1、儿童结核病的挑战与进展Carlos M. Perez-Velez, MDAttending Physician, Division of Infectious Diseases Banner-University Medical CenterConsultant, Tuberculosis Clinic Maricopa County Department of Public HealthAssistant Professor, Clinical Medicine and Child HealthUniversity of Arizona College of MedicinePhoenix,
2、 ArizonaCMPerezVelezGNational survey of drug-resistant tuberculosis in China. Zhao et al. N Engl J Med. 2012 Jun 7;366(23):2161-70.Findings2007 national survey of drug-resistant tuberculosis in China.3037 patients with new cases of TB - 5.7% MDR892 with previously treated cases - 25.6% MDR 8% XDR (E
3、xtensively-Drug Resistant, i.e., resistant to at least INH, Rmp, ofloxacin, or - H/o residing in, or traveling to, a community where TB is endemicTB unlikely- Evaluate for alternative DDxFindings c/w TB disease- Neither clinical* nor radiologicalFindings supportive of TB as etiology- TB exposure- Ne
4、gative immune-based test Step 1* Findings c/w TB disease- Neither clinical* nor radiologicalFindings supportive of TB as etiology-TB exposure- Positive immune-based test Findings c/w TB disease- Either clinical* or radiologicalFindings supportive of TB as etiology- TB exposure- Negative or positive
5、immune-based test- Alternative DDx ruled outFindings c/w TB disease- Both clinical* and radiologicalFindings supportive of TB as etiology- TB exposure- Negative or positive immune-based test- Alternative DDx ruled outStep 2*- Specimen collection not indicated - Collect specimens for NAAT(otherwise microscopy) & culture - Specimen collection not indicated- Collect specimens for NAAT(otherwise microscopy) & culture Immunocompromising risks factors Step 3*TB exposure in immunocompromised host (including children 75%）有肺部 -及 自 免疫严重 制 临床表现复 集本的质量保 - 数及培 的 - 检测
