763例儿童潜伏期结核感染调查分析

目的进行结核菌素试验,筛查潜伏结核感染,为预防结核病提供参考依据。方法采用随机抽样的方法抽取包头铁路地区3个月～18岁不同年龄组763人进行结核菌素试验,抽取人群均接受过卡介苗初种。结果结核菌素试验结果分为阴性(-)、阳性( )、中度阳性( )和强阳性( )。阴性率(-)3岁以后变化不大,0～3岁39.34%、3～7岁62.86%、8～14岁59.38%、>14岁41.6%。阳性率( )3岁以后明显下降,0～3岁52.94%、3～7岁22.82%、8～14岁25%、>14岁25%。中度阳性率( )随着年龄的增长而逐年增高,0～3岁7.72%、3～7岁10.7%、8～14岁15.63%、>14岁25%。强阳性( )随着年龄的增长而逐年增高,0～3岁0.11%、3～7岁3.34%、8～14岁12.5%、14岁后强阳性率明显增高为33.33%。结论结核病的易感者主要集中于3～14岁,人体接种卡介苗后的特异性免疫力只维持5～10年。对3～14岁的儿童应加强结核病的监测。     

志丹县儿童结核感染情况调查及有关因素分析

我们于87年4～7月,对陕西志丹县城及距县城五公里的二个乡的部分儿童进行了以旧结核菌素试验为主的调查分析,报导如下。 一、对象及方法 以居住在城内及武沟、刘坪二个乡的15岁以下儿童为对象,年龄最小三个月。以1:2000单位旧结核菌素注射于前臂皮内,要求皮丘达到0.6～1.0毫米,固定专人操作。结果判断     

儿童继发性肺结核的临床特征分析

目的:总结儿童继发性肺结核的临床及影像学特点,提高对其早期识别及诊断水平。方法:回顾性分析2015年1月至2021年12月首都医科大学附属北京儿童医院呼吸二科确诊的30例继发性肺结核患儿临床资料,分析临床特点及影像学表现。结果:30例患儿中男10例、女20例,就诊年龄13.0（12.0,13.3）岁,常见的症状为咳嗽2...     

结核感染T细胞斑点试验辅助诊断小儿肺结核的临床研究

目的 探讨结核感染T细胞斑点试验(T.SPOT-TB)在小儿肺结核诊断中的意义.方法 对2006年10月-2007年12月新疆医科大学第一临床医院0～14岁75例疑似肺结核患儿进行T.SPOT-TB检测,其结果与最终诊断相比较,并与PPD试验、结核抗体检测结果进行对比.结果 T.SPOT-TB灵敏度为80.6%,特异度为89.5%.在结核病组中,T.SPOT-TB阳性率显著高于PPD试验与结核抗体检测阳性率(48.4%、15%,P<0.01).结论 T.SPOT-TB诊断小儿肺结核敏感、快速、准确,对儿童肺结核有早期诊断价值.     

儿童多发性脑及脊髓结核瘤合并结核性脑膜炎、粟粒性肺结核1 例报告并文献回顾

目的探讨中枢神经系统多发结核感染的临床特点。方法回顾分析1例多发性脑及脊髓结核瘤合并结核性脑膜炎、粟粒性肺结核患儿的临床资料,并复习相关文献。结果男性患儿,8岁,脑结核瘤呈粟粒样分布,病灶数达30余个,累及双侧大脑、小脑、丘脑、脑干、视束,合并颈髓结核瘤、结核性脑膜炎及粟粒性肺结核,抗结核治疗1年后痊愈。文献检索发现7例脑及脊髓结核瘤患儿,其中1例累及视束,1例合并结核性脑膜炎;6例为亚急性或慢性起病,1例急性起病;7例患儿均无明显脑结核瘤表现,但均有脊髓受压表现;5例合并急性粟粒性肺结核(或肺结核);1例诊断结核性脑膜炎,在治疗后出现脑及脊髓结核瘤;1例在治疗中出现新增结核瘤;7例患儿抗结核治疗均恢复良好。结论脑及脊髓结核瘤的早期诊断需结合临床表现、影像学特点、颅外结核证据、抗结核治疗有效等综合判定,早期诊断、及时治疗可改善预后。     

警惕儿童结缔组织疾病合并结核感染

结缔组织病患儿本身存在多种免疫紊乱,大剂量皮质激素、免疫抑制剂的应用加重了细胞免疫缺陷,生物制剂进一步增加了结核感染的风险.结缔组织病合并结核感染临床表现复杂,有时很难鉴别是原发疾病活动还足结核感染.肺部影像学检查是临床诊断结核病的主要手段,QFT-G试验和T-SPOT.TB开辟了辅助诊断新途径.应详细询问结核接触史、卡介苗接种史,常规进行血清结核杆菌抗体检测及PPD皮试.临床高度提示结核感染者,应给予诊断性抗结核治疗.     

复方黄芪鼻腔喷雾预防儿童反复呼吸道感染

急性呼吸道感染是婴幼儿常见疾病,而反复呼吸道感染(RRI)又占其中30％左右,严重影响了患儿 的健康。本文总结了采用中药黄芪 多糖,经合理工艺提取,供鼻腔喷雾用药预防RRI,取得了明显效果。     

结核分枝杆菌特异性效应T细胞斑点数鉴别儿童活动性结核病与潜伏结核感染的价值

目的 通过γ干扰素释放试验探讨结核分枝杆菌特异性效应T细胞斑点数（简称T细胞斑点数）鉴别儿童活动性结核病（TB）与潜伏结核感染（LTBI）的价值。方法 纳入T细胞斑点试验（T.SPOT.TB）阳性且未经过抗结核治疗的93例活动性TB（重症TB 27例,非重症TB 66例）和47例LTBI儿童,根据T.SPOT.TB结果对T细胞斑点数进行比较分析。结果 活动性TB组T细胞斑点数中位数84（6～710）显著高于LTBI组17（6～316）,P=0.000;非重症TB患儿的T细胞斑点数中位数为99（6～710）,显著高于重症TB的44（6～268）,P=0.011,也显著高于LTBI组17（6～316）,P=0.000;重症TB儿童T细胞斑点数中位数高于LTBI组儿童（44 vs 17）,但差异无统计学意义（P=0.084）,T细胞斑点数分布在活动性TB、重症TB、非重症TB和LTBI之间均有较大范围重叠。受试者工作特征曲线分析显示以T细胞斑点数43.5作为区分活动性TB与LTBI的最佳界值,其敏感度与特异度分别为69.9%和70.2%。结论 T细胞斑点数在活动性TB尤其是非重症TB患儿显著高于LTBI儿童;T细胞斑点数的数量可反映体内的结核分枝杆菌负荷,但不能用于区分儿童活动性TB与LTBI。     

哮喘缓解期患儿及并结核、支原体感染的肺功能改变

目的 观察儿童哮喘缓解期合并结核感染、支原体感染对肺功能的影响。方法 哮喘缓解期患儿107例，分无感染、结核感染、支原体感染三组。对照组28例。观察FVC、VC、FEV1、PEF、V50、V25 6项指标的变化。结果 三组6项指标均值较对照组明显降低（P＜0．001）。结感组、支感组FVC、VC、FEV1核无感组降低，两者差异显著（P＜0．05）。结论 儿童哮喘缓解合并结核感染、支原体感染者以中重度较多，并以限制性通气障碍为主的混合性通气功能障碍多见。     

先天性巨细胞病毒感染的母婴防治进展

人巨细胞病毒（HCMV）在世界范围内均有较高的感染率,先天性巨细胞病毒（CMV）感染者出生时85%~90%为无症状性感染,表现为听力损失、精神运动迟缓、学习障碍等;10%~15%为症状性感染,部分早产儿生后CMV感染,可造成败血症样综合征、血小板减少症、中性粒细胞减少症、肝损伤、肺损伤等。目前育龄妇女对CMV认识度极低,为孕妇提供CMV教育和卫生预防措施,可以预防怀孕妇女和新生儿先天性CMV感染。CMV疫苗及高价免疫球蛋白预防胎儿先天性CMV感染的研究尚无明确结果。近年来的研究证实尿液或唾液CMV-DNA检测的特异性和敏感性达98%以上,有助于先天性CMV感染的早期诊断。除了更昔洛韦的短期治疗,对有症状的先天性CMV感染患儿予口服缬更昔洛韦长期治疗更安全,而且似乎比短期治疗效果更好。未来还需加强对孕妇的宣传教育,加强对CMV感染的母婴管理,开展CMV疫苗的研究,以及进一步规范治疗方案等。     

Preventing tuberculosis in children: A global health emergency

It is estimated that 20 million children are exposed to tuberculosis (TB) each year, making TB a global paediatric health emergency. TB preventative efforts have long been overlooked. With the view of achieving “TB elimination” in “our lifetime”, this paper explores challenges and potential solutions in the TB prevention cascade, including identifying children who have been exposed to TB; detecting TB infection in these children; identifying those at highest risk of progressing to disease; implementing treatment of TB infection; and mobilizing multiple stakeholders support to successfully prevent TB.     

Pediatric tuberculosis pyramid and its fate with and without chemotherapy/chemoprophylaxis

The latest available information on total and infectious cases of tuberculosis in the country and also large number of sputum positive cases being detected annually, particularly after the involvement of multipurpose workers in the primary health care programme for the control of tuberculosis, is presented. The consequences of the large pool of infectious cases in the population lead to spread of bacilli to children with development of primary infection in them. These children with primary infection, specially high risk group in infancy and early childhood, get serious complications of the disease. It may be emphasized that BCG vaccination cannot prevent the lodgement of tubercle bacilli in the lung but can only contain or restrict haematogenous spread. Inspite of increasing coverage of infants with BCG vaccination there are an increasing number of cases of intrathoracic tuberculosis, particularly various groups of mediastinal nodes. However, to a lesser extent haematogenous complications do occur in malnourished children, as BCG has a limited value in preventing serious complications in children with malnutrition. The clinical pattern of pediatric tuberculosis has also changed in vaccinated and partly or inadequately drug treated children. Hence, chemoprophylasis/ chemotherapy to prevent complications of primary infection has been tried. Even relatively privileged children in developed countries are reported to have complications of primary infection to an extent of 10 to 15%, as per the studies all over world. So preventive chemoprophylaxls, preferably with two bactericidal drugs, should be considered as the main strategy for controlling primary infection. Chemoprophylaxis with two drugs should be used as incidence of isoniazid resistant bacilli has increased. All concerned with child health should consider the strategy of treatment of primary infection in high risk children by chemoprophylaxis by starting a large multicentric trial both in urban and rural areas, as a part and parcel of primary health care intervention already in practice for cases of sputum positive pulmonary tuberculosis.     

Skeletal tuberculosis in children

The objective of this review is to present the imaging findings of skeletal tuberculosis in children. The incidence of tuberculosis is increasing and skeletal tuberculosis accounts for 10–20% of all extra-pulmonary cases. The most common manifestations of skeletal tuberculosis in children are spondylitis, arthritis and osteomyelitis. Tuberculous spondylitis involves the intervertebral disc only late in the disease. Subligamentous spread of the infection may lead to multiple levels of vertebral body involvement that may either be continuous or skipped. Extension of the disease into the paravertebral or extra-dural space may occur. Tuberculous arthritis usually occurs as a result of metaphyseal spread to the joint. Tuberculous osteomyelitis may appear as cystic, well-defined lesions, infiltrative lesions or spina ventosa. The latter is a term used to describe a form of tuberculous osteomyelitis where underlying bone destruction, overlying periosteal reaction and fusiform expansion of the bone results in cyst-like cavities with diaphyseal expansion. Radiographs are still the mainstay of evaluation of patients with bony lesions. Ultrasonography can detect soft-tissue extension of the bony lesions and guide drainage or biopsy procedures. CT accurately demonstrates bony sclerosis and destruction, especially in areas difficult to assess on radiographs such as the posterior elements of the vertebral body. MRI is the modality of choice in evaluating early marrow involvement and soft-tissue extension of the lesion.     

Perinatal tuberculosis: new challenges in the diagnosis and treatment of tuberculosis in infants and the newborn

With increasing rates of tuberculosis (TB) infection and disease worldwide, the rate of perinatal TB is also affected. A high index of suspicion by health professionals, in both the developed and developing world, is required to detect and manage tuberculosis in pregnancy and the early newborn period. Differences in immune responses in the fetus and neonate add to the diagnostic difficulties already recognised in young children. Although specific guidelines for the treatment of this potentially devastating disease are lacking due to paucity of experience, outcome is favourable, if the condition is recognised and treated according to existing TB protocols. HIV co-infection, multi- and extensively-drug resistant (MDR/XDR) TB contribute to the challenges. New diagnostic and vaccine developments hold future promise, but much work is needed to completely understand the complex immune responses to tuberculosis and control this disease.     

新型冠状病毒感染所致急性肺损伤的机制及防治

2019新型冠状病毒(2019 novel coronavirus,2019-nCoV)的主要靶器官是肺,严重者发生急性呼吸窘迫综合征而危及生命。2019-nCoV的人类病毒受体主要为血管紧张素转换酶2(ACE2),其他已报道的受体还有CD147蛋白、酪氨酸蛋白激酶受体UFO、神经纤毛蛋白1、肾损伤因子1等。2019-...     

Infection control and paediatric tuberculosis: A practical guide for the practicing paediatrician

Tuberculosis (TB) in children requires close attention to infection control to prevent transmission to other patients and health care workers. Although many children with TB are not infectious, appropriate airborne precautions must be maintained until conditions that increase the risk of transmission have been ruled out and accompanying adults, who may also be infectious, have been screened. Concurrent strategies to prevent TB transmission should be implemented, including administrative, engineering and personal protective measures. The most important measure is maintaining a high clinical index of suspicion for TB in patients with compatible symptoms and epidemiological risk factors. Comprehensive tuberculin skin test programmes and the use of N 95 masks can reduce the risk of transmission within health care settings. Current standards of practice should be followed to prevent transmission from patients with active TB disease.     

Advances in diagnosis of tuberculosis

The diagnosis of childhood tuberculosis is acknowledged to be an imprecise process since bacteriological confirmation is available in only 30–40% of cases. Newer developments in diagnosis of tuberculosis include use of fluorescent stains for smears, newer systems for radiometric detection of mycobacteria, rapid sensitivity testing using firefly bioluminescence, liquid chromatographic analysis of mycolic acids, immunodiagnostics forM. tuberculosis specific antigens and the impact of molecular diagnostics with amplification methods. The search for simple, reliable test for early stages of the disease (in particular TB meningitis) still continues.     

危重肺部疾病早产儿肾上腺皮质功能不全及其与预后的关系#br#

目的：探讨危重肺部疾病早产儿肾上腺皮质功能不全的发生及其与预后的关系。方法对纳入的50例危重肺部疾病早产儿采用化学发光法测定基础皮质醇及ACTH浓度,同时行小剂量ACTH（1μg/kg）刺激实验,30 min后测其峰值,若基础皮质醇<15μg/dl或皮质醇增值<9μg/dl定义为肾上腺皮质功能不全。肾上腺皮质功能不全早产儿为AI组,其余早产儿归为肾上腺皮质功能正常(AN组)。结果50例危重肺部疾病早产儿中,31例肾上腺皮质功能不全,发生率62.0%。AI组血清基础皮质醇以及ACTH刺激试验后皮质醇峰值均低于AN组,差异有统计学意义(P<0.01);但两组皮质醇增值的差异无统计学意义(P>0.05);AI组ACTH浓度低于AN组,差异有统计学意义(P<0.01)。AI组平均动脉压也低于AN组,差异有统计学意义(P<0.01)。AI组与AN组早产儿的血糖、血钾、血钠水平差异均无统计学意义(P>0.05);两组死亡率及支气管肺发育不良(BPD)发生率的差异也均无统计学意义(P>0.05)。结论危重肺部疾病早产儿肾上腺皮质功能不全发生率高,其发生可能继发于内源性ACTH产生相对不足;危重肺部疾病早产儿肾上腺皮质功能不全时血压偏低,但未发现其死亡及BPD发生与肾上腺皮质功能不全有关。