Recent advances in the diagnosis and treatment of childhood tuberculosis.
Recent advances in the diagnosis and treatment of childhood tuberculosis.
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DOI：
10.4103/0976-9668.159988
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发表时间：
2015-07
期刊：
影响因子：
--
通讯作者：
Singh A
中科院分区：
文献类型：
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作者：
Kumar MK;Kumar P;Singh A
尽管印度的结核病病例超过230万例(占全球负担的26%)，但对儿童结核病的准确诊断仍然是一项重大挑战。患有结核病的儿童通常患有少菌病，对社区内的疾病传播几乎没有贡献。因此，结核病控制方案往往不把儿童结核病的治疗视为优先事项。对儿童时期的结核病感染进行充分和及时的评估可以减轻流行病学负担，因为诊断不足的儿童患者最终可能演变为活跃状态，并有可能传播结核分枝杆菌，特别是增加这一世界性公共卫生问题。在这篇综述中，我们讨论了在儿童结核病诊断方面最重要的最新进展：(1)基于症状的方法；(2)基于免疫的新方法，包括体外干扰素-γ免疫球蛋白释放试验；(3)用于结核病诊断和/或耐药性检测的更快速和/或更便宜的细菌学和分子方法。最近的进展提高了我们诊断儿童潜伏感染和活动性结核病的能力，然而，确定艾滋病毒感染儿童的潜伏感染或活动性疾病的诊断仍然是一项重大挑战。
Despite over 2.3 million (26% of global burden) cases of tuberculosis (TB) in India the accurate diagnosis of childhood TB remains a major challenge. Children with TB usually have paucibacillary disease and contribute little to disease transmission within the community. Consequently the treatment of children with TB is often not considered a priority by TB control programmes. Adequate and timely assessment of TB infection in childhood could diminish epidemiological burden as underdiagnosed pediatric patients can eventually evolve in to an active state and have the potential to disseminate the etiological agent Mycobacterium tuberculosis, notably increasing this worldwide public health problem. In this review we discuss the most important recent advances in the diagnosis of childhood TB: (1) Symptom-based approaches, (2) novel immune-based approaches, including in vitro interferon-γ IGRA release assays IGRA tests; and (3) bacteriological and molecular methods that are more rapid and/or less expensive than conventional culture techniques for TB diagnosis and/or drug-resistance testing. Recent advances have improved our ability to diagnose latent infection and active TB in children, nevertheless establishing a diagnosis of either latent infection or active disease in HIV-infected children remains a major challenge.