Goal of the study: to analyze the tendencies in tuberculosis situation among children in Sakha Republic (Yakutia) for the last ten years when some new diagnostic tools have been introduced.

Materials and methods. The analysis included data of official statistic reporting on tuberculosis (Form no. 33) among children in Sakha Republic (Yakutia) from 2005 to 2014. During this period of time tuberculosis was newly diagnosed in 647 children in the age from 0 to 14 years old. Their ethnicity, age, tuberculosis detection methods, clinical forms, frequency of bacillary excretion and types of complications were studied.

Results. In 2005-2009 in Sakha Republic (Yakutia) the part of children among all new tuberculosis cases made 11.2% and in 2010-2014 it reduced down to 8.2%. The number of children who developed tuberculosis reduced by 51.5% in 2014 versus 2005 (2014 – 51, 2005 – 105 cases). Among new tuberculosis cases in children the exposure to tuberculosis was identified in 57.9% (2005-2009) and in 73.9% (2010-2014), which provided the evidence of severe burden of tuberculosis in the Republic. The part of children in age from 0 to 2 years old made 20.8% in 2005-2009 and 20.4% in 2010-2014. Children in the age from 7 to 14 years old developed tuberculosis the most often. In 2005-2009 tuberculosis was detected in children mostly by tuberculin tests (70.4%) and in 2010-2014 during examination after exposure to a tuberculosis case (43.6%) and less frequently by tuberculin tests (40.2%). 

Introduction of new examination techniques to tuberculosis control in children resulted in the increase of Group IIIA of the dispensary follow-up.

Goal: to define criteria of tuberculosis disease activity when calcification is detected in the chest lymph nodes of children. Follow-up included children in the age from 1,5 months to 17 years old examined in TB dispensaries of Yekaterinburg and Tyumen. 1A Subgroup (n = 145) of children demonstrated further increase and/or induration of calcification and in 27 children calcification did not change (1B Subgroup). In Subgroup 2A1  – 184 patients had changes in the X-ray manifestations, 31 persons demonstrated calcification in chest lymph nodes (Subgroup 2A2 ), 13 persons demonstrated no changes in X-ray manifestations which was considered as metatuberculous (fibrous) changes (2B Group). Two criteria witnessing of the absence of active tuberculosis disease were identified: infection with tuberculosis more than 4 years ago and stable level of α2-fraction in the protein profile. These indicators can serve as true criteria when no clinical signs of intoxication are observed and calcification is detected by X-ray, while the child has not been exposed to tuberculosis. 

The article presents the results of three year follow-up over 96 HIV positive children registered in the AIDS Center. During 3 year follow up the infection with tuberculous mycobacteria was diagnosed in 27.3% (n = 23) of HIV positive children from the followed up group. The leading risk factor of tuberculosis is family exposure to a tuberculosis patient – 22.6% (n = 19). Compliance to follow-up and treatment, timely prescribed preventive anti-tuberculosis chemotherapy and highly active antiretroviral therapy enhanced prevention of development of local forms of tuberculosis in the followed up group of children.

The efficiency of sanatorium rehabilitation of 92 children (13-17 years old) was assessed; children were divided into two groups: those with active respiratory tuberculosis – 49 patients and those infected with tuberculous mycobacteria but without active disease – 43 patients. PedsQL questionnaire (version 4.0) was used for evaluation of life quality by the start of sanatorium treatment and its completion. It was found out that emotional and social aspects suffered the most in 13-17 year old children in need of rehabilitation. Repeated use of questionnaire could be the important criterion of treatment and rehabilitation efficiency.

More specific antigens are still being searched for in order to increase informativeness of techniques for early diagnostics of tuberculous infection. Aimed at the investigation of proteins of tuberculous mycobacteria (PPD-L, ESAT 6, 85, hybrid of ЕSAT 6 CFP 10, CFP32B, Rv2660c) the study was conducted including testing of induced IFN-γ in the children ill with tuberculosis in the early period of primary tuberculous infection and also those not infected with tuberculous mycobacteria – 130 children in the age from 6.0 ± 0.4 years old. It was found out that tuberculin remained to be valuable for evaluation of the intensity of anti-tuberculosis immunity. Antigens of ESAT 6, 85, CFP32B, Rv2660c were identified as proteins of the early stage of tuberculous infection. The presence of response when stimulating by the above antigens was typical of the favorable course of tuberculosis. Antigens of ESAT 6 and Rv2660c were valuable for assessment of latent tuberculous infections and the hybrid of ЕSAT 6 CFP 10 – for diagnostics of tuberculosis. Therefore introduction of immunological tests (in vitro) into the set of diagnostic tools allows optimizing the early diagnostics of tuberculous infection in children and forecasting the course of the disease when tuberculosis has developed.

The article presents the algorithm for working with tuberculosis patients in TB hospital, providing implementation of multidisciplinary patient-centered activities for early diagnostics of psychiatric and social disorders, therapy and rehabilitation of concurrent psychiatric disorders and addictions. Multidisciplinary approach to activities within TB unit is aimed at improvement of treatment compliance of tuberculosis patients. The training programme has been developed in order to improve competency of medical personnel on the issue of treatment interruption prevention and motivating patients to undergo the continuous treatment.

Goal of the study: to enhance efficiency of laboratory diagnostics of tuberculous infection through investigating the effect of various storage conditions of samples on the growth properties of Tuberculosis complex mycobacteria.

Materials and Methods. 2058 samples of sputum collected by coughing were examined. All sputum samples were aliquoted into 5 parts stored under various conditions: in the fridge under +7°С for 2 hours; frozen for 7 days; by room indoor temperature for 48-72 hours; with the use preservative 10% solution of triple-substituted natrium phosphate for 48 hours; in the fridge under +7°С for 2 hours with consequent treatment by 1% solution of N-acetyl-L-cysteine.

Results. The most optimal sputum storage conditions are freezing by -20°С, providing maximum safety of mycobacteria and minimum contamination of the samples with foreign bacteria. Sputum storage by indoor room temperature for 2-3 days reduces the number of positive results of cultures on nutritive media. Using 10% solution of triple-substituted natrium phosphate provides high positive results of bacterioscopic and cultural testing techniques. Time prolongation for biomaterials storage in the preservative solution for more than 72 hours results in the death tuberculous mycobacteria. 

The article presents the clinical and epidemiological data on tuberculosis meningitis among children in Astrakhan Region. It was found out that among those cases 77.8% were children under 7 years old exposed to tuberculosis in their families, meningitis developed against the background of active respiratory tuberculosis and only 17.4% had post-vaccinal scar out of 85.2% who had BCG vaccination. There were two clinical forms of tuberculosis meningitis: basilar form in 59.2% and meningoencephalitis in 40.8% of patients. Late diagnostics and untimely start of treatment were observed in 88.9% of patients.

Goal: to close the fistula of right main bronchus stump with the use of the vascular occluder of ASD. The clinical case is described. Materials and methods. The fistula of right main bronchus, developed after final pulmonectomy on the right performed due to emergency indications caused fibrous cavernous tuberculosis, complicated by pulmonary hemorrhage, was closed by ASD occluder with 8 mm diameter, relevant to the diameter of bronchopleural fistula. Empyema space was first of all sanitated through thoracostoma, the volume of right hemithorax was reduced due preceding seven-costal posterosuperior thoracoplasty. The intervention was done under local anesthesia with double monitoring from tracheal lumen by bronchoscope and from thoracostoma space. The intervention lasted for 20 minutes. Results. Air discharge stopped immediately after the installation of the occluder. The patient demonstrated significant improvement of respiration and voicing even without pleural space plugging. In the follow-up period in 12 months the occluder was covered by epithelium fully stopping the air inflow from bronchus into pleural space. Management of bronchial fistula with ASD occluder is a fast, safe and effective intervention.