Tuberculosis. Symptoms, treatment and prevention of tuberculosis in children

It is a chronic infectious disease that affects many internal organs(most often - lungs).

Approximately half of children whose mothers have active tuberculosis develop tuberculosis in the first year of life if they are not vaccinated and treated with antibiotics.

Symptoms

Symptoms of tuberculosis in a newborn are quite pronounced and characteristic . In pulmonary tuberculosis, this is an increase in temperature, poor appetite, drowsiness, difficulty breathing. If other organs are affected, other symptoms also arise: the liver and spleen become enlarged (it is they that filter tuberculosis bacteria), the infected child does not gain weight or gains extremely little (underdevelopment syndrome).

Causes of tuberculosis in newborns

Even in the womb, the fetus can be infected. The same can happen immediately after childbirth when air with infected droplets is inhaled, and during childbirth when infected amniotic fluid is ingested or inhaled.

Diagnostics

If active tuberculosis is suspected in a pregnant woman, she is thoroughly examined. If there is a positive tuberculin test, the child is given an intradermal Mantoux test with tuberculin in the first year of life. It happens that the test result gives a negative result, which may turn out to be a false negative. In this case, if tuberculosis is suspected, a culture of the cerebrospinal fluid is performed, gastric juice and sputum.

Also carried out X-ray examination chest, which shows the infection of the lungs with tuberculosis. To confirm the diagnosis, a biopsy of the lungs, lymph nodes, and pleura is performed.

Treatment of tuberculosis in newborns

Treatment begins with isolating the infected mother from her baby until she is no longer a source of infection. The child is vaccinated with the BCG vaccine against tuberculosis immediately after birth. Unfortunately, vaccination does not guarantee that a child will not get tuberculosis, but it reduces the severity of its course.

Tuberculosis continues to be one of the most common infectious diseases dangerous to all people, especially children and adolescents. The infection affects any organ, often developing into hidden form. You need to know what the first symptoms are, start emergency treatment, as the disease gradually progresses, severe and not always curable types of tuberculosis arise. In many countries of the world, including Russia, children are given BCG vaccination. Parents must understand what its significance is, whether it needs to be done a second time, and in what cases.

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Ways of infecting children with tuberculosis

Tuberculosis bacteria (Koch bacilli) are extremely resistant to conditions external environment. They are capable for a long time to be in the human body in a “dormant” state, when their vital activity is almost completely suspended. In this form, the infection is not sensitive even to the action of anti-tuberculosis drugs.

The active development of bacteria begins if favorable conditions When the human body is weakened, the necessary immune protection is absent. In children, immunity is formed in several stages up to the age of 16, so children from birth are at risk of contracting tuberculosis. In addition, the ease of penetration of infection into children's body explained physiological characteristics organ structures respiratory system. They have worse lung ventilation than adults, the cough reflex is poorly developed, and the glands that produce mucus in the bronchi are underdeveloped, which facilitates the penetration of bacteria.

The infection is spreading by airborne droplets and enters the child’s body as follows:

1. During inhalation of street dust or the air of unventilated rooms, where Koch bacilli enter when a sick person coughs and sneezes. When coughing, bacteria can be detected at a distance of 2 m, and when sneezing - at a distance of up to 9 m. The infection enters the lungs and affects various tissues of the body. You can get infected even in public transport or store.
2. When consuming meat and milk from animals infected with tuberculosis. The spread of bacteria occurs through the esophagus.
3. When contaminated dust gets into the eyes, the infection affects the conjunctiva, lacrimal sacs, from where it spreads to other organs.
4. When contaminated dust is rubbed into the skin or gets into the child's mouth from dirty hands.

Tuberculosis most often affects children living in poor sanitary conditions (dirty, damp, unventilated rooms), lacking nutrition, with weakened physical development. A child living in an area can also become infected. normal conditions but is in contact with a sick person. Tuberculosis is especially dangerous infants, since their disease very quickly acquires active form, which leads to serious consequences.

Classification of tuberculosis

Depending on the stage of development of infection in the body, there are the following types tuberculosis in children:

• primary;
• tuberculosis respiratory organs;
• tuberculosis of other organs (except for nails, teeth and hair, it can affect any organs).

There are early and chronic types of the disease. In children younger age most often occurs primary view. Development more severe forms the disease occurs faster and is more difficult to treat than in older children and adolescents.

The most dangerous for infants are tuberculous meningitis and miliary tuberculosis (damage to the lungs, lymph nodes, kidneys).

Video: Symptoms of tuberculosis in children. Diagnostics

How the disease develops

The appearance of the first symptoms of tuberculosis in children is associated with the entry of mycobacteria into the mucous membrane of the nasopharynx. From here they pass to lymphatic system, where they interact with phagocytes (cells of the immune system that absorb bacteria). However, mycobacteria are capable of multiplying rapidly, and the immune system can't cope with them. Harmful rods enter the bloodstream and spread throughout the body.

First signs in children

During the first 2 months, the body produces antibodies to mycobacteria. During this period, the child exhibits the same symptoms as with acute respiratory infections (slight increase in temperature, cough, increased anxiety). The younger he is, the brighter the manifestations. Despite the illness, the baby remains active.

The Mantoux test for tuberculosis gives a positive reaction, which may indicate infection. Further development The disease depends on the number of bacteria that are in the body. If there are few of them, then the antibodies destroy the bacteria. If the Mantoux test result is positive, the child is thoroughly examined and treated in a specialized hospital.

If there are a lot of bacteria, they continue to multiply, then after about six months the formation of so-called tuberculous tubercles begins (an accumulation of mycobacteria around foci of tissue necrosis). Gradually they merge, and separate areas of tissue damage are formed in the lungs and thoracic lymph nodes. In some cases, the tubercles resolve on their own, and the development of bacteria stops.

But most often the lesions become calcified and become overgrown fibrous tissue, which leads to scar formation. If the focus is completely isolated, bacterial death may occur. Otherwise, the disease goes into a latent (inactive, dormant) form. So-called “primary tuberculosis” occurs. From the moment of manifestation positive reaction For the Mantoux test, the child in this case must be under the supervision of doctors for 1 year and undergo treatment.

If you do not pay attention to the appearance of symptoms of tuberculosis in children (such as fever, cough, weight loss and others), and do not take Mantoux, then over time an active tuberculosis process will begin in various organs(secondary tuberculosis).

Through the stage primary infection most people pass. By the age of 1-12 years, approximately 25-30% of children are infected. By the age of 14, this figure already reaches 50%. By age 30, about 70% of people are infected.

Symptoms of tuberculosis

They appear as a result of poisoning of the body with waste products of mycobacteria, as well as destruction of tissues of various organs.

Intoxication of the body. One of the first signs of tuberculosis is loss of appetite and weight loss. The baby is weakening and lagging behind in development. He has observed increased sweating. The palms and soles of the feet are always damp. The temperature constantly stays around 37.2°-37.5°. There is a rapid heartbeat, pallor with the appearance of an unnatural blush on the cheeks, glitter in the eyes, and a feverish state.

Symptoms of damage to individual organs. These include:

• soreness and swelling of the lymph nodes;
• cough, hemoptysis (with lung damage);
• shortness of breath and chest pain (with damage to the pleura);
• lower back pain and urination disorder (with kidney damage);
• back pain, bone deformation, limitation of movements (in case of spinal disease);
• nausea, vomiting, pain in the navel (if the intestines or lymph nodes located in the peritoneum are affected).

Paraspecific reactions. They are considered to be the first signs of tuberculosis in children. Such signs are conjunctivitis and inflammation of the eyelids, which are accompanied by photophobia and lacrimation. Joint pain occurs, which can easily be mistaken for arthritis. Ring-shaped red spots appear on the skin of the hands, buttocks, legs and other parts of the body.

At hidden current tuberculosis infection can only be determined using the Mantoux test and blood tests. Parents can suspect the presence of tuberculosis in a child based on a combination of the following manifestations:

• a temperature that does not subside for a long time does not exceed 38° (antipyretics do not help);
• cough lasting more than 2 weeks;
• weight loss, lack of appetite, weakness, blue under the eyes, unnatural blush, sparkle in the eyes;
• absence of any reaction of the body to conventional antibiotics.

Are increasing The lymph nodes in various areas of the body. Gradually, from soft and elastic, they become more and more dense. The acute course of tuberculosis resembles the flu or pneumonia in its symptoms.

Manifestations of various forms of tuberculosis in children

Depending on the organ in which the development of tuberculosis infection occurs, there are several forms of tuberculosis that have specific clinical manifestations.

Tuberculosis of the intrathoracic lymph nodes. This disease occurs most often in children. In an uncomplicated course, the infection affects several lymph nodes, and there are no pronounced symptoms. Tuberculosis capsules become calcified, and further proliferation of mycobacteria does not occur. In a complicated form, the infection spreads to neighboring lymph nodes and tissues. This form often affects children under 3 years of age, who have the weakest immunity.

Tuberculosis of the bronchi. As a result of the disease, the passage of air through the bronchi is disrupted, resulting in purulent pneumonia, which often ends in death. If treatment is not started immediately after the onset of symptoms and diagnostic test, will appear irreversible changes in the structure of the bronchi, and the child may become disabled.

Tuberculous pleurisy. This form occurs in children 2-6 years old. Manifests elevated temperature(37.0°-37.5°), shortness of breath and chest pain. At timely treatment recovery begins.

Pulmonary tuberculosis. May appear in the lungs focal tuberculosis(single lesions) or disseminated (in the form of many areas of tissue necrosis). Symptoms of such tuberculosis occur mainly in adolescents 14-16 years old.

Tuberculosis of bones and joints. Leads to the destruction of cartilage in joints, as well as vertebrae. arise purulent inflammation, fistula formation is possible, and paralysis of the limbs may occur due to compression of the nerve endings in the spine.

Tuberculous meningitis. This type of disease is very rare in children who have not received the BCG vaccine. This type of disease is most severe in infants. Convulsions and paralysis occur. A protruding fontanel indicates increased intracranial pressure. The disease is indicated by the postures characteristic of meningitis, which the baby takes due to tension in the muscles of the neck and back.

Tuberculous kidney damage. Occurs in approximately half of primary cases extrapulmonary tuberculosis. The lesion begins with the formation of cavities in the walls of the organ, spreads inward, and progresses to bladder, urinary tract. After healing, adhesions and scars form.

Diagnostics. Mantoux test

The only method for reliable diagnosis of tuberculosis is to check the body's reaction to the Mantoux test (also called the Perquet test). The tuberculin reagent includes a mixture of antigens to tuberculosis bacilli. When it is introduced under the skin or applied to its surface in an organism infected with bacilli or vaccinated with the BCG vaccine, a response occurs allergic reaction for tuberculin. It does not appear immediately, but within 72 hours.

At the site of tuberculin injection, swelling appears and a papule forms. After 3 days, use a ruler to measure the diameter of the seal. A negative test is when the papule is completely absent, and redness of no more than 1 mm in diameter is observed around the injection site.

If the redness is 2-4 mm and there is slight swelling, the test is considered doubtful. If the infiltrate is larger than 5 mm, the test is positive. A positive result does not mean that the child is necessarily sick. He is referred to a phthisiatrician for treatment if there is a patient with tuberculosis in the family or if there is a sharp increase in the papule to 10-16 mm.

A positive result in a child previously vaccinated with the BCG vaccine indicates that the vaccination was successful. If the result is negative, it means the vaccine was of poor quality.

The purpose of such an examination is to confirm the presence of tuberculosis infection or the existence of a risk of disease. In addition, the study allows you to determine whether the child needs to be vaccinated again.

To diagnose tuberculosis, biochemical and immunological tests of blood and sputum, and x-ray examination of organs are also used.

Treatment of tuberculosis

Treatment takes place in 2 stages. To eliminate the symptoms of tuberculosis in children, first intensive course treatment simultaneously with several drugs that suppress the action of both active and dormant mycobacteria. Microorganisms sometimes show resistance to some of them and get used to their action. Therefore, a group of such drugs is used at once.

The second stage of treatment is restorative. Medicines are prescribed to maintain the functioning of the affected organs and prevent the proliferation of remaining microorganisms. Used in treatment vitamin preparations, in some cases - hormonal agents. The patient is recommended to have an increased calorie diet.

Prevention of tuberculosis in children

As Dr. E. Komarovsky emphasizes, there are different kinds preventive measures aimed at combating tuberculosis. Measures that the state should take: high-quality vaccination of children, creation of normal sanitary and living conditions in institutions and in public places, ensuring a decent standard of living and normal medical care. Measures that parents can take: keeping the house clean, teaching the baby to follow the rules of hygiene, strengthening the immune system, hardening, good nutrition, walks in the open air.

How to protect your child from infection if you have a sick relative

All members of the patient’s family, including children, are periodically tested for the presence of mycobacteria in the body. If the risk of disease is high, preventive treatment is carried out. It is necessary to carefully ensure that the patient uses separate dishes (they must be disinfected), household and bath accessories, and has as little contact with children as possible.

In the apartment it is necessary to do it often wet cleaning using antiseptics. In this case, it is especially useful for children to be in the clean mountain air, in a coniferous forest.

Video: Causes of tuberculosis. The role of vaccination

Importance of vaccination

The peculiarity of tuberculosis infection is that even its own antigens cannot cope with it. Immunity to this disease is not produced. Therefore, vaccinating children with the BCG vaccine is of great importance.

Doctors emphasize that universal remedy There is no vaccine that completely protects children from tuberculosis. However, the vaccine protects against the occurrence of the most severe, fatal dangerous forms diseases (disseminated, miliary, tuberculous meningitis).

The vaccine is available in the form of a solution containing live tuberculosis bacilli. It is administered on the 3rd day of the baby’s life, before he has time to enter an unfavorable environment that creates conditions for infection.

Revaccination is carried out only if the Mantoux test subsequently gives a negative result. If the child was not vaccinated with BCG in the maternity hospital (the parents objected or the child was born too weak), then it can be done later, again taking into account the result of the Mantoux test.

After a few weeks, a bubble filled with liquid appears at the injection site, which gradually dries out, leaving behind a scar several millimeters in diameter.

It is important to know: The vaccination site must not be treated with anything, combed, rubbed, or the crust removed from it.

Since live mycobacteria are administered, in rare cases complications arise due to their spread. Such complications may include skin ulceration, enlarged lymph nodes, bone diseases. If signs of tuberculosis appear in a child or any complications after vaccination, you must immediately show him to a doctor and begin treatment with anti-tuberculosis drugs.

Video: Prevention of tuberculosis. Reasons for the increase in incidence

Judging by your diet, you don’t care about your immune system or your body at all. You are very susceptible to diseases of the lungs and other organs! It's time to love yourself and start improving. It is urgent to adjust your diet, to minimize fatty, starchy, sweet and alcoholic foods. Eat more vegetables and fruits, dairy products. Nourish your body by taking vitamins and drinking more water(precisely purified, mineral). Strengthen your body and reduce the amount of stress in your life.

Clinical manifestations Tuberculosis of newborns are nonspecific, but are usually characterized by involvement of multiple organs. The newborn may appear sick in acute or chronic form, and may develop fever, lethargy, respiratory distress, hepatosplenomegaly, or rapid growth failure.

Diagnosis of tuberculosis in newborns

• Culture of tracheal aspirate, gastric lavage, and urine.
• Chest X-ray.
• Skin tests.

All newborns should have a chest x-ray and cultures of tracheal aspirates, gastric lavages, and urine for acid-fast mycobacteria; The placenta should be examined and preferably cultured. Skin tests are not very sensitive, especially initially, but should be done. A biopsy of the liver, lymph nodes, lungs or pleura is necessary to confirm the diagnosis.

Uncomplicated newborns whose mothers have a positive tuberculin skin test, a negative chest radiograph and no signs active disease, you need to conduct careful observation, and also examine all family members. If there is a patient with active tuberculosis in the environment of the newborn after delivery, newborns should be examined if congenital tuberculosis is suspected, as described above. If the newborn is well and active and disease is reasonably excluded by chest x-ray and physical examination, the newborn is started on treatment with isoniazid. Further observation and management are identical to those for asymptomatic newborns. born by women with active tuberculosis, including skin test at the age of 3-4 months.

Treatment of tuberculosis in newborns

Pregnant women with positive tuberculin test. Treatment is carried out for 9 months with additional administration of pyridoxine. Treatment of a pregnant woman who has been in contact with an active form of tuberculosis should be postponed until the end of the first trimester.

Pregnant women with active tuberculosis. Isoniazid, ethambutol, rifampicin in recommended doses during pregnancy did not have a teratogenic effect on the fetus. The recommended duration of therapy is at least 9 months; if the pathogen is drug-resistant, it is recommended to consider infection, and therapy may need to be extended to 18 months. Streptomycin is potentially harmful to the developing fetus and should not be used on early stages pregnancy, unless rifampicin is contraindicated. Breast-feeding possible for mothers receiving therapy and who are not contagious.

Newborns are usually separated from their mothers only if effective treatment mother and newborn is not fully realized. Once the newborn receives isoniazid, separation from the mother is not necessary if the mother (or household contact) is infected with multidrug-resistant mycobacteria or is poorly adherent to treatment (including not wearing a mask if active tuberculosis) and directly observed treatment is not possible. Household contacts should be tested for undiagnosed TB before the infant returns home.

If adherence to treatment can be high enough and there are no patients with tuberculosis in the family (i.e. the mother is on treatment and there are no other sources of infection), the newborn is prescribed treatment according to the regimen: isoniazid - and is discharged home to normal term. Skin testing should be done at 3-4 months of age. If newborns are tuberculin negative, isoniazid is discontinued. If the skin test is positive, a chest x-ray and culture for acid-fast bacilli are performed as described above, and if active disease is excluded, treatment with isoniazid is continued for a total of 9 months. If culture tests for tuberculosis are always given positive results, the newborn will need to be treated for tuberculosis.

In the absence of evidence of tuberculosis infection in the newborn's environment, vaccination of the infant may be considered and isoniazid therapy should be started as soon as possible. BCG vaccination does not protect against exposure to the pathogen and the development of tuberculosis, but provides significant protection against severe and widespread infestation (for example, tuberculous meningitis). BCG vaccination should only be given if the newborn's skin test is negative. Newborns should be monitored for tuberculosis, especially during the first year of life. As is known, the BCG vaccine is contraindicated in patients with immunosuppression and persons with suspected HIV infection. However, in high-risk groups, WHO recommends that HIV-infected, asymptomatic newborns be given BCG vaccine at birth or shortly thereafter.

Newborns with active tuberculosis. For congenital tuberculosis, the Academy of Pediatrics recommends treatment with isoniazid, rifampicin and aminoglycosides (amikacin or streptomycin). This scheme can be changed in accordance with the results of the assessment of the child's condition.

For tuberculosis acquired after birth, the use of isoniazid, rifampicin and pyrazinamide is suggested. Fourth medicinal product- ethambutol. If antibiotic resistance or tuberculous meningitis is suspected, aminoglycosides should be added to therapy. After the first 2 months of treatment, isoniazid and rifampicin are continued until the completion of a 6-12 month course, and other drugs are discontinued. Breastfed infants should also receive pyridoxine.

Tuberculosis - serious illness, which can be fatal in its active state. However, if detected early, you can prevent it from causing any real damage to your baby's health. Find out more about tuberculosis in children, its symptoms, causes and treatment in this article.

Tuberculosis and its types

Tuberculosis is a contagious infection caused by the bacteria Mycobacterium tuberculosis. Bacteria can affect any part of the body, but the infection primarily affects the lungs. The disease is then called pulmonary tuberculosis or basic tuberculosis. When tuberculosis bacteria spread the infection beyond the lungs, it is known as nonpulmonary or extrapulmonary pulmonary tuberculosis.

There are many types of tuberculosis, but the main 2 types are active and latent (latent) tuberculosis infection.

Active tuberculosis- This is a disease that is intensely manifested by symptoms and can be transmitted to others. Latent disease is when a child is infected with germs, but the bacteria do not cause symptoms and are not present in the sputum. This occurs due to the work of the immune system, which inhibits the growth and spread of pathogens.

Children with latent tuberculosis usually cannot transmit the bacteria to others if the immune system is strong. The weakening of the latter causes reactivation, the immune system no longer suppresses the growth of bacteria, which leads to the transition to an active form, so the child becomes infectious. Latent tuberculosis looks like an infection chickenpox, which is inactive and can reactivate years later.

Many other types of tuberculosis can also be either active or latent. These species are named for the characteristics and body systems that Mycobacterium tuberculosis infects, and symptoms of infection vary from person to person.

Thus, pulmonary tuberculosis mainly affects pulmonary system, skin tuberculosis has skin manifestations, and miliary tuberculosis involves widespread, small infected areas (lesions or granulomas measuring about 1 - 5 mm) found in all organs. It is not uncommon for some people to develop more than one type of active TB.

Atypical mycobacteria that can cause disease are M. avium complex, M. fortuitum complex, and M. kansasii.

How does infection occur and develop?

Tuberculosis is contagious and spreads by coughing, sneezing and contact with sputum. Therefore, infection of a child’s body occurs through close interaction with infected people. Outbreaks occur in areas of constant close contact large quantity of people.

When infectious particles reach the alveoli in the lungs, another cell called a macrophage engulfs the TB bacteria.

The bacteria are then transferred to the lymphatic system and bloodstream, moving on to other organs.

The incubation period ranges from 2 to 12 weeks. A child can remain contagious for a long period of time (as long as viable bacteria are present in the sputum) and may remain contagious for several weeks until appropriate treatment is given.

However individuals have a good chance of being infected, but contain the infection and show symptoms years later. Some never develop symptoms or become contagious.

Symptoms of tuberculosis in children

The most common is considered pulmonary form tuberculosis in children, but the disease can also affect other organs of the body. Signs of extrapulmonary tuberculosis in children depend on the location of foci of tuberculosis infection. Infants, young children, and children with weakened immune systems (such as children with HIV) are more at risk of developing the most serious forms of TB, TB meningitis or disseminated TB.

There may be no signs of tuberculosis in the early stages in children.

In some cases, the following first signs of tuberculosis in children occur.

1. Heavy sweating at night. This manifestation of tuberculosis often occurs earlier than others and persists until anti-tuberculosis therapy is started.
2. Increased fatigue, weakness, drowsiness. At first, these symptoms of tuberculosis in children early stage poorly expressed and many parents believe that the cause of their appearance is ordinary fatigue. Parents try to ensure that the child rests and sleeps more, but if the child is sick with tuberculosis, such measures will be ineffective.
3. Dry cough. For the later stages of development of pulmonary tuberculosis (as well as in some cases of extrapulmonary tuberculosis) productive cough when there is expectoration, sometimes with blood. In the early stages, patients develop a dry cough, which can easily be confused with a sign of a common cold.
4. Low-grade fever. This is a condition when the body temperature rises slightly, usually no more than 37.5 ºС. In many children, this temperature remains in the later stages, but generally the body temperature with an advanced process rises to 38 ºС or more.

The first symptoms of tuberculosis in children are almost identical to those in adults, although young patients experience a decrease in appetite and, as a result, weight loss.

Primary pulmonary tuberculosis

The symptoms and physical signs of primary pulmonary tuberculosis in children are surprisingly sparse. When actively detected, up to 50% of infants and children with severe pulmonary tuberculosis have no physical manifestations. Babies with more likely exhibit subtle signs and symptoms.

A nonproductive cough and mild shortness of breath are the most common symptoms of tuberculosis in children.

Systemic complaints such as fever, night sweats, weight loss and activity are presented less frequently.

Some babies have difficulty gaining weight or developing as normal. And this trend will continue until several months of effective treatment have been completed.

Pulmonary signs are even less common. Some infants and young children with bronchial obstruction have localized wheezing or noisy breathing, which may be accompanied by rapid breathing or (less commonly) respiratory distress. These pulmonary symptoms Primary tuberculosis intoxication is sometimes relieved by antibiotics, indicating bacterial superinfection.

This form of tuberculosis is rare in childhood, but can occur in adolescence. Children with cured tuberculosis infection acquired before age 2 years rarely develop chronic recurrent lung disease. It is more common in those who acquire the initial infection after the age of 7 years. This form of the disease usually remains localized to the lungs because the established immune response prevents further extrapulmonary spread.

Adolescents with reactivated tuberculosis are more likely to have fever, malaise, weight loss, night sweats, productive cough, hemoptysis, and chest pain than children with primary pulmonary tuberculosis.

Signs and symptoms of reactive pulmonary tuberculosis in children decrease within a few weeks of onset effective treatment, although the cough may last for several months. This form of tuberculosis can be highly contagious if there is significant sputum production and coughing.

The prognosis is complete recovery if patients are prescribed appropriate therapy.

Pericarditis

The most common form of cardiac tuberculosis is pericarditis - inflammation of the pericardium (heart lining). It is rare among episodes of tuberculosis in children. Symptoms are nonspecific and include low-grade fever, malaise, and weight loss. Chest pain is not common in children.

Lymphohematogenous tuberculosis

Tuberculosis bacteria spread from the lungs to other organs and systems through the blood or lymphatic system. Clinical picture caused by lymphohematogenous spread depends on the number of microorganisms released from the primary site and the adequacy of the patient's immune response.

Lymphohematogenous spread is usually asymptomatic. Although the clinical picture can be acute, it is more often sluggish and prolonged, with fever accompanying the release of microorganisms into the bloodstream.

Involvement of multiple organs is common, resulting in hepatomegaly (enlarged liver), splenomegaly (enlarged spleen), lymphadenitis (inflammation) of superficial or deep lymph nodes, and papulonecrotic tuberculomas appearing on the skin. Bones, joints or kidneys may also be affected. Meningitis occurs only late in the disease. Lung involvement is surprisingly mild but diffuse, and involvement becomes apparent with prolonged infection.

Miliary tuberculosis

The most clinically significant form of disseminated tuberculosis is miliary disease, which occurs when great amount tuberculosis bacteria enters the bloodstream, causing disease in 2 or more organs. Miliary tuberculosis usually complicates the primary infection, occurring within 2 to 6 months of the onset of the initial infection. Although this form of the disease is most common in infants and children early age, it also occurs in adolescents, which is a consequence of a previously caused primary pulmonary lesion.

The onset of miliary tuberculosis is usually severe and, after a few days, the patient may become seriously ill. Most often, the manifestation is insidious, with early systemic signs, including weight loss and low-grade fever. At this time, there are usually no pathological physical signs. Lymphadenopathy and hepatosplenomegaly develop within a few weeks in approximately 50% of cases.

The fever becomes higher and more persistent as the disease progresses, although the chest x-ray is usually normal and respiratory symptoms insignificant or absent. Over the course of several more weeks, the lungs become colonized with milliary infectious deposits, and coughing, shortness of breath, wheezing or wheezing occur.

When these lesions first become visible on a chest x-ray, they are less than 2 to 3 mm in diameter. Small lesions merge to form larger ones. Signs or symptoms of meningitis or peritonitis occur in 20 to 40% of patients with advanced disease. Chronic or recurrent headache in a patient with miliary tuberculosis often indicates the presence of meningitis, while abdominal pain or tenderness on palpation is a sign of tuberculous peritonitis. Skin lesions include papulonecrotic tuberculomas.

Cure for miliary tuberculosis is slow, even with proper therapy. Fever usually subsides within 2 to 3 weeks of starting chemotherapy, but radiological signs illnesses may not go away for many months. The prognosis is excellent if the diagnosis is made early and adequate chemotherapy is given.

Tuberculosis of the upper respiratory tract and hearing organ

Tuberculosis of the upper respiratory tract It is rare in developed countries but is still observed in developing countries. Children with laryngeal tuberculosis have a croup-like cough, sore throat, hoarseness, and dysphagia (difficulty swallowing).

The most common signs of middle ear tuberculosis are painless unilateral otorrhea (fluid discharge from the ear), tinnitus, hearing loss, facial paralysis and perforation (violation of the integrity) of the eardrum.

Tuberculosis of lymph nodes

Tuberculosis of superficial lymph nodes is the most common form of extrapulmonary tuberculosis in children.

The main symptom of this type of tuberculosis is gradual increase lymph nodes, which may last for several weeks or months. When pressing on enlarged lymph nodes, the patient may experience mild to moderate pain. In some cases, in the later stages of the disease there are signs of general intoxication: fever, weight loss, fatigue, intense sweating at night. Coughing is often a symptom of tuberculosis of the mediastinal lymph nodes.

On initial stages disease, the lymph nodes are elastic and mobile, the skin over them looks completely normal. Later, adhesions (adhesions) form between the lymph nodes, and in the skin above them, inflammatory processes. At later stages, necrosis (death) begins in the lymph nodes, they become soft to the touch, and abscesses appear. Severely enlarged lymph nodes sometimes put pressure on neighboring structures, and this can complicate the course of the disease.

Tuberculosis of the central nervous system

Central nervous system tuberculosis is the most serious complication in children, and without timely and suitable treatment it leads to death.

Tuberculous meningitis usually occurs due to the formation of metastatic lesions in the cerebral cortex or meninges, which develops with lymphohematogenous spread of the primary infection.

Tuberculous meningitis complicates about 0.3% of untreated tuberculosis infections in children. This often occurs in children between 6 months and 4 years of age. Sometimes tuberculous meningitis occurs many years after infection. Clinical progression of tuberculous meningitis can be rapid or gradual. Rapid progression occurs more often in infants and young children, who may experience symptoms for just a few days before developing acute hydrocephalus, seizures, and cerebral swelling.

Typically, signs and symptoms progress slowly over several weeks and can be divided into 3 stages:

• 1st stage usually lasts 1 to 2 weeks and is characterized by nonspecific symptoms such as fever, headache, irritability, drowsiness and malaise. There are no specific neurological signs, but infants may experience developmental delays or loss of basic skills;
• second phase usually begins more abruptly. The most common signs are lethargy, rigidity occipital muscles, convulsions, hypertension, vomiting, paralysis cranial nerves and other focal neurological signs. The progressive disease occurs with the development of hydrocephalus, high intracranial pressure and vasculitis (inflammation of blood vessels). Some children show no signs of irritation meninges but there are signs of encephalitis, such as confusion, movement problems, or speech problems;
• third stage characterized by coma, hemiplegia (unilateral paralysis of the limbs) or paraplegia (bilateral paralysis), hypertension, loss of vital reflexes, and ultimately death.

The prognosis of tuberculous meningitis most accurately correlates with clinical stage illness at the time of treatment. Most stage 1 patients have an excellent outcome, whereas most stage 3 patients who survive have permanent disabilities, including blindness, deafness, paraplegia, diabetes insipidus, or mental retardation.

The prognosis for infants is generally worse than for older children.

Tuberculosis of bones and joints

Infection of bones and joints, complicating tuberculosis, in most cases occurs with damage to the vertebrae.

It occurs more often in children than in adults. Tuberculous bone lesions may resemble purulent and fungal infections or bone tumors.

Skeletal tuberculosis is late complication tuberculosis and is very rare since the development and introduction of anti-tuberculosis therapy

Tuberculosis of the peritoneum and gastrointestinal tract

Tuberculosis of the oral cavity or pharynx is quite uncommon. The most common lesion is a painless ulcer on the mucosa, palate or tonsil with enlargement of regional lymph nodes.

Tuberculosis of the esophagus is rare in children. These forms of tuberculosis are usually associated with extensive pulmonary disease and ingestion of infected sputum. However, they can develop in the absence of pulmonary disease.

Tuberculous peritonitis occurs more often in young men and rarely in adolescents and children. Typical manifestations are abdominal pain or tenderness on palpation, ascites (fluid accumulation in abdominal cavity), weight loss and low-grade fever.

Tuberculous enteritis is caused by hematogenous spread or ingestion of tuberculosis bacteria released from the patient's lungs. Typical presentations are small ulcers, which are accompanied by pain, diarrhea or constipation, weight loss and low-grade fever. The clinical picture of tuberculous enteritis is nonspecific and mimics other infections and conditions that cause diarrhea.

Tuberculosis of the genitourinary system

Renal tuberculosis is rare in children because incubation period is several years or more. Tuberculosis bacteria usually reach the kidney through lymphohematogenous spread. Renal tuberculosis is often clinically asymptomatic in the early stages.

As the disease progresses, dysuria (impaired urination), pain in the side or abdomen, and hematuria (blood in the urine) develop. Superinfection with other bacteria is common and may delay the diagnosis of tuberculosis underlying kidney disease.

Tuberculosis of the genital tract is rare in boys and girls before puberty. This condition develops as a result of lymphohematogenous introduction of mycobacteria, although there have been cases of direct spread from intestinal tract or bones. Adolescent girls can become infected with genital tract tuberculosis during a primary infection. Most often involved fallopian tubes(90 - 100% of cases), then the endometrium (50%), ovaries (25%) and cervix (5%).

The most common symptoms are lower abdominal pain, dysmenorrhea ( pain syndrome during menstruation) or amenorrhea (absence of menstruation for more than 3 months). Genital tuberculosis in teenage boys causes the development of epididymitis (inflammation of the epididymis) or orchitis (inflammation of the testicle). The condition usually manifests as unilateral, nodular, painless swelling of the scrotum.

Congenital tuberculosis

Symptoms of congenital tuberculosis may be present at birth, but more often begin in the 2nd or 3rd week of life. The most common signs and symptoms are respiratory distress (a dangerously poor lung function), fever, enlarged liver or spleen, poor appetite, lethargy or irritability, lymphadenopathy, bloating, failure to thrive, and skin lesions. Clinical manifestations vary depending on the location and size of the lesions.

Diagnosis of tuberculosis in children

After obtaining the medical history and physical examination, the next routine test is the Mantoux test. It is an intradermal injection of tuberculin (a substance made from killed mycobacteria). After 48 - 72 hours, a visual assessment of the injection site occurs.

A positive test indicates that the child has been exposed to live mycobacteria or is actively infected (or has been vaccinated); lack of response does not suggest that the child has negative results on tuberculosis. This test may have false-positive results, especially in individuals vaccinated against tuberculosis. False negative results are possible in immunocompromised patients.

Other studies:

• A chest x-ray may indicate an infection in the lungs;
• sputum culture, culture to test bacterial activity. This will also help doctors know how the child will respond to antibiotics.

Treatment of tuberculosis in children

The main principles of treatment of tuberculosis disease in children and adolescents are the same as in adults. Several drugs are used to provide relatively rapid action and prevent the emergence of secondary drug resistance during therapy. The choice of regimen depends on the degree of tuberculosis incidence, individual characteristics patient and the likelihood of drug resistance.

Standard therapy for pulmonary tuberculosis and lesions of intrathoracic lymph nodes in children is a 6-month course of Isoniazid and Rifampicin, supplemented in the 1st and 2nd months of treatment with Pyrazinamide and Ethambutol.

Some clinical trials showed that this regimen offers a high success rate approaching 100%, with an incidence of clinically significant adverse reactions<2%.

A nine-month regimen of isoniazid and rifampin alone is also highly effective for drug-susceptible tuberculosis, but the length of treatment and the relative lack of protection against possible initial drug resistance have led to the use of shorter regimens with additional drugs.

Extrapulmonary tuberculosis is usually caused by a small number of mycobacteria. In general, treatment for most forms of extrapulmonary tuberculosis in children is the same as for pulmonary tuberculosis. Exceptions are bone and articular, disseminated and central nervous system tuberculosis. These infections are treated for 9 - 12 months. Surgery is often necessary for bone and joint disease, and ventriculoperitoneal shunting (a neurosurgical procedure) for central nervous system disease. Corticosteroids are also prescribed.

Corticosteroids are useful in treating some children with tuberculosis disease. They are used when the patient's inflammatory response significantly contributes to tissue damage or organ dysfunction.

There is reasonable evidence that corticosteroids reduce mortality and long-term neurological complications in selected patients with tuberculous meningitis by reducing vasculitis, inflammation and, ultimately, intracranial pressure.

Reducing intracranial pressure limits tissue damage and promotes the spread of anti-TB drugs across the blood-brain barrier and meninges. Short courses of corticosteroids are also effective for children with endobronchial tuberculosis, which causes respiratory distress, localized emphysema, or segmental lung lesions.

Drug-resistant tuberculosis

The incidence of drug-resistant tuberculosis is rising in many parts of the world. There are two main types of drug resistance. Primary resistance occurs when a child is infected with M. tuberculosis that is already resistant to a particular drug.

Secondary resistance occurs when drug-resistant microorganisms emerge as the dominant population during treatment. The main causes of secondary drug resistance are poor adherence to treatment by the patient or inadequate treatment regimens prescribed by the doctor.

Failure to take one drug is more likely to lead to secondary resistance than failure to take all medications. Secondary resistance is rare in children due to the small size of their mycobacterial population. Thus, drug resistance in children in most cases is primary.

Treatment of drug-resistant tuberculosis is successful when given 2 bactericidal drugs to which the infectious strain of M. tuberculosis is susceptible. When a child has drug-resistant tuberculosis, usually 4 or 5 drugs should be administered initially until the susceptibility pattern is determined and a more specific regimen can be developed.

The specific treatment plan should be individualized for each patient according to the results of susceptibility testing. A treatment duration of 9 months with Rifampicin, Pyrazinamide and Ethambutol is usually sufficient for isoniazid-resistant tuberculosis in children. When resistance to isoniazid and rifampicin is present, the total duration of therapy must often be increased to 12 to 18 months.

The prognosis for single- and multidrug-resistant tuberculosis in children is usually good if drug resistance is identified early in treatment, appropriate drugs are administered under the direct supervision of a health care professional, adverse drug reactions do not occur, and the child and family live in a supportive environment.

Treatment of drug-resistant tuberculosis in children should always be carried out by a specialist with specialized knowledge in the treatment of tuberculosis.

Home care for children with tuberculosis

In addition to treatment, children with a disease such as tuberculosis need additional help at home for a speedy recovery. As a rule, isolation becomes necessary if the patient has multidrug-resistant tuberculosis. In such cases, the child may be hospitalized.

For other types of tuberculosis, the drugs work quickly and help the patient get rid of the infection within a short time. You can take your child home and continue treatment.

Here are some home care tips to follow when monitoring a child with an active TB infection:

• Make sure you are giving the medicine in the correct doses as prescribed by your doctor. If there are any adverse reactions, tell your doctor immediately;
• a healthy diet and lifestyle are also necessary to help your child regain the weight he has lost;
• Ask your child to rest as much as possible, as illness can sometimes tire him out.

Prevention

The highest priority of any TB control campaign should be to find measures that interrupt transmission of infection between people through close contacts. All children and adults with symptoms suggestive of tuberculosis, and those who are in close contact with an adult with suspected pulmonary tuberculosis, should be tested as quickly as possible.

BCG vaccine

The only available vaccine against tuberculosis is BCG, named after two French researchers, Calmette and Gerin.

The routes and schedule of administration of BCG vaccines are important components of the effectiveness of vaccine prevention. The preferred method of administration is intradermal injection using a syringe and needle, as this is the only method that accurately measures the individual dose.

Recommended vaccination schedules vary widely between countries. The official World Health Organization recommendation is a single dose given in infancy. But children with HIV infection should not receive BCG vaccination. In some countries, booster vaccination is universal, although no clinical trials support this practice. The optimal age for administration is not known because adequate comparative trials have not been performed.

Although dozens of BCG trials have been reported in different populations, the most useful data come from a few controlled studies. The results of these studies were mixed. Some have shown protection from BCG vaccination, while others have shown no effectiveness. A recent meta-analysis (pooling of results) of published BCG vaccination studies found that BCG vaccine is 50% effective in preventing pulmonary tuberculosis in adults and children. The protective effect for disseminated and meningeal tuberculosis appears to be somewhat higher, with BCG preventing 50–80% of cases. BCG vaccination given in infancy has little effect on the incidence of tuberculosis in adults, indicating that the effect of the vaccine is limited in time.

BCG vaccination worked well in some situations and poorly in others. It is clear that BCG vaccination has had little impact on the final control of TB worldwide, as more than 5 billion doses have been administered, but TB remains at epidemic levels in most regions. BCG vaccination does not significantly affect the chain of transmission, since cases of open pulmonary tuberculosis in adults, which can be prevented by BCG vaccination, constitute a small part of the sources of infection in the population.

The best use of BCG vaccination appears to be the prevention of life-threatening types of tuberculosis in infants and young children.

Tuberculosis in children is not a disease you should take lightly. Whether it is latent or active, you need to take the utmost care of your baby to make sure he receives the necessary treatment and nutrition to fight off the disease-causing bacteria.

You must also support the child morally, since the disease is severe and long-lasting. Your support will help your child fight the disease.