Prognostic factors for tuberculosis development in children with latent tuberculous infection

Goal of the study: to detect specific immune response in children with latent tuberculous infection and define factors to forecast the development of the active disease in this group.Materials and methods. The changes in clinical, X-ray and immunological data were analyzed in 127 children when latent tuberculous infection was diagnosed and after 12 months of follow-up. The number of immunological tests was done for evaluation of humoral and cellular immunity in those suffering from latent tuberculous infection and active disease.Results. The obtained results showed high negative prognostic relevance of exposure to tuberculosis, concurrent disease, refusal to have preventive treatment and low efficiency of short-course preventive treatment, specific features of humoral and cellular immunity were defined which could be used as additional forecasting criteria for active tuberculosis development in children with latent tuberculous infection

DISSEMINATED CUTANEOUS TUBERCULOSIS

Cutaneous tuberculosis is a clinically and morphologically heterogeneous group of skin diseases directly or indirectly caused by mycobacteria of the tuberculosis complex, occupying the 5th place among all localizations of extra-pulmonary tuberculosis. Manifestations of cutaneous tuberculosis are extremely diverse and depend on the immune status and ways of penetration of mycobacteria into the skin. Skin involvement can occur as a result of exogenous inoculation, contiguous spread from an adjacent focus, or hematogenous spread from other foci. Family cases of disseminated cutaneous tuberculosis are described. A combination of several clinical forms of cutaneous tuberculosis — scrofuloderma, tuberculosis cutis lichenoides (moniliformis scrophulosorum) and lupus — are observed in a 5 year old child with a family history of tuberculosis. The issues of pathogenesis and advanced methods of diagnosis of cutaneous tuberculosis are also discussed

Прогностические факторы развития туберкулеза у детей с латентной туберкулезной инфекцией

Goal of the study: to detect specific immune response in children with latent tuberculous infection and define factors to forecast the development of the active disease in this group.Materials and methods. The changes in clinical, X-ray and immunological data were analyzed in 127 children when latent tuberculous infection was diagnosed and after 12 months of follow-up. The number of immunological tests was done for evaluation of humoral and cellular immunity in those suffering from latent tuberculous infection and active disease.Results. The obtained results showed high negative prognostic relevance of exposure to tuberculosis, concurrent disease, refusal to have preventive treatment and low efficiency of short-course preventive treatment, specific features of humoral and cellular immunity were defined which could be used as additional forecasting criteria for active tuberculosis development in children with latent tuberculous infection. Цель исследования: выявить особенности иммунного ответа у детей с ЛТИ и определить прогностические факторы развития туберкулеза у пациентов данной группы.Материалы и методы. Проведен анализ в динамике клинических, рентгенологических, иммунологических данных 127 детей - при постановке диагноза ЛТИ и через 12 мес. наблюдения. Также проведен комплекс иммунологических методов для оценки гуморального и клеточного иммунитета у пациентов с ЛТИ и больных туберкулезом.Результаты. Установлены высокая отрицательная прогностическая значимость наличия контакта с больным туберкулезом, сопутствующей патологии, отказа от проведения превентивной терапии, а также низкая эффективность краткосрочных курсов превентивной терапии, определены особенности клеточного и гуморального иммунитета пациента, которые могут быть использованы как дополнительные прогностические критерии развития туберкулеза у детей с ЛТИ

РЕЗУЛЬТАТЫ ПРИМЕНЕНИЯ ИММУНОЛОГИЧЕСКИХ ТЕСТОВ НОВОГО ПОКОЛЕНИЯ У ДЕТЕЙ В УСЛОВИЯХ МАССОВОЙ ВАКЦИНАЦИИ ПРОТИВ ТУБЕРКУЛЕЗА

Development of new methods of immune diagnostics of tuberculous infection and their introduction into tuberculosis control practice have changed approaches to diagnostics of tuberculosis in Russia. Along with world recognized IGRA-tests the test with tuberculous recombinant allergen (TRA) developed by Russian researchers is also widely used. High diagnostic value of each of the methods is proved by multiple national and international trials however there is no research comparing results of these methods in the diagnostics of tuberculous infection in children, including those with concurrent conditions. During the study data of testing in 654 children in the age from 0 to 14 years old with positive sensitivity to tuberculin as per Mantoux test with 2 TU were analyzed. All patients had modern immunological tests done: TRA and IGRA-tests (QuantifeRON® Gold ELISA (QFT) and T-SPOT.TB). The study confirmed the low value of Mantoux test with 2 TU as a method of early tuberculosis detection in children; it detected underdiagnosis (10-50%) and overdiagnosis (78%) of latent tuberculous infection in the children with different sensitivity level as per data of Mantoux test with 2 TU. Comparing the results of TRA and IGRA tests it is possible to state that they are compatible for 76-81% of cases. The group of children was detected who had allergic and endocrine disorders (obesity), for whom IGRA tests were recommended to exclude chances of false-positive results of TRA tests. Разработка новых методов иммунодиагностики туберкулезной инфекции и их внедрение во фтизиатрическую практику изменили подходы к диагностике туберкулеза в России. Наравне со всемирно признанными IGRA-тестами широкое применение получила проба с аллергеном туберкулезным рекомбинантным (АТР), разработанная отечественными учеными. Высокая диагностическая информативность каждого из методов доказана многочисленными исследованиями как отечественных, так и зарубежных ученых, однако работы по сопоставлению их результатов между собой в диагностике туберкулезной инфекции у детей, в том числе с сопутствующей патологией, отсутствуют. В исследовании проведен анализ данных обследования 654 детей в возрасте от 0 до 14 лет с положительной чувствительностью к туберкулину по пробе Манту с 2 ТЕ. Всем пациентам были выполнены современные иммунологические тесты: АТР и IGRA-тесты (QuantifeRON® Gold ELISA (QFT) и T-SPOT.TB). Исследование позволило подтвердить низкую значимость пробы Манту с 2 ТЕ как метода раннего выявления туберкулеза у детей, установить гипо- (10-50%) и гипердиагностику (78%) латентной туберкулезной инфекции у детей с различным уровнем чувствительности по данным пробы Манту с 2 ТЕ. При сравнении результатов АТР и IGRA-тестов можно говорить об их сопоставимости в 76-81% случаев. Выявлена группа детей, имеющих сопутствующую аллергическую и эндокринную патологию (ожирение), у которых рекомендованы IGRA-тесты для исключения возможности получения ложноположительных результатов по пробе с АТР.

Clinical and epidemiological characteristics of registered childhood tuberculosis cases in the North-Western Region of Russia when introducing a tuberculosis diagnosis complex using diaskintest and multislice spiral computed tomography

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

RESULTS OF IMMUNOLOGICAL TESTING OF NEW GENERATION IN CHILDREN UNDER MASSIVE VACCINATION AGAINST TUBERCULOSIS

Development of new methods of immune diagnostics of tuberculous infection and their introduction into tuberculosis control practice have changed approaches to diagnostics of tuberculosis in Russia. Along with world recognized IGRA-tests the test with tuberculous recombinant allergen (TRA) developed by Russian researchers is also widely used. High diagnostic value of each of the methods is proved by multiple national and international trials however there is no research comparing results of these methods in the diagnostics of tuberculous infection in children, including those with concurrent conditions. During the study data of testing in 654 children in the age from 0 to 14 years old with positive sensitivity to tuberculin as per Mantoux test with 2 TU were analyzed. All patients had modern immunological tests done: TRA and IGRA-tests (QuantifeRON® Gold ELISA (QFT) and T-SPOT.TB). The study confirmed the low value of Mantoux test with 2 TU as a method of early tuberculosis detection in children; it detected underdiagnosis (10-50%) and overdiagnosis (78%) of latent tuberculous infection in the children with different sensitivity level as per data of Mantoux test with 2 TU. Comparing the results of TRA and IGRA tests it is possible to state that they are compatible for 76-81% of cases. The group of children was detected who had allergic and endocrine disorders (obesity), for whom IGRA tests were recommended to exclude chances of false-positive results of TRA tests