Takamatsu I
Department of Pediatrics, Osaka Prefectural Habikino Hospital, Japan.
Kekkaku. 1999 Apr;74(4):365-75.
We performed a retrospective analysis of 394 patients who were treated for active tuberculosis (TB) at our hospital from 1976 to 1997. The diagnosis criteria for establishing TB were history of direct contact with TB patients, tuberculin skin test reactivity, positive bacteriology and radiographic findings compatible with TB. There were 192 males and 202 females (age range 1 month to 18 years of age, mean 6.3 years of age). Fifty-four percent of the cases were under 5 years of age. Primary pulmonary TB was presented in 200, post primary pulmonary TB in 97, pleural effusion in 53, endbronchial TB in 4, TB meningitis (TBM) in 28, miliary TB in 28 and other extra-pulmonary TB in 31. A history of contact with the patients was obtained in 72.8% of cases. Two hundred and thirty (58.4%) had received BCG, 134 (34%) no BCG, 30 (7.6%) were unclear. Especially, under 5 years of age, only 29 (13.6%) had received BCG. TBM is not disappeared in Japan and there were 28 cases with TBM. Fifteen patients out of them recovered completely, 8 patients recovered with severe neurological sequelae which included mental retardation, motor weakness, seizures and hydrocephalus and 5 patients died. Twenty-six had no BCG. Particularly in 1990s, we had experienced 4 dead TBM cases, 1 multi-drug resistant (MDR) TBM case and 1 TBM case due to nosocomial infection. Children with TBM should received 12-month regimen using initial daily treatment with isoniazid, rifampin, pyrazinamide, and streptmycin, followed by isoniazid and rifampin administered daily. Pulmonary TB in children is successfully treated with 6-month standard chemotherapy using isoniazid, rifampin, and pyrazinamide daily for 2 months, followed by isoniazid and rifampin daily for 4 months. In order to promote TB control and eliminate childhood TB, especially in infants, the following is necessary; 1) early detection and treatment of adult TB patients, source of infection, 2) prompt and appropriate contact examination and chemoprophylaxis, 3) BCG vaccination during early infancy, 4) protection from MDR TB are most important in Japan.
我们对1976年至1997年在我院接受活动性结核病（TB）治疗的394例患者进行了回顾性分析。确立结核病的诊断标准为有与结核病患者直接接触史、结核菌素皮肤试验反应性、细菌学阳性以及与结核病相符的影像学表现。其中男性192例，女性202例（年龄范围1个月至18岁，平均6.3岁）。54%的病例年龄在5岁以下。原发性肺结核200例，继发性肺结核97例，胸腔积液53例，支气管内膜结核4例，结核性脑膜炎（TBM）28例，粟粒性肺结核28例，其他肺外结核31例。72.8%的病例有与患者接触史。230例（58.4%）接种过卡介苗，134例（34%）未接种，30例（7.6%）情况不明。特别是在5岁以下儿童中，仅29例（13.6%）接种过卡介苗。结核性脑膜炎在日本并未消失，共有28例结核性脑膜炎病例。其中15例患者完全康复，8例患者康复但伴有严重神经后遗症，包括智力发育迟缓、运动无力、癫痫发作和脑积水，5例患者死亡。26例未接种卡介苗。特别是在20世纪90年代，我们经历了4例结核性脑膜炎死亡病例、1例耐多药（MDR）结核性脑膜炎病例和1例医院感染导致的结核性脑膜炎病例。结核性脑膜炎患儿应接受为期12个月的治疗方案，初始每日使用异烟肼、利福平、吡嗪酰胺和链霉素治疗，随后每日使用异烟肼和利福平。儿童肺结核采用6个月标准化疗方案可成功治愈，即每日使用异烟肼、利福平、吡嗪酰胺治疗2个月，随后每日使用异烟肼和利福平治疗4个月。为促进结核病控制并消除儿童结核病，尤其是婴儿结核病，以下措施是必要的：1）早期发现和治疗作为传染源的成年结核病患者；2）及时且适当的接触者检查和化学预防；3）婴儿早期接种卡介苗；4）在日本，预防耐多药结核病最为重要。
