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。     

儿童耐药结核病诊治进展

结核病是全世界致死率较高的传染病之一,特别是耐药结核病的存在加重了全球疾病负担。儿童作为结核患者中的特殊群体,其临床症状不典型、检测标本采集困难、标本细菌载量低,故在疾病的诊断与治疗上均存在较大困难。近年来基于循证医学证据,出现了许多关于耐药结核病检测新技术及药物治疗新方案,但目前仍缺乏儿童相关的临床研究数据及指南、共...     

Drug-resistant tuberculosis in two children in Greece: Report of the first extensively drug-resistant case

Extensively drug-resistant (XDR) tuberculosis (TB) represents a serious and growing problem in both endemic and non-endemic countries. We describe a 2.5-year-old girl with XDR-pulmonary TB and an 18-month-old boy with pre-XDR-central nervous system TB. Patients received individualized treatment with second-line anti-TB agents based on genotypic and phenotypic drug susceptibility testing results. Both children achieved culture conversion 3 months and 1 month after treatment initiation, respectively. The child with XDR-pulmonary TB showed evidence of cure while treatment adverse events were managed without treatment interruption. The child with pre-XDR-central nervous system TB after 6-month hospitalization with multiple infectious complications had a dismal end due to hepatic insufficiency possibly related to anti-TB treatment. This is the first report of children with pre-XDR and XDR TB in Greece, emphasizing the public health dimensions and management complexity of XDR TB.     

Mycobacterium tuberculosis in children with human immunodeficiency virus type 1 infection.

A retrospective study was conducted at the Childrens Hospital Center at Jackson Memorial Hospital in Miami, FL, to evaluate the natural history of Mycobacterium tuberculosis infection in nine children with vertically acquired human immunodeficiency virus type 1 infection. The patients' ages ranged from 6 months to 7 years (median age, 42 months). Common presenting symptoms included prolonged fever, cough and anorexia. Only one patient had a positive tuberculin test. Five patients evidenced only pulmonary disease, three patients had pulmonary and extrapulmonary disease and one patient developed extrapulmonary tuberculosis (mastoiditis) and pulmonary interstitial disease that could not be attributed to mycobacterial infection because of lack of information. Organisms isolated before January, 1989, were susceptible to isoniazid and rifampin whereas isolates from three patients cultured after that time were resistant to multiple antituberculosis drugs. The median survival time after M. tuberculosis diagnosis for all children was 20 months. Our study suggests that children with human immunodeficiency virus type 1 infection who have tuberculosis have an increased risk for extrapulmonary disease. A high index of suspicion for the diagnosis of M. tuberculosis should be maintained in human immunodeficiency virus type 1-infected children with prolonged fever and respiratory symptoms. In areas of high endemicity of multidrug-resistant organisms, therapy with a broader panel of drugs may need to be instituted until susceptibility testing becomes available.     

免疫缺陷患儿合并结核分枝杆菌感染的临床特征分析

目的 探讨继发性免疫缺陷病（SID）及原发性免疫缺陷病（PID）患儿合并结核分枝杆菌感染的临床特征。方法 回顾性分析合并结核分枝杆菌感染的免疫缺陷患儿（SID组36例、PID组52例）及非免疫缺陷患儿（对照组108例）的临床资料。结果 PID组患儿起病年龄低于对照组和SID组（P < 0.05）,男性比例高于对照组和SID组（P < 0.05）。SID组及PID组患儿其他结核中毒症状（盗汗、消瘦、乏力、食欲下降）及PPD试验阳性率均低于对照组（P < 0.05）,且更易出现肺叶受累≥ 3叶（P < 0.05）。PID患儿更易合并多器官受累（P < 0.05）。SID组肺部粟粒影发生率高于对照组和PID组（P < 0.05）,PID组γ-干扰素释放试验阳性率低于对照组和SID组（P < 0.05）。结核分枝杆菌感染在SID组表现为潜伏结核感染（36.1%）和活动性结核病（63.9%）;在PID组以卡介苗病（90.4%）为主,有2例（3.8%）同时合并结核病。结论 免疫缺陷患儿合并结核分枝杆菌感染的临床症状不典型,易出现播散性感染,PPD试验及γ-干扰素释放试验阳性率较低,容易出现误诊及漏诊。免疫缺陷患儿应常规进行结核相关筛查,早期识别及干预以改善预后。     

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喘鸣是婴幼儿时期呼吸道疾病中最常见的症状,病因很多,并非所有的喘鸣均由哮喘引起。气管、支气管炎及气管、支气管软骨软弱、异物、血管畸形,胸内肿瘤以及支气管淋巴结核等,均可引起喘鸣。分析天津市儿童医院收治的以喘鸣为主要症状的3岁以下婴幼儿196例,其主要病因见表1。表1天津市儿童医院收治的196例以喘鸣为主要症状的婴幼儿喘鸣病因病因例数大气道阻塞气管、支气管异物21气管、支气管淋巴结核51先天性气管、支气管、肺发育畸形12支气管软骨软化3纵隔囊肿和(或)肿瘤19血管畸形1中叶综合征5小气道阻塞毛细支气管炎30以喘息为表型的婴幼…     

Colonizing and invasive strains of Streptococcus pneumoniae in Uruguayan children: type distribution and patterns of antibiotic resistance.

For the first time in Uruguay the frequency of moderate to heavy colonization of the upper respiratory tract by Streptococcus pneumoniae was investigated in children with acute respiratory infections (n = 717) and in healthy controls (n = 564). Serotypes of S. pneumoniae were identified as colonizing and invasive strains and their susceptibility to antibiotics was determined. Semiquantitative cultures of nasopharyngeal aspirates yielded 42.1% of positives in ambulatory patients and 15.2% in controls. Throat swabs from hospitalized children and matched controls revealed, respectively, 18.4 and 11.5% colonization. Different sampling and culture procedures were evaluated. Seasonal variations in colonization were also detected. Geographic variations in serotype frequency and distribution were assessed. Serotype 14 was predominant among invasive and colonizing strains in patients. Ten serotypes, included in the 23-valent S. pneumoniae vaccine, were not detected. Intermediate resistance to penicillin was seldom observed, but 37.2% of the invasive strains were resistant to cotrimoxazole, indicating the need for a permanent surveillance of isolates to antibiotic susceptibility.     

Serologic response to a secreted and a cytosolic antigen of Mycobacterium tuberculosis in childhood tuberculosis.

BACKGROUND AND AIM: Bacteriologic diagnosis of childhood tuberculosis is difficult, and alternate methods are needed. The utility of a serologic test for major secretory antigen (30 kDa) and a cytosolic antigen (16 kDa) of Mycobacterium tuberculosis was evaluated for the diagnosis of tuberculosis in children. METHODS: Enzyme-linked immunosorbent assay was used. Specific IgG, IgA and IgM antibodies were measured in the sera from 26 clinically and/or bacteriologically diagnosed cases of childhood tuberculosis and 61 normal children. RESULTS: Anti-IgG antibodies alone, against both 30- and 16-kDa antigens, were detected in 65.4% of patients. However, by combination of all three isotypes, increased sensitivities of 84.6 and 73%, with a specificity of 96.7% each, were obtained for 30- and 16-kDa antigens, respectively. CONCLUSIONS: We found good specificity and reasonably good sensitivity for detection of antibodies by enzyme-linked immunosorbent assay to 30-kDa antigen alone. The 16-kDa antigen did not perform as well.     

儿童原发干燥综合征4例报告

原发干燥综合征(primary Sjogren's syndrome,pSS)是一种主要侵犯外分泌腺的慢性炎症性自身免疫性疾病,在儿科临床中较少见.早期外分泌腺受累症状不明显,临床表现多样,与成人临床表现差异较大.目前国内外尚无大宗儿童病例报道.2002年9月至2007年11月我院确诊4例儿童pSS,现报道如下.