Johnston Niall, Sandys Nichola
Paediatric Department, Nkhoma Mission Hospital, Nkhoma, Malawi.
BMJ Case Rep. 2017 Apr 26;2017:bcr-2016-218953. doi: 10.1136/bcr-2016-218953.
Childhood tuberculosis (TB) is a significant global health burden. There are more than 1 million new cases of childhood TB annually. Despite this, many national TB control programs largely focus on identification and treatment of smear positive adults. Early case detection is essential if childhood TB is to be controlled and eradicated.Delayed diagnosis of TB is associated with more advanced disease and worse treatment outcomes. Younger children who go undiagnosed for long periods are at risk of developing severe pulmonary and extrapulmonary disease, such as meningitis. Additionally, advanced childhood TB is a common respiratory cause of death in TB-endemic areas. Undoubtedly, delayed diagnosis contributes significantly to TB-related morbidity and mortality.Diagnostic delay may be divided into patient delay, the duration between development of symptoms and presentation to healthcare provider, and healthcare provider delay, the duration between presentation and initiation of appropriate treatment.
儿童结核病是一项重大的全球健康负担。每年有超过100万例儿童结核病新发病例。尽管如此，许多国家的结核病控制项目主要侧重于涂片阳性成人的识别和治疗。如果要控制和消除儿童结核病，早期病例发现至关重要。结核病的延迟诊断与病情更严重及治疗效果更差相关。长期未被诊断的年幼儿童有发展为严重肺部和肺外疾病（如脑膜炎）的风险。此外，晚期儿童结核病是结核病流行地区常见的呼吸道死亡原因。毫无疑问，延迟诊断在很大程度上导致了与结核病相关的发病和死亡。诊断延迟可分为患者延迟（即从出现症状到就医的时长）和医疗服务提供者延迟（即从就医到开始适当治疗的时长）。
