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儿科周围性结核性淋巴结炎:阿根廷布宜诺斯艾利斯一家三级护理儿童医院的16年经验

Peripheral tuberculous lymphadenitis in pediatrics: 16 years of experience in a tertiary care pediatric hospital of Buenos Aires, Argentina.

作者信息

Neyro Silvina E, Squassi Isabel R, Medín Martín, Caratozzolo Ana, Martínez Burkett Andrés, Cerqueiro María C

机构信息

Sección de Tisiologia, Hospital de Niños Ricardo Gutiérrez, Ciudad de Buenos Aires.

Servicio de Anatomia Patológica, Hospital de Niños Ricardo Gutiérrez, Ciudad de Buenos Aires.

出版信息

Arch Argent Pediatr. 2018 Dec 1;116(6):430-436. doi: 10.5546/aap.2018.eng.430.

Abstract

Extrapulmonary tuberculosis accounts for 15-20 % of all clinical presentations of tuberculosis. Peripheral tuberculous lymphadenitis is the second most common presentation of extrapulmonary tuberculosis in children, after pleural tuberculosis, in Argentina. We analyzed 92 patients with peripheral tuberculous lymphadenitis seen at the Department of Tisiology of Hospital de Niños "Dr. Ricardo Gutiérrez" between August 2000 and September 2015. The patients' mean age was 8.7 ± 5 years. Nodal sites corresponded to single peripheral (31.5 %), multiple peripheral (20.6 %), and peripheral associated with deep nodes (47.8 %). Cervical lymph nodes were the most common site of involvement (80 %). In 80 % of patients previous antibiotic therapy had been administered, without response. The tuberculosis source was known in 56 %; 69 % had a positive tuberculin skin test; and 54 %, a pathological chest X-ray. Tuberculosis treatment was started on all patients based on clinical criteria, exposure and/or positive tuberculin skin test, prior to microbiological or histological confirmation. The clinical course was either healing (81.5 %), referral to a facility near home (8.7 %) or dropout (8.7 %). One patient died.

摘要

肺外结核占所有结核病临床表现的15%-20%。在阿根廷,儿童外周结核性淋巴结炎是继胸膜结核之后肺外结核的第二常见表现。我们分析了2000年8月至2015年9月间在“里卡多·古铁雷斯博士”儿童医院结核病科就诊的92例外周结核性淋巴结炎患者。患者的平均年龄为8.7±5岁。淋巴结部位包括单个外周淋巴结(31.5%)、多个外周淋巴结(20.6%)以及与深部淋巴结相关的外周淋巴结(47.8%)。颈部淋巴结是最常见的受累部位(80%)。80%的患者此前接受过抗生素治疗,但无反应。56%的患者已知结核病传染源;69%结核菌素皮肤试验呈阳性;54%胸部X线检查有异常。所有患者在微生物学或组织学确诊之前,根据临床标准、接触史和/或结核菌素皮肤试验阳性结果开始进行抗结核治疗。临床转归为治愈(81.5%)、转诊至离家较近的机构(8.7%)或失访(8.7%)。1例患者死亡。

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