Lolekha Rangsima, Anuwatnonthakate Amornrat, Nateniyom Sriprapa, Sumnapun Surin, Yamada Norio, Wattanaamornkiat Wanpen, Sattayawuthipong Wanchai, Charusuntonsri Pricha, Sanguanwongse Natpatou, Wells Charles D, Varma Jay K
Global AIDS Program, Thailand MOPH - US CDC Collaboration, Nonthaburi, Thailand.
BMC Infect Dis. 2008 Jul 18;8:94. doi: 10.1186/1471-2334-8-94.
Of the 9.2 million new TB cases occurring each year, about 10% are in children. Because childhood TB is usually non-infectious and non-fatal, national programs do not prioritize childhood TB diagnosis and treatment. We reviewed data from a demonstration project to learn more about the epidemiology of childhood TB in Thailand.
In four Thai provinces and one national hospital, we contacted healthcare facilities monthly to record data about persons diagnosed with TB, assist with patient care, provide HIV counseling and testing, and obtain sputum for culture and susceptibility testing. We analyzed clinical and treatment outcome data for patients age < 15 years old registered in 2005 and 2006.
Only 279 (2%) of 14,487 total cases occurred in children. The median age of children was 8 years (range: 4 months, 14 years). Of 197 children with pulmonary TB, 63 (32%) were bacteriologically-confirmed: 56 (28%) were smear-positive and 7 (4%) were smear-negative, but culture-positive. One was diagnosed with multi-drug resistant TB. HIV infection was documented in 75 (27%). Thirteen (17%) of 75 HIV-infected children died during TB treatment compared with 4 (2%) of 204 not known to be HIV-infected (p < 0.01).
Childhood TB is infrequently diagnosed in Thailand. Understanding whether this is due to absence of disease or diagnostic effort requires further research. HIV contributes substantially to the childhood TB burden in Thailand and is associated with high mortality.
在每年新增的920万例结核病病例中，约10%为儿童病例。由于儿童结核病通常不具传染性且不致命，国家项目并未将儿童结核病的诊断和治疗列为优先事项。我们回顾了一个示范项目的数据，以更多地了解泰国儿童结核病的流行病学情况。
在泰国的四个省份和一家国立医院，我们每月与医疗机构联系，记录被诊断为结核病的人员的数据，协助患者护理，提供艾滋病毒咨询和检测，并获取痰液进行培养和药敏试验。我们分析了2005年和2006年登记的15岁以下患者的临床和治疗结果数据。
在14487例总病例中，仅有279例（2%）发生在儿童中。儿童的中位年龄为8岁（范围：4个月至14岁）。在197例肺结核儿童中，63例（32%）经细菌学确诊：56例（28%）涂片阳性，7例（4%）涂片阴性但培养阳性。1例被诊断为耐多药结核病。75例（27%）记录有艾滋病毒感染。75例感染艾滋病毒的儿童中有13例（17%）在结核病治疗期间死亡，而204例未感染艾滋病毒的儿童中有4例（2%）死亡（p<0.01）。
在泰国，儿童结核病很少被诊断出来。要弄清楚这是由于疾病不存在还是诊断不力所致，还需要进一步研究。艾滋病毒在很大程度上加重了泰国儿童结核病的负担，并与高死亡率相关。
