Recombinant Tuberculosis Allergen Research Articles

The significance of preventive treatment for tuberculosis infection in children

Objective: to evaluate the value of tuberculosis preventive treatment (PTT) in children with tuberculosis infection. Material and methods. As part of a continuous study, a cohort of 200 children from 1 to 17 years old taken for clinical observation in group VI A (positive test result with the recombinant tuberculosis allergen [ATR]) was analyzed. All children underwent additional examination methods to exclude the local form of tuberculosis: physical examination, laboratory clinical and biochemical tests of blood and urine, multislice computed tomography of the chest organs and, according to clinical recommendations, PTT was proposed, which the parents of 65 children refused. Study groups: 1 — those with no family contact with a patient with tuberculosis (ТВ) (n=70): 2 — those with contact with a patient with ТВ (n=65), in group 3 included children whose parents refused PTT, despite the presence of indications (n=65), incl. 14 children were from Tl lesions. Children group 1 and 2 received PTT. Control over the PTT was carried out on the "Yandex.Teleconference". Results. As a result of comparison of the three groups, reliable data were obtained on the effectiveness of PTT according to the criteria of preventing the disease and reducing the results of the ATR test. A significantly high percentage of sick children in group 3 was established, compared with children from group 1 (p=0.008; x2=18.6). When assessing the dynamics of the results of immunodiagnostic tests in children of the group 1 who received PTT, a decrease in the test with ATR was significantly more often observed compared to children without PTT(p=0.001; x2=17.2). It is worth noting that children had satisfactory tolerability of the drugs; no adverse events were observed in patients with daily video recording. Conclusion. A conclusion was made about the need for preventive work with parents of children who refused preventive treatment to increase their level of adherence, the need to evaluate the effectiveness of PTT courses using primary and additional criteria, including the importance of controlled PTT.

Assessment of specificity of immunologic tests for detection of tuberculosis infection in children with juvenile idiopathic arthritis

Introduction. The use of genetic engineering biological agents (GEBA) in the treatment of rheumatic diseases over the past decades has led to a significant improvement in the prognosis in this group of patients. However, against the background of anti-tumor necrosis factor α therapy (anti TNF-α), the risk of developing tuberculosis increases tenfold.Aim. To evaluate the specificity and safety of Mantoux test, recombinant tuberculosis allergen (RTA) test, IGRA tests: TB-Feron IGRA, T-SPOT.TB, QuantiFERON-TB GIT in patients from 5 to 18 years of age, who are at risk for the development of tuberculosis, due to the use of immunosuppressive therapy, including GEBP.Materials and methods. This clinical trial is a prospective single-center open-label study with 120 patients under observation. Girls predominated among the patients – 71 (59.2%), the average age was 12 years (95% CI [5.2–17.4]). As part of the treatment of the underlying disease, patients in the vast majority of cases (78.3%) received iFNO-α drugs: etanercept (67 people), adalimumab (25 people), golimumab (2 people).Results and discussion. According to the results of a comprehensive medical examination, including CT scan of the chest organs, the presence of active tuberculosis was not established in any of the patients. A positive result of the RTA sample was registered in 0.8% of the subjects, Mantoux test in 46.6%, T-SPOT.TB – 1.7%, TB-Feron IGRA and QuantiFERON-TB GIT – 0.8% each. During the safety assessment, it was noted that within 28 days after the study, none of the 120 patients had any adverse events. Patients need appropriate screening before starting treatment and regular follow-up examinations.Conclusions. The Mantoux test with 2 TE has low specificity (0.49), and the sample with RTA (0.99), TB-Feron IGRA (0.99), T-SPOT.TB (0.98) and QuantiFERON-TB GIT (0.99) are highly specific and safe as tests for detecting tuberculosis infection in children with juvenile idiopathic arthritis.

INFLUENCE OF LATENT TUBERCULOSIS INFECTION ON THE STATE OF THE AUTONOMIC NERVOUS SYSTEM AND SOMATOTROPIC HORMONE PRODUCTION

The influence of latent tuberculosis infection (LTBI) on the state of the autonomic nervous system (ANS) and the level of somatotropic hormone (STH) in adolescents (100 people) aged 11 to 13 years was studied. In patients with LTBI, there was an autonomic imbalance with a predominance of sympathicotonia, which was accompanied by hyperergic reactions to the recombinant tuberculosis allergen, while in vagotonic and eutonic patients the number of hyperergic reactions was significantly less. Insignificant dynamics of the immunological test, low levels of growth hormone, and low activity of phagocytosis in adolescents with vagotonia were established, which may indicate a lack of cellular immune response. A more pronounced inversion of the immunological test with the recombinant tuberculosis allergen was revealed against the background of preventive treatment in eutonics and sympathicotonics, who had a higher level of growth hormone and phagocytosis activity initially. The established relationship between the functional state of the ANS and the growth hormone indicator, which influence the activity of phagocytosis in patients with latent tuberculosis infection, can be used to predict the effectiveness of anti-tuberculosis preventive therapy and can serve as an additional prognostic criterion for assessing the risks of developing active tuberculosis.

ВОЗМОЖНОСТИ КОЖНОЙ ПРОБЫ С АЛЛЕРГЕНОМ ТУБЕРКУЛЕЗНЫМ РЕКОМБИНАНТНЫМ КАК ПРЕДИКТОРА РАЗВИТИЯ ТУБЕРКУЛЕЗА У ВИЧ-ИНФИЦИРОВАННЫХ ПАЦИЕНТОВ С РАЗЛИЧНЫМ ИММУННЫМ СТАТУСОМ

We analyzed the epidemic situation of TB/HIV co-infection in Primorsky Krai in 2008–2023 and revealed the tendency towards escalation of TB/HIV co-infection, which required a detailed analysis and improved effectiveness of preventive measures against TB infection in HIV-positive people. The study established that these goals would be achieved using recombinant tuberculosis allergen (RTA – Diaskintest®) for the detection of latent TB infection in HIV-positive people. Positive reactions to RTA were observed in 23.5% of HIV patients, out of them 40% demonstrated hyperergic reactions, which allowed considering the intradermal test with RTA a criterion of screening for TB infection in HIV-positive people. We also proved the correlation between intensity of the local response to RTA and the number of CD4+ lymphocytes.

ЛАТЕНТНАЯ ТУБЕРКУЛЕЗНАЯ ИНФЕКЦИЯ У ЛИЦ С НАЛИЧИЕМ ОСТАТОЧНЫХ ПОСТТУБЕРКУЛЕЗНЫХ ИЗМЕНЕНИЙ В ОРГАНАХ ДЫХАНИЯ ПО ДАННЫМ КОЖНОЙ ПРОБЫ С ПРЕПАРАТОМ ДИАСКИНТЕСТ®

Aim: to study the prevalence of latent tuberculosis infection (LTI) among individuals with residual post-tuberculosis changes in the lungs and assess the effectiveness of the Diaskintest® for LTI detection. Materials and methods. We carried out a retrospective analysis of results of the skin test with recombinant tuberculosis allergen (RTA), i.e. Diaskintest®, in 181 patients (109 men and 72 women) with residual post-tuberculosis changes in the lungs in 2011–2022. The study did not include household or occupational contacts of active TB patients or HIV-infected individuals. Results. We established LTI in 52.5% of individuals with residual post-tuberculosis changes in the lungs. LTI was common among young men (56%) with history of active TB and TB treatment (69%), and those with large residual changes (57.3%). The frequency of LTI detection in individuals with inactive residual post-tuberculosis changes in the lungs allowed classifying them as high riskgroup for TB recurrence. This group requires dynamic observation including yearly fluorography screening and sputum examination for M. tuberculosis detection. Conclusion. Frequent detection of LTI among individuals with residual post tuberculosis changes in the lungs justifies the use of the Diaskintest® during dynamic follow-up of this group, which is predisposed to TB recurrence.

Issues of interdisciplinary interaction during detection and diagnosis of tuberculosis in children and adolescents: a literature review and comments

Interdisciplinary interaction between phthisiatricians and pediatricians on the issues of detection and diagnosis of tuberculosis provides basis for the reduction of duration of the diagnostic process and the early identification of disease progression. The purpose of this review and comments is to systematize the knowledge of pediatricians about the detection and diagnosis of tuberculosis in children and adolescents in primary health care (PHC) facilities to improve the diagnostic process. We have performed an analysis and systematization of the current directive and methodological documents, articles on the detection and diagnosis of tuberculosis in PHC facitlities. The significance of skin immunological tests (Mantoux test using 5 tuberculin units (TU) of purified protein derivative (PPD)-L and a test with recombinant tuberculosis allergen (RTA)) during mass and selective screening to form groups at high risk for Tuberculosis and detect the disease is emphasized. The doctor’s actions based on the current guiding documents and laws are presented for cases when parents/legal representatives or the patient himself refuses from immunological skin tests. Positions that determine the need for interdisciplinary interaction for pediatricians on the issues of detection, diagnosis and differential diagnosis of tuberculosis are clearly articulated. The pathway to diagnosis begins with the formation of groups at high risk for tuberculosis in PHC facilities and with seeking medical help from a pediatrician in the presence of clinical signs similar to those of tuberculosis. Particular attention is paid to the detection of the disease when patients with clinical symptoms similar to those of tuberculosis seek medical help, and the missed opportunities for its early diagnosis are presented. Predictors allowing pediatricians to suspect tuberculosis and promptly refer a patient to a phthisiatrician to confirm / exclude the disease are provided.

Latent Tuberculosis Infection in Patients with Oncological Pathology Based on Skin Test with Recombinant Tuberculosis Allergen

Введение. Возникновение туберкулёза у лиц из групп высокого онкологического риска и активное выявление заболевания остаётся актуальной проблемой здравоохранения. У больных с онкологическими заболеваниями снижение иммунитета и иммуносупрессивная терапия могут привести к прогрессированию латентной туберкулёзной инфекции. Цель. Выявление наличия латентной туберкулёзной инфекции у больных со злокачественными новообразованиями различной локализации с помощью кожной пробы с аллергеном туберкулёзным рекомбинантным. Методы исследования. По архивным историям болезни изучены данные иммунологического обследования пациентов с помощью пробы с аллергеном туберкулёзным рекомбинантным на наличие латентной туберкулёзной инфекции у 132 больных с верифицированным диагнозом злокачественной опухоли различных локализаций, поступивших в Воронежский областной противотуберкулёзный диспансер в течение 2011-2022 гг. для исключения наличия активного туберкулёза органов дыхания. Среди них было 100 (75,76 %) мужчин и 32 (24,24 %) женщины в возрасте от 44 до 86 лет. Наличие латентной туберкулёзной инфекции у пациентов подтверждалось положительной реакцией на пробу с аллергеном туберкулёзным рекомбинантным. Результаты. Установлено, что пациенты с онкологическими заболеваниями в 37,1 % случаев имеют латентную туберкулёзную инфекцию и, следовательно, повышенный риск прогрессирования туберкулёза. При наличии у больных остаточных неактивных туберкулёзных изменений в различных органах латентная туберкулёзная инфекция наблюдается чаще, чем при их отсутствии — 53,8 % против 30,1 % (p < 0,05). Заключение. При выявлении и подготовке к лечению больных с онкологическими заболеваниями целесообразным является обследование их на латентный туберкулёз с помощью кожной пробы с аллергеном туберкулёзным рекомбинантным с последующим решением вопроса о необходимости профилактической терапии и наблюдения.

Latent tuberculosis infection in risk groups of the adult population of the Saratov Region

Introduction. The priority of anti-tuberculosis work in the Saratov Region is the early detection of the disease and the prevention of new cases of pathology. The presence of medical and social risk factors for developing tuberculosis significantly increases the risk of developing local forms of tuberculosis, especially if patients have latent tuberculosis infection (LTBI).Aim. To assess the prevalence of LTBI in the adult population with an increased risk of developing tuberculosis in the adult population.Materials and methods. The design of the study is a retrospective non-comparative. The data of patients from high-risk groups for the development of the disease for the period of 2015–2019, examined using a skin test with a recombinant tuberculosis allergen (Diaskintest, Generium JSC, Russia) in the Saratov Region, were analyzed.Results. 153,120 people from medical outpatient risk groups and 3,099 people from social risk groups were examined. Among adults with medical risk factors for developing tuberculosis, the largest number of positive and doubtful results of Diaskintest were recorded in patients with chronic bronchopulmonary pathology – 15.88%; among the group of those surveyed with social risk factors for developing tuberculosis – in persons released from penitentiary institutions (25.88%).Conclusions. The decrease in incidence rates in the Saratov Region confirms the correctness of the chosen tactics regarding the use of the Diaskintest test to identify individuals with LTBI among the adult population and the implementation of measures to reduce the reservoir of tuberculosis infection. Given the effectiveness of the measures taken, it is advisable to work with risk groups for Diaskintest and further examination in a general medical network. To do this, it is necessary to make additions to the current Order of the Ministry of Health of the Russian Federation dated March 21, 2017 No. 124n “On approval of the procedure and terms for conducting preventive medical examinations of citizens in order to detect tuberculosis” regarding the use of recombinant tuberculosis allergen samples in the adult population.

Evaluation of the specificity of an intradermal test with recombinant tuberculosis allergen in Bacillus Calmette-Guérin-vaccinated healthy volunteers.

The tuberculin skin test has significant limitations for use in individuals vaccinated with BCG. The presence in the genome of Mycobacterium tuberculosis of the RDI region, which is absent in the genome of Mycobacterium bovis BCG and most non-tuberculous mycobacteria, made it possible to develop new skin tests, which include a skin test with a recombinant tuberculosis allergen [RTA (Diaskintest®, JSC Generium, Russia)]. Diaskintest has shown high diagnostic performance in clinical trials and in conditions of high prevalence of tuberculosis infection. In 2021, the Russia was excluded from the WHO list of high TB burden countries, which makes relevant an assessment of the specificity of the RTA test under conditions of low epidemiologic risk for tuberculosis to confirm the high specificity of the test. To assess the specificity of Diaskintest in the regions of the Russian Federation with low epidemiologic risk for tuberculosis. A multicenter, open-label, prospective study was conducted, which included 150 healthy volunteers aged 18-30 years old, vaccinated with BCG, who were not at risk of tuberculosis, from regions with low epidemiologic risk (Oryol region, Ryazan region, and Arkhangelsk region). During the study, 4 visits were scheduled for each participant: [Visit 0 (screening), Visit 1, Visit 2 (in 72 h) and Visit 3 (in 28 days)]. All participants, who excluded active and latent tuberculosis infection, underwent a test with RTA. To assess the safety of RTA tests, all systemic and local adverse events that occurred during 28 days were recorded. The trial was filed in the NIH clinical trials database ClinicalTrials.gov (NCT05203068). In individuals with a negative T-SPOT.TB test, the specificity of the RTA test was 97% (95% CI: 92-99%) with a cut-off of >0 mm. The study findings confirm data 2009: 100.00 (95% CI: 94-100). When evaluating the safety of the RTA test during 28 days of follow-up, the participants did not report local and systemic adverse reactions that had a causal relationship with the RTA test. Diaskintest is highly specific and safe, therefore it is a valuable tool as a screening test for early detection of tuberculosis.

Changes of abdominal organs in children with tuberculosis infection detected by ultrasound diagnostics

BACKGROUND: Ultrasound diagnostics of abdominal organs is an early method of detecting functional and structural changes in tuberculosis infection before the manifestation of clinical manifestations. Currently, there are no uniform criteria for interpreting the sonographic pathology of parenchymal organs in tuberculosis infection in children, which requires its analysis.
 AIM: The aim is to determine the frequency and nature of sonographic changes in abdominal organs in children with tuberculosis infection, as well as their dynamics against the background of chemotherapy.
 MATERIALS AND METHODS: 192 patients aged 6 months 14 years of tuberculosis department of City Childrens Infectious Hospital No. 3 for the period 20192021 were examined. 3 groups of patients were identified: group 1 92 children with active tuberculosis of the respiratory organs; group 2 52 children with residual post-tuberculosis changes; group 3 48 children with latent tuberculosis infection from tuberculosis risk groups. Comprehensive examination of patients included evaluation of the results of immunodiagnostics (Mantoux test with 2TE and test with recombinant tuberculosis allergen), multispiral computed tomography of the chest, laboratory tests. Ultrasound examination of the abdominal organs was prescribed to children in the diagnosis of tuberculosis infection and on the background of anti-tuberculosis therapy after 3 and 6 months.
 RESULTS: Sonographic changes of the liver (reactive and/or intrahepatic cholestasis and/or hepatomegaly) were observed in children with active tuberculosis in 40.2 5.1% of cases, in children of group 3 in 35.4 6.9% of cases and less often in children of group 2 in 17.3 5.3% of cases (p 0.05). Changes of the gallbladder (violations of bile outflow and/or shape changes) in children with active tuberculosis were visualized in 73.9 4.6% of cases, in children of group 3 (60.4 7.1%), less often in children of group 2 (55.8 6.7%, p 0.05 for group 1). Changes of the pancreas were reactive and were more often observed in children of group 1 (in 14.1 3.5%) than in children of group 2 (5.8 3.2%, p 0.05) and group 3 (4.2 2.9%). Changes of the spleen were more often detected in children with active tuberculosis (in 17.4 4.0%) than in children of group 2 (5.8 3.2%, p 0.05) and group 3 (2.1 2.1%, p 0.05). During chemotherapy, there was an increase in the number of sonographic changes of the liver and gallbladder by 23 months, which was due to the undesirable effects of anti-tuberculosis drugs.
 CONCLUSIONS: Ultrasound diagnostics of the abdominal organs allows the most timely diagnosis of changes in the abdominal organs in children with tuberculosis infection, which allows individualizing pathogenetic therapy, if necessary, tuberculosis chemotherapy regimen.

Tuberculosis screening and early diagnostics in adolescents in Primorsky Krai

Aim. To define the objectives of phthisiatric service with respect to organizing screening for tuberculosis infection (TB) and early diagnostics among adolescents in Primorsky Krai.Material and Methods. The data of epidemiological monitoring conducted by the Primorsky Regional TB Dispensary in 1994–2021 were analyzed. The TB incidence, clinical structure of newly-diagnosed cases, phases of the tuberculosis process, as well as the presence of bacterial excretion were assessed. At a level of 0.95, the statistical hypothesis of equal shares was tested under an alternative hypothesis.Results. The implementation of mass immunodiagnostics using the recombinant tuberculosis allergen (TBA) by medical organizations, which are joint into a unified medical network, improves screening efficiency of TB among adolescents. This is confirmed by a decreased TB incidence rate and improved clinical structure of newly-diagnosed cases. The prevalence of secondary TB forms in the clinical structure of newly-diagnosed cases in adolescents justifies the importance of annual fluorographic examination. Annual RTA testing and fluorographic examination of the chest in adolescents once every six months should be a priority anti-tuberculosis measure.Conclusions. TB in adolescents remains to be a serious phthisiological problem. An effective system of screening and early detection of TB in adolescents should include mass immunodiagnostics and, with an interval of six months, fluorographic examination of the chest.

A screening study of latent tuberculosis infection in children in a metropolis city

Objective. To carry out a screening study among children and adolescents for tuberculosis infection in the city of Moscow using modern immunodiagnostic methods.Materials and methods. The results of a mass screening study for tuberculosis prevalence in the pediatric population of a metropolis city were analyzed. The study was conducted during 2019–2021 in Moscow using the Mantoux skin test with 2 TE PPD-L and a skin test with a recombinant tuberculosis allergen (RTA), as well as the indicators of tuberculosis incidence in children.Results. The introduction of mass screening for tuberculosis based on RTA among the pediatric population and subsequent work with the identified risk groups contributed to a decrease in the number of newly-diagnosed cases. In 2019–2021, the incidence of tuberculosis among children in Moscow did not exceed 3.8 per 100 thousand children aged 0–17 years, with this number varying from 1.2 to 2.1 among permanent residents. The risk indicators of primary infection among children aged 1–7 according to the Mantoux test (0.37% in 2019, 0.47%, in 2020, and 0.35% in 2021) and the prevalence of latent tuberculosis according to the results of screening based on RTA among children aged 8–17 in 2019–2021 (no more than 0.3%) indicate a stable epidemiological situation as regards tuberculosis infection in the city.Conclusions. The development of an effective monitoring system for preventive tuberculosis screening among urban pediatric populations contributed to the detection of latent tuberculosis cases prior to the development of its local forms. The subsequent implementation of preventive measures in risk groups allowed the incidence of tuberculosis among children to be reduced.

Comparative sensitivity of immunodiagnostic tests <i>in vivo</i> (Mantoux and RTA) and <i>in vitro</i> (QuantiFERON – GIT) in children with chronic nonspecific bronchopulmonary pathology associated with various tuberculosis

Aim. Selection and combination of immunodiagnostic tests to detect active tuberculosis (TB) in children with concomitant bronchopulmonary pathologies.Materials and methods. A prospective study of children and adolescents (n = 236) was conducted, which included cases with localized pulmonary tuberculosis; pulmonary tuberculosis associated with allergic or infectious and inflammatory forms of chronic nonspecific lung diseases (CNSLD); chronic nonspecific lung diseases under a significant absence of active TB but the presence of Mycobacterium tuberculosis. All patients underwent immunodiagnostic tests by Mantoux test, recombinant tuberculosis allergen (RTA) test, and QuantiFERON – GIT.Results. Mantoux and RTA tests were found to exhibit high sensitivity in children both with tuberculosis associated with concomitant pathologies and without such pathologies. Differences were observed in the results obtained by the Mantoux test in children with tuberculosis-associated bronchopulmonary pathology and those with localized tuberculosis. The Mantoux test may be positive as a result of many factors, other than active TB infection. Thus, children with allergic and infectious-inflammatory pathologies of the lungs exhibit an altered sensitivity to the Mantoux test. Such cases require in vitro diagnostics with the Quanti- FERON test, whose sensitivity is high despite the presence of CNSLD.Conclusions. Children with infectious-inflammatory CNSLD should undergo TB examination in stages based on in vivo and in vitro tests, when necessary. Children with allergic CNSLD should undergo in vitro tests at the first stage.

TREC as a personalized tuberculosis predictor in infants and preschool children

Aim. Quantitative assessment of TREC and KREC in infants and preschool children infected with tuberculosis infection (TI). Material and methods. A prospective cross-sectional study was conducted in 2022. The observation group consisted of 87 children of early childhood age in contact with TB patients, of whom 27 were diagnosed with TB, 34 were tested positive to TB based on skin tests without signs of a local specific process (TI), 26 were children without signs of tuberculosis infection according to the results of skin tests and local process (conditionally healthy children).Results. The following factors significant in the assessment of tuberculosis infection were determined: anti-tuberculosis therapy (F = 42.001; p = 0.000001); positive or negative response to the tuberculosis recombinant allergen (RTA) during an intradermal test (F = 39.394; p = 0.000001); high TREC levels in the blood (F = 12.707; p = 0.000001); the presence of a tuberculin response (F = 10.625; p = 0.000006); and KREC levels (F = 3.182; p = 0.039). Conclusions. According to the obtained results, TREC levels can be considered as a personalized risk predictor of tuberculosis infection in infants and preschool children.

ИЗУЧЕНИЕ ЦИТОКИНОВОГО ПРОФИЛЯ У БОЛЬНЫХ ХРОНИЧЕСКОЙ БОЛЕЗНЬЮ ПОЧЕК 5-Й СТАДИИ И ТУБЕРКУЛЕЗОМ

In the recent years detection and diagnosis of TB has widely involved such immunological tests as the recombinant tuberculosis allergen (RTA) skin test (Diaskintest®) and interferon gamma release assay (IGRA) tests. However, numerous defects of cellular and humoral immunity in patients with stage 5 chronic kidney disease (CKD) lower sensitivity of the above tests for TB detection (42% and 47% respectively). The altered immune response in stage 5 CKD patients dictates the need for search for other biomarkers of TB infection for this specific category of patients. The review analyzes literature data for the recent 30 years related to scientific research into cytokine profiling in stage 5 CKD patients with TB infection as a specific comorbid group. We have compared data on immunological studies of TB patients without uremia, including quantitative evaluation of innate immunity cytokines (some interleukins, tumor necrosis factor α) and enzyme immunoassay, analysis of cytokine gene expression using real-time polymerase chain reaction. The data on immune defects in CKD patients on renal replacement therapy (hemodialysis) are represented. The data on elevated concentrations of inflammation markers in dialysis patients and the information about the correlation between dialysis duration and cytokine concentrations are provided. False negative results of immunological tests for TB in CKD patients are partially explained. The current tendencies in search for TB infection biomarkers in CKD patients, including those on renal replacement therapy, are shown, as well asthe tendencies in search for TB activity markers and responses to TB treatment. Despite the controversial data, we believe that our study of immune responses of stage 5 CKD patients can provide the basis for the development of new tools for detection and diagnosis of TB infection in this immunocompromised group. The study of cytokine production in stage 5 CKD patients provides opportunities for the development of new diagnostic tests and/or markers of TB infection activity in this specific group of patients.

Latent tuberculosis infection in draft aged young men

Evaluation of latent tuberculosis infection based on the results of skin test with a recombinant tuberculosis allergen (RTA) in men aged 15–17 linked to care at TB dispensary, and influence of epidemiological and clinical signs on immunological test intensity were studied. The results of RTA tests of 96 adolescents (main group — 57 (59.4%) young men, and comparison group — 39 (40.6%) girls) followed up at St Petersburg Tuberculosis Dispensary no. 5 from 2017 through 2019 were evaluated. In the main group the average size of RTA test was 9.25±6.5 mm. 15 young men (26.3%) had hyperergic tests — 17.4±2.3; 16 (28.1%) — pronounced positive (11.2±1.5); 11 (19.3%) — moderately positive (6.5±1.4); 4 (7.0%) — slightly positive (3.25±1.0); and 11 (19.3%) — negative. For girls the mean value of the RTA tests was 9.8±7.3 mm: hyperergic — 17.3±3.4 (12; 30.8%) pronounced positive — 12.2±1.5 (11; 28.2%), moderately positive — 8,2±1.4 (4; 10.3%); no slightly positive tests; negative tests — 12 (30.8%). 11 (19.3%) young men had chronic accompanying diseases and their tests were hyperergic (5) and pronounced positive (4). 19 (33.3%) young men and 17 (43.6%) girls had contact with TB patients: 12 (26.7%) young men grew up in single-parent families and these cases were with hyperergic and pronounced positive RTA tests. 9 girls had an incomplete family: 2 of them were with hyperergic, 5 — pronounced positive, 2 — moderately positive tests. Draft aged young men with latent tuberculosis infection should comprise a group of especially strict diagnostics and treatment in view of their further possible conscription into military service

LACTOFERRIN – A ROLE IN THE PROTECTIVE FUNCTIONS IN ADOLESCENTS WITH LATENT TUBERCULOSIS INFECTION

When evaluating the role of lactoferrin to improve the effectiveness of preventive treatment of latent tuberculosis infection in adolescents, it was found that the prescriptions of Lactoferrin imun + Colostrum contributed to a significantly more pronounced decrease in the frequency of hyperergic reactions in test with tuberculosis recombinant allergen (from 51.3% to 12.5% in the main group, from 50.7 % to 33.3% in the comparison group, p < 0.05), a decrease in the average size of the papule (from 17.6 mm to 8.2 mm in the main group and from 17.1 to 14.5 mm in the comparison group, p < 0.05). In patients of the main group, the restoration of free radical oxidation and antioxidant protection indicators to the level of healthy donors was established, while in the comparison group, the intensity of blood plasma chemiluminescence and the activity of myeloperoxidase in neutrophils remained elevated, while the activity of catalase and superoxidedismutase remained reduced. The level of lactoferrin during treatment in the main group increased to normal values (740 ng/ml, 95%CI 702.2-777.8), and in the control group remained reduced (440 ng/ml, 95%CI 411.5-478.5), p < 0.05. At the same time, the continuing level of positive reactions to tuberculosis recombinant allergen (Diaskintest®) against the background of normalization of the lactoferrin level indicates the high diagnostic capabilities of Diaskintest® to detect LTBI in adolescents

PREVALENCE OF LATENT TUBERCULOSIS INFECTION AMONG MEDICAL WORKERS

The analysis of the results of immunological tests (skin test with tuberculosis recombinant allergen in standard dilution, hereinafter referred to as the test with ATP) and laboratory immunological test IGRA, delivered in 2019-2022 to employees of medical organizations of the Moscow Department of Health, working in four administrative districts of Moscow (Central, Western, South-Western, Troitsk and Novomoskovsk, next – CAD, WAD, SWAD/T&NAD). Among the average annual number of employees over 5 years – 43,452 people, with medical examination and exclusion of tuberculosis, the prevalence of persons with latent tuberculosis infection (LTI) was 2.6, 6.1 and 1.8%, in the CAD, WAD and SWAD/T&NAD, respectively, or 3.4% in general to these districts. At the same time, the average annual frequency of detection of cases of LTI («first detected LTI») was 0.6, 1.3 and 0.6% in these districts, respectively, and 0.75% in all districts as a whole. 95.4% of the employees were assigned a course of preventive therapy (PT), 45.8% of which the course was started. Among the latter, 85.0% successfully completed the course, 14.1% – the course was interrupted by the patient, and 0.9% – canceled by the doctor due to adverse events. The main PT regimen used (78.4%) included 3 months of taking a combination of isoniazid and pyrazinamide (INN: isoniazid 150 mg + pyrazinamide 500 mg), which showed a low proportion of adverse events – 3.1%. The identification of workers of medical organizations of LTI allows to determine a group high risk for tuberculosis and to allocate a group of persons for preventive therapy

ТУБЕРКУЛЕЗ ИЛИ РАК: ПРИЧИНЫ ОШИБОК ДИФФЕРЕНЦИАЛЬНОЙ ДИАГНОСТИКИ

We carried out an analysis of differential diagnostic errors among patients with cancer diagnosed in TB institutions in Smolensk region in 2017–2021. Delayed diagnostics of tumors in the lungs or pleura was revealed. The causes of overdiagnosis of TB in patients with malignant tumors were as follows: the similarity of clinical and radiological signs of the diseases, the similarity of laboratory test results, false positive results of M. tuberculosis detection in sputum, lack of the recombinant tuberculosis allergen (RTA) test, misinterpretation of radiological data. In indeterminate cases it is vital to verify the diagnosis as soon as possible by performing biopsy from the pathological site.

The feasibility of ct scanning in children with a positive recombinant tuberculosis allergen test

The problem of substantiating the use of diagnostic methods using ionizing radiation in children remains topical, and the importance of the problem grows every year. Special attention should be paid to this issue in children’s TB. Thirty-three children suspected of TB were monitored for tubercular recombinant allergen (ATP). The study showed that the diagnosis made by the clinicians and the computed tomography (CT) data in children with modified ATP samples have no reliable influence (p=0.89; Fisher criterion=0.11). Diagnosis of TB was more dependent on clinical, laboratory, radiological, and historical data combined, and often CT had no effect on patient management. The rationale for applying CT in children with modified ATP responses should be corrected and applied on strict grounds to maintain radiation safety.