■先天性结核病(CTB)相对罕见,大多数患者在病例报告中都有描述。
■探讨26例儿童CTB的临床特点。
■回顾性分析2013年1月至2021年12月在中南部长沙市中心医院收治的26例CTB患儿。
■发病年龄中位数为25天(17-33),约有73%的病例在4周龄内。在24位母亲中(包括两位双胞胎母亲),18人(75.0%)在怀孕期间无症状,其中4人在产前被诊断为肺结核。结核性脑膜炎的数量,结核性脑炎和肝结核分别为17例(65.4%),五个(19.2%)和四个(15.4%),分别。主要症状为发热(18例,69.2%)和咳嗽(16例,61.5%)。T-SPOT阳性率。TB,抗酸杆菌涂片,结核分枝杆菌培养和GeneXpertMTB/RIF试验,分别,84.2%(16/19),42.3%(11/26),43.5%(10/23)和83.3%(5/6)。X线摄影或计算机断层扫描均显示出典型的肺结核性病变,头部磁共振成像(MRI)显示有7例(26.9%)明显的脑膜增强或实质病变。一例患有耐药结核病。随访期间,9例有不同程度的肝损伤,一个人延缓了生长和发育。8人死亡,18人康复。
■怀孕期间的孕产妇结核病状况,流行病学史,T-SPOT。结核病和其他与结核病相关的病因检查和影像学检查对于CTB的早期诊断和治疗非常重要。并与有利的结果相关联。
■AFB:抗酸杆菌;Amk:阿米卡星;Cs:环丝氨酸;CT:计算机断层扫描;E:乙胺丁醇;GeneXpertMTB/RIF:GeneXpert结核分枝杆菌和利福平耐药;H:异烟肼;IVF-ET:体外受精-胚胎移植;TB:结核分枝杆菌感染T淋巴细胞的斑点试验;Z:吡嗪酰胺。
Congenital tuberculosis (CTB) is relatively rare and most patients are described in case reports.
To investigate the clinical characteristics of CTB in 26 children.
A retrospective analysis of 26 children with CTB from January 2013 to December 2021 in Changsha Central Hospital in Central Southern China was undertaken.
The median age at onset was 25 days (17-33) and within 4 weeks of age in approximately 73% of cases. Of 24 mothers (including two mothers of twins), 18 (75.0%) were asymptomatic during pregnancy, and four were diagnosed with tuberculosis prenatally. The numbers of tuberculous meningitis, tuberculous encephalitis and liver TB were 17 (65.4%), five (19.2%) and four (15.4%), respectively. The main symptoms were fever (n = 18, 69.2%) and cough (n = 16, 61.5%). Positive rates of T-SPOT.TB, acid-fast bacilli smear, culture of Mycobacterium tuberculosis and GeneXpert MTB/RIF test were, respectively, 84.2% (16/19), 42.3% (11/26), 43.5% (10/23) and 83.3% (5/6). Radiograph or computed tomography demonstrated typical pulmonary tuberculous lesions in all cases and the head magnetic resonance imaging (MRI) showed marked meningeal enhancement or parenchymal lesions in seven cases (26.9%). One case had drug-resistant TB. During follow-up, nine cases had varying degrees of liver injury, and one had delayed growth and development. Eight died and 18 recovered satisfactorily.
Maternal TB status during pregnancy, the epidemiological history, T-SPOT.TB and other TB-related aetiological tests and imaging are important for the early diagnosis and treatment of CTB, and are associated with a favourable outcome.
AFB: acid-fast bacilli; Amk: amikacin; Cs: cycloserine; CT: computed tomography; E: ethambutol; GeneXpert MTB/RIF: GeneXpert Mycobacterium tuberculosis and rifampicin resistance; H: isoniazid; IVF-ET: in-vitro fertilization-embryo transfer; Lzd: linezolid; Mfx: moxifloxacin; MTB: Mycobacterium tuberculosis; mNGS: next generation sequencing; MTB-DNA: Mycobacterium tuberculosis-deoxyribonucleic acid; Pto: protionamide; R: rifampicin; TB: tuberculosis; T-SPOT.TB: spot test of mycobacterium TB infection T-lymphocytes; Z: pyrazinamide.