ChildhhoodTB_section3-儿童结核病的治疗.pdf

Module 3 TREATMENT OF CHILDHOOD TB ? Tuberculosis (TB) in children is common wherever TB is common in adults i.e. TB endemic settings ? TB is an important cause of illness and death in children in many TB endemic countries ? Over half a million (550 000) children become ill with tuberculosis (TB) each year. ? Up to 80 000 HIV-uninfected children die of TB every year*. ? 70–80% of children with TB, have the disease in their lungs (pulmonary TB). The rest are affected by TB disease in other parts of the body (extrapulmonary TB). ? There were over ten million orphans due to parental TB deaths in 2010. ? An understanding of the risks for infection and disease due to TB in children is critical for improved diagnosis and preventive management ? The HIV epidemic has increased the burden of childhood TB and the clinical challenges ? The main benefit of neonatal BCG is protection against severe disseminated TB in children Burden of TB in children Treatment of TB in children ? Principles of treatment of TB in children are same as for adults – with similar regimens ? Most children have paucibacillary disease Treatment response in children ? Children with TB usually respond well with symptomatic improvement during intensive phase and good outcome ? HIV-infected children with TB show poorer response to TB treatment – and require ART and CPT as well as TB treatment Short-course chemotherapy in children n Site % EPTB F/up period Relapse Mortality Biddulph J. PIDJ 1990 639 PNG 35% 24 mths 7 of 373 2 % Reis FJ et al. Am Rev Resp Dis 1990 117 Brazil 0% 21 mths 0 0 % Te Water Naude et al. PIDJ 2000 206 South Africa 0% 18-36 mths 1 0 % Al Dossary et al. PIDJ 2002 175 USA 9% 4 years 1 0 % Impact of HIV on TB treatment outcome Complete recovery HIV+ HIV- p value Mortality HIV+ HIV- p value South Africa Jeena et al 1994 65% 95% 0.002 15% 0% 0.05 Cote d’Ivoire Mukadi et al 1995