Tuberculosis Of Intrathoracic Lymph Nodes Research Articles

Diagnostic value and influencing factors of endobronchial ultrasound-guided transbronchial needle aspiration combined with Xpert MTB/RIF for intrathoracic lymph node tuberculosis

Objective: To evaluate the sensitivity of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) puncture to obtain intrathoracic lymph node samples combined with Xpert MTB/RIF (Xpert) detection for the diagnosis of intrathoracic lymph node tuberculosis. Methods: From March 2018 to June 2021, 106 patients [55 males and 51 females, age (45.1±18.6) years] with suspected intrathoracic lymph node tuberculosis and EBUS-TBNA were collected in Zhejiang Hospital of Integrated Traditional Chinese and Western Medicine, including 64 patients with subsequent diagnosis of intrathoracic lymph node tuberculosis and 42 patients without tuberculosis. Xpert test and traditional etiology test were performed on the patients' intrathoracic lymph node puncture specimens. The positive results of different detection methods and different methods were analyzed, and the influencing factors of Xpert independent detection positive were analyzed by univariate and multivariate logistic regression. Results: The sensitivity of Xpert was 65.6% (95%CI: 52.7%-77.1%), the specificity was 97.6% (95%CI: 87.4%-99.9%), the positive predictive value was 97.7% (95%CI: 85.7%-99.7%), the negative predictive value was 65.1% (95%CI: 57.0%-72.4%). The positive rate of Xpert alone (65.6%, 42/64) was not significantly different from that of MGIT960, histopathology and Xpert combined detection (70.3%, 45/64) (P<0.05). Multivariate logistic regression analysis showed that the location of the diseased lymph nodes in the mediastinum (OR=5.84, 95%CI: 1.112-30.704, P=0.037), necrosis in the lymph nodes (OR=6.32, 95%CI: 1.460-27.384, P=0.014), and the axial depth of the lymph nodes≥17 mm (OR=6.61, 95%CI: 1.408-30.969, P=0.017) were the promoting factors for the positive Xpert test. Conclusions: EBUS-TBNA combined with Xpert detection has a high clinical diagnostic value for intrathoracic lymph node tuberculosis. When the number of puncture samples is small, Xpert detection can be preferred. The positive rate of Xpert detection can be improved by selecting lymph nodes with mediastinal lesions, lymph nodes necrosis, and axial lymph nodes depth≥17 mm for puncture.

A rare case of calcified focus discharged into the tracheal lumen in a child with tuberculosis of intrathoracic lymph nodes: a clinical case

The article presents a rare case of the isolation of a large calcified lesion in a 1-year-old child A., who was treated for tuberculosis of the intrathoracic lymph nodes, after family contact with his grandfather, a patient with fibrocavernous tuberculosis with bacterial isolation. Bronchi and lymphatic vessels are the main routes of spread of the tuberculosis process in the lungs, and in some cases reactivation of tuberculosis foci is possible. This may be due to damage and destruction of the bronchial wall. Residual tuberculous changes, caseous masses can carry a certain danger in the form of their breakthrough into the lumen of the trachea and bronchus. Aspiration of the contents contributes to the spread of tuberculosis infection; atelectasis, atelectatic pneumonia, etc. may occur. In early childhood, asphyxia with sudden death (suffocation by caseous masses) can occur. During the treatment of tuberculosis, you may encounter rare manifestations of the X-ray picture, the details of which must be assessed in time to choose the right tactics for patient management. In the presented case, the patient did not have activation of residual tuberculous changes; a large calcified lesion was coughed up due to the disintegration of dystrophic changes in the trachea in the affected area. A favorable outcome was recorded.

Tuberculosis Trends in the Sverdlovsk Region

Introduction: Medical and social importance of a continuous decrease in tuberculosis morbidity and mortality remains high implementation of tuberculosis control programs involves the analysis of current regional trends in the epidemic situation and interdepartmental cooperation in taking comprehensive measures to prevent the spread of this infectious disease. Objective: To analyze local trends and features of the spread of tuberculosis in the population of the Sverdlovsk Region. Materials and methods: Based on the results of a retrospective and prospective study for 2012–2022, we analyzed tuberculosis incidence, prevalence and mortality rates, bacterial carriage, drug resistance, combination with HIV infection, and the structure of clinical forms of tuberculosis in the Sverdlovsk Region. The data were retrieved from the reports of the Federal State Statistics Service, Russian Federal Service for Surveillance on Consumer Rights Protection and Human Wellbeing (Rospotrebnadzor), Ministries of Health of the Russian Federation and the Sverdlovsk Region, the Federal Register of Tuberculosis Patients, and departmental statistics of prison health care. Results: We observed a decline in the regional tuberculosis incidence, prevalence and death rates over the study period that were consistently higher than the national averages. The proportion of patients with bacterial excretion, multidrug resistance, and tuberculosis/HIV coinfection was increasing among the incident cases while the proportion of cases of disseminated and intrathoracic lymph node tuberculosis was rising in the structure of clinical forms. The main regional factors influencing the epidemiological situation of tuberculosis include a large number of prisoners and a higher prevalence of HIV infection among the general population. Conclusion: Based on the analysis of the situation, further implementation of a set of measures for interdepartmental cooperation for monitoring and combating tuberculosis is envisaged by the regional program.

Extrapulmonary tuberculosis: diagnostic features

Objective. To study demographic, clinical characteristics and concomitant pathology of patients with extrapulmonary tuberculosis (EPTB) in Gomel city and Gomel region for the period 2017-2021. To evaluate the informative value of different techniques for the detection of Mycobacterium tuberculosis (MBT) in non-respiratory samples in the diagnosis of extrapulmonary tuberculosis.Materials and methods. A retrospective study of extrapulmonary tuberculosis cases registered from 2017 to 2021 in Gomel and Gomel region (308 patients) was carried out. The results of microscopic, bacteriological and molecular genetic methods of non-respiratory and respiratory samples relevant in the diagnosis of extrapulmonary forms of tuberculosis were analyzed.Results. Demographic and clinical characteristics of patients with EPTB in Gomel and Gomel region for the period 20172021 were revealed. Concomitant pathology in patients with EPTB was analyzed, the features of EPTB diagnostics were studied. It was determined that EPTB is more susceptible to males aged 31 to 50 years and to women aged over 60 years. EPTB is more frequently diagnosed in patients from urban areas and when patients come to medical institutions with nonspecific complaints, except for intrathoracic lymph node tuberculosis (ITLN).Conclusion. In the structure of clinical forms of EPTB, lesions of bones and joints (62.7%) and intrathoracic lymph nodes (19.5%) predominate. HIV-positive patients are more common in the ITLN group. MBT is most often detected in the following localizations of extrapulmonary process: intrathoracic and peripheral lymph nodes, pleural tuberculosis. The most highly informative method of examination of biological nonrespiratory material for detection of MBT in extrapulmonary localization is molecular genetic study.

Абдоминальный туберкулез у ребенка раннего возраста (клиническое наблюдение)

Abdominal tuberculosis is a specific tuberculous lesion of the abdominal organs. In children, abdominal tuberculosis is mostly secondary, occurring mainly in the form of mesadenitis and intestinal tuberculosis. In most cases (63–96%), the process is localized in the ileocecal valve. The article presents a case of untimely diagnosed abdominal tuberculosis with lymph node lesions of the peritoneum and intestines in a child with intrathoracic lymph node tuberculosis of all groups during densification and the calcification onset. The examination (computed tomography) revealed a lesion of the ileocecal valve, while histology of biopsy material taken during colonoscopy showed granulomatous colitis of mycobacterial nature. The leading clinical manifestation was malabsorption syndrome with increased protein-energy undernutrition. The disease pattern was the rare localization of a specific lesion — in the small intestine with the development of jejunal stenosis, which led to a significant disorder of enteral nutrition and the development of malabsorption syndrome with severe trophological insufficiency. The decisive factor in determining the cause of the malabsorption syndrome was laparotomy, which was performed in presented signs of acute intestinal obstruction. In our opinion, an indication for diagnostic laparoscopy in children with abdominal tuberculosis should be considered the enteral nutrition disorder and malabsorption syndrome, which cannot be corrected at the therapeutic process stage. KEYWORDS: primary generalized tuberculosis, mycobacterium tuberculosis, intestinal tuberculosis, mesadenitis, malabsorption syndrome, jejunal stenosis, computed tomography, histology. FOR CITATION: Poddubnaya L.V., Dubakova G.F., Geleskul T.S., Shilova E.P., Kolpakova T.A., Osipenko M.F., Nikonov S.D., Drobysheva V.P. Abdominal tuberculosis in a baby (case report). Russian Medical Inquiry. 2023;7(5):337–342 (in Russ.). DOI: 10.32364/2587-6821-2023- 7-5-13.

Characteristics of the course of multidrug-resistant pulmonary tuberculosis in children and adolescents from focuses of chemoresistant tuberculosis infection

Objective — to study the features of multidrug-resistant tuberculosis of the lungs of respiratory organs in children and adolescents from focuses of chemoresistant tuberculosis infection. &#x0D; Materials and methods. To study the features of the course of multidrug-resistant pulmonary tuberculosis (MDR-TB), an analysis of clinical, X-ray, microbiological, and generally accepted laboratory examinations was conducted in 256 patients (102 children and 154 adolescents), who were divided into two groups The main group included 145 patients with MDR-TB: of them, 67 (42.2 %) children and 78 (53.8 %) teenagers from focuses of multidrug-resistant tuberculosis infection (MDR-TBI). The control group consisted of 146 patients with «chemosusceptible» pulmonary tuberculosis (CS-TB), of which 70 (47.9 %) were children and 76 (52.1 %) were adolescents from focuses of chemosusceptible tuberculosis infection (CS-TBI).&#x0D; Results and discussion. In children with multidrug-resistant pulmonary tuberculosis (MDR-TB), along with classic forms of tuberculosis (primary tuberculosis complex — 14.9 % and tuberculosis of the intrathoracic lymph nodes — 14.9 %), miliary tuberculosis (11.9 %), tuberculosis of the lungs and central nervous system (5.9 %), caseous pneumonia (8.9 %) and fibro-cavernous tuberculosis (4.5 %) were diagnosed. In the case of MDR-TB of the lungs, adolescents were statistically significantly more likely to be diagnosed with infiltrative tuberculosis (29.4 %) and disseminated pulmonary tuberculosis (35.9 %). At the same time, destructive changes were observed 1.6 times more often in adolescents with MDR-TB than in children, especially with multiresistant specific process (70.5 % vs. 43.3 %, p &lt; 0.05).In children with MDR-TB, 3.5 times more often than in chemosusceptible tuberculosis, signs of the progression of a specific process due to lymphogenous and hematogenous dissemination in the form of tuberculosis of peripheral, intrathoracic and mesenteric lymph nodes, miliary tuberculosis were observed in adolescents, along with complications of a specific complications of a non-specific nature were observed: respiratory failure and non-specific catarrhal endobronchitis). In both children and adolescents, the intensity of bacterial excretion is greater in the presence of MDR-TB than in CS-TB. In the foci of multiresistant infection, an almost complete coincidence of the nature of MTB resistance in children with the source of infection was established. However, teenagers are most often found to be resistant to the combination of HRSE (66.1 %), HRESZ (13.6 %), unlike adults and children.&#x0D; Conclusions. The majority of contact children and adolescents with MDR-TB was detected when referring to a general practitioner or a pediatrician (62.3 % of children and 70.5 % of adolescents), which became the main reason for underdiagnosis of tuberculosis in children and adolescents in general. Our studies show the importance of a thorough examination of all contact children and adolescents in focuses of tuberculosis infection: anamnesis studies, tuberculin diagnostics (quantiferon test), clinical, radiological and microbiological examination for the timely detection of tuberculosis or infection and the appointment of appropriate chemotherapy or chemoprophylaxis.

Differentiated Approaches to the Choice of Timing of Surgical Treatment for Intrathoracic Lymph Node Tuberculosis in Children during Increasing Incidence of Multiple Drug Resistant Tuberculosis

The objective: to develop differentiated approaches to the choice of timing of surgical treatment of intrathoracic lymph node tuberculosis (ITLNTB) in children during the increasing incidence of multiple drug resistant tuberculosis (MDR-TB).Subjects and Methods. 52 patients of 2-12 years old had their intrathoracic lymph nodes removed at different stages of anti-tuberculosis therapy. All children had massive (more than 10-15 mm) conglomerates in their intrathoracic lymph nodes. Additionally to changes in intrathoracic lymph nodes, 12 people had active tuberculous changes in the lungs or bronchial tuberculosis.Results. 5 patients were operated before chemotherapy, 35 patients after 2 months of treatment, and 12 patients underwent surgery afterwards. The elective surgery was performed in 51 children, and 1 child had surgery before the start of chemotherapy due to vital indications (the threat of breakthrough of caseous masses into the trachea).Planned surgical treatment in children with tuberculosis of intrathoracic lymph nodes should be carried out within the following timing: before the start of anti-tuberculosis therapy in the absence of clinical, laboratory and radiological signs of the disease being active; as soon as possible from the start of chemotherapy (it is enough to focus on the results of the first CT control after 2 months of treatment (there should be no tendency to involution of pathological changes) in the presence of minimal signs of tuberculosis activity). The choice of timing of planned surgical treatment is individual and determined by the timing of stabilization of pulmonary changes or the cure of bronchial tuberculosis (after 6, 9, 12 months) in patients with newly diagnosed active tuberculosis of intrathoracic lymph nodes in combination with lung and/or bronchial lesions. The development of life-threatening complications is an absolute indication for emergency surgery.

Tuberculosis associated immune reconstitution inflammatory syndrome in patients infected with HIV: the current state of the problem

Tuberculosis-associated immune reconstitution inflammatory syndrome (TB-IRIS) is an enhanced inflammatory immune response to Mycobacterium tuberculosis antigens due to immune system recovery in HIV-infected patients within 6 months of antiretroviral therapy (ART).&#x0D; Objective — to assess the incidence of TB-IRIS in patients with tuberculous meningitis. Evaluation of mortality caused by TB-IRIS.&#x0D; Materials and methods. A retrospective analysis of 60 cases of confirmed tuberculous meningitis in patients who were treated in anti-tuberculosis institutions in Kiev and Kiev region in 2017—2019 was carried out. The medical records of the patients were studied.Results and discussion. Co-infection with HIV-TB among patients was confirmed in 57 (95 %) cases. In 21 patients (36.8 %; CI 24.7—50.0 %) with HIV-TB co-infection, a link was established between the appointment of ART and the development of tuberculous meningitis. 19 (90.5 %) of them had risk factors at the time of ART. Fifteen (71.4 %) patients had other localizations of tuberculosis besides tuberculosis of the central nervous system (pulmonary tuberculosis, tuberculosis of intrathoracic lymph nodes, tuberculosis of peripheral lymph nodes, tuberculosis of the genitourinary system). The mean CD4+-lymphocyte count before ART was (61.6 ± 16.9) cells/µL (p ≤ 0.05). All patients were prescribed standard antimycobacterial therapy and ART. 9 (42.8 %) patients were cured. One (4.7 %) developed severe disability: peripheral tetraparesis and severe cerebrosthenia. 11 patients died, mortality was 52.4 % (CI 30.2—74.1 %).&#x0D; Conclusions. TB-IRIS is the cause of tuberculous meningitis in HIV-infected patients in 36.8 % of cases; (CI 24.7—50.0 %). Tuberculous meningitis always complicates the prognosis with TB-IRIS, while the mortality rate is 52.4 % (CI 30.2—74.1 %).

Genitourinary tuberculosis in the structure of autopsy morphological findings in deceased patients at the late stages of HIV infection

Introduction. The problem of tuberculosis (TB) has not lost its significance due to the overlapping epidemic of HIV infection and the addition of specific lesions at its late stages. It is due to the lack of adherence to antiretroviral therapy in a large number of patients. The high mortality rate in HIV-associated TB requires an increase in the interest of all doctors for the early detection of various TB localizations against the background of HIV, allowing the patient to be cured. For urologists, information on the frequency of genitourinary TB in HIV patients is of interest to improve its diagnosis. Purpose of the study. To identify the proportion of genitourinary TB in the structure of the specific lesions in patients with HIV-associated TB. Materials and methods. The case-records of 115 deceased patients with a combination of HIV infection and TB were retrospectively analyzed using a continuous method. The number of men among them was 81.7 ± 3.6% (94). The average age of men was 37.1 ± 27.2 years, women — 31.9 ± 6.3 years. The research results were processed statistically. Results. The average period from the moment of HIV infection detection to the registration of a lethal outcome was 2.8 ± 1.3 years, from the moment of TB diagnosis — 6.96 ± 7.3 years. The majority of patients with HIV infection had a stage of secondary diseases (93.1 ± 2.4%). At the time of admission to the TB dispensary, the average CD4 + lymphocyte level was 131.06 ± 75.8 cells/pL, 10.03 ± 2.5%. Anti-retroviral therapy was observed only in 19 (16.5 ± 3.5%) patients. In deceased patients disseminated pulmonary TB was more often verified at autopsy — 52.2 ± 4.7%, miliary — 7.8 ± 2.5%, infiltrative — 11.3 ± 3.0%. In patients with disseminated and miliary pulmonary TB, foci of dropout were often observed in the spleen (71.7 ± 5.8% and 55.6 ± 16.6%) and liver (46.7 ± 6.4% and 33.3 ± 15,7%). The kidney damage occurred in 60.0 ± 6.3% of patients with disseminated and 44.4 ± 16.6% miliary pulmonary TB. Kidneys TB was confirmed by bacterioscopic urine examination in three cases only (2.6 ± 1.5%) during life. Prostate TB was confirmed by analysis of expressed prostatic secretion on Mycobacterium tuberculosis (2.6 ± 1.5%) and was combined with kidney TB. The lesions of the lymphatic system during life were exposed in 17.4 ± 3.5% of patients. A pathomorphological examination revealed TB of intrathoracic lymph nodes in 37.4 ± 4.5%, intra-abdominal lymph nodes — in 22.6 ± 3.9%, peripheral — 6.1 ± 2.2%, more often in miliary and disseminated pulmonary TB. TB meningitis was registered in 31 cases as well as meningoencephalitis in 32 patients during life and at autopsy, respectively. Intestinal TB was confirmed by autopsy in 9.6 ± 2.7% of patients; during life, it was accompanied by the detection of the pathogen in the feces. The pancreatic TB was detected in 2.6 ± 1.5%, TB spondylodiscitis in 1.7 ± 1.2%, myocardial TB in 0.9 ± 0.9% and pericardium TB in 0.9 ± 0.9% cases. Conclusion. Thus, generalized TB is diagnosed in patients in the late stages of HIV infection, in the structure of which kidney damage is in second place, yielded only to spleen damage. Obtaining this information should form the alertness of urologists in terms of detecting and diagnosing genitourinary TB in patients with HIV infection.

The relevance of household contacts tracing among child contacts of patients with multidrug-resistant tuberculosis

BACKGROUND. The World Health Organization (WHO) reports an unknown contact history of pediatric tuberculosis (TB), especially in children younger than 5 years old. Tracing pediatric household contacts of patients with multidrug-resistant TB (MDR-TB) is considered to be a highly effective intervention for detection of new cases of chemoresistant TB in children and timely prevention of its transmission. OBJECTIVE. To study the nature of TB process manifestations and concordance of mycobacterium tuberculosis (MBT) drug resistance profiles in household child contacts of patients with MDR-TB. MATERIALS AND METHODS. The nature of TB process manifestations and concordance of MBT drug resistance profiles in 12 household child contacts of patients with MDR-TB in 6 households (6 adult MDR-TB index patients, IP) were studied. Adults and children were examined and treated in the Pulmonary Tuberculosis Department No 3 and in the Pediatric Department of the Clinical Base of the Department of Phthisiology and Pulmonology of Zaporizhzhia State Medical University at the Municipal Institution “Zaporizhzhia Regional Tuberculosis Clinical Dispensary”. RESULTS AND DISCUSSION. The tracing of children who were household contacts of the MDR-TB IP revealed the following features. The incidence of child TB was 2 times higher than that of contact adults (44 % vs. 20 %). Moreover, the incidence among children younger than 2 years of age was almost 3 times higher than in children across other age groups (54.5 % vs. 18.2 % in children younger than 5 years of age and 18.2 % in children aged 5 years and older). The children were non-BCG vaccinated in 63.6 % of cases. There was an alarmingly high rate of non-BCG vaccinated children, namely 83.3 % among individuals younger than 2 years of age and all of those younger than 5 years of age (100 %). The children mostly presented small clinical forms of non-destructive TB: intrathoracic lymph node TB (36.4 %), MBT complex (36.4 %) and focal TB (18.2 %). Most of the children (63.6 %) who developed TB were detected within the first year of IP with MDR-TB follow-up, and it is worthy of note that in the majority of cases (4 households; 66.6 %). With respect to the concordance of MBT drug resistance profiles between the children and MDR-TB IP in the households, diagnosis in children was microbiologically confirmed in only 3 cases (3 households) demonstrating the complete concordance of profiles in each one. At the same time, the complete concordance of MBT drug resistance profiles between adult household contacts and the MDR-TB IP was also recorded in 3 cases. As is evident, across the household contacts group aged between 0 and 18 years who were exposed to the MDR-TB IP, the most susceptible to develop TB were non-BCG vaccinated children younger than 2 years. More worryingly is that among 3 microbiologically conformed individuals of this age group, 2 children younger than 2 years were found to have their own drug resistant MTB isolates. CONCLUSIONS. Tracing household child contacts of MDR-TB IP is particularly effective for timely detection of active TB within the first year of MDR-TB IP follow-up. Non-BCG vaccinated children younger than 2 years of age are at the highest risk for MDR-TB followed by non-BCG vaccinated children younger than 5 years of age. The early detection and timely antimycobacterial therapy initiation based on drug susceptibility test results of a MDR-TB IP is a guarantee not only for an effective treatment but also for a reduction in the MDR-TB transmission to other persons.

Identification of different shapes and localizations of tuberculosis in children of different ages: the role of screening examination

There was performed an analysis of the age structure of clinical forms of tuberculosis in children aged from 0 to 14 years. The most favorable structure of clinicalforms in children ofpreschool age was established to be characterized by absolute predominance of tuberculosis of intrathoracic lymph nodes (TILN), the minimum number of complications and generalized processes. The greatest number of the diseasedfor the 25-year period of observation was consisted of children ofprimary school age. The main method of detection of tuberculosis in children remained to be screening annual examination with the use of Mantoux test with 2 ТЕ PPD-L, in this way there were revealed 48% of all tuberculosis cases in children and 63,9% of cases of TILN. Extrapulmonary and generalized tuberculosis more frequently was revealed at the request for medical care and on contact, tuberculosis of the urinary system in 39,5% was revealed during examination of risk groups.

Features of the medico-social help to adolescents in the conditions of tuberculosis sanatorium

Introduction. One of the most important problems of modern health care is the problem ofprevalence of tuberculosis, especially among children and adolescents. Despite of the improvement of an epidemic situation on tuberculosis in Russia, indices in our country are still significantly worse, than in countries of the Western Europe. Materials and methods. There are presented data of the analysis of official reports concerning the activity of the tuberculosis sanatorium for 24 years (1991-2014), retrospective data of following up teenagers aged from 15 to 18 years in various years, results of sociological survey of teenagers and their families. Results. During mentioned period the portion of patients with tuberculosis of intrathoracic lymph nodes and primary tuberculosis complex decreased by 1,7 times and 2,5 times correspondingly, but at that, the share of an infiltrative form sharply increased by 6,6 times. The number ofpatients from foci of a tuberculosis infection increased. As a result of the differentiated approach to each patient in combination with specific and senatorial methods of management, educational and pedagogical work in the sanatorium, in most of cases there was succeeded to achieve of clinical recovery as a result of the accomplishment of a basic course of management. Conclusion. Development of medical and organizational measures on optimization of therapeutic and rehabilitation processes in a tuberculosis sanatorium should be implemented on the basis of a comprehensive approach with taking into account not only the course of the disease, but also in dependence on the social and epidemiological characteristics.

Успешное хирургическое лечение сочетания внутридолевой секвестрации легкого и туберкулеза внутригрудных лимфоузлов у ребенка

Успешное хирургическое лечение сочетания внутридолевой секвестрации легкого и туберкулеза внутригрудных лимфоузлов у ребенка

And Epidemiological Characteristics of Tuberculosis in Children in the Astrakhan Region

The article presents the results of the analysis of the epidemiological situation of tuberculosis in children of the Astrakhan region for the period from 2013 to 2017. The incidence of tuberculosis of children in the region exceeds the average Russian Federation 2.9, the southern Federal district in 3.2 time. In the structure of morbidity of children is dominated by tuberculosis of intrathoracic lymph nodes (75.6%). The increase of tuberculosis morbidity of children population of the region could also be: the increasing incidence and delayed diagnosis of tuberculosis in adults introduction in practice of modern methods of diagnostics (computer tomography, PCR, Diaskintest) allowing to identify the disease in a larger number of patients, lack of alertness of doctors of general medical network on early diagnosis of tuberculosis.

ЖИЗНЕСПОСОБНОСТЬ ВОЗБУДИТЕЛЯ У БОЛЬНЫХ ЛЕКАРСТВЕННО-ЧУВСТВИТЕЛЬНЫМ И ЛЕКАРСТВЕННО-УСТОЙЧИВЫМ ТУБЕРКУЛЕЗОМ ОРГАНОВ ДЫХАНИЯ

To predict outcomes of tuberculosis we investigated the viability of Mycobacterium tuberculosis (MTB) in relation to drug resistance of strains and clinical manifestations of tuberculosis. During the study on solid Lowenstein - Jensen medium, we determined the speed, growth rate and drug resistance of MBT in 5945 cultures, isolated from the sputum of patients with pulmonary tuberculosis - residents of the Irkutsk region (2193 -from newly diagnosed patients, 3752 - from previously treated patients). The criterion of high viability of MBT was the growth rate of >100 colonies over 20 days; and low viability corresponded with the growth rate of 30 days. 2171 cultures (36.5 %) had high viability of MBT strains, 3021 (50.8 %) - low, and 753 (12.7 %) cultures had average degree of viability. A high degree of pathogen viability was more often determined in newly diagnosed patients with tuberculosis of intrathoracic lymph nodes (all patients with HIV-infection without antiretroviral therapy), fibrotic-cavernous and infiltrative tuberculosis. Among previously treated patients with tuberculosis the high viability of MBT was often determined in patients with fibrous-cavernous and infiltrative tuberculosis, and caseous pneumonia. Cultures from previously treated patients with tuberculosis of intrathoracic lymph nodes had low degree of viability. The number of drug-sensitive strains was 1992, drug-resistant ones - 3953, including 1430 strains with multidrug resistance. We have found that 37.5 % drug-resistant strains associated with a high degree of viability (multidrug resistance - 38.5 %), it's was more often than the drug-sensitive (35.4 %; p < 0.01).

THE SUBEPITHELIAL PIGMENT SPOTS OF TRACHEOBRONCHIAL TREE: DETECTION RATE AND ETIOLOGY ACCORDING TO BRONCHOSCOPY FINDINGS

Background: The etiology of tracheobronchial tree subepithelial pigment spots, detected by endoscopic examination, has not been yet finally established. Some authors attribute them to an active tuberculous process or its outcome; other researchers suggest their association with the professional pathology. Aim: To study the detection rate and etiology of tracheobronchial tree subepithelial pigmented spots within the unspecialized bronchoscopic examination. Materials and methods: A total of 3404 primary therapeutic and diagnostic bronchoscopic data were analyzed. The examinations were conducted using bronchoscopes ВF-1T60 and MAF-TM (Olympus, Japan). Endobronchial photos were performed using a bronchoscope MAF-TM. Results: During the study, the subepithelial pigment spots were detected in 20 (0.59%) cases. In none of these cases, an active tuberculous process or professional pathology was confirmed. Fistulas in projection of subepithelial pigmented spots were found in 3 cases. Conclusions: Detection rate of subepithelial pigmented spots during the non-specialized bronchoscopic procedure is low, less than 1% (0.59% in our study). Clinical, laboratory, instrumental, and anamnestic analyses allowed us to associate the studied pathology with the previous tuberculosis of intrathoracic lymph nodes.

THE COURSE OF PYELONEPHRITIS IN CHILDREN AND ADOLESCENTS INFECTED IN THE PAST AND UNINFECTED WITH MYCOBACTERIUM TUBERCULOSIS

Objective: to evaluate the course of pyelonephritis in children and adolescents infected since the past years and uninfected with Mycobacterium tuberculosis. The study included 50 patients aged 3 to 17 years with acute and chronic pyelonephritis. Clinical, laboratory, instrumental, and functional examinations were used, by obligatorily verifying the uropathogenic etiological factor. The investigators identified contacts with tuberculosis patients and analyzed the results of BCG vaccination, Mantoux test, and, if indicated, chest X-ray, and urine test for Mycobacterium tuberculosis by flotation and culture methods. Among the 50 children with pyelonephritis, 24 patients were diagnosed with Mycobacterium tuberculosis infection since the previous years (more than 1 year); one had the early stage of primary tuberculosis infection. Among the 25 infected children, one patient was detected to have intrathoracic lymph node tuberculosis in the calcification phase (no evidence of activity). Conclusion. One-half of the children with pyelonephritis were found to have Mycobacterium tuberculosis infection; of them, one-half of the cases were identified to have contacted a patient with tuberculosis and the signs of its activity, as shown by a tuberculin test and Diaskintest®. The findings give grounds to consider children with pyelonephritis to be at risk for renal tuberculosis.

P186 Intrathoracic Lymph Node Tuberculosis - A Comprehensive Clinical Description

Background Intrathoracic lymph node tuberculosis (ITLNTB) is an extra-pulmonary manifestation of tuberculosis (TB) and a predominant feature of primary TB in children. Historical literature supports the key role of lymph nodes in tuberculosis pathogenesis yet there is a paucity of literature describing ITLNTB in adults. Methods This study comprehensively reviewed the clinical, radiological and pathological features of ITLNTB from 2009–2012 at a busy urban tuberculosis clinic. Results 113 adult patients with ITLNTB were identified between 2009–2012. Patients were usually male, with a mean age of 41.5 ± 15.8 years and mostly from White, Black-African or Indian ethnic groups. 86% were non-UK born and most presented within 5–10 years of entering the country. 43% were asymptomatic. A subgroup of patients who were mycobacterial culture positive on endobronchial ultrasound sampling (EBUS) of intrathoracic lymph nodes were identified as patients with definite mycobacterial infection of the lymph nodes (n = 27). Comparisons between symptomatic and asymptomatic groups in the whole cohort and EBUS culture positive subgroup demonstrated significant associations between symptoms and disease dissemination (p = 0.0002 and p = 0.01 respectively); and symptoms and cytological response in the lymph nodes (p = 0.02 and p = 0.01 respectively), suggesting the presence of a spectrum of disease reflected in congruent clinical and pathological responses (Table 1). Comparisons between disease sites affected also showed a significant association between host response in the lymph nodes and disease dissemination (p = 0.006). The presence of radiological necrosis, number of affected nodal stations, and largest node size were significantly greater in symptomatic patients in the whole cohort; with a similar trend observed in the EBUS culture positive subgroup. In the EBUS culture positive subgroup, asymptomatic patients were identified significantly earlier following entry to the UK (p = 0.01). Discussion This study provides the first comprehensive clinical description of ITLNTB in adults. There is a spectrum of disease based on clinical severity, disease phenotype and diagnostic and radiological findings. Host response in the lymph nodes is reflected by both symptom manifestation and disease dissemination, implicating the lymph nodes in a critical role in the natural history of TB infection. Finally, a subclinical phenotype was identified, suggesting an early stage of disease progression in TB.

Comparison of T-SPOT TB and Tuberculin Skin Test in Children with Tuberculosis of Intrathoracic Lymph Nodes

Comparison of T-SPOT TB and Tuberculin Skin Test in Children with Tuberculosis of Intrathoracic Lymph Nodes

Particular Features of the Sonograms of the Ligamentum Arteriosum and Para-Aortic Arterial Calcifications in Children Suffering From Tuberculosis of Intrathoracic Lymph Nodes

The paper presents the results of a study aimed to check the assumption that there is disparity in interpretation of X-ray and ultrasound images of Ductus arteriosus in children supposed to have tuberculosis. In total the images of 230 children with ambiguous Mantoux tuberculin skin test and with calcification adjusted to aortic window described in terms of regular X-ray were investigated. It is stated that multispiral computer tomograms are usually falsely interpreted as presenting calcifications in cases when ultrasound scans reveal only tissue heterogeneity near former Ductus arteriousus.