Shingadia Delane, Novelli Vas
Department of Academic Child Health, St Barthlomews and The London Medical and Dental School, Queen Mary, University of London, UK.
Lancet Infect Dis. 2003 Oct;3(10):624-32. doi: 10.1016/s1473-3099(03)00771-0.
There has been a recent global resurgence of tuberculosis in both resource-limited and some resource-rich countries. Several factors have contributed to this resurgence, including HIV infection, overcrowding, and immigration. Childhood tuberculosis represents a sentinel event in the community suggesting recent transmission from an infectious adult. The diagnosis of tuberculosis in children is traditionally based on chest radiography, tuberculin skin testing, and mycobacterial staining/culture although these investigations may not always be positive in children with tuberculosis. Newer diagnostic methods, such as PCR and immune-based methods, are increasingly being used although they are not widely available and have a limited role in routine clinical practice. Diagnostic approaches have been developed for use in resource-limited settings; however, these diagnostic methods have not been standardised and few have been validated. Short-course, multidrug treatment has been adopted as standard therapy for adults and children with tuberculosis, with or without directly observed therapy. Compliance is a major determinant of the success of drug treatment. Although uncommon in children, multidrug-resistant tuberculosis is also increasing and treatment will often involve longer courses of therapy with second-line antituberculosis drugs. Treatment of latent infection and chemoprophylaxis of young household contacts is also recommended for tuberculosis prevention, although this may not always be carried out, particularly in high incidence areas.
最近，结核病在资源有限的国家和一些资源丰富的国家都出现了全球范围内的再度流行。多种因素导致了这种再度流行，包括艾滋病毒感染、过度拥挤和移民。儿童结核病是社区中的一个警示事件，表明近期有来自感染性成人的传播。传统上，儿童结核病的诊断基于胸部X光检查、结核菌素皮肤试验以及分枝杆菌染色/培养，尽管这些检查在患有结核病的儿童中可能并不总是呈阳性。更新的诊断方法，如聚合酶链反应（PCR）和基于免疫的方法，越来越多地被使用，尽管它们尚未广泛普及，并且在常规临床实践中的作用有限。已经开发出适用于资源有限环境的诊断方法；然而，这些诊断方法尚未标准化，很少有经过验证的。短程、多药联合治疗已被采用作为成人和儿童结核病的标准疗法，无论是否采用直接观察治疗。依从性是药物治疗成功的主要决定因素。虽然儿童中耐多药结核病并不常见，但也在增加，治疗通常需要使用二线抗结核药物进行更长疗程的治疗。为预防结核病，也建议对潜伏感染进行治疗以及对年轻的家庭接触者进行化学预防，尽管这可能并不总是能实施，特别是在高发病率地区。
