| Objective: To investigate the clinical characteristics of miliary pulmonary tuberculosis in children,to reduce misdiagnosis and improve diagnosis and treatment.Methods:We make a retrospective analysis of the 101 patients who were hospitalized in Affiliated Hospital of Chongqing Medical University from January 2012 to December 2017,at the same time,they were diagnosed with miliary pulmonary tuberculosis.The clinical data was analyzed by the statistical software SPSS 22.0.P<0.05 means that there was a statistical significant difference.Results:(1)General situation: The ratio of male to female was 1:1.35,and the ratio of urban and rural areas was 1:5.31;The median age was 2.6 years and the infants accounted for 51.5%(52/101);The median time of pre-hospital course was 15 days;The median time of length of stay was 17 days.(2)Epidemiology: The proportion of BCG vaccinated was 69.3%(70/101);The history of close contact with tuberculosis patients was 44.55%(45/101).(2)Clinical manifestations: The main manifestations were fever(75.2%?76/101)?cough(75.2%?76/101)?malaise(83.2%?84/101)?night sweat(56.4%?57/101)?marasmus(66.3%?67/101)?hot flashes(26.7%?27/101).The positive rate of physical examination: superficial lymphadenopathy(40.6%?41/101)?the moist rales of lung(25.7%?26/101)?hepatomegaly(37.6%?38/101)?spleen enlargement(26.7%?27/101).(4)Laboratory examination: The proportion of occurrence: WBC> 10 *10^9/L(62.4%?63/101),CRP > 8mg/L(58.4%?59/101),ESR > 15mm/1hr(78.8%?67/85).The positive rates of PPD test was 40%(30/75).The positive rates of T-SPOT.TB was 90.9%(40/44).The positive rates of tuberculosis antibody was 12.8%(12/94).The positive rates of phlegm and gastric juice etiology(acid-fast bacillus?tuberculosis culture?TB-PCR)were 34.7%(33/95)?42.2%(35/83)?37.5%(21/56)respectively.The positive rates of cerebrospinal fluid etiology(acid-fast bacillus?tuberculosis culture?TB-PCR)were 8.6%(8/93)?7.7%(7/91)?8.7%(2/23)respectively.(5)Imaging examination: The chest x-ray suggested a typical miliary nodular shadow of 55.6%(20/36);The chest CT suggested a typical miliary nodular shadow of 58.2%(57/98),and suggested 41.8%(41.98%)of both lungs with diffuse or diffuse disease.(6)Diagnosis and treatment: The misdiagnosis rate at the beginning of the disease was 36.6%(37/101);The combination of tuberculous meningitis was 60.4%(61/101);The anti tuberculosis combined with small dose of anti inflammatory was(84.1%,85/101),and drug induced liver damage was 30.7%(31/101).(7)Prognosis: The patients were followed up to 79 cases,of which the mortality rate was 21.8%(18/79);79 cases were divided into two groups according to survival and death,and analyzed univariate that may affect prognosis.Statistics found that age group(?6monuths),diarrhea,convulsion,uninoculated BCG,tuberculous meningitis and liver function damage have effect on prognosis of P<0.05.Logistic regression analysis found that convulsions(OR:9.236,95% confidence intervals:1.692-50.424)and uninoculated BCG(OR: 5.302,95% confidence intervals: 1.334-21.064)were independent risk factors for prognosis.Conclusion: Miliary pulmonary tuberculosis in children is mainly from rural areas,mainly infants.The main clinical manifestations were fever,cough,malaise,night sweats,marasmus,hot flashes,etc.The positive rate of etiological laboratory tests is not high.The imaging examination of military tubercle is a specificity manifestation of military pulmonary tuberculosis.The miliary pulmonary tuberculosis is easy to merge with tuberculous meningitis.Liver function damage is a common adverse reaction in the process of anti tuberculosis treatment.The convulsions and uninoculated BCG were independent risk factors for prognosis. |
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