Dash Nabaneeta, Jain Lovely, Malik Meenakshi, Pradhan Pranita, Choudhary Monica, Mandula Phani Priya, Kaur Kulbir, Purohit Abhishek, Mathew Joseph L
Department of Telemedicine, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.
Advanced Centre for Evidence Based Child Health (ACEBCH), Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.
Am J Trop Med Hyg. 2024 Sep 18;111(6):1273-1279. doi: 10.4269/ajtmh.24-0174. Print 2024 Dec 4.
Tuberculosis treatment is sometimes associated with clinical deterioration, referred to as paradoxical reaction (PR), especially in those with HIV coinfection. However, the burden and characteristics of PR in children without HIV coinfection are unclear. We undertook a systematic review to estimate the burden and clinical characteristics of PR in HIV-negative children. We searched PubMed, Embase, Web of Science, CINAHL, Scopus, Cochrane Library, ProQuest, and OpenGrey for studies reporting PR in HIV-negative children (<18 years old). We included observational studies including case series with at least five cases. Data on incidence/prevalence, clinical features, risk factors, management strategies, and outcome of PR were extracted. Risk of bias in the included studies was assessed using the NIH's quality assessment and Joanna Briggs Institute critical appraisal tools. We pooled the prevalence data using random effects meta-analysis. We identified 1,673 studies, of which 10 were eligible for inclusion. They described PR in 133 HIV-negative children. The pooled prevalence was 8.8% (95% CI: 2.9%, 14.6%). Owing to heterogeneity among studies, risk factors for the development of PR could not be identified. Limited data suggested that children developing PR were younger and had neurological or lymph node tuberculosis more often. Most children were treated with corticosteroids, but data were insufficient to identify the optimal management strategy. The review showed that PR affects nearly 1 in 12 HIV-negative children receiving tuberculosis treatment. The paucity of studies emphasizes the need for surveillance/studies to better characterize clinical features, risk factors, appropriate management strategies, and outcome.
结核病治疗有时会伴有临床病情恶化，即所谓的矛盾反应（PR），尤其是在合并感染艾滋病毒的患者中。然而，未合并感染艾滋病毒的儿童中PR的负担和特征尚不清楚。我们进行了一项系统评价，以估计未感染艾滋病毒儿童中PR的负担和临床特征。我们在PubMed、Embase、Web of Science、CINAHL、Scopus、Cochrane图书馆、ProQuest和OpenGrey中检索了报告未感染艾滋病毒儿童（<18岁）PR的研究。我们纳入了观察性研究，包括至少有5例病例的病例系列。提取了关于PR的发病率/患病率、临床特征、危险因素、管理策略和结局的数据。使用美国国立卫生研究院的质量评估和乔安娜·布里格斯研究所的批判性评价工具评估纳入研究的偏倚风险。我们使用随机效应荟萃分析汇总患病率数据。我们识别出1673项研究，其中10项符合纳入标准。这些研究描述了133例未感染艾滋病毒儿童中的PR。汇总患病率为8.8%（95%CI：2.9%，14.6%）。由于研究之间存在异质性，无法确定PR发生的危险因素。有限的数据表明，发生PR的儿童年龄较小，更常患有神经或淋巴结结核。大多数儿童接受了皮质类固醇治疗，但数据不足以确定最佳管理策略。该评价表明，PR影响近十二分之一接受结核病治疗的未感染艾滋病毒儿童。研究的匮乏凸显了进行监测/研究以更好地描述临床特征、危险因素、适当管理策略和结局的必要性。
