Plućna tuberkuloza u pedijatrijskoj praksi

Pandemija COVID-19 uzrokovala je pad kvalitete medicinske skrbi oboljelih od tuberkuloze. Iako se broj prijavljenih novooboljelih slučajeva tijekom pandemije smanjio, povisio se broj umrlih od tuberkuloze uz pretpostavku povećanja broja novooboljelih. Tuberkuloza pluća u djece stoga je ostala izazov u zbrinjavanju pacijenata te važan javnozdravstveni problem. Osnova dijagnoze tuberkuloze u djece predstavlja dobro uzimanje anamnestičkih podataka koji se odnose na karakteristike izvornoga indeksnog pacijenta, karakteristike i vrstu kontakta te karakteristike djeteta, prvenstveno njegove dobi te imunološkog stanja. Karakteristični simptomi bolesti prisutni su u starije djece, dok mlađa djeca mogu biti i asimptomatska. Također, radiološki nalaz postaje specifičan u adolescentnoj dobi, dok u manje djece može pokazivati nekarakteristične promjene. Za dokaz infekcije s Mycobacterium tuberculosis koristi se interferon gamma releasing assay, brza i sigurna pretraga iz krvi kojom se dokazuje imunološka reakcija na Mycobacterium tuberculosis. Mikrobiološka obrada sputuma i želučanih lavata mikroskopski i uzgojem kultura neizostavan je stupanj obrade, no u mlađe djece također je smanjene osjetljivosti. Terapija u djece odnosi se na profilaktičku terapiju tuberkulozne infekcije kojoj je svrha spriječiti razvoj aktivnih oblika bolesti i punu intenzivnu antituberkulotsku terapiju kod aktivne tuberkuloze pluća. Praćenje i obrada djece sa suspektnom ili dokazanom tuberkulozom u domeni je dječjeg pulmologa u suradnji s primarnim pedijatrom i nadležnom epidemiološkom službom, a u svrhu pravodobne dijagnostike bilo latentne ili aktivne tuberkuloze te adekvatnog liječenja i suzbijanja bolesti.
COVID-19 pandemic caused a decline in health care quality of patients with tuberculosis. Although the number of reported new tuberculosis cases has fell during the pandemic, the number of dead from the disease has increased as has the number of estimated disease cases. Lung tuberculosis in children has, therefore, remained a medical challenge and serious health care problem. The most important part of the diagnostic process is detailed patient history regarding the characteristics of the source index patient, characteristic and types of contact with the index patient and the age and immunologic characteristics of the child. Typical symptoms are evident in older children, while younger children can be asymptomatic. Also, radiological pulmonary examination is specific in the adolescent age group, while in the younger children it can present uncharacteristic changes. Interferon gamma releasing assay is used to detect Mycobacterium tuberculosis infection. It is a well established quick and sensitive blood test which determines an immunological reaction to the Mycobacterium tuberculosis. Microbiologic examination of the sputum or gastric lavates by microscopy and cultures is paramount in the diagnostic examination, but is also less reliable in younger children. Therapy in children involves prophylactic therapy of the tuberculosis infection which prevents progression of the infection to the active pulmonary tuberculotic disease. Full antituberculotic therapy is used when active tuberculosis has been diagnosed. Diagnostic examination and therapy is supervised by pediatric pulmologist in cooperation with primary health pediatrician and epidemiologist with the aim of early diagnosis of latent or active disease and early implementation of therapy to cure the disease.