Thadchanamoorthy V, Dayasiri Kavinda
Honorary Consultant Paediatrician & Senior Lecturer, Clinical Science Department, Faculty of Health Care Sciences, Eastern University, Sri Lanka.
Consultant Paediatrician, Base Hospital, Mahaoya, Sri Lanka.
Respir Med Case Rep. 2020 Sep 16;31:101229. doi: 10.1016/j.rmcr.2020.101229. eCollection 2020.
Tuberculosis in infants although less common compared to older children and adults, is associated with a high risk for milliary tuberculosis, tuberculosis meningitis and overall higher mortality. Lung abscess commonly presents following severe community acquired bacterial infections and is extremely rare in infants with tuberculosis. This report presents the case of a 10-month-old infant who had an unusual presentation of pulmonary tuberculosis with no cough, poor growth or documented temperature >38 C despite extensive right lung involvement with lung abscess formation and pleural effusions. Inflammatory markers were minimally deranged. The diagnosis of pulmonary tuberculosis was confirmed based on positive tuberculosis polymerase chain reaction test. The child made a successful clinical and radiological recovery upon completion of anti-tuberculosis drug regimen for six months. This report brings to light that it is crucial for clinicians to have a high index of suspicion of tuberculosis irrespective of age of the patient, presenting symptoms and low prevalence since delayed diagnosis of tuberculosis in infants is associated with poor outcomes.
婴儿结核病虽然与大龄儿童和成人相比不太常见，但与粟粒性肺结核、结核性脑膜炎的高风险以及总体较高的死亡率相关。肺脓肿通常在严重的社区获得性细菌感染后出现，在患结核病的婴儿中极为罕见。本报告介绍了一名10个月大婴儿的病例，该婴儿患有不寻常的肺结核表现，尽管右肺广泛受累并形成肺脓肿和胸腔积液，但无咳嗽、生长发育不良或体温记录>38℃。炎症标志物仅有轻微紊乱。基于结核聚合酶链反应试验阳性确诊为肺结核。患儿在完成六个月的抗结核药物治疗后临床和影像学恢复良好。本报告揭示，临床医生无论患者年龄、呈现的症状以及低患病率如何，都必须对结核病保持高度怀疑指数，这至关重要，因为婴儿结核病的延迟诊断与不良预后相关。
