Clinical and Radiological Characteristics of Respiratory Tuberculosis Treatment Failures in Children and Adolescents and Timing of their Detection Depending on Examination Method

The objective: selection of optimal timing for chest CT to identify respiratory tuberculosis treatment failures in children and adolescents through clinical and radiological comparison.

Subjects and Methods. A retrospective comparative study was conducted. Totally 70 patients aged from 2 to 17 years with various clinical forms of respiratory tuberculosis were examined. Retrospectively, patients were divided into 3 groups: Group 1 (35 people) – CT was performed before the treatment start and, as the first control, after 2-3 months of chemotherapy; Group 2 (17 people) had a CT before the chemotherapy start and after 2-3 months – plain X-ray (or in combination with linear tomography), CT control – after 6-9 months after the chemotherapy start; Group 3 (18 people) included patients who had only plain X-ray (or in combination with linear tomography) before and during chemotherapy, CT was first performed after treatment failure

Results. In all groups, in more than 40% of cases, radiological changes were the only informative criterion of treatment failure. CT performed in the early stages was optimal for timely detection of treatment failure: before the chemotherapy start and in 2-3 months (Group 1). In patients of Groups 2 and 3, opportunities for timely correction of chemotherapy were missed due to inadequate assessment of pathological changes. CT performed after 6-9 months of treatment reliably revealed irreversible changes in 53% and 78% (Groups 2 and 3), respectively.

1. Aksenova V.A., Sterlikov S.A., Belilovsky E.M., Kazykina T.N., Rusakova L.I. Tuberculosis epidemiology in children. Sovremennye Problemy Zdravookhraneniya i Meditsinskoy Statistiki, 2019, no. 1. (In Russ.) Available: https://cyberleninka.ru/article/n/epidemiologiya-tuberkuleza-u-detey Accessed May 28, 2023

2. Gavrilov P.V. Radialogical diagnostics of tuberculosis of intrathoracic lymph nodes in children. Problems and ways to solve them. Meditsinsky Alyans, 2014, no. 2, pp. 26-31. (In Russ.)

3. Gavrilov P.V., Pribytok K.V., Sinitsina A.V., Mikhaylova S.V. Sensitivity of chest CT in detecting local forms of tuberculosis in children with a positive result of the test with recombinant tuberculosis allergen. Luchevaya Diagnostika I Terapiya, 2017, vol. 2, no. 8, pp. 83-84. (In Russ.)

4. Gegeeva F.E., Lazareva Ya.V., Aksenova V.A. Comparative description of X-ray diagnostic techniques of minor forms of tuberculosis. Problemy Tuberkuleza, 2006, no. 5, pp. 20-23. (In Russ.)

5. Gubkina M.F., Petrakova I.Yu., Bagirov M.A., Yukhimenko N.V., Khokhlova Yu.Yu., Sterlikova S.S. 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. Tuberculosis and Lung Diseases, 2022, vol. 100, no. 7, pp. 14-21. (In Russ.) https://doi.org/10.21292/2075-1230-2022-100-7-14-21

6. Klinicheskie rekomendatsii Tuberkulez u detey. [Clinical guidelines on tuberculosis in children]. 2022, 2023, 2024. 31.05.2022. Available: https://cr.minzdrav.gov.ru Accessed May 31, 2023

7. Klinicheskie rekomendatsii. Latentnaya tuberkuleznaya infektsiya. [Guidelines. Latent tuberculous infection]. 2016. Available: http://roftb.ru Accessed May 31, 2023

8. Lazareva Ya.V. Value of computer tomography for diagnostics and classification of chest lymph nodes tuberculosis in children. Problemy Tuberkuleza i Bolezney Legkikh, 2005, no. 12, pp. 14-19. (In Russ.)

9. Legeza S.M., Perfiliev A.V. X-ray diagnostics in children and adolescents ill with respiratory tuberculosis in the preoperative period. Problemy Tuberkuleza i Bolezney Legkikh, 2009, no. 5, pp. 34-36. (In Russ.)

10. Perelman M.I., Kessel M.A., Klevno V.I., Aksenova V.I. Indications for surgery and timing of surgical treatment for tuberculosis of the intrathoracic lymph nodes in children and adolescents. Tuberculosis of intrathoracic lymph nodes in children and adolescents: diagnosis and surgical treatment. Tuberculosis and Lung Diseases, 2010, no. 8, pp. 23-25. (In Russ.)

11. Petrakova I.Yu., Gubkina M.F., Bagirov M.A., Lepekha L.N., Larionova E.E., Yukhimenko N.V., Sterlikova S.S. Approaches to timing of surgical treatment for tuberculous lesions of the pleura in children in the context of increasing incidence of multiple drug resistant tuberculosis. Vestnik TSNIIT, 2022, no. 3, pp. 74-87. (In Russ.)

12. Starshinova A.A., Dovgalyuk I.F., Korneva N.V., Ananiev S.M., Gavrilov P.V., Yakunova O.A. Modern opportunities in diagnostics of chest lymph nodes tuberculosis in children. Tuberculosis and Lung Diseases, 2014, no. 11, pp. 23-29. (In Russ.) https://doi.org/10.21292/2075-1230-2014-0-11-19-26

13. Fatykhova R.Kh., Alekseev A.P. Efficiency of screening for tuberculous infection among children in Tatarstan Republic. Tuberculosis and Lung Diseases, 2016. vol. 94, no. 6, pp. 39-42. (In Russ.) https:// doi.org/10.21292/2075-1230-2016-94-6-39-42

14. Frolova Yu.V., Myakisheva T.V., Pushkareva O.B. The role of screening in pediatric population for tuberculosis infection. Smolenskiy Meditsinskiy Almanakh, 2017, no. 3. (In Russ.) Available: https://cyberleninka.ru/article/n/rol-skriningovyh-obsledovaniy-detskogo-naseleniya-na-tuberkuleznuyuinfektsiyu Accessed May 28, 2023

15. Shavelkina I.I., Kopylova I.F., Piskunova N.N. Computed tomography in the diagnosis of respiratory tuberculosis in children and adolescents. MiD, 2010, no. 2. (In Russ,) Available: https://cyberleninka.ru/article/n/kompyuternaya-tomografiya-v-diagnostike-tuberkuleza-organov-dyhaniya-u-detey-i-podrostkov Accessed May 28, 2023

16. Shepeleva L.P. Diagnostic efficiency and significance of computed tomography in diagnosis of primary tuberculosis in children and adolescents. Vestnik of SVFU, 2012, no. 4. (In Russ.) Available: https://cyberleninka.ru/article/n/diagnosticheskaya-effektivnost-i-znachenie-metoda-kompyuternoy-tomografii-v-diagnostike-pervichnogotuberkuleza-u-detey-i-podrostkov Accessed May 28, 2023

17. Shepeleva L.P., Luginova E.F. Optimization of using X-ray tools when examining children and adolescents for tuberculosis. Tuberculosis and Lung Diseases, 2014, no. 8, pp. 113-115. (In Russ.) https://doi.org/10.21292/2075-1230-2014-0-8-113-115

18. Diagnostika i khirurgicheskoye lecheniye zabolevaniy organov dykhaniya s ispol'zovaniyem innovatsionnykh tekhnologiy. [Diagnosis and surgical treatment of respiratory diseases using innovative technologies]. Available: https://nmrc.ru Accessed May 31, 2023

19. Canetti G. Present aspects of bacterial resistance in tuberculosis. Am. Rev. Respir. Dis., 1965, vol. 92, no. 5, pp. 687-703.

20. Crofton J. Streptomycin resistance in pulmonary tuberculosis. British Medical Journal, 1948, no. 2, pp. 1009-1015.

21. Mitchinson D.A. Influence of initial drug resistance on the response to short-course chemotherapy of pulmonary tuberculosis. Am. Rev. Respir. Dis., 1986, no. 133, pp. 423-430.