Cutaneous hypersensitivity reactions due to thiacetazone in the treatment of tuberculosis in Zambian children infected with HIV-I.
Cutaneous hypersensitivity reactions due to thiacetazone in the treatment of tuberculosis in Zambian children infected with HIV-I.
复制标题
在治疗感染 HIV-I 的赞比亚儿童的结核病中，由于硫醋酮引起的皮肤过敏反应。
DOI：
10.1136/adc.68.5.665
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发表时间：
1993
影响因子：
5.2
通讯作者：
Zumla,A
中科院分区：
文献类型：
--
作者：
Chintu,C;Luo,C;Bhat,G;Raviglione,M;DuPont,H;Zumla,A
结核病是感染艾滋病毒的赞比亚成人和儿童最常见的感染之一。在非洲，已充分记录了感染艾滋病毒-I的成年人在治疗结核病期间因噻醋腙引起的皮肤超敏反应。本研究监测了18个月内结核病治疗期间的药物不良反应（1990年4月1日至1991年10月31日）237名临床诊断为结核病的儿童（125名男孩和112名女孩; 88/237（37%）感染了HIV-I）和242名对照儿童（149名男孩和93名女孩; 26/242（11%）感染了HIV-I）。237名结核病儿童中有22名（9%）在治疗过程中出现皮肤过敏反应。皮肤不良反应在感染HIV的儿童中比在未感染HIV的儿童中更常见（比值比11.65，95%置信区间3.07至34.88）。在88名感染艾滋病毒的儿童中，有19名（21%）感染了艾滋病毒，在149名未感染艾滋病毒的儿童中，有3名（2%）感染了艾滋病毒。这些皮肤反应发生在接受HST（异烟肼、链霉素、硫醋松）方案的14名儿童和接受HSTR（异烟肼、链霉素、硫醋松、利福平）方案的8名儿童治疗2 - 4周后。22名对治疗有不良反应的儿童中有12名（55%）发展为史蒂文斯-约翰逊综合征。所有12名患有史蒂文斯-约翰逊综合征的儿童都感染了艾滋病毒。这些发生Stevens-Johnson综合征的儿童的死亡率为91%（12例中有11例在反应发生后3天内死亡）。11名儿童在停用硫醋腙继续治疗结核病6个月后从皮肤超敏反应中恢复，未观察到进一步的反应。这项研究的结果部分地促成了世界卫生组织提出的建议，即在治疗感染艾滋病毒的儿童的结核病时避免使用硫醋腙。
Tuberculosis is one of the most common infections in Zambian adults and children infected with HIV. In Africa, cutaneous hypersensitivity reactions attributed to thiacetazone during treatment of tuberculosis in adults infected with HIV-I have been well documented. This study monitored adverse drug reactions during treatment for tuberculosis over an 18 month period (1 April 1990 to 31 October 1991) in 237 children with a clinical diagnosis of tuberculosis (125 boys and 112 girls; 88/237 (37%) infected with HIV-I) and 242 control children (149 boys and 93 girls; 26/242 (11%) infected with HIV-I). Twenty two (9%) of the 237 children with tuberculosis developed hypersensitivity skin reactions during the course of treatment. Adverse skin reactions were seen more often in children infected with HIV than in those who were not (odds ratio 11.65, 95% confidence interval 3.07 to 34.88). These represented 19 (21%) of 88 children infected with HIV and three (2%) of 149 children not infected with HIV. These skin reactions occurred after a period of treatment ranging between two and four weeks among 14 children receiving the HST (isoniazid, streptomycin, thiacetazone) regimen and eight children receiving the HSTR (isoniazid, streptomycin, thiacetazone, rifampicin) regimen. Twelve (55%) of the 22 children who reacted adversely to treatment developed the Stevens-Johnson syndrome. All 12 of these children with the Stevens-Johnson syndrome were infected with HIV. The mortality among these children who developed the Stevens-Johnson syndrome was 91% (11 of 12 died within three days of the onset of the reaction). No further reactions were observed in the 11 children who recovered from the cutaneous hypersensitivity reactions after thiacetazone was discontinued over a period of six months of further treatment of tuberculosis. The results of this study were in part responsible for the recommendations put forward by the World Health Organization to avoid the use of thiacetazone in the treatment of tuberculosis in children infected with HIV.