Pavlinac Patricia B, Naulikha Jaqueline M, John-Stewart Grace C, Onchiri Frankline M, Okumu Albert O, Sitati Ruth R, Cranmer Lisa M, Lokken Erica M, Singa Benson O, Walson Judd L
Department of Global Health, University of Washington, Seattle, Washington; Department of Pediatrics, University of Washington, Seattle, Washington; Department of Epidemiology, University of Washington, Seattle, Washington; Department of Medicine, University of Washington, Seattle, Washington; Kenya Medical Research Institute, Centre for Clinical Research, Nairobi, Kenya; Kenya Medical Research Institute (KEMRI)/CGHR Centre for Global Health Research, Kisumu, Kenya; Department of Pediatrics, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, Georgia
Department of Global Health, University of Washington, Seattle, Washington; Department of Pediatrics, University of Washington, Seattle, Washington; Department of Epidemiology, University of Washington, Seattle, Washington; Department of Medicine, University of Washington, Seattle, Washington; Kenya Medical Research Institute, Centre for Clinical Research, Nairobi, Kenya; Kenya Medical Research Institute (KEMRI)/CGHR Centre for Global Health Research, Kisumu, Kenya; Department of Pediatrics, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, Georgia.
Am J Trop Med Hyg. 2015 Nov;93(5):1087-91. doi: 10.4269/ajtmh.15-0365. Epub 2015 Aug 31.
In children, Mycobacterium tuberculosis (M. tuberculosis) frequently disseminates systemically, presenting with nonspecific signs including fever. We determined prevalence of M. tuberculosis bacteremia among febrile children presenting to hospitals in Nyanza, Kenya (a region with high human immunodeficiency virus (HIV) and M. tuberculosis prevalence). Between March 2013 and February 2014, we enrolled children aged 6 months to 5 years presenting with fever (axillary temperature ≥ 37.5°C) and no recent antibiotic use. Blood samples were collected for bacterial and mycobacterial culture using standard methods. Among 148 children enrolled, median age was 3.1 years (interquartile range: 1.8-4.1 years); 10.3% of children were living with a household member diagnosed with M. tuberculosis in the last year. Seventeen percent of children were stunted (height-for-age z-score < -2), 18.6% wasted (weight-for-height z-score < -2), 2.7% were HIV-infected, and 14.2% were HIV-exposed uninfected. Seventeen children (11.5%) had one or more signs of tuberculosis (TB). All children had a Bacille Calmette-Guerin vaccination scar. Among 134 viable blood cultures, none (95% confidence interval: 0-2.7%) had Mycobacterium isolated. Despite exposure to household TB contacts, HIV exposure, and malnutrition, M. tuberculosis bacteremia was not detected in this pediatric febrile cohort, a finding consistent with other pediatric studies.
在儿童中，结核分枝杆菌（M. tuberculosis）常发生全身播散，表现为包括发热在内的非特异性症状。我们确定了肯尼亚尼扬扎地区（人类免疫缺陷病毒（HIV）和结核分枝杆菌感染率均较高的地区）因发热前往医院就诊的儿童中结核分枝杆菌菌血症的患病率。在2013年3月至2014年2月期间，我们纳入了6个月至5岁、发热（腋温≥37.5°C）且近期未使用抗生素的儿童。采用标准方法采集血样进行细菌和分枝杆菌培养。在纳入的148名儿童中，中位年龄为3.1岁（四分位间距：1.8 - 4.1岁）；10.3%的儿童家中有家庭成员在过去一年被诊断为感染结核分枝杆菌。17%的儿童发育迟缓（身高别年龄Z评分＜ -2），18.6%消瘦（身高别体重Z评分＜ -2），2.7%感染HIV，14.2%暴露于HIV但未感染。17名儿童（11.5%）有一项或多项结核病（TB）体征。所有儿童均有卡介苗接种疤痕。在134份有活力的血培养样本中，未分离出结核分枝杆菌（95%置信区间：0 - 2.7%）。尽管该队列儿童接触过家庭结核病患者、暴露于HIV且存在营养不良，但未检测到结核分枝杆菌菌血症，这一结果与其他儿科研究一致。
