Cutaneous tuberculosis in Indian children: the importance of screening for involvement of internal organs
Cutaneous tuberculosis in Indian children: the importance of screening for involvement of internal organs
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DOI：
10.1111/j.1468-3083.2004.00970.x
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发表时间：
2004-09-01
影响因子：
9.2
通讯作者：
Khurana, N
中科院分区：
文献类型：
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作者：
Pandhi, D;Reddy, BSN;Khurana, N
目的和目的近年来，皮肤结核特别是耐药菌株的死灰复燃已经得到了充分的记录，但这一问题在儿科年龄组中并未受到太多关注。因此，我们进行了本研究，以分析儿童皮肤结核的临床和治疗方面。材料与方法对所有患儿进行详细的临床检查、血清学、HIV血清学、Mantoux试验、胸部x线、细胞学、培养、组织病理学等检查。给予抗结核治疗（WHO方案），并随访临床反应。结果142例皮肤结核患者中，儿童68例（女40例，男28例）。这些儿童的年龄从9个月到14岁不等。病程从1个月到6年不等。有结核家族史的28例（41.2%）。30例（44.1%）患者以阴囊皮病最常见，优先累及宫颈（56.2%）和腹股沟（20%）区域。寻常性狼疮15例（22.1%），其中角化型最为常见（46.7%），阴囊地衣16例，皮肤疣状结核3例，多型结核4例。累及肺14例（20.6%），累及骨7例（10.2%），同时累及肺和骨4例（5.9%）。组织病理学证实临床诊断54例（80.6%），培养阳性6例（8.8%）。50例（73.5%）患者完成治疗，反应良好，无多药耐药病例。结论皮肤结核仍然是儿童发病的重要原因，其内部受累的可能性很高，特别是在患有硬皮病的患者中。需要寻找更灵敏、更经济的诊断工具。4周后对治疗的反应通常有助于证实可疑病例的结核病诊断。
Aims and objectives Resurgence of skin tuberculosis especially with drug-resistant strains has been well documented in recent years, but this problem has not received much attention in the paediatric age group. Hence, we carried out the present study to analyse the clinical and therapeutic aspects of cutaneous tuberculosis in children.Materials and methods A detailed clinical examination, investigations, such as haemogram, serology for HIV, Mantoux test, chest X-ray, cytology, culture and histopathology were carried out in all children. They were treated with antitubercular therapy (WHO regimen), and the clinical response was followed up.Results Of 142 patients with cutaneous tuberculosis, 68 were children (40 females, 28 males). These children were aged from 9 months to 14 years. The duration of the disease varied from 1 month to 6 years. Family history of tuberculosis was present in 28 (41.2%) of the patients. Scrofuloderma was the most common presentation encountered in 30 (44.1%) patients with preferential involvement of the cervical (56.2%) and inguinal (20%) regions. Fifteen (22.1%) patients had lupus vulgaris, of which the keratotic type was the most common (46.7%), 16 had lichen scrofulosorum, three had tuberculosis verrucosa cutis, and four had more than one type of tuberculosis. Involvement of the lung in 14 (20.6%), bone in seven (10.2%), and both in four (5.9%) was found. Histopathology corroborated the clinical diagnosis in 54 (80.6%), culture was positive in six (8.8%). Fifty (73.5%) patients completed the treatment with an excellent response, no multidrug resistant cases were seen.Conclusions Cutaneous tuberculosis in children continues to be an important cause of morbidity, there is a high likelihood of internal involvement, especially in patients with scrofuloderma. A search is required for more sensitive, economic diagnostic tools. Response to treatment at 4 weeks often helps in substantiating the diagnosis of tuberculosis in doubtful cases.