结核病治疗后的悖论性反应
Sabine M Hermans1,2, Onno W Akkerman3,4, Graeme Meintjes5,6,7
1Centre for Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Amsterdam Public Health-Global Health, Amsterdam Infection and Immunity, Amsterdam UMC, Location University of Amsterdam, Amsterdam, The Netherlands. s.m.hermans@amsterdamumc.nl.
Infection
|July 2, 2024
概括
结核病 (TB) 治疗后可能出现悖论性反应 (PR),特别是在淋巴结TB. 区分治疗后的PR与复发是适当管理的关键,通常涉及抗炎治疗.
科学领域:
- 免疫学 免疫学 免疫学
- 传染性疾病 传染性疾病
- 临床医学 临床医学
背景情况:
- 对结核病 (TB) 治疗的悖论反应 (PR) 在治疗期间很常见,但在治疗结束后也可能出现.
- 区分治疗后的PR与微生物复发对于患者管理至关重要.
- 关于治疗后PR的文献有限,需要进一步的合成和理解.
研究的目的:
- 综合现有的有关结核病治疗后发生的矛盾反应的流行病学,诊断和管理的文献.
- 提供关于区分治疗后的PR与结核病复发的见解.
- 报告治疗后PR的发生率和特征.
主要方法:
- 对已发表的关于治疗后矛盾反应的研究进行系统的文献搜索.
- 综合了30项研究的数据,包括案例简报.
- 专注于流行病学,诊断和管理策略.
主要成果:
- 大多数报告的治疗后PR病例涉及淋巴结结结核结核 (LN-TB) 和中枢神经系统结核 (CNS-TB).
- 在LN-TB中,治疗后PR的发生率在3-14%之间,超过了该组的复发率.
- 治疗后的PR通常发生在治疗完成后的6个月内,但可能会在几年后出现.
结论:
- 消极的真菌菌培养对于诊断治疗后的PR至关重要.
- 抗炎治疗是管理治疗后PR的主要支柱.
- 建议在LN-TB中对疑似治疗后的PR进行观察,而中枢神经系统结核病例需要迅速调查和治疗.
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