Pediatric Infection and Vaccine

The Korean Society of Pediatric Infectious Diseases (대한소아감염학회)
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Clinical Review of Pulmonary Tuberculosis in Teenagers According to the Involved Lung

소아청소년기 폐결핵의 방사선상 침범위치에 따른 배양 양성률과 임상양상에 대한 연구

  • Im, Bong Chil (Department of Pediatrics, Kwang-ju Christian Hospital) ;
  • Kim, Young (Department of Pediatrics, Kwang-ju Christian Hospital) ;
  • Kim, Kyoung Sim (Department of Pediatrics, Kwang-ju Christian Hospital) ;
  • Kim, Yong Wook (Department of Pediatrics, Kwang-ju Christian Hospital) ;
  • Kim, Eun Young (Department of Pediatrics, Kwang-ju Christian Hospital) ;
  • You, Eun Jung (Department of Pediatrics, Kwang-ju Christian Hospital) ;
  • You, Ju Hee (Department of Pediatrics, Kwang-ju Christian Hospital) ;
  • Cho, Hyoung Min (Department of Pediatrics, Kwang-ju Christian Hospital)
  • 임봉칠 (광주기독병원 소아청소년과) ;
  • 김령 (광주기독병원 소아청소년과) ;
  • 김경심 (광주기독병원 소아청소년과) ;
  • 김용욱 (광주기독병원 소아청소년과) ;
  • 김은영 (광주기독병원 소아청소년과) ;
  • 유은정 (광주기독병원 소아청소년과) ;
  • 유주희 (광주기독병원 소아청소년과) ;
  • 조형민 (광주기독병원 소아청소년과)
  • Received : 2010.08.28
  • Accepted : 2010.10.18
  • Published : 2010.12.25
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Abstract

Purpose : The purpose of this study was to investigate clinical features and culture-positive rates according to the involved lung in adolescent pulmonary tuberculosis (TB). Methods : We retrospectively reviewed the medical records of adolescents who ranged in age from 10 to 20 years and who had been hospitalized with a diagnosis of TB at Kwangju Christian Hospital from 2000 to 2008. Results : Sixty-six patients were identified with pulmonary TB: median age 16.82 years; 48.5% males. Among them, 90.9% of patients were between 15 and 20 years of age. Most patients presented with multiple symptoms, and the most common included cough (74.2%), sputum (60.6%), fever (39.5%), and night sweating (18.2%). Sputum samples were smear-positive in 28 (42.4%), culture-positive in 40 (60.6%), and PCR-positive in 46 (69.7%). The most common radiological patterns included cavitation in 18 (27.3%), pleural effusion in 18 (27.3%), lymphadenopathy in 10 (15.2%), and tuberculoma in 5 (7.6%). The prevalence of smear, culture, and PCR positive rates increased as the number of involved lobes increased (P<0.05, P<0.01, P<0.05). The median treatment duration was 7 months. Twelve patients (18.2%) had lower lung field TB (Group A) and forty-four patients (66.7%) had other areas involving TB, except for Group A (Group B), and ten patients (15.1%) had only TB pleurisy (Group C). The difference of clinical characteristics and culture rates between group A and group B was not significant. Conclusion : Pulmonary TB toward late adolescence is increasing. We need to pay more attention to lower lung field TB, which is difficult to detect with specific radiographic findings.

목적 : 청소년기 폐결핵의 침범위치에 따른 임상양상 및 배양률의 차이에 대해 알아보고자 하였다. 방법 : 2000년부터 2008년까지 광주기독병원에서 폐결핵으로 외래 및 입원치료 했던 10-20세 환자를 대상으로 의무기록지와 흉부방사선 소견을 통한 후향적 조사를 시행하였다. 결과 : 총 66명 중 90.9%가 15-20세였고, 평균나이는 16.82세(범위 10-20세)였다. 기침(74.2%), 객담(60.6%), 발열(39.5%) 순으로 많았다. 도말검사 42.4%, 배양검사 60.6%, PCR검사 69.7%의 양성률을 보였다. 공동형성이 18명, 가슴막삼출이 18명에서 보였다. 객담도말검사에서 침범엽수가 많을수록 양성률은 통계적으로 의미있게 높았다(P<.05). 치료기간은 평균 7개월이었다. 하폐야 결핵 12명(A군), A군을 제외한 폐병변이 있는 44명(B군), 결핵 가슴막염만 있는 10명(C군)으로 구분하였으며, 각 군간의 임상양상 및 배양 양성률의 차이는 통계적인 유의성은 없었다. 결론 : 청소년기 후반으로 갈수록 폐결핵이 증가하고, 폐결핵의 특징적인 방사선 소견으로 진단하기 어려운 하폐야 결핵에 대한 관심이 필요하겠다.

Keywords

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