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发展中国家儿童潜伏性结核感染的管理。

Management of Latent Tuberculosis Infection in Children from Developing Countries.

机构信息

Department of Pediatrics, AIIMS, New Delhi, 110029, India.

出版信息

Indian J Pediatr. 2019 Aug;86(8):740-745. doi: 10.1007/s12098-019-02861-3. Epub 2019 Feb 11.

Abstract

Tuberculosis (TB), once widely prevalent throughout the world, experienced falling incidence rates in early twentieth century in developed nations, even before the introduction of anti-TB drugs, attributed to improved hygiene and living conditions. Active TB may develop following fresh infection or activation of latent tuberculosis infection (LTBI). LTBI is a state of persistent bacterial viability, however, the host stays asymptomatic and there is no evidence of clinically active tuberculosis. Therefore, treatment of all LTBI is considered as one of the ways to control tuberculosis. Diagnosis of LTBI relies on presence of immune-reactivity to TB antigen and commonly used tests include tuberculin skin test and interferon gamma release assay (IGRA). At present there is no diagnostic test that can identify an individual with LTBI who will progress to develop active disease or remain asymptomatic. Therefore, it is unclear whom to treat. In the current scenario, treatment for LTBI is restricted to high risk groups which include under-5 y contacts of adults with pulmonary TB. Various regimens for treatment of LTBI are evolving and consist of isoniazid (INH) alone for 6-9 mo or combination of INH and rifampicin for 3-4 mo or once a week combination of rifapentin and INH for 3 mo. There is a need for research to identify LTBI, risk factors for progression of LTBI to active disease and a shorter regimen for treatment.

摘要

结核病(TB)曾在 20 世纪初在世界范围内广泛流行,但在抗结核药物问世之前,发达国家的发病率已有所下降,这归因于卫生条件和生活条件的改善。活动性结核病可能是在新的感染或潜伏性结核感染(LTBI)激活后发展而来。LTBI 是一种持续存在细菌活力的状态,但宿主无症状,且没有临床活动性结核病的证据。因此,治疗所有 LTBI 被认为是控制结核病的方法之一。LTBI 的诊断依赖于对 TB 抗原的免疫反应性,常用的检测方法包括结核菌素皮肤试验和干扰素释放试验(IGRA)。目前,没有诊断试验可以确定 LTBI 患者会发展为活动性疾病或保持无症状。因此,尚不清楚应该治疗谁。在目前的情况下,LTBI 的治疗仅限于高危人群,包括与成人肺结核密切接触的 5 岁以下儿童。LTBI 的各种治疗方案正在不断发展,包括单独使用异烟肼(INH)治疗 6-9 个月,或 INH 和利福平联合治疗 3-4 个月,或每周一次利福喷丁和 INH 联合治疗 3 个月。需要研究来确定 LTBI、LTBI 向活动性疾病进展的危险因素,以及更短的治疗方案。

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