UCSF Benioff Children's Hospital Oakland, Oakland, California; and Tuberculosis Control Branch, Division of Communicable Disease Control, Center for Infectious Diseases, California Department of Public Health, Richmond, California.
Tuberculosis Control Branch, Division of Communicable Disease Control, Center for Infectious Diseases, California Department of Public Health, Richmond, California.
Pediatrics. 2015 Nov;136(5):e1276-84. doi: 10.1542/peds.2014-3958. Epub 2015 Oct 5.
To describe the epidemiology and factors associated with pediatric central nervous system (CNS) tuberculosis (TB) in California from 1993 to 2011.
We analyzed California TB registry data for persons aged ≤18 years, comparing CNS TB cases versus non-CNS TB cases reported from 1993 to 2011. Factors associated with CNS TB and TB deaths were identified by using multivariate logistic regression.
A total of 200 CNS TB cases were reported. Compared with non-CNS TB case patients, CNS TB case patients were more likely to be aged <5 years (72.0% vs 43.6%; odds ratio [OR]: 3.8 [95% confidence interval (CI): 2.4-5.9]), US-born (82.0% vs 58.2%; OR: 3.3 [CI: 2.3-4.7]), and Hispanic (75.0% vs 63.2%; OR: 1.7 [CI: 1.3-2.4]). Among US-born CNS TB case patients (during 2010-2011), 76.5% had a foreign-born parent. Tuberculin skin test results were negative in 38.2% of 170 CNS TB cases tested. In multivariate analysis, age <5 years (adjusted odds ratio [aOR]: 3.3 [CI: 2.0-5.4]), US birth (aOR: 1.8 [CI 1.2-2.7]), and Hispanic ethnicity (aOR: 1.5 [CI: 1.1-2.1]) were associated with an increased risk of developing CNS TB. For deaths, CNS TB (aOR: 3.8 [CI: 1.4-9.9]) and culture positivity (aOR: 6.2 [CI: 2.2-17.3]) were associated with increased risk of death, whereas tuberculin skin test positivity (aOR: 0.1 [CI: 0.04-0.2]) was associated with decreased risk.
Subsets of children are at increased risk for CNS TB in California and may benefit from additional prevention efforts.
描述 1993 年至 2011 年加利福尼亚州儿童中枢神经系统（CNS）结核病（TB）的流行病学和相关因素。
我们分析了加利福尼亚州结核病登记处的数据，比较了 1993 年至 2011 年报告的 CNS TB 病例与非 CNS TB 病例。使用多变量逻辑回归确定与 CNS TB 和 TB 死亡相关的因素。
共报告了 200 例 CNS TB 病例。与非 CNS TB 病例患者相比，CNS TB 病例患者更可能年龄<5 岁（72.0% vs 43.6%；比值比[OR]：3.8[95%置信区间（CI）：2.4-5.9]），为美国出生（82.0% vs 58.2%；OR：3.3[CI：2.3-4.7]），并且为西班牙裔（75.0% vs 63.2%；OR：1.7[CI：1.3-2.4]）。在 2010-2011 年期间，在美国出生的 CNS TB 病例患者中，有 76.5%的患者父母有外国出生。在接受测试的 170 例 CNS TB 病例中，有 38.2%的结核菌素皮肤试验结果为阴性。在多变量分析中，年龄<5 岁（调整后的比值比[aOR]：3.3[CI：2.0-5.4]）、美国出生（aOR：1.8[CI 1.2-2.7]）和西班牙裔（aOR：1.5[CI：1.1-2.1]）与 CNS TB 发病风险增加相关。对于死亡，CNS TB（aOR：3.8[CI：1.4-9.9]）和培养阳性（aOR：6.2[CI：2.2-17.3]）与死亡风险增加相关，而结核菌素皮肤试验阳性（aOR：0.1[CI：0.04-0.2]）与死亡风险降低相关。
加利福尼亚州的某些儿童群体患 CNS TB 的风险增加，可能需要额外的预防措施。
