The paper analyzes changes in the pattern of clinical forms of registered tuberculosis cases, in the proportion of detected complications and phases of the specific process in children in 2007 to 2012. The findings were compared with registered morbidity rates and changes in the set of performed examinations [introduction of diaskintest (DST) and computed tomography (CT)] in 5 areas of the North-Western Region of the Russian Federation. There was a rise in the notified number of children with tuberculosis in some areas and a decline in the others, which is due to different frequencies to use DST and CT in the diagnostic complex. The wide introduction of CT may be a cause of more frequent detection of the specific process in the phase of involution and calcification because standard radiographic techniques used in the early stages of the specific process fail to diagnose these changes. The findings suggest the untimely detection of the disease and necessitate an improvement in the screening of children for the early manifestations of tuberculosis infection.

adolescents. Fluorography is the basic method used as usual to detect tuberculosis in adolescents. The use of diaskintest in the diagnosis of tuberculosis infection in adolescents has reinforced its high informative value. The test was positive in 96.7% of the patients with tuberculosis and could reveal dormant tuberculosis infection in 29.2% of the cases. In the patterns of its clinical forms, there is a preponderance of secondary tuberculosis (infiltrative forms, including those with bacterial excretion); most (64.3%) cases show multidrug resistance (MDR) in Mycobacterium tuberculosis (MBT). Accelerated methods for determining MBT resistance in a number of patients can reveal MDR in MBT in early periods, which allows antituberculosis therapy to be timely corrected. Multidrug-resistant pulmonary tuberculosis is characterized by severe clinical symptoms and multisegmental destruction in the lung.

The paper presents the results of an analysis of 328 individual child development cards in different ethnic population groups intheRepublic of Sakha (Yakutia). In these groups, the quality of BCG and BCG-M vaccinations was assessed from the size of a postvaccination scar. The mean scar sizes were largest (4.45±0.30 mm) in nonindigenous children and smallest (3.85±0.15 mm) in Yakut ones (p < 0.01). The quality of BCG and BCG-M vaccinations did not differ significantly. There was a 2.3-fold decline in the number of complications due to immunoprophylaxis with BCG-M vaccine.

The main epidemiological parameters of tuberculosis were studied in children and adolescents, including those who had bacillary contacts. The incidence of tuberculosis in these persons is 42 times higher than that in resident children and adolescents.

The paper characterizes the foci of the infection and shows the importance of an intrafamilial contact, the proportion of which among all contacts was 51.8 to 90.8%. There is an inadequate follow-up of children in the infection foci – 30-40% of the patients who had been ill because of contacts were not followed up by a phthisiatrician. The given data indicate that some aspects of prevention work in the infection foci must be revised. 

The paper gives the results of an analysis of intracutaneous Mantoux tuberculin tests with 2 TU, 1 TU, 0.1 TU, and 0.01 TU PPD-L and intracutaneous Diaskintest using recombinant tuberculosis allergen in the standard dilution in 63 children with tuberculosis. A moderate correlation was found between the results of the above tests. There was the highest sensitivity of the immune system to the administration of 0.01 TU PPD-L (0.0006 µg). A high specific responsiveness as a hyperergic reaction was established when recombinant tuberculosis allergen was used in standard dilution (0.2 µg). There were moderately intensive and weakly positive reactions (10-14- and 5-9-mm infiltrates) to the administration of 2 TU (0.12 µg) of tuberculin in the skin test. The tuberculin skin test with 0.01 TU PPD-L was ascertained to be of more significant diagnostic value than the Diaskintest using recombinant tuberculosis allergen in standard dilution.

The performed investigation showed that the specific feature of a group of children and adolescents with destructive pulmonary tuberculosis is the frequent absence of sputum (64.7%). The informative value of sputum examination for Mycobacterium tuberculosis (MBT) DNA by a polymerase chain reaction assay was significantly higher than that of oropharyngeal lavage (100 and 20.5%, respectively; p < 0.001). Drug resistance in MBT was determined by a microarray test in only 16 (23.5%) out of 68 patients for lack or paucity of DNA in the diagnostic material. Initial chemotherapy regimens were used in these patients in terms of definite resistance. In the other 52 (72.5%) cases, empirical chemotherapy regimens taking into account the possible risk for drug resistance in MBT from their history data and clinical and X-ray findings were given before drug resistance tests or in the absence of bacterial excretion. The first estimates of procalcitonin levels in the children and adolescents with destructive pulmonary tuberculosis may suggest that the positive tests are indicative of the high activity of a mycobacterial population. In the patients with positive procalcitonin tests, unlike those with negative ones, bacterial excretion was significantly more frequently detected by both luminescence microscopy and inoculation Bactec MGIT 960: 85.7 and 20.8%, respectively (p < 0.001), 100 and 50.0%, respectively (p < 0.005).

Much clinical material (more than 9,500 diagnostic samples) was used to evaluate the efficiency of using different microbiological and molecular genetic studies for the diagnosis of tuberculosis in laboratory practice. Current accelerated techniques (a bacteriological assay with liquid media and a Bactec MGIT 960 analyzer, as well as molecular genetic studies) compared to traditional methods for tuberculosis diagnosis (microscopy, dense media culture) were found to have advantages in the time spent to obtain results and in the efficient detection of mycobacteria. The results of studies performed by different methods were compared and it was shown that a set of traditional and accelerated microbiological and molecular genetic methods should be concurrently employed to enhance the efficiency of tuberculosis diagnosis.

Autopsy protocols for deaths of 7-14-year-old children in 1947 to 2012, which indicated tuberculosis of the central nervous system (CNS), were analyzed; the incidence of the above pathology was 80.3% among 132 children who died from tuberculosis in this period,. It was ascertained that in 1947-1956 the children died from generalized tuberculosis with involvement of CNS and other organs. As a result of induced pathomorphism, the number of autopsies reduced by 13.9 times in 1957-1966 and by 97 times in 1967-1994 as compared to 1947-1956. Changes occurred in the pattern of forms of CNS tuberculosis and the number of autopsied deaths from CNS tuberculosis concurrent with generalized tuberculosis decreased by 16.7 times; there was a decline in the number of affected organs. However, the 1995-2012 deaths from generalized tuberculosis with involvement of CNS and other organs in 7-14-year-old children are suggestive of the reversion of severe tuberculosis and the necessity of intensifying social, preventive, and remedial measures among them.

The paper analyzes the epidemic situation of pulmonary tuberculosis among the female population of the Nizhny Novgorod Region in 2011-2013. There was a tendency for a reduction in main epidemiological parameters among the region’s female population over time, suggesting some stabilization of the tuberculosis process. At the same time, there was a rise in the rates of primary morbidity for bacillary pulmonary tuberculosis and morbidity in penitentiary facilities. In a 25-34 year old age group of women, the main epidemiological parameters exceed the average regional ones, besides, there is an increase in the morbidity rates of fibrocavernous tuberculosis and found postmortem rates in this age group, pointing to epidemiological ill-being in the region.

The investigation enrolled 60 infertile patients diagnosed with genital tuberculosis who had completed a basic cycle of etiotropic specific antituberculosis treatment. 53.3% of the women developed adverse reactions (ARs) to anti-TB drugs. In the majority (78.1%) of the patients, chemotherapy for genital tuberculosis was complicated by one type of ARs. In the patients with genital tuberculosis and infertility, the most common AR to anti-TB agents was drug-induced hepatitis that was noted in 62.5% of the women. Digestive comorbidity and high adherence to antituberculosis therapy favored the development of ARs in most patients. ARs to anti-TB drugs did not affect the efficiency of treatment for genital tuberculosis in infertile women; however, they contributed to longer treatment in hospital.

The paper describes a case of generalized tuberculosis in a HIV-infected child. The specific feature of the case is the late detection of both tuberculosis and HIV infection. Tuberculosis was diagnosed on the basis of the data of multislice spiral computed tomography and bacteriological examination of bronchial washes. The case demonstrates the development of severe generalized tuberculosis in the child with untimely detected HIV infection, as well as pediatricians’ low alertness to HIV infection in children and inadequate HIV detection works among pregnant women.