edith Lincoln (1899-1971), one of the most influential American pediatricians to study childhood tuberculosis, managed more than a thousand children from time of tuberculosis infection into adult life. She spoke with authority regarding the prognosis of childhood tuberculosis. Her observations of chemotherapy in children treated with isoniazid led directly to chemoprophylaxis, now of great importance in the management of the human immunodeficiency syndrome.

Tuberculosis (TB) in children has conventionally been classified as pulmonary TB (PTB) and extrapulmonary TB (EPTB) disease, including disseminated TB (TB meningitis and miliary disease). There is no existing approach that comprehensively characterizes the spectrum and severity of pediatric TB. This limits accurate classification of patients and comparison across cohorts.To develop a classification of pediatric TB that reflects the spectrum and severity of clinical disease better than currently available approaches.We propose a framework for the standard classification of TB disease severity in children. From a literature search, the following sources of information were used: clinical data, bacteriologic, histopathologic, and imaging data (including information from chest radiography, computerized tomography, and bronchoscopy). Each individual disease entity was systematically considered. Based on the extent and the presence of complications, each entity was then classified as "severe" or "nonsevere." As an initial application, we compared the proposed classification with the convention (PTB, EPTB) in a cohort of HIV-infected and -uninfected infants with culture-confirmed TB. Agreement between the 2 systems was poor.The proposed comprehensive disease classification system may more accurately reflect the clinical TB disease spectrum in children, is relevant to clinical management, and may be valuable to inform research on diagnostic tools and TB treatment strategies in children. Prospective studies are required to evaluate this approach in representative pediatric populations, correlating TB disease severity with diagnostic yield, treatment response, and application in existing and novel treatment strategies.

Pyrazinamide plasma concentrations were determined in 34 children (median age, 3.32 years) 1 month after commencing antituberculosis treatment. The median (interquartile range) peak concentration was 30.7 (25.5, 35.0) mg/L after a median dose of 23 mg/kg. Peak concentrations20 mg/L were found in 5 children (15%) and such low concentrations were particularly likely after doses20 mg/kg.

Drug resistance in children with tuberculosis is usually primary (transmitted); however, resistance acquisition during treatment is possi- ble. We describe a child with tuberculosis who acquired drug resistance while receiving directly observed but inadequate first-line therapy and the programmatic and clinical factors that may have contributed to resistance acquisition.

Treatment of extensively drug-resistant tuberculosis (XDR-TB) is a challenge. We describe a young child with pulmonary XDR-TB who did not respond to an aggressive multidrug-resistant TB treatment regimen, but was cured with linezolid in combination with other reserve antituberculous drugs. No serious adverse events were observed during 19 months of treatment for XDR-TB.