Pediatric herpetic keratoconjunctivitis

Introduction to herpes simplex keratoconjunctivitis The most common clinical eye disease associated with tuberculosis infection is herpetickeratoconjunctivitis, which is an allergic reaction to Mycobacterium tuberculosis or its products. More common in children with primary tuberculosis, especially seen in the age of 5, sometimes as the first symptom of the primary infection, often found the presence of active tuberculosis in other areas. This disease is more common in children with tuberculosis who are highly allergic. basic knowledge Sickness ratio: 0.5% Susceptible people: children Mode of infection: non-infectious Complications: cervical lymph node tuberculosis

Causes of herpetic keratoconjunctivitis in children

(1) Causes of the disease

Herpetic keratoconjunctivitis is an allergic reaction to Mycobacterium tuberculosis or its products. It is more common in children with primary tuberculosis caused by Mycobacterium tuberculosis invading the body for the first time. There are 4 types of Mycobacterium tuberculosis: human, bovine, bird and mouse. The pathogenicity of the human body is human tuberculosis and tuberculosis, and most of the children's tuberculosis in China is caused by human tuberculosis. The tuberculosis has strong resistance, except for acid, alkali and alcohol resistance. It has strong tolerance to cold, heat, dryness, light and chemical substances. The moist heat has strong bactericidal power against tuberculosis. It can be killed at 65 ° C for 30 min, 70 ° C for 10 min, and 80 ° C for 5 min. Hot sterilizing power is poor, dry heat 100 ° C takes more than 20 minutes to kill, so dry heat sterilization, temperature needs high, time needs to be long, tuberculosis in the sputum is killed within 2 hours under direct sunlight, and ultraviolet light only needs 10min, on the contrary, it can survive for several months in the dark. If the tuberculosis in the sputum is disinfected with 5% carbolic acid (phenol) or 20% bleaching solution, it takes 24 hours to take effect.

(two) pathogenesis

Herpes lesions are nodules composed of lymphocytes, epithelioid cells and macrophages. There are no tubercle bacilli, and some changes have been found in cheese.

Pediatric herpes keratoconjunctivitis prevention

1. Control the source of infection and reduce the chance of infection. The positive smear of tuberculosis is the main source of tuberculosis in children. Early detection and rational treatment of smear-positive tuberculosis patients is a fundamental measure to prevent tuberculosis in children. Members should conduct detailed examinations (photographing chest, PPD, etc.). Regular physical examinations should be conducted for primary and child care institutions to detect and isolate infection sources in a timely manner, which can effectively reduce the chance of tuberculosis infection in children.

2. Popularization of BCG vaccination has proved that vaccination with BCG is an effective measure to prevent tuberculosis in children. BCG was invented by French physicians Calmette and Guerin in 1921, so it is also called BCG. In China, it is prescribed to inoculate BCG in the neonatal period. The upper left deltoid muscle was injected intradermally at a dose of 0.05 mg/time. The scratch method is now rarely used. The Ministry of Health notified in 1997 to cancel the 7-year-old and 12-year-old BCG re-integration plan, but if necessary, the age-related Children who are negative in the test may still be given multiple cropping. In the neonatal period, BCG can be injected on the same day as the hepatitis B vaccine.

Contraindications to vaccination with BCG: positive lignin response; patients with eczema or skin disease; recovery period of acute infectious disease (1 month); congenital thymic dysplasia or severe combined immunodeficiency disease.

3. Prophylactic chemotherapy is mainly used for the following subjects:

(1) Infants under the age of 3 have not been vaccinated with BCG and have a positive test.

(2) Close contact with patients with open tuberculosis (multiple family members).

(3) The sputum test has recently changed from negative to positive.

(4) The sputum test is a strong positive responder.

(5) Children with positive serotonin test need to use adrenocortical hormone or other immunosuppressive agents for a longer period of time.

The drug used for chemopreventive drugs is mainly isoniazid, the dose is 10mg/(kg·d), the course of treatment is 6-9 months, the newborns of the newly born tuberculosis parents under the age of 6 and the newborns born to the tuberculosis women, regardless of the knot If the results of the test are all the same, the isoniazid should be given. The dose is the same as above. After 3 months of administration, the test is performed. If it is positive, the isoniazid is continued for 9 months; if the test is negative (<5mm) ), isoniazid is discontinued, and anti-HIV-positive children with a history of tuberculosis should be treated with isoniazid for 12 months regardless of the outcome of the test.

If the tuberculosis patient contacted by children is resistant to isoniazid, the chemotherapeutic drug should be changed to rifampicin, 15mg/(kg·d), 6-9 months; if it is resistant to isoniazid and resistant to rifampicin, It is recommended to give pyrazinamide plus ofloxacin for 6 to 9 months, or pyrazinamide plus ethambutol for 6 to 9 months.

Complications of herpetic keratoconjunctivitis in children Complications, cervical lymph node tuberculosis

It can form corneal scars, with severe facial appearance, skin eczema-like changes and cervical lymph node tuberculosis, and posterior corneal scars affect vision.

Pediatric herpes keratoconjunctivitis symptoms common symptoms tears purulent secretions photophobic lymph node tuberculosis nodules conjunctival congestion herpes

Herpes is a small grayish white or grayish yellow nodule with a diameter of 1 to 3 mm. The typical location is at the limbus. The conjunctiva around it is fan-shaped, and herpes can also occur on the cornea adjacent to the cornea and sclera. Sometimes several Herpes can appear simultaneously or sequentially in different parts of the eyes or one eye, can disappear without leaving traces, or the surface layer falls off, and the ulcers heal after healing, but the herpes occurs on the cornea, and after the ulcer is formed, each scar remains, when the conjunctiva is simple When invaded, there are generally no symptoms. When the cornea is invaded, there may be mild tearing, photophobia and phlegm. In severe cases, there is a sputum facial. At this time, the nasal mucosa is swollen and septic, and there is purulent secretion. Things, swelling of the lips, skin eczema-like changes and cervical lymph node tuberculosis, when the herpes spread to the corneal center, can leave scars of the cornea, and even affect vision, this type is currently rare, herpes simplex has a high recurrence trend Time is good and bad, increasing the chance of damaging your vision.

Examination of herpetic keratoconjunctivitis in children

1. Mycobacterium tuberculosis antibody detection In the past, the detection antibody (PPD-IgG, PPD-IgM) was detected by natural antigen PPD, and the sensitivity and specificity were poor. For the past ten years, due to the preparation of purified or semi-purified antigen of Mycobacterium tuberculosis, Significant progress has been made in the detection of specific antibodies against Mycobacterium tuberculosis. The commonly used antigens are semi-purified Mycobacterium tuberculosis antigen 5, antigen 6, AOO antigen; semi-purified glycolipid antigens such as glycolipids SAGA1, B1 and C, phenol glycolipids ( PGL-Tb1), lipoarabinomannan (LAM) antigen, sulfolipid (SL-I, SL-IV), TB-C-1 antigen, lipopolysaccharide (LPS), etc.; purified antigen has tuberculosis protein antigen ( 38kDa, 30/31kDa, 71kDa, 45kDa, 14kDa, 19kD3a Mycobacterium tuberculosis antigen), recombinant 38kDa tuberculosis protein.

(1) Enzyme-linked immunosorbent assay (ELISA): used to detect anti-tuberculosis antibodies in serum, cerebrospinal fluid and serosal fluid of tuberculosis patients, which can be used as an auxiliary diagnostic index. The sensitivity of ELISA for semi-purified antigen is 65%~ 85%, sensitivity to sputum smear-negative tuberculosis is 53% to 62%, sensitivity to extrapulmonary tuberculosis is 34% to 40%, specificity is 95%, ELISA detection antibody using 38kDa purified antigen, sensitivity is 73 %, sensitivity to tuberculosis-negative tuberculosis was 70%, specificity was 98%. ELISA was used to detect specific antibodies in cerebrospinal fluid of patients with tuberculous meningitis with sensitivity of 70% and specificity of 100%.

(2) Enzyme-linked immunosorbent electrophoresis (ELIEP): an immunological technique that combines ELISA with electrophoresis and is a serological method for the diagnosis of various tuberculosis.

2. ESR can accelerate during the active period of tuberculosis, and the erythrocyte sedimentation rate gradually decreases after anti-tuberculosis treatment. It also indicates that there is active disease, and the erythrocyte sedimentation test has no specificity. The normal erythrocyte sedimentation rate cannot exclude active tuberculosis.

Chest X-ray examination should be performed routinely, and the primary lung lesions can often be found.

Diagnosis and diagnosis of herpetic keratoconjunctivitis in children

Clinical manifestations plus a history of tuberculosis exposure, increased erythrocyte sedimentation rate, positive tuberculin test can help diagnose.

Different from conjunctivitis caused by other causes, this disease has typical conjunctival herpes and other primary active tuberculosis infection lesions are easy to identify.

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