Search

Detailed analysis of risk factors in 161 children with pulmonary tuberculosis has established that tuberculosis risk-group children are ill in most cases (82.6%). Examining the results of annual tuberculin diagnosis in 2478 children aged 1 to 14 years in a children's city polyclinic could ascertain that the most risk groups comprise children with a conversion of tuberculin tests (5.2%) and tuberculosis-infected children with increased tuberculin sensitivity (7%) who are the basic contingent of followed up local district pediatric phthisiologists. The priorities of activities of pediatric phthisiology involve the detection of tuberculosis risk groups by the general pediatric service by the tuberculin diagnostic technique under the guidance of a phthisiological service and the choice of individual management policy by their pediatric phthisiologists.

The paper analyzes a contingent of children and adolescents from a tuberculous sanatorium in 2000-2002. It was established that the children and adolescents with local forms of tuberculosis amounted to 14.5%, the children with a variety of tuberculin reactions were 33.5%; the children infected with tuberculosis and risk factors were 42.1%; the total proportion of children who had contacted patients with tuberculosis was 31.7% of the whole contingent of the sanatorium, i.e. about a third. In addition to different manifestations of tuberculous infection, nonspecific abnormalities were detected in 96.4% of the children and adolescents, in the vast majority they being first diagnosed at the sanatorium. The foregoing suggests that a children's tuberculosis sanatorium is of great medical importance under the present conditions.

Examination of risk factors of infection and falling ill with tuberculosis in 453 adolescents who had different contacts with patients with tuberculosis (a study group) and 246 from the healthy environment (a control group) has ascertained that adolescents living in death foci fell ill with tuberculosis 6 times as frequent as the controls (18.2 versus 3.3%) and 3 times as frequent as other subgroups. A subgroup from bacterial isolation foci was the second severest epidemiological risk. They fell ill with tuberculosis twice as frequent as the persons having a contact with patients without bacterial isolates (8.0 and 4.1%) and 2.5 times as frequent as the controls (8.0 and 3.3%). In these subgroups of those fell ill with tuberculosis was slightly more than in the control group (4.1, 4.0, and 3.3%, respectively).

The immunological and hormonal links of homeostasis and the pattern of their relationships were studied in 137 adolescents with early primary tuberculous infection (EPTI) and 79 adolescents uninfected with tuberculosis (control). There was a significant increase in the specific functional activity of T lymphocytes and a reduction in their nonspecific functional activity as compared with the controls, as well as an elevation of the levels of thyroxine, cortisol, and insulin. In EPTI, there was an unbalanced enhancement of the activity of cortisol and insulin with the relative deficiency of the latter, which is indicative of overstrain of nonspecific adaptation reactions. In EPTI, integration of immune-hormonal liaison has been established to occur with the radical (90%) change of the body's functional system. Highly reliable two-dimensional indicators have been proposed for the diagnosis of EPTI in adolescents.

In the Kharkov Region, the rate of tuberculosis infection in children was 28.8%; among them children with a curve of tuberculin reactions was 3.8%; most of them had a moderate sensitivity to tuberculin. The remaining 71.2% of the examinees were not infected with tuberculosis; more than 50% of them (41.1%) had postvaccinal allergy.

Examining active tuberculosis in 38 infants has established the following features: the disease is characterized by predominantly (71%) classical forms of primary tuberculosis; moreover, a primary tuberculosis complex is more common (41.7%) than tuberculosis of intrathoracic lymph nodes (26.3%); by complicated tuberculosis in more than a third of the infants, by extrapulmonary tuberculosis in 23.7%, and by the affliction of 2 systems in 13.2%. Tuberculosis runs most severely in children under 1 year of age. The group at the highest risk for tuberculosis may include infants contacting patients with tuberculosis (65.8%), ill vaccinated infants with BCG (89.4%), infants with symptoms of intoxication and thoracic complaints (79.3%), and those with hyperergic and pronounced sensitivity to tuberculin.

Sixty-five children and adolescents with respiratory tuberculosis were examined to determine the proportion of cytomegalovirus infection among patients with tuberculosis and its impact on the occurrence and course of different forms of tuberculosis. The number of children and adolescents infected with cytomegalovirus among the patients with respiratory tuberculosis (66.2%) was found to be three times more than that among those not infected with tuberculosis (21.0). The absolute majority (91.3%) of the examinees with the complicated course of a tuberculous process were carriers of cytomegalovirus. They were found to have both antigens and antibodies to cytomegalovirus 9 times more frequently than patients with the smooth course of tuberculosis, which is indicative of the activity of cytomegalovirus infection. The findings suggest that cytomegalovirus infection has an impact on the occurrence and pattern of a tuberculous process.

Comparative study of the distribution of antigens of HLA-A, B, and C, as well as somato- and phenotype in 234 adolescents has revealed that HLA-A11 and HLA-B12 antigens may indicate a predisposition to tuberculosis and HLA-A28, HLA-B8, and HLA-B51 antigens are involved in its prevention. It has been found that there is predominance of persons having severe forms of somatotype (dolychobrachymorphic) and that there is also a high phenotype stigmatization in adolescents with different manifestations of tuberculous infection.

Clinical and X-ray characteristics were studied in 102 children with first detected active respiratory tuberculosis. The patients with intrathoracic lymph nodal tuberculosis were 39.2%, those with a primary complex, tuberculosis pleurisy, disseminated tuberculosis, infiltrative tuberculosis, and focal tuberculosis, 33.3, 14.7, 4.9, 5.9, and 1.9%, respectively. Under the present conditions, respiratory tuberculosis is encountered more commonly (72.5%) in infants and pre-school children, which is characterized by its complicated course (30.4%), clinical symptomatology with signs of tuberculous intoxication (66.6%), hyperergic (29.4%) and pronounced (46.1%) tuberculin sensitivity. Surveys have revealed the disease in 58.8% of patients, by tuberculin diagnosis in 36.6 of them.

Immunological reactivity was assessed in 108 adolescents aged 12-17: 25 healthy subjects, 29 and 54 adolescents with a turn in tuberculin tests. The latter received isoniazid alone for 3 months and in combination with levamisole electrophoresis, respectively. Immunological reactivity responded more advantageously in 54 subjects exposed to adjuvant levamisole electrophoresis. They showed inhibition of immunospecific reactions and enhancement of nonspecific ones as well as of skin tuberculin sensitivity. Levamisole electrophoresis raised the efficacy of secondary prophylaxis in adolescents with a turn in tuberculin tests.