Teškoće u dijagnostici tuberkuloze bez bakteriološke potvrde kod 15-godišnjeg bolesnika dobijene kontaktom sa obolelim od tuberkuloze
Sažetak
Uvod. Nakon kontakta prethodno zdrave dece sa obolelim od tuberkuloze (TB) mogućnost razvoja bolesti iznosi 1%–16%. Dijagnozu TB kod dece nije lako potvrditi tako da 15%–25% slučajeva ostaje nedijagnostikovano. Prikaz slučaja. Dečak star 15 godina hospitalizovan je zbog produktivnog kašlja, bola u desnom slabinskom predelu, povišene temperature, malaksalosti, gubitka apetita i noćnog znojenja. Jedan dečakov ujak izlečen je od tuberkuloze, drugi ujak ima aktivnu tuberkulozu, obojica su bila u kontaktu sa dečakom, ali ne žive u istom domaćinstvu. Pri fizikalnom pregledu bolesnik je bio febrilan, dispnoičan, bled, sa profuznim znojenjem, adinamičan. BCG (Bacillus Calmette – Guérin) ožiljak je prisutan. Radiografija grudnog koša ukazivala je na masivnu desnostranu pleuropneumoniju. Parametri inflamacije su bili povišeni, a u uzorcima sputuma i gastričnog lavata nije nađen Mycobacterium tuberculosis (MTB). Pleuralnom punkcijom, utvrđeno je da je punktat eksudativne prirode. Citološki pregled bio je nespecifičan, nisu nađeni MTB i sve zasejane podloge na kulturi Lowenstein-Jensen ostale su sterilne. Tuberkulinski kožni test Mantoux bio je pozitivan (+10 mm). Interferon Gamma Release Assay (QuantiFERON-TB GOLD in-Tube) bio je negativan. Dečak je bez uspeha lečen antibioticima širokog spektra dejstva. Video–asistiranom torakoskopijom, isečak tkiva pleure potvrdio je da se radi o benignom, hroničnom granulomatoznom procesu, dok histohemijskim bojenjem nisu viđeni MTB. Započeto lečenje antituberkuloticima dovelo je do kliničkog oporavka i radiografske regresije. Dečak je sada dobrog opšteg stanja, bez sekvela bolesti. Zaključak. Ovaj prikaz slučaja ukazao je na značaj faktora rizika, kao i otežano dijagnostikovanje TB kod dece. Auskultacijom pluća ustanovljeno je nečujno disanje od skapule desno ka bazi pluća.
Reference
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