Kaba Özge, Kara Manolya, Odacılar Cemile Ayşe, Kamer İbrahim, Sütçü Murat, Demir Sevliya Öcal, Çalışkan Emine, Törün Selda Hançerli, Salman Nuran, Somer Ayper
Division of Pediatric Infectious Diseases, Department of Pediatrics, İstanbul University Faculty of Medicine, İstanbul, Turkey.
Department of Pediatrics, İstanbul University Faculty of Medicine, İstanbul, Turkey.
Turk Pediatri Ars. 2019 Jul 11;54(2):86-92. doi: 10.14744/TurkPediatriArs.2019.33239. eCollection 2019.
Extrapulmonary tuberculosis is observed more frequently and leads to complications with a higher rate in children compared with adults because the risk of lymphohematogen spread is higher. In this study, the clinical, laboratory, and radiologic findings and treatment outcomes were evaluated in pediatric patients who were followed up in our clinic with a diagnosis of extrapulmonary tuberculosis.
Seventy patients aged 0-18 years who were followed up with a diagnosis of extrapulmonary tuberculosis between 2008 and 2017 in the Division of Pediatric Infectious Diseases in our hospital were examined retrospectively.
The median age of the patients was 8,8 (range, 0,4-17) years and 47.1% were female (n=33). Twenty-seven patients (38.6%) were aged 0-4 years, 15 (21.4%) were aged 5-9 years, and 28 patients (40%) were aged 10-18 years. Forty-four patients (62.9%) were diagnosed as having extrapulmonary tuberculosis and 26 (37.1%) had pulmonary + extrapulmonary tuberculosis. The most common form of extrapulmonary tuberculosis was extrathoracic lymphadenopathy, which was found in 22 patients (31.4%). The other patients were diagnosed as having musculoskeletal system tuberculosis (n=10, 14.3%), gastrointestinal system tuberculosis (n=9, 12.9%), miliary tuberculosis (n=8, 11.4%), intrathoracic lymphadenopathy (n=7, 10%), renal tuberculosis (n=6, 8.6%), central nervous system tuberculosis (n=5, 7.1%), and pleural tuberculosis (n=3, 4.3%). Among a total of 58 patients in whom tuberculin skin test and interferon gamma release tests were studied together, tuberculin skin test positivity (n=37, 63.8%) was found with a higher rate compared with interferon gamma release test positivity (n=32, 55.2%), but the difference was not statistically significant (p=0.35). The median treatment period was 12 (range, 6-24) months. Among the patients whose treatments were terminated, improvement was observed in 52 patients (74.2%) and the development of sequela was observed in six patients (8.5%). Two patients who were diagnosed as having central nervous system tuberculosis (2.8%) died.
Clinical, laboratory, and radiologic data should be evaluated together when making a diagnosis of extrapulmonary tuberculosis in children. Interferon gamma release tests alone are not superior to tuberculin skin test, but should be considered to be used in combination in the diagnosis.
与成人相比，儿童肺外结核更为常见，且因淋巴血行播散风险较高，导致并发症发生率更高。在本研究中，对我院门诊诊断为肺外结核并接受随访的儿科患者的临床、实验室及影像学检查结果和治疗转归进行了评估。
回顾性分析了我院儿科传染病科2008年至2017年间诊断为肺外结核并接受随访的70例0至18岁患者。
患者的中位年龄为8.8岁（范围0.4至17岁），女性占47.1%（n = 33）。27例（38.6%）患者年龄在0至4岁，15例（21.4%）年龄在5至9岁，28例（40%）年龄在10至18岁。44例（62.9%）诊断为肺外结核，26例（37.1%）为肺结核合并肺外结核。肺外结核最常见的形式是胸外淋巴结结核，见于22例（31.4%）。其他患者诊断为肌肉骨骼系统结核（n = 10，14.3%）、胃肠道系统结核（n = 9，12.9%）、粟粒性结核（n = 八，11.4%）、胸内淋巴结结核（n = 7，10%）、肾结核（n = 6，8.6%）、中枢神经系统结核（n = 5，7.1%）和胸膜结核（n = 3，4.3%）。在总共58例同时进行结核菌素皮肤试验和干扰素γ释放试验的患者中，结核菌素皮肤试验阳性率（n = 37，63.8%）高于干扰素γ释放试验阳性率（n = 32，55.2%），但差异无统计学意义（p = 0.35）。中位治疗期为12个月（范围6至24个月）。在治疗结束的患者中，52例（74.2%）病情改善，6例（8.5%）出现后遗症。2例诊断为中枢神经系统结核的患者（2.8%）死亡。
儿童肺外结核诊断时应综合评估临床、实验室及影像学资料。单独的干扰素γ释放试验并不优于结核菌素皮肤试验，但在诊断中应考虑联合使用。
