Schaaf H S, Gie R P, Beyers N, Smuts N, Donald P R
Tygerberg Hospital, University of Stellenbosch, Department of Paediatrics and Child Health, Republic of South Africa.
Arch Dis Child. 1993 Sep;69(3):371-4. doi: 10.1136/adc.69.3.371.
The clinical and radiological features in 38 infants less than 3 months of age with tuberculosis proved by culture are described and may aid early diagnosis of this often fatal condition. Respiratory symptoms, cough in 33 (87%) and tachypnoea in 31 (82%), were the commonest presenting symptoms. Twenty five infants (66%) had hepatomegaly and 20 (53%) splenomegaly. Mantoux testing gave an induration of > 15 mm in three of 17 (18%) infants. In a further five a Tine test gave confluent response. Chest radiography in 27 infants showed miliary tuberculosis in seven (26%) and hilar or paratracheal adenopathy in 14 (52%) and 10 (37%) respectively. Compression of either the bronchi or trachea or both was noted in 15 (56%). Detection of this complication was aided by high kilovolt radiographs. A culture of Mycobacterium tuberculosis was obtained from gastric aspirate in 35 (92%) infants, but positive cultures were also obtained from cerebrospinal fluid, tracheal or bronchial aspirate and liver and lymph node biopsy. Of 30 mothers evaluated seven (23) had previously unsuspected pulmonary tuberculosis.
本文描述了38例3个月龄以下经培养证实患有结核病婴儿的临床和放射学特征，这些特征可能有助于早期诊断这种往往致命的疾病。呼吸道症状是最常见的表现症状，33例（87%）咳嗽，31例（82%）呼吸急促。25例婴儿（66%）肝肿大，20例（53%）脾肿大。17例婴儿中有3例（18%）结核菌素试验硬结直径>15mm。另有5例结核菌素划痕试验呈融合反应。27例婴儿的胸部X线检查显示，7例（26%）有粟粒性肺结核，14例（52%）和10例（37%）分别有肺门或气管旁淋巴结肿大。15例（56%）发现支气管或气管或两者均受压。高千伏X线片有助于发现这一并发症。35例（92%）婴儿的胃抽吸物培养出结核分枝杆菌，但脑脊液、气管或支气管抽吸物以及肝脏和淋巴结活检也获得了阳性培养结果。在接受评估的30位母亲中，有7位（23%）此前未被怀疑患有肺结核。
