Starke J R
Baylor College of Medicine, Houston, Texas.
Pediatr Clin North Am. 1988 Jun;35(3):441-64. doi: 10.1016/s0031-3955(16)36465-3.
Tuberculosis in children remains an important infectious disease in the United States, with 1261 cases reported in 1985. The percentage of extrapulmonary manifestations is increasing. Advances in the diagnosis and treatment of tuberculosis in children have lagged behind those in adults owing to diminished familiarity with the disease and difficulty in performing clinical studies in children. Tuberculosis in the United States now occurs mainly in clusters of high-risk people, such as the foreign born, Hispanics, blacks, Native Americans, and the impoverished. In general, the diagnosis of tuberculosis is epidemiologic, supported by the chest roentgenogram, skin test, and, most important, contact tracing. As the rate of drug-resistant tuberculosis increases, greater effort should be made to obtain cultures. New advances, such as DNA probes and serodiagnosis, may improve diagnostic accuracy, especially for extrapulmonary tuberculosis. Noncompliance is the major problem in treating tuberculosis, and greater effort should be directed toward novel treatment approaches in children, such as twice-weekly supervised therapy and shorter, more intense durations of therapy.
在美国，儿童结核病仍然是一种重要的传染病，1985年报告了1261例病例。肺外表现的比例正在增加。由于对该疾病的熟悉程度降低以及在儿童中进行临床研究存在困难，儿童结核病的诊断和治疗进展落后于成人。美国的结核病现在主要发生在高危人群聚集的地方，如外国出生者、西班牙裔、黑人、美洲原住民和贫困人口。一般来说，结核病的诊断是基于流行病学，胸部X光片、皮肤试验，以及最重要的接触者追踪提供支持。随着耐多药结核病发病率的上升，应更加努力获取培养物。DNA探针和血清诊断等新进展可能会提高诊断准确性，尤其是对于肺外结核病。不依从是治疗结核病的主要问题，应更加努力探索针对儿童的新治疗方法，如每周两次的监督治疗以及疗程更短、强度更大的治疗。
