Padayatchi Nesri, Bamber Sheila, Dawood Halima, Bobat Razia
CAPRISA, Nelson Mandela School of Medicine, University of KwaZulu Natal, Durban, South Africa.
Pediatr Infect Dis J. 2006 Feb;25(2):147-50. doi: 10.1097/01.inf.0000199314.88063.4c.
Tuberculous meningitis (TBM) is the most frequent manifestation of central nervous system tuberculosis (TB) and is more common in children than in adults. The diagnosis of TBM in children is difficult because signs and symptoms are vague. Information about drug resistant TB in children is scarce, and there is no published information on drug resistant TBM in children.
This is a retrospective review of medical records of children with culture-confirmed multidrug-resistant tuberculous meningitis (MDR-TBM) at King George V Hospital in Durban, South Africa.
Between 1992 and 2003, there were 8 children with MDR-TBM; 6 were HIV infected and 2 were HIV negative. Only one child survived. The diagnosis was made posthumously in almost all the children.
The changes in the cerebrospinal fluid (CSF) in early TBM can be nonspecific and can change rapidly; therefore, CSF studies should always include culture and susceptibility testing. Factors that contributed to the high mortality were disseminated TB, HIV infection, delay in diagnosis and treatment, the absence of a standardized approach to the management of MDR-TBM and the poor CSF penetration of most MDR-TB drugs. MDR-TB therapy should be considered if there is a history of TB: a MDR-TB contact or a poor clinical response to TB therapy despite adequate adherence to treatment. Early diagnosis is important because TBM in children is often associated with a grave outcome.
结核性脑膜炎（TBM）是中枢神经系统结核病（TB）最常见的表现形式，在儿童中比在成人中更常见。儿童TBM的诊断困难，因为其体征和症状不明确。关于儿童耐药结核病的信息匮乏，且尚无关于儿童耐药TBM的公开报道。
这是一项对南非德班乔治五世医院确诊为耐多药结核性脑膜炎（MDR-TBM）儿童的病历进行的回顾性研究。
1992年至2003年间，有8例MDR-TBM儿童；6例感染了HIV，2例HIV阴性。仅1名儿童存活。几乎所有儿童均在死后确诊。
早期TBM患者脑脊液（CSF）的变化可能不具有特异性且变化迅速；因此，CSF检查应始终包括培养和药敏试验。导致高死亡率的因素包括播散性结核病、HIV感染、诊断和治疗延迟、缺乏MDR-TBM管理的标准化方法以及大多数MDR-TB药物脑脊液穿透性差。如果有结核病病史：MDR-TB接触史或尽管充分坚持治疗但对TB治疗临床反应不佳，则应考虑MDR-TB治疗。早期诊断很重要，因为儿童TBM往往与严重后果相关。
