Moore B K, Anyalechi E, van der Walt M, Smith S, Erasmus L, Lancaster J, Morris S, Ndjeka N, Ershova J, Ismail N, Burton D, Menzies H
Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
South African Medical Research Council, Cape Town, South Africa.
Int J Tuberc Lung Dis. 2015 Jun;19(6):663-9. doi: 10.5588/ijtld.14.0879.
To describe the demographic and clinical characteristics of children and adolescents diagnosed with resistance to any anti-tuberculosis drug (drug-resistant tuberculosis; DR-TB) in South Africa.
We retrospectively reviewed medical records of all children (<13 years) and adolescents (13 to <18 years) with DR-TB at specialty hospitals in four South African provinces from 2005 to 2010.
During the review period, 774 children and adolescents (median age 11.3 years) were diagnosed with DR-TB at selected facilities. A high proportion of patients had a history of previous TB treatment (285/631; 45.2%), human immunodeficiency virus (HIV) infection (375/685; 54.7%), contact with a TB case (347/454; 76.4%), and smear-positive (443/729; 60.8%), cavitary (253/680, 38.7%) disease. Eighty-two per cent of patients with HIV infection received antiretroviral therapy. Of 626 patients diagnosed with multidrug-resistant TB (MDR-TB), 561 (89.6%) received a regimen consistent with national guidelines; the median length of treatment was 22 months (IQR 16-25). Among 400 patients with any DR-TB and a known outcome, 20.3% died during treatment.
Pediatric DR-TB in these provinces is characterized by complex clinical features at diagnosis, with one in five children dying during treatment. History of previous treatment and contact with a TB patient indicate opportunities for earlier diagnosis and treatment to improve outcomes.
描述在南非被诊断为对任何抗结核药物耐药（耐多药结核病；DR-TB）的儿童和青少年的人口统计学和临床特征。
我们回顾性分析了2005年至2010年南非四个省份专科医院中所有患有DR-TB的儿童（<13岁）和青少年（13至<18岁）的病历。
在回顾期间，选定机构中有774名儿童和青少年（中位年龄11.3岁）被诊断为DR-TB。很大一部分患者有既往结核病治疗史（285/631；45.2%）、人类免疫缺陷病毒（HIV）感染（375/685；54.7%）、与结核病病例接触史（347/454；76.4%），以及涂片阳性（443/729；60.8%）、有空洞（253/680，38.7%）病变。82%的HIV感染患者接受了抗逆转录病毒治疗。在626名被诊断为耐多药结核病（MDR-TB）的患者中，561名（89.6%）接受了符合国家指南的治疗方案；中位治疗时长为22个月（IQR 16 - 25）。在400名有任何DR-TB且已知转归的患者中，20.3%在治疗期间死亡。
这些省份的儿童DR-TB在诊断时具有复杂的临床特征，五分之一的儿童在治疗期间死亡。既往治疗史和与结核病患者接触表明有机会进行更早的诊断和治疗以改善转归。
