Hussey G, Chisholm T, Kibel M
Department of Paediatrics and Child Health, University of Cape Town, South Africa.
Pediatr Infect Dis J. 1991 Nov;10(11):832-6. doi: 10.1097/00006454-199111000-00008.
This is a retrospective review of the clinical, radiologic and laboratory features of 94 cases of childhood miliary tuberculosis seen during a 5-year period, 1985 to 1989. A history of Bacillus Calmette-Guérin vaccination was documented in 88% of children. The median age at presentation was 10.5 months, 52% of cases occurring in those younger than 1 year. The presenting symptoms were nonspecific: cough (72%); fever (61%); loss of appetite and weight (40%); and diarrhea and vomiting (33%). The main presenting signs were hepatomegaly (82%), splenomegaly (54%), lymphadenopathy (46%) and pyrexia (39%). Most of the patients were malnourished and anergic. Meningitis occurred in 19% of patients and this was the only significant risk factor identified for mortality, the overall case fatality rate being 14%. The diagnosis in the vast majority was made on the clinical presentation supported by a classic miliary pattern on chest roentgenogram (91% of cases). Mycobacterium tuberculosis was cultured in 33% of cases. In addition a review of hospital admissions from 1981 to 1989 revealed that annually miliary tuberculosis in children and adults accounted for 8.3 and 1.3%, respectively, of all tuberculosis admissions. This study confirms that miliary tuberculosis is a relatively common complication of tuberculosis in young children.
这是一项对1985年至1989年5年间所见的94例儿童粟粒性肺结核的临床、放射学和实验室特征的回顾性研究。88%的儿童有卡介苗接种史。就诊时的中位年龄为10.5个月，52%的病例发生在1岁以下儿童。主要症状不具特异性：咳嗽（72%）；发热（61%）；食欲不振和体重减轻（40%）；腹泻和呕吐（33%）。主要体征为肝肿大（82%）、脾肿大（54%）、淋巴结病（46%）和发热（39%）。大多数患者营养不良且无反应性。19%的患者发生脑膜炎，这是确定的唯一显著死亡危险因素，总体病死率为14%。绝大多数病例的诊断基于临床表现，并得到胸部X线片上典型粟粒样表现的支持（91%的病例）。33%的病例培养出结核分枝杆菌。此外，对1981年至1989年医院住院情况的回顾显示，儿童和成人粟粒性肺结核分别占所有结核病住院病例的8.3%和1.3%。本研究证实，粟粒性肺结核是幼儿结核病相对常见的并发症。
