Impact of human immunodeficiency virus 1 infection on clinical presentation, treatment outcome and survival in a cohort of Ethiopian children with tuberculosis
Impact of human immunodeficiency virus 1 infection on clinical presentation, treatment outcome and survival in a cohort of Ethiopian children with tuberculosis
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DOI：
10.1097/00006454-200211000-00016
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发表时间：
2002-11-01
影响因子：
3.6
通讯作者：
Giesecke, J
中科院分区：
文献类型：
--
作者：
Palme, IB;Gudetta, B;Giesecke, J
背景儿童结核病（TB）很难可靠诊断，因为体征和症状是非特异性的，并且很难获得直接显微镜检查的痰液，特别是在非常年幼的儿童中。这种诊断困境被认为随着艾滋病毒的流行而增加。关于高流行国家双重感染儿童的治疗结果的研究报告很少。本研究探讨艾滋病毒感染对埃塞俄比亚儿童结核病的临床表现、诊断标准和治疗结果的影响。对1995年12月至1997年1月在阿迪斯诊断为结核病的儿童进行了一项前瞻性队列研究，其中将HIV阳性儿童与HIV阴性儿童的病史、体征和症状、营养状况、胸部X线摄影、结核菌素皮肤试验、对结核病治疗的反应和最终结果进行了比较。对有肺部表现的患儿进行结核分枝杆菌培养。艾滋病毒阳性儿童年龄较小，体重不足，死亡率比艾滋病毒阴性儿童高6倍。结核菌素皮肤试验敏感性较低，胸部X线摄影在HIV感染患者中特异性较低。治疗依从性高（96%），HIV阳性和HIV阴性结核病患者的治愈率分别为58%和89%。艾滋病毒阳性儿童有可能出现结核病诊断错误和延误诊断。与艾滋病毒阴性儿童相比，结核病的表现更为严重，发展至死亡的速度更快。年龄别体重可用于识别具有致死性结局高风险的儿童。
Background. Childhood tuberculosis (TB) is difficult to diagnose reliably because signs and symptoms are nonspecific and sputum for direct microscopy is difficult to obtain, especially in very young children. This diagnostic dilemma is thought to have increased with the HIV pandemic. Few studies on treatment outcome of dually infected children in high endemic countries have been reported. This study examines the impact of HIV infection on clinical presentation, diagnostic criteria and treatment outcome of TB in Ethiopian children.Methods. A prospective cohort study of children with TB diagnosed in Addis Ababa from December 1995 to January 1997 in which HIV-positive children were compared with HIV-negative children with regard to medical history, signs and symptoms, nutritional status, chest radiography, tuberculin skin test, response to TB treatment and final outcome. Mycobacterium tuberculosis was cultured in children with pulmonary manifestations.Results. HIV-positive children were younger, were underweight and had a 6-fold higher mortality than HIV-negative children. The tuberculin skin test was less sensitive and chest radiography was less specific in HIV-infected patients. Adherence to treatment was high (96%), and the cure rate was 58% for HIV-positive and 89% for HIV-negative TB patients.Conclusion. HIV-positive children are at risk of diagnostic error as well as delayed diagnosis of TB. TB manifestations are more severe and progression to death is more rapid than in HIV-negative children. Weight for age may be used to identify children at high risk of a fatal outcome.