Pedicino R, Bressan K, Bedetta M
UOC TIN e Patologia Neonatale, Dipartimento di Pediatria, Policlinico Umberto I, Roma.
Minerva Pediatr. 2010 Jun;62(3 Suppl 1):35-7.
TBC is a major infectious emergency in the world. OMS suggest that there are 8 millions of affected every year and 2 millions of deaths. Italy is considered a country with low prevalence, but the increase of the immigration from Africa Asia and Est Europa (country with high risk) imposes attention to the problem. The delivery is a critical moment to investigate people at risk of disease. The infection of the newborn can happen intrauterine or in the expulsive period, but is possible also at home, from somebody affected by an active pulmonary disease. Diagnosis in the newborn is not easy for the aspecificity of clinical signs and for the frequent initial negativeness of Mantoux test. Culture of placenta, gastric aspirate, tracheal secretions, urine would be requested, cerebrospinal fluid if necessary. Neonatal disease needs therapy with isoniazide, rifampicine, pirazinamide and, or ethambutol, or streptomycin. Profilaxis of a newborn from a woman affected by an active form of tuberculosis or living with people affected by an active pulmonary form consists in giving isoniazide until diagnostic tests are negative and in removing the sicks (only with pulmonary disease). New dangerous kinds of pharmacological multiresistent tuberculosis are appeared in the last years in the world and, with the coinfection HIV-TBC and the reorganization of the surveillance system, represents the major obligation for the next years.
结核病是全球主要的突发公共卫生事件。世界卫生组织指出，每年有800万人感染，200万人死亡。意大利被认为是结核病低发国家，但来自非洲、亚洲和东欧（高风险国家）移民的增加使这一问题受到关注。分娩是筛查疾病高危人群的关键时期。新生儿感染可能发生在子宫内或分娩期，但也可能在家中，由患有活动性肺结核的人传播。由于临床症状缺乏特异性以及结核菌素试验初筛结果常为阴性，新生儿结核病的诊断并不容易。需要对胎盘、胃液、气管分泌物、尿液进行培养，必要时还需对脑脊液进行培养。新生儿结核病需要使用异烟肼、利福平、吡嗪酰胺和（或）乙胺丁醇或链霉素进行治疗。对于母亲患有活动性结核病或与患有活动性肺结核的人生活在一起的新生儿，预防措施包括在诊断性检查结果为阴性之前给予异烟肼，并将患者隔离（仅针对肺结核患者）。近年来，世界上出现了新型危险的多重耐药结核菌株，加上艾滋病合并结核病以及监测系统的重组，这成为未来几年的主要任务。
