Department of Paediatrics, The University of Melbourne and Infectious Diseases Unit, Department of General Medicine, Royal Children's Hospital Melbourne, Flemington Road, Parkville, VIC 3052, Australia.
Eur J Clin Microbiol Infect Dis. 2011 Nov;30(11):1303-10. doi: 10.1007/s10096-011-1239-5. Epub 2011 Apr 15.
The prevalence of tuberculosis (TB) continues to rise worldwide. Current migration patterns and increased travel to high-prevalence TB countries will result in more frequent presentations of less common forms of TB. Tuberculous dactylitis, a form of tuberculous osteomyelitis, is well recognised in countries with a high prevalence of TB. We provide a systematic review of all published cases of tuberculous dactylitis in children and adolescents and describe a case to illustrate the typical features of the disease. Our review revealed 37 cases of tuberculous dactylitis in children and adolescents, all reported in the last 17 years. Children less than 10 years of age are most frequently affected and the hand is the most commonly affected site. Concurrent pulmonary TB is present in a fifth of cases and systemic symptoms are usually absent. Positive TST and IGRA support the presumptive diagnosis, but cannot be used as rule-out tests. The definitive diagnosis relies on the detection M. tuberculosis by PCR or culture. Treatment should comprise of a standard three to four drug anti-tuberculous regimen. The optimal treatment duration remains unknown. Surgery has a limited role in the treatment in general but may play a supportive role, and curettage of the cavity has been recommended for avascular lesions.
结核病（TB）的患病率在全球范围内持续上升。当前的移民模式和前往高患病率 TB 国家的旅行增加，将导致不太常见形式的 TB 更频繁地出现。结核性指炎，一种结核性骨髓炎，在 TB 患病率高的国家已得到广泛认识。我们对所有已发表的儿童和青少年结核性指炎病例进行了系统回顾，并描述了一个病例来说明该疾病的典型特征。我们的综述共发现 37 例儿童和青少年结核性指炎，均在过去 17 年中报告。年龄小于 10 岁的儿童最常受累，手部是最常受累的部位。五分之一的病例并发肺结核，通常没有全身症状。阳性 TST 和 IGRA 支持推测诊断，但不能作为排除试验。明确诊断依赖于 PCR 或培养检测结核分枝杆菌。治疗应包括标准的三联或四联抗结核方案。最佳治疗持续时间仍不清楚。手术在一般治疗中作用有限，但可能发挥辅助作用，已建议对无血管病变进行空洞刮除术。
