巴西里约热内卢儿童和青少年中的结核病-关注肺外疾病。

Tuberculosis among children and adolescents in Rio de Janeiro, Brazil - Focus on extrapulmonary disease.

机构信息

Post Graduation Program in Medical Clinics, Federal University of Rio de Janeiro, Rio de Janeiro (RJ), Brazil.

Pediatrics Department, Faculty of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro (RJ), Brazil.

出版信息

Int J Infect Dis. 2021 Apr;105:105-112. doi: 10.1016/j.ijid.2021.02.023. Epub 2021 Feb 14.

DOI:10.1016/j.ijid.2021.02.023

PMID:33596481

Abstract

OBJECTIVE

To compare the socio-demographic, clinical, and diagnostic characteristics and treatment outcomes between extrapulmonary tuberculosis (EPTB) and pulmonary tuberculosis (PTB) in children and adolescents in Rio de Janeiro, a high TB-burdened Brazilian city.

METHODS

This retrospective study used data from patients with EPTB and PTB aged 0 - 18 years, notified on two national databases from 2014 to 2016.

RESULTS

Among the 1008 patients, 144 (14.2%) had EPTB. Patients with EPTB showed higher odds of hospital-based diagnosis (odds ratio (OR): 6.76 [95% confidence interval (95% CI): 4.62-9.90]; p < 0.001), no laboratory confirmation (OR: 4.9 2.14 [95% CI: 3.07 - 7.85]; p < 0.001), and being <14 years old (OR: 3.13 [95% CI: 2.18-4.49]) than those with PTB. A diagnosis without laboratory investigation was observed among 301/864 (34.8%) patients with PTB, 48/144 (33.3%) with EPTB, and among those aged under five years with EPTB (15/27 [55.6%]). TB deaths were more frequent in patients with EPTB (5/144 [3.5%]) than in those with PTB (4/864[0.5%]) (p = 0.001); 4/5 (80%) TB deaths were due to TB meningitis; 50% died within 14 days of diagnosis.

CONCLUSIONS

EPTB remains a clinical diagnostic challenge that needs to be addressed to fully benefit from the higher sensitivity laboratory investigations.

摘要

目的

比较巴西里约热内卢高结核负担城市中儿童和青少年的肺外结核（EPTB）和肺结核（PTB）的社会人口学、临床和诊断特征及治疗结局。

方法

本回顾性研究使用了 2014 年至 2016 年两个国家数据库中报告的年龄在 0-18 岁的 EPTB 和 PTB 患者的数据。

结果

在 1008 例患者中，144 例（14.2%）患有 EPTB。与 PTB 患者相比，EPTB 患者更有可能在医院诊断（比值比（OR）：6.76[95%置信区间（95%CI）：4.62-9.90]；p<0.001），无实验室确诊（OR：4.92.14[95%CI：3.07-7.85]；p<0.001），且年龄<14 岁（OR：3.13[95%CI：2.18-4.49]）。在 864 例 PTB 患者中有 301/864（34.8%），144 例 EPTB 中有 48/144（33.3%），EPTB 中年龄在 5 岁以下的患者中有 15/27（55.6%），未进行实验室检查即做出诊断。EPTB 患者的结核病死亡（5/144[3.5%]）比 PTB 患者（4/864[0.5%]）更常见（p=0.001）；4/5（80%）结核病死亡是由于结核性脑膜炎；50%的患者在确诊后 14 天内死亡。