폐외 결핵의 진단과 치료 = Diagnosis and treatment of extrapulmonary tuberculosis

다국어 초록 (Multilingual Abstract)

Diagnosing extrapulmonary tuberculosis (E-TB) remains a challenge because clinical samples obtained from sites that are not easily accessible are sometimes paucibacillary, decreasing the sensitivity of diagnostic tests. Adenosine deaminase (ADA) is widely used for adjunct diagnosis of E-TB with extrasanguinous fluid. However, ADA is not a specific marker for E-TB, so a more specific test is urgently needed for the confirmation of E-TB. Recently, an IFN-gamma releasing assay using peripheral blood mononuclear cells and extrasanguinous fluid mononuclear cells, and the newly-developed Xpert MTB/RFP have shown promising results for the rapid diagnosis of E-TB. Although the regimen of antituberculous medication for E-TB is similar to that for pulmonary tuberculosis, the treatment of E-TB is occasionally complicated due to a paradoxical response during antituberculous therapy and after the completion of antituberculous therapy, especially in tuberculous lymphadenopathy. The proposed algorithm for the management of paradoxical response in tuberculous lymphadenopathy is presented, and the treatment for E-TB in various sites is briefly reviewed.

참고문헌 (Reference)

1 조오현, "폐외결핵 환자에서의 항결핵제 내성" 대한감염학회 43 (43): 258-261, 2011

2 Riquelme A, "Value of adenosine deaminase (ADA) in ascitic fluid for the diag-nosis of tuberculous peritonitis: a meta-analysis" 40 : 705-710, 2006

3 Mayosi BM, "Tuberculous pericarditis" 112 : 3608-3616, 2005

4 Van Loenhout-Rooyackers JH, "Tuberculous meningitis: is a 6-month treatment regimen sufficient?" 5 : 1028-1035, 2001

5 Asghar RJ, "Tuberculosis in South Asians living in the United States, 1993-2004" 168 : 936-942, 2008

6 Yang H, "Tuberculosis in Calgary, Canada, 1995-2002: site of disease and drug sus-ceptibility" 9 : 288-293, 2005

7 Schlossberg D, "Tuberculosis and nontuberculous mycobac-terial infections" ASM Press 2011

8 Kim SH, "Rapid Diagnosis of Tuberculous Meningitis by T Cell-Based Assays on Peripheral Blood and Cerebrospinal Fluid Mononuclear Cells" UNIV CHICAGO PRESS 50 (50): 1349-1358, 2010

9 Cho OH, "Paradoxical responses in non-HIV-infected patients with peripheral lymph node tuberculosis" W B SAUNDERS CO LTD 59 (59): 56-61, 2009

10 Haas DW, "Is adjunctive corticosteroid therapy indicated dur-ing tuberculous peritonitis?" 27 : 57-58, 1998

11 Fan L, "Interferon-gamma release assays for the diagnosis of extrapulmonary tuberculo-sis: a systematic review and meta-analysis" 65 : 456-466, 2012

12 Park KH, "Incidence and outcomes of paradoxical lymph node en-largement after antituberculosis therapy in non-HIV patients" 67 : 408-415, 2013

13 Peto HM, "Epidemiology of extrapulmonary tuberculosis in the United States, 1993-2006" 49 : 1350-1357, 2009

14 Cho OH, "Diagnostic performance of T-SPOT.TB for extrapulmonary tuberculosis according to the site of infection" 63 : 362-369, 2011

15 Lee YM, "Diagnostic Usefulness of a T-Cell-Based Assay in Patients With Miliary Tuberculosis Compared With Those With Lymph Node Tuberculosis" OXFORD UNIV PRESS INC 56 (56): 26-29, 2013

16 Kim SH, "Diag-nostic usefulness of a T-cell based assay for extra-pulmonary tuberculosis" 167 : 2255-2259, 2007

17 Thwaites GE, "Dexamethasone for the treatment of tubercu-lous meningitis in adolescents and adults" 351 : 1741-1751, 2004

18 Engel ME, "Corticosteroids for tu-berculous pleurisy" (4) : CD001876-, 2007

19 Tortoli E, "Clinical validation of Xpert MTB/RIF for the diagnosis of extrapulmonary tuberculosis" 40 : 442-447, 2012

20 Rock RB, "Cen-tral nervous system tuberculosis: pathogenesis and clinical aspects" 21 : 243-261, 2008

21 Tuon FF, "Adenosine deaminase and tuberculous pericarditis: a systematic review with meta-analysis" 99 : 67-74, 2006

22 Greco S, "Adenosine deaminase and interferon gamma measurements for the diagnosis of tuberculous pleurisy: a meta-analysis" 7 : 777-786, 2003

23 Liao YJ, "Adenosine deaminase activity in tuberculous peritonitis among patients with underlying liver cirrhosis" 18 : 5260-5265, 2012

24 Korea Centers for Disease Control and Prevention, "2012 An-nual report on the notified tuberculosis patients in Korea" Bokjiro