儿童和青少年的传染性结核病：范围界定综述。

IF 3.4 3区医学 Q2 INFECTIOUS DISEASES

International Journal of Tuberculosis and Lung Disease Pub Date : 2024-09-01 DOI:10.5588/ijtld.24.0106

D Buonsenso, F Mariani, R Morello, R Song

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引用次数: 0

摘要

目的总结有关儿童和青少年粟粒性肺结核的临床表现、免疫学和微生物学诊断、治疗和结果的现有文献。方法检索 1950 年 1 月 1 日至 2023 年 1 月 31 日的四个数据库。"结果在 257 项研究中，共纳入了 1,883 名粟粒性肺结核患者。223/549（40.6%）名儿童证实接种过卡介苗（BCG）。据报告，367/924（39.7%）例患者的中枢神经系统（CNS）受累；其中许多人没有神经系统症状，尽管脑成像也异常。在已知结果的 1112 名儿童中，有 341 人（30.6%）死亡；1995 年以前发表的病例死亡率较高（41.5%），中枢神经系统受累的儿童死亡率也较高（31.9%）。结核病微生物学确诊率（55.8%）、结核菌素皮试灵敏度（46.9%）和定量FERON Gold（72.4%）总体较低。腰椎穿刺（LP）和脑成像是否都应作为治疗儿童淤胆型肺结核的常规方法，还是应根据最初的腰椎穿刺结果采取循序渐进的方法，目前仍不清楚。这项研究应让政策制定者和资助机构了解目前存在的重大差距，这些差距需要通过未来的高质量研究来弥补。

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Miliary TB in children and adolescents: a scoping review.

OBJECTIVETo summarise the available literature regarding clinical presentation, immunological and microbiological diagnosis, treatment, and outcomes of miliary TB in children and adolescents.METHODSFour databases were searched from 1 January 1950 to 31 January 2023. "Miliary" and "disseminated" TB were the main search concepts.FINDINGSOf 257 studies, 1,883 patients with miliary TB were included. Bacille Calmette-Guérin (BCG) vaccination was confirmed in 223/549 (40.6%) children. Central nervous system (CNS) involvement was reported in 367/924 (39.7%) cases; many of them had no neurological symptoms despite also having abnormal brain imaging. Of 1,112 children with known outcomes, 341 (30.6%) died; mortality was higher in publications before 1995 (41.5%) and in children with CNS involvement (31.9%). TB microbiological confirmation (55.8%) and sensitivity of tuberculin skin test (46.9%) and QuantiFERON Gold (72.4%) were overall low.CONCLUSIONSEvidence is lacking to support best practices for paediatric miliary TB. Whether lumbar puncture (LP) and brain imaging should both be routinely done in miliary TB children, or a step-by-step approach based on initial LP findings, remains unclear. This study should inform policymakers and funding agencies about current significant gaps that need to be addressed by future high-quality studies..

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来源期刊

International Journal of Tuberculosis and Lung Disease 医学-传染病学

CiteScore

4.90

自引率

20.00%

发文量

266

审稿时长

2 months

期刊介绍： The International Journal of Tuberculosis and Lung Disease publishes articles on all aspects of lung health, including public health-related issues such as training programmes, cost-benefit analysis, legislation, epidemiology, intervention studies and health systems research. The IJTLD is dedicated to the continuing education of physicians and health personnel and the dissemination of information on tuberculosis and lung health world-wide.