Popielska Jolanta, Marczyńska Magdalena, Dobosz Sabina, Szczepańska-Putz Małgorzata
Klinika Chorób Zakaźnych Wieku Dzieciecego, Instytutu Chorób Zakaźnych i Pasozytniczych AM w Warszawie.
Przegl Epidemiol. 2006;60(1):65-70.
Tuberculosis (TB) is important threat in HIV-infected people. Although there is slow but constant decline TB-infections among adults and children in Poland, about 30% HIV-(+) adults is coinfected with TB. There were 12 cases of TB in HIV(+) children diagnosed in Department of Pediatric Infectious Diseases in 1994-2005. The aim was analysis of reasons for TB diagnostic tests in HIV (+) children, coinfection HIV and TB and efficacy of anti TB treatment. TB diagnostics was performed in 23 children because of clinical indications (15/23) and conversion or excessive skin tests (8/23). There were bacteriological and radiological exams done in all cases of TB suspicion. When active TB was diagnosed there were 4 tuberculostatic drugs used (6-12 months). In latent or unlocalized TB-INH was used for 12 months.
12 cases of TB infection were diagnosed: active TB--4, BCG-itis--1, latent--1 and unlocalized TB--6. In 10 cases TB infection was excluded. All cases of tuberculostatic treatment was successful. 5/12 cases are presently treated.
Skin test is lonely, generally used method of TB control in HIV (+) children without clinical manifestations of TB. There is a necessity of diagnosis and chemoprophylaxis in all cases of conversion or enlarged (above 10 mm, vesicularis) skin test. TB diagnosis is an indication for HIV diagnostics.
结核病(TB)对感染艾滋病毒的人来说是一个重大威胁。尽管波兰成年人和儿童中的结核病感染率在缓慢但持续下降,但约30%的艾滋病毒阳性成年人合并感染了结核病。1994年至2005年期间,儿科传染病科诊断出12例艾滋病毒阳性儿童患有结核病。目的是分析艾滋病毒阳性儿童结核病诊断检查的原因、艾滋病毒与结核病的合并感染情况以及抗结核治疗的疗效。23名儿童因临床指征(15/23)以及结核菌素试验结果转化或结果过大(8/23)而进行了结核病诊断。所有疑似结核病病例均进行了细菌学和放射学检查。确诊为活动性结核病时,使用了4种抗结核药物(6至12个月)。对于潜伏性或未定位的结核病,使用异烟肼治疗12个月。
诊断出12例结核病感染:活动性结核病4例、卡介苗炎1例、潜伏性结核病1例和未定位结核病6例。10例被排除结核病感染。所有抗结核治疗病例均成功。目前有5/12的病例正在接受治疗。
结核菌素试验是在没有结核病临床表现的艾滋病毒阳性儿童中普遍使用的结核病筛查方法。对于结核菌素试验结果转化或增大(超过10毫米,水疱状)的所有病例,都有必要进行诊断和化学预防。结核病诊断是进行艾滋病毒诊断的指征。