Abstract：
Paradoxical reactions (PR) to tuberculosis (TB) treatment are common during treatment, but have also been described after treatment. A presentation with recurrent signs or symptoms of TB after cure or completion of prior treatment needs to be differentiated between microbiological relapse and a paradoxical reaction. We searched all published literature on post-treatment PR, and present a synthesis of 30 studies, focusing on the epidemiology, diagnosis and management of this phenomenon. We report an additional case vignette. The majority of studies were of lymph node TB (LN-TB), followed by central nervous system TB (CNS-TB). A total of 112 confirmed and 42 possible post-treatment PR cases were reported. The incidence ranged between 3 and 14% in LN-TB and was more frequent than relapses, and between 0 and 2% in all TB. We found four reports of pulmonary or pleural TB post-treatment PR cases. The incidence did not differ by length of treatment, but was associated with younger age at initial diagnosis, and having had a PR (later) during treatment. Post-treatment PR developed mainly within the first 6 months after the end of TB treatment but has been reported many years later (longest report 10 years). The mainstays of diagnosis and management are negative mycobacterial cultures and anti-inflammatory treatment, respectively. Due to the favourable prognosis in LN-TB recurrent symptoms, a short period of observation is warranted to assess for spontaneous regression. In CNS-TB with recurrent symptoms, immediate investigation and anti-inflammatory treatment with the possibility of TB retreatment should be undertaken.
摘要：
在治疗过程中，结核病（TB）治疗的反常反应（PR）很常见，但治疗后也有描述。在治愈或完成先前治疗后，结核病的复发体征或症状的表现需要在微生物学复发和矛盾反应之间进行区分。我们搜索了所有发表的关于治疗后PR的文献，并提出了30项研究的综合，专注于流行病学，这种现象的诊断和管理。我们报告了一个额外的病例插图。大多数研究是淋巴结结核（LN-TB），其次是中枢神经系统TB（CNS-TB）。总共报告了112例确诊和42例可能的治疗后PR病例。LN-TB的发病率介于3％至14％之间，并且比复发更频繁，在所有TB中介于0和2%之间。我们发现了四例治疗后的肺或胸膜TBPR病例的报告。发病率随治疗时间的不同而不同，但在最初诊断时与年龄较小有关，并且在治疗期间有PR（后来）。治疗后PR主要在结核病治疗结束后的前6个月内发展，但已在多年后报告（最长报告10年）。诊断和管理的支柱是分枝杆菌培养阴性和抗炎治疗，分别。由于LN-TB复发症状的良好预后，有必要进行短期观察以评估自发性消退.在有反复症状的CNS-TB中，应立即进行调查和抗炎治疗,并有可能进行结核病再治疗.
