НЕКОТОРЫЕ КЛИНИЧЕСКИЕ ОСОБЕННОСТИ ТУБЕРКУЛЕЗА У ДЕТЕЙ ДОШКОЛЬНОГО И МЛАДШЕГО ШКОЛЬНОГО ВОЗРАСТА (ОПЫТ ОМСКОЙ ОБЛАСТИ)

Abstract

Objective of the study: to evaluate the structure of clinical forms of tuberculosis (TB) and the results of immunodiagnostics in children of preschool and primary school age. Materials and methods of research: a cohort retrospective non-randomized controlled study was conducted: 609 children aged 4–11 years who fell ill with active TB during the period from 2000 to 2020 were included in the study, groups were formed by 4–6 and 7–11 years of age. Results: in children of comparable ages, statistically significant differences were obtained in the frequency of TB diagnosis of the respiratory organs – 94.7% and 89.9% in groups (p=0.037), in particular, TB of the intrathoracic lymph nodes – 85.7% and 75.3% (p=0.003) and primary tuberculosis complex – 13.2% and 23.3% (p=0.003) and isolated extrapulmonary TB – the proportion was 5.6% and 1.3% of cases (p=0.008). According to the results of immunodiagnostics, 57.1% and 55.6% of children were identified, and in risk groups – 0.7% and 3.3% (p=0.043). There were no statistically significant differences in the results of the Mantoux test at the pre-hospital and hospital stages. The Mantoux test upon admission to the hospital was positive in 96.7% and 97.3% of cases (p>005), the test with the recombinant tuberculosis allergen (RTA) – in 99.1% and 95.5%. In patients aged 4–6 years, at discharge from the hospital, statistically significant differences were obtained as a result of weakly positive reactions of the test with ATP – 23.9% versus 6.7% of cases in children aged 7–11 years (p=0.008). Conclusion: in children aged 4–6 and 7–11 years, there is a favorable pattern of clinical forms of TB. The main method for detecting TB in children aged 4 to 11 years is immunodiagnosis, but the cases of the disease detected during the contact examination, despite the course of preventive chemotherapy, are alarming. The RTA test at the stage of TB detection gives a higher percentage of hyperergic reactions than the Mantoux test, which indicates its greater diagnostic significance. When monitoring TB treatment, samples with RTA and tuberculin react the same way in terms of reducing the frequency of hyperergic reactions.