When treating a child infected with tuberculosis. BCG vaccination is the basis for the prevention of tuberculosis in children. Respiratory tuberculosis

Tuberculosis– this is a specific infectious disease, the causative agent of which is Mycobacterium tuberculosis, which can affect absolutely every system and organ of humans and animals, and 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 is a lot of it. Suffering from tuberculosis a large number of people of different ages, gender, status and income in many countries of the world. Some celebrities and very rich people also suffer or have suffered from tuberculosis, they just don’t talk about it, for obvious reasons.

Most people are also surprised that children also get tuberculosis. 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, on public transport - in general, in all conditions. And also in stores when going for sweets, in the park, playing in the sandbox, in children's groups, where teachers can get sick, and when borrowing 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.

Children are very vulnerable to tuberculosis infection due to their unformed, imperfect immunity. Most phthisiology specialists have one opinion: tuberculosis in children can only be defeated if tuberculosis among adults is eliminated. Until this happens, doctors have to carry out enormous organizational work on 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 develops tuberculosis during their lifetime and infects others. A vicious vicious circle is formed, which is very difficult to break. This is probably why tuberculosis has always existed...

Some statistics!

A huge amount of research is being conducted around the world on effective diagnostic methods and effective therapy for tuberculosis with the goal of reducing the burden of tuberculosis in the world. The World Health Organization (WHO) is trying to control tuberculosis in many countries around the world, but at this stage, the epidemic of this infection has been registered in many underdeveloped countries. The parallel epidemic of HIV infection and the prevalence of tuberculosis resistant to anti-tuberculosis drugs add fuel to the fire.

So, every year about 9 million people in the world 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 tuberculosis pathogen in the body without manifestation of the disease itself).

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

Factors contributing to the tuberculosis epidemic:

• the level of the country's economy;
• the spread of alcoholism and drug addiction;
• prevalence of HIV infection;
• 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 ranges from 1 to 10 new cases per year per 100 thousand children (data are presented based on the results of the last 10 years).

In prosperous countries (the countries of the European Union, the USA, Japan), the incidence rate in children is very low, sometimes there are isolated cases, and those are 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 child population. High incidence is also observed in Asian countries (India, China, Philippines, Afghanistan, Vietnam and others).

It is known that 85% of all tuberculosis cases in the world occur in 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 children,
• Moldova - about 20 per 100 thousand child population,
• Russia - on average 15 per 100 thousand children,
• Armenia - on average 10 per 100 thousand children,
• Ukraine and Georgia - from 8 to 10 per 100 thousand child population.

• Tuberculosis is one of the most ancient diseases. Specific tuberculous changes in bones were found in mummies of 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. And March 24 is World Tuberculosis Day.
• People have called tuberculosis consumption since ancient times, this is due to the fact that a patient with this disease “wasters before our eyes” as a result of exposure to prolonged tuberculosis intoxication.


• Tuberculosis affects absolutely all organs and systems of the body. Previously, it was believed that tuberculosis does not affect hair and nails, but in recent years this issue has been studied and the possibility of tuberculosis affecting these structures has been proven.


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


• Treatment of tuberculosis 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 the 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 to fight tuberculosis, and as a thank you to all those who donated, the girls distributed white daisies.

Anatomy of the lungs

Lungs- the respiratory organ, where 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. The air flow during inhalation passes through the upper respiratory tract, then enters the bronchial tree of the lungs and the alveoli. Gas exchange occurs in the acinus, a structural unit of the lung.

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 lung contains two lobes (upper and lower). Tuberculosis most often affects the upper lobes of the lungs.

Each lobe of the lung is divided into segments, the right lung has 10 segments, and the left lung 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- an anatomical formation that connects the lung to the mediastinal organs.

Structure lung root:

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

Mediastinal organs:

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

Pleura

Pleura- This paired organ, which limits the lungs from the chest. The pleura is a kind of two-layer bag. The two layers form a pleural gap between themselves, which normally contains only up to 2 ml of pleural fluid. The leaves represent serosa, 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 Kohn's pores, which connect the pleural cavity with the lungs.

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

Layers of pleura:

• parietal pleura– adjacent to the chest,
• visceral pleura– adjacent directly 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;
• phrenic-mediastinal sinus- the space between the mediastinum and the diaphragm.

Schematic representation of the 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 O chest during breathing, a small amount of fluid in the pleural cavity contributes to the sliding of the pleural layers in relation to each other during breathing;
• lung maintenance in a straightened state.

Intrathoracic lymph nodes

Groups of intrathoracic lymph nodes:

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

The normal size of intrathoracic lymph nodes in adults is from 7 to 10 mm, and in children about 2 mm; they are invisible 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 to humans	Mycobacterium of the human species (Mycobacterium tuberculosis)
		Bovine mycobacterium (Mycobacterium bovis)
		Mycobacterium of intermediate species (Mycobacterium africanum)
		Avian mycobacterium (Mycobacterium avium) causes the disease quite rarely, mainly in HIV-positive patients, and is severe.
What does it look like		Small thin fixed rods ranging in size from 1.5 to 4 microns by 0.4 microns. Conventional gauze and disposable masks are ineffective in contact with Koch bacilli due to the fact that they are very small and penetrate through the pores of medical masks. Effective personal protection when in contact with tuberculosis is carried out using special respirators with 3M characteristics.
Structural features	Cell wall determines the resistance of mycobacteria to various factors.	The cell wall has 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 interaction between the mycobacterial cell and the environment occurs - nutrition, release of toxins. The cell wall contains antigens (exogenous toxins) that cause a delayed-type hypersensitivity immune reaction in the human body and a cord factor that determines the virulence of the mycobacterium (the ability to penetrate the cells of the human body).
Properties of Mycobacterium tuberculosis	Acid resistance, alkali resistance, alcohol resistance	They continue their life activity under the influence of acids, alkalis and alcohol.
	High survival rate in the environment	Mycobacterium tuberculosis is very tenacious and insidious. In a damp, low-light environment, Koch's wand can live for ten years. Lives well in milk. Mycobacterium tuberculosis can live in dust for several months, and they persist for the same amount of time in library dust. Tuberculosis bacilli live in soil for about 2 months, in water for up to 5 months, in animal feces more than a year. Also, Koch's bacillus is quite resistant to freezing and heating; when the sputum of a tuberculosis patient is boiled, the death of mycobacteria occurs only after 5-10 minutes, and under the influence sun rays does not die within 30 minutes.
	Polymorphism (variability, variety of forms)	Several forms of Mycobacterium tuberculosis can be found in the human body at the same time: rod-shaped - the most active; granular, filamentous, coccal – intermediate states of mycobacteria; filterable and L-forms - temporarily inactive, under favorable conditions they are transformed into rod-shaped ones.
	Adaptation to the effects of anti-tuberculosis drugs	At incorrect modes treatment or their poor absorption in the intestine, chemo-resistant forms of tuberculosis often develop, which are not affected by a number of anti-tuberculosis drugs, which significantly worsens the prognosis for curing tuberculosis.
	Disinfection	Disinfection against Mycobacterium tuberculosis is possible only when treated with chlorine-containing disinfectants and during quartz treatment.
	Aerobic capacity	For the life of mycobacteria, in most cases, oxygen is necessary, but under anaerobic conditions (lack of oxygen) they will also feel good. Therefore, mycobacteria can also be classified as facultative anaerobes.
Reproduction	Reproduction occurs through cell division	They multiply very slowly, one division lasts up to 18 hours (for comparison, the division of staphylococci lasts about 10 minutes on average). For the proliferation of mycobacteria, in addition to time, a temperature regime is also required - optimally 37 o C.
Growth on nutrient media		Egg-based solid Löwenstein-Jensen medium. It grows for a long time, for 2 to 3 months. Dry, wrinkled, yellowish colonies (R-forms) are detected; sometimes moist, smooth colonies (S-forms) can be seen.
		Liquid agar-based medium is used for inoculating mycobacteria in the BACTEK apparatus. It grows in 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:

   • For tuberculosis of the lungs and upper respiratory tract - during coughing, sneezing, talking, using dishes, kissing, etc.;
   • In case of skin tuberculosis - contact with areas of skin affected by tuberculosis, 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 contact and items of clothing and household items;
   • In intestinal tuberculosis, Mycobacterium tuberculosis is detected in feces;
   • With tuberculosis of the genitourinary system, Koch's bacillus is detected in urine and vaginal discharge.
   • With isolated tuberculosis of the nervous system and eyes, the release of mycobacteria does not occur at all.
2. Animals with tuberculosis(especially large cattle, Guinea pigs, dogs, cats and other rodents can suffer from tuberculosis) the causative agents of tuberculosis are also isolated:
   • with feces,
   • with milk and meat.

Routes of transmission of tuberculosis

1. Airborne path– the main route of infection of tuberculosis in children and adults. In this case, infection occurs directly through contact with a patient with active pulmonary tuberculosis during sneezing, coughing, talking, or deep breathing.


2. At air-dust path tuberculosis infection occurs less frequently. As mentioned above, mycobacteria are especially tenacious in the environment and persist for a long time in dust. By inhaling dust particles to which Koch's bacillus has stuck, tuberculosis infection can occur in both children and adults.


3. Nutritional route– also an infrequent route of infection with tuberculosis, Mycobacterium tuberculosis enters the human body through the mouth with milk, meat from sick animals that have not undergone proper heat treatment, when using untreated dishes (in cafes and restaurants, dishes are rarely boiled or treated with disinfectant solutions). If hand hygiene is insufficient after contact with objects on which Koch sticks remain (for example, after traveling in transport, an elevator, playing in the sandbox, contact with banknotes and coins), tuberculosis infection can also occur. The nutritional route of infection is more common in children, since dirty hands and mouths are normal for them, and the intestinal immunity of children is imperfect.


4. Transplacental route– transmission from mother to child during pregnancy due to the strong placental barrier is rare. This is possible if the genital organs are affected by tuberculosis, disseminated (widespread) tuberculosis, subject to a violation of the placental barrier (for example, partial placental abruption). In this case, the child is already born with manifestations of congenital tuberculosis. Congenital tuberculosis in children is extremely severe with extensive liver damage and is often fatal. 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 disrupted 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 way– a combination of ways that tuberculosis bacilli enter the human body. More often found in the focus of tuberculosis infection.

Causes of tuberculosis in children

Risk factors for tuberculosis incidence in children

1. Epidemiological factors(the presence of obvious contact of the child with a person or animal with active tuberculosis, consumption of milk or meat from a sick animal);
2. Medical and biological factors:
   • The child is not vaccinated against tuberculosis with BCG in countries with an unfavorable situation with tuberculosis;
   • Infection with tuberculosis in early childhood positive and hyperergic reactions of the Mantoux or Diaskintest test (specific tests for tuberculosis);
   • Genetic predisposition– presence of tuberculosis in relatives of older generations;
   • 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 sports, abortion or childbirth, etc.);
   • Presence of concomitant diseases:
     • chronic diseases of the upper respiratory tract (chronic rhinitis, sinusitis, adenoiditis, tonsillitis and others),
     • chronic lung diseases (bronchial asthma, frequent bronchitis and pneumonia, pulmonary form of 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 of the blood and other organs, conditions requiring long-term use glucocorticosteroids and others medicines, which reduce immunity - cytostatics),
3. Social factors:
   • Unbalanced, incorrect, irregular nutrition of the child;
   • alcoholism or drug addiction in the child’s parents, bad habits (including smoking) in the children themselves;
   • stay of the child’s parents in prison;
   • homeless children;
   • children from shelters, boarding schools and other closed children's groups;
   • large families and low-income families;
   • children who arrived from countries with an unfavorable situation with tuberculosis (Africa, some countries in Asia and other regions) and children who have changed climate.

What determines the risk of infection with tuberculosis?

• the presence of a source of tuberculosis and the child’s microorganism;
• the degree of bacterial excretion of Mycobacterium tuberculosis at the source of infection and the degree of close contact;
• the presence of at least one of the risk factors in the child that contribute to a decrease in protective forces against tuberculosis;
• the age of the child (the younger, the greater the risk of getting sick; adolescence is also a dangerous period during hormonal changes)
• duration of contact with the tuberculosis pathogen;
• virulence of the pathogen itself (mycobacterial activity, ability to cause disease);

How does tuberculosis become infected and contracted in children?

Latent tuberculosis infection is characterized by:

• availability positive reaction for tuberculin (Mantoux test or Diaskintest), which shows the presence of anti-tuberculosis immunity,
• absence of clinical manifestations of tuberculosis,
• absence of changes during radiography and other types of studies for tuberculosis,
• preserved immunity.

Pathogenesis and mechanism of tuberculosis infection

1. Contact of the tuberculosis pathogen on the mucous membranes of the upper respiratory tract, tonsils, where immune cells (lymphocytes, macrophages, monocytes and other phagocytes) enter into a protective reaction and phagocytize (absorb) them, at this stage, provided there is good immunity and a small number of microbes, tuberculosis infection may not occur. Otherwise, Koch bacilli enter the lungs.
2. Entry of Mycobacterium tuberculosis into the alveoli of the lungs.
3. Penetration of bacteria through the walls of the alveoli, no specific changes occur in them.
4. Entry of mycobacteria into the lymphatic tract and lymph nodes where they reproduce. The infection can remain in the lymphatic system 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 continue for about 2 weeks, the tuberculosis pathogen does not multiply in the blood.
6. Spread of infection by tissues and organs of the body. In this case, primary tuberculosis disease or latent tuberculosis infection may develop.

   Mycobacterium tuberculosis can also penetrate into the lymphatic tract 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 the mycobacteria a specific tuberculous tubercle (granuloma) is formed, which consists of cheesy necrosis (caseosis) and perifocal inflammation.
8. Status 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 turns 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, reversion of Mycobacterium tuberculosis occurs - the transition of L-forms to rod-shaped forms.

Depending on the mechanism of tuberculosis disease, the following 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 developed as a result of the 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– growth lymphoid tissue;
• Granulomatous stage– the appearance of a tuberculous tubercle, epithelioid giant cells of Pirogov-Langhans (an indicator of tuberculosis, present in almost all cases of tuberculosis, may not be present in miliary tuberculosis and tuberculosis in HIV - positive people);
• Exudative stage– a large number of vessels are involved in the process, a large amount of fluid is formed, for example, the occurrence of pleurisy.
• Caseosis stage– caseous (cheesy) necrosis, in which destruction of the tissues of the affected organ occurs, for example, during the formation of a cavity. And when the tuberculosis process destroys the walls of blood vessels, a complication of tuberculosis may develop - such as hemoptysis or pulmonary hemorrhage;
• Stage of pus formation– a large number of epithelioid giant cells, neutrophils and lymphocytes are detected, massive destruction of the tissues of the affected organ is observed, for example, with 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)– connective tissue with a few small cellular elements is detected. In this case, scarring of tuberculous changes occurs, that is, healing of the affected organ, this stage is present in any form of the tuberculosis process, tuberculosis does not go away without a trace, residual changes in the form of fibrosis are always formed ( connective tissue, which replaces areas of normal organ tissue or adhesions).

1. Infiltration phase– fresh tuberculous changes with progression of tissue damage;
2. Lung tissue breakdown phase– formation of destructions (cavities);
3. Compaction phase– reverse development of the tuberculosis process during treatment or spontaneous recovery;
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 types A, M, G are formed.

Incubation period of tuberculosis– from 2-3 months to several dozen years.

Types of tuberculosis in children

• Tuberculosis without bacterial excretion or “BK-” when examining the patient’s sputum (microscopy and culture), tuberculosis pathogens were not identified,
• Tuberculosis with bacterial excretion or “BK+” - tuberculosis bacilli are detected in the patient’s sputum.

• Active tuberculosis –“Fresh” changes are detected; there are signs of the vital activity of Mycobacterium tuberculosis. On radiographs, active tuberculosis has a lower intensity, and in dynamics it gives positive or negative dynamics. In the clinic - the presence of intoxication and chest symptoms.
• Inactive tuberculosis – residual changes after tuberculosis (RTB). Active tuberculosis may become inactive as a result of anti-tuberculosis therapy or spontaneous cure (self-healing of tuberculosis). Spontaneously cured tuberculosis is often detected during medical examinations. Special treatment Such inactive tuberculous changes do not require monitoring; they must be monitored at least once a year and when any symptoms appear. On radiographs, inactive changes are highly intense, may contain calcium inclusions, and do not change in dynamics even after several years.

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

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

1. Sensitive tuberculosis– the tuberculosis bacillus does not have resistance (resistance) to any of the anti-tuberculosis drugs.
2. Chemoresistant tuberculosis– the mycobacterium that causes this disease is resistant to at least one of the drugs. In recent years, the number of cases of chemo-resistant tuberculosis has been increasing in geometric progression, including among children. Depending on which anti-tuberculosis drugs the Koch bacillus is resistant to, the types of chemo-resistant tuberculosis are distinguished:
   • Monoresistant (to any one drug),
   • Multidrug-resistant – resistance to several anti-tuberculosis drugs,
   • Multidrug-resistant tuberculosis (MRTB) is a combination of drugs including isoniazid and rifampicin,
   • Extensively drug-resistant tuberculosis (XDR) is resistance to isoniazid, rifampicin, aminoglycoside and fluoroquinolone. The most severe form of tuberculosis with a poor prognosis.

It is not always possible to obtain the pathogen itself in children, so chemo-resistant tuberculosis in children can be suspected based on the presence of resistance in the patient in the environment of the child, from whom the baby most likely became infected.

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

Tuberculosis of unspecified localization

The symptoms of this form of tuberculosis increase gradually and are chronic. In most cases, parents do not notice changes in the child’s condition, so this form of tuberculosis in children is diagnosed extremely rarely, although the disease itself is common. It is difficult for parents to explain that the child is suffering from tuberculosis without visible changes, because the only confirmation of tuberculosis is positive tests for tuberculin (Mantoux test and Diaskintest). But if this condition is not treated, tuberculosis can develop into a widespread, more severe form. 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 large amounts of tuberculosis exotoxin, which affects all organs and systems. Also, a diagnosis of tuberculosis of unspecified localization can be made if extrapulmonary tuberculosis is insufficiently diagnosed, because tuberculosis affects absolutely all organs and tissues.

Respiratory tuberculosis

1. Tuberculosis of intrathoracic lymph nodes– one of the most common primary forms of tuberculosis in children early age. Single intrathoracic lymph nodes or all groups of lymph nodes on one or both sides may be affected. It is severe in young children, as significant compression of the bronchi by enlarged intrathoracic lymph nodes is possible.

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

   • Small form tuberculosis of the intrathoracic lymph nodes - often asymptomatic, has a favorable course. With this form of tuberculosis, a slight increase in single lymph nodes occurs; the hyperplastic and granulomatous stages of inflammation predominate in them. It is difficult to diagnose; this pathology can be missed on ordinary radiographs; it is better visible on computed tomography sections.
   • Infiltrative form – the lymph nodes are enlarged in size from 10 to 20 mm, while the granulomatous and exudative phases of inflammation predominate, and slight compression of the bronchi occurs.
   • 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 (collapse 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 the intrathoracic lymph nodes. The pulmonary fields are without visible pathological changes; there is an expansion of the root of the lungs on the right due to an increase in the 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 (subject to timely adequate treatment), but it can also occur with complications in the form of obstruction of bronchial tubes. With the primary tuberculosis complex, vivid manifestations of symptoms of tuberculosis intoxication are often observed.

   Components of the primary tuberculosis complex:

   • Lymphadenitis– damage to one or more intrathoracic lymph nodes,
   • Lymphangitis– damage to the lymphatic vessel,
   • Primary affect- damage to a section of the lungs.
   These components are interconnected with each other.

   Survey X-ray of the chest organs of a 3-year-old child. Diagnosis: bilateral primary tuberculosis complex. The x-ray shows foci of infiltration in the upper lobes of both lungs associated with enlarged lung roots (enlarged lymph nodes).



3. Focal pulmonary tuberculosis can be either primary or secondary. It usually occurs in children over the age of 10 years, especially often in adolescents. It is characterized by the appearance of foci of tuberculous inflammation in one of the lungs, limited to no more than two segments of the lungs, the size of which is less than 10 mm. The favorite place for lesions is the apex of the lungs. In pathogenesis focal tuberculosis highest value the granulomatous phase of inflammation with slight exudation plays. There may be no symptoms of intoxication with this form of tuberculosis; most often, foci are found during preventive examinations. This is one of the most favorable forms of tuberculosis.

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



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

   A survey X-ray of the chest organs and some computed tomography sections of the upper lobes of the lungs of a teenager. Diagnosis: infiltrative tuberculosis of the upper lobe right lung with destruction and contamination. In the upper lobe of the right lung there is a small infiltrate with destruction of lung tissue and low-intensity foci around. These X-ray studies clearly demonstrate the advantage of a computed tomograph over conventional radiographs.



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

   Plain X-ray of the chest organs of a 10-year-old child with severe HIV-associated tuberculosis. Diagnosis: Disseminated tuberculosis of both lungs. Throughout all fields of the lungs, multiple foci of varying 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 forms of tuberculosis. It is often a manifestation of primary tuberculosis in childhood and develops immediately after massive contact with tuberculosis patients. Children suffer from this form of tuberculosis in an average of 10% of cases; adolescents are more often affected.

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

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

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

   Expected effects from BCG vaccination:

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

   1. Vaccination is carried out only in a medical institution by specially trained medical personnel.
   2. Methods for diluting the vaccine and the dose of the drug are determined according to the instructions; they may differ from different manufacturers.
   3. The vaccine is injected into the area between the upper and middle third 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; when administered correctly, a whitish infiltrate with a “lemon peel” measuring from 4 to 7 mm is formed. If the vaccine is administered incorrectly, some complications (BCG-itis) may develop.

   What happens after vaccination?

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

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

   • red speck;
   • papule (seal);
   • vesicle (vesicle) and pustule (abscess);
   • crust ( yellow color);
   • scar (scar).
   The size of these skin elements does not exceed 10 mm. These skin changes cannot 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 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 vaccine administration. Moreover, statistics have proven that what larger sizes scar BCG, the higher the effectiveness of vaccination. And if after the vaccination there is no trace left, then after 2 years, subject to negative Mantoux tests, the pediatrician can offer additional vaccination BCG.

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

   What type of BCG vaccine is there?

   IN former USSR Since the 30s of the last century, the BCG vaccine produced in Russia (Stavropol) has been used. Over the years, this vaccine has shown its effectiveness and safety.

   But there is more in the world Manufacturers of tuberculosis vaccine:

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

   These BCG strains differ in their virulence (activity), effectiveness and risk of vaccine complications. According to these characteristics, vaccines from 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 strain of BCG
   Virulence	High	Moderate
   Reactogenicity(ability to provoke 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 people.	Low probability of complications - only 0.01-0.02% of all vaccinated people.
   Price	High price, 20 times higher than the Russian BCG vaccine	Cheap vaccine.

   
   As we can see, the Russian vaccine, although less effective in preventing 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. Thus, 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, which can be treated at home, but in very rare cases (1:1000000) are possible severe consequences threatening the life of a child. More often, complications occur during the first vaccination, in newborns or children in the first year of life.

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

   • presence of contraindications during vaccinations, underestimated by doctors or occurring in a hidden form;
   • individual characteristics of the immune system or its insufficiency;
   • genetic predisposition (it happens that the same complications of BCG occur in members of the same family, twins);
   • presence of tuberculosis contact during the formation of anti-tuberculosis immunity with BCG;
   • high virulence and reactogenicity of the BCG vaccine strain.
   Let's decide when you can't get a BCG vaccination 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 previous vaccination;
   • infection with tuberculosis (positive Mantoux test), active tuberculosis, past disease.
   
   

   
   Other 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	Develops 1-8 months after vaccination. The only reason this complication– deep subcutaneous rather than intradermal administration of the vaccine. Violation of the vaccination technique leads to specific inflammation of the subcutaneous fat.	An infiltrate (compaction) larger than 10 mm in size; over time, an abscess can form and open, releasing an odorless grayish-yellow curdled content. Such an abscess is called cold because it is painless, the skin over it is not hot, and there is no general reaction body. General state the child is not impaired, the child grows and develops according to his age. After recovery, a large scar resembling a star forms at the site of the abscess.	A “cold” abscess often resolves or opens on its own. But without treatment, it is possible to develop an ulcer around the abscess or spread the 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 the 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 common complication of the BCG vaccine, especially European strains. Absolutely any group of lymph nodes can be affected, but most often the regional ones on the left are 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 bluish. The lymph node often suppurates and can open on its own, forming a fistula to the skin (passage) 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 do not suffer. After recovery, radiographs and palpation in most cases reveal calcifications (like pebbles) - residual changes.	Treatment of such a complication is mandatory, since without it other groups of lymph nodes may be affected. A fistula formed as a result of independent opening of a 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; externally – ointments with rifampicin and dimexide; surgery : opening of suppurative lymph nodes, removal of large calcifications, and so on. The course of treatment is 3-6 months.
   Superficial ulcer	A fairly uncommon 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 site of vaccine administration, ulcers form, merging with each other, the area of ​​​​the skin affected has a diameter of more than 10 mm. Weeping, crusting, and dropouts of rashes are noted. The ulcer may heal on its own, forming a large, irregularly shaped scar or several scars.	externally – sprinkling with isoniazid powder; antibacterial ointments (Levomekol and others); recommended for long-term ulcers and large surface areas 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, when the vaccine is administered in an unspecified place. A few months after vaccination, a compaction more than 10 mm in diameter appears at the site of BCG injection, the skin above it is white, bluish or unchanged. It manifests itself as constant itching, burning and pain at the injection site.	injection with glucocorticoids (hydrocortisone); injection with lidase solution; surgical treatment and excision of the scar can lead to its enlargement and progression.
   BCG osteitis	A rare complication characterized by the spread of the vaccine strain throughout the body into the bone tissue.	This complication is also detected 12-18 months after vaccination. It is characterized by a specific inflammation of any bones; the heel bone is most often affected. Main symptoms: pain; movement disorder; fistula formation.	Treatment of such a complication is the same as for active tuberculosis, with standard anti-tuberculosis drug regimens. The course of treatment is 12 months. In some cases, surgical treatment is resorted to.
   Generalized BCG infection	The most severe complication of BCG is associated with the entry of the vaccine strain into the blood and its spread throughout the body.	The development of this complication is extremely rare (1: 1,000,000). The course of generalized BCG infection is similar to miliary tuberculosis.	Treatment is the same as for miliary tuberculosis.

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

   At school they gave the children Mantoux tests, a speck appeared, and they sent them to a tuberculosis clinic. Many parents begin to panic in such a situation. But not all positive Mantoux reactions are tuberculosis; in most cases, this is just a reason for examination and possible prevention of tuberculosis in a child. After all, the Mantoux reaction reveals not only active tuberculosis, but also tuberculosis infection. During the 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 widespread forms of the disease, when it is too late.

   Let's decide positive Mantoux test- this is the presence of any compaction (papules) measuring 5 mm or more 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 phthisiatrician.

   What awaits a child at the TB dispensary?

   1. Survey about the presence of contacts with tuberculosis patients, the presence of complaints, previous diseases, and so on.
   2. Medical examination, first of all, assessment of BCG scars, palpation of lymph nodes, listening to the lungs, etc.
   3. Grade tuberculin reactions for all years, the presence of BCG vaccinations and identification of risk group on tuberculosis. If the child really belongs to this group, then the TB doctor prescribes a mandatory minimum examination.
   4. Survey X-ray of the chest organs.
   5. General blood and urine tests, liver tests.
   6. Evaluation of the results obtained and deciding on the need for isoniazid prophylaxis.
   7. Issuing a prescription and a detailed description of the rules for taking medications, notification of possible side effects of medications, the prescription of hepatoprotectors (Karsil, Gepabene and others) and B vitamins.
   8. Issuance of a medical certificate with admission to the children's team.
   9. Recommended while taking anti-tuberculosis drugs monthly blood and urine tests in order to control drug tolerance.
   10. If active tuberculosis is detected the child is sent for inpatient treatment to the children's department of the tuberculosis hospital.

   HIV infection and tuberculosis in children, features of combined infection

   1. Tuberculosis is the most common concomitant pathology of an HIV-infected child.

   2. The HIV epidemic is contributing to the tuberculosis epidemic throughout the world today.

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

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

   5. HIV-infected children suffer from tuberculosis 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 do not get vaccinated with BCG or are vaccinated late;
   • more often than other children come into contact with tuberculosis patients who parents can become;
   • have imperfect immunity , because mother could give little during pregnancy and lactation;
   • have various pathologies associated with complicated pregnancy (underweight, hypoxic changes, intrauterine infections, and so on).
   7. Difficulties in diagnosing tuberculosis in children with HIV:
   • The 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 pneumonia and fungal pneumonia. In HIV-infected people, it is better to perform a CT or MRI of the lungs; a regular X-ray often does not give the proper picture.
   • It is very rare that the causative agent of tuberculosis can be identified in children with AIDS laboratory methods diagnostics
   • 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 the immune response to tuberculosis , as a result, an atypical radiological, clinical and histological picture.
   • Children with HIV infection suffer from common and severe forms of tuberculosis (miliary, disseminated tuberculosis, tuberculous meningitis).
   • Extrapulmonary forms of tuberculosis are often detected: tuberculosis of peripheral lymph nodes, mesenteric lymph nodes, nervous system, eyes and so on.
   • More often they suffer from “closed” forms of tuberculosis.
   • On histological examination In the biopsy material of the affected organ, changes typical for tuberculosis are not found, but with special staining of the specimen, Mycobacterium tuberculosis is often detected.
   • Children with HIV are more likely to suffer from chemoresistant forms of tuberculosis.
   9. What happens to HIV during tuberculosis?
   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 a transition from the stage of HIV infection to the stage of AIDS.

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

   • Treatment it is advisable to carry out in a hospital setting anti-tuberculosis dispensary or department for the treatment of HIV in children.
   • Tuberculosis therapy must be carried out 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 contracting tuberculosis, 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 an infectious disease specialist, since some drugs are not compatible with rifampicin.
   • Doses and treatment regimens anti-tuberculosis drugs are the same as without HIV.
   • The difficulty of treating such children lies in the poor tolerance of a large number of “heavy” drugs.
   11. What is the prognosis for HIV-associated tuberculosis?
   • The high mortality rate from HIV-associated tuberculosis is associated with late detection and severe course of these two infections.
   • With timely initiation of complex therapy, tuberculosis is cured and the child’s immune status is improved.
   • Relapses of tuberculosis are often observed, especially with the progression of HIV; relapses often occur in children who have interrupted antiretroviral therapy.
   12. How to prevent tuberculosis in HIV-positive children?
   • Timely initiation of lifelong antiretroviral therapy Immediately after HIV diagnosis, the child can maintain good immune status and the ability to resist tuberculosis.
   • Observation of such children by a TB specialist , they receive isoniazid prophylaxis at a dose of 10 mg/kg per day for 6 months before prescribing HAART, and then periodically and as indicated.
   • Periodic examination for tuberculosis (X-ray and Mantoux test every 6 months).
   • Regular screening of parents for tuberculosis (fluorography).
   • BCG vaccination children with HIV absolutely contraindicated.

   Treatment of tuberculosis with folk remedies, risks and benefits.

   A lot of traditional methods of treating tuberculosis have been used in the world since ancient times. And earlier, even before the invention of anti-tuberculosis drugs, in principle, tuberculosis was treated only with these methods. But let’s not forget what the mortality rate was from tuberculosis. Previously, consumption was considered practically incurable, and almost all patients died, except in cases where spontaneous self-healing of tuberculosis was observed, but this occurs in some patients even without treatment with folk remedies.

   Modern medicine does not exclude the use of traditional methods of treating tuberculosis, but it is strongly recommended not 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 can’t tuberculosis be treated only with traditional medicine?

   • There is not a single method, other than a specific medication, that is effective against Koch’s bacillus;
   • these methods can lead to the death of the patient or trigger the disease before complications of the tuberculosis process appear, when the effectiveness of drug treatment is significantly reduced;
   • during experiments with traditional medicine, the patient continues to infect people around him;
   • some drugs can harm the body as a whole (for example, badger, bear and other fats can lead to fatty liver).
   Why can’t traditional medicine methods be used at the beginning of drug anti-tuberculosis treatment?
   • Tools such as aloe, bee products (honey, propolis, royal jelly) are powerful natural biostimulants of all processes in the body. Therefore, during the period of inflammation, they stimulate inflammation processes, and during the recovery period, they stimulate 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 of tuberculosis. But when using aloe and honey during the “quiescence” of the process, it has a very good effect on the effectiveness of treatment and the reduction of residual changes.
   • Use of fats eating various “exotic” animals (dogs, badgers, bears, camels, etc.) with anti-tuberculosis drugs has a detrimental effect on the liver. But the use of fats after drug therapy slightly reduces the risk of relapse of the disease.
   It is also widely suggested to use mole cricket powder , they seem to be resistant to tuberculosis, and their immune cells and enzymes are capable of destroying Koch bacilli. I, as a phthisiatrician, do not know of a single case of recovery while taking Medvedka, but there are a lot of cases of advanced tuberculosis due to self-medication with Medvedka. If you want to drink Medvedok, drink for 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 infusing earthworms with vodka, drinking water containing nails, eating tar, puppy meat, drinking children's urine, eating wax moths and many other strange activities. If tuberculosis were so easy to treat, would they begin to massively “poison” all tuberculosis patients with pills throughout 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 with which you can joke and waste time, but this is an infection that belongs to the group of especially dangerous ones.

   Isoniazid, indications and side effects

   Isoniazid- this is the most effective drug against Mycobacterium tuberculosis (unless, of course, the bacillus is resistant to it). It has a bactericidal effect (that is, it can kill the pathogen) only against tuberculosis; it has no effect on other microorganisms.

   Isoniazid is isonicotinic acid hydroside (HINA) 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 tests, etc.) – 5-8 mg/kg body weight per day for 3-6 months, maximum 0.3 g per day for children weighing more than 40 kg .
   • prevention of tuberculosis in HIV-infected people - 10 mg/kg body weight per day for 6-9 months.
   • prevention of relapse of tuberculosis in children - 5-8 mg/kg body weight per day for 3-6 months.
   • treatment of complicated course of the BCG vaccine – 5-10 mg/kg body weight for 3-6 months.
   • included in treatment regimens for active tuberculosis sensitive to isoniazid.
   Isoniazid can be in the form of tablets, injection solution and syrup for children. The entire dose of the drug must be taken in one dose daily.

   Side effects from taking isoniazid:

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

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

     7. Side effects from the reproductive system:

     • menstrual irregularities in women, uterine bleeding;
     • gynecomastia in men (growth of mammary glands);
     • increased sexual desire in men and women.

     After reading the instructions for isoniazid in detail, 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 although side effects of the drug are not uncommon, many of them can be prevented.

     How to prevent development side effects from taking isoniazid?

     • the drug is better tolerated when taken in the evening before bedtime;
     • isoniazid should be taken after meals and washed down with a glass of liquid, possibly milk or juice (just not tea);
     • simultaneous administration B vitamins help eliminate side effects from the nervous system; vitamin B6 (pyridoxine) is an antidote for drug overdose;
     • simultaneous use of isoniazid with hepatoprotectors (Carsil, Hofitol, Gepabene and others) or essential phospholipids (Essentiale, Livolife and others) significantly reduces 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 the ears, accompanied by itching and a burning sensation; this disease is popularly 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 - This medical term for scrofula. With this pathology, the deep layers of the skin are affected. Nodular areas of inflammation form under the skin, which gradually increase and fester. Subsequently, pus comes to the surface of the skin - hence the oozing. When the pus dries, crusts form.

     How are scrofula and tuberculosis connected?

     Still, the most common cause of scrofula in children is diathesis associated with an allergic reaction to food (namely to 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 develops scrofula, it is better to further examine him to exclude tuberculosis (Mantoux test, chest x-ray, skin scraping followed by testing for tuberculosis).

     Be healthy!
     

Tuberculosis is a disease that is transmitted primarily by airborne droplets. Its causative agent is Koch's bacillus. Tuberculosis can be called a social disease, because 80% of patients have a fairly low standard of living.

In the modern world, it is not at all necessary to live on the street to get tuberculosis; everyone is at risk - both children and adults.

Tuberculosis in children is more severe than in adults. This is due to the fact that children are much more susceptible and weaker. It is about childhood tuberculosis that we will talk today. Let's find out what pulmonary tuberculosis is in children, how it develops and how it is treated.

Factors of infection and development of the disease

It is quite easy for a child to become infected with tuberculosis. The main route of infection is contact with the sputum of a sick person with an open form of the disease. When coughing, the patient sprays particles of sputum around himself, which fall on the people around him and settle on the floor and furniture.

A child can become infected by inhaling contaminated air, through contact with contaminated things, or by consuming contaminated products. Most often, the stick enters the child’s body through oral cavity, however, in rare cases, a transplacental route of infection is also possible.

The child’s mother must be extremely careful, follow all the doctor’s recommendations, and then the child has every chance of growing up completely healthy. Thus, the causes of tuberculosis in children are few - usually it is a simple disregard for hygiene or contact with an infected person.

Stages of the disease in children

Once in the body, the Koch bacillus affects the cells of the immune defense, and then the tissues of the body. T-lymphocytes also begin to work actively, but they are weak and die quickly.

As a result, it is through the fault of T-lymphocytes that necrotic tissues are formed, which are an excellent environment for the development of the disease.

Cells pass through the capillaries, which help the formation of tuberculous granulomas, increasingly expanding the focus of inflammation. The affected tissues die.

The body responds to MBT with tuberculous inflammation caused by three components:

• exudative;
• proliferative;
• damaging.

Each of these components is characterized by an individual process. During exudation, cellular components come out of the vessels, during proliferation they grow, and at the stage of destruction, cheesy necrosis is formed. These processes occur regardless of the form and location of the disease. Below we will look at the phases of tuberculosis in more detail.

Phases of tuberculosis during primary infection

At first, infection practically does not manifest itself in any way. Clinically, signs are either very scarce or non-existent. During this period, pathogens enter the lymphatic system and organs of immunogenesis. It is at this time that the reaction to Mantoux becomes positive.

This is followed by a pre-allergic period (lasting 2 weeks), during which antibodies are formed. Despite the presence of Koch bacillus in the body, Mantoux is often negative.

The allergic period is characterized by fixation of infection on the organs of immunogenesis (these include the spleen, bone marrow, liver, lymph nodes). Lymphocytes accumulate around the office. There are no signs of intoxication yet, there is no damaging component, but the lymph nodes are already enlarged.

With proliferation, the number of lymphocytes around the office increases. They prevent the growth of the destructive process. The higher the immunity, the greater the number of lymphocytes “protecting” the infection. After six months, the destruction of surrounding tissues begins and a caseous-necrotic (destructive) component appears. Intoxication is still mild.

1 year after infection, mininecrosis with miniproliferation (proliferation of surrounding tissues) is observed, which is caused by each of the rods that enter the body.

Intoxication is pronounced, Mantoux is positive. Local forms of tuberculosis appear in children and adolescents, which treatment helps prevent. A sick child should visit a pediatric TB specialist.

If tuberculosis in a child subsides, points of caseous necrosis remain on his organs (lungs, bronchi, intestines, bones, lymph nodes), where inflammation was previously localized, which can become the cause of newly developed tuberculosis in adulthood. This trend is observed in 90% of cases.

Due to external factors that reduce the strength of the immune system, it begins to react to the presence of mycobacteria in the body, sending there certain families of lymphocytes, namely macrophages. They begin to absorb harmful bacteria, but die, releasing special enzymes.

The latter liquefy the caseous tissue. With pulmonary tuberculosis, mycobacteria are released into the tissue and then into the surrounding space, and the patient becomes pathologically dangerous to other people.

Reversal of the disease

The healing process occurs after treatment or without it, if the sick child has a strong enough immune system. In this case, the decay cavities begin to shrink and close, being replaced by scars. The process subsides and the infection stops its development (usually this occurs at 3, 4 and 5 years).

During the fight against MBT, lymphocytes begin to damage healthy tissue. In response, the body produces antipreases.

This process can be balanced, but if the immune system cannot cope, then the cirrhotic form of pulmonary tuberculosis begins.

Primary and re-infection

Like adults, childhood tuberculosis can have various shapes, depending on the time it develops in the child. Each of the forms has its own subtypes, but not all of them develop in children or develop quite rarely. Therefore, we will limit ourselves to describing the most common types of each form of tuberculosis in children and adolescents.

General symptoms

The first 1-2 weeks, the symptoms of an acute illness resemble those of a cold. If they do not go away after 3 weeks, there is a risk of developing the disease. For the first 3 weeks, children suffer from a dry cough, but why does a wet cough with pinkish discharge begin?

Among the main ones are:

Other symptoms that can be confused with other diseases include:

• when the meninges are damaged, convulsions, headaches, and vomiting are observed;
• intestinal tuberculosis is manifested by indigestion, vomiting, blood in the stool;
• tuberculosis of bones and joints causes pain when moving, increases the risk of fractures and lameness;
• tuberculosis of the genitourinary system announces itself with pain in the lower back, high temperature, pain during urination and blood in the urine;
• the skin affected by the infection is thickened, the lymph nodes enlarge and rot, tearing the membrane.

How do the forms of the disease manifest themselves in children?

Pulmonary tuberculosis in children of the primary form occurs in the vast majority of infected people, in contrast to the secondary form, the occurrence of which in children is quite rare. For children under 2-4 years of age, pulmonary tuberculosis is especially dangerous and is much more difficult to tolerate than in adults.

In the period up to 4-7 years, the tendency to extensive infection is especially pronounced, since the effect of the BCG vaccination weakens by this time, so complications are often observed. However, even in such conditions, there is a high chance of the lesion shrinking or completely disappearing.

Tuberculosis of the intrathoracic lymph nodes is a primary infection. It is diagnosed in 80% of children with this disease. Specific changes are little pronounced, therapy gives positive dynamics. The tumorous (tumor-like) form has a more severe course and is more common in young children (up to 4-6 years).

Secondary tuberculosis is diagnosed in adolescents not so often; as a rule, these are young people who suffered a primary infection in childhood. It usually coincides with puberty and is diagnosed at 13-14 years of age. The symptoms coincide with the primary genesis. Infiltrative and focal pulmonary tuberculosis predominates.

Disseminated tuberculosis is rare in children and adolescents. It is preceded by a primary infection with a breakthrough of the lesion into the blood with sensitivity of the vascular system. The main reason for the appearance of this form is an endogenous decrease in immunity.

In early adolescence, the infection often occurs in the form of damage to other organs along with the lungs.

The subacute form develops as the primary infection subsides, but sometimes manifests itself as a secondary form.

The chronic form acquires fibrous-tricky features, with seasonal exacerbations. Its outcome is usually unfavorable. Tuberculous pleurisy, which also sometimes occurs in adolescents, can be a complication of tuberculosis of the intrathoracic lymph nodes or a separate disease.

Separately, it is worth mentioning extrapulmonary tuberculosis. Studies have shown that over the past 15 years the percentage of extrapulmonary forms of the disease has decreased. In young children (from 1 to 5-7 years), tuberculitic meningitis and tuberculosis of the central nervous system are most often diagnosed, and in adolescents - tuberculosis of the peripheral lymph nodes and genitourinary system.

Treatment and prevention

Are vaccinated children at risk of infection? This vaccination does not protect the child from infection, but it significantly reduces this risk and does not allow the disease to pass from a closed form to an open one, and also helps to avoid severe complications in case of infection.

A vaccine with a weakened virus allows the body to develop immunity without infecting the child. Many doctors recommend vaccinating children, despite the presence of preservatives in the vaccine.

There are two types of treatment for tuberculosis in children and adolescents:

A doctor should advise how to treat a child if there is a tuberculosis infection. It has been noticed that children who began treatment in a timely and correct manner often recover, since their tissue regeneration occurs faster.

If detected in late stages, it is very severe and can lead to serious complications and even death. The consequences of treatment for tuberculosis, which sometimes lasts two to three years, can be both positive and negative. Chemotherapy in 15% of cases causes a side effect - toxic or allergic. It often affects children who are at risk - those with chronic diseases, excess body weight, and a tendency to allergies.

The peculiarity of tuberculosis in children, first of all, is its danger to health. As mentioned above, in children under 5 years of age, it causes more complications than in older children. However, in addition to age, factors such as poor nutrition, lack of vitamins, stress and lack of sleep play a major role in the development of the disease.

In conclusion, I would like to say that, despite the seriousness of this disease, it is always possible to cure a child. The main thing is to constantly monitor his health, regularly check for tuberculosis, not self-medicate and strictly follow the doctor’s recommendations.

Each stage has its own coloring and manifestations.
It is in childhood that a person encounters this pathology, since the baby’s immune system is not fully formed.
According to statistics, subsequent infections in older age do not pass without a trace for a person, which cannot be said about a childhood disease.

Therapist: Azalia Solntseva ✓ Article checked by doctor

Symptoms and first signs of tuberculosis in children

Symptoms of the disorder depend on the type of illness the child has, as well as his age. The most common is pulmonary tuberculosis.

The form of pathology with extrapulmonary lesions occurs in approximately 20-30% of all cases. Tuberculous meningitis is more common in children under 3 years of age.

Infants and young children are at particular risk of developing severe, widespread, and often fatal disease, which may manifest as a miliary (systemic) infection. Adolescents are exposed to adult-type pathology.

In children with pulmonary tuberculosis, the most common symptoms are a chronic cough that lasts more than 21 days, fever, weight loss, or developmental delays. Other manifestations are nonspecific.

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Signs of tuberculosis in the early stages

Initial symptoms and signs may appear differently for each child. Everything depends, first of all, on his age.

The most common first signs of tuberculosis in children in the early stages in babies under one year of age:

• cough;
• fever;
• chills;
• increase in the size of the tonsils;
• growth slowdown;
• weight loss.

The most common first symptoms of tuberculosis in children under 3 years of age are:

• chest pain;
• cough lasting more than 3 weeks;
• blood in sputum;
• fever;
• night sweats;
• chills;
• swollen tonsils;
• weight loss;
• weakness;
• decreased appetite;
• fatigue.

Manifestations of the disease may simulate other health conditions. Important when similar symptoms seek medical help.

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Ways of infection of babies under one year old

Tuberculosis occurs when babies inhale bacteria spread by infected people. The microorganism grows and is transferred to the intracellular environment, where it may remain metabolically inactive for many years before reactivation and onset of disease.

Pathogenicity (pathogenicity) is the ability of a pathogen to cause disease. In this pathogen, this ability is manifested in its impact on immune reactions: incomplete phagocytosis of macrophages and delayed immune allergic reactions.

A child becomes infected with tuberculosis in basically the same way as an adult, when they come into contact with mycobacteria that are in the air. The source of infection for children is usually adults with active disease, in which the cough is contagious. Transmission of infection in public places such as schools and kindergartens is of great importance.

Once bacteria enter the lungs, they can multiply and then spread through blood vessels to nearby lymph nodes. Several weeks after the initial infection, the child develops an immune response.

In most children, the body's defense system stops tuberculosis bacteria from further developing and spreading, although the microorganisms often manage to survive the initial immune reaction.

The risk of progression of the pathology is greatest when the child is under three and a half years old, and to a lesser extent when he is under ten. There is also a greater risk of infection spreading in babies with weakened immune systems, for example if they are HIV-infected.

Typically, within two years after the initial infection, the child develops an active form of the disease. In a small number of older children, the pathology develops later, either due to reactivation after an inactive period or as a result of reinfection.

Lymphohematogenous spread, especially in young patients, can lead to miliary tuberculosis, with caseous material reaching the bloodstream from the primary site. Meningitis can also be a consequence of this process.

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Types of disease in children 3.5 years old

The disease is divided into two large type: pulmonary and extrapulmonary. They, in turn, are divided into several subgroups, depending on the damage to organs or systems.

Endobronchial tuberculosis with lymphadenopathy is a common type of pulmonary tuberculosis. The symptoms result from pressure on various structures from the enlarged lymph nodes. A persistent cough results in symptoms suggestive of bronchial obstruction, while difficulty swallowing may result from compression of the esophagus.

Pleural effusions (accumulation of pathological fluid in the pleural cavity due to inflammatory processes) usually occur in older children and are rarely associated with miliary disease. The medical history reveals an acute onset of fever and chest pain that worsens with deep inspiration.

Elevated body temperature usually persists for 14-21 days. Progression of the pulmonary parenchymal component can lead to pneumonia and atelectasis.

It is more common in young children than in teenagers. The child develops symptoms of fever, cough, malaise, and weight loss.

Patients with peripheral lymphadenopathy (a form of extrapulmonary tuberculosis) may have a history of enlarged nodes. Fever, weight loss, fatigue, and malaise are usually absent or minimal.

The main symptom appears 6-9 months after the initial infection with bacilli. Common sites of involvement include the anterior cervical, submandibular and supraclavicular, inguinal, or axillary lymph nodes.

One of the most serious complications of the pathology is tuberculous meningitis, which develops in 5-10% of children under the age of 2 years; after this the frequency drops to 1%. The subacute process begins within 3-6 months after the primary infection.

Nonspecific symptoms such as anorexia, weight loss and fever may be present. After 1-2 weeks, patients may experience vomiting and seizures or changes in consciousness. Deterioration in mental status may progress to coma and death, despite prompt diagnosis and early intervention.

There are three stages of tuberculous meningitis:

1. The first stage is determined by the absence of focal or generalized neurological signs. Only nonspecific behavioral abnormalities are diagnosed.
2. The second stage is characterized by a stiff neck, altered tendon reflexes, lethargy, or cranial nerve palsies.
3. The third and final stage includes major neurological defects: coma, seizures, and abnormal movements (eg, choreoathetosis, paresis, paralysis of one or more limbs). Patients with tuberculomas or brain abscesses may have focal neurological signs depending on the location of the bacteria.

Miliary tuberculosis is a complication of the primary form in young children. May present with low-grade fever, malaise, weight loss, and fatigue.

Skeletal tuberculosis can occur acutely or subacutely. Spinal lesions may not be detected for months to several years due to slow progression.

Common pathological sites include large supporting bones, vertebrae, hip and knee joints. Bone deformation is late sign diseases.

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Correct medical diagnosis

Detection of the disease in children is difficult due to nonspecific and variable clinical and radiographic signs, especially in patients younger than 4 years and in those with HIV infection. Diagnosis of tuberculosis in children and treatment of the inactive form of the pathology are important to reduce the risk of developing active tuberculosis, since the disease often occurs in a latent form.

Until 2001, the tuberculin skin test was the only one commercially available immunological analysis to identify infection. It is used all over the world to diagnose any form of disease, but has some limitations.

It should be administered properly using the Mantoux method, consisting of an intradermal injection of 0.1 ml of tuberculin-produced protein derivative antigen into the forearm area. Although positive results are usually associated with increased risk worsening of a current or future disorder, the test may also give false positives in BCG vaccinated individuals.

Due to these limitations, interferon-gamma expression assays have been developed that also detect pulmonary pathology. These new tests evaluate drug release in response to synthetic overlapping peptides directed against mycobacteria.

These proteins are absent in BCG vaccine strains, so the analysis is much more accurate than the standard one. To perform the test, fresh blood from the patient is collected and mixed separately with reagents and then incubated for 16-24 hours.

To make a diagnosis of congenital tuberculosis, children and adolescents must have proven lesions and at least one of the following:

• conclusion about tuberculosis infection of the placenta or maternal birth canal;
• eliminating the possibility of postnatal transmission;
• the presence of a primary infectious complex in the liver;
• skin lesions during the first week of life, including papular defects or petechiae.

Sputum samples can be used in older children (6 years and older). Before this age, the cough is not productive enough to produce mucus for analysis. Nasopharyngeal secretions and saliva have no diagnostic value.

Gastric aspirates are used instead of sputum in children under 6 years of age. Since gastric acidity is poorly tolerated by tuberculosis bacilli, neutralization of the removed sample must be carried out immediately. Even with correct technique microorganisms can be detected in only 70% of infants and 30-40% of children.

Mycobacteria increase serum antibody levels. However, serodiagnostic tests for tuberculosis have not yet been developed that have adequate sensitivity and specificity for routine use in diagnosing the disease in children.

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Effective treatment of the disease

Anti-tuberculosis drugs kill mycobacteria, thereby preventing further complications of early primary disease and progression of pathology, protecting the child’s body from infection.

First of all this:

• rifampin (rifampicin),
• isoniazid,
• pyrazinamide,
• ethambutol
• streptomycin.

Secondly, the following are used:

• capreomycin,
• ciprofloxacin,
• cycloserine,
• ethionamide,
• kanamycin,
• ofloxacin,
• levofloxacin
• para-aminosalicylic acid.

Recommendations for the treatment of pulmonary tuberculosis include a 6-month course of isoniazid and rifampin, which should be supplemented with pyrazinamide for the first 2 months. Ethambutol is allowed to be included in the initial regimen until the results of drug susceptibility studies are available.

Most cases of the extrapulmonary form, including cervical lymphadenopathy, can be treated using the same regimens that are used to treat the primary pathology. The exceptions are diseases of bones and joints, miliary pathology and meningitis. For such severe forms, the recommended regimen is 2 months of isoniazid, rifampicin, pyrazinamide and streptomycin once daily, followed by 7-10 months of taking only the first two drugs once daily.

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Rehabilitation period and prevention

The key method of preventing the disease is prompt identification and treatment of patients with tuberculosis. Childhood tuberculosis is extremely dangerous. The primary symptom of the disease often does not appear in the early stages.

Thorough training in adherence to therapy, side effects medications and follow-up care is an important part of the fight.

Adults with a positive tuberculin skin test result, clinical or radiographic manifestations, receiving therapy with this drug, do not get sick in 54-88% of cases, while children are 100% protected.

BCG is available for the prevention of disseminated tuberculosis. It is a live vaccine obtained from weakened strains of mycobacteria.

The most important role of vaccination is to prevent serious and life-threatening diseases such as miliary tuberculosis and mycobacterial meningitis in children. The BCG vaccination does not prevent tuberculosis infection.

The key method in the rehabilitation of patients after illness is:

• active lifestyle,
• active games in the fresh air,
• maintaining adequate sleep and wakefulness.

The previously used tactics of prolonged bed rest and minimal physical activity have not proven effective. When infections affect the body, it is necessary to deal not only with treating the disease, but also strengthening the immune system.

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Tuberculosis is a disease acquired by airborne droplets (through touch, personal belongings, air). Its catalyst is Koch's bacillus, which easily enters the body but is difficult to remove.

Tuberculosis in children is noticeably more severe than in adults, since the immune system of children has not yet fully formed, so the body cannot fully repel the attack of harmful bacteria. In this regard, symptoms of tuberculosis are more often observed in children than in older people.

It is worth knowing that with tuberculosis in children, not only the lungs (the most common case), but also other body systems can be affected.

Classification

Previously divided into open and closed form, tuberculosis is now classified as “BK-” (without bacterial excretion) and “BK+” (with bacterial excretion). In the first case, the study does not detect tuberculous mycobacteria; accordingly, with “BC+” they are detected.

Depending on the activity of the disease process, tuberculosis is divided into:

1. Active. Signs of life and activity of Koch's rods are detected. X-ray images show a noticeable decrease in intensity; in the future, positive/negative dynamics appear. The clinical picture shows intoxication and chest symptoms.
2. Inactive. The so-called “residual” effects of past tuberculosis. The disease can turn from the first form into the second due to successful treatment, although there is a possibility of a “miracle” - sudden self-healing, which can be noticed when examined by a doctor. Afterwards, the only requirement is to visit doctors at least once a year. On x-rays, the changed part shows increased intensity. Possible calcium content. The dynamics have remained unchanged for years.

• First time diagnosis. Until this moment, the patient had not been observed by a phthisiatrician.
• Relapse. Recurrence of the disease. This usually happens under the influence of some stressful situations.
• Therapy after a break. The patient stopped the course of treatment ahead of schedule, which is why tuberculosis returned and the situation worsened.

• Sensitive. The mycobacterium is not resistant to all treatment drugs. This means that defeating the disease is much easier than with the next type of tuberculosis.
• Chemoresistant. The stick is resistant to at least one agent.
• Monoresistant – resistance to one drug.
• Multiresistant – to several.
• Multidrug-resistant - a combination of drugs, contains isoniazid, rifampicin.
• Broadly drug-resistant – resistant even to isoniazid and rifampicin. The most severe type of disease.

Sources of infection

According to statistics, a person infected with tuberculosis can transmit the infection to about twenty people per year.

There are various ways to acquire pulmonary tuberculosis in children:

• Pulmonary tuberculosis in children often appears due to the constant presence of little fidgets on the street, which is full of dust. When there is a strong wind, mycobacteria rise from the ground and enter the baby’s lungs.

• Childhood tuberculosis can occur due to contact with an infected person (cough with tuberculosis is accompanied by sputum containing tuberculosis bacteria). When you cough, bacteria fly two meters away, and when you sneeze – nine meters.
• Tuberculosis in children can form due to conjunctivitis of the eyes, through the lacrimal sacs, even with banal rubbing of the eyes with fists on the surface of which there are tubercle bacilli.
• The disease can occur if a small patient eats the meat/milk of an infected animal.
• If a child played in the sandbox, was on public transport, but did not wash his hands afterwards, the disease may also develop.
• The baby can get the infection at birth if the genital tract is infected. The newborn is then considered congenitally infected.

By the way, tuberculosis in adolescents can appear in the same way.

One of the important points for parents is not to miss the first signs of tuberculosis in children.

Risk factors

About a third of the world's population are carriers of Koch's bacillus, but not all of them suffer from tuberculosis.

There are circumstances that increase the likelihood of developing the disease:

• direct contact with a sick person, eating contaminated foods, etc. (see above).
• The newborn was not vaccinated with BCG.
• Predisposition to the disease from a genetic point of view, that is, relatives of the older generation suffered from the same disease.
• The disease can manifest itself in stressful situations. For example, the loss of a loved one, high workload at school, extra clubs, exams, etc.).
• The disease can develop against the background of other diseases:

1. permanent diseases of the upper respiratory tract (rhinitis, tonsillitis);
2. permanent lung diseases (asthma, bronchitis, pneumonia, cystic fibrosis);
3. endocrine diseases (diabetes mellitus);
4. diseases of the gastrointestinal tract (viral hepatitis, gastritis, stomach and duodenal ulcers);
5. immunodeficiency (congenital, blood oncology, etc.).

• Unbalanced, incorrect, irregular nutrition.
• Destructive lifestyle of parents (smoking, drinking alcohol and drugs; children can also develop these bad habits).
• Children living on the street, in boarding schools, shelters, orphanages, have a much higher risk of the disease.
• Finding parents in prison.
• In large families and low-income families, children get sick more often.

Signs

How to recognize tuberculosis? in children can be easily confused with symptoms common cold. At further stages, the symptoms in children become more clear.

Symptoms of tuberculosis at an early stage in children are not numerous,

But you still need to try not to overlook them:

• decreased activity, apathy;
• getting tired quickly;
• poor appetite;
• unhealthy pallor;
• persistent cough;
• slight enlargement of lymph nodes;
• sleep disturbance.

If on the twenty-first day the listed signs remain, it will be necessary to conduct a diagnosis to obtain a reliable answer.

At the final stage, additional signs of tuberculosis in children appear:

• increased temperature at night, accompanied by fever, increased secretion sweat;
• The cough with tuberculosis was at first dry, then turned into wet;
• A cough with tuberculosis lasts more than three weeks, sputum begins to come out, and blood may be present. Then you will need to call the doctors immediately.

Do not forget that in children the symptoms may be present in whole or in part, but in order to accurately determine whether the little person is sick, it will be necessary to send him to a phthisiatrician. A quick response and timely treatment tuberculosis in children will not be allowed to develop the disease.

As mentioned above, tuberculosis in children can affect more than just the respiratory organs, such as the bones. The infection, having penetrated the bones and joints, does not develop quickly. The child experiences pain with any physical activity, so if the baby complains of pain, you should pay attention to this.

How does bone tuberculosis manifest:

• frequent bone fractures associated with their fragility;
• difficulty moving due to severe pain;
• pain in the joints and spine;
• deformation, swelling of joints/bones.

If parents notice any signs of illness, they should immediately notify the doctor.. Symptoms noticed at an early stage and treatment provided in a timely manner will help stop the progression of the disease.

Video

Video - suspected tuberculosis in a child

Diagnostics

Tuberculosis in children and adolescents can be diagnosed in several ways: using the Mantoux test (up to sixteen years), Diaskintest, and upon reaching fifteen - fluorography. In addition, they conduct research in the laboratory where they study biomaterials (blood, urine, sputum, etc.), wanting to find out about the presence of Koch’s bacillus. If necessary, carry out linked immunosorbent assay(ELISA) and polymerase chain reaction (PCR).

Mantoux test

Mantoux is an injection containing fragments of mycobacteria, given only to children, which can show whether a small patient is sick.

There are several possible reactions of the body to the administered drug:

• negative. With this result, there is no compaction, redness, or enlargement at the injection site. After seventy-two hours, only a point should remain from the injection site, the size of which does not exceed one millimeter.
• Doubtful. A compaction forms, slightly reddens, and increases by two to four millimeters.
• Positive. The injection site is quite dense, the diameter of the increase is up to five millimeters.

Diaskintest

An analogue of the Mantoux test is a new generation drug. The difference between them: the test is much more accurate - ninety percent versus fifty to seventy. Diaskintest can be done from one year old, every three months.

Blood analysis

ELISA will show whether a person’s blood contains substances that can resist Koch’s bacillus. Despite the quick result (the next day), the effectiveness of the examination is quite low.

A general blood test is done together with a differential examination. This makes it possible to understand whether the patient has inflammation. If a person is infected, a jump in the number of leukocytes and rod neutrophils is observed in his blood.

PCR

The newest method for clarifying the diagnosis, determining the presence of harmful bacteria in the body. This study guarantees an almost 100% accurate result.

The examination is carried out by doctors. They culture the stomach contents for the disease three times.

It is worth noting that PCR diagnostics is capable of, but also many other diseases.

Treatment

Up to three years of age, sick children are observed by a pediatric phthisiatrician (pediatrician), after which - by a phthisiatrician in a dispensary.

The infected person undergoes chemoprophylaxis, which consists of taking anti-TB drugs for three months. It is necessary to take him to a doctor once every ten days, when the course is over - once every six months.

Tuberculosis in children is treated comprehensively. Three stages of therapy:

1. Observation in hospital.
2. Treatment in a sanatorium.
3. Clinical examination.

The doctor can tell how long the therapy will last by assessing the severity of the disease. According to statistics, the average treatment period is approximately two years.

Plays an important role in the speed of recovery of young children. proper nutrition with the appropriate mode. Parents should feed their child high-calorie foods every day and take them for long daily walks.

When observing a turn, the child is not admitted to the hospital; outpatient treatment will be sufficient (its period is three months). The most popular drugs are Tubazid, Ftivazid. Stay in the dispensary for one year. Upon completion, the child will need to undergo a medical examination again and have a blood test (ELISA, PCR). If negative indicators are observed, the baby may be removed from the register.

If the results are positive, a complex treatment containing from two to four medications will be prescribed. Therapy will be carried out in stages: supportive therapy follows immediately after intensive therapy.

And if the disease persists after six to eight months with pronounced symptoms, surgical intervention may be required.

Rehabilitation

During the rehabilitation period it is important nap baby (at least three hours). If your child attended sports clubs in kindergarten/school before becoming ill, it would be best to stop attending them for a while.

It is strictly forbidden to leave a child in the open sun for a long time. It would be very helpful if the parents of a small patient could purchase vouchers to a sanatorium with a focus on helping in the recovery of patients who have suffered tuberculosis.

Complications

Until the age of three, until the baby’s immune system is formed, the disease is severe,

Can lead to quite serious consequences:

• tuberculous meningitis. In this situation, the membranes of the spinal cord and brain become inflamed;
• Tuberculous sepsis. The blood becomes infected with mycobacteria.
• Pleurisy. The pulmonary lining becomes inflamed.
• Miliary tuberculosis. Tuberculosis tubercles form inside all vital organs.
• This is an unfinished list possible complications in children under three years of age.

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Anyone can get tuberculosis. In children, this disease is quite severe and can cause numerous complications. This article will tell you what parents should know about this dangerous pathology.

What it is?

An infectious disease of internal organs that is caused by mycobacteria is called tuberculosis. This pathology occurs in both adults and children. Many parents believe that only children from socially disadvantaged families can get tuberculosis. However, this is a big misconception. Every child has a risk of contracting this infection.

The prevalence of this infection varies in different countries of the world. In economically developed countries, tuberculosis is much less common than in developing countries. This fact further confirms the importance of the influence of social factors in the development of this disease. Every year scientists conduct hundreds of different scientific research aimed at finding new drugs that will help cope with the adverse symptoms of the disease.

The susceptibility of the child's body to various infections is quite high. This is due to the insufficient functioning of the immune system. WHO experts believe that coping with massive outbreaks of tuberculosis in the population can only be done by preventing new cases of the disease in adults. They identify several countries that are most disadvantaged in terms of the development of this dangerous infection. According to statistics, in these countries, by adolescence, more than 70% of children are infected with mycobacteria.

Tuberculosis is a rather dangerous disease. More than 1.5 million people die from this infection every year. Child mortality from tuberculosis is also quite high. This trend suggests that the incidence of this infection should be closely monitored.

In the last decade, tuberculosis affects from 1 to 10 out of 100,000 children. Most cases of the disease occur in Asia and Africa. In our country, pulmonary tuberculosis is a fairly common pathology.

Since Soviet times, various government medical programs have been carried out to reduce the incidence of this infection. Currently, the situation regarding this disease cannot be called prosperous. Doctors note that the disease in children is quite severe and has an unfavorable tendency to develop an infectious process not only in the lungs, but also in other internal organs.

There is historical evidence that the first cases of tuberculosis were recorded in the Ancient World. Scientists were able to establish from the remains and bones of some pharaohs that they had signs of tuberculosis. This infectious disease has worried doctors for many centuries.

During the Middle Ages, he was often called “consumption.” This popular name quite accurately conveys the essence of the disease - a person, having fallen ill, begins to weaken (waste away).

For quite a long time, doctors believed that tuberculosis affected only the lungs. However, this is not at all true. Modern laboratory instruments have made it possible to establish other localizations of this dangerous illness. Even hair and nails can be involved in this pathological process.

Quite often, lesions of internal organs are combined. The inflammatory process in this infectious pathology is specific. It causes special morphofunctional disorders that do not occur in other infections. A similar type of inflammation also occurs during syphilis and leprosy.

Scientists distinguish several stages in the development of the disease. They differ significantly from each other not only in the development of unfavorable symptoms, but also in the characteristics of morphological disorders that arise during the disease process.

More information about the causative agent of infection

The microorganisms that cause this disease were first identified at the end of the 19th century. This discovery was made by the outstanding scientist of those years, Robert Koch. This scientific breakthrough gave rise to popular name the causative agent of the disease, which also became known as “Koch’s bacillus.”

Several centuries ago, scientists knew about only one type of mycobacteria. Currently, scientifically confirmed information has appeared that they exist in 74 different types. They are widespread not only among the human population, but are also present in water, soil and in some animals.

Pathogenic microorganisms that cause tuberculosis can be of different subtypes. The main causative agent of this infectious pathology in humans is Mycobacterium tuberculosis. This subtype of mycobacteria includes several other types of microorganisms that differ from each other mainly in the degree of manifestation of virulent properties and their pathogenicity.

Koch stick

The virulence of microorganisms and the initial state of the child’s body determine how severe the disease will be in the baby or whether it will be limited to carriage. The causative agents of this infection survive well in unfavorable conditions. external environment. They are highly resistant to most acids.

In their shape, mycobacteria look like elongated rods. They do not exceed 10-12 microns in length. The end sections of the microorganism's body are slightly rounded, which makes them look like barrels or sticks.

In the external environment, mycobacteria remain immobile, but do not form spores. The special structure of cell walls, which protect bacteria from unfavorable environmental influences, allows them to maintain their vital activity for a long time without losing their pathogenic properties.

On the outside, these microbes are surrounded by a dense shell, which consists of several layers. Such cellular protection is like “armor” that protects microorganisms from the effects of disinfectants.

The main properties of mycobacteria are contained in tuberculoproteins. These are special proteins that cause certain immunological reactions on the part of the child’s immune system. This systemic response of the child’s body is called delayed-type hypersensitivity. This is a very specific mechanism for the development of immune inflammation.

The presence of certain lipids in the cellular structure of bacteria makes them more tolerant to the effects of various external chemicals and biologically active components that are released by the immune system in response to these microbes entering the body.

Exposure to alcohol and some strong alkalis also does not have a detrimental effect on microorganisms. Infectious agents are well preserved in house dust. They can exist in it for several months.

There are a huge number of scientific experiments showing that mycobacteria are perfectly preserved in milk. They can remain viable for several months in soil and water.

It is important to note that boiling has a detrimental effect on microorganisms. However, to completely kill them, it is necessary to boil water or other liquid containing tuberculosis pathogens for 5-10 minutes.

Under unfavorable environmental conditions, microbes enter a certain “dormant” state. At this time they are called L - form of mycobacteria. When they enter a child’s body in conditions favorable for their life, they quickly recover and begin to exert their negative effects.

Some external factors And chemical substances still have a detrimental effect on the microbes that cause tuberculosis. Disinfection using chlorine-containing products helps reduce the concentration of pathogens in the room. Quartzization carried out by special regime, also has a pronounced detrimental effect against mycobacteria.

The causative agents of tuberculosis infection can be classified as microorganisms that multiply for a long time. This morphological feature influences the course of the disease, as well as the duration of appropriate treatment.

The reproduction cycle of one mycobacterial cell is about 18-20 hours. For staphylococcal flora this time period is much shorter - 8-10 minutes. Morphological feature cellular structure microbes and a fairly slow rate of reproduction lead to the fact that areas of inflammatory infiltration begin to form in the affected internal organs. This is a consequence of the granulomatous process.

Externally, such areas look like numerous tubercles, which can be of very different sizes. These formations are quite susceptible to decay.

How can a child become infected?

The most common culprit of infection in children is a sick person suffering from the active stage of tuberculosis. During this period of illness, he usually releases a large number of mycobacteria into the environment, so direct contact with such an infected person significantly increases the risk of possible infection with tuberculosis.

The most common method of infection is airborne. The baby can become infected during conversation or close contact.

Infection with tuberculosis infection in public transport is quite common. Sharing utensils, toys and household items also contributes to possible infection with tuberculosis.

Adults who have active tuberculosis infection and release mycobacteria into the environment can infect a child through a kiss or a warm hug.

There are other ways of transmitting infection. They occur in situations where a person infected with tuberculosis has tuberculous lesions some internal organs. So, with an infection of bones and lymph nodes, infection occurs through contact and household contact. In this case, mycobacteria enter the skin of a sick person through open fistulas.

With tuberculosis of the skin and nails, infection can occur when simple rules personal hygiene.

In some cases, a child can become infected with this infection by drinking contaminated water or milk.

Cattle are also a possible source of infectious pathology. Drinking unboiled milk from farms can cause the baby to develop tuberculosis.

In young children, the most common route of infection is the alimentary (food) route. The habit of putting dirty hands into your mouth on the street or while playing in the sandbox with other children can also lead to possible infection.

Cases of congenital tuberculosis are also quite common in pediatric practice. In this case, infection occurs at the stage of intrauterine development: the baby becomes infected with a tuberculosis infection while in the womb.

But a mother infected with tuberculosis does not always give birth to a baby with signs of the disease. If the pregnancy proceeds quite smoothly and without pathologies, then the risk of infection of the unborn child is significantly reduced.

Mixed infection is quite rare. In this case, the development of the disease is caused by different mechanisms infection. In pediatric practice, this is mainly a combination of airborne and contact-household methods of transmission of infection.

Clinical forms

Mycobacterium tuberculosis can affect a variety of internal organs. This causes the emergence of a huge variety of very different clinical forms of the disease. Features of the course of the disease largely depend on the initial localization of the infectious process, as well as the state of the child’s immune system.

Doctors distinguish several clinical variants of tuberculosis infection:

Respiratory organs

This form occupies a leading position in the structure of the incidence of this infectious pathology. It is accompanied by the development of specific changes in the lung tissue, less often in inflammatory process bronchi and trachea are involved. As a rule, this form of the disease is diagnosed spontaneously - during an X-ray of the lungs and much less often at outpatient appointments with a doctor.

X-ray photo of tuberculosis in children

Lymph nodes

It is also a fairly common pathology in children; in adults, this form of tuberculosis is much less common. The risk of infection is high in babies with HIV infection. Most often, groups of cervical and axillary lymph nodes are involved in the infectious process, however, other peripheral lymph nodes can also be affected. Establishing a final diagnosis is impossible without a puncture.

Kidney

This form of the disease is quite rare in children. Characterized by the involvement of renal tissue in infectious inflammation. A long course of tuberculosis leads to the appearance in a child of signs of functional disorders in the functioning of the kidneys. Delayed or incorrectly selected treatment contributes to the appearance of multiple complications in the baby, one of which is the development of renal failure.

X-ray of the kidneys

Bones

Quite a common clinical variant in children TB practice Persistent tuberculosis of bones and joints often leads to disability in a child. Tuberculous changes can develop in almost all anatomical structures skeletal system. Quite often the disease is detected in the later stages of development.

Intrathoracic lymph nodes

A fairly common form of the disease, especially in young children. Pathological process can be one- or two-sided. Enlarged intrathoracic lymph nodes have strong pressure on nearby bronchi, which leads to the appearance of corresponding symptoms in the child. The first signs of the disease are often recorded in children aged 2-3 years.

Nervous system

This clinical variant of the disease is perhaps one of the most severe. It is characterized by the development of tuberculous meningitis or meningoencephalitis in a child. The course of these pathologies is quite severe, characterized by the appearance of quite unpleasant symptoms that significantly affect the baby’s well-being. Most often, this form of the disease occurs in infants.

Gastrointestinal tract

Another favorite location for the activity of mycobacteria in a child’s body is the intestines and mesenteric lymph nodes. This pathology occurs rarely in children. Children suffering from AIDS are more susceptible to this form of the disease. In some cases, this clinical variant of tuberculosis occurs in children with severe immunodeficiency states, which are quite severe.

Eye

In pediatric practice, cases of this type of tuberculosis are extremely rare. The development of tuberculous conjunctivitis or keratitis is often facilitated by a pronounced decrease in immunity or multiple diseases of the internal organs. Children with visual pathologies are also at increased risk.

How does tuberculosis intoxication manifest?

Doctors distinguish several periods in the development of this pathological condition. The early period of tuberculosis intoxication in children and adolescents is manifested primarily by severe disturbances of nervous activity. A sick child becomes more nervous, develops a nonspecific headache, fatigue, and absent-mindedness. Children attending school note that they cannot concentrate on the school curriculum and do not learn the educational material well.

Upon careful examination of the child, you may notice some changes in appearance. A sick baby becomes paler and apathetic.

As a rule, the child develops a persistent low-grade fever. The body temperature rises to 37-37.5 degrees. Long-term low-grade fever significantly affects the general well-being of the child. The baby's appetite sharply decreases, and problems with sleep duration may occur.

In some cases, especially in thin babies, the liver and spleen can be easily felt. A sick child may develop bowel problems, which most often manifest as persistent constipation.

As a rule, by the end of the first month from the moment of primary infection, a specific manifestation of tuberculosis appears - turn of the tuberculin test. This reaction is manifested by a positive tuberculin test and helps to recognize the disease at fairly early stages.

Another characteristic manifestation of the disease in the early period is the appearance of specific skin formations. This pathological condition is called erythema nodosum. It is characterized by the appearance bright red spots, which are localized mainly on the legs.

These skin rashes are usually preceded by quite high promotion body temperature. Often this unfavorable symptom occurs in children aged 5-6 years.

The second period of development of tuberculosis intoxication is its transition to a chronic form. This period is extremely unfavorable, as it is already accompanied by the appearance of persistent morphofunctional disorders, leading to the development of specific symptoms of the disease.

A long-term disease leads to the fact that the child lags significantly behind his peers in terms of physical and mental development. The sick child looks rather pale and emaciated.

Pathological changes in the lymph nodes lead to persistent functional disorders. When palpating peripheral lymph nodes, it is possible to determine the compaction of their structure, as well as changes in size.

In some cases, lymph nodes become pebble-like in density. Chronic tuberculosis intoxication is usually accompanied by damage to 6-9 adjacent groups of lymph nodes. This pathological condition is called micropolyadenia.

The diagnosis of this condition is made based on the persistent persistence of positive tuberculin tests. In this case, one year must pass from the moment of the first turn.

In some cases, there is a pronounced increasing dynamics. Tuberculin tests in an infected child only increase every year. Such dynamics must be assessed by a pediatric phthisiatrist.

In the chronic version of tuberculosis intoxication, numerous pronounced morphological abnormalities in the internal organs are already observed. Quite often they occur in the bone marrow, peripheral lymph nodes, as well as the liver, spleen and gastrointestinal tract.

The chronic period differs from the early period in the severity of all symptoms. In later stages, they occur more vividly and greatly disturb the baby’s well-being.

Reduced appetite during chronic tuberculosis intoxication leads to the fact that the baby loses a lot of kilograms. This contributes to a pronounced lag in physical development. The child's muscle mass. Such babies look asthenic and quickly lose weight.

The baby's skin loses moisture and becomes drier to the touch. Skin turgor is noticeably reduced.

The thickness of the subcutaneous tissue also decreases noticeably due to a pronounced decrease in appetite.

The child’s well-being is noticeably depressed by constant changes in body temperature. Usually its values ​​during this period vary from 37 to 37.5 degrees. In some cases, fever and chills may occur.

The child's mood and behavior change noticeably during this period. A long-term illness leads to changes in the child’s mental personality type.

Noisy active games with friends do not bring satisfaction and joy to the child. A sick child tries to spend more time with himself. Even habitual activities can lead to excessive fatigue.

A sick child can hardly exercise and gets tired after a short walk.

The chronic period of tuberculosis intoxication is quite dangerous, as it is accompanied by the development of numerous persistent disorders. To prevent it, you should carry out timely diagnosis diseases. Only timely prescribed and carried out treatment will contribute to the regression of the disease.

If you suspect that your baby has signs of tuberculosis, you should immediately consult a pediatric phthisiatrician.

Tuberculosis infection, which is not accompanied by the appearance of symptoms, or a latent form of the disease can be determined using special laboratory and instrumental diagnostic methods.

Symptoms

During the incubation period, there are no specific symptoms of the disease. For tuberculosis infection this time is usually ½ to 4 months.

There is evidence in the scientific literature that in some cases the incubation period was even several years. The duration of this time is determined by the individual morphological characteristics of the pathogen, as well as the initial parameters of the immunity of the infected baby.

Tuberculosis has different masks. The variety of symptoms can be so enormous that it can significantly complicate the clinical diagnosis of the disease.

Some forms of the disease are virtually asymptomatic. It is important to note that tuberculosis infections that occur without the appearance of adverse clinical signs are quite common in children.

In this case, only alternative diagnostic methods can help establish the correct diagnosis.

The following symptoms are typical for tuberculosis infection:

• Persistent increase in temperature. This symptom persists at almost all stages of the disease. In most cases, body temperature does not rise above 37.5 degrees. Febrility occurs only when severe course diseases. An increase in temperature exhausts the baby and significantly worsens his well-being.
• Severe weakness and fatigue. The child becomes quite emotional and quickly gets irritated over small things. Some kids have unmotivated outbursts of anger. Quite often, sick children develop various depressive states.
• Loss of appetite. This symptom accompanies all periods of the disease. A decrease in appetite leads to severe weight loss, and ultimately leads to a lag in physical development. In severe cases, affected babies can lose up to 40% of their weight.
• Increased sweating. This symptom most often occurs at night. In phthisiatric practice, this clinical sign is often called the “collar symptom”, since increased sweating occurs mainly in the neck area. In some cases, hyperhidrosis is profuse.
• Severe dry skin and pathological brittleness of nails. A fairly common manifestation of tuberculosis infection is the appearance of areas of increased peeling on the skin. In adolescence, this symptom often resembles seborrheic dermatitis.

• Enlargement and hardening of lymph nodes. Almost all groups of peripheral lymph nodes are involved in the infectious process. They become dense to the touch and accessible to palpation. The affected lymph nodes increase in size several times. In severe cases, enlarged lymph nodes become visible when viewed from the side.
• Pronounced pallor of the skin. Babies' skin becomes thinner with clearly visible blood vessels. Bruises appear under the eyes and dark circles. In some cases, areas of acrocyanosis also appear around the nasolabial triangle. The long course of tuberculosis leads to the fact that the child’s fingers take on the shape drumsticks, and the nails have the appearance of a “watch glass”.

• Cardiopalmus. Tachycardia occurs not only when physical activity, but also in complete peace. Some babies experience aching and tingling sensations in the chest area.
• Pain in the joints. This symptom is very nonspecific. Quite often it occurs with tuberculosis musculoskeletal system. Joint pain can appear even at rest, without making active movements. Young children experience increased pain when standing up or crawling.
• Characteristic skin rashes, also called erythema nodosum. This form of the disease is characterized by the appearance of bright red spots that can itch and cause severe discomfort to the child. As erythema nodosum develops, the spots change color and acquire a blue tint. Adverse symptoms usually persist in babies for 3-4 weeks.

How does it manifest in newborns?

You can get tuberculosis at any age. The first signs of the disease sometimes occur even in newborn babies. The appearance of symptoms in this case is very nonspecific. This depends on the initial location of the tuberculosis focus. If there is an infection in the respiratory system, the child develops clinical signs associated with impaired respiratory function. Tuberculosis of the internal organs is accompanied by the appearance of a variety of symptoms, which may manifest as discomfort or pain in the abdomen, abnormal bowel movements or loss of appetite.

Diagnostics

Only TB specialists can make a final diagnosis of tuberculosis. Initially, for this purpose, doctors conduct a clinical examination of the baby, which in some cases makes it possible to establish signs of the disease. The diagnosis is confirmed by the results of laboratory and instrumental studies. This examination is carried out in a TB clinic. Laboratory tests consist of tuberculin tests. Tuberculin diagnostics helps determine increased sensitivity delayed type to specific proteins of Mycobacterium tuberculosis. In its own way chemical structure tuberculin is a special substance that is a purified tuberculosis toxin. Introducing it into a child’s body cannot lead to the baby becoming infected with tuberculosis.

• Negative the reaction is considered to be the absence of a red bright spot in the area where the needle was inserted.
• Doubtful sample- this is the appearance of a spot of hyperemia, up to ½ cm in size.
• If the reaction is positive skin papule exceeds 5 mm in size.
• In case of hyperergic reaction the size of the red spot at the injection site exceeds 17 mm or a bubble (vesicle) is formed, filled from the inside with serous fluid.

All positive and hyperergic reactions require mandatory additional diagnostic methods to exclude signs of tuberculosis in the child. These studies are necessary to determine normality or pathology.

In difficult clinical cases it is necessary to carry out PCR diagnostics. This method has high sensitivity and specificity, which makes it possible to determine the presence of mycobacteria in a child’s body quite accurately.

The most modern examination method used to diagnose tuberculosis is called spot research. This immunological test has been carried out in Russia since 2012.

The material for the study is deoxygenated blood. It usually takes 3-4 days. The information content of this test ranges from 95 to 98%, and sensitivity varies from 85 to 98%.

A modern and accurate alternative to conventional diagnostic tests for tuberculosis - carrying out Diaskintest. The use of this method makes it possible to identify both active and latent forms of the disease. The essence of the study is the introduction of protein allergens into the skin to determine a specific immune response. A positive result of this test indicates that the child’s body is already familiar with the infectious agent introduced into it.

Parents are often mistaken in considering Diaskintest a vaccination. It's not like that at all. This study is carried out for diagnostic purposes only and is necessary to establish the correct diagnosis. The result is assessed 2-3 days after the allergen is introduced.

In a child who has not had a previous infection with tuberculosis, no red spots or swelling will appear at the injection site.

Treatment

Various combinations of anti-tuberculosis drugs are used to treat the disease. These medications are prescribed for continuous use: omissions and short-term discontinuation of these medications are not permissible. The duration of treatment usually ranges from 6 months to several years.

Tuberculosis therapy is carried out in special TB hospitals. For the treatment of tuberculosis infection, multicomponent treatment is prescribed. It involves prescribing several medications at once.

The first treatment regimen, which was used to eliminate the adverse manifestations of the disease in our country, was three-component. It included taking three first-line drugs: streptomycin, isoniazid and para-aminosalicylic acid. For quite a long time, such treatment was successfully used in phthisiology and brought positive results.

Due to the fact that microbes quickly mutate and change their properties, the three-component tuberculosis treatment regimen was replaced by a four-component one. It is currently used to treat babies infected with sensitive strains. This treatment regimen includes the use of streptomycin or kanamycin, rafabutin or rifampicin, isoniazid or ftivazid, as well as pyrazinamide or ethionamide. It can cause numerous side effects in the child, since it includes quite a lot of strong antibiotics of the latest generations.

For many centuries, doctors have been talking about the importance and effectiveness of spa treatment young patients suffering from tuberculosis.

A combination of various physiotherapeutic techniques, a balanced high-calorie diet and fresh air help to significantly restore a child’s body weakened during illness.

It is advisable that the child undergo such treatment every year: this is an excellent prevention of the progression of the disease. If drug therapy is ineffective, doctors may recommend surgical treatment.

Indications for operations are determined by the attending physician. Most often, operations are performed if the baby has pathological formations in the lungs, which arise from pulmonary tuberculosis and are called cavities. After the operation, the child is prescribed restorative treatment.

Clinical examination of children with tuberculosis is carried out taking into account their distribution into clinical registration groups. Currently there are 7 groups. Children and adolescents are monitored by a pediatric TB specialist until they reach the age of 18 years. For each dispensary group there is a certain frequency and timing of tests for the isolation of mycobacteria and preventive treatment.

Look in next video the program “Live Healthy” with Elena Malysheva, dedicated to tuberculosis.