Clinical case of diagnosis of generalized tuberculosis in a child with a positive result of an intradermal test

Abstract

At present day, generalized forms are rarely found in the structure of tuberculosis in children. A significant risk factor for the development of generalized lesions is prolonged contact with a tuberculosis patient. The diagnosis of a specific etiology is often complicated by the absence of pathognomonic symptoms. Immunodiagnostics, microbiological and molecular genetic research play an important role in the diagnosis of tuberculosis infection in children. The purpose of this study was to analyze the case of the development and diagnosis of generalized tuberculosis in a child of primary school age (7 years and 11 months) with lesions of the lungs, larynx, middle ear. The examination methods included immunological intradermal tests (Mantoux test, RTA test), in vitro test (QuantiFERON-TB), multispiral computed tomography, bronchoscopy and laboratory methods of examination. The manifestation of the disease occurred gradually with the occurrence of hypochromic anemia with a further increase in symptoms of intoxication. A comprehensive examination established a disseminated process in the lungs, larynx and middle ear lesions. Family tuberculosis contact was established when the disease was detected in a child. During the examination, the evaluation result of the Mantoux test showed an increase in sensitivity to tuberculin. The hyperergic result of the RTA test indicated the activity of MBT in the body. At the same time, the irregular conduct of immunodiagnostics using the Mantoux test, the monotony of the test did not allow timely measures to be taken in relation to the in-depth examination of the child for tuberculosis. The specific etiology of the disease was reliably confirmed by cultural and molecular genetic research methods. The child was diagnosed with generalized tuberculosis, disseminated pulmonary tuberculosis in the infiltration phase, MBT (+) with drug resistance to isoniazid, streptomycin, paraaminosalicylic acid, tuberculosis of the larynx and vocal apparatus, PCR (+) with drug resistance to isoniazid, tuberculous right-sided otitis media, MBT (+) with drug resistance to isoniazid, streptomycin, paraaminosalicylic acid. The presented clinical case indicates the need for timely detection of tuberculosis contacts, regular immunodiagnostics, and compliance with phthisiological alertness of doctors of all specialties in relation to children with long-lasting symptoms of various diseases. The complete physical examination using an intradermal RTA test (Diaskintest), microbiological and molecular genetic research methods allows to establish the tuberculous etiology of the lesion.