小儿结核病的防治

近20年来由于各国对结核病的忽视,使结核病流行重新加剧,使这一古老的传染病又成为严重的公共卫生问题。     

小儿结核病的流行病学及诊断问题

端木宏谨教授、张本医师（１０１１４９，北京市结核病胸部肿瘤研究所）：１９７９年以来，相继进行了３次全国结核病流行病学抽样调查，随后建立了全国肺结核患者登记年报和监测点，对无卡介苗疤痕、无接种史儿童的结核纯蛋白衍生物（ＰＰＤ）试验调查表明：１９７９年０...     

儿童耐药结核病与耐多药结核病

近15年来,在全球范围内,结核病的发病率又重新升高,结核病有卷土重来的趋势。全世界每年有800万～1000万新发病例,300万例病死,受害最严重的是小儿。结核菌耐药是小儿结核病发病率居高不下的一个重要原因。     

儿童结核病流行病学及诊治现状

2014年, 全球共报告35.9万例儿童（0～14岁）结核病,占登记报告结核病病例的6.5%。2013年我国研究数据显示,不同结核病疫情地区5～15岁儿童的结核菌素试验（PPD）阳性率为8.09%～21.26%（≥10 mm）。2015年,全国共报告儿童肺结核患者6861例,发病率为3.03/10万。2014年,全国0～14岁儿童结核病死亡率为0.12/10万。儿童结核病诊断要基于对接触史、临床检查和相关检查等证据的全面评估。儿童结核病治疗原则与成人相同。目前国务院下发了《“十三五”全国结核病防治规划》,提出要完善儿童结核病的防治措施,对儿科医生开展结核病防治技术培训,规范儿童结核病的诊断和治疗服务。     

无反应性结核病误诊二例分析

例一,女,11岁,以“发热,浮肿月余”收入院。无结核接触史。查体:T39℃,P118次分,R24次/分,BP80/60mmHg,神清,消瘦,浅表淋巴结肿大,眼睑浮肿,结膜充血,心肺肝脾无殊,腹膨隆,腹水征阳性,双下肢水肿,尿蛋白( ),按“肾炎”给抗感染、利尿等处理,效差,入院第七天出现尿少,并解肉眼血尿一次,量约150毫升,腹胀加剧,尿蛋白 ～ ,RBC(?),颗粒管型     

小儿结核病117例

近年来 ,特别是艾滋病发现以来 ,结核病在全世界范围内的发病率有上升趋势[1] ,本文收集了我院住院结核病患儿117例 ,现报告如下。临床资料一、病例来源　 1998年 1月～ 2 0 0 0年 12月我院儿科住院并确诊为结核病儿 117例 ,男 6 6例 ,女 5 1例 ,年龄 13ｄ～14岁。二、方法　将收集病例按各年龄组进行分组 ,统计各型结核病例数、有无结核接触史、有无卡介苗接种史等。部分资料经电话咨询确认。结　　果一、我院 1998年收治结核病儿 2 9例 ,1999年 37例 ,2 0 0 0年 5 1例 ,呈逐年上升趋势。新生儿期 1例 ,婴儿期 17例 ,幼儿期 31例 ,学龄前期…     

当前小儿结核病的特点

在当前新的流行病学条件下,小儿结核病的发生、临床、X 线表现、病程和治疗均有其特点、现综述如下。婴幼儿结核病婴幼儿结核病的临床表现各种各样,且与发病年龄、发病前健康状态、是否接种卡介苗、病变部位、范围及其是否存在并发症有关。但总的情况提示婴幼儿结核病有播散和坏死倾向,并发症多,因此具有较高的死亡率。苏联学者研究50例婴幼儿结核病患者,发现婴幼儿气管支气管淋巴结核少见,小病灶型肺结核多见,常见的并发症为支气管肺部受损、浸润和肺组织血行播散。婴儿对结核菌素的敏感性显著降低。支气管肺部受损婴幼儿,其病变常局限于右上肺,且分布于1～2个节段,此时临床症状较轻,如果肺部     

小儿结核病192例

我院 1989～ 1999年共收住结核病人 192例 ,门诊均误诊为其他疾病 ,现分析如下。临床资料一、一般资料　 192例中男 10 6例 ,女 86例 ,年龄 3个月～ 14ａ,Ⅰ型肺结核 (Ｔｂ) 62例 ,Ⅱ型肺Ｔｂ 84例 ,颅内Ｔｂ 3 6例 ,其他结核病 10例。分别误诊为上呼吸道感染 62例 ,肺炎5 4例 ,化脓性脑膜炎 16例 ,败血症 10例 ,癫痫 12例 ,病毒性脑炎、伤寒、风湿热各 8例 ,肺炎、支气管炎各 7例。二、临床表现　发热 176例 ,10 4例以发热为唯一症状 ,咳嗽 4 8例 ,盗汗、消瘦 2 7例 ,头痛、呕吐 16例 ,抽搐、昏迷 6例。腹痛、呕吐 6例 ,抽搐 12例。肺部湿…     

婴幼儿结核病的临床特点与误诊分析

婴幼儿结核病较易误诊 ,本组 2 0例 ,均为 1 999～ 2 0 0 1年门诊接收基层医院转诊患儿 ,现就其临床特点与误诊原因进行分析。临床资料一、一般资料　男 1 1例 ,女 9例 ,年龄 8个月～ 3岁 ,除 1例为市郊外 ,余均为农村婴幼儿。二、临床特点　 1 .4例 (2 0 % )以高热、咳嗽为主要症状 ,胸透肺部无病变。 2 .以呼吸道症状为首发 1 0例 (50 % ) ,出现咳嗽、发热、气喘、呼吸困难 ,同时肺部出现湿罗音。胸透肺部有病变 ,3 .以高热、全身皮疹为首发症状 2例 (1 0 % ) ,胸透肺部无病变。 4 .以惊厥、意识障碍起病 4例 (2 0 % ) ,胸透肺部无病变 ,…     

综合性儿科门诊中常见的心理障碍

心理障碍或精神障碍（mental disorder）是儿童的常见问题。有关流行病学研究表明，大约20％的儿童患有情绪、心理或行为异常，近10％的儿童患有较严重的心理障碍，而且与过去相比呈明显上升趋势。在儿科综合性门诊中，大约66．7％的患儿是心理障碍患儿或躯体疾病与心理障碍同时存在。     

Epidemiology of childhood tuberculosis in the Ashkelon region in Israel, 1958–1994

The incidence rates of tuberculosis (TB) in Israel decreased steadily up to 1984, but rose again between 1985 and 1991, mainly due to immigration waves from Ethiopia. The epidemiology of TB in children was surveyed in the Ashkelon region. The regional TB register of Barzilai Medical Centre, kept since 1958, was used as the source for our data. Two hundred and fifty TB cases in children were reported between 1958 and 1994, constituting 9.7% of the total 2565 cases reported in the whole population of Israel's southern Mediterranean coast. While in the late 1950s and early 1960s the majority of reported cases occurred in children of North African origin, reflecting the large wave of immigration from North Africa at that time, in 1985-94 at the time of the Ethiopian immigration wave, Ethiopian children constituted the majority of the patients. They were diagnosed up to 9 years after arrival. None of the reported cases was HIV-positive.     

儿童结核病分子诊断技术研究进展

结核病是由结核分枝杆菌(MTB)引起的慢性传染病,儿童结核病灶由于MTB含量低,常不能引起典型的临床症状及影像学表现,同时被誉为"金标准"的MTB检测多以罗氏培养法为基础,检测耗时长,阳性率低,患儿不能得到及时准确的诊断与治疗。如何快速、准确诊断是当前儿童结核病诊断与治疗中的首要问题。分子诊断技术因其快速、准确、高效、操作简便等显著优点得到广泛的临床应用和发展。文章综述近年来儿童结核病的分子诊断技术研究的最新进展。     

Globalization of pediatric transplantation: The risk of tuberculosis or not tuberculosis

The risk of TB among pediatric SOT recipients increases as the globalization of medical care continues to broaden. Unlike adults, children and especially infants are more susceptible to TB as a complication after transplantation. Little data exist regarding the true incidence of TB and the optimal risk‐based management of this very vulnerable population. Here, we highlight the theoretical and practical issues that complicate the management of these patients and pose some questions that should be addressed when managing these patients. More data are needed to provide optimal guidance of the best diagnostic and management practices to this unique population.     

综合医院儿科医院感染分析

在当今医院感染发病率中,儿科病房医院感染占有一定的比例。预防和控制儿科病房医院感染的发生,是现代医院感染管理和医疗护理质量管理的一个重要组成部分。为了探讨综合医院儿科医院感染的相关性因素和控制对策,本文对我院2003～2005年儿科住院患儿发生的医院感染,采取整体抽样进行回顾性调查分析,其结果报道如下。     

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??In 2014??a total of 359 000 cases of tuberculosis??0-14 years old?? in children were reported worldwide??accounting for 6.5 percent of the registered TB cases. According to China’s research data in 2013??the PPD positive??≥10 mm??rate of children aged 5 to 15 in different TB epidemic areas was 8.09% to 21.26%. In 2015??6 861 cases of tuberculosis in children were reported nationwide??with a incidence of 3.03/100 000. In 2014??the national TB mortality rate among children aged 0 to 14 was 0.12/100 000. The diagnosis of childhood tuberculosis should be based on a comprehensive assessment of evidence such as contact history??clinical examination and related examinations. The principles of childhood TB treatment are the same as those of adults. At present the state council issued a national tuberculosis control program??put forward to improve the prevention and treatment of tuberculosis in children??to provide technical training to pediatricians on TB control??and to standardize the diagnosis and treatment of childhood tuberculosis.     

Pulmonary tuberculosis presenting as fever without source in a pediatric patient with acute lymphoblastic leukemia

Children who undergo treatment for malignancies are at high for infection with both typical and opportunistic pathogens. Fever in these children prompts extensive evaluation and empiric treatment with broad‐spectrum antimicrobials. In the United States (US), tuberculosis is an infrequently reported cause of fever in the pediatric cancer patient and has not been well described. In this report we describe a case of primary pulmonary tuberculosis (TB) in a boy with precursor B‐cell acute lymphoblastic leukemia (ALL) and review the pertinent literature. Pediatr Blood Cancer 2009; 53:1318–1320. © 2009 Wiley‐Liss, Inc.     

Experience with diarrheal disease in a university pediatric hospital

In 1987, 3227 diarrhea cases, half of which were infants, presented at the Out-patient Department of the Istanbul University Children's Hospital. An examination of these cases showed that in 1,066 cases diarrheal disease (DD) was accompanied by a coexisting infection or other disease. The cases with severe dehydration, shock or severe systemic disease were immediately hospitalized. All the remaining cases were administered oral rehydration therapy (ORT) in the Diarrhea Unit, and 94.7 percent of them were successfully rehydrated with ORT. Severe dehydration, shock, severe systemic infection, abdominal distention, failure of rehydration by the enteral route, severe protein energy malnutrition (PEM), and the presence of convulsions were the indications for i.v. therapy. The overall mortality rate was 11 percent. Our experience with DD indicates that widespread implementation of ORT in diarrheal disease and the establishment of Diarrhea Units in large hospitals will contribute not only to saving more lives but will also have an economic impact by reducing the number of admissions.     

The epidemiology, mortality and morbidity of tuberculosis in Australia: 1850-94

: The review covers the four major changes in the history of tuberculosis in Australia from 1850 to 1994. During the first 100 years there was no significant effective treatment. Mass miniature radiological chest screening and effective bacteriological examination of World War II army recruits resulted in reliable diagnosis. The Australian Tuberculosis Campaign 1948-76 utilized the army experience for detection, and the use of specific treatment virtually eliminated the disease. Failure to maintain strict screening of high-risk groups, especially immigrants, has led to a resurgence of tuberculosis as shown by an increase in notifications in adults and prevalence rates in secondary school children.     

Risk of pulmonary tuberculosis in children with congenital heart disease

Children with low-flow congenital heart lesions are reported to have an increased incidence of pulmonary tuberculosis. The aim of this study was to investigate if children with congenital heart disease have an increased incidence of pulmonary tuberculosis and to determine if patients with certain heart conditions are more susceptible to pulmonary tuberculosis than others. This retrospective study over a 6-year period showed that pulmonary tuberculosis was 2.5-fold more common in children with congenital heart disease than in normal children from the same community. Children with congenital pulmonary stenosis had a prevalence equal to those with acyanotic (ventricular and atrial septal defects) and cyanotic (transposition of the great arteries) high-flow heart lesions, whereas there were no cases of tuberculosis in children with low-flow cyanotic heart lesions such as tetralogy of Fallot. Cardiac surgery had to be postponed as a result of pulmonary tuberculosis in 7.2% of all patients in whom it was required. Over the 6-year period of the study, cardiac surgery had to be delayed in 60% of cases with pulmonary tuberculosis and congenital heart lesions so antituberculosis therapy could be completed. Physicians treating children with congenital heart lesions should maintain a high index of suspicion for the development of pulmonary tuberculosis, especially in those with acyanotic and cyanotic high-flow lesions and pulmonary stenosis.