Solomons R, Grantham M, Marais B J, van Toorn R
Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa.
Marie Bashir Institute for Infectious Diseases and Biosecurity and The Children's Hospital at Westmead, University of Sydney, Westmead, New South Wales, Australia.
Int J Tuberc Lung Dis. 2016 Oct;20(10):1309-1313. doi: 10.5588/ijtld.16.0062.
The diagnosis of tuberculous meningitis (TBM) in children is often delayed, with disastrous consequences. The Integrated Management of Childhood Illness (IMCI) strategy aims to ensure the accurate assessment of ill children using simple yet reliable clinical signs.
We conducted a retrospective observational study of 30 consecutive children aged 3 months to 5 years diagnosed with TBM at Tygerberg Hospital, Cape Town, South Africa. Clinical records were reviewed to assess diagnostic delay and identify IMCI indicators that were present at the time of initial presentation.
Six patients (20%) presented with stage I, 6 (20%) with stage II and 18 (60%) with stage III TBM. Recent contact with an adult TB source case was recorded in 21 (70%) cases. The median number of health care visits before hospital admission was 4.0 (range 1-6). At the first health care visit, 21 (70%) had potential TB features and recent contact with an adult household TB source case.
Adequate implementation of IMCI clinical indicators is essential to ensure earlier diagnosis and prompt treatment initiation in children with TBM, as the majority of cases present with advanced disease. Recent contact with an adult TB source case is an important consideration.
儿童结核性脑膜炎（TBM）的诊断常常延迟，会带来灾难性后果。儿童疾病综合管理（IMCI）策略旨在通过简单却可靠的临床体征确保对患病儿童进行准确评估。
我们对南非开普敦泰格堡医院连续诊断的30名年龄在3个月至5岁的TBM患儿进行了一项回顾性观察研究。回顾临床记录以评估诊断延迟情况，并确定初次就诊时出现的IMCI指标。
6例（20%）为I期TBM，6例（20%）为II期，18例（60%）为III期TBM。21例（70%）记录有近期与成人结核病源病例接触史。入院前就诊的医疗保健次数中位数为4.0（范围1 - 6）。在首次医疗保健就诊时，21例（70%）有潜在结核病特征且近期与成人家庭结核病源病例接触。
由于大多数病例表现为晚期疾病，充分实施IMCI临床指标对于确保TBM患儿早期诊断和及时开始治疗至关重要。近期与成人结核病源病例接触是一个重要的考量因素。
