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Retrospective analysis of the data available in the reporting form 0-89/y-[cyrillic letter: see text] and information analytical tables for Moscow tuberculosis monitoring) over 7 years on all notified new cases of tuberculosis among 15-17-year-old children has indicated that it is necessary to change the procedure for detecting tuberculosis for this age group of children in order to improve the early diagnosis of the disease. The Mantoux test is likely to be rather effective in examining adolescent schoolchildren and students from secondary specialized establishments and ineffective among unorganized young people and in migrants' families. Planned fluorography is of rather informative value in all the groups under study if there is a timely referral for examination. The authors consider whether it is worth making a tuberculosis 2 TE PPD-L in organized collective bodies (schools, colleges, etc.). Other groups of children may undergo only digital small-dose fluorography. Unorganized children above 10 years of age who lack annual Mantoux test results must be referred for digital small-dose fluorography. Refusal to undergo fluorography is justifiable only if there is no tuberculin sensitivity or evident symptoms of intoxication. In the megapolis, due to uncontrolled migration, a lawmaker must consolidate the statute on that mandatory control should be exercised over 15-17-year-old adolescents who must undergo fluorography during their each visit to a health care facility, on entering an educational establishment, or on employment. On consulting a physician, the adolescent who has undergone fluorography 6 months before must have it again.

DST was ascertained to have a high sensitivity in virtually all patients with tuberculosis and a positive reaction was first noted in the infected. With stabilization and regression, the response to DST was much less pronounced than that in clinical and primary infection (that to the Mantoux test being more evident). DST showed its use as a marker of active tuberculosis not only in its local forms, but also in latent tuberculous infection. This makes it possible to apply DST when preventive treatment is performed. The agent may be used to monitor the progress of treatment. DST has a high specificity--healthy individuals had a negative response to DST while the Mantoux test was positive in many cases. The high specificity of DST was suggested by the fact that the persons vaccinated with (this caused BCG ostitis) had a negative reaction to DST while the Mantoux test was positive in all cases BCG-vaccinated BCG. The findings warrant the use of DST for the differential diagnosis of tuberculosis and BCG-associated complications and the possibility of differentiating postvaccinal and infection allergy in children and adolescents.

A new reagent for a skin test given the name Diaskintest has been designed for the screening diagnosis of tuberculosis and preclinical and clinical trials conducted. Preclinical trials were carried out on 315 laboratory animals (guinea-pigs, albino mice). The reagent Diaskintest was ascertained to be nontoxic, to have no sensitizing properties, to be safe and specific, and to induce no positive reactions in BCG-vaccinated animals and healthy guinea-pigs. Its specific activity was comparable with that of the national reference--purified tuberculin PPD-L-2. With progression of tuberculous lesions, the guinea-pigs showed higher responses to Diaskintest dilution and the BCG-vaccinated animals lacked responses to Diaskintest with increased delayed type hypersensitivity. The clinical trial was permitted by the Federal Service for Surveillance in Health Care and Social Development of the Russian Federation. Clinical trials were conducted in 150 persons. The safety, specificity, sensitivity of Diaskintest were first examined in the clinical studies and its action was compared with the results of tuberculin skin test (Mantoux test) with 2 TE of PPD L-2. Diaskintest was ascertained to be highly sensitive when given in a dose of 0.2 microg in 0.1 ml. In patients with active tuberculosis and new cases of Mycobacterium tuberculosis infection, the agent induced a positive skin reaction (a papule of more than 10 mm) in 98-100% of cases (p < 0.05). The agent caused no reaction associated with BCG vaccination. The specificity of the test was 93-100% with 95% significance. The rate of overexuberant reactions (vesicular necrotic changes, lymphangitis, and lymphadenitis) was 4-14% with 95% significance. Tuberculosis patients with significant immunopathological disorders might have no skin sensitivity to Diaskintest, as to PPD L-2 (a negative test). The findings substantiate the use of Diaskintest for mass epidemiological surveys for the differential diagnosis of tuberculosis and BCG vaccination-associated complications. The agent may be also used to evaluate the activity of the process in patients with tuberculosis and the efficiency of treatment in combination with other methods and to make a differential diagnosis of tuberculosis.

Tuberculosis morbidity was comparatively analyzed in the children and adolescents of Moscow and the Penza Region. The epidemiology of tuberculosis in the children and adolescents was established to be universal in the compared regions in the study period. This manifested itself as a stable tendency for higher morbidity rates (MR), increased incidence of destructive tuberculosis, inadequate use of the existing methods for active detection of tuberculosis in these age groups, and, among those who had fallen ill with this disease, an increase in the number of persons from the foci of tuberculous infection and persons with established contact with patients with tuberculosis. Along with a steady MR growth for tuberculosis among the children and adolescents, there has been a quantitative modification to the proportion of all epidemiologically hazardous forms of tuberculosis, such as the bacillary and destructive forms of pulmonary tuberculosis complicated by extrapulmonary tuberculosis. Hypodiagnosis of tuberculous pleurisy and extrapulmonary tuberculosis has been recently noted in the general health care network. The analysis also leads to the conclusion that the quality of mass tuberculin diagnosis remains poor. In both regions, general pediatricians are not adequately alert to tuberculosis, extrapulmonary tuberculosis in particular. With a rise in tuberculosis endemic, the incidence of tuberculosis in 18-21-year-old persons is 2-3 times greater than that in adolescents, which is associated with the greater activity of this population group and with the underdetection of the asymptomatic forms of tuberculosis in adolescents.

Fifty-eight adolescents aged 13-17 years who had new-onset pulmonary tuberculosis were examined. The serum levels of C-reactive protein (CRP), alpha-antitrypsin (alpha1-AT), haptoglobin (Hp), serum protein fractions, medium-weight molecules (MWM), and malonic dialdehyde (MDA) were assayed in the patients on admission, 2 weeks, and 1, 2, 3, and 6 months after treatment. The parameters of a systemic inflammatory response were ascertained to naturally vary in the adolescents with new-onset tuberculosis, by reflecting as both a defense reaction (increases in the levels of CRP, a,-AT, Hp) and as metabolic decompensation manifestations (increases in the concentrations of MWM and MDA and a reduction in the almubin/globulin (A/G) ratio. The magnitude of these changes makes it possible to judge the severity of a process to a certain extent and it is unassociated with the genesis of the disease. The levels of acute-phase reagents and MDA undergo positive changes just 2 weeks of effective specific chemotherapy whereas there are no changes after ineffective treatment. After correction of chemotherapy and achieving a clinical effect, there was a complete normalization in the levels of CRP, Hp, and A/G ratio, but a slight increase in alpha1-AT and MDA in all the children by month 6 of therapy. In all the adolescents, the baseline increased concentration of MWM increased at the early stage of chemotherapy and returned to the original value after 6-month therapy, by remaining significantly higher than the normal values.

Two hundred and eighteen Mycobacterium tuberculosis-infected children and adolescents aged 4 to 18 years were examined. Whether the patients and their relatives had a history of allergic reactions was ascertained. A complex of diagnostic studies is of great value in verifying the presence of concomitant allergic diseases. The rate of allergic reactions in the child's history does not itself determine the likelihood of development of allergic states. The Mantoux (tuberculin) test in allergic children does not lead to an exacerbation of the underlying disease at remission. The remission manifestations of paraallergy are noted in 15.8% of the patients with allergic diseases and in 42.9% of the children having allergic reactions in the history. This supports the quality of a follow-up and treatment by an allergist, as well as an adequate response to a Mantoux test with 2 TE of PPD-L in the bulk of allergic children. The use of antihistamines as preparation for the test allows an inference about true infection and the sensitivity to tuberculin in both the most of allergic patients and persons with a history of allergic manifestations.

The 2000-2006 results of tuberculin diagnosis made in a city numbering 10.5 million people were retrospectively analyzed on the basis of an epidemiological tuberculosis survey among children. The higher cut-offs are not helpful in interpreting the tuberculin test. With more than 5 mm, it is necessary to have criteria for clear differences between the active tuberculous process, inactive tuberculous changes, and recent or previous Mycobacterium tuberculosis infection. With the low prevalence of tuberculosis among children in a megapolis, the sensitivity of the method was 97.4%. Its specificity was 41.7%; out of these children, a risk group forms in 1% of cases and the children who had been referred by a pediatrician and had failed to be examined by a specialist at a tuberculosis dispensary. With positive and negative tests, the likelihood of the disease in a child is 0.01 and 99.9%, respectively. At the same time, morbidity in risk group children formed by the results of tuberculin tests is high and indicative of a need for searching for objective indicators (except for tuberculin diagnosis and history data) to identify the disease just before registration as a risk group. The practical value of chemotherapy for latent tuberculosis infection in the megapolis requires studies and evidence-based results. Preventive chemotherapy is currently the priority in preventing tuberculosis for individual risk groups (among the HIV-infected and those who are from tuberculosis infection foci).

The specific features of tuberculin sensitivity were studied in 210 children and adolescents aged 4-17 years who had active pulmonary tuberculosis. There were more common significant and hyperergic tuberculin sensitivities, conversion of tubercular tests, and an increase in tuberculin sensitivity. Timely phthisiological examination of patients with these values of tuberculin sensitivity could promote early detection of local forms of tuberculosis in 71.1% of the patients detected on their visit to a doctor. There was a correlation of the hyperergic tuberculin sensitivity with the phase of incomplete calcification in patients with tuberculosis of the intrathoracic lymph nodes, which may suggest that the macroorganism is hypersensitized in patients with slow reparative processes. There is evidence that the Mantoux test with 2 TE of PPD-L preserves its diagnostic value in patients with clinical and X-ray changes in the differential diagnosis of tuberculosis and nonspecific diseases of the lung.

Based on the annual reports of Moscow tuberculosis dispensaries, the analysis of their follow-up of dispensary registration group VI patients, the authors have developed preventive chemotherapy regimens in relation to the specific features of tuberculin sensitivity, the presence or absence of additional risk factors (concomitant somatic diseases, social risk factors). Regimen I (1 antituberculous drug (isoniazid) for 3 months) may be used in dispensary registration groups VIA and VIB patients without additional risk factors. Regimen II (2 antituberculous drugs (isoniazid + pyrazinamide/ethambutol) for 3 months) may be employed in dispensary registration groups VIA and VIB patients with additional risk factors, as well as in children from dispensary registration group VIB, whether additional risk factors are present or absent. A repeated course of preventive chemotherapy regimen II is indicated when tuberculin sensitivity is increased or a hyperergic reaction is retained after termination of treatment in patients having additional risk factors.

The paper provides the data of analysis of antituberculous care to teenagers in Moscow and characterizes its problems. Emphasis is placed on the tense and unstable situation associated with the detection of the disease in this age group. In the bulk of adolescents, the disease is identifies when they come to see a doctor, including at somatic hospitals. Active tuberculosis detection techniques (tuberculin diagnosis and fluorography) fail to produce adequate effect mainly due to organizational problems (the bulk of teenagers are outside the organized collective bodies or the latter are frequently changed; the detection of tuberculosis in Moscow nonresidents or in whose who enter secondary specialized colleges claims attention). Age-related sociomedical risk factors, such as hormonal rearrangement, comorbidity, a negative attitude towards preventive medical measures, deviant behavior, social family, and dysadaption, are of importance for the development of tuberculosis. A sociomedical portrait of an adolescent with tuberculosis is given. Attention is drawn to the fact that on implementing antituberculous measures, it is a need for an interaction of a tuberculosis-controlling service with general care health network facilities, including those that deal with the problems of social diseases and educational establishments.

The study covered 56 patients (aged 6-14 years) having hyperergic tuberculin sensitivity, including 28 patients with pulmonary tuberculosis (Group 1) and 28 patients infected with Mycobacterium tuberculosis (MBT) (Group 2). All tuberculous processes were asymptomatic and limited. Minor forms of tuberculosis, diagnosed by computed tomography, were found in 71.4% of cases. The signs of incomplete calcification were detectable in 93% of cases. In the past year, tuberculin sensitivity has progressed to hyperergic one in 75% of Group 2 patients. The patients with tuberculosis were treated with 3 drugs; those infected with M BT received 2 agents. In the patients with minor forms of tuberculosis, the level of specific IgG antibodies was equal to those in healthy MBT-infected individuals with hyperergic tuberculin sensitivity, the levels of immunoglobulins of subclasses G1 and G4 were lower, that of IgE antibodies were higher than in the MTB-infected. These data may suggest the stability of the immune system in patients with minor forms of tuberculosis, detected in the phase of calcification, and its instability in the MBT-infected with tuberculin sensitivity increasing up to hyperergic one.

Sixty-two case histories of Moscow children aged 4-12 years, treated at the Central Research Institute of Tuberculosis, Russian Academy of Medical Sciences, for first detected intrathoracic lymph node tuberculosis (ITLNT), were studied. Planned and prophylactic studies revealed the disease in 95.1% (including 66.1% after mass tuberculin diagnosis and 29% on examination for their contact). The disease was more commonly asymptomatic. Mild or moderate signs of the total disorder syndrome were prevalent in the clinical picture. In 56.5% of cases, a tuberculous process was detected in the phase of consolidation and calcinations. Among the patients with intrathoracic lymph nodal changes in the infiltration phase, the children with minor forms of ITLNT whose diagnosis was verified by computed tomography were 72.7%. The use of computed tomography in the diagnosis of ITLNT allowed one to make the fullest evaluation of changes in intrathoracic lymph nodes, including the groups of the anterior and posterior mediastinum.

Eighteen patients with multidrug resistant Mycobacterium tuberculosis (MBT), including 4 (22.2%) children aged 12-14 years and 14 (77.8%) adolescents, were followed up. In 89% of cases, 5 drugs were included into the intensive phase of the chemotherapy regimen. The commonest causes limiting the use of the sixth drug were MBT resistance to essential and reserve drugs (41.2%), uncorrectable adverse reactions to the drugs to which sensitivity was retained (30.7%). The intensive phase lasted 5 months; the mean continuation phase was 5.5 months. The reduction in the latter is attributable to the surgical treatment in 38.9% of the patients with sustained decay cavities and bacterial isolation. Treatment should be complex, by applying different treatment options, such as chemotherapy, collapdotherapy, and surgical treatment. After complex treatment, bacterial isolation ceased in 94.4% of cases, decay cavities closed in 83.3%. There were pronounced residual changes in 66.6%.

Treatment of 329 patients aged 4-17 years who had first detected tuberculosis was analyzed. The clinical pattern is mainly represented by infiltrative, focal tuberculosis and tuberculosis of intrathoracic lymph nodes (94.5%) and, in single cases, by other forms of tuberculosis. Treatment was performed according to regimens I and III. The time of abacillation is 1-2 months shorter than positive X-ray changes. In this connection, the results of X-ray monitoring may be regarded as the leading criterion for completion of intensive care. Microbiological monitoring methods should be primarily used to evaluate the initial combination of chemotherapy. The active application of pathogenetic treatment modalities that promote the acceleration of reparative processes (physiotherapy in particular) generated the necessity of using 3 antituberculous agents in the phase of treatment continuation.

A follow-up of 558 children and adolescents contacting the patients with tuberculosis who isolated bacteria was analyzed. In 46.5% of cases, the children and adolescents contacting the patients with tuberculosis were in the foci of drug-resistant Mycobacterium tuberculosis (MBT) in the source of infection. The patients from these foci fell ill with tuberculosis 3.4 times more frequently than those from the foci where the sources of infection isolated MBT susceptible to antituberculous drugs. Processes with bacterial isolation were detected in 47.7% of the ill children and adolescents, primary MBT resistance to antituberculous drugs being noted in 68.8% of cases. Preventive chemotherapy reduces the risk for children and adolescents contacting the patients with tuberculosis to fall ill by 7.6 times. Ineffective preventive chemotherapy performed in those contacting the patients was due to the use of MBT-resistant antituberculous drugs in the source of infection. The administration of the MBT-resistant drugs in the source of infection led to the same high incidence of tuberculosis in children and adolescents from the bacterial foci of tuberculous infection as in its absence.

For the treatment of children and adolescents with tuberculosis, the needs for reserve drugs are 24.0 and 48.6%, respectively. The main reason of the use of reserve drugs is intolerability of essential antituberculous drugs in children (16.4%), and resistance to these drugs in adolescents (40%). Overall, different types of intolerability events (allergic, toxic, toxicoallergic reactions) were observed in 27 (34%) of 79 children and in 46 (65%) of 70 adolescents. Adverse reactions to essential drugs were significantly more frequently observed than those to reserve drugs in both the children and the adolescents: in 96.3 and 3.7% (p < 0.001) and in 89.1 and 10.9% (p < 0.001) cases, respectively.

The paper presents the basic sections of the nonspecific prevention of tuberculosis. The main objective, tasks, and methods for solving the latter are formulated for each section. Emphasis is placed on the social and age groups of the population while doing sanitary and educational work. Attention is given to that it is necessary to evaluate the efficiency of implementation of educational programs, which is important for making amendments when the epidemic situation and the population's sanitary education change.

During treatment, 65.7% of the patients developed adverse reactions to antituberculosis drugs. Allergic reactions were most commonly associated with the use of streptomycin. The simultaneous inclusion of isoniazid, rifampicin, and pyrazinamide into the treatment regimens irrespective of the total number of drugs was found to increase the incidence of hepatotoxic reactions as compared with the regimens which do not contain a combination of these 3 drugs. Cycloserin may be given to adolescents with multidrug resistant tuberculosis. Glutaminic acid prevents the toxic effect of the drug on the CNS, therefore cycloserin may be prescribed for a long period (for as long as 9 months).

A total of 188 children and adolescents were examined. In all the children, blood Mycobacterium tuberculosis (MBT) DNA was determined by polymerase chain reaction (PCR) and MBT antigens (AG) and antibodies (AB) were by enzyme immunoassay. The studies have shown that it is expedient to concurrently determine MBT DNA and MBT AT in order to identify local forms of tuberculosis in children from risk groups. If the tests are positive, a comprehensive examination for tuberculosis is required; the presence of the syndrome of common disturbances is generally associated with tuberculous infection. When a local form of tuberculosis is excluded, preventive chemotherapy should be performed. Further negative tests for MBT DNA and lower MBT AT may be a criterion for the efficiency of preventive treatment. In children with tuberculosis, the results of repeated blood and urine tests for MBT DNA provide a way of evaluating the course of a tuberculous process and the efficiency of chemotherapy. PCR used to determine blood and urine MBT DNA is a highly specific test as positive results were in 79% of the children with tuberculosis.

It is possible to achieve a qualitative annual intradermal testing of children and adolescents by the Mantoux test with 2 TE PPD-L and to form Dispensary Registration Group 6 completely only when there is a combination of a mass tuberculin diagnosis, team's well organized work and systematic control methods for its work quality. Standards have been developed for the quality of registration of Group 6 patients and for that of registration of positive Mantoux tests with 2 TE PPD-L, for the completeness of formation of the above group of patients, for organization of controlled chemoprophylaxis in children's collective bodies.

In 19 of 40 adolescent patients with disseminated pulmonary tuberculosis, supravenous blood laser radiation was used in the complex treatment 2-3 weeks after the initiation of chemotherapy. The use of this type of laser therapy enhanced the efficiency of the treatment, accelerated positive changes of tuberculosis by 2.5-3.5 months, as evidenced by clinical and laboratory parameters, led to a smooth course of tuberculosis to develop less pronounced residual changes in the lung.

Luminescence bacterioscopy of capillary blood has been found to be an additional rapid laboratory method that verifies a clinical diagnosis in cases of negative sputum bacterioscopic tests in 48.8% of the adolescent patients. The Boy luminescence microscopy shows that in adolescent tuberculosis patients, Mycobacteria are significantly more frequently present in the capillary blood (72.4%) than in the sputum (30.9%) and bronchial washes (34.8%). The detection of Mycobacteria in the capillary blood has been evidenced by cultural tests of some venous blood samples in the BACTEC 460 TB system.

Positive enzyme immunoassay (EIA) was found in 59.6% of patients of tuberculosis. Positive responses were significantly more frequently detected in patients with pulmonary tuberculosis than in those with intrathoracic lymph nodal tuberculosis (ITLNT) (62.2 +/- 7.4 versus 38.9 +/- 11.8%, respectively; p < 0.05. There was no significance difference in the rate of positive responses in patients with ITLNT (38.9 +/- 11.8%) and healthy individuals inoculated with Mycobacterium tuberculosis (17.6 +/- 9.5%). Sixteen (61.5%) patients with pneumonia showed a positive response, which amounted to 38.5% specificity of the method. The findings suggest that EIA may not be used as a screening test for early diagnosis of tuberculosis in children and teenagers and for differential diagnosis of pulmonary tuberculosis and nonspecific pneumonia. EIA data may be assessed only in combination with other diagnostic criteria.

The paper presents guidelines in treating tuberculosis in children from the experience gained in Russia and other foreign countries. Emphasis is laid on the necessity of applying a comprehensive approach to the treatment whose main constituents are sanitary and dietary regimens, etiotropic and pathogenetic therapies, prevention of exacerbations or treatment of concomitant diseases. It is important to use antituberculous agents rationally by determining a standard treatment regimens for patients with various somatic diseases. Of great value is the pattern of organization of a therapeutical process at different stages (institutional treatment at a hospital, day hospital, or sanatorium and outpatient treatment), which secures continuity and accordingly enhances the efficiency of treatment as a whole.

Because of deterioration of epidemiological situation by tuberculosis, individuals from tuberculous infection foci and social risk group require special care. It is important to integrate efforts of phthisiatric and general therapeutic and prophylactic services in detection of tuberculosis in children and adolescents, to create controlled conditions for conduction of antituberculous measures.

The paper deals with the detection of carbohydrate metabolic disturbances in adolescents with tuberculosis and analyzes their impact on the course of a specific process. Borderline carbohydrate metabolic disorders were identified in 10.8% of the 130 patients examined. A trend for tuberculosis to run less favourably was found in patients with carbohydrate metabolic disturbances than in those without these disorders; however, there was no significant difference between the groups. Fourteen tuberculosis adolescents with diabetes mellitus were followed up. Their concurrence showed a severe course. In 33.2% of patients, the course of tuberculosis was poor, by progressing to fibro-cavernous tuberculosis.

In 25 of 44 teenagers suffering from acute and progressive tuberculosis, intravenous blood laser radiation was included into its multimodality treatment following 2-4 weeks of the initiation of chemotherapy. The use of laser enhanced the efficiency of treatment, accelerated positive changes by 1.5-2 months by major clinical and laboratory indices, made the disease run smoothly and caused less pronounced residual changes in the lung.

The paper shows the efficiency of combined use of magnetic laser therapy (MLT) and lymphotropic drug therapy in 40 teenagers with common forms of tuberculosis. The use of laser makes it possible to modify methods of regional lymphotropic therapy, to prolong its use and increase indications for it. MLT in combination with lymphotropic drug therapy accelerates positive changes and hence enhances the efficiency of tuberculosis treatment.

Tuberculous infection is no longer controllable in Moscow. Tuberculosis ranks first in the structure of morbidity caused by monoinfections. The prevalence of tuberculosis is increasing both among adults and children. Increasing incidence of forms with bacterial release is especially dangerous. Such patients represent the greatest epidemic hazard for the population. In Moscow the situation with tuberculosis is characterized by a notable reservoir of infection among socially maladapted subjects. A special department for this patient population was created in tuberculosis hospital No. 11; besides medical care, the patients are rendered social care there. The situation with tuberculosis in Russia and in Moscow requires urgent measures aimed at stabilization of the epidemiological process.

The phenotype of haptoglobin (Hp) was determined and Hp and alpha 1-antitrypsin (alpha 1-AT) were many times measured in the sera of 131 adolescents with first identified tuberculosis. The phenotype of Hp was found to produce no effects on tuberculosis morbidity among adolescents, but Hp2-2 carriers fall ill more frequently if they have a baseline gastrointestinal abnormality. In tuberculosis patients with Hp2-2, resolution of infiltrative changes in the lung tissue occurs less rapidly than in those with other Hp variants. Great increases in the serum levels of alpha 1-AT, which reflects the severity of tissue damages, suggest a less favourable prognosis. By the end of sixth-month continuous combined drug therapy, an inflammatory reaction diminishes and the synthesis of acute phase reactants (APR) becomes normal in patients without baseline lung tissue decay. In the presence of the latter, the intensity of inflammation considerably decreases in the first 3 months of combined drug therapy, then becomes steady-state at a definite level, which is potentiated by continuous invasion of proteolytic enzymes. APR monitoring more accurately assesses the time course of therapy-induced changes in the process.

Fifty seven adolescents having tuberculosis and clinical signs of drug intolerance were examined by immunological tests (thermistometry and blast-transformation reaction in 20 and 37 patients, respectively). Of them 30 patients had concomitant diseases. Patients with concurrent abnormalities require laboratory evidence for drug intolerance. Of all negative tests, they were more common in patients with concomitant abnormalities (65.5%), but they amounted to 34.5% in those without concomitant abnormalities. There was a similarity of the clinical symptomatology of intolerance with negative immunological responses to the exacerbation or increased symptoms of concomitant diseases.

Under the conditions of society's socioeconomic instability and increased migratory processes, ever increasing numbers of children and adolescents are being brought up in socially disadapted families. The social status of a family largely determines the infection and morbidity rates of tuberculosis and affects the diagnosis, course and prognosis of the disease in children and adolescents. The infection rates in this group of children are 2-5 times higher than those of children in Russia, the risk of primary infection is 10.9%. In children and adolescents from the socially disadapted families, there was a torpid and undulating course in 50% of cases, 25% being found to have primary resistance to antituberculous drugs, which corresponds to that in the source of infection. To enhance the efficiency of antituberculous diagnostic and therapeutic measures among children and adolescents from socially disadapted population groups, the Ministry of Internal Affairs, public educational institutions, and the general therapeutical network should jointly make a complex of measures within the framework of a goal-oriented sponsored programme.

In recent years, there has been a rise in tuberculosis morbidity among children and adolescents in Russia. Society's social problems which contribute to the accumulation of an uncontrolled infection reservoir that is unknown to the antituberculous service system. The reservoir is formed primarily among children and adolescents who are brought up in socially disadapted, migrants' refugees, or homeless families, among delinquent children and adolescents. The existing complex of antituberculosis measures is under way only among permanent residents. In this connection, antituberculous measures in the above risk groups are to be improved. Some specific proposals are given in the paper.

Follow-up study of 106 adolescents with advanced and complicated tuberculosis revealed causes and risk factors of the severe disease: late detection and treatment, massive infection, inadequate initial treatment, drug resistance of M. tuberculosis, poor tolerance of chemotherapy, presence of associated diseases and chronic infection foci, harmful habits. Of importance is also age-sex factor, absence of BCG revaccination, low quality of preventive, diagnostic and therapeutic service, inadequate hygienic education of adolescents.

Tuberculous antigens and antibodies, antigens and antibodies to pneumococcus, haemophilus bacteria. Klebsiella pneumonia, proteus bacteria were determined in 100 adolescents (87 with tuberculosis and 13 with nonspecific lung diseases). Specific antigens and antibodies were detected in 62% of tuberculous and 7.7% of nontuberculous patients. The most pronounced immune response to M. tuberculosis antigens and antibodies as well as to nonspecific flora was registered in patients with long-term and disseminated processes. Immunological investigations are thought an important tool in diagnosis, differential diagnosis of tuberculosis and planning combined treatment policy.

The authors analyse the data obtained on 366 tuberculous adolescents treated in the central Research Institute of Tuberculosis in 1989-1990. Active disease occurred in 30% of them. As evident from larger proportion of infiltrative tuberculosis with destruction and dissemination, the incidence rate of which had grown from 11.5% in 1989 to 40% in 1992 and of caseous pneumonia (the growth, respectively, from 7.7% in 1990 to 25% in 1992), clinical patterns of tuberculosis takes a more serious course. Of late, caseous pneumonia in adolescents has been characterized by an acute onset, loss of weight against severe intoxication, pronounced bacterial discharge, shifts in blood and immunity indices, associated affections. Most of the adolescents were infected in their family who had failed to receive BCG revaccination. Adequate combined treatment has resulted in favourable outcomes which, however, have been often accompanied by defective healing.

Attention is attached to the improvement of health education in school collectives in the epidemiologically unfavourable rural areas. The level of their awareness of tuberculosis prevention has been studied on the basis of questionnaires given to 153 teachers and 90 schoolchildren and hence the optimal forms of activity have been suggested, including lesions in tuberculosis prevention that should be included in the curriculum of biology. Variants of tuberculin diagnosis used in early tuberculosis detection and adequate formation of risk groups in the presence or absence of a contact with tuberculosis patients in school collectives have been proposed. Special consideration is given to these activities in rural boarding schools.

The paper deals with the data of follow-up of adolescents with disseminated pulmonary processes of different etiology. Among the patients who were treated in the department during the last 10 years disseminated processes amounted to 3.3%, with disseminated pulmonary tuberculosis being recorded in 1.3% and dissemination of the nontuberculous etiology in 2% of the patients. Mucoviscidosis, metastasis, of the thyroid cancer, histiocytosis X, toxoplasmosis and echinococcosis were among the disseminations of the nontuberculous etiology. Basic diagnostic criteria have been determined.

The results of questionnaires given to students of boarding schools who live in the areas differing in epidemiological situation are presented. In compiling questionnaires consideration should be given to the social composition of students and the epidemiological situation in the area. Questionnaires collected in the areas with a favorable situation enable one to form more fully new groups of risk (IVB, VIB) for tuberculosis, to improve health education aimed at raising social culture (harm of smoking, alcohol abuse and their association with tuberculosis, etc.). In the unfavourable epidemiological areas they play the leading role in the adequate formation of Dispensary Registration Group IV duet to the deeper search for a source of infection. Hence, health education should be mainly concerned with the development of hygienic habits in students.

Data are given on the examination of 23,507 schoolchildren, students of specialized secondary and technical vocational schools covering 13 regions of the country. It has been found that tuberculosis contamination of adolescents is 30-33%, on average, but it varies considerably depending on the general epidemiologic situation at the place of residence, and the social status of adolescents. As compared to schoolchildren, tuberculosis contamination and the frequency of tuberculin reaction reversion are higher in students of technical vocational schools. The importance of BCG vaccination in adolescents, as the main method for tuberculosis is prevention, is substantiated. About 30% of adolescents, on average, are subject to revaccination. It is concluded that children and adolescents should be revaccinated twice: at 6-7 years (1st form) and 14-15 years (8-9th form).

Observation findings concerning 112 adolescents with tuberculosis are presented. The patients were divided into 2 groups. Group 1 included 61 cases with primary forms of tuberculosis and without lung tissue destruction or bacillary excretion. The best part of this group was affected by tuberculosis of intrathoracic lymph nodes and focal tuberculosis. Group 2 consisted of 51 patients with primary tuberculosis in addition to lung tissue destruction or bacillary excretion. Most of these patients had infiltrative tuberculosis. Their treatment regimens were standard ones. The patients of group 1 are recommended to have a 6-month hospital management and a subsequent additional treatment at a sanatorium for 3 months. The period of the in-patient chemotherapy of group 2 should be no less than 9 months plus 3 months of additional treatment at a sanatorium.

The analysis of 91 case records of children and adolescents living in rural area with a high incidence of tuberculosis was made. These patients were detected through screening and by means of tuberculin diagnosis and fluorography carried out by a team of health workers on a case-finding mission. The organization of work with due regard for the local conditions makes it possible to use the above methods for an early detection of the given disease; to assess the results obtained from the very beginning of their combined and parallel application; to practice fluorography from the age of 7; to exercise a differentiated approach to an additional examination depending on the distance between the population area and regional center; and optimize health record handling.