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新加坡儿童腹部结核病:一项10年回顾性研究系列

Pediatric Abdominal Tuberculosis in Singapore: A 10-Year Retrospective Series.

作者信息

Wong Sarah Ailyne, Lee Meijuan Dawn, Loh Sin Wee, Thoon Koh Cheng, Tan Natalie Woon Hui, Chong Chia Yin

机构信息

KK Women's and Children's Hospital, Singapore, Singapore.

National University of Singapore, Singapore, Singapore.

出版信息

Glob Pediatr Health. 2020 Feb 5;7:2333794X20903952. doi: 10.1177/2333794X20903952. eCollection 2020.

Abstract

. Tuberculosis (TB) remains a major cause of mortality and morbidity globally. Pediatric patients are more likely to develop severe disease. Abdominal TB is a rare manifestation of pediatric TB and can present with chronic and nonspecific abdominal symptoms. This study examines the clinical profile of pediatric patients with abdominal TB and treatment outcomes. . A retrospective study of patients admitted to a tertiary pediatric hospital in Singapore over 10 years. Clinical characteristics and outcomes were examined. There were 3 male and 3 female patients with mean age of 11.3 years. Household contacts were traced in 3 cases. The most common presenting symptoms were fever, weight loss, and abdominal symptoms such as diarrhea, vomiting, and loss of appetite. Inflammatory markers were raised with mean C-reactive protein (CRP) and erythrocyte sedimentation (ESR) rate at 70.9 mg/L and 90 mm/h respectively. Abdominal imaging showed abnormalities such as splenic foci and thickened bowel wall with significant intraabdominal lymphadenopathy. was isolated from stool, rectal swabs and intra-adominal specimens. Two patients underwent excisional biopsy of lymph node to obtain diagnosis. Two patients required emergency laparotomy and 1 patient received esophagogastroduodenoscopy and colonoscopy. Four out of the 6 patients had pulmonary involvement. . Abdominal TB should be a differential diagnosis in children with chronic abdominal symptoms for at least 8 weeks with anemia, raised ESR and CRP. The gold standard for diagnosis still remains as positive microbiological culture. However, abdominal imaging studies are also vital in obtaining further supportive evidence for chronic infection.

摘要

结核病(TB)仍是全球死亡和发病的主要原因。儿科患者更易发展为重症疾病。腹部结核是儿科结核病的罕见表现,可出现慢性和非特异性腹部症状。本研究探讨了儿童腹部结核患者的临床特征及治疗结果。

对新加坡一家三级儿科医院10年间收治的患者进行回顾性研究。研究了临床特征和治疗结果。共有3例男性和3例女性患者,平均年龄11.3岁。3例患者追踪了家庭接触者。最常见的症状为发热、体重减轻以及腹泻、呕吐和食欲不振等腹部症状。炎症指标升高,平均C反应蛋白(CRP)和红细胞沉降率(ESR)分别为70.9mg/L和90mm/h。腹部影像学检查显示脾脏病灶、肠壁增厚及显著的腹腔内淋巴结肿大等异常情况。粪便、直肠拭子和腹腔内标本中分离出……。2例患者接受淋巴结切除活检以明确诊断。2例患者需要急诊剖腹手术,1例患者接受了食管胃十二指肠镜检查和结肠镜检查。6例患者中有4例有肺部受累。

对于有慢性腹部症状至少8周、伴有贫血、ESR和CRP升高的儿童,应将腹部结核列为鉴别诊断之一。诊断的金标准仍然是微生物培养阳性。然而,腹部影像学检查对于获得慢性感染的进一步支持证据也至关重要。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c6b9/7003167/60d5b6e960f3/10.1177_2333794X20903952-fig1.jpg

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