소아의 경증과 중증결핵에 대한 고찰 = A Clinical Study of Mild and Severe Tuberculosis in Infancy and Childhood

다국어 초록 (Multilingual Abstract)

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다국어 초록 (Multilingual Abstract)

This study was undertaken to evaluate tuberculosis in infancy and childhood, and to see possible factor related to the severity. The medical records were reviewed of 288 patients who had been diagnosed as having TB based on history, physical findings, tuberculin skin test, chest X-ray, and smear and culture examinations in our department from January 1992 through May 1993. They were classified into two categories: severe and mild TB. The results are as follows; 1) Of 288 patients, 58% of all cases fell under 5 years of age; 149 cases (58.9%) of mild TB were found under 5 years of age, whereas 18 (51.4%) of severe cases were detected in the same age group. Male to female ratio was 1.3: l. 2) Of 288 patients, 253 had mild TB, consisting 136 cases (47.2%) of asymptomatic tuberculous infection without diseases, followed by 69 (24.0%) primary pulmonary TB and 48 (16.7%) lymphatic TB, while 35 cases of severe TB comprised 10 cases (3.5%) of bone TB, 9 (3.1%) Of pleurisy, 7 (2.4%) meningitis (including brain tuberculoma), 6 (2.1%) mililary TB, 2 (0.7%) progressive pulmonary TB, and 1 (0.3%) of endobronchial TB. 3) The source of infection was identified in 60.4% of all cases. 4) Positive tuberculin skin reaction was found in 93% of all cases (100% in mild TB, in contrast to only 42.9% in severe TB). 5) 81.6% of all cases had been vaccinated with BCG. However, severe TB cases had undergone BCG vaccination only in 62.9%, significantly lower than mild TB cases with 84.2% (p<o.o01). 6) Of 83 cases with positive family history of TB, 18 cases (21.7%) showed positive conversion of skin test after INH prophylaxis for 3 months. 7) Fatal outcome was found in none and only transient hepatotoxic reaction was observed in 2 cases, Family history of tuberculosis and tuberculin skin test are important in diagnosis of childhood tuberculosis, and BCG vaccination as well as early diagnosis and treatment of primary tuberculosis is essential for prevention of severe tuberculosis.