Туберкулез ЛОР-органов у детей раннего возраста

Abstract

The identification of millions of newly infected with tuberculosis while maintaining a sufficiently high mortality rate, despite the existing treatment protocols, confirms the urgency of the problem of diagnosing this disease and dictates the need for an interdisciplinary approach to this problem. In the overwhelming majority of cases, tuberculosis is associated with lung damage, but its “extrapulmonary” manifestations are also possible, in particular with localization in the head and neck region (about 10%), including in the ENT organs. According to the literature, the incidence of tuberculous lesions is maximum for the larynx (from 14,5 to 15–37%), minimum for ear diseases (from 0,04–0.09% to 2,4–4,18%). To focus the attention of otorhinolaryngologists on the problem of “extrapulmonary tuberculosis” of ENT localization in pediatric practice, this study analyzes the case histories of 496 patients of tuberculous pulmonary pediatric department No. 1 of the Moscow Research and Clinical Center for Tuberculosis Control. Tuberculous lesion of ENT localization against the background of a generalized process was found in 7 patients (1.4%) aged from 2,5 months to 1 year 9 months. Tuberculous otitis media was most often detected (4 patients (0.6%)), in single cases – tuberculosis of the larynx, tuberculosis of the pharynx, tuberculosis of the salivary gland, including in combination with other organic ENT pathology (for example, papillomatosis and tuberculosis of the larynx). Thus, the lesion of the head and neck (including the ENT organs) is one of the “underestimated” extrapulmonary localizations of tuberculosis, and the diagnosis and verification are delayed. Among the “extrapulmonary” ENT manifestations of tuberculosis in young children, according to our data, otitis media prevails. To verify the diagnosis of “Tuberculosis” of any localization, it is necessary to inoculate Mycobacterium tuberculosis and be sure to consult the material obtained with histologists. Doctors of various specialties should not forget about the possibility of setting Mantoux tests with 2 tuberculin units (TU) and adenosine triphosphate (ATP) test for diagnostic purposes, despite the absence of a routine immunological examination in the national immunization schedule for children of the first year of life. Tuberculosis is curable, the main thing is to remember the need for early and timely diagnosis and adequate long-term treatment.