Prevalence of tuberculosis in childrenWHO report shows that in 2014 there were 1 million children with tuberculosis in the world, about 140
Prevalence of tuberculosis in children
WHO report shows that in 2014 there were 1 million children with tuberculosis in the world, about 140 thousand children died of tuberculosis. Children under three years of age, children with malnutrition or low immune function have a high risk of tuberculosis. Although children with pulmonary tuberculosis infection is still the main, 20%-30% children will appear in other parts of the symptoms. In particular, infants and young children are prone to severe and fatal tuberculosis, such as tuberculous meningitis.
How to diagnose tuberculosis in children?
Characteristics of childhood tuberculosis:
1, the whole childhood is a period of susceptibility to tuberculosis, especially newborns and infants.
2, the source of infection is mainly adult tuberculosis patients, especially in the family is extremely important infection.
3, the transmission of tuberculosis in children often belong to direct communication".
High sensitivity to Mycobacterium tuberculosis
1, abnormal allergic reaction, children's body in Gao Min state.
2, children showed strong positive reaction to the tuberculin test, the emergence of various allergic manifestations.
Extensive involvement of the lymphatic system
With a strong reaction, 1 infant lymph node infection, mild infection can appear inflamed swollen lymph node.
2, often involving multiple groups of lymph nodes, the most common is the mediastinal lymph nodes and cervical lymph nodes.
The detection rate of Mycobacterium tuberculosis in children was low
1, children's sputum quality is not high.
2, children's sputum Mycobacterium tuberculosis low load per unit volume.
Early hematogenous dissemination, extrapulmonary tuberculosis
Comprehensive analysis on diagnosis of tuberculosis in children
First, ask for a detailed history of tuberculosis or close contact. Secondly, the PPD skin test and careful examination. If 10 children under the age of unexplained cough for more than 2 weeks, unexplained weight does not increase or decrease, have a fever of unknown origin (> 38 C) for more than 1 weeks, all of a sudden slump, tuberculosis should be considered. The following 2 months of suspected tuberculosis baby apart from these symptoms occur, there will be unexplained pneumonia, hepatosplenomegaly and other conditions.
Auxiliary examination generally choose imaging examination, bacterial examination (such as smear, culture, nucleic acid amplification test), pathological biopsy. If the above evidence can not help judge, you can take the experimental treatment.
How to treat tuberculosis in children?
Short course chemotherapy is the preferred treatment for WHO. A good chemical treatment program must be able to kill the bacteria metabolism (A), but also to kill slow growing bacteria (B) and intermittent breeding bacteria (C), in order to achieve the purpose of cure and prevent recurrence in a short period of time. The complete chemotherapy process depends on the total number of medications taken rather than the duration of the treatment.
Commonly used drugs and recommended dose
The commonly used anti tuberculosis drugs: isoniazid (H), Li Fuping (R), pyrazinamide (Z/PZA), ethambutol (E) and streptomycin (S).
Recommended dosage of commonly used drugs:
H - 10mg/kg (7-15mg/kg); maximum dosage 300mg/d
R - 15mg/kg (10-20mg/kg); maximum dosage 600mg/d
Z - 35mg/kg (30-40mg/kg)
E - 20mg/kg (15-25mg/kg)
Commonly used chemotherapy regimens: 2HRZE/4HR. For the infection of multi drug resistant strains of tuberculosis in children, can give fluoroquinolone treatment.
Tuberculosis of the lung or peripheral lymph nodes
Living in the high prevalence of HIV and / or isoniazid resistance high area of children, living in low prevalence and low resistance to isoniazid HIV area but with extensive pulmonary lesions in children with 2HRZE/4HR scheme. Living in low prevalence and isoniazid resistant low HIV region's children and I HIV negative, using 2HRZ/4HR program.
Tuberculous meningitis: 2HRZE/10HR.
Tuberculosis of bone and joint: 2HRZE/10HR.
Precautions for chemotherapy
Start treatment time
Infants under 4 years of age have a higher risk of disseminated tuberculosis, once suspected tuberculosis should begin treatment. For larger children or adolescents, if suspected tuberculosis, or patients with severe pulmonary or extrapulmonary lesions suspected to be tuberculosis, usually results in the cultivation of sputum smear, sputum before after treatment with the recommended scheme of time. If the treatment for 2 months, children with no clinical or radiological response, should terminate treatment.
Intermittent therapy (2 times / week or 3 times per week)
Children who live in areas with high HIV prevalence (or confirmed as HIV) should not be treated with intermittent therapy. In the consolidation phase of treatment, to live in the DOT (direct view of the whole process of drug management and supervision) to observe the area, HIV negative tuberculosis children. Intermittent therapy.
Therapeutic outcome evaluation index
1, sputum smear positive sputum bacteria should be monitored.
2, for sputum negative pulmonary tuberculosis and extrapulmonary tuberculosis, should be based on X-ray changes, changes in symptoms, laboratory tests, such as a comprehensive analysis of efficacy evaluation.
How to deal with common side effects?
Drug induced hepatitis is the most serious side effect of treatment. Drug induced hepatitis is defined as: in children with symptoms, serum AST more than 3 times the upper limit of normal value; asymptomatic, serum AST more than 5 times the upper limit of normal.
Methods: 1, immediately stop drug hepatotoxicity, and search for no other causes of liver damage. 2, after the liver function recovery, and then a medicine to restore the original treatment plan.
Note: 1, if there is a dominant jaundice, should avoid the use of PZA. Recommended scheme for 2SHE/10HE. If the children for serious tuberculosis, 2 kinds of drugs with low toxicity in liver during abnormal liver function (S, E) to continue treatment, liver function recovery and re start the anti tuberculosis scheme commonly used.
Mild liver injury
AST (ALT) is less than 2 times the upper limit of normal, no symptoms, liver treatment, close observation. If the review should be discontinued without improvement in liver function. AST (ALT) is less than 2 times the upper limit of normal value, symptoms, liver protection drugs should be stopped. Source: medical infection channel