著者

池田 一成 杉森 光子 川崎 一輝 黒川 博 錐本 忠市

出版者

JAPANESE SOCIETY FOR TUBERCULOSIS

雑誌

結核 (ISSN:00229776)

巻号頁・発行日

vol.67, no.10, pp.653-658, 1992

被引用文献数

1

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Twelve children who developed active tuberculosis even after receiving isoniazid (INH) chemoprophylaxis were seen at Tokyo Metropolitan Children's Hospital from 1982 through 1991. All cases received INH more than 9mg/kg/day, except for one case in which the amount of INH administered at the referring hospital was unknown and Streptomycin was administered together with INH. The age of starting INH prophylaxis ranged from 2 months to 13 years, and the age at which clinical symptoms and/or laboratory evidences of active tuberculosis were first manifested ranged from 4 months to 18 years. Five patients developed active tuberculosis after the completion of chemoprophylaxis and patients during chemoprophylaxis, with the first presentation ranging from primary complex (seven), chronic pulmonary tuberculosis (two), tuberculous meningitis (two), and tuberculous pleuritis (one). None of the Mycobacterium tuberculosis resistant to INH was isolated.<BR>Reviewing these patients, eleven cases had at least one of the following factors: (1) age less than two years old (2) infectious sources expectorated more Mycobacterium tuberculosis (3) delay in starting INH. Above factors should be considered in initiating INH chemopro phylaxis and subsequent follow-up of the patients.

著者

池田 一成 杉森 光子 川崎 一輝 黒川 博 雉本 忠市

出版者

JAPANESE SOCIETY FOR TUBERCULOSIS

雑誌

結核 (ISSN:00229776)

巻号頁・発行日

vol.67, no.9, pp.607-612, 1992

被引用文献数

1

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We evaluated the clinical and laboratory findings of tuberculous meningitis admitted to Tokyo Metropolitan Children's Hospital from 1980 through 1991 retrospectively. They consisted of 26 patients (14 boys and 12 girls), and their age ranged from 4 months to 11 years. Seventeen patients were under 3 years of age. Mortality rate was 4% (1/26), and there were 13 patients with sequelae on discharge from the hospital, and 12 patients without any sequelae. The period to recover normal CSF findings was relatively long. Some cases which did not seem to respond well to chemotherapy at the initial stage, recovered from meningitis without sequelae. This suggests that it is not necessary to change the chemo therapy at the initial few weeks of therapy. The risk factors of poor prognosis were age less than 2 years, decreased level of consciousness on admission, convulsion, CSF protein more than 70 mg/dl, and CSF glucose less than 20 mg/dl. Tryptophan reaction was not always positive. Chloride in CSF was not so important to diagnose tuberculous meningitis in children. For the proper diagnosis of tuberculous meningitis in children one should consider several factors such as tuberculin skin test, family history, chest X-ray findings and CSF study.<BR>BCG was inoculated in six children (three patients were under one year old and the rests were older than 4 years). In three patients under one year old BCG was seemed to be inoculated after Mycobacterium tuberculosis infection, and apparently not effective to prevent tuberculosis meningitis. We conclude that BCG vaccination is necessary in early infancy to prevent tuberculous meningitis.