Multidrug-resistant tuberculous meningitis in children in Durban, South Africa
Multidrug-resistant tuberculous meningitis in children in Durban, South Africa
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DOI：
10.1097/01.inf.0000199314.88063.4c
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发表时间：
2006-02-01
影响因子：
3.6
通讯作者：
Bobat, R
中科院分区：
文献类型：
--
作者：
Padayatchi, NI;Bamber, S;Bobat, R
背景资料：结核性脑膜炎（TBM）是中枢神经系统结核病（TB）最常见的表现，在儿童中比成人更常见。儿童结核性脑膜炎的诊断很困难，因为体征和症状很模糊。有关儿童耐药结核病的信息是稀缺的，并没有发表的信息对耐药结核性脑膜炎在children.Methods：这是一个回顾性审查的医疗记录，培养证实的耐多药结核性脑膜炎（MDR-TBM）的儿童在国王乔治五世医院在德班，南非。结果：1992 ~ 2003年共检出MDR-TBM患儿8例，其中HIV感染6例，HIV阴性2例。只有一个孩子活了下来。在几乎所有的children.Discussion死后作出的诊断：脑脊液（CSF）在早期TBM的变化可以是非特异性的，可以迅速改变，因此，CSF的研究应始终包括文化和药敏试验。导致死亡率高的因素是播散性结核病、艾滋病毒感染、诊断和治疗延误、缺乏管理耐多药结核病的标准化方法以及大多数耐多药结核病药物的脑脊液渗透性差。如果有结核病史，应考虑耐多药结核病治疗：接触耐多药结核病或尽管充分坚持治疗但对结核病治疗的临床反应较差。早期诊断很重要，因为儿童的TBM通常与严重的结果有关。
Background: Tuberculous meningitis (TBM) is the most frequent manifestation of central nervous system tuberculosis (TB) and is more common in children than in adults. The diagnosis of TBM in children is difficult because signs and symptoms are vague. Information about drug resistant TB in children is scarce, and there is no published information on drug resistant TBM in children.Methods: This is a retrospective review of medical records of children with culture-confirmed multidrug-resistant tuberculous meningitis (MDR-TBM) at King George V Hospital in Durban, South Africa. Results: Between 1992 and 2003, there were 8 children with MDR-TBM: 6 were HIV infected and 2 were HIV negative. Only one child survived. The diagnosis was made posthumously in almost all the children.Discussion: The changes in the cerebrospinal fluid (CSF) in early TBM can be nonspecific and can change rapidly; therefore, CSF studies should always include culture and susceptibility testing. Factors that contributed to the high mortality were disseminated TB, HIV infection, delay in diagnosis and treatment, the absence of a standardized approach to the management of MDR-TBM and the poor CSF penetration of most MDR-TB drugs. MDR-TB therapy should be considered if there is a history of TB: a MDR-TB contact or a poor clinical response to TB therapy despite adequate adherence to treatment. Early diagnosis is important because TBM in children is often associated with a grave outcome.