Rennert W P, Kilner D, Hale M, Stevens G, Stevens W, Crewe-Brown H
Chris Hani Baragwanath Hospital, Department of Paediatrics, University of the Witwatersrand, Soweto, South Africa.
Int J Tuberc Lung Dis. 2002 Sep;6(9):806-13.
Chris Hani Baragwanath Hospital, Soweto, South Africa.
To compare post mortem histological, microbiological and biochemical findings with clinical and radiological data generated ante mortem in children infected with HIV dying from clinical lung disease.
Post mortem lung and liver biopsies were undertaken on 93 consecutive deaths in children with HIV. Specimens were processed for culture, histology and staining for M. tuberculosis, Pneumocystis carinii pneumonia (PCP) and cytomegalovirus (CMV). Post mortem diagnoses were compared with clinical and radiological data generated during the final hospitalisation.
Tuberculosis (TB) was diagnosed post mortem in four (4.3%) cases; a further 17 (18.2%) patients had been treated empirically for TB before death, and the remaining 72 (77.5%) patients had not been treated for TB. TB was more prevalent in children aged 1 year or older (13.4%) than in younger patients (1.4%) (P < 0.025). Patients with PCP, CMV pneumonitis or lymphocytic interstitial pneumonitis (LIP) had the same clinical presentation or radiographic appearances as patients with TB. The only features distinguishing patients with TB were older age and ante mortem gastric aspirate cultures positive for M. tuberculosis.
The diagnosis of TB in children infected with HIV remains difficult. Clinical and radiographic features are shared with other opportunistic diseases. Case identification strategies relying on clinical and radiographic findings lead to overtreatment, particularly in children younger than 1 year of age. Gastric aspirate cultures remain a reliable tool for the identification of infected patients.
南非索韦托的克里斯·哈尼·巴拉干纳特医院。
比较感染艾滋病毒且因临床肺部疾病死亡的儿童尸检时的组织学、微生物学和生化检查结果与生前产生的临床及放射学数据。
对93例连续死亡的艾滋病毒感染儿童进行尸检肺和肝活检。对标本进行培养、组织学检查以及结核分枝杆菌、卡氏肺孢子虫肺炎（PCP）和巨细胞病毒（CMV）染色。将尸检诊断结果与最后一次住院期间产生的临床及放射学数据进行比较。
尸检确诊4例（4.3%）患有结核病（TB）；另有17例（18.2%）患者在死亡前接受过结核病经验性治疗，其余72例（77.5%）患者未接受过结核病治疗。1岁及以上儿童结核病患病率（13.4%）高于年幼儿童（1.4%）（P<0.025）。患有PCP、CMV肺炎或淋巴细胞间质性肺炎（LIP）的患者与患有结核病的患者临床表现或影像学表现相同。区分结核病患者的唯一特征是年龄较大以及生前胃抽吸物培养结核分枝杆菌呈阳性。
艾滋病毒感染儿童结核病的诊断仍然困难。临床和影像学特征与其他机会性疾病相同。依靠临床和影像学检查结果的病例识别策略会导致过度治疗，尤其是在1岁以下儿童中。胃抽吸物培养仍然是识别感染患者的可靠工具。
