FEATURES OF TUBERCULOSIS IN CHILDREN AND ADOLESCENTS

Abstract

SUMMARY. The aim of the work is to analyze the features of diagnostics and clinic of tuberculosis in children and adolescents, to determine the structure of clinical forms, variants of the course, the nature of complications of pulmonary and extrapulmonary tuberculosis. To present a description of a clinical case.

Patients and methods. The features of detection, diagnosis and clinical course of tuberculosis in 30 children and adolescents were analyzed. There were 19 children aged 2–14 years, three of them under 5 years, and 11 adolescents (15–17 years).

Results. Among the clinical forms of primary genesis, the more common primary tuberculosis complex prevailed (7 patients), tuberculosis of the intrathoracic lymph nodes was in one case. Infiltrative tuberculosis was diagnosed in 6 cases, disseminated tuberculosis in 3 cases, and focal tuberculosis in one case. These forms of tuberculosis were equally common in both children and adolescents and in 4 patients were combined with extrapulmonary specific lesions. Lung destruction was detected in 3 adolescents and one 6-year-old child with primary tuberculosis complex. Mycobacterium tuberculosis (MTB) was detected in tracheal and bronchial material in 7 patients. MDR-TB resistance to antituberculosis drugs was observed in 2 children. Tuberculosis of extra-pulmonary localization was diagnosed in 16 (53.3 %) patients. Tuberculosis of the peripheral lymph nodes was detected in 4 patients, and skin tuberculosis in 3. Spinal tuberculosis with destructive changes and formation of a nodule was diagnosed in 4 children, in one child in combination with focal pulmonary tuberculosis. In one case, a specific lesion of the knee joint with fistula formation and eye tuberculosis were diagnosed. In combination with pulmonary tuberculosis, there were: tuberculous pleurisy (1), encephalitis with destruction (1), tuberculosis of the mastoid process (1). All cases of tuberculosis of the skin, peripheral lymph nodes and mastoid process were confirmed histologically. In the knee joint specimen and pleural fluid, MDR-TB was detected.

Conclusions. In children and adolescents with pulmonary and extrapulmonary tuberculosis, common forms with complications and bacterial excretion predominated. Extra-pulmonary localization of the process was diagnosed in 53.3 % of children and adolescents with tuberculosis. In case of suspected tuberculosis in children and adolescents, the results of the Mantoux test and quantiferon test should be taken into account in combination with other examination methods.