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肺外结核。

Extrapulmonary tuberculosis.

机构信息

Department of Molecular Medicine, Jamia Hamdard Institute of Molecular Medicine, New Delhi, India.

Departments of General Medicine & Pulmonary Medicine, JNMC, Datta Meghe Institute of Medical Sciences (DMIMS), Wardha, India.

出版信息

Expert Rev Respir Med. 2021 Jul;15(7):931-948. doi: 10.1080/17476348.2021.1927718. Epub 2021 Jul 14.

Abstract

: Tuberculosis (TB) is a major cause of morbidity and mortality globally. Extrapulmonary TB (EPTB) constitutes about 15%-20% of all TB patients, but accounts for 50% among HIV-coinfected. Confirmation of microbial diagnosis of EPTB is usually challenging.: Availability of newer imaging modalities like FDG-PET-CT and PET-MRI has facilitated precise anatomical localization of the lesions and mapping the extent of EPTB. The use of image- and endoscopy-guided invasive diagnostic methods has made procurement of tissue/body fluids for diagnostic testing possible. With the advent of universal drug-susceptibility testing, a rapid diagnosis of drug-resistance is now possible in EPTB. Drug-susceptible EPTB usually responds well to first-line anti-TB treatment; TB meningitis, bone and joint TB and lymph node TB requires longer durations of treatment.: Adjunctive use of corticosteroids in the initial period is recommended in the central nervous system and pericardial TB. Surgical intervention is helpful to obtain tissue samples for diagnosis. Adjunctive surgical treatment along with medical treatment is useful in treating complications like hydrocephalus, Pott's spine. Follow-up of EPTB patients is crucial as treatment period is usually prolonged, requires recognition of development of immune reconstitution and inflammatory syndrome (IRIS), monitoring of adverse events, serious adverse events like anti-TB drug-induced hepatotoxicity, organ-related complications, and treatment adherence.

摘要

结核病(TB)是全球发病率和死亡率的主要原因。肺外结核病(EPTB)约占所有结核病患者的 15%-20%,但在 HIV 合并感染者中占 50%。EPTB 的微生物诊断确认通常具有挑战性。

新型成像方式如 FDG-PET-CT 和 PET-MRI 的应用有助于精确定位病变的解剖位置,并描绘 EPTB 的范围。影像和内镜引导的有创诊断方法的应用使获取组织/体液进行诊断检测成为可能。随着普遍药敏检测的出现,现在可以快速诊断 EPTB 的耐药性。对一线抗结核药物敏感的 EPTB 通常对治疗反应良好;结核性脑膜炎、骨和关节结核和淋巴结结核需要更长的治疗时间。

在中枢神经系统和心包结核中,建议在初始阶段辅助使用皮质类固醇。手术干预有助于获取组织样本进行诊断。辅助手术治疗与药物治疗相结合,可有效治疗脑积水、波特脊柱等并发症。EPTB 患者的随访至关重要,因为治疗期通常较长,需要识别免疫重建和炎症综合征(IRIS)的发展,监测不良反应、抗结核药物引起的肝毒性等严重不良反应、器官相关并发症以及治疗依从性。

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