Rebecca Betsy, Chacko Anila, Verghese Valsan, Rose Winsley
Department of Pediatrics, Christian Medical College, Vellore, 632004, India.
J Trop Pediatr. 2018 Dec 1;64(6):544-547. doi: 10.1093/tropej/fmy007.
Pediatric tuberculosis (TB) is often underdiagnosed with poor estimate of its true burden. Availability of Xpert MTB/RIF assay enhances diagnostic capacity of pediatric TB.
A 3-year retrospective review of hospital records was done for all children diagnosed with confirmed and unconfirmed TB. Comparison was made between intrathoracic, single-site extrathoracic and disseminated TB.
In total, 274 children had TB with 130 (47.4%) having confirmed TB. Pulmonary (23.4%), lymph node (23%) and central nervous system (12.8%) TB were the three commonest forms. HIV TB coinfection was 2.9%. Mycobacterial culture was positive in 90 (32.8%) and XPert MTB/RIF in 85 patients (31%). Mycobacterial confirmation was obtained in 45 (56.3%) intrathoracic TB, 69 (45.4%) extrathoracic TB and 16 (38.1%) disseminated TB. Correlation between positive Xpert and mycobacterial culture was poor (kappa 0.38). Rifampicin resistance was present in 25 (19.2%) of the 130 microbiologically confirmed TB.
Extrathoracic TB is common in children. Mycobacterial confirmation in pediatric TB is improved with use of Xpert.
儿童结核病（TB）常常诊断不足，对其真实负担估计不佳。Xpert MTB/RIF检测的可用性提高了儿童结核病的诊断能力。
对所有确诊和疑似结核病儿童的医院记录进行了为期3年的回顾性审查。对胸内、单部位胸外和播散性结核病进行了比较。
共有274名儿童患有结核病，其中130名（47.4%）确诊为结核病。肺结核（23.4%）、淋巴结结核（23%）和中枢神经系统结核（12.8%）是最常见的三种形式。HIV与结核病合并感染率为2.9%。90名（32.8%）患者的分枝杆菌培养呈阳性，85名患者（31%）的Xpert MTB/RIF检测呈阳性。胸内结核有45名（56.3%）、胸外结核有69名（45.4%）、播散性结核有16名（38.1%）获得了分枝杆菌确诊。Xpert检测阳性与分枝杆菌培养之间的相关性较差（kappa值为0.38）。在130例经微生物学确诊的结核病中，25例（19.2%）存在利福平耐药。
胸外结核在儿童中很常见。使用Xpert可提高儿童结核病的分枝杆菌确诊率。
