A profile of bacteriologically confirmed pulmonary tuberculosis in children.
A profile of bacteriologically confirmed pulmonary tuberculosis in children.
复制标题
经细菌学证实的儿童肺结核概况。
作者：
S. Swaminathan;M. Datta;M. Radhamani;S. Mathew;A. M. Reetha;S. Rajajee;R. Mathew;A. Radhakrishnan;M. B. Raghu
目的
描述细菌学确诊的儿童结核病的临床特征。
研究设计
1995年7月至1997年12月在钦奈市的三家医院进行了多中心研究。进一步调查了6个月至12岁的儿童，这些儿童的体征和症状提示结核病。所有患者均行临床检查、胸片、结核菌素皮试、痰或洗胃作分枝杆菌涂片和培养，必要时行淋巴结活检。
结果
共有2 652名儿童进行了登记，201名儿童经细菌学证实患有结核病。主要症状为隐匿性疾病史（49%）、发热和咳嗽（47%）、体重减轻（41%）和可见的腺体肿胀（49%）。呼吸道症状很少，62%的人营养不良。超过一半的确诊结核病患者的胸部X线检查正常。异常X线表现包括47%的肺实质阴影和26%的肺门或纵隔淋巴结肿大。异烟肼耐药率为12.6%，耐药率为4%。
结论
患有结核病的儿童表现为发热和咳嗽，起病隐匿。淋巴结病是一个共同的特点，即使在儿童肺结核。尽管胃吸出物培养阳性，仍有相当比例的儿童胸部X线检查正常。儿童的耐药率反映了这一地理区域成年人的耐药模式。
OBJECTIVE
To describe the clinical profile of children with bacteriologically confirmed tuberculosis.
STUDY DESIGN
A multicentric study was conducted in three hospitals in Chennai city between July 1995 and December 1997. Children aged 6 months to 12 years with signs and symptoms suggestive of tuberculosis were investigated further. Clinical examination, chest radiograph, tuberculin skin test with 1 TU PPD and, sputum or gastric lavage for mycobacterial smear and culture were done for all and, lymph node biopsy when necessary.
RESULTS
A total of 2652 children were registered and tuberculosis was bacteriologically confirmed in 201. Predominant symptoms were history of an insidious illness (49%), fever and cough (47%), loss of weight (41%) and a visible glandular swelling (49%). Respiratory signs were few and 62% were undernourished. Over half the patients with confirmed TB had normal chest X-ray. Abnormal X-ray findings included parenchymal opacities in 47% and hilar or mediastinal lymphadenopathy in 26%. The prevalence of isoniazid resistance was 12.6% and MDR TB 4%.
CONCLUSIONS
Children with tuberculosis present with fever and cough of insidious onset. Lymphadenopathy is a common feature even in children with pulmonary TB. A significant proportion of children have normal chest X-rays despite positive gastric aspirate cultures. Drug resistance rates in children mirror the pattern seen in adults in this geographic area.