Mafukidze Arnold T, Calnan Marianne, Furin Jennifer
University Research Co., LLC, Mbabane, Swaziland.
Harvard Medical School, Department of Global Health and Social Medicine, Boston, MA, USA.
J Clin Tuberc Other Mycobact Dis. 2015 Dec 3;2:5-11. doi: 10.1016/j.jctube.2015.11.002. eCollection 2016 Jan.
Peripheral neuropathy (PN) is a serious condition affecting the nerves that is commonly seen in patients with tuberculosis (TB). Causes of PN in patients with TB are multiple, and can include TB itself, other co-morbid conditions, such as Human Immune-deficiency virus (HIV) disease, malnutrition, or diabetes mellitus (DM), and several anti-tuberculous medications. The condition can manifest with a variety of symptoms, and a diagnosis can usually be made on a clinical basis. Treatment and prognosis of PN vary depending on the underlying cause, but often the condition can lead to permanent disability in individuals with TB. For this reason, primary prevention is key as is early identification and management of symptoms. Treatment can include withdrawal of possible offending agents, vitamin supplementation, physical therapy, analgesics, and targeted agents, including tricyclic antidepressants, selective serotonin reuptake inhibitors, and gabapentin. Additional research is needed to better describe the morbidity and disability associated with PN in persons with TB and to improve management strategies for persons at risk for and affected by this condition. Case review: RM is a 47 year-old man who is in his third month of treatment for drug-resistant TB (DR-TB). His treatment regimen consists of kanamycin (1 gm intramuscular daily), levofloxacin (1000 mg by mouth daily), cycloserine (750 mg by mouth daily), ethionamide (750 mg by mouth daily), pyrazinamide (1500 mg by mouth daily), and Para-Amino Salicylate (12 gm by mouth daily). He is HIV-infected with a CD4 count of 470 cell/µl and on a stable antiretroviral therapy regimen of tenofovir, lamivudine, and efavirenz, which he started 8 weeks ago. He works in a platinum mine, denies smoking, reports drinking beer "on the weekend" and denies other drugs. He presents for his 3 month clinical visit for his DR-TB follow-up and states he is doing well, but he does report some "burning" in the bottom of his feet.
周围神经病变（PN）是一种影响神经的严重病症，常见于结核病（TB）患者。结核病患者发生周围神经病变的原因多种多样，可能包括结核病本身、其他合并病症，如人类免疫缺陷病毒（HIV）感染、营养不良或糖尿病（DM），以及多种抗结核药物。该病症可表现出多种症状，通常可根据临床情况做出诊断。周围神经病变的治疗和预后因潜在病因而异，但在结核病患者中，这种病症往往会导致永久性残疾。因此，一级预防至关重要，早期识别和症状管理也同样重要。治疗方法可包括停用可能的致病药物、补充维生素、物理治疗、使用镇痛药以及使用靶向药物，包括三环类抗抑郁药、选择性5-羟色胺再摄取抑制剂和加巴喷丁。需要进行更多研究，以更好地描述结核病患者中与周围神经病变相关的发病率和残疾情况，并改善对有此病症风险和受此病症影响者的管理策略。病例回顾：RM是一名47岁男性，正在接受耐多药结核病（DR-TB）治疗的第三个月。他的治疗方案包括卡那霉素（每日1克肌肉注射）、左氧氟沙星（每日1000毫克口服）、环丝氨酸（每日750毫克口服）、乙硫异烟胺（每日750毫克口服）、吡嗪酰胺（每日1500毫克口服）和对氨基水杨酸（每日12克口服）。他感染了HIV，CD4细胞计数为470个/微升，正在接受替诺福韦、拉米夫定和依非韦伦的稳定抗逆转录病毒治疗方案，该方案于8周前开始。他在一家铂矿工作，否认吸烟，称“周末”喝啤酒，否认使用其他药物。他前来进行耐多药结核病随访的3个月临床检查，称自己情况良好，但确实报告说脚底有一些“烧灼感”。
