Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Tygerberg Hospital, Stellenbosch University, Cape Town, South Africa.
Department of Pediatric Radiology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.
Pediatr Pulmonol. 2024 Dec;59(12):3446-3456. doi: 10.1002/ppul.27232. Epub 2024 Aug 26.
The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic had a significant impact on tuberculosis (TB) control globally, with the number of new TB diagnoses decreasing. Coinfection with some viruses, especially measles, could aggravate TB in children. This is presumably a result of depressed cellular immunity. Reports on children with TB and SARS-CoV-2 coinfection are limited.
A retrospective analysis of children up to 13 years old admitted to Tygerberg Hospital, Cape Town, South Africa, from March 2020 to December 2022 with suspected TB-induced airway compression requiring bronchoscopy. Children were included if they presented with severe intrathoracic airway obstruction and/or radiographic evidence of complicated TB. The patients were divided into two groups based on SARS-CoV-2 respiratory polymerase chain reaction results. Demographics, TB exposure, microbiology, SARS-CoV-2 laboratory data, imaging, inflammatory cytokine levels, and bronchoscopy data were collected. Statistical analyses compared SARS-CoV-2 positive and negative groups.
Of the 50 children undergoing bronchoscopy for TB airway obstruction, 7 (14%) were SARS-CoV-2 positive. Cough was more prevalent in the SARS-CoV-2 positive group (p = 0.04). There was no difference in TB culture yield between groups. However, SARS-CoV-2 positive children showed slower radiological improvement at 1 month (p = 0.01), pleural effusions (p < 0.001), and a higher need for endoscopic enucleation (p < 0.001). FDG PET/CT scans indicated an ongoing inflammation in the SARS-CoV-2 positive group.
Coinfection with SARS-CoV-2 in children with TB airway obstruction appears to complicate the disease course, necessitating more medical interventions and demonstrating a longer duration of the TB inflammatory process. Further research is needed to understand the impact of viral infections on TB progression and outcomes in pediatric patients.
严重急性呼吸综合征冠状病毒 2 (SARS-CoV-2) 大流行对全球结核病 (TB) 控制产生了重大影响，新诊断的结核病病例数量减少。一些病毒的合并感染，特别是麻疹，可能会使儿童结核病恶化。这大概是细胞免疫抑制的结果。关于儿童结核病与 SARS-CoV-2 合并感染的报告有限。
对 2020 年 3 月至 2022 年 12 月期间因疑似 TB 引起的气道压迫需要支气管镜检查而入住南非开普敦泰格伯格医院的 13 岁以下儿童进行回顾性分析。如果患儿出现严重的胸内气道阻塞和/或复杂 TB 的影像学证据，则将其纳入研究。根据 SARS-CoV-2 呼吸道聚合酶链反应结果，将患儿分为两组。收集患儿的人口统计学、TB 暴露、微生物学、SARS-CoV-2 实验室数据、影像学、炎症细胞因子水平和支气管镜检查数据。对 SARS-CoV-2 阳性和阴性组进行统计学分析。
在因 TB 气道阻塞而行支气管镜检查的 50 名患儿中，有 7 名（14%）SARS-CoV-2 阳性。SARS-CoV-2 阳性组患儿更常见咳嗽（p=0.04）。两组的 TB 培养阳性率无差异。然而，SARS-CoV-2 阳性患儿在 1 个月时的影像学改善较慢（p=0.01），胸腔积液更多（p<0.001），需要内镜切除术的比例更高（p<0.001）。FDG PET/CT 扫描表明 SARS-CoV-2 阳性组存在持续的炎症。
在患有 TB 气道阻塞的儿童中，SARS-CoV-2 合并感染似乎使疾病过程复杂化，需要更多的医疗干预，并表明 TB 炎症过程持续时间更长。需要进一步研究以了解病毒感染对儿童患者 TB 进展和结局的影响。
