pediatric tuberculosis
Introduction
Introduction to Pediatric Tuberculosis Tuberculosis is a chronic infectious disease caused by Mycobacterium tuberculosis. It can be involved in all organs of the body, but tuberculosis is the most common. Pediatric tuberculosis refers to tuberculosis in children between the ages of 14 and 14 years. In early childhood, tuberculosis is easy to form hematogenous dissemination and tuberculous meningitis. Early detection and early treatment of primary pulmonary tuberculosis in children is important for further reducing tuberculosis mortality. Primary infection of tuberculosis in children is the main source of tuberculosis in adulthood. Therefore, in order to control and eliminate tuberculosis, we must attach great importance to the prevention and treatment of tuberculosis in children. basic knowledge Sickness ratio: 0.0001% Susceptible people: children, people with low immunity are susceptible Mode of infection: respiratory transmission Complications: hemoptysis spontaneous pneumothorax chronic pulmonary heart disease
Cause
Causes of childhood tuberculosis
Drug stimulating factors (15%):
Corticosteroids and immunosuppressive agents often cause occult tuberculosis, such as long-term use of hormones in asthma, long-term use of hormones and immunosuppressive agents in organ transplantation, and surgery and chemotherapy in malignant tumors. These conditions have increased in recent years.
Tuberculosis infection (26%):
For most people, after inhalation of tuberculosis, tuberculosis becomes active if the immune system does not stop the growth of tuberculosis. When tuberculosis becomes active (breeding in your body), this is called tuberculosis. People with tuberculosis are called tuberculosis patients.
Reduced body resistance (25%):
When the body's resistance is reduced, the tuberculosis bacteria that invade the human body through the respiratory tract or the digestive tract often form a primary lesion in the lung or intestinal wall, and 90 to 95% occur in the lungs.
Genetic factors (10%):
Studies have shown that the identical proportion of identical twins with tuberculosis is much higher than that of fraternal twins, which proves that genetic factors have a positive impact on tuberculosis patients.
Prevention
Pediatric tuberculosis prevention
1. Strengthen primary care
It is necessary to rely on the strength of urban and rural primary health care networks to give full play to the role of doctors at all levels, including rural doctors. Clinically, the incidence of tuberculosis is closely related to the health status and living environment of children. Attention should be paid to reasonable nutritious hygienic habits and prevention of measles pertussis.
2. Early detection and prevention of cases
Early detection is a prerequisite for early treatment of children. Regular physical examination to detect early exposure to active tuberculosis patients, the incidence and prevalence of infection rate are significantly higher than the average child. According to Beijing Children's Hospital, the prevalence of children exposed to children from 1962 to 1965 was 6.5%, while the prevalence of group children was 0.15%. According to the average follow-up observation of active pulmonary tuberculosis patients, the cumulative prevalence rate was 6%. Therefore, it is an important way for early detection of tuberculosis by examining the presence or absence of tuberculosis infection or illness in children. Secondly, in children with strong OT reaction, special attention should be paid to early detection. Although tuberculosis is a chronic and extremely stubborn infectious disease, it can be cured if it can be followed up early.
3. Carry out missions and attach importance to isolation
Carry out extensive health education and work, so that the masses have a correct understanding of tuberculosis and do a good job of disinfection and isolation of TB patients' families. Protect children from infection. Collective institutions, such as nursery nurseries and primary school nurses and teachers, should regularly check for tuberculosis. Once active patients are found, they should leave their jobs and be actively treated. Hiring a babysitter or hiring a tutor in a family should first perform a chest ray to ensure that there is no tuberculosis. In addition, pay attention to other preventive measures, such as dairy dairy management, pre-marital check, pregnancy check, promotion, spitting and so on.
4. BCG vaccination
In 1908, Callmette and Guérin were applied to 5% glycerol bile potato medium on 5% glycerol bile potato medium. After 13 years of repeated culture for more than 230 generations, the bacteria lost pathogenicity and then made bacteria. Miao (BCG BCG), inoculated into the human body to enable the recipient to develop immunity against tuberculosis.
5. Chemoprevention
That is, taking isoniazid to prevent tuberculosis can be considered in the following situations: 1 infants and young children exposed to open tuberculosis; 2 naturally infected children whose neon response changes from negative to positive; 3 infants and school age with strong positive reaction Pre-children; 4 children with positive TB symptoms and early tuberculosis symptoms but normal X-ray examination; 5 positive for sputum and concurrent treatment with adrenal cortex hormone for other diseases; 6 children with positive reaction After taking measles and whooping cough, the preventive dose is 10mg/(kg·d) for 6 months to 1 year.
Chemoprevention can achieve three effects: 1 prevention of active tuberculosis in children; 2 prevention of re-ignition of tuberculosis in adolescence; 3 prevention of extrapulmonary tuberculosis.
Complication
Pediatric tuberculosis complications Complications hemoptysis spontaneous pneumothorax chronic pulmonary heart disease
1, hemoptysis
Hemoptysis is the most common complication of tuberculosis, the incidence rate is 20% to 90%, and the amount of hemoptysis can vary. Large hemoptysis is often accompanied by aspiration pneumonia, atelectasis, tuberculosis bronchial dissemination, hemorrhagic shock, and even suffocation. Severe comorbidities, tuberculosis hemoptysis due to exudative or cavitary lesions, or bronchial tuberculosis and local tuberculosis caused by bronchial deformation, distortion and expansion.
[Treatment] In most cases, hemoptysis often indicates that tuberculosis has activity and progress. Therefore, tuberculosis patients with hemoptysis should go to the hospital in time for regular anti-tuberculosis treatment. For a large number of hemoptysis patients, they should actively stop bleeding treatment at the same time. The airway is smooth, preventing suffocation and hemorrhagic shock.
2, spontaneous pneumothorax
The incidence of spontaneous pneumothorax in tuberculosis patients is about 1.4%. Patients often have sudden chest pain, cough, dyspnea and purpura. Pneumothorax is more common in the following cases: subpleural lesions or cavities break into the chest; tuberculosis fibrosis or scarring Cause emphysema or pulmonary bullous rupture; miliary tuberculosis causes interstitial emphysema pulmonary bullous rupture.
[Treatment] For patients with simple pneumothorax, and clinical symptoms without obvious symptoms, bed rest, high-flow oxygen therapy and other conservative treatments may be used. For patients with tension, traffic pneumothorax and simple pneumothorax for more than 2 weeks, thoracic closure is often required. Drainage, if continuous closed drainage for more than 1 week is still not healed or combined with pleural effusion, empyema, should use intermittent vacuum suction or continuous constant vacuum suction.
3. Chronic pulmonary heart disease
Patients with severe pulmonary tuberculosis due to extensive destruction of lung tissue, leading to pulmonary ventilation and ventilation dysfunction, advanced pulmonary hypertension and pulmonary heart disease, patients often have cyanosis, palpitations, shortness of breath, lower extremity edema.
[Treatment] Because of the difficulty in the treatment of chronic pulmonary heart disease, it is necessary to actively control tuberculosis lesions, prevent further deterioration of the disease, delay heart involvement, and patients with pulmonary tuberculosis who have complicated pulmonary heart disease must be hospitalized in time.
4, secondary lung infection
Tuberculosis cavity (especially fibrous cavity), pleural thickening, tuberculous fibrosis caused by bronchiectasis, atelectasis and bronchial tuberculosis caused by airway obstruction, is the pathological basis of tuberculosis secondary to other bacterial infections, infection pathogens are more common with G-bacteria, And because long-term use of antibiotics can be secondary to fungal infections, it often manifests as a mixed infection.
[Treatment] Secondary infection should be treated with corresponding antibiotics or antifungal drugs for different pathogens.
Symptom
Pediatric tuberculosis symptoms common symptoms dyspnea leukocytosis hemoptysis nasal tuberculosis low fever herpes bloodshot tuberculosis poisoning immunodeficiency lymph node tuberculosis
Early symptoms are mild, no specificity, and respiratory symptoms are not obvious. The main symptoms of hypothermia and tuberculosis are fever, night sweats, fatigue, loss of appetite, weight loss and so on. And more phlegm, cough, hemoptysis or difficulty breathing, etc., often occur when the condition is serious.
Fever: Children will have irregular high fever in the early stage of the disease. After 1-2 weeks, it gradually turned into low heat. Mostly, it is low in the afternoon, the body temperature is more than 38 degrees, and there is more than 1 degree of body temperature fluctuation every day.
Night sweats: more often with fever. It is sweating before waking up in the middle of the night or in the morning. More sweat on the chest, head or underarms.
Children will experience burnout, lack of energy, crying, abnormal temperament, unexplained loss of appetite and weight loss and other systemic symptoms.
Herpes may be recurrent with herpetic conjunctivitis. In the presence of systemic symptoms, symptoms of lesions such as headache, cough, abdominal pain, and diarrhea may occur.
The above symptoms are not specific to tuberculosis, and the diagnosis should be noted.
If the above symptoms occur, and other causes are not found, and there are close contact with active tuberculosis patients, especially those who have not been vaccinated with BCG, they should consider whether they have tuberculosis or not.
Examine
Pediatric tuberculosis examination
X-ray examination, tuberculin test (nodal test), sputum gastric smear staining or tuberculosis culture or animal inoculation, blood test, peripheral lymph node puncture smear examination.
The tuberculin test (also known as the Muntu test, PPD test) is a tool for diagnosing tuberculosis. It is one of the two major tuberculin skin tests in the world and has largely replaced a variety of puncture tests, such as the Tine test.
Diagnosis
Diagnosis and diagnosis of tuberculosis in children
diagnosis
Diagnosis can be based on medical history, clinical symptoms, and laboratory tests.
Differential diagnosis
Pediatric pneumonia and pediatric tuberculosis, both of which are lung diseases, and pediatric pneumonia is the most common disease in pediatric clinical pulmonary diseases. When children have fever, cough, and chest fluoroscopy, they should consider pneumonia or tuberculosis carefully. Failure to carefully analyze it can cause misdiagnosis and delay treatment, causing great losses to the patient. How to identify the two is described as follows:
(1) Bronchial pneumonia should be differentiated from hilar lymph node tuberculosis when X-ray shows hepatic gate weight gain.
1 first identify from the symptoms: bronchial pneumonia most of the onset of acute, high fever, cough, sputum, asthma, hilar lymphatic tuberculosis is generally asymptomatic, cough symptoms occur when the lymph nodes enlarge to a certain degree of compression of the bronchus,
2 The important signs of bronchial pneumonia are dry and wet rales in both lungs, while hilar lymphatic tuberculosis lacks lung signs.
3 characteristics of blood picture: bacterial pneumonia, high total number of white blood cells, increased neutrophils; viral pneumonia, the total number of white blood cells is not high, neutral cells are not high, lymphocytes increase, and when infected with tuberculosis, mononuclear cells increase, relative lymphocytes decrease ,
4 Both chests have lung texture weight gain. In bronchial pneumonia, inflammation spreads from the bronchus. Therefore, the lung texture gains weight and there is a spotted shadow in the lung field, which spreads from the hilar to the hilar lymph node tuberculosis. At the time, the enlarged lymph nodes near the hilar and the inflammation around the lymph nodes form a deepening of the hilar shadow, but there is no lesion in the lung field, so timely chest resection can help identify.
(2) Invasive pulmonary tuberculosis and mycoplasma pneumonia, mycoplasma pneumonia caused by mycoplasma, the symptoms are different, most asymptomatic, when mycoplasma pneumonia has only low fever, dry cough and flaky shadow in the lungs, easy to be confused with invasive pulmonary tuberculosis Therefore, it should be identified.
1X-ray examination: The lung infiltration of mycoplasmal pneumonia is extended from the hilum to the lung field, sometimes it is very light and sometimes diffuse, especially in the middle and lower lobe of the lungs. A few are large-leaf shadows, often one has dissipated and it There is a new infiltration, and invasive pulmonary tuberculosis occurs mostly at the tip of the lungs or at the top of the frosted glass.
The signs of 2 mycoplasma pneumonia are mild and the X-ray often has significant lesions, which is one of its characteristics.
The pathogenesis of 3 mycoplasma pneumonia is about 2 to 3 weeks, but it can be cured without treatment, but there are often recurrences. The tuberculous infiltration lesions are absorbed slowly, and it is necessary to treat them with anti-tuberculosis drugs in time.
4 Condensation set test, positive after 2 weeks of onset of mycoplasmal pneumonia (1:32 or more), tuberculosis is negative, if necessary, tuberculin test is needed for identification.
Pediatric pneumonia and tuberculosis, although they are all lung diseases, but the onset of pneumonia is acute and the course of disease is short; most of the tuberculosis is slow onset, and the course of disease is long. Misdiagnosis is often easy to occur in the early stage. In addition to carefully observing and mastering the history, symptoms and signs, Prompt chest and blood examination in time to help the differential diagnosis of the two.
