Correct Answer:

positive; perform a chest x-ray

Educational Objective:

Interpret tuberculin skin test results in an immunocompromised child.

Key Point:

A child with HIV has a positive tuberculin skin test reading if the induration is > 5 mm.

Explanation:

A positive tuberculin skin test in infants, children, and adolescents is defined as:

Induration ≥ 5 mm in children in contact with people with tuberculosis, who are suspected to have the disease, or who are immunocompromised
Induration ≥ 10 mm in children at risk of disseminated disease (e.g., children < 4 years of age), with certain medical conditions, or have a likely increased exposure to the disease Induration ≥ 15 mm in children age ≥ 4 years without any risk factors The test should be read at 48 to 72 hours following placement. Because this child is immunocompromised and he has an induration greater than 5 mm, his results would be considered positive. The next step is to perform x-ray of the chest to determine whether he has latent infection or active disease. If findings on the chest x-ray showed active disease, then he would start a multidrug regimen for treatment. If the x-ray findings were negative, then he would start a drug such as isoniazid for treatment of latent tuberculosis.

Reference:

American Academy of Pediatrics. Red Book: Report of the Committee on Infectious Diseases. 31st ed., 2018.

Michaels MG, Green M. Infections in immunocompromised persons. In: Kliegman RM, et al. Nelson Textbook of Pediatrics. 20th ed., 2016:1287-1295.