Kim Dongsub, Lee Sodam, Kang Sang-Hee, Park Mi-Sun, Yoo So-Young, Jeon Tae Yeon, Choi Joon-Sik, Kim Bora, Choi Jong Rim, Cho Sun Young, Chung Doo Ryeon, Choe Yon Ho, Kim Yae-Jean
Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Department of TB Epidemic Investigation, Center for Disease Prevention, Korea Centers for Disease Control and Prevention, Cheongju, Korea.
Korean J Pediatr. 2018 Nov;61(11):366-370. doi: 10.3345/kjp.2018.07206. Epub 2018 Nov 15.
Tuberculosis (TB) is one of the most important diseases that cause significant mortality and morbidity in young children. Data on TB transmission from an infected child are limited. Herein, we report a case of disseminated TB in a child and conducted a contact investigation among exposed individuals.
A 4-year-old child without Bacille Calmette-Guérin vaccination was diagnosed as having culture-proven disseminated TB. The child initially presented with symptoms of inflammatory bowel disease, and nosocomial and kindergarten exposures were reported. The exposed individuals to the index case were divided into 3 groups, namely household, nosocomial, or kindergarten contacts. Evaluation was performed following the Korean guidelines for TB. Kindergarten contacts were further divided into close or casual contacts. Chest radiography and tuberculin skin test or interferon-gamma-releasing assay were performed for the contacts.
We examined 327 individuals (3 household, 10 nosocomial, and 314 kindergarten contacts), of whom 18 (5.5%), the brother of the index patient, and 17 kindergarten children were diagnosed as having latent TB infection (LTBI). LTBI diagnosis was more frequent in the children who had close kindergarten contact with the index case (17.1% vs. 4.4%, P=0.007). None of the cases had active TB.
This is the first reported case of TB transmission among young children from a pediatric patient with disseminated TB in Korea. TB should be emphasized as a possible cause of chronic diarrhea and failure to thrive in children. A national TB control policy has been actively applied to identify Korean children with LTBI.
结核病（TB）是导致幼儿显著死亡和发病的最重要疾病之一。关于受感染儿童传播结核病的数据有限。在此，我们报告一例儿童播散性结核病病例，并对接触者进行了调查。
一名未接种卡介苗的4岁儿童被诊断为经培养证实的播散性结核病。该儿童最初表现为炎症性肠病症状，并报告了医院和幼儿园接触史。将该病例的接触者分为3组，即家庭接触者、医院接触者或幼儿园接触者。按照韩国结核病指南进行评估。幼儿园接触者进一步分为密切接触者或一般接触者。对接触者进行胸部X线检查和结核菌素皮肤试验或干扰素-γ释放试验。
我们检查了327人（3名家庭接触者、10名医院接触者和314名幼儿园接触者），其中18人（5.5%），即该病例的兄弟，以及17名幼儿园儿童被诊断为潜伏性结核感染（LTBI）。与该病例有密切幼儿园接触的儿童中LTBI诊断更为常见（17.1%对4.4%，P = 0.007）。所有病例均无活动性结核病。
这是韩国首例报道的儿童播散性结核病患儿在幼儿中传播结核病的病例。应强调结核病是儿童慢性腹泻和发育不良的可能原因。韩国已积极实施国家结核病控制政策以识别LTBI患儿。
