Clevenbergh Philippe, Maitrepierre Isabelle, Simoneau Guy, Raskine Laurent, Magnier Jean-Dominique, Sanson-Le-Pors Marie-José, Bergmann Jean-François, Sellier Pierre
Myanmar Office, HIV Department, International Union Against Tuberculosis and Lung Disease, Mandalay, Myanmar.
Presse Med. 2010 Oct;39(10):e223-30. doi: 10.1016/j.lpm.2010.02.055. Epub 2010 Jun 19.
Few large cohorts of patients with lymph node tuberculosis (LNTB) have been reported in developed countries.
To describe the epidemiological and clinical characteristics of LNTB in patients living in France but born and raised in geographic areas with varying burdens of tuberculosis and human immunodeficiency virus (HIV) infection.
A retrospective study of all patients with bacteriologically-proven LNTB assessed in a French hospital from March 1996 through April 2005.
The analysis included 92 patients. HIV coinfected patients had a higher risk than those without HIV of presenting with disseminated TB and systemic symptoms and of hospitalization. Lymph node diagnostic procedures had a high yield when samples were cultured. About 25% of patients had an abnormal chest radiograph, and most of them were positive for acid-fast bacilli on sputum smears or for Mycobacterium tuberculosis culture. Treatment was generally prescribed for a longer duration than that recommended by international guidelines. One quarter of the patients developed a paradoxical reaction. A high proportion of our patients were classified as nonadherent and 20% defaulted or were lost to follow-up.
Most of the differences in the clinical presentation among patients from various geographic areas were driven by the epidemiology of TB and HIV in the countries of origin. LNTB is frequently a clinical sign of disseminated disease, and culture for M. tuberculosis from LN or other sites is crucial for diagnosis. Adopting the strategy of Directly Observed Treatment, Short course (DOTS) might reduce the rates of nonadherence and default.
在发达国家，鲜有关于淋巴结结核（LNTB）患者的大型队列报道。
描述在法国生活但在结核病和人类免疫缺陷病毒（HIV）感染负担各异的地理区域出生并长大的LNTB患者的流行病学和临床特征。
对1996年3月至2005年4月在一家法国医院评估的所有经细菌学证实的LNTB患者进行回顾性研究。
分析纳入了92例患者。合并HIV感染的患者比未感染HIV的患者出现播散性结核病和全身症状以及住院的风险更高。当样本进行培养时，淋巴结诊断程序的阳性率较高。约25%的患者胸部X线片异常，其中大多数痰涂片抗酸杆菌阳性或结核分枝杆菌培养阳性。治疗通常比国际指南推荐的疗程更长。四分之一的患者出现了矛盾反应。我们的患者中很大一部分被归类为不依从，20%的患者失访或失察。
来自不同地理区域的患者临床表现的大多数差异是由原籍国的结核病和HIV流行病学驱动的。LNTB常常是播散性疾病的临床体征，对淋巴结或其他部位进行结核分枝杆菌培养对诊断至关重要。采用直接观察短程治疗（DOTS）策略可能会降低不依从率和失访率。
