骨髓活检在疑似播散性分枝杆菌病患儿中的价值。

Value of bone marrow biopsy in children with suspected disseminated mycobacterial disease.

机构信息

Department of Paediatrics and Child Health, Faculty of Health Sciences, Stellenbosch University, Cape Town, South Africa.

出版信息

Int J Tuberc Lung Dis. 2011 Feb;15(2):200-4, i.

PMID:21219681

Abstract

BACKGROUND

Disseminated tuberculosis (TB) is a severe form of disease that can be difficult to diagnose or exclude. The diagnostic role of bone marrow biopsy and culture in children with suspected disseminated TB is not clearly defined.

METHODOLOGY

In a prospective hospital-based study conducted from November 2007 to October 2008, bone marrow biopsy and culture were performed in all children referred with possible disseminated TB; relevant clinical and laboratory data were reviewed.

RESULTS

Thirty-five children were included in the study. An alternative diagnosis was established in 10 (29%) and mycobacterial disease confirmed or probable in 25 (71%). Among those with mycobacterial disease, multiple respiratory specimens provided the best yield (17/25; 68%). Bone marrow histology and/or culture were positive in 5/25 (20%), but were frequently collected after initiation of TB treatment. Blood cultures were positive in only one patient. Mycobacterium tuberculosis accounted for 16/19 (84%) confirmed cases, M.bovis bacille Calmette-Guérin for one, M. avium complex for one, and one was culture-negative. Histology results were available within 24 hours; TB was confirmed exclusively by bone marrow in two cases.

CONCLUSION

Bone marrow biopsy is a valuable diagnostic procedure in children with suspected disseminated mycobacterial disease. Ideally, patients should be referred prior to treatment initiation.

摘要

背景

播散性结核病（TB）是一种严重的疾病形式，可能难以诊断或排除。骨髓活检和培养在疑似播散性 TB 患儿中的诊断作用尚未明确。

方法

在 2007 年 11 月至 2008 年 10 月进行的一项前瞻性基于医院的研究中，对所有疑似播散性 TB 患儿进行骨髓活检和培养；回顾相关临床和实验室数据。

结果

35 例患儿纳入研究。10 例（29%）确立了替代诊断，25 例（71%）确诊或可能患有分枝杆菌病。在患有分枝杆菌病的患儿中，多个呼吸道标本的检出率最高（17/25；68%）。骨髓组织学和/或培养阳性 5/25（20%），但常在开始 TB 治疗后采集。仅 1 例血培养阳性。16/19（84%）确诊病例为结核分枝杆菌，1 例为牛型分枝杆菌卡介苗，1 例为鸟分枝杆菌复合体，1 例为培养阴性。组织学结果可在 24 小时内获得；2 例完全通过骨髓活检确诊 TB。