Characteristics of the course of multidrug-resistant pulmonary tuberculosis in children and adolescents from focuses of chemoresistant tuberculosis infection

Abstract

Objective — to study the features of multidrug-resistant tuberculosis of the lungs of respiratory organs in children and adolescents from focuses of chemoresistant tuberculosis infection. Materials and methods. To study the features of the course of multidrug-resistant pulmonary tuberculosis (MDR-TB), an analysis of clinical, X-ray, microbiological, and generally accepted laboratory examinations was conducted in 256 patients (102 children and 154 adolescents), who were divided into two groups The main group included 145 patients with MDR-TB: of them, 67 (42.2 %) children and 78 (53.8 %) teenagers from focuses of multidrug-resistant tuberculosis infection (MDR-TBI). The control group consisted of 146 patients with «chemosusceptible» pulmonary tuberculosis (CS-TB), of which 70 (47.9 %) were children and 76 (52.1 %) were adolescents from focuses of chemosusceptible tuberculosis infection (CS-TBI). Results and discussion. In children with multidrug-resistant pulmonary tuberculosis (MDR-TB), along with classic forms of tuberculosis (primary tuberculosis complex — 14.9 % and tuberculosis of the intrathoracic lymph nodes — 14.9 %), miliary tuberculosis (11.9 %), tuberculosis of the lungs and central nervous system (5.9 %), caseous pneumonia (8.9 %) and fibro-cavernous tuberculosis (4.5 %) were diagnosed. In the case of MDR-TB of the lungs, adolescents were statistically significantly more likely to be diagnosed with infiltrative tuberculosis (29.4 %) and disseminated pulmonary tuberculosis (35.9 %). At the same time, destructive changes were observed 1.6 times more often in adolescents with MDR-TB than in children, especially with multiresistant specific process (70.5 % vs. 43.3 %, p < 0.05).In children with MDR-TB, 3.5 times more often than in chemosusceptible tuberculosis, signs of the progression of a specific process due to lymphogenous and hematogenous dissemination in the form of tuberculosis of peripheral, intrathoracic and mesenteric lymph nodes, miliary tuberculosis were observed in adolescents, along with complications of a specific complications of a non-specific nature were observed: respiratory failure and non-specific catarrhal endobronchitis). In both children and adolescents, the intensity of bacterial excretion is greater in the presence of MDR-TB than in CS-TB. In the foci of multiresistant infection, an almost complete coincidence of the nature of MTB resistance in children with the source of infection was established. However, teenagers are most often found to be resistant to the combination of HRSE (66.1 %), HRESZ (13.6 %), unlike adults and children. Conclusions. The majority of contact children and adolescents with MDR-TB was detected when referring to a general practitioner or a pediatrician (62.3 % of children and 70.5 % of adolescents), which became the main reason for underdiagnosis of tuberculosis in children and adolescents in general. Our studies show the importance of a thorough examination of all contact children and adolescents in focuses of tuberculosis infection: anamnesis studies, tuberculin diagnostics (quantiferon test), clinical, radiological and microbiological examination for the timely detection of tuberculosis or infection and the appointment of appropriate chemotherapy or chemoprophylaxis.