The first symptom of tuberculosis in children. Tuberculosis in children: symptoms and treatment

The epidemiological situation of tuberculosis in our country causes a high risk of infection. Particularly susceptible to infection are children who have not been vaccinated with BCG, as well as those suffering from congenital or acquired immunodeficiency conditions.

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Victoria asks:

My husband is ill with tuberculosis and is not treated regularly. At home, small children recently began to bleed. I'm afraid that he can infect children, they didn't take him urgently. Repeatedly called an ambulance, he refused to go to the hospital to leave us, where the house belongs to her husband. How can I put him in the hospital and what should I do. It has an open shape.

Responsible Medical consultant of the health-ua.org portal:

Victoria, you need to look for a way out of this situation, since living with your husband is dangerous for you and your children. Talk to his doctor, explain the situation and ask for hospitalization.

Maria asks:

Hello, my daughter is 3 months old, breastfed, BCG was done at the maternity hospital. My dad has been treated at the tuberculosis dispensary for 6 months, he is released for the weekend. single foci of compaction of the lung tissue with uneven contours, there is a decay cavity with the presence of liquid. Previously, there was no bacterial excretion, during treatment for 4 months.
1) Can a child get infected, I am very worried about her, but at the same time I don’t want to deprive my father of the happiness of communicating with her?
2) what preventive measures should be taken, except for daily cleaning, ventilation, separate dishes?
3) Is the risk of infection higher due to cavity decay?
Thanks for answers.

Responsible Strizh Vera Alexandrovna:

Dear Maria! You understand almost everything correctly and worry very correctly. But the main measure to prevent tuberculosis in a child who is in contact with a patient with active tuberculosis (regardless of bacterial excretion) is to give the child anti-tuberculosis drugs for the entire period of communication. Yes, you also need chemoprophylaxis. So that the choice is who is more expensive. Does it make sense to infect your daughter? Is it possible to? When she becomes an adult, she will not say thank you for your “kindness”. The child has the right to be healthy and live long!!! Stop contact until dad is cured. In young children, tuberculosis is more likely to be fatal, and very quickly. Adults, on the contrary, can wither for years. A grandfather can see his granddaughter, but to live with you on the same square or to nurse a child - no, he has no moral right. If the patient does not find sticks, this only means that they were not found and does not mean that they are not there. Mycobacteria were not detected. Think about the words “did not reveal” - if the moon is not visible in the sky during the day, this does not mean that it does not exist. It can be seen at night. Mycobacteria have not been identified and are absent in humans - this is different categories. Do not be ill.

Elena asks:

Hello! Please clarify a few questions.
1. The Mantoux test can only diagnose infection with mycobacteria, but not tuberculosis itself?
2. Is it possible to catch or become infected from someone infected with tuberculosis? Or only from a patient with an open form?
3. What alternative methods diagnosis of infection and disease can be used for a child of 2.5 years instead of Mantoux? What diagnostic material (blood?) Is used in PCR and what calls for a positive result: infection or disease? Is the same about ImmunoChrome-antiMT-Express test? And what is the Suslov test? And is there any sense and difference in the results of these tests depending on the presence or absence of BCG?
Thank you!

Responsible Strizh Vera Alexandrovna:

1. The Mantoux test is aimed at determining the activity of tuberculosis infection and is not intended for diagnosis. It is possible to distinguish the period of infection from the disease only on the basis of X-ray examination and other methods.
2. It is possible to become infected only from the patient. An infected MBT is a healthy person. The role of open and closed forms of TB in the spread of infection depends on the localization. For example, patients with a closed form of pulmonary tuberculosis, in 30% of cases are a source of infection for those who are in close contact with them. The concept of closeness in this case is determined by the resolution of laboratory research methods. A patient with isolated tuberculosis of the lymph nodes, when there are no fistulas and there is no outward discharge of the contents of the lymph node, is not contagious.
3. There is no alternative to the Mantoux test yet. The information content of PCR diagnostics (to identify the period of MBT infection) in the form in which it is proposed today does not exceed 20-30%. The MBT vaccine or infectious strain is detected with different PCR “settings” and is simultaneously checked by other laboratory methods that are currently under development. Individual diagnostics is possible, but it will be scientific, but not mass-produced. For mass implementation, expensive large-scale research and “working out the conditions” of testing are needed.
The information content of the Mantoux test is 70-80%, and with simultaneous immunochromatography, according to some authors, the information content of tuberculin diagnostics can be increased by only 8%. Conclusion, the information content of immunochromatography during the period of infection is only 8%!!!
Suslov's test is a photohistochemical method: complexone and tuberculin are injected into a drop of blood on a glass slide, which give a lumpy pattern - a conclusion is made according to the nature of the pattern - positive, doubtful or negative result. Pattern formation depends on many factors, including atmospheric characteristics. The sensitivity of the Suslov method in children with tuberculosis (according to the research of our clinic - the method of blind randomization) does not exceed 50%, in children infected with mycobacterium tuberculosis - 23.8%, which also does not allow recommending the test for mass screening and individual diagnosis of the period of infection in children .

Oksana asks:

Hello! I described our history of complicated BCG on 2011-01-20 00:07:22. So, little has changed since that time, the fistula has not healed, they are being driven to hospitals back and forth! They did a CT scan of the chest. Description: The presence of an enlarged LU in armpit on the left, up to 8.6*9.8*8.6mm. There is an increase in (small) LNs in the roots of the lungs (broncho-pulmonary group). The superior mediastinum is dilated, TTI 0.45 (n to 0.37) The lungs are airy and adjacent to chest wall over the entire surface. Pleural thickening and accumulation of fluid is absent. The pulmonary pattern is somewhat strengthened and enriched. Intrapulmonary nodes, formations or foci of changes in density are not determined. The roots of the lungs are compacted due to enlarged LU, the main bronchi look normal. Conclusion: lymphadenopathy. LU increase. Focal, infiltrative shadows are not determined. Thymomegaly.
I saw 3 doctors and they said it's okay. There are 2 phthisiatricians in our region, one says everything is very serious, you need to go to the hospital, take four anti-tuberculosis drugs. Another says that there is nothing to worry about, and even reduced the dose of isoniazid we take from 0.05 to 0.03. We looked at 4 radiologists and together with them the regional radiologist of the tubes of the hospital, they said that they did not see anything. Tell me, how serious is the conclusion of our survey, who to believe? a week before the examination, the child had been ill (runny nose, cough), are such changes possible due to illness? And most importantly, can a complicated course of BCG develop into tuberculosis !!! Thank you.

Responsible Strizh Vera Alexandrovna:

Yes, Oksana, unfortunately, poorly treated or untreated BCG-itis can develop into local tuberculosis. I recommended the treatment “...2 anti-tuberculosis drugs (isoniazid and pyrazinamide) against the background of hepatoprotectors, vitamins and beneficial bacteria + for a fistula for sure !!! lotions in the composition of 20% dimexide + 0.45 rifampicin per 100 g of solution for at least 2-4 months”, if you correctly found your question for January. Please note: rifampicin was in lotions, and isoniazid and pyrazinamide should have been started by mouth. And you, as I understood from the letter, drink only isoniazid? You can read about the complications of BCG vaccination here http://health-ua.com/articles/2492.html. From the order of the Ministry of Health of Russia: “Treatment of post-vaccination complications is carried out by a phthisiatrician, in the conditions of an anti-tuberculosis dispensary, according to the general principles of treating a child with extrapulmonary tuberculosis, with individualization depending on the type of complication and the prevalence of the process. Hospitalization in a specialized hospital is indicated in case of impossibility of adequate therapy on an outpatient basis. Carrying out any other preventive vaccinations during the treatment of a child (teenager) for a complication is strictly prohibited. If you are being treated at home, then every 1-2 weeks you should be examined by a pediatric phthisiatrician who conducts treatment. You can’t sit at home for months without medical supervision and reduce! dose of the drug (on the recommendation of a phthisiopediatrician?!), especially against the background of an unhealed one! fistula. As the child grows, the dose increases. The description of the x-ray indicates the presence of enlarged (small) lymph nodes of the broncho-pulmonary group. Regarding who to believe, I can only say after examining the radiographs. You ask about interrelation of ORZ and changes on a roentgen. So are these changes - the regional radiologist does not confirm their presence? Once again, I draw your attention to the fact that fistulas heal for a long time, several months (3-6) - and only against the background of anti-tuberculosis therapy with 2 drugs (isoniazid + pyrazinamide or isoniazid + ethambutol) through the mouth + the third (rifampicin) locally in the form of lotions and powders. In the case of a persistent fistula, its surgical excision is indicated against the background of anti-tuberculosis therapy. Get well. Where do you live?

Tatyana asks:

Hello! I am 19 years old, in April of this year I was diagnosed with infiltrative TB, without decay, BK + and resistance to first-line drugs, the doctors said that the process on the lungs is not big, to this day I take drugs, After 3 months. X-ray treatment was done, the dynamics are positive, sowing has not yet come, but they have been doing it for 2 months already. All this time I have been in contact with my brother, he is 14 years old. As soon as we learned that I got sick, I began to live in a single room. time quartz and ventilated the apartment, washed with bleach. I am very worried about my brother’s health, he often has a cold, they did an x-ray, everything is in order, he drank isoniazid for 3 months, they injected him with an immunomodulator, but they didn’t do mantoux, because in our city there is no tuberculin. What should be done so that he does not get sick in the future? And how to keep his immunity?
Thanks in advance!

Responsible Strizh Vera Alexandrovna:

Good afternoon, Tatyana! In order to increase the safety of relatives living with you in the same living space, personal hygiene and respiratory hygiene are recommended. Relatives should use respirators when communicating with you if bacterial excretion continues. Ideal - to isolate you from the family! Why are you still at home and not in the hospital?! Relatives cannot stay in a respirator for days! You, during the period of isolation of mycobacteria, should wear a medical gauze / disposable mask when in contact with relatives. During coughing and sneezing, to cover the mouth and nose (during the entire period of treatment and regardless of the presence or absence of bacterial excretion), use disposable wipes / pieces of tissue and disinfect them in accordance with the requirements of current legislation (phthisiatrician will explain); use disposable spitting containers. Cover your mouth and nose when coughing and sneezing with the back of your hand. At the same time, immediately treat the hand with disinfectant and wash with soap and water. Reduce the time of contact with relatives - this will be your best concern for their health. If it is impossible to interrupt contact with the brother and other family members, they should take anti-tuberculosis drugs during the entire period of contact, taking into account the results of mycobacteria sensitivity in you. You should be outdoors as much as possible, avoid visiting public places, do not use public transport, use natural and mechanical ventilation with hepafilters at home. To maintain immunity at a level sufficient to prevent disease, it is necessary good nutrition, enriched with proteins (meat, cottage cheese, buckwheat, legumes) and natural fats (daily butter), refuse drinks such as Coca-Cola, chips, fast foods, and do not contact you without a respirator. This is such a beautiful picture.

Albina asks:

Hello, please tell me if it is possible for my father to see and play with my son, i.e. with his grandson, because my father has had closed tuberculosis for a long time and he was recently treated for a very long 8 months in the hospital, but he really wants to play nurse my first grandchild, but I'm afraid there is a possibility of infection??? Tell me what to do, I don’t want to offend my dad ... (but I’m very afraid for my son

Responsible Strizh Vera Alexandrovna:

Albina! Depending on what changes in the lungs are present, what kind of TB activity the father has, there may be several communication options - from a categorical ban on close contact (you can see each other from a distance with a respirator on) to a short-term pickup of the child (as they say, hold a little in your arms) with a respirator on and complete freedom of communication. Contact your dad's doctor with this question, because. the probability of infection of the child can only be assumed by the doctor who knows the characteristics of the course of the disease and the effectiveness of the treatment. If we are talking about chronic TB, then the risk of infecting the child is high, even if the father does not “excrete” the sticks. The meager amount of bacteria in sputum may simply not get on the glass to the laboratory assistant. If dad really wants to babysit his grandson, then the baby should drink isoniazid during the entire period of communication with the patient. However, even taking the drug prophylactically will not protect against the likelihood of getting sick. Children are at high risk of contracting and getting TB. In young children, the barriers of the immune system are easily vulnerable, so any infection quickly spreads throughout the body. Contact your father's phthisiatrician and if the doctor says that dad cannot contact the child for medical reasons, you will have to tell the father the truth, weighing what is more important for you - not to offend dad or kill your son? Sorry for the harshness, but if dad asks to communicate with the child, perhaps he misunderstands his condition or you exaggerate the danger. Only the attending phthisiatrician or local phthisiopediatrician will help to find the right solution.

Natalia asks:

Clarification to the previous question. - The nanny worked in a group for the last 2 weeks before the sick leave - where does my child go - is this a contact?
In order to avoid a conditionally positive result, Mantoux wants to wait 2 months with him (10 weeks after the last contact of the child with the nanny) - Am I right?
the child is allergic (atopic dermatitis) and is quite difficult to tolerate even simple medications ... then I don’t want to treat the consequences of TB prevention later

Responsible Strizh Vera Alexandrovna:

Hello, Natalia! Yes, it's a close relationship. Quote: "...to avoid a conditionally positive Mantoux result." There is no conditionally positive Mantoux result. There is a doubtful reaction, negative and positive. Mantoux is always a specific test. Considering that the test is intradermal, the result, in the presence of exacerbation (!!!) of dermatitis, may increase by 2-3 mm or be accompanied by severe edema and hyperemia of the skin during the first day after the Mantoux reaction. Therefore, Mantoux should be put in the absence of rashes on the skin. Wait 10 weeks after contact with a nanny? For what? What does it give? 2 months is the minimum period after contact during which a person can become ill. Do you want to experiment on your child - will he get sick or not? With a disease, not 1 or 2 drugs are prescribed to patients, but 5-6 or more. The risk of disease after infection with mycobacterium remains in subsequent years. This risk is always there for everyone. The situation is determined by the massiveness and aggressiveness of the infection received. Close contact with a bacterioexcretor, which was the nanny for 2 weeks, is a high risk for a preschool child. Yes, not everyone gets sick after contact with a tuberculosis patient, but there are no such exact criteria to determine who gets sick and who does not. There are only parameters by which the degree of risk of the disease is determined. Do not want to treat the consequences of TB prevention? Which? Do you want to be treated for tuberculosis? Or have a sick child?

Murad asks:

Hello
1. If a child is infected with tuberculosis, is the disease immediately detected or can it manifest itself at an older age?
2. Is it possible to get infected from a person who has closed tuberculosis?

Responsible Strizh Vera Alexandrovna:

After being infected (contaminated) with Mycobacterium tuberculosis, you may or may not become ill with tuberculosis. A person with a weak immune system (few T-cells and their function is reduced), who has a hereditary predisposition, who long time inhales a large number of pathogenic bacteria, who eat poorly and irregularly, who experience stress, who live in a damp and poorly ventilated room, who lead an antisocial lifestyle, drug addicts, alcoholics, migrants, people without a permanent place of residence, etc. The risk group, of course, are children, since the formation of their organs and systems has not yet been completed. Each of the above risk factors can appear at any time and provoke tuberculosis. The main prevention of tuberculosis in a child is a harmonious, age-appropriate daily routine, study, nutrition, sufficient exposure to fresh air, positive emotions, a complete family, etc. Speak with a phthisiopediatrician, he will help identify the risk factors that your boy has and give advice for the future. You can get infected from any patient with active pulmonary tuberculosis. Of course, the risk of infection will be higher with prolonged contact with patients with open forms of TB.

Love asks:

Hello!
I have such a situation! When passing a medical examination of my daughter at the age of 1 and after her test of a manta 13 mm (it seemed doubtful to the pediatrician), I was sent to undergo FGL. After a bunch of additional examinations, a diagnosis was made of tuberculoma of the left lung S1 on the left 1 by 1.2 cm against the background of pneumofibrosis. BC are all negative. Previously, during the passage of PMO at work, nothing was detected. After reviewing the R-archive, the phthisiatrician concluded that tuberculoma had been present since 2010 and was visible on the images. Last year I gave birth to a daughter. Those. She had tuberculoma throughout her pregnancy and gave birth on her own. Now daughters are 1.2. Thank God everything is without dynamics since 2010 according to the pictures. My son is now 8 years old. He has had a positive mantoux test since 2009. By the way, when he was 1.5 months old he had acute lymphadenitis, with surgery, then it came right up to resuscitation, but everything worked out! The children were examined, both diaskenes were negative, the x-rays, the tests were good, but my son Mantoux had 19 mm. Now both children have been prescribed prophylactic chemotherapy. I myself have also been taking pills (rifampicin, isoniazid, pyrazinamide, ethambutol) for almost 2 months now. Coming soon x-ray. The doctor said that if there were no dynamics, they would suggest an operation. Of course, I understand that it is difficult to say this online, but still: I have questions:
1. What are the general statistics after such operations, is it possible to get sick again???

2. how dangerous I am for my loved ones, although there is no allocation of BC, but I still worry.

3. Whether the lymphadenitis of the son in 1,5 months can be connected. with my illness, i.e. could it be a complication of the BCG???

4. Did my daughter need to put BCG??? After all, I didn’t know anything about my illness until my daughter’s year.

5. How many years can I get sick in general??? The doctor also said that the tuberculoma is quite dense, what does this mean ???

Responsible Strizh Vera Alexandrovna:

1. What are the general statistics after such operations, is it possible to get sick again??? After removal of a single small tuberculoma, there is no risk of getting sick if there are no other risk factors, such as contact with a bacterioexcretor, occupational hazardous production (cement dust, etc.) I'm still worried. You are absolutely safe for those around you. with my illness, i.e. could it be a complication of the BCG??? what is the localization of lymphadenitis? Perhaps it was post-vaccination BCGit. 4. Did my daughter need to put BCG??? After all, I didn’t know anything about my illness until my daughter’s year. Yes, a healthy newborn is vaccinated and isolated from a patient with active TB for 2 months. Tuberculoma without signs of activity of a specific process and complications is not dangerous for the environment 5. How many years can I get sick in general??? The doctor also said that the tuberculoma is quite dense, what does this mean ??? Tuberculoma is a completed TB, a residual change that is considered a positive outcome. Surgery is an option, especially thoracic. With a tuberculoma of 1 cm, you can live happily for 100 years.

Maria asks:

Hello Vera Alexandrovna!
My name is Maria, I found your address on one of the sites where you answered
to questions in the forum.
My daughter is 2 months old, we were vaccinated with BCG at the maternity hospital, now she has
left-sided lymphadenitis - as a result of this vaccination. We were assigned
treatment - refampicin, isoniazid, lymphomiazone, galstena - internally and
externally troumel C ointment and synthomycin ointment mixed with 10
refampicin tablets.
Please tell me if this disease can be cured without
surgical intervention?

Responsible Strizh Vera Alexandrovna:

Hello Maria. It can be cured without surgery if the lymph node has not yet melted, and the body will not heal the lymph node by depositing lime in the lymph node. If melting occurs, then the contents of the lymph node must be aspirated with a syringe and streptomycin should be injected into the cavity. It is impossible to determine which way the healing will go - scarring, complete resorption or deposition of lime and the transformation of the lymph node into a pebble - it is impossible. Treatment should include 2 anti-tuberculosis drugs - isoniazid and pyrazinamide. Rifampicin can be used instead of pyrazinamide. The choice of drug depends on many factors. But, pyrazinamide penetrates better into the caseous mass of the lymph node. Galstena and lymphomyosot can be left, but additional vitamins of group B and beneficial bacteria(bifiform, linex, etc.). It is better to put compresses consisting of 20 g of dimexide + 80 g of water + 0.45 rifampicin on the skin above the lymph node. Synthomycin emulsion with rifampicin is used if there is an ulcer or fistula. The final decision on the choice of treatment method is made by the doctor who examined the child! Virtual consultation is only a carrier of information for you.

Xana asks:

Hello! I really need advice on this issue: the boy has been going to the garden since he was 1.5 years old with my daughter, none of the garden staff was informed that his mother was ill with Turbeculosis! now when the children are 5 years old - it turned out, because unfortunately her son got sick! in the last 3 months he was sick for a long time 2 times, from the hospital he brought a certificate of bronchitis!?! Now they are in Luhansk for treatment. Everyone (almost everyone) in the garden was tested about 1.5 months ago, it was negative for everyone, now all the children and teachers need to donate blood from a finger and take an x-ray. Is this enough to be able to say with certainty that a person is healthy or sick? Will we be registered? How often and for how long will the child need to be monitored? did the mother act rightfully, who kept silent about the fact that the boy in the family has such patients? could this boy go to an ordinary garden? how could it be that the boy was diagnosed with bronchitis 2 times??? and also this boy attended dance classes (in a group of about 30 people) who will report there and whether it is necessary to take any measures there? thank you in advance

Responsible Strizh Vera Alexandrovna:

The minimum period after infection with a tubercle bacillus during which a person cannot get sick is 2 months. This is the minimum period during which the Mantoux test from negative can become positive. Therefore, within 2-3 months after contact, a person should take anti-tuberculosis drugs to prevent the possibility of the disease after 2 months. and more after contact. In the absence of any deviations in the state of health, Mantoux can be repeated after 6 months. and after 1 year. If contact was only with a child whose tuberculosis is localized in the lymphatic system, then the question of the need preventive treatment all contact is solved individually. Sometimes, during the period of pronounced manifestations of tubintoxication, people begin to catch colds more often or suffer from bronchitis. These are the so-called paraspecific reactions of the body to tuberculosis infection. For each case of detected tuberculosis, doctors submit an emergency notification to the sanitary and epidemiological station, whose employees, together with the district phthisiatrician, carry out work in the focus of infection. Personally, you do not need to take any measures in relation to other mothers.

Ludmila asks:

Good afternoon My child is 14 years old. A week ago, a full examination was performed at the district hospital regarding an enlarged lymph node in the neck on the right. CT scan showed nothing else except the node, but ultrasound showed foci of calcification. The node was sent for histology to exclude onco, result: data for the neoplastic process No. diagnosis: this picture can be observed with granulomatous lymphadenitis various etiologies. Blood, pictures, Mantoux tests - do not cause any suspicion. The phthisiatrician is only embarrassed by the presence of calcifications. And on the basis of this, she diagnoses us with: Tuberculosis of the peripheral lymph nodes. She prescribes pills and sends her home. When we arrive home, we go to the local phthisiatrician, provide all the extracts and conclusions, and she sends my child to the TB dispensary for treatment for six months! Is it really impossible to carry out prevention at home? Why should I risk reinfection my child? Moreover, it is written in the conclusion: he can attend school, he was not even removed from physical education. Can we drink these pills without going to the TB dispensary? Thank you.

Responsible Strizh Vera Alexandrovna:

Lyudmila! Anti-tuberculosis drugs are serious medicines. During treatment, various complications can occur, which only a doctor who observes the child every day can notice in time. In addition, such children need a certain regimen, nutrition, sufficient nighttime and mandatory daytime sleep, removal of downloads at school, physiotherapy exercises with a set of breathing exercises, maximum exposure to fresh air, and limiting contact with viral patients. Those. lifestyle should be aimed at strengthening the immune system, which is impossible to fully organize in a modern school. Doctors will not be able to give permission for homeschooling, because there is no such normative document for patients with tuberculosis. There is no need to talk about the risk of re-infection in the TB dispensary. Your child did not get infected there. Where, you don't know. Perhaps a housemate or one of the relatives. In this case, the dispensary will be safer. The form of tuberculosis that you write about is not dangerous for others, but the child himself does not need school loads for the period of treatment. Ideally - a sanatorium school.

Responsible Strizh Vera Alexandrovna:

Alexei! You have no right to forbid a healthy child to attend kindergarten, even if he lives in a family where there are TB patients (do they live with the child or not?). TB is contagious in a different way than the flu, for example, where one contact is sufficient. To get TB, you need close and long-term contact. A random one-time meeting on the street will not lead to illness. The ways of transmission of TB are such that the microbe can enter the body only with droplets of the patient's sputum, through infected cow milk, and some others. That is, in order for a child to become 100% sick, a patient with an open form of TB must directly “cough up” on him and not one once. At the same time, the volume of a single infection and the observance of elementary rules of personal and public hygiene are important. There is no guarantee today that someone will not get TB, even in the absence of a known contact. Not everyone who gets TB knows the source of the infection. Therefore, knowing who is sick on the contrary helps to be warned. For example, in your situation, protection may be keeping a distance with a sick, but not with a healthy child.

Dima asks:

Hello. Tell me please. A 3-year-old child who is often ill was offered to go to a kindergarten for tube-infected children. Is it worth giving the child away if he does not have such a diagnosis, how dangerous is it?

Responsible Strizh Vera Alexandrovna:

Tuberculosis without detected local tuberculous changes in the organs is not a disease. This is the period when, in children with a good immune system, a balance is established between infection and immunity. Such children are healthy, although they are prone to more frequent colds. Frequent colds, in turn, reduce immunity, which can cause active reproduction of tubercle bacilli in the child's body. Therefore, children infected with Mycobacterium tuberculosis (MBT) are at risk for tuberculosis. Unlike uninfected children, they need enhanced nutrition with a protein-fortified diet, special treatment days and careful prevention of SARS. Communication with healthy MBT-infected children is not dangerous for others, they are not a source of infection and do not release mycobacteria into the environment. Additional information about BCG vaccination and the dynamics of Mantoux tests in your boy will allow you to give a more convincing answer.

Valentina asks:

Hello. my child is 4 years old, we were in contact with a girl (5 years old) whose whole family is ill with tuberculosis open form(a couple of weeks ago, the mother of this girl died (from tuberculosis in an open form) The girl is separate from this family, but for a long time she naturally contacted them, just when she was taken away from the family by doing a fluorogram, tuberculosis was not detected, although her younger sister (2 years old ) is also infected with tuberculosis in an open form. I have a question, can a fluorogram be wrong? Can a person carry a tuberculosis infection, but the fluorogram did not show, and infect people. (after all, this girl constantly coughs and yesterday she had a cough (as later it turned out) when we had contact with her, what she rewarded us with, my child began to cough too in the morning)? ???

Responsible Strizh Vera Alexandrovna:

Dear Valentina! Young children rarely have forms of tuberculosis that can become a source of infection for others. Children with severe forms of TB do not walk down the street, but are in the hospital. A child with a normal fluorogram cannot be a source of tuberculosis. Cough in children often occurs as a result of a cold or SARS. Tuberculosis can occur without signs of illness. If the child was in contact with a patient with tuberculosis, then a control radiograph of the organs is taken. chest cavity. If you have been in contact with a healthy child who lives in a focus of TB infection, but not with a TB patient, there is no risk of infection. If a healthy child continues to be in contact with a TB patient, the risk of infection and disease increases. You can continue to communicate with healthy children of a mother who died of TB if there are no other patients with active forms of TB in the family (or the contact of the child with them is interrupted).

Tuberculosis- this is a specific infectious disease, the causative agent of which is Mycobacterium tuberculosis, can affect absolutely every system and organ of humans and animals, is characterized by a chronic course, the presence of intoxication and the formation of specific foci of inflammation.

Many people believe that tuberculosis is somewhere out there, in prison, among homeless people and alcoholics, but I assure you that this infection is very close and there are a lot of it. Tuberculosis affects a large number of people of different ages, gender, status and wealth in many countries of the world. Some celebrities and very rich people also suffer or have suffered from tuberculosis, they just don’t spread about it, it’s understandable for what reasons.

Most people are also surprised that children also get TB. But they not only get sick, but also become disabled due to complications of tuberculosis and, unfortunately, die. Our children can encounter the tuberculosis pathogen everywhere: at home, when guests come or relatives are sick, near the house when in contact with sick neighbors, in public transport- in general, all conditions. And also in shops when going for sweets, in the park, playing in the sandbox, in children's groups, where teachers can get sick and taking a book from the library. There are cases of illness in children who lived in an apartment where a person once died of tuberculosis. There are a lot of examples.

Babies are very vulnerable to tuberculosis infection due to their unformed, imperfect immunity. Most phthisiology specialists have one opinion: tuberculosis in children can be defeated only if tuberculosis is eliminated among adults. Until this happens, doctors have to carry out a huge organizational work for the timely detection and prevention of tuberculosis among the child population of countries with an unfavorable situation with tuberculosis. In such countries, by the age of 14, 70% of children are already infected with tuberculosis (without manifestation of the disease). Every tenth of them during his life falls ill with tuberculosis and infects others. A vicious vicious circle is formed, which is very difficult to break. Perhaps that is why tuberculosis has always been ...

Some statistics!

The world is great amount research on effective methods for diagnosing and effective treatment of tuberculosis in order to reduce the burden of tuberculosis in the world. The World Health Organization (WHO) is trying to control tuberculosis in many countries of the world, but at this stage the epidemic of this infection has been registered in many underdeveloped countries. Adding fuel to the fire is a parallel epidemic of HIV infection and the prevalence of tuberculosis resistant to anti-TB drugs.

So, every year in the world about 9 million people fall ill with tuberculosis and about one and a half million people die from tuberculosis (according to WHO). And every third person in the world is infected with tuberculosis (the presence of the causative agent of tuberculosis in the body without the manifestation of the disease itself).

We can talk about an epidemic when the incidence of newly diagnosed cases reaches more than 50 per 100 thousand of the population.

Factors contributing to the TB epidemic:

• the level of the country's economy;
• the spread of alcoholism and drug addiction;
• the prevalence of HIV infection;
• the spread of tuberculosis resistant to treatment with anti-tuberculosis drugs;
• ecological situation.

There are no exact statistics on the incidence of children in the world, but WHO suggests that the incidence of tuberculosis in children in the world is from 1 to 10 new cases per year per 100 thousand of the child population (data are presented based on the results of the last 10 years).

In prosperous countries (EU countries, the USA, Japan), the incidence rate of children is very low, sometimes there are isolated cases, and those are more often imported from countries that are unfavorable for tuberculosis. While in African countries, the incidence of children can reach 200, and in some poor African regions even up to 800 per 100 thousand of the child population. A high incidence is also observed in Asian countries (India, China, the Philippines, Afghanistan, Vietnam and others).

It is known that 85% of all cases of tuberculosis in the world fall on Africa and Asia.

In the CIS countries, there is also an epidemic of tuberculosis and a high incidence of children under 14 years of age:

• Kazakhstan and Kyrgyzstan - about 30 per 100 thousand child population,
• Moldova - about 20 per 100 thousand child population,
• Russia - an average of 15 per 100 thousand children,
• Armenia - an average of 10 per 100 thousand child population,
• Ukraine and Georgia - from 8 to 10 per 100 thousand of the child population.

• Tuberculosis is one of the oldest diseases. Specific tuberculous changes in the bones were found in the mummies of the pharaohs in the pyramids of Theops. Consumption was described by many writers and doctors of past centuries, but the causative agent of tuberculosis was identified by Robert Koch only on March 24, 1882, which is why the causative agent of tuberculosis was popularly called Koch's wand. March 24th is World TB Day.
• Tuberculosis has long been called consumption by the people, this is due to the fact that the patient with this disease "withers before our eyes" as a result of exposure to prolonged tuberculosis intoxication.


• Tuberculosis affects absolutely all organs and systems of the body.. It was previously believed that tuberculosis did not affect hair and nails, but in last years this question has been studied and the possibility of defeat by tuberculosis and these structures has been proved.


• Tuberculosis is a specific infectious disease because tuberculous inflammation is specific only to tuberculosis and does not occur in any other process. TO specific diseases also include syphilis and leprosy.


• Tuberculosis treatment measured not in days and weeks, but in months and years. Tuberculosis is curable only when the patient completes the entire course, otherwise, the tuberculosis bacillus adapts to those anti-tuberculosis drugs that the patient has already taken.


• Chamomile has become a symbol of the fight against tuberculosis. In 1912, the first charity event was held in Russia to raise funds for the fight against tuberculosis, and as a thank you to all those who donated, the girls distributed white daisies.

Anatomy of the lungs

Lungs- the respiratory organ, in them the main gas exchange occurs - the absorption of oxygen and the removal of carbon dioxide from the blood.

The lungs are located in the chest cavity, occupying most of it. Normally, the lungs are filled with air. When inhaled, the air flow passes through the upper respiratory tract, then enters the bronchial tree of the lungs and into the alveoli. Gas exchange occurs in the acinus, the structural unit of the lung.

The structure of the bronchial tree:

• main bronchi,
• lobar bronchi,
• segmental and lobular bronchi,
• acinus (bronchiole, alveolus, blood vessel).

The right lung contains three lobes (upper, middle and lower), and the left two lobes (upper and lower). Tuberculosis often affects the upper lobes of the lungs.

Each lobe of the lung is divided into segments right lung has 10 segments, and the left one has 9. In the literature and in practice, it is customary to designate segments as the Latin letter S and indicate the segment number.

The figure shows a diagram of the division of the lungs into lobes and segments.

lung root- anatomical formation that connects the lung to the organs of the mediastinum.

The structure of the root of the lung:

• main bronchus,
• pulmonary artery and vein
• lymphatic vessels and nodes,
• nerve fibers.

Mediastinal organs:

• Anterior mediastinum - thymus, blood vessels, intrathoracic lymph nodes;
• middle mediastinum - heart, aorta, trachea, main bronchi, blood and lymphatic vessels, intrathoracic lymph nodes;
• Posterior mediastinum - esophagus, nervus vagus, thoracic lymphatic duct (one of the largest lymphatic vessels), vessels and lymph nodes.

Pleura

Pleura- This is a paired organ that limits the lungs from the chest. The pleura is a two-layer bag. Two sheets form a pleural gap between them, which normally contains only up to 2 ml of pleural fluid. The leaves are a serous membrane, in the wall of which there are a large number of capillaries and lymphatic vessels, which contributes to the production of pleural fluid and its evacuation from the cavity.

Also in the visceral pleura there are pores of Kohn, which communicate the pleural cavity with the lungs.

With pathological processes in the pleura or its damage, a cavity is formed between the sheets of the pleura with the presence of fluid in them (pleurisy) or air (pneumothorax).

Pleura sheets:

• parietal pleura- close to chest
• visceral pleura- adjacent to the lung

• costophrenic sinus- the space between the ribs and the diaphragm, the largest sinus;
• costomediastinal sinus- the space between the ribs and the mediastinum, small in size;
• diaphragmatic-mediastinal sinus the space between the mediastinum and the diaphragm.

Schematic representation pleural cavity, front view.

Functions of the pleura:

• participation in the act of breathing, provide negative pressure (pressure below atmospheric) during the act of breathing;
• protection of the lung from friction about the chest during breathing, a small amount of fluid in the pleural cavity contributes to the sliding of the pleural sheets in relation to each other during breathing;
• lung maintenance in a stretched state.

Intrathoracic lymph nodes

Groups of intrathoracic lymph nodes:

• paratracheal,
• tracheobronchial.
• bifurcation,
• bronchopulmonary.

Normally, the size of the intrathoracic lymph nodes in adults is from 7 to 10 mm, and in children about 2 mm, they are not visible during x-ray studies.

The causative agent of tuberculosis

Place in the hierarchy of microorganisms	Domain	bacteria
	Type	Actinobacteria
	Class	Actinobacteria
	Order	actinomycetes
	Suborder	corynebacteria
	Family	Mycobacteria
	Genus	Mycobacteria
	Species pathogenic for humans	Mycobacterium of the human species (Mycobacterium tuberculosis)
		Mycobacterium bovine (Mycobacterium bovis)
		Intermediate Mycobacterium (Mycobacterium africanum)
		Mycobacterium avian species (Mycobacterium avium) causes the disease quite rarely, mainly in HIV-positive patients, it is severe.
What does it look like		Small, thin, motionless rods ranging in size from 1.5 to 4 microns by 0.4 microns. Conventional gauze and disposable masks are ineffective when in contact with Koch sticks due to the fact that they are very small and penetrate through the pores of medical masks. Effective personal protection in case of contact with tuberculosis is carried out with the help of special respirators with a 3M characteristic.
Structural features	cell wall determines the resistance of mycobacteria to various factors.	The cell wall has a complex structure, consists of three layers: The outer layer (lipid, contains mycolic acid) forms a microcapsule; tuberculopeptide layer; polysaccharide layer. All layers are interconnected by pores and channels through which the relationship between the mycobacterium cell and the environment occurs - nutrition, release of toxins. The cell wall contains antigens (exogenous toxins) that cause a delayed-type immune hypersensitivity reaction in the human body and a cord factor that determines the virulence of mycobacteria (the ability to penetrate into the cells of the human body).
Properties of Mycobacterium tuberculosis	acid resistance, alkali resistance, alcohol resistance	Continue their vital activity under the influence of acids, alkalis and alcohol.
	high survival rate in environment	Mycobacterium tuberculosis is very tenacious and insidious. In a damp, poorly lit environment, Koch's wand can live for ten years. Lives well in milk. Mycobacterium tuberculosis can live in dust for several months, the same time they remain in library dust. Tuberculosis bacilli live in soil for about 2 months, in water up to 5 months, in animal feces for more than a year. Also, Koch's wand is quite resistant to freezing and heating, when boiling the sputum of a tuberculosis patient, the death of mycobacteria occurs only after 5-10 minutes, and under the action of sunlight it does not die within 30 minutes.
	Polymorphism (variability, variety of forms)	In the human body, several forms of Mycobacterium tuberculosis can be found simultaneously: rod-shaped - the most active; granular, filamentous, coccal - intermediate states of mycobacteria; filtered and L-forms - temporarily inactive, under favorable conditions are converted into rod-shaped.
	Adaptation to the effects of anti-tuberculosis drugs	At wrong modes treatment or their poor absorption in the intestine often develop chemoresistant forms of tuberculosis, which are not affected by a number of anti-tuberculosis drugs, which significantly worsens the prognosis for the cure of tuberculosis.
	Disinfection	Disinfection against Mycobacterium tuberculosis is possible only when treated with chlorine-containing disinfectants and quartz treatment.
	Aerobicity	For the life of mycobacteria, in most cases, oxygen is needed, but under anaerobic conditions (lack of oxygen), they will also feel good. Therefore, mycobacteria can also be attributed to facultative anaerobes.
reproduction	Reproduction occurs by cell division	They multiply very slowly, one division lasts up to 18 hours (for comparison, the division of staphylococci on average lasts about 10 minutes). For the reproduction of mycobacteria, in addition to time, the temperature regime is also necessary - optimally 37 ° C.
Growth on nutrient media		Lowenstein-Jensen solid medium, egg-based. It grows for a long time, within 2 to 3 months. Dry, shriveled, yellowish colonies (R-forms) are seen, sometimes moist, smooth colonies (S-forms) are seen.
		Liquid medium on the basis of agar is used for sowing mycobacteria in the conditions of the BAKTEK apparatus. Grows about 10-20 days. Colonies are visible under fluorescent light.

source of tuberculosis infection

1. Patient with active tuberculosis is the main source of infection

   Methods for isolating tuberculosis bacteria into the environment:

   • With tuberculosis of the lungs and upper respiratory tract - during coughing, sneezing, talking, using dishes, kissing, etc .;
   • With tuberculosis of the skin - contact with tuberculosis-affected areas of the skin, as well as items of clothing and household items;
   • In case of tuberculosis of bones and lymph nodes - in the presence of fistulas (discharge of pus through the skin), Mycobacterium tuberculosis can get on the skin of the person in contact and clothing and household items;
   • In intestinal tuberculosis - Mycobacterium tuberculosis are detected in feces;
   • With tuberculosis genitourinary system- Koch's wand is detected in the urine, and vaginal discharge.
   • With isolated tuberculosis of the nervous system and eyes, the isolation of mycobacteria does not occur at all.
2. Animals with tuberculosis(especially cattle, Guinea pigs, dogs, cats and other rodents can get sick with tuberculosis) tuberculosis pathogens are also isolated:
   • with faeces,
   • with milk and meat.

Ways of transmission of tuberculosis

1. airborne way- the main way of infection with tuberculosis in children and adults. In this case, infection occurs directly through contact with a patient with active pulmonary tuberculosis during sneezing, coughing, talking, deep breathing.


2. At air-dust path TB infection is less common. As mentioned above, mycobacteria are especially tenacious in the environment and persist in dust for a long time. When inhaling dust particles, on which Koch's wand has stuck, infection with tuberculosis is possible, both for children and adults.


3. Alimentary way- also an infrequent way of contracting tuberculosis, mycobacterium tuberculosis enters the human body through the mouth with milk, meat from sick animals that have not been properly heat treatment, when using untreated dishes (in cafes and restaurants, dishes are rarely boiled or treated with disinfectant solutions). With insufficient hand hygiene after contact with objects on which Koch's sticks have remained (for example, after a trip in transport, an elevator, playing in a sandbox, contact with banknotes and coins), infection with tuberculosis can also occur. The alimentary route of infection is more common in children, since dirty hands in the mouth - this is normal for them, and the immunity of the intestines in children is imperfect.


4. Transplacental route- transmission from mother to child during pregnancy is rare due to the strong placental barrier. This is possible when the genital organ is affected by tuberculosis, disseminated (common) tuberculosis, provided that the placental barrier is violated (for example, partial placental abruption). In this case, the child is already born with manifestations of congenital tuberculosis. Congenital tuberculosis in children is extremely difficult with extensive liver damage, often has death. The literature describes isolated cases of congenital tuberculosis from a healthy mother, this is possible when the mother is infected during pregnancy, the placental barrier is broken and the pregnant woman's immunity is reduced (for example, the presence of concomitant diseases such as HIV infection, TORCH infection, and others).


5. mixed path- a combination of ways in which tuberculosis bacilli enter the human body. It is more common in the focus of tuberculosis infection.

Causes of tuberculosis in children

Risk factors for the incidence of tuberculosis in children

1. Epidemiological factors(presence of obvious contact of the child with a person or animal with active tuberculosis, eating milk or meat from a sick animal);
2. Biomedical factors:
   • Child not vaccinated against tuberculosis BCG in countries with an unfavorable situation in tuberculosis;
   • Tuberculosis infection in early childhood positive and hyperergic reactions of the Mantoux or Diaskintest test (specific tests for tuberculosis);
   • genetic predisposition- the presence of tuberculosis disease in relatives of older generations;
   • The presence of HIV infection, AIDS in a child, as well as the birth of a baby from an HIV-positive mother, even if the child is healthy;
   • stressful conditions(for example, passing exams, death of a loved one, overload at school and in sports, abortion or childbirth, etc.);
   • Presence of comorbidities:
     • chronic diseases of the upper respiratory tract (chronic rhinitis, sinusitis, adenoiditis, tonsillitis and others),
     • chronic lung diseases (bronchial asthma, frequent bronchitis and pneumonia, pulmonary cystic fibrosis and others),
     • endocrine diseases (diabetes mellitus, autoimmune thyroiditis and others),
     • diseases of the gastrointestinal tract (viral hepatitis, biliary dyskinesia, gastritis, peptic ulcer of the stomach and duodenum, and others),
     • immunodeficiency diseases in children (congenital immunodeficiencies, oncological diseases blood and other organs, conditions requiring long-term use of glucocorticosteroids and other drugs that reduce immunity - cytostatics),
3. Social factors:
   • Unbalanced improper, irregular nutrition of the child;
   • alcoholism or drug addiction in the parents of the child, the presence of bad habits (including smoking) in the children themselves;
   • stay of the child's parents in places of deprivation of liberty;
   • homeless children;
   • children from orphanages, boarding schools and other closed children's groups;
   • large families and families with low incomes;
   • children arriving from countries with an unfavorable situation for tuberculosis (Africa, some countries in Asia and other regions) and children who have changed the climate.

What is the risk of contracting tuberculosis?

• the presence of a source of tuberculosis and the macroorganism of the child;
• the degree of bacterial excretion of Mycobacterium tuberculosis at the source of infection and the degree of tightness of contact;
• the presence of at least one of the risk factors in a child that contributes to a decrease in protective forces against tuberculosis;
• age of the child (the younger, the more risk get sick, also a dangerous teenage period during hormonal changes)
• duration of contact with the causative agent of tuberculosis;
• the virulence of the pathogen itself (the activity of mycobacteria, the ability to cause disease);

How does TB infection and disease occur in children?

Latent tuberculosis infection is characterized by:

• the presence of a positive reaction to tuberculin (Mantoux test or Diaskintest), which indicates the presence of anti-tuberculosis immunity,
• lack of clinical manifestations of tuberculosis,
• the absence of changes in the conduct of x-rays and other types of studies for tuberculosis,
• preserved immunity.

Pathogenesis and mechanism of tuberculosis infection

1. Contact with the causative agent of tuberculosis on the mucous membranes of the upper respiratory tract, tonsils where immune cells (lymphocytes, macrophages, monocytes, and other phagocytes) enter into defensive reaction and phagocytize (absorb) them, at this stage, subject to good immunity and a small number of microbes, infection with tuberculosis may not occur. Otherwise, Koch sticks get into the lungs.
2. The entry of Mycobacterium tuberculosis into the alveoli of the lungs.
3. Penetration of bacteria through the walls of the alveoli, there are no specific changes in them.
4. Entry of mycobacteria into the lymphatic tract and lymph nodes where they reproduce. In the lymphatic system, the infection can be for a long time, sometimes throughout the life of the macroorganism - a state of latent tuberculosis infection.
5. Period of bacteremia(circulation of Mycobacterium tuberculosis in the bloodstream) will last about 2 weeks, the causative agent of tuberculosis does not multiply in the blood.
6. Spread of infection in tissues and organs of the body. In this case, a primary tuberculosis disease or a latent tuberculosis infection may develop.

   Mycobacterium tuberculosis can also penetrate into the lymphatic tracts and lungs in other ways: through the tonsils, damaged mucous membrane of the mouth or nasopharynx, intestines, then into the regional lymph nodes, from where they enter the surrounding organs and tissues.

7. Formation of anti-tuberculosis immunity occurs within 2-3 months, around mycobacteria there is a formation of a specific tuberculous tubercle (granuloma), which consists of curdled necrosis (caseosis) and perifocal inflammation.
8. The state of infection with Mycobacterium tuberculosis - in the absence of progression of the process, the granuloma resolves or becomes covered with a connective tissue capsule, and the MBT inside the granuloma passes into L-forms (dormant mycobacteria).
9. Tuberculosis disease- under unfavorable conditions for the macroorganism, tuberculosis infection can be reactivated with the development of secondary active tuberculosis, there is a reversion of Mycobacterium tuberculosis - the transition of L-forms to rod-shaped forms.

Depending on the mechanism of tuberculosis disease, the forms of tuberculosis are distinguished:

• Primary form of tuberculosis- Tuberculosis, which developed immediately after the initial entry of Mycobacterium tuberculosis into the body, mainly occurs in children.
• Secondary form of tuberculosis- a form of tuberculosis that has developed as a result of reversion of inactive forms of mycobacteria, as well as during repeated contact of a person with the causative agent of tuberculosis. This form of tuberculosis occurs in both adults and children, especially in adolescence.

Histological changes in tuberculosis

• Hyperplastic stage- proliferation of lymphoid tissue;
• Granulomatous stage- the appearance of a tuberculous tubercle, Pirogov-Langhans epithelioid giant cells (indicator of tuberculosis, is present in almost all cases of tuberculosis, may not be with miliary tuberculosis and tuberculosis in HIV - positive people);
• Exudative stage- involvement in the process of a large number of vessels, a large amount of fluid is formed, for example, the occurrence of pleurisy.
• Caseosis stage- caseous (curdled) necrosis, with the destruction of the tissues of the affected organ, for example, during the formation of a cavity. And when the tuberculous process destroys the walls of the vessels, such a complication of tuberculosis can develop - such as hemoptysis or pulmonary bleeding;
• Stage of pus formation- a large number of epithelioid giant cells, neutrophils and lymphocytes are found, massive destruction of the tissues of the affected organ is observed, for example, in caseous pneumonia - one of the most severe forms of tuberculosis, which leaves large residual tuberculous changes in the form of fibrous-cavernous tuberculosis.
• Productive stage (stage of fibrosis formation)- detect connective tissue with small few cellular elements. In this case, the scarring of tuberculous changes occurs, that is, the healing of the affected organ, this stage is present in any form of the tuberculous process, tuberculosis does not pass without a trace, residual changes are always formed in the form of fibrosis (connective tissue that replaces areas of normal organ tissue or adhesions).

1. Infiltration phase- fresh tuberculous changes with the progression of tissue damage;
2. The phase of lung tissue decay– formation of destructions (caverns);
3. Compaction phase- reverse development of the tuberculous process against the background of treatment or spontaneous cure;
4. Resorption or scarring phase- healing of tissues affected by tuberculosis with the formation of connective tissue at the site of inflammation.

Immunity in tuberculosis

During the formation of anti-tuberculosis immunity, immunoglobulins of type A, M, G are formed.

The incubation period of tuberculosis- from 2-3 months to several decades.

Types of tuberculosis in children

• Tuberculosis without bacterial excretion or "BK-" when examining the patient's sputum (microscopy and culture), tuberculosis pathogens were not detected,
• Tuberculosis with bacterioexcretion or "BC +" - tuberculosis bacilli are detected in the patient's sputum.

• Active tuberculosis -“fresh” changes are revealed, there are signs of vital activity of mycobacterium tuberculosis. On radiographs, active tuberculosis has a lower intensity, in dynamics it gives a positive or negative trend. In the clinic - the presence of intoxication and chest symptoms.
• Inactive TB - residual changes after TB (ORTB). Active tuberculosis may become inactive as a result of anti-tuberculosis therapy or spontaneous cure (self-healing tuberculosis). Spontaneously cured tuberculosis is often detected during medical examinations. Such inactive tuberculous changes do not require special treatment, it is necessary to monitor them at least once a year and when any symptoms appear. On radiographs, inactive changes are of high intensity, may contain calcium inclusions, and do not change in dynamics even after several years.

Also, depending on the history of the disease, cases of tuberculosis are distinguished:

• Newly diagnosed tuberculosis The patient has not been previously treated for tuberculosis.
• Tuberculosis relapse- the patient was considered cured, but there was an activation of the tuberculosis process. Often a relapse occurs after some kind of stress for the body or exposure to a risk factor for tuberculosis.
• Treatment after break- the patient had previously started anti-tuberculosis therapy, but stopped taking it for more than 1 month. Any break in treatment can lead to the development of resistant forms of tuberculosis!

1. Susceptible tuberculosis- tuberculosis bacillus does not have resistance (resistance) to any of the anti-tuberculosis drugs.
2. Chemoresistant tuberculosis- the mycobacterium that caused this disease is resistant to at least one of the drugs. In recent years, the number of cases of chemoresistant TB has been on the rise. geometric progression, including among children. Depending on which anti-tuberculosis drugs there is resistance to Koch's bacillus, there are types of chemoresistant tuberculosis:
   • Mono-resistant (to any one drug),
   • Multi-resistant - resistance to several anti-tuberculosis drugs,
   • Multidrug-resistant tuberculosis (MRTB) is a combination of drugs containing isoniazid and rifampicin,
   • Extensively drug-resistant tuberculosis (XDR) - resistance to isoniazid, rifampicin, aminoglycoside and fluoroquinolone. The most severe form of tuberculosis with a poor prognosis.

In children, it is not always possible to obtain the pathogen itself, therefore, in children, chemoresistant tuberculosis can be suspected based on the presence of resistance in a patient surrounded by a child, from whom the baby was most likely infected.

Classification of tuberculosis according to the localization of the tuberculosis process:

Tuberculosis of unspecified localization

The symptomatology of this form of tuberculosis increases gradually, is chronic. In most cases, parents do not notice changes in the child's condition, so this form of tuberculosis in children is rarely diagnosed, although the disease itself is common. It is difficult for parents to explain that without visible changes the child suffers from tuberculosis, because the only confirmation of tuberculosis is positive tests for tuberculin (Mantoux test and Diaskintest). But if the condition is left untreated, TB can become more widespread and more severe. The occurrence of tuberculosis of unspecified localization is explained by the rapid reproduction and spread of mycobacteria in the lymphatic system with the release of a large amount of tuberculous exotoxin, which affects all organs and systems. Also, the diagnosis of tuberculosis of unspecified localization can be made with insufficient diagnosis. extrapulmonary tuberculosis, because tuberculosis affects absolutely all organs and tissues.

Tuberculosis of the respiratory organs

1. Tuberculosis of intrathoracic lymph nodes- one of the most frequent primary forms of tuberculosis in young children. Single intrathoracic lymph nodes or all groups of lymph nodes on one or both sides can be affected. It is severe in young children, since significant compression of the bronchi by enlarged intrathoracic lymph nodes is possible.

   Depending on the stage of inflammation and the prevalence of the lesion, there are forms of tuberculosis of the intrathoracic lymph nodes (TBVLNU):

   • small form tuberculosis of the intrathoracic lymph nodes - often asymptomatic, has a favorable course. With this form of tuberculosis, there is a slight increase in single lymph nodes, they are dominated by hyperplastic and granulomatous stages of inflammation. Difficult to diagnose, can be missed on plain radiographs this pathology better seen on CT scans.
   • Infiltrative form - the lymph nodes are enlarged in size from 10 to 20 mm, while the granulomatous and exudative phases of inflammation predominate, there is a slight compression of the bronchi.
   • Tumorous form - the most severe form of tuberculosis of the intrathoracic lymph nodes, all groups on both sides are often affected, their size is more than 20 mm. In the lymph nodes, the phase of exudation and caseosis predominates, that is, suppuration of the lymph nodes occurs. This form often occurs with complications in the form of a breakthrough of pus into the bronchus (the child can suffocate with these masses) or complete compression of one or more bronchi (falling of individual sections of the lungs - atelectasis), which leads to impaired ventilation of the lungs.
   X-ray of a 2-year-old child. Diagnosis: infiltrative form of tuberculosis of intrathoracic lymph nodes. Lung fields without visible pathological changes, there is an expansion of the root of the lungs on the right due to an increase in intrathoracic lymph nodes.


2. Primary Tuberculosis Complex (PTC)- the primary form of tuberculosis, which occurs mainly in childhood, one of the most common forms of tuberculosis in young children. The prognosis is usually favorable (provided timely adequate treatment), but can also occur with complications in the form of impaired bronchial patency. In the primary tuberculous complex, there are often vivid manifestations of symptoms of tuberculous intoxication.

   Components of the primary tuberculosis complex:

   • Lymphadenitis- defeat of one or more intrathoracic lymph nodes,
   • Lymphangitis- damage to the lymphatic vessel,
   • primary affect- damage to the lung.
   These components are interconnected with each other.

   Plain radiograph of the chest organs of a 3-year-old child. Diagnosis: bilateral primary tuberculosis complex. On the x-ray in the upper lobes of both lungs, foci of infiltration associated with dilated roots of the lungs (enlarged lymph nodes) are noted.



3. Focal pulmonary tuberculosis can be either primary or secondary. In children, it usually occurs over the age of 10 years, especially in adolescents. It is characterized by the appearance of foci of tuberculous inflammation in one of the lungs on a limited within no more than two segments of the lungs, the dimensions of which are less than 10 mm. A favorite place of foci is the tops of the lungs. In the pathogenesis of focal tuberculosis, the granulomatous phase of inflammation with slight exudation plays the most important role. Symptoms of intoxication in this form of tuberculosis may not be, most often foci are found during preventive examinations. This is one of the most favorable forms of tuberculosis.

   Digital fluorography of the chest cavity. Diagnosis: focal tuberculosis upper lobe of the left lung. On the left at the apex, single focal shadows are determined against the background of an enhanced pulmonary pattern.



4. Infiltrative tuberculosis more often secondary. Occurs in children of school age. One of the most common forms in adults. The pathogenesis is dominated by the phase of exudation (fluid formation) and caseosis. Sometimes, at the site of the infiltrate, destruction of the lung tissue (cavity) is determined, possibly seeding of foci of tuberculosis around the infiltrate itself, as well as along the lymphatic or blood vessels. A rather severe form of tuberculosis, often with the release of Mycobacterium tuberculosis, can be complicated by hemoptysis or pulmonary hemorrhage, lead to the formation of "non-healing" cavities, tubercles.

   Plain radiograph of the chest organs and some sections of the computed tomography of the upper lobes of the lungs of a teenager. Diagnosis: infiltrative tuberculosis of the upper lobe of the right lung with destruction and seeding. In the upper lobe of the right lung there is a small infiltrate with destruction of the lung tissue and foci of low intensity around. On these x-ray studies, the advantage of computed tomography over conventional x-rays is clearly seen.



5. Disseminated pulmonary tuberculosis- a severe, widespread form of tuberculosis that affects more than two segments of the lungs, is characterized by many foci, against which a thin-walled cavity is often determined. The spread of foci during dissemination occurs either along the blood vessels (hematogenous disseminated tuberculosis) or lymphatic (lymphogenic disseminated tuberculosis). This form of tuberculosis can be either primary or secondary. Children also get this form of tuberculosis at any age.

   Plain radiograph of the chest organs of a 10-year-old child, with severe course HIV-associated tuberculosis. Diagnosis: Disseminated tuberculosis of both lungs. Throughout all fields of the lungs, multiple foci of different sizes and intensity are noted.



6. Tuberculous pleurisy- This is a tuberculous inflammation of the pleura, mainly on one side. It can be isolated or as a complication in any other form of tuberculosis. Often it is a manifestation of primary tuberculosis in childhood, it develops immediately after massive contact with tuberculosis patients. Children suffer from this form of tuberculosis on average in 10% of cases, adolescents are more often ill.

   It is difficult to differentiate this disease from ordinary serous or purulent pleurisy, this is only possible when performing a puncture (puncture) of the pleural cavity with a further study of the cellular composition of the pleural fluid, as well as a histological examination of the pleural biopsy.

   An insidious disease in itself, sometimes it goes away on its own against the background of non-specific antibiotic therapy, forming adhesions without anti-tuberculosis therapy, but after a while tuberculosis can return in the form of common forms of tuberculosis.

   Many mothers doubt whether to vaccinate their long-awaited baby against tuberculosis, because he is so small, and the vaccine is alive, with possible complications. And although the choice is always only for the parents, everyone should know what they refuse or what they agree to. The BCG vaccine does not 100% protect against tuberculosis, but it significantly reduces the risk of a child getting sick, especially at an early age, when the child's immunity is physiologically imperfect.

   Expected effects of BCG vaccination:

   • reduces the risk of tuberculosis infection;
   • in case of infection, immunity after BCG reduces the risk of active tuberculosis, according to statistics, vaccinated children get tuberculosis 7 times less often than unvaccinated children;
   • if, nevertheless, active tuberculosis has developed, then vaccinated children practically do not get sick with common forms of tuberculosis;
   • rarely, with close and massive contact of a child with a bacterioexcretor or in the presence of immunodeficiency, a vaccinated child can get a common form of tuberculosis, but the effectiveness of treatment for such a child is much higher and the prognosis for complete recovery without major residual changes is much better.
   How is the BCG vaccine given?

   1. Vaccination is carried out only in a medical institution by specially trained medical personnel.
   2. Methods of dilution of the vaccine and the dose of the drug is determined according to the instructions, in different manufacturers they may differ.
   3. The vaccine is injected into the area between the upper and middle thirds of the left shoulder, the skin is pre-treated with 70% alcohol and dried with a sterile cotton swab.
   4. The BCG vaccine is administered only strictly intradermally, with the correct administration, a whitish infiltrate with a "lemon peel" in size from 4 to 7 mm is formed. If the vaccine is not administered correctly, some complications (BCG-itis) may develop.

   What happens after vaccination?

   At the injection site, at first there may be only an injection mark, but on average, after a month, reactions will appear there, and this is normal.

   Normal skin reactions at the injection site of BCG (in order of appearance):

   • speck of red;
   • papule (seal);
   • vesicle (vesicle) and pustule (abscess);
   • crust (yellow);
   • scar (scar).
   The size of these skin elements does not exceed 10 mm. These skin changes should not be touched, treated with ointments, antiseptics, and so on.

   The scar is fully formed 12 months after the first vaccination and 3-6 months after revaccinations.

   How to determine the effectiveness of the vaccination in a child?

   The main indicator of the formation of anti-tuberculosis immunity in a child is the scar that remains at the site of the vaccine. Moreover, statistics have shown that the larger the size of the BCG scar, the higher the effectiveness of vaccination. And if there is no trace left after the vaccination, then after 2 years, subject to negative Mantoux tests, the pediatrician may offer additional BCG vaccination.

   Also, effective vaccination is indicated by a positive Mantoux reaction one year after the vaccination received, this is the so-called post-vaccination allergy , which must be differentiated from infection with tuberculosis.

   What is the BCG vaccine?

   In the former USSR, since the 30s of the last century, the BCG vaccine of Russian production (Stavropol) has been used. Over the years, this vaccine has shown its effectiveness and safety.

   But there is more in the world tuberculosis vaccine manufacturers:

   • Denmark;
   • France;
   • Poland;
   • England;
   • Germany and others.
   All these vaccines differ in their genetics, that is, they are different strains of BCG. Maybe that's why a certain vaccine is more effective in some regions and completely ineffective in others.

   These strains of BCG differ in their virulence (activity), efficacy, and risk of vaccine complications. According to these characteristics, the vaccines of European manufacturers are very similar to each other, and the vaccine Russian production has a number of advantages and disadvantages.

   Comparative characteristics of BCG vaccine strains

   Parameter	European strains of BCG	Russian BCG strain
   Virulence	High	Moderate
   Reactogenicity(ability to elicit an immune response)	High	Moderate
   Efficiency	High	Moderate
   Post-vaccination complications	A very high percentage of complications, in the form of lymphadenitis, 1.5-4% of all vaccinated.	Low probability of complications - only 0.01-0.02% of all vaccinated.
   Price	High price, 20 times higher than the Russian BCG vaccine	Cheap vaccine.

   
   As we can see, the Russian vaccine, although less effective for the prevention of tuberculosis, is much safer than the European one.

   Some countries have already abandoned mandatory mass BCG vaccination, but this is only possible if there is no epidemic in the region. So, in England, BCG vaccination was canceled several times and temporarily resumed when outbreaks of tuberculosis were recorded in the country.

   In our country, it is incorrect to talk about abandoning BCG, because the tuberculosis epidemic is currently in full swing.

   BCG and complications, what are the risks?

   After BCG vaccination, various complications are possible. More common local complications that can be treated at home, but in very rare cases (1: 1000000) are possible severe consequences threatening the life of the child. More often, complications occur during the first vaccination, in newborns or children of the first year of life.

   Possible reasons for the development of a complicated course of BCG vaccination:

   • presence of contraindications during the vaccination, underestimated by doctors or occurring in a latent form;
   • individual feature of the immune system or its insufficiency;
   • genetic predisposition (it happens that the same BCG complications occur in members of the same family, twins);
   • presence of tuberculosis during the formation of anti-tuberculosis immunity BCG;
   • high virulence and reactogenicity of the BCG vaccine strain.
   Let's decide when it is impossible to vaccinate BCG at all.

   Absolute contraindications:

   • HIV infection;
   • congenital immunodeficiency;
   • the entire period of pregnancy and lactation;
   • cases of severe complications of BCG in the family or during a previous vaccination;
   • infection with tuberculosis positive test Mantoux), active tuberculosis, past disease.
   
   

   
   The remaining contraindications are temporary.

   What are the complications after BCG vaccination?

   Type of complication	Cause and pathogenesis	What does it look like	Treatment plan
   "Cold" abscess	It develops 1-8 months after vaccination. The only reason for this complication is deep subcutaneous rather than intradermal administration of the vaccine. Violation of the vaccination technique leads to a specific inflammation of the subcutaneous fat.	An infiltrate (seal) larger than 10 mm, an abscess may form over time and it opens with the release of a grayish-yellow cheesy odorless content. Such an abscess is called cold because it is painless, the skin over it is not hot, and there is no general reaction of the body. The general condition of the child is not disturbed, the child grows and develops according to age. After recovery, a large scar resembling a star forms at the site of the abscess.	A "cold" abscess often resolves or ruptures on its own. But without treatment, it is possible to develop an ulcer around the abscess or spread BCG infection through the lymphatic vessels to the lymph nodes, where lymphadenitis occurs. Treatment plan: hydrocortisone ointment; ointments containing rifampicin and dimexide; suction of pus with a syringe; surgical treatment in the form of opening an abscess (in cases of ineffectiveness of conservative treatment). The course of treatment is on average 1-3 months.
   Lymphadenitis	In situations where the immune system cannot cope with the live vaccine, BCG bacteria enter the regional lymph nodes and cause specific inflammation there, similar to tuberculosis.	This complication develops 2-8 months after vaccination and is the most frequent complication BCG vaccines, especially European strains. Absolutely any group of lymph nodes can be affected, but the regional ones on the left are most often affected: axillary; supra- and subclavian. The lymph node is enlarged in size more than 10 mm, painless, dense, the skin over it is hyperemic or cyanotic. The lymph node often suppurates and can open on its own with the formation of a fistula to the skin (stroke) with the release of a large amount of pus. One or more lymph nodes of one group or even lymph nodes of several groups are affected. The general condition of the child and his development does not suffer. After recovery, on the x-ray and during probing, in most cases, calcifications (such as pebbles) are detected - residual changes.	Treatment of such a complication is mandatory, since without it, other groups of lymph nodes can also be affected. The fistula formed as a result of self-opening of the lymph node does not heal for a long time. Treatment plan: ingestion of anti-tuberculosis drugs : isoniazid and / or rifampicin; pyrazinamide is not used, since the BCG strain is initially resistant to it; outwardly - ointments with rifampicin and dimexide; surgery : opening of suppurated lymph nodes, removal of large calcifications and so on. The course of treatment is 3-6 months.
   superficial ulcer	A rather infrequent complication associated with the spread of BCG infection in the skin, in appearance and nature of inflammation, a superficial ulcer is very similar to skin tuberculosis. The reason is the imperfection of the immune system.	This complication develops 1-3 months after vaccination. At the injection site, sores are formed that merge with each other, the area of ​​the skin lesion has a diameter of more than 10 mm. Moisture, crusts, screenings of rashes are noted. The ulcer may heal on its own with the formation of a large irregularly shaped scar or several scars.	outwardly - sprinkling with isoniazid powder; antibacterial ointments (Levomekol and others); with long-term ulcers and their large surfaces recommended taking anti-tuberculosis drugs (isoniazid and/or rifampicin). The course of treatment is on average 3 months.
   Keloid scar	This complication is associated with an allergic reaction to the vaccine. A keloid scar is an overgrowth of connective tissue.	It develops mainly in adolescents, with the introduction of a vaccine in an unspecified place for this. A few months after vaccination, a seal more than 10 mm in diameter appears at the injection site of BCG, the skin above it is white, cyanotic or not changed. It is manifested by constant itching, burning and pain at the injection site.	injection with glucocorticoids (hydrocortisone); chipping with a solution of lidase; surgical treatment, excision of the scar can lead to its increase and progression.
   BCG osteitis	A rare complication characterized by the spread of the vaccine strain throughout the body into bone tissue.	This complication is also detected 12-18 months after vaccination. It is characterized by specific inflammation of any bones, most often the calcaneus is affected. Main symptoms: pain; movement disorder; fistula formation.	Treatment of this complication is the same as for active tuberculosis, with standard anti-tuberculosis drug regimens. The course of treatment is 12 months. In some cases, resort to surgical treatment.
   Generalized BCG infection	The most severe complication of BCG, associated with the ingestion of the vaccine strain into the blood and its spread throughout the body.	The development of this complication is extremely rare (1:1000000). The course of generalized BCG infection is similar to miliary tuberculosis.	The treatment is the same as for miliary tuberculosis.

   Positive Mantoux reaction in a child, what to do, what to expect?

   At school, they made Mantoux tests for the children, some kind of spot appeared, and they sent them to the TB dispensary. Many parents panic in this situation. But not all positive Mantoux reactions are tuberculosis, in most cases this is just a reason for examination and possible prevention tuberculosis in a child. After all, the Mantoux reaction reveals not only active tuberculosis, but also tuberculosis infection. In an epidemic, almost all adults are infected with tuberculosis and undergo annual preventive fluorography. And in children, the only method of preventive examination for tuberculosis is the Mantoux test. This is a method of early diagnosis, because symptoms often appear only in advanced and common forms of the disease, when it is already too late.

   Let's decide positive Mantoux test- this is the presence of any seal (papules) of 5 mm or more in size or the presence of any bubbles (vesicles) at the site of the sample. If the test is really positive, then you will have to visit a TB specialist.

   What awaits a child in a TB dispensary?

   1. Survey about the presence of contacts with patients with tuberculosis, the presence of complaints, previous diseases, and so on.
   2. Medical examination, primarily assessment of BCG scars, palpation of the lymph nodes, listening to the lungs, and so on.
   3. Grade tuberculin reactions for all years, the presence of BCG vaccinations and definition of risk group on tuberculosis. If the child is really included in this group, then the phthisiatrician prescribes a mandatory minimum examination.
   4. Plain radiograph of the chest cavity.
   5. General blood and urine tests, liver tests.
   6. Evaluation of the results and addressing the need for isoniazid prophylaxis.
   7. Issuing a prescription and a detailed schedule of the rules for taking medications, notification of possible side effects of medications, the appointment of hepatoprotectors (Karsil, Gepabene and others) and B vitamins.
   8. Issuance of a medical certificate with admission to the children's group.
   9. When taking anti-tuberculosis drugs, it is recommended monthly blood and urine tests to control drug tolerance.
   10. If active tuberculosis is detected The child is admitted to hospital for children's department tuberculosis hospital.

   HIV infection and tuberculosis in children, features of combined infection

   1. Tuberculosis is the most common comorbidity in an HIV-infected child.

   2. The HIV epidemic contributes to the tuberculosis epidemic in our time around the world.

   3. Currently, there is a separate epidemic of HIV-associated tuberculosis.

   4. HIV infection and tuberculosis in children and adults always exacerbate each other.

   5. HIV-infected children get TB more often than children without HIV 170-250 times and children with AIDS - 700-800 times.

   6. Children born to HIV-positive mothers also belong to the risk group for tuberculosis and get sick 20-30 times more often than children from healthy mothers, even if they are not infected, because:

   • such children not vaccinated with BCG or are vaccinated late;
   • more often than other children come into contact with tuberculosis patients which parents can become;
   • have imperfect immunity , because mother could give little during pregnancy and feeding;
   • have various pathologies associated with complicated pregnancy (underweight, hypoxic changes, intrauterine infections, and so on).
   7. Difficulties in diagnosing tuberculosis in children with HIV:
   • Complaints of HIV intoxication and tuberculosis are very similar - weight loss, enlarged lymph nodes, weakness, and so on.
   • The x-ray picture of tuberculosis is very similar to other infections that affect children with AIDS - for example, pneumocystis and fungal pneumonia. In HIV-infected patients, it is better to perform CT or MRI of the lungs; a plain radiograph often does not give a proper picture.
   • Very rarely, in children with AIDS, it is possible to identify the causative agent of tuberculosis by laboratory diagnostic methods.
   • The Mantoux test in such children is almost always negative, even in the presence of active tuberculosis.
   8. Features of the course of tuberculosis in children with AIDS:
   • HIV alters immune response to TB , as a result - an atypical radiological, clinical and histological picture.
   • Children with HIV infection have common and severe forms of tuberculosis (miliary, disseminated tuberculosis, tuberculous meningitis).
   • Extrapulmonary forms of tuberculosis are often detected: tuberculosis of peripheral lymph nodes, lymph nodes of the mesentery, nervous system, eyes, and so on.
   • More often they suffer from "closed" forms of tuberculosis.
   • On histological examination The material of the biopsy of the affected organ does not find changes typical for tuberculosis, but with a special staining of the preparation, Mycobacterium tuberculosis is often detected.
   • Children with HIV are more likely to develop chemoresistant forms of tuberculosis.
   9. What happens to HIV during TB?
   In most cases, there is a decrease in the level of T-lymphocytes and an increase in viral load - indicators of the state of the immune system of an HIV-infected person. Regardless of the state of immunity, tuberculosis leads to the transition from the stage of HIV infection to the stage of AIDS.

   10. How to treat HIV-associated tuberculosis in children?

   • Treatment it is desirable to carry out in a hospital setting TB dispensary or department for the treatment of HIV in children.
   • Be sure to carry out tuberculosis therapy in combination with antiretroviral therapy HAART(special therapy for HIV infection, aimed at suppressing the virus, is prescribed for life, allowing a patient with HIV to live a full life).
   • If antiretroviral therapy has not been prescribed before tuberculosis, then it is prescribed no earlier than 2 weeks after the start of anti-tuberculosis treatment.
   • If the child received antiretroviral therapy before tuberculosis , then it is necessary to adjust the HAART regimen with the infectious disease specialist, since some drugs are not compatible with rifampicin.
   • Doses and treatment regimens anti-TB drugs are the same as without HIV.
   • The difficulty in treating these children is poor tolerance a large number of "heavy" drugs.
   11. What are the prognoses for HIV-associated TB?
   • High mortality from HIV-associated tuberculosis is associated with late detection and severe course of these two infections.
   • With the timely commencement of complex therapy, tuberculosis is cured and the immune status of the child is improved.
   • Tuberculosis recurrences are often observed, especially with the progression of HIV, often relapses occur in children who have interrupted antiretroviral therapy.
   12. How to prevent tuberculosis in HIV-positive children?
   • Timely initiation of lifelong antiretroviral therapy the child immediately after being diagnosed with HIV allows you to maintain a good immune status and the ability to resist tuberculosis.
   • Supervision of such children by a phthisiatrician receiving isoniazid prophylaxis at a dose of 10 mg/kg per day for 6 months before the appointment of HAART, and then periodically and according to indications.
   • Periodic examination for tuberculosis (radiography and Mantoux test every 6 months).
   • Regular TB screening of parents (fluorography).
   • BCG vaccination children with HIV absolutely contraindicated.

   Treatment of tuberculosis with folk remedies, risks and benefits.

   In the world, for a long time, a lot of folk methods of treating tuberculosis have been used. And earlier, even before the invention of anti-tuberculosis drugs, in principle, tuberculosis was treated only by these methods. But do not forget what was the mortality rate from tuberculosis. Previously, consumption was considered practically incurable, and almost all the sick died, except for those cases when spontaneous self-healing of tuberculosis was observed, but this happens in some patients even without treatment with folk remedies.

   Modern medicine does not exclude the use of alternative methods of treating tuberculosis, but it is strongly not recommended to use them as the only method of therapy. All these drugs should complement drug anti-tuberculosis therapy, and then at the stage of recovery, and not at the beginning of treatment.

   Why it is impossible to treat tuberculosis only by methods of traditional medicine?

   • There is not a single method, except for a specific drug, effective against Koch's wand;
   • these methods can lead to the death of the patient or start the disease before the appearance of complications of the tuberculosis process, when the effectiveness of drug treatment is significantly reduced;
   • during experiments with folk medicine the patient continues to infect other people;
   • some drugs can harm the body as a whole (for example, badger, bear and other fats can lead to fatty liver).
   Why is it impossible to use traditional medicine methods at the beginning of drug anti-tuberculosis treatment?
   • Tools such as aloe, bee products (honey, propolis, royal jelly) are powerful natural biostimulators of all processes in the body. Therefore, during the period of inflammation, they stimulate the processes of inflammation, and during the period of recovery, the healing processes. Also, these biostimulants can promote the formation of a large amount of connective tissue, which prevents the resorption of tuberculous changes and contributes to the formation of large residual changes in tuberculosis. But when using aloe and honey during the “calming down” of the process, it has a very good effect on the effectiveness of treatment and the reduction of residual changes.
   • Use of fats various "exotic" food animals (dogs, badgers, bears, camels, and so on) with anti-tuberculosis drugs adversely affect the liver. But the use of fats after drug therapy slightly reduces the risk of recurrence of the disease.
   It is also widely suggested to use bear powder , they seem to be resistant to tuberculosis, and their immune cells and enzymes are able to destroy Koch's sticks. I, as a specialist in phthisiatrician, do not know of a single case of recovery at the reception of Medvedka, but there are a lot of cases of advanced tuberculosis against the background of self-treatment with Medvedkas. If you want to drink a bear, drink it to your health, it will not harm, but in parallel with taking the pills recommended for the treatment of tuberculosis, and not instead of them.

   Some recommend steeping earthworms in vodka, drinking water containing nails, eating tar, puppy meat, drinking baby urine, eating wax moths, and many other strange activities. If tuberculosis could be treated so simply, would they massively “poison” all TB patients with pills all over the world for months and years?

   Before deciding which methods to use, folk or official, you need to think a hundred times, because tuberculosis is not a disease that you can joke about and play around with, but it is an infection that belongs to a group of especially dangerous ones.

   Isoniazid indications and side effects

   Isoniazid- this is the most effective drug against Mycobacterium tuberculosis (unless, of course, the stick is not resistant to it). It has a bactericidal effect (that is, it is able to kill the pathogen) only against tuberculosis, it has no effect on other microorganisms.

   Isoniazid is isonicotinic acid hydroside (GINK) and is the most effective in its group.

   Indications for taking isoniazid and how the drug is used in children:

   • prevention in risk groups for tuberculosis (contacts with tuberculosis patients, positive Mantoux reactions, and so on) - 5-8 mg / kg of body weight per day for 3-6 months, a maximum of 0.3 g per day for children weighing more than 40 kg .
   • prevention of tuberculosis in HIV-infected - 10 mg / kg of body weight per day for 6-9 months.
   • prevention of recurrence of tuberculosis in children - 5-8 mg / kg of body weight per day for 3-6 months.
   • treatment of a complicated course of the BCG vaccine - 5-10 mg / kg of body weight for 3-6 months.
   • is included in the treatment regimens for active tuberculosis sensitive to isoniazid.
   Isoniazid can be in the form of tablets, injection, and syrup for children. The entire dose of the drug must be taken in one dose daily.

   Side effects of taking isoniazid:

   1. Violation of the central nervous system(most common complications):

   • dizziness;
   • decreased concentration and forgetfulness;
   • convulsions (may occur with an overdose of the drug or if the patient has epilepsy);
   • peripheral neuritis; .

     7. Side effects from the reproductive system:

     • violation of the menstrual cycle in women, uterine bleeding;
     • gynecomastia in men (growth of the mammary glands);
     • elevated sex drive in men and women.

     After reading in detail the instructions for isoniazid, any normal person will be horrified by the possible side effects. But the harm from using the drug in the proper dose is much less than from refusing it, that is, from untreated tuberculosis. And though side effects drug reactions are not uncommon, and many of them can be prevented.

     How to prevent the development of side effects from taking isoniazid?

     • The drug is better tolerated when taken in evening time before bedtime;
     • isoniazid should be taken after meals and washed down with a glass of liquid, you can milk or juice (but not tea);
     • simultaneous intake of B vitamins helps to eliminate side effects from the nervous system, vitamin B6 (pyridoxine) is an antidote for drug overdose;
     • simultaneous administration of isoniazid with hepatoprotectors (Karsil, Hofitol, Gepabene and others) or essential phospholipids (Essentiale, Livolife and others) significantly reduce the risk of developing toxic hepatitis.

     "Scrofula" in children and tuberculosis, what do they have in common?

     Some children have weeping areas of skin with yellowish-golden scales behind their ears, accompanied by itching and a burning sensation, in the people this disease is called scrofula.

     Many doctors have been arguing for years about the cause of scrofula. Most are inclined to believe that this is a manifestation atopic dermatitis or diathesis, and some insist on a tuberculous cause of scrofula. In general, both of them claim that scrofula is more often allergic manifestations on the skin.

     What is scrofula?

     Sclofuloderma - is the medical term for scrofula. With this pathology, the deep layers of the skin are affected. Nodular areas of inflammation are formed under the skin, which gradually increase and suppurate. Subsequently, pus comes to the surface of the skin - hence weeping. When the pus dries, crusts form.

     How are scrofula and tuberculosis connected?

     Yet the most common cause scrofula in children is diathesis associated with an allergic reaction to food (namely proteins). And tuberculosis is only one of the causes of scrofula.

     Scrofula may be a manifestation of skin tuberculosis or a paraspecific (essentially allergic) reaction to tuberculosis toxins. It has been proven that children suffering from scrofula are more likely to develop active tuberculosis.

     So, if a child has scrofula, it is better to additionally examine him in order to exclude tuberculosis (Mantoux test, x-ray of the lungs, scraping from the skin, followed by a study on tuberculosis).

     Be healthy!
     

Tuberculosis is an infectious lesion of the body, the causative agent of which is a bacterium - the Koch bacillus, named after its discoverer. Symptoms of this disease do not develop immediately, that is, it has incubation period from 3 months to 1 year.

This the disease is characterized by the presence of specific tuberculous formations. In this case, the target organs can be the lungs, kidneys, brain, intestines, eyes. It affects both adults and children.

Children's tuberculosis is especially dangerous, as it is more difficult to tolerate and has a lot of consequences.

The cause of tuberculosis is the contact of a child with a sick person. As a rule, this is one of the family members. The disease is transmitted by airborne droplets, household, alimentary routes, as well as from mother to fetus. Contributing factors can be:

• decreased immunity due to frequent colds, HIV infection, therapy with hormonal, antibacterial drugs;
• lack of active immunity, which occurs if the child has not been given the appropriate vaccination;
• unfavorable social environment.

Disease pathogenesis

Mycobacterium tuberculosis is highly resistant both in the environment and in the human body.

Being covered with a protective shell, the tubercle bacillus can exist in the carrier's body and not cause disease, subject to good immunity.

Invading the human body, mycobacteria first of all enters the lymphatic system, and lymphocytes are the first cells that stand up to fight it. If they do not cope with the task, the pathogen enters the bloodstream and spreads to the organs with the bloodstream.

Settling in the target organ, the pathogen forms a caseous accumulation of cells in the form of a hillock - a granuloma. It differs from granulomas accompanying other diseases by the presence in the center of a necrotic focus, which has the consistency of cottage cheese. When these formations burst, many Koch sticks scatter throughout the body or enter the nearby tissues of the affected organ. The burst formation begins to disintegrate, and then thicken, scar and calcify, that is, become covered with calcium salts.

The first signs of tuberculosis in children

At the beginning of the development, the disease does not cause any symptoms., that is, it is in the prodromal phase. It can last from 6 months to a year.

The only sign may be a positive Mantoux reaction.

After the latent period, the child has the first symptoms of the disease. They are manifested by tuberculosis intoxication:

• decreased activity of the child;
• dizziness, headaches;
• poor appetite, weight loss;
• temperature: against the background of subfebrile condition, temperature flashes up to 39 ° flicker;
• excessive sweating, especially at night. Particularly the palms and feet sweat profusely;
• enlarged lymph nodes of several groups. They are soft and painless.

These primary signs are a manifestation of all types of tuberculosis.

Symptoms

After the stage of tuberculosis intoxication, the primary tuberculosis complex develops. It can form in any organ, but the lungs are most commonly affected.

At the same time, bacteria, choosing the most well-ventilated area of ​​the lungs, accumulate in it and cause an inflammatory focus. It grows, and pathogens move to nearby lymph nodes, causing inflammation there as well. Usually this process develops in children with low immunity. Perhaps its self-healing.

Signs of pulmonary tuberculosis in children in the early stages of the disease are all the same symptoms of intoxication, an increase in body temperature up to 37.5 °. Often the onset of the disease can be confused with a respiratory infection.

Patients develop shortness of breath and cough. Cough in a child with tuberculosis differs in the duration of the course - more than 3 weeks. At the beginning of the disease, it is dry, then it is replaced by wet.

A characteristic symptom is the release of sputum with blood.

Such children are very thin, pale, and their cheeks are burning with a blush. There is a painful gleam in the eyes.

With the involvement of the lymph nodes of the mediastinum and the roots of the lungs, bronchoadenitis develops. The above symptoms are accompanied by pain between the shoulder blades, a rough, wheezing exhalation as a result of compression by enlarged lymph nodes of the bronchi or trachea.

Cough also accompanies this pathology. It is dry and paroxysmal, reminiscent of whooping cough. A venous pattern appears in the upper part of the chest.

Classification by localization

Tuberculosis is a disease that can affect any organ. It all depends on where the mycobacterium gets into the blood stream. Depending on the affected system, there are several types of it.

Tuberculosis pulmonary system , which includes:

1. Primary tuberculosis complex.
2. bronchoadenitis.
3. Tuberculosis of the bronchi, lungs, upper respiratory tract th.
4. Tuberculous pleurisy.
5. Pulmonary tuberculosis:
   • focal- formation in the lung tissue of small areas of damage (within 1 segment);
   • cavernous- a cavity is formed in the lungs without signs of inflammation;
   • fibrous-cavernous. There is a compaction of the cavernous cavity and nearby lung tissues;
   • cirrhotic- lung tissue is replaced by connective tissue, which causes the lung to lose elasticity;
   • disseminated- a severe form of tuberculosis infection, in which multiple focal lesions appear in the lungs. Then the infection with the blood flow, lymph enters other organs;
   • miliary- a type of disseminated tuberculosis, in which multiple foci formed in the lungs are small;
   • infiltrative- characterized by the formation of an area of ​​inflammation in the lung tissue with necrosis in the center;
   • tuberculoma- this is a tuberculous inflammation in a capsule larger than 10 mm.

Symptoms and treatment of pulmonary tuberculosis in children depend on the location and severity of the process. But still, the signs of manifestation are similar to each other: it is a cough, hemoptysis, shortness of breath, chest pain.

Tuberculosis of the meninges . The most common form is tuberculous meningitis. When this occurs, damage to the membranes of the brain. The process is accompanied by severe headaches, mood lability, high fever, vomiting, muscle hypotension.

Tuberculosis of the musculoskeletal system in turn is divided into:

• spinal tuberculosis- the process at the beginning of the disease is limited to 1 vertebra. Therefore, intoxication and pain syndromes are poorly expressed. As the process progresses, the symptoms increase. Appear sharp pains in the spine of a different nature and tension of the vertebral muscles. To reduce pain, a person takes a forced position. His posture and gait change. The chest is severely deformed, curvature of the spine develops;
• tuberculosis of the joints characterized by pain in the affected joint area. The skin above it is dense, hot to the touch, swelling is pronounced. First, there is difficulty in flexion and extension of the joint, then its complete immobility occurs. The general condition is broken;
• bone tuberculosis accompanied by pain in the bones, and, as a result, a violation of the function of the organ. It should be noted that the cause of tuberculosis skeletal system, in addition to general
  causes of tuberculosis, is an overload of the musculoskeletal system.

Tuberculosis of the kidneys . Its symptoms are pain in the back, pain when urinating, blood in the urine, a violation of the general condition.

Lupus. Among children, the most common skin symptom is a tuberculous chancre: first, a reddish seal appears on the skin, which then turns into an ulcer. It is painless, against its background, the lymph nodes located near it become inflamed.

Another type of childhood tuberculosis of the skin is its change in the area of ​​the affected lymph node. The skin over it becomes cyanotic, then ulcerates. Such formations are painless. Small bumps may also appear covering the face and neck. If you press on them, they turn yellow.

Tuberculosis of peripheral lymph nodes in children is accompanied by their painless increase. They are mobile. With an increase in inflammation, they rupture, forming a fistula with purulent discharge. There is hyperthermia up to 40 °, headaches. The submandibular, submental and cervical lymph nodes are most often affected.

Tuberculosis of the intestine accompanied by pain in the abdomen, impaired intestinal motility, stools with blood, hyperthermia. The general condition is also disturbed.

Tuberculosis of the eye causes decreased vision, photophobia, tearfulness. There is blackness or clouding in the eyes, pain.

It is important to know that tuberculosis can occur in an open form, that is, with the release of Koch's bacillus into the environment, and, consequently, with further infection of people in contact with the sick. It can also be in a closed form, in which bacteria do not enter the external space.

Features of tuberculosis in children and adolescents

Tuberculosis for children - an extremely serious disease that leaves behind a number of complications.

Features of the course of tuberculosis in children under 2 years of age characterized by the severity of the process. As a rule, it is generalized. From the primary focus with blood flow, pathogenic microorganisms enter other organs, significantly complicating the child's condition. Such children often develop disseminated, meningeal tuberculosis and even sepsis.

In older children the immune system is improved. It allows you to localize the process, preventing its generalization. They are characterized by tuberculosis of the lymph nodes.

The younger the child, the worse he tolerates the disease. This is due to the peculiarity of the child's body: its immune system is still immature, unformed, because of this, it cannot fully resist the infection.

The next critical age for the development of the disease is adolescence.. It also differs in disseminated forms of infection, with damage to the lungs and brain. This is due to hormonal surges, which lead to an imbalance in the body, and, as a result, a reduced ability to resist the disease.

A form of the disease that occurs only in children is congenital tuberculosis.

Infection of the fetus occurs from a sick mother through the placenta or when the child swallows amniotic fluid. In this case, the causative agents of the disease with the blood flow are primarily transferred to the baby's liver, where the initial focus is formed. pathological process.

These babies are born prematurely.. A month later, the first symptoms of the disease begin to appear: hyperthermia, depression or anxiety. Symptoms of respiratory failure develop very quickly. Often the infection causes inflammation of the membranes of the brain. In this case, there are signs of damage to the central nervous system, tension of the occipital muscles, discharge from the ears.

The most common type of childhood tuberculosis is a lesion of the lung tissue. Tuberculosis of the lungs in children occurs in 80% of cases. Therefore, the appearance of a cough in a child that does not go away within a month, and an increase in temperature should alert parents and become a signal to examine the baby.

The most effective way to prevent tuberculosis is the BCG vaccine. It is a weakened strain of tuberculosis bacillus. Vaccination for newborns is less aggressive. The BCG-M vaccine is used for it. The first tuberculosis vaccine was made in France in the 1920s.

Timing of BCG vaccination:

• carried out in the maternity hospital for newborn babies on the 3-7th day of life;
• RV1 (that is, 1 revaccination) is carried out at 7 years;
• RV2 is administered at age 14 to healthy children.

Immunity after BCG vaccination is formed after 2 months and protects the child from tuberculosis for 4 years. This is especially important for young children, as tuberculosis can become a fatal disease for them.

Vaccination is done in the upper outer third of the shoulder intradermally. First, a slight swelling appears at the injection site. Then it turns into a pustule - a vial of fluid. The pustule bursts, forming a small sore. The ulcer is covered with a crust. After 6 months, a scar forms in its place. He should be 5-8mm. This indicates a successful vaccination.

Sometimes after vaccination there is no trace left. This may indicate innate immunity to the disease.

Complications after the introduction of tuberculosis vaccine can be:

• cold abscess;
• BCGit;
• keloid scar.

Contraindications to BCG:

• if among the contact of the child there are patients with tuberculosis;
• if the mother has HIV infection;
• diseases of the nervous system;
• any acute illness;
• immunodeficiency; neoplasms;
• prematurity; body weight less than 2.5 kg;

Diagnosis of the disease is the Mantoux reaction. This is not a vaccine that protects your child from getting sick. This is an indicator that shows whether the baby is sick or not.

The Mantoux test is placed in the middle third of the forearm.. Tuberculin is administered, which is a filtrate of killed mycobacteria. It contains tuberculoprotein, which acts as an allergen. The drug is administered intradermally, a "lemon peel" is formed at the injection site.

The result is evaluated no earlier than 48 hours later:

• if a seal (papule) less than 5 mm in size has formed at the injection site, this indicates a negative reaction;
• 5 mm-10mm - the reaction is doubtful;
• if the size of the papule is more than 10 mm, then the reaction is considered positive and may be a sign of tuberculosis.

It is advisable not to wet and rub the “button” formed after vaccination.

It should be noted that a positive Mantoux reaction can be observed in healthy children within 1-2 years after BCG.

Contraindications for the Mantoux test:

• hyperthermia;
• allergies in the acute stage;
• convulsions;
• skin diseases;
• quarantine.

Diagnosis and testing for tuberculosis

Diagnosis of the disease is aimed at identifying pathogenic bacteria in the environment of the body, as well as in target organs.

Early identification of the disease helps to cope with it as much as possible. a short time with minimal damage to the body.

Diagnosis of tuberculosis in children is very rarely goes without a Mantoux reaction. It is carried out annually, starting from 1 year of age. It allows you to identify the disease at an early stage of the disease. As well as those people who are carriers of this infection, but do not get sick themselves.

Other research methods include:

1. Fluorography, radiography, tomography.
2. bacteriological method. It consists in identifying the pathogen in various environments of the body. First of all, it is mucus. As well as punctate from the pleural and abdominal cavities, joints, lymph nodes. For analysis, cerebrospinal fluid, the contents of wounds and fistulas, blood, urine can be used. PCR diagnostics is a modern method of bacteriological research. This is a rather sensitive method. A small amount of bacteria is enough to carry it out. Suitable for the study of any body fluids. It consists in identifying the DNA of a bacterium. This procedure is so accurate that it allows you to identify the disease in the negative results of other tests.
3. Bronchoscopy.
4. Biopsy of the affected organ. It is most often performed during diagnostic operations, when other methods are not very indicative. Most often, this is a biopsy of the lymph nodes, as well as lung tissue at the opening of the chest.

Treatment

Treatment of tuberculosis in children rather long. It is aimed at suppressing the development of tubercle bacillus and restoring the affected organ.

Treatment of detected tuberculosis in a hospital is started, when the bacteria are concentrated in the extracellular space. The person is contagious.

1 stage of treatment - taking anti-tuberculosis drugs. These include: rifampicin, isoniazid, pyrazinamide, ethambutol and others. They are the most effective and least toxic. The treatment regimen must contain at least 3 such drugs. Antibacterial therapy is also used.

Also widely used physiotherapy treatments. With exudative and necrotic inflammation, UHF therapy, inhalations, and electrophoresis are indicated. In the future, ultrasound, magnetotherapy, and a laser are used for resorption of infiltrates, tissue repair, and wound healing.

Mandatory application immunostimulating drugs to increase the resistance of the body in the fight against infection.

The patient must maintain an appropriate regimen, eat a balanced diet, lead a healthy lifestyle.

When the stage of the disease passes into a closed form, it is allowed to treat tuberculosis at home under the supervision of a phthisiatrician.

When conservative treatment fails apply surgical methods . This may be the removal of part of an organ or an affected area.

The treatment of tuberculosis is a rather extensive process that requires patience and the correct implementation of all its stages. It is complex, that is, it affects the body from all sides in different ways. It must be remembered that the earlier the disease is detected, the easier and faster it is to cope with it.

Prevention of tuberculosis in children and adolescents

Prevention of tuberculosis for a child begins in the hospital with the first BCG vaccination.

Vaccination is an important, and probably the most important step in preventing the development of the disease. And don't neglect them.

Improving the child's immunity- the second most important stage of prevention. Balanced, fortified nutrition, hardening, correct mode work and leisure - a pledge healthy life baby.

It also plays a role in preventing the development of the disease. early detection infected people and their temporary isolation to prevent infection of a healthy part of the population.

Tuberculosis is a rather complex disease, and, unfortunately, it is highly contagious. Every year, the number of people infected with this disease is growing. That is why so much attention is paid to the prevention of tuberculosis. After all, it is much better to strain the immune system than to endanger the life of a child.

© S.I. Kochetkova, T.N. Tataurova, 2002
UDC 616.24-002.5-053.1/2
Received on January 14, 2002

S.I. Kochetkova, T.N. Tataurova

State Medical Academy, Nizhny Novgorod

A case of congenital tuberculosis in a newborn child

Congenital tuberculosis is rare, but pediatricians and obstetrician-gynecologists should be aware of the possibility of its occurrence in a child. According to the literature, at present there is information about the description of one thousand cases of intrauterine infection of the fetus (Yanchenko E.N., Greimer N.S., 1999).

Infection of the fetus occurs mainly in two ways: hematogenous, transplacental or by ingestion and aspiration of amniotic fluid, mucus from the birth canal infected with Mycobacterium tuberculosis.

With the hematogenous route of intrauterine infection, mycobacteria penetrate from mother to fetus through the umbilical vein, entering the liver, or through the ductus venosus Auranzii into right heart and lungs. An important prerequisite for the hematogenous route of infection is the defeat of the placenta by mycobacteria, however, the vessels of the placenta in a pregnant woman for the most part thrombosed and the fetus is uninfected. The transplacental route of spread of infection is especially likely in disseminated forms of tuberculosis in the mother (with hematogenous outbreaks of tuberculosis in pregnant women). Cases of intrauterine infection are described in hematogenous outbreaks of tuberculosis in pregnant women in the form of exudative pleurisy and spondylitis. With the hematogenous route of infection, the primary affect is formed in the liver with involvement in the process of regional lymph nodes of the hilum of the liver, mesenteric and less often intrathoracic lymph nodes.

In the second way - alimentary - the child becomes infected when the birth canal is infected, most often in women suffering from genital tuberculosis, and therefore they often have infertility, so congenital tuberculosis of this genesis is rare. With latent tuberculosis of the female genital organs, pregnancy proceeds outwardly normally and infection occurs in the last stages of pregnancy or during childbirth. With the alimentary route of infection, the primary focus is formed in the lungs, middle ear, and intestines.

The clinic of congenital tuberculosis is diverse and is determined by the genesis, the nature of the pathological process in the mother, the duration of pregnancy, the massiveness and virulence of the infection.

If infection of the fetus occurs early, the mother has a miscarriage or stillbirth. While maintaining pregnancy, children are born prematurely, with malnutrition. In the absence of contraindications, children are vaccinated with the BCG vaccine. But by the end of the second week, their condition worsens, appetite decreases, lethargy, drowsiness, fever, weight loss, dyspepsia appear, the liver, spleen, peripheral lymph nodes increase, and respiratory failure increases. Jaundice, hemorrhagic syndrome, neurological symptoms are possible.

The diagnosis of congenital tuberculosis is difficult to make. Differential diagnosis is carried out with intrauterine, generalized, mycoplasmal infections, pneumocystosis, sepsis, congenital syphilis, HIV infection.

We present an observation of the disease of a newborn child who died from congenital generalized tuberculosis.

Roman B. was born on 07/03/1999 in maternity hospital No. 4 from the second pregnancy, in urgent delivery. Mother, a gypsy, was not observed in the consultation. Apgar score - 9 points. Condition at birth - satisfactory. Weight - 2850 g, height - 46 cm. Head circumference - 33 cm, chest circumference - 34 cm. Attached to the chest on the 2nd day. The umbilical cord fell off on the 3rd day. 05.07 BCG vaccination was made.

The mother arbitrarily left the maternity hospital on the 4th day after birth. She felt unwell at home, she had a fever.

The child was delivered to the nursery on the 5th day city ​​hospital No. 1 father complained of the child's anxiety and an increase in body temperature up to 38°C. Its mass was 2680 g.

The condition at admission was of moderate severity, the cry was loud, there was a tremor of the limbs. Meningeal symptoms are negative. Skin - with an icteric shade, clean; acrocyanosis, pastosity of the lower abdomen. Peripheral lymph nodes - small, elastic, mobile. Large fontanel - 232 cm, does not bulge, nasal breathing is difficult. Percussion above the lungs - tympanitis, breathing - hard, wheezing was not heard. Respiratory rate - 50 per minute, heart sounds - rhythmic, clean, heart rate - 140 per minute. Belly swollen. Umbilical wound - under the crust. The liver protrudes 2 cm from under the costal arch.

Complete blood count: Hb - 199 g/l; col. pok. - 0.94; er. - 6.3 1012/l; thrombus - 365 109/l; le. - 9.4 109/l; rod-eater. - 14%; segmented. - 53%; eoz. -2%; limf. - 25%; monoc.-8%; ESR - 14 mm/h.

Urinalysis: no color; transparent; complete; protein - 0.099‰, le. - 2-4 in p. sp., cylinders - hyaline.

The Mantoux reaction with 2 TU is negative. Chest X-ray at admission - swelling of the lung fields, a decrease in transparency in the medial sections, against which the pulmonary pattern and the right root are not differentiated.

Bilirubin total - 224 mmol / l, increased due to free - 209 mmol / l; increased ASAT - 1.56 units; AlAT - 1.25 units; LDH - 41.4 units; glutamine transferase - 2.49 units. In blood metabolic acidosis; pH - 7.15; glucose - 5.8 mmol / l.

No microflora was found in blood, urine, and cerebrospinal fluid. Mycobacterium tuberculosis was not isolated from the root of the tongue.

A diagnosis of acute viral infection, hyperbilirubinemia was made. Genesis is not clear. Are celebrated perinatal encephalopathy, acute period; hypertension syndrome.

Treatment was prescribed: cefazolin - 150,000 units. 2 times intramuscularly, immunoglobulin, detoxification therapy, trental, riboxin, cytochrome, choleretic.

The child's condition gradually worsened. WITH

On the 3rd day of hospital stay, he became more restless, the temperature was 38-39°C, in the lungs - moist fine bubbling rales, tachycardia, muffled heart sounds, enlarged liver.

On the 6th day of stay in the intensive care unit, a painful cry appeared, the head tilted back. Examination of cerebrospinal fluid: colorless; transparent; reaction Pandey +; protein - 0.26‰; cytosis 22/3; limf. - 5%; neutral - 1%.

The child's mother was admitted to maternity hospital No. 4 again on 16.07. The woman's condition was critical high fever. A diagnosis of "postpartum endometritis, sepsis, septic pneumonia" was made. X-ray examination of the chest was not performed.

On July 20, an operation was performed - extirpation of the uterus and tubes.

On July 21, the patient died due to symptoms of respiratory and heart failure. Pathological anatomical diagnosis - hematogenous disseminated tuberculosis with lesions of the lungs, liver, spleen, lymph nodes, uterus. Complications - sepsis, septicopyemia, DIC.

On July 23, from the maternity hospital to the children's hospital, it was reported that the mother had died, the pathoanatomical diagnosis was disseminated tuberculosis.

The child's condition, despite intensive detoxification and antibiotic therapy, continued to deteriorate: lethargy, acrocyanosis, high temperature were noted, the liver and spleen were enlarged. Cefobid and gentamicin, hormonal therapy were prescribed.

26.07 was consulted by a phthisiatrician. The Mantoux reaction with 2 TU, repeated X-ray tomography, spinal puncture, examination from the root of the tongue for Mycobacterium tuberculosis were performed.

X-ray conclusion - bilateral pulmonary edema, right-sided pneumonia, segmental atelectasis of the right lung, pneumothorax on the left, cardiopathy. Cerebrospinal fluid analysis: protein 0.85‰; cytosis - 63/3; limf. - 4%; neutral - 16%; reaction Pandey ++++; glucose - 2 mmol / l.

Repeatedly consulted by a phthisiatrician about the alleged etiology of the child's disease, isoniazid 20 mg per 1 kg of body weight, streptomycin, rifampicin in suppositories were prescribed, however, the child's condition progressively worsened and on the 23rd day of hospitalization a lethal outcome occurred with symptoms of increasing respiratory and heart failure .

Clinical diagnosis - intrauterine infection, sepsis, septicopyemia, purulent meningitis, bilateral pneumonia, pulmonary and cerebral edema, ulcerative necrotic enterocolitis, ascites, hepatitis, probably of tuberculous etiology. perinatal encephalopathy.

Pathological anatomical conclusion - congenital hematogenous (transplacental) tuberculosis with lesions internal organs: liver, lungs, lymph nodes, spleen, kidneys, complicated by multiple organ failure. Swelling of tissues, membranes of the brain. Venous plethora and dystrophic changes in parenchymal organs.

Of course, the described case of death of a child from congenital tuberculosis is rare in practice. In this observation, the pregnant woman was not observed in antenatal clinic She had never had an x-ray before. In the maternity hospital, an anamnesis was not collected to determine the risk factors for developing tuberculosis (possible contact with a patient with tuberculosis, complaints and condition during pregnancy). Upon re-admission to the maternity hospital, the diagnosis was "septic pneumonia?" without chest X-ray.

Due to the mother's unidentified diagnosis and the absence of contraindications, the child was vaccinated with the BCG-m vaccine, which accelerated the course of tuberculosis infection.

From the maternity hospital only on the third day it was reported about the death of the mother and the results of the postmortem examination. He was consulted by a phthisiatrician on the 5th day, and specific therapy was prescribed at a second consultation on the 7th day, when the child was in intensive care in an extremely serious condition. The child was referred for pathoanatomical autopsy with a diagnosis of sepsis, intrauterine infection, septicopyemia, bilateral pneumonia, ulcerative necrotic enterocolitis, hepatitis, possibly of tuberculous etiology. Meanwhile, the epidemiological history made it possible to make the diagnosis of congenital tuberculosis a top priority.

The described case vividly illustrates how important it is for pediatricians and obstetricians to remember the possibility of mother and child having tuberculosis in order to take timely measures.

Tuberculosis is a serious infectious disease that frightens many people and makes them constantly undergo tuberculin diagnostics. The fact that Koch's wand can infect not only adults adds to the fear, tuberculosis in children is also not uncommon. Moreover, children's pathology is much more complicated than an adult's, therefore, having noticed its signs in children, parents should immediately consult a doctor. An unformed organism cannot adequately fight back the disease, so the infection affects the tissues of the body faster and more efficiently. To avoid complications of tuberculosis, pathology should be diagnosed as soon as possible and treatment should begin.

Infected children develop various symptoms and signs. The primary tuberculosis complex includes the so-called symptoms of intoxication. While the foci of pathology have not yet become visible, the patient manifests tuberculosis intoxication, and its intensity depends on the severity of the infection. If the bacteria are just beginning to spread throughout the body, then the infectious symptoms of tuberculosis in children are more noticeable.

• general weakness;
• a slight increase in temperature over a long period of time;
• loss of appetite;
• causeless weight loss;
• constant poor health;
• increased sweating;
• development problems;
• pale skin;
• disorders of the autonomic nervous system, which are manifested by increased effusion on the palms and soles of the feet, palpitations, abrupt shifts moods.

Tuberculosis infection in children provokes a weak gradual development of manifestations of intoxication, which distinguishes it from acute respiratory viral infections, which require a little time for strong manifestations symptoms of intoxication.

Previously, pulmonary tuberculosis in children was accompanied by fever in its classic manifestation, but today the disease often occurs without fever.

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• Congratulations! The chances of you being over TB are close to zero.

  But do not forget to also monitor your body and regularly undergo medical examinations and you are not afraid of any disease!
  We also recommend that you read the article on.

• There is reason to think.

  It’s impossible to say with accuracy that you are sick with tuberculosis, but there is such a possibility, if these are not Koch sticks, then something is clearly wrong with your health. We recommend that you go immediately medical examination. We also recommend that you read the article on early detection of tuberculosis.

• Contact a specialist immediately!

  The probability that you are affected by Koch sticks is very high, but it is not possible to make a remote diagnosis. You should immediately contact a qualified specialist and undergo a medical examination! We also strongly recommend that you read the article on early detection of tuberculosis.

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Task 1 of 17

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Does your lifestyle involve heavy physical activity?

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   How often do you have a TB test (eg mantoux)?

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   Do you carefully observe personal hygiene (shower, hands before eating and after walking, etc.)?

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   Are you taking care of your immunity?

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   Have any of your relatives or family members suffered from tuberculosis?

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   Do you live or work in an unfavorable environment (gas, smoke, chemical emissions from enterprises)?

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   How often are you in a damp or dusty environment with mold?

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   How old are you?

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   What gender are you?

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   Have you been feeling very tired lately for no particular reason?

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    Have you been feeling physically or mentally unwell lately?

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    Have you noticed a weak appetite lately?

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    Have you seen a sharp decline in your health lately? abundant food?

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    Have you felt an increase in body temperature for a long time lately?

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    Have you been having trouble sleeping lately?

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    Have you noticed excessive sweating lately?

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    Have you observed yourself recently unhealthy pallor?

One of the very first symptoms to appear is the paraspecific reaction syndrome. Primary tuberculosis in children causes the body to produce special antibodies that cause Koch's bacillus to pass from the blood into the macrophage system. Such cells are located in many human organs, and therefore the symptoms often appear in different parts of the patient's body.

A paraspecific reaction does not appear in the body for long, often such symptoms in children disappear after a couple of months. However, the disappearance of paraspecific reactions does not mean getting rid of the disease, since it takes much more time to treat it.

A real paraspecific reaction is not inflammation due to tuberculosis infection, but the concentration of cells in certain organs, which becomes the result of the tuberculosis pathogen entering the body.

The types of symptoms depend on the location of the TB, the extent of the infection, and the presence of complications. Infection with tuberculosis infection of different organs in children causes different symptoms.

Tuberculosis infection affects the work of the whole organism, but the brunt of the blow goes to the organ on which the infection spreads.

TB has many forms that affect how the disease develops. Depending on the acquired form, there are various features pathologies in children. The pathology of the primary form occurs in the first year after infection, although these terms are very blurred. If the period of development of primary tuberculosis is very short, then most likely the disease destroys the body too quickly. In most cases, harmful bacteria infect the lymph nodes, and the characteristics of the development of pathology depend on the characteristics of this infection, possible complications and duration of treatment.

1. Tuberculosis intoxication is becoming quite common. This form appears when early stages diseases when full-fledged foci of infection have not yet formed in the body. Feeling unwell is accompanied by loss of appetite and a slight but constant increase in temperature in the evening. The patient's mood often changes, heart palpitations and headaches appear. With any manifestations of tuberculous intoxication, the child's body is subject to a detailed study to identify infected areas.
2. Primary tuberculosis complex of the lung. Tuberculosis bacteria enter the lung tissue, forming a small inflammation, which becomes the focus of the disease. Over time, inflammation spreads to the area of ​​intrathoracic lymph nodes. Most often, this form of pathology has good ability to self-healing. The BCG vaccine, which is currently publicly available, is capable of preventing the development of a focus. According to statistics, vaccinated children are less likely to get this form of pathology. Also, in the fight against tuberculous inflammation, natural resistance to the disease is useful.
3. Tuberculous infection of the intrathoracic lymph nodes. Most cases of childhood tuberculosis are infections of the intrathoracic lymph nodes. When a small number of nodes are infected without particularly noticeable symptoms, the pathology passes in an uncomplicated form. During treatment, hyaline appears in the lymph nodes, and dead tissue is replaced by calcareous capsules (calcifications). If the infection proceeds with complications, then the infection passes to nearby areas. In most cases, complications appear when a child is infected in the first years of life. This happens due to incompletely formed organs, undeveloped defense mechanisms, and unformed immunity. The clinical picture of such a disease is expressed quite clearly.
4. Tuberculous bronchoadenitis. The disease spreads to the visceral thoracic lymph nodes. The trachea and bronchial nodes are also infected. With this form of the disease, the lymph nodes of the root of the lung begin to become inflamed. At the beginning of the disease, the child develops intoxication syndromes, and with the development of pathology, the patient coughs in two tones due to compression of the bronchi. Toddlers often experience choking, accompanied by blueness, uneven breathing, swelling of the nasal wings and retraction of the space between the ribs. To make the child feel better, the baby is placed on the stomach, and the infected lymph node is moved forward.
5. congenital tuberculosis. This form is extremely rare, but, nevertheless, such cases are known. Congenital pathology means that the fetus was infected during pregnancy from the mother. In most cases, a woman becomes infected during pregnancy, but sometimes the pathology transferred shortly before pregnancy also affects the fetus. The baby has noticeably shortness of breath, inactivity, loss of appetite, fever, enlarged liver and spleen, and sometimes inflammation of the membranes of the brain and spinal cord.
6. Infiltrative tuberculosis. This form of the disease is secondary, inflammation appears on the lungs with the formation of infiltrates, and the foci undergo caseous decay. The patient suffers from symptoms of intoxication, overheating of the body, intense cough. Additional signs of infiltrative tuberculosis are pain in the side and coughing up blood. Every second patient with such a disease suffers from an acute form of the disease. Asymptomatic development of the disease also occurs, and transitional states are possible between these two options.
7. 
   miliary tuberculosis. This diagnosis is about acute form illness. With miliary tuberculosis, capillaries first of all suffer, and then tubercles appear on the organs, and both the lungs and other organs suffer from such a pathology. Most often this form occurs in adolescents and children, and adults get sick with it much less often. The main symptoms of miliary tuberculosis: moist cough, constant weakness in the body, shortness of breath and fever. These symptoms are intermittent and get worse and then subside.
8. Tuberculous meningitis is characterized by inflammation of the meninges due to the ingress of pathogens into them. This form is one of the forms of extrapulmonary tuberculosis. The symptoms of such a disease appear sharply, and from the beginning of infection until the full formation of the disease, meningitis does not show any signs. With the development of the disease, the patient begins to notice overheating of the body, headaches, vomiting, problems with the cranial nerves, impaired consciousness, and typical symptoms of simple meningitis. The neglected form often causes loss of consciousness and even paralysis.
9. Tuberculosis of the lungs is uncommon in children; most cases are past adolescence at the time of infection. Once in the lungs, the pathogen causes inflammation of the lung tissue. The inflammation causes fever and frequent coughing. Other symptoms depend on the extent and severity of the disease. This form of pathology is difficult to cure, but the timely determination of the presence of the disease will greatly simplify the task. If a very small child becomes infected with pulmonary tuberculosis, then the infectious foci infect other organs of the child.
10. Tuberculosis of unspecified localization is assumed when the patient has tuberculosis intoxication, but no local changes are observed. If doctors do not detect infection in any organs, then it remains only to make such a diagnosis. Most often, this form of the disease is found in children due to the sensitivity of the body to allergic manifestations. Symptoms develop slowly and become chronic. Parents rarely notice the disease in time, so doctors have to treat an already running form. Also, such a diagnosis is possible with incomplete diagnosis of a form of extrapulmonary tuberculosis.
11. Tuberculosis of the musculoskeletal system. Such a disease is always accompanied by pulmonary tuberculosis. The disease affects the growth cartilage and affects the joints and spine. The patient has purulent inflammation, accumulation of pus in the tissues, small but deep wounds, and when squeezing the spinal cord, paralysis is also possible.
12. Kidney tuberculosis is one of the most common forms of extrapulmonary tuberculosis. Infection is carried by the blood in primary tuberculosis. First, the infection affects the medulla, causing cavities and foci of decay, and then moves deep into the kidneys and passes to neighboring organs. After getting rid of the disease, scars remain on the body.

With the development of local tuberculous forms, an exacerbation of paraspecific reactions is observed. Also, pathology has a good potential for self-healing.

With the development of science and medicine, many ways to diagnose tuberculosis have appeared.

1. Mantu test. For this method of diagnosis, the subject is given an injection of tuberculin, which contains a small amount of the strain of the disease. By the reaction of the body, the doctor determines whether the patient's immunity is able to resist tuberculosis. A mantoux test is carried out annually. Good analogue such a tuberculin test is considered diaskintest.
2. Fluorographic study. With the help of special radiation, the equipment shows a multi-layered image of the lungs.
3. X-ray study. When positive results, listed above research methods, prescribe radiography. Such a diagnosis is needed to confirm the diagnosis and determine the form of the disease.
4. bacteriological research. With the help of special equipment, the patient's sputum is examined. In our country, such diagnostics are not particularly popular, unlike in Europe.
5. Bronchoscopy. This procedure is difficult to carry out, but it gives very accurate results, so it is used mainly because of the vague results of other diagnostic methods.

To accurately determine the presence of the disease and its form, it is necessary to go through several methods of diagnosing the disease.

Prevention of tuberculosis in children

Tuberculosis is an unpleasant pathology, and this applies not only to the consequences of the disease, but also to contagiousness. This disease is transmitted in many ways, but the main method of infection is airborne. This feature makes even simple communication with an infected person dangerous.

Of course, it is impossible to completely protect yourself from tuberculosis infection, but there are some preventive measures that will help to significantly reduce the risks of infection.

• carrying out tuberculin tests and vaccinations against tuberculosis;
• conversations about the danger of the disease and talk about the risks of contact with the infected;
• observation of children at risk (living in an area with a large number of infected people or constantly in contact with a sick person);
• providing infected people with conditions for treatment and limiting their contact with healthy children and adults.

BCG vaccination and the Mantoux test are considered the most effective tuberculosis prevention. Some parents, fearing complications after vaccination, refuse to give their children such injections. Such actions endanger not only the health but also the lives of children, and complications are extremely rare and in most cases do not pose a serious threat. Thus, vaccinations do more good than harm, and such measures have already saved many lives.

The causative agent of tuberculosis is Koch's bacillus, which penetrates the human body and begins to slowly destroy the infected system. In most cases, the bacterium enters the body by airborne droplets, but there are other ways for Koch's bacillus to infect a person. The main part of sick children became infected due to communication with a sick person due to the bacteria getting into the air first, and then into the respiratory tract of the child.

• through the digestive system due to food obtained from sick animals;
• infection of the conjunctiva of the eye;
• transmission of the infection to the child from a pregnant woman through the placenta or due to damage to the placenta during childbirth.

There are also reasons that contribute to the development of the disease in children. Most often, it is a weak immune system that allows the infection to develop in the body.

• congenital predisposition;
• chronic infections;
• stressful situations;
• improper nutrition.

The causes of tuberculosis are different, but the risks of infection in children in adverse living conditions are much greater than in children from wealthy families.

Today, the treatment of tuberculosis in children follows several scenarios. The doctor compares the degree of development of the disease, the state of the body and the possible consequences, choosing more suitable way treatment.

There are two types of treatment:

1. Treatment with chemotherapy. If tuberculosis is detected, it is mandatory to take anti-tuberculosis drugs. Often, the patient takes several types of medicines at once, which the doctor selects individually for each patient. The duration of chemotherapy varies depending on the form of the disease, the response of the body and the presence of complications. On average, therapy is carried out for six months, but there are cases when the patient takes medication for several years.
2. IN running forms tuberculosis, drug treatment alone is not enough, and then the patient is subjected to surgical intervention. However, surgical removal of tuberculosis does not replace drug treatment, they complement each other.

Treatment for a child is prescribed only by his doctor. Neglect of a medical appointment leads to a slowdown in recovery, and sometimes nullifies all efforts, so parents are required to follow all the doctor's recommendations. Additional methods of treatment are also possible, if they do not contradict medical prescriptions. So, some parents supplement the treatment with traditional medicine or prayer for tuberculosis.

Quiz: How susceptible are you to TB?

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• Congratulations! Are you OK.

  The probability of getting tuberculosis in your case is no more than 5%. You are a completely healthy person. Continue to monitor your immunity in the same way and no diseases will bother you.

• There is reason to think.

  Everything is not so bad for you, in your case, the probability of getting tuberculosis is about 20%. We recommend that you better monitor your immunity, living conditions and personal hygiene, and you should also try to minimize the amount of stress.

• The situation clearly calls for intervention.

  In your case, everything is not as good as we would like. The probability of infection with Koch sticks is about 50%. You should contact a specialist immediately if you experience first symptoms of tuberculosis! And it is also better to monitor your immunity, living conditions and personal hygiene, you should also try to minimize the amount of stress.

• It's time to sound the alarm!

  The probability of infection with Koch sticks in your case is about 70%! You need to see a specialist if you experience any unpleasant symptoms, such as fatigue, poor appetite, a slight increase in body temperature, because this can all be tuberculosis symptoms! We also highly recommend that you undergo a lung examination and a medical test for tuberculosis. In addition, you need to better monitor your immunity, living conditions and personal hygiene, you should also try to minimize the amount of stress.

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