АКТУАЛЬНЫЕ ПРОБЛЕМЫ ТУБЕРКУЛЕЗА У ПОДРОСТКОВ ИЗ ОЧАГОВ ТУБЕРКУЛЕЗНОЙ ИНФЕКЦИИ

The article characterizes respiratory tuberculosis in adolescents exposed to tuberculous infection. Exposure to tuberculosis in the family or when contacting close relatives makes the biggest contribution into development of the disease unless the patient is isolated from those exposed. Advanced and severe forms of tuberculosis with bacillary excretion are detected, compromising the life quality of adolescents. The main causes of late diagnostics are poor performance of TB services, primary medical units, low level of health education aimed at the increase of motivation to have planned medical examinations in the general population and to take relevant sanitary and hygienic measures in the sites of infection. Adolescents from the sites with bacillary excretion, and, first of all, if multiple or extensive drug resistant tuberculosis is detected, are to be considered a high priority group facing the risk to develop the disease with more frequent monitoring and deeper examination. In primary medical units, should any sings typical of tuberculosis be presented, it is sensible to add skin tests (Mantoux test and test with tuberculous recombinant allergen) to the minimum diagnostic procedures. Organizational, methodical and health education activities in the sites of infection are to be improved.Дана характеристика туберкулеза органов дыхания у подростков из контакта с больным туберкулезом. Набольшее значение для развития заболевания имеет контакт в семье и с близкими родственниками без изоляции контактирующих лиц от больного. Выявляются тяжелые, распространенные процессы с бактериовыделением, которые снижают качество жизни заболевшего подростка. Основные причины поздней диагностики – недостатки в работе противотуберкулезной службы, первичной медико-санитарной помощи (ПМСП), низкий уровень санитарно-просветительной работы по повышению мотивации населения к плановым обследованиям и соблюдению санитарно-гигиенических мероприятий в очаге. Подростки из очагов с бактериовыделением, в первую очередь при обнаружении микобактерий туберкулеза с множественной/широкой лекарственной устойчивостью, должны рассматриваться как приоритетная группа риска развития заболевания с более частым мониторингом, углубленным обследованием. В учреждениях ПМСП при наличии клинических признаков, таких же как при туберкулезе, целесообразно включить в диагностический минимум кожные иммунологические тесты (проба Манту и проба с аллергеном туберкулезным рекомбинантным). Необходимо совершенствование работы организационно-методической и санитарно-просветительной работы в очагах

Reasons for late diagnostics of tuberculosis in adolescents

In total the authors reviewed 83 patient records: disease development anamnesis, results of the standard clinical, radiological and laboratory examinations.  Tuberculosis in adolescents  found during routine examination is characterized by a high epidemic risk (45% of patients were sputum positive), severe clinical forms of the disease with the pronounced residual abnormalities and therefore need of surgical treatments. Patients with the clinical signs of pulmonary disease (pneumonia, bronchitis, recurrent acute respiratory infections) belong to the risk group requiring evaluation for tuberculosis including with the use of immunological skin tests

ACTUAL ISSUES OF TUBERCULOSIS IN ADOLESCENTS EXPOSED TO TUBERCULOSIS INFECTION

The article characterizes respiratory tuberculosis in adolescents exposed to tuberculous infection. Exposure to tuberculosis in the family or when contacting close relatives makes the biggest contribution into development of the disease unless the patient is isolated from those exposed. Advanced and severe forms of tuberculosis with bacillary excretion are detected, compromising the life quality of adolescents. The main causes of late diagnostics are poor performance of TB services, primary medical units, low level of health education aimed at the increase of motivation to have planned medical examinations in the general population and to take relevant sanitary and hygienic measures in the sites of infection. Adolescents from the sites with bacillary excretion, and, first of all, if multiple or extensive drug resistant tuberculosis is detected, are to be considered a high priority group facing the risk to develop the disease with more frequent monitoring and deeper examination. In primary medical units, should any sings typical of tuberculosis be presented, it is sensible to add skin tests (Mantoux test and test with tuberculous recombinant allergen) to the minimum diagnostic procedures. Organizational, methodical and health education activities in the sites of infection are to be improved

INDIVIDUAL TREATMENT OF PULMONARY MDR/XDR TUBERCULOSIS IN ADOLESCENTS

The article presents 3 clinical cases of treatment of drug resistant tuberculosis in children and adolescents, illustrating the variants of the individual approach to treatment of tuberculosis with multiple/extensive drug resistance  In order to improve treatment outcomes, bronchologic methods were used for the collection of specimens for bacteriological tests, chemotherapy regimens were adjusted in a timely manner, valve bronchial block (implantation of endobronchial valve) was used in one the patients to promote the cavity healing, the other patient underwent VATS resection of the upper lobe of the left lung due to numerous large foci As a result, it was possible to use a short course treatment in those patient