– a specific infectious and inflammatory lesion of various tissues and organs caused by Mycobacterium tuberculosis. The main clinical forms of tuberculosis in children are early and chronic tuberculosis intoxication, primary tuberculosis complex, tuberculous bronchoadenitis, acute miliary tuberculosis; Less common are tuberculous meningitis, mesadenitis, tuberculosis of peripheral lymph nodes, skin, kidneys, eyes, and the osteoarticular system. Diagnosis of tuberculosis in children includes microscopy, culture, PCR examination of biological media; tuberculin tests, radiography, tomography, bronchoscopy, etc. For tuberculosis in children, the use of tuberculostatic drugs is indicated.

ICD-10

A15-A19 Tuberculosis

General information

Tuberculosis in children is an infectious disease that occurs with the formation of specific inflammatory foci (tuberculous granulomas) in various organs. Tuberculosis belongs to the group of socially dangerous diseases, since in recent decades there has been a steady increase in incidence not only among adults, but also among children and adolescents. The incidence of tuberculosis among children in Russia as a whole in recent years has amounted to 16-19 cases per 100 thousand people, and the infection rate of children under 14 years of age with Mycobacterium tuberculosis ranges from 15 to 60%, which reflects the general unfavorable epidemic situation and the presence of a large “reservoir” tubinfection. The primary task of pediatrics and phthisiology at the present stage is the prevention and early detection of tuberculosis in children.

Reasons

Mycobacterium tuberculosis (tuberculosis bacillus, Koch bacillus), due to the presence of an acid-resistant wall, can maintain viability and virulence in various environmental conditions - drying, freezing, exposure to acids, alkalis, antibiotics, etc. The ability to form L-forms determines a wide range of variability morphological properties and adaptability to existence in various conditions. Two types of pathogens are highly pathogenic for humans: Mycobacterium tuberculosis humans (human type) and Mycobacterium bovis (bovine type).

Mycobacterium tuberculosis can enter a child’s body through aerogenic, nutritional, contact, or mixed routes, resulting in the formation of a primary focus of inflammation. In children, intrauterine transplacental infection with tuberculosis or intrapartum infection may occur during childbirth during aspiration of amniotic fluid.

Children at increased risk for tuberculosis include:

• those who did not receive BCG vaccination during the neonatal period;
• receiving long-term treatment with hormones, cytostatics, antibiotics;
• living in unfavorable sanitary, epidemiological and social conditions;
• those suffering from diabetes, etc.

In most cases, children become infected with tuberculosis at home and in the family, but epidemic outbreaks in kindergartens and schools, nosocomial infection, and infection in other public places are possible. Children under 2 years of age are most susceptible to tuberculosis - they are characterized by generalized forms of infection (miliary tuberculosis, tuberculous sepsis). Among children over 2 years of age, respiratory tuberculosis is more common (75% of cases), and all other forms are much less common.

Pathogenesis

Initially, tuberculosis in children manifests itself as a general infection, then, under favorable conditions for the pathogen, lesions (tuberculous tubercles) develop in one or another organ. The outcome of the primary tuberculosis process can be complete resorption, fibrous transformation and calcification of foci, where live Mycobacterium tuberculosis often persists. With reinfection, an exacerbation and progression of the tuberculosis process occurs, often with dissemination of mycobacteria and the formation of multiple foci in other organs (secondary tuberculosis).

Classification

The classification of forms of tuberculosis in children takes into account clinical and radiological signs, course, extent (localization) of the process:

A long-term causeless low-grade fever is typical, against the background of which temperature candles appear up to 38-39 ° C; There is increased sweating, especially during sleep. Tuberculosis intoxication is accompanied by a specific reaction of the lymph nodes - their multiple enlargement (micropolyadenia).

If signs of tuberculosis intoxication in children persist for more than 1 year, the condition is regarded as chronic.

Primary tuberculosis complex

This form of tuberculosis in children is characterized by a triad of symptoms: the development of a specific inflammatory reaction at the site of infection, lymphangitis and damage to regional lymph nodes. It develops when a combination of massiveness and high virulence of tuberculosis infection with a decrease in the immunobiological properties of the body. The primary tuberculosis complex can be localized in the lung tissue (95%), intestines, and less commonly in the skin, tonsils, nasal mucosa, and middle ear.

The disease can begin acutely or subacutely; masquerade as influenza, acute pneumonia, pleurisy, or be asymptomatic. Clinical manifestations include intoxication syndrome, low-grade fever, cough, shortness of breath. Changes in the primary lesion go through an infiltrative phase, a phase of resorption, compaction and calcification (formation of a Gohn's lesion).

Tuberculous bronchoadenitis

Bronchoadenitis or tuberculosis of the intrathoracic lymph nodes in children occurs with specific changes in the lymph nodes of the root of the lung and mediastinum. The frequency of this clinical form of tuberculosis in children reaches 75-80%.

In addition to low-grade fever and symptoms of intoxication, the child develops pain between the shoulder blades, whooping cough or bitonic cough, expiratory stridor, caused by compression of the enlarged intrathoracic lymph nodes of the trachea and bronchi. Upon examination, attention is drawn to the expansion of the subcutaneous venous network in the upper chest and back.

Complications of tuberculous bronchoadenitis in children may include endobronchitis, atelectasis or pulmonary emphysema. This clinical variant of tuberculosis in children requires differentiation from Beck's sarcoidosis, lymphogranulomatosis, lymphosarcoma, and nonspecific inflammatory adenopathy.

Diagnostics

The variety of clinical “masks” and manifestations of tuberculosis in children creates certain difficulties in the timely diagnosis of the disease. Therefore, children with suspected tuberculosis must be referred by their pediatrician for consultation with a phthisiatrician. In a specialized anti-tuberculosis institution, a comprehensive diagnosis is carried out, including taking an anamnesis to identify possible sources and routes of infection, physical, instrumental and laboratory examination.

1. Screening for tuberculosis. Currently, for the mass detection of tuberculosis among children, the Mantoux test with 2 TE and the Diaskin test are used as the main screening tests. If parents wish, they can be replaced with blood tests for tuberculosis (T-spot, quantiferon test). At the ages of 15 and 17 years, adolescents undergo preventive fluorography.
2. Chest X-ray. In various forms of respiratory tuberculosis in children, it allows one to visualize changes in the intrathoracic lymph nodes or lungs. If necessary, the study is supplemented with linear or computed tomography of the chest organs.
3. Endoscopy. Bronchoscopy for a child is necessary to assess indirect signs of the tuberculosis process (identify signs of endobronchitis, deformation of the trachea and bronchi due to enlarged lymph nodes) and obtain swabs for research.
4. Laboratory diagnostics. To isolate the pathogen from various biological media (sputum, urine, feces, blood, pleural fluid, bronchial lavage water, bone sequestration discharge, cerebrospinal fluid, throat smear and conjunctival smear), microscopic, bacteriological, ELISA, and PCR studies are carried out. The collection and examination of material at the KUB is carried out at least 3 times.
5. Specific diagnostics. In a dispensary, children with suspected infection or tuberculosis undergo individual tuberculin diagnostics (repeated Mantoux test, Pirquet test, Koch test).

Treatment of tuberculosis in children

The principles of treatment of tuberculosis in children imply phasing, continuity and complexity. The main stages include treatment in a hospital, a specialized sanatorium and an anti-tuberculosis dispensary. The duration of the course of therapy is on average 1.5-2 years. An important role in organizing the treatment of tuberculosis in children is given to sanitary and dietary measures (high-calorie diet, exposure to fresh air, cough training).

Complex therapy of tuberculosis in children includes chemotherapy, surgery and rehabilitation. The specific anti-tuberculosis treatment regimen (combination of drugs, duration of administration, need for hospitalization) is determined by a pediatric phthisiatrician based on the form of the disease and the presence of bacilli excretion.

Children with severe tuberculosis reactions do not require hospitalization and are treated on an outpatient basis with one anti-tuberculosis drug (isoniazid, ftivazid) for 3 months. Dispensary observation lasts 1 year, after which, if clinical and laboratory examination data are negative, the child can be removed from the register. In other cases, in accordance with individual indications, combinations of 2, 3 and 4 or more anti-tuberculosis drugs are used, the main ones being streptomycin, rifampicin, isoniazid, pyrazinamide and ethambutol. The course of treatment for tuberculosis in children is divided into an intensive therapy phase and a maintenance therapy phase.

If pronounced residual effects persist 6-8 months after active therapy for tuberculosis in children, the issue of surgical intervention is decided.

Prognosis and prevention

The outcome of treatment may be significant improvement, improvement, no change, worsening of the course of tuberculosis in children. In most cases, with proper treatment, complete recovery is achieved. A serious prognosis of tuberculosis can be expected in young children, with dissemination of the process, development of tuberculous meningitis.

Specific prevention of tuberculosis in children begins during the neonatal period and continues into adolescence (see Vaccination against tuberculosis). A major role in the prevention of tuberculosis in children is played by systematic tuberculin diagnostics, improvement of sanitary and hygienic conditions, rational feeding, physical hardening of children, and identification of adults with tuberculosis.

Tuberculosis in children, like other diseases of an infectious and non-infectious nature, has a number of characteristic features that must be taken into account in order to recognize and treat the disease in time. In children, tuberculosis is more severe than in adults. This is due to the characteristics of the child’s immune system, which is not able to immediately limit the source of infection.

Features of tuberculosis in children.

The development of this disease depends both on the characteristics of the microbe that causes the disease, and on the characteristics of the body of the patient himself. An important role is played by the immune status of the patient’s body, how actively the body’s immune system fights infection. The child’s immune system is not fully formed and therefore its activity is reduced - this is an age-related feature of the child’s body. For this reason, a child’s body is more susceptible to various infections than an adult’s body. The weak immunity of children is the reason why tuberculosis in children is often extremely severe and occurs with many complications.

In children under 2 years of age, immediately after infection, a massive spread of infection is possible: miliary tuberculosis, tuberculous meningitis, tuberculous sepsis, etc. In older children, the immune system manages to localize the infection at the level of the lungs and therefore they more often develop pulmonary tuberculosis.

Risk factors for infection and development of tuberculosis in children primarily include malnutrition, lack of vitamins, poor living conditions, and chronic fatigue.
Symptoms of tuberculosis in children, as in adults, depend on the form of the disease and the location of the infectious process.
In uncomplicated pulmonary tuberculosis, the main symptoms of the disease are cough (more than 3 weeks), prolonged fever, fatigue, decreased attention, learning disabilities, loss of appetite and weight loss.
Miliary tuberculosis or tuberculous meningitis is characterized by more pronounced symptoms of intoxication (impaired consciousness, high fever, signs of irritation of the meninges, shortness of breath).

Let us draw the attention of parents to the fact that the symptoms of pulmonary tuberculosis in a child can be mistakenly taken for symptoms of a common cold, acute respiratory infection or bronchitis. In order to suspect tuberculosis, you should pay attention to the duration of the cough and temperature, as well as the general condition of the child (tuberculosis is characterized by the prolonged presence of cough and temperature).

Diagnosis of tuberculosis in children

Diagnosis begins with clarifying the main symptoms of the disease and identifying signs of extrapulmonary forms of tuberculosis (bone deformation, pain and swelling in the abdomen, etc.). The doctor pays attention to the child’s weight (weight loss is typical for tuberculosis).
If tuberculosis is suspected, the child is referred for additional examination: x-ray examination of the lungs, microscopic examination of sputum, Mantoux skin test. Based on the data from these examinations, the doctor will be able to establish or refute the diagnosis of tuberculosis.
If the diagnosis of tuberculosis is confirmed, treatment of the child begins immediately.

Treatment of tuberculosis in children

Treatment is carried out according to the same regimens and with the same drugs as the treatment of tuberculosis in adults. Children usually tolerate treatment well, and damaged lung tissue in children recovers much better than in adults.

Prevention of tuberculosis in children

Includes two main areas: prevention of tuberculosis in children who have not had contact with tuberculosis patients and prevention of tuberculosis in children who have been in contact with tuberculosis patients.
In the first case, the main measure to prevent tuberculosis is vaccination with the BCG vaccine. The BCG vaccine contains live weakened microbes (bovine type), which in their structure are very similar to the causative agents of tuberculosis. The vaccine is administered only intradermally 5 cm below the top of the shoulder. Vaccination ensures the creation of protective immunity.

In the second case (children who have been in contact with a patient with tuberculosis), tuberculosis prevention begins with identifying possible signs of the disease, after which the child is prescribed a course of preventive treatment (taking Isoniazid 5 mg/kg for 6 months).

The child's body is vulnerable to various ailments that can strike at any moment, one of these is tuberculosis. If symptoms are identified in a timely manner and assistance is provided, the immune system will be able to cope with the disease without problems. Infection most often occurs through contact with a sick person. The first confirmation of the existence of a pathogenic bacterium was at the end of the 18th century by R. Koch, from where it got its name.

Most often, the Koch bacterium is dangerous for children who have weakened protective functions of the immune system, suffer from malnutrition and lack of sleep, and do not receive enough vitamins. Typically, the disease can recur and subside.

The most common test for detecting tuberculosis infection is Mantoux test, which is conducted quarterly for children in schools. But parents should not panic if the reaction to the tuberculin test is positive. This result does not yet indicate that the child has tuberculosis. A positive reaction may confirm the body's lack of resistance to tuberculosis infection. Therefore, more vigilant health monitoring is necessary in the future.

Penetration of the pathogenic bacillus into the child’s body occurs in several ways. More than 90% of children with tuberculosis are infected through airborne droplets. In other cases, infection occurred through direct contact with the carrier of the disease or with his things (through dishes, clothes, toys). It was also noted in medical practice that infection can occur at the intrauterine level, but infection in this way is extremely rare.

But the highest risk is when the excreting bacillus lives with the child in the same area. The most critical age, when infection with the tuberculosis bacillus can lead to the most terrible consequences, is adolescence, when a complete restructuring of the body occurs, a newborn and early up to three years.

Typically, after infection, the disease does not manifest itself immediately, but can remain in the incubation period for several months and even years. The initial stages also do not differ in visible symptoms, so diagnosing childhood tuberculosis with multivariate clinical pictures is extremely difficult.

Classification of childhood tuberculosis

There are several types that affect the child’s body:

1. Primary tuberculosis intoxication.
2. Tuberculous disease of the respiratory system.
3. Tuberculosis disease of other organs.

In turn, tuberculosis intoxication can be early as well as chronic. Young children most often suffer from primary tuberculosis. For newborns and infants, the miliary and meningitis forms are dangerous. Tubin toxicity is typical for older children, but with favorable prognosis for recovery.

Symptoms of tuberculosis in children

The signs of the disease are not very specific, but despite this, they can still attract the attention of parents. TO primary symptoms include:

1. Excessive fatigue without extra physical activity.
2. Increased level of irritability.
3. Lack of normal appetite.
4. Disturbances in normal sleep.
5. The child becomes inactive and joyless.
6. The skin takes on an unhealthy appearance and becomes pale.
7. Headaches become more frequent.
8. Possible weight loss.
9. Periodic changes in temperature indicators (increase to 37.5 C).
10. On palpation, an enlargement of the lymph nodes is felt.
11. Allergic manifestations are possible.

If we talk about symptoms, which confirms chronic course of the disease, then the following signs should be noted:

1. There is delayed physical development.
2. The child begins to noticeably lose weight.
3. Sweating levels increase.
4. Increased slight temperature for a long time.
5. The child begins to feel frequently unwell.
6. Pale skin with pink cheeks.
7. The eyes are characterized by a glassy shine.
8. When palpated, you can notice an enlarged liver.

You can clearly see what childhood tuberculosis is in the video, which provides brief information about the manifestations of Koch's bacillus in children and comments from specialists on this matter.

Pay attention! Self-diagnosing tuberculosis in a child will not lead to anything good, because the above symptoms are not an accurate confirmation of infection. The diagnosis is made only after an X-ray of the respiratory organs and a detailed blood test.

Video - Pediatric tuberculosis

Clinical forms of manifestation

If the Mantoux test gave a positive result, then the disease itself, if it occurs in a chronic form, may appear only after six months or even a year. To understand the danger of the disease, you should familiarize yourself with all possible clinical forms.

Damage area	Brief description
Tuberculosis of joints and bones	This form of the disease is characterized by a rather slow development. Most often, the lesion is localized in the spine, knee joints, and hip joints. Among the characteristic symptoms can be identified limping. Additionally, the child may complain of painful movements.
Tuberculosis of lung tissue	Infection of children's lungs occurs much less frequently. It is characterized by a clear, prolonged increase in temperature that does not go away on its own. Therapy for this form of manifestation is difficult, but a complete cure is possible. Pulmonary tuberculosis is dangerous for very young children and, if not detected in a timely manner, can lead to the collapse of lung tissue and damage to other organs.
Tuberculosis of the bronchial glands	It is considered the most common form of the disease among children. When a pathogenic bacillus enters, it forms a focus of tuberculous inflammation. Manifestations occur in two ways: 1. Occurs like the flu with characteristic symptoms and is accompanied by a prolonged cough with prolonged fever. 2. It can occur in a latent form and manifest itself in the form of behavioral changes: the child becomes more capricious, gets tired quickly, and coughs occur.
Tuberculosis of the lymph nodes	The very first and most obvious sign is greatly enlarged lymph nodes. Over time, the process of damage leads to suppuration of the lymph nodes, and even fistulas can form
Tuberculous lesion of the meninges	According to medical statistics, meningitis occurs more often among children than adults. The disease can develop over three weeks and only after this time obvious symptoms appear: 1. The child becomes very restless. 2. No appetite. 3. Lethargy occurs. 4. High temperature. 5. Vomiting. 6. Sometimes even cramps

Reference! For quite a long period, specialists were powerless against the manifestations of tuberculosis of the meninges, so most cases had unfavorable prognoses and even deaths. Today, medicine has made significant progress and can eliminate this type of disease through the use of special antibacterial therapy, which belongs to a new generation.

You can learn how childhood tuberculosis is diagnosed and treated from the video, where a specialist gives a detailed commentary on the course and treatment of the disease.

Video - Diagnosis and treatment of tuberculosis in children

How to prevent infection: preventive measures

To prevent tuberculosis, special live pathogens are used. Microbes cannot fully infect a child’s body because they are weakened. Revaccination is recommended during adolescence, since during this period the protective functions are very weakened due to changes in the body. A general strengthening course is also required. Parents need:

1. Make sure your diet is correct so that it is fortified and balanced.
2. The child should regularly walk in the fresh air.
3. Routine preventive vaccinations are required.
4. Be sure to do Mantoux tests and, if the reaction is positive, monitor the child’s health throughout the year.
5. Do not skip scheduled fluorography.

Attention! For preventive purposes, BCG vaccination is mandatory in the maternity ward. It prevents the newborn from becoming infected with tubercle bacilli.

What to do if there is an excretory bacillus in the family?

In order to prevent infection of other family members, in particular the child, it is necessary to urgently contact a phthisiatrician who will conduct an examination and special chemoprophylaxis. Preventive measures for families of infected people include the following:

1. All necessary utensils for the patient should be exclusively individual and stored in a separate, remote place.
2. Dishes must be processed using special means.
3. The patient needs to have individual bed linen and towels.
4. The premises must be subjected to special wet cleaning daily.
5. The patient must have a spittoon.
6. Upon hospitalization or death of a patient, the sanitary and epidemiological service should be called to disinfect the entire residential area.

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Prevention of tuberculosis in children is necessary to prevent infection of the body and the formation of complications. The set of measures includes vaccination, chemoprophylaxis and other additional methods: physical activity, vaccination, diet and others.

Phthisiatricians draw the attention of parents to the fact that there are several basic preventive methods for the prevention of tuberculosis. We are talking about vaccination and chemoprophylaxis, all the rest are additional and without the two presented will be effective to a much lesser extent.

Particular attention should be paid to such prevention, which is carried out in places with a significant concentration of children: schools, kindergartens. In this case, the individual approach to the process is aggravated, because mass prevention is necessary.

An additional way to strengthen the body and speed up metabolism is fortification. It helps cope with the consequences of even chronic diseases and is great for children. After all, it is known that children’s immunity is the most labile and susceptible, which means that when implementing tuberculosis prevention, numerous nuances should be taken into account. It is most important to get vaccinated correctly, because this will be the main key to maintaining lung health.

The nuances of vaccination in children

Measures to prevent tuberculosis include vaccination. Normally, it is carried out once during the calendar year, however, if necessary, more frequent vaccinations are possible (2-3 times during the year). Parents should be reminded that:

• the initial introduction of the vaccine is carried out in the maternity hospital, 3-7 days after the child is born;
• artificially formed immunity will remain for the next five years, including permanent protection of the child from lung diseases;
• after the child reaches the age of seven, primary revaccination is carried out;
• after reaching the age of 12 - the second, and at 17 years - the third, if an open form of tuberculosis is not identified.

Vaccination, or BCG, has certain contraindications, in which the procedure can cause serious harm to the body. In this regard, it is recommended to consult with a pulmonologist or phthisiatrician before implementing it. In addition, certain side effects may be identified after BCG, which may not subside within 4-7 days. If you experience severe pain or discomfort, you should consult a doctor. This will facilitate the transition to the next stage of prevention – chemoprophylaxis.

Basics of chemoprophylaxis

The presented method of preventive treatment for children must be carried out in strict compliance with all its norms. This is explained by the high activity of drugs used to restore the body and immunity.

Independent use of certain medications can be disastrous, so you should contact a phthisiatrician.

It is equally important to take into account those cases in which chemoprophylaxis is a 100% indication for improving the functioning of the body. The presented activity is carried out with the help of isoniazid, the calculations are extremely simple: 10 mg of the drug per 1 kg of weight. Prevention of tuberculosis in children is carried out for those who are in constant contact with people affected by tuberculosis and patients with type 1 or type 2 diabetes mellitus (the child usually develops a type 1 pathological condition).

We should not forget about people who have suffered tuberculosis (especially if there are residual effects in the body in the form of fibrous areas, scars or calcifications). The next indication for chemoprophylaxis is children who are carriers of chronic diseases, who are forced to use glucocorticoids all the time. The list is supplemented by patients with peptic ulcer disease and children suffering from negative environmental conditions that provoke deviations in the functioning of the pulmonary system.

Prevention in kindergarten

Pulmonologists note that for prevention in childhood, it is best to combine several methods and do this under the strict guidance of a specialist. Measures for the prevention of tuberculosis taken in kindergartens and other places where large numbers of children gather are the most problematic. This is due to the following factors:

Given the scale of the required activities and its complexity, it is important to organize everything in such a way as to avoid subsequent total infection or outbreak of disease. Particular attention should be paid to sanitization and disinfection of premises, because only this is the most effective method of combating tuberculosis bacteria.

After the implementation of the presented measures and, preferably, cosmetic repairs, it is permissible to resume the activities of educational institutions and kindergartens. This will improve the situation if tuberculosis was discovered in kindergarten.

The benefits of proper nutrition

Correct and rational nutrition is the key to maintaining health in case of any disease and at any age. Therefore, it is not surprising that doctors pay enormous attention to this point. A properly composed menu for a child with tuberculosis will strengthen the immune system and the functioning of the pulmonary system, speed up metabolism and other processes in the body, which will help cope with bacteria as quickly as possible.

Particular attention should be paid to the completeness of nutrition, because food must include all the elements that the body needs. We are talking about seasonal vegetables, fruits and berries, natural proteins, fats and carbohydrates, as well as mineral complexes. According to WHO research on proper nutrition, it was found that if you eat well for a month, your health indicators will improve significantly.

This includes optimizing metabolism, normalizing blood pressure, heart rate, and improving blood composition. All this is extremely important for such an insidious disease as tuberculosis.

Maintaining physical activity

Prevention of pulmonary tuberculosis involves mandatory physical activity. This not only adds vitality to the body, but also makes it possible to speed up metabolism and remove mycobacteria from the child’s body. To maintain an optimal balance of substances in childhood, it is necessary to move the most, which is why daily walks and morning exercises will be beneficial.

These measures should not be limited, because to combat tuberculosis it is important to use all methods. Pulmonologists recommend sending your child to swimming or to any other sports club at school - this is important so that the child gets involved in sports as much as possible. Such prevention of pulmonary tuberculosis will negate the formation of complications or other critical consequences of the disease.

Is hardening acceptable?

Many phthisiatricians argue about the admissibility of hardening in childhood (up to 13-14 years). The fact is that the child’s body at this time may not yet be ready for such events. In this regard, doctors recommend paying attention to the following:

• hardening should begin gradually: first with light contrast showers, gradually making them more powerful;
• to increase efficiency, you should use vitamin complexes and other drugs that will improve the functioning of the body and prevent the formation of colds;
• If you are intolerant or feel unwell when trying to implement hardening, you should abandon the presented measure.

The ideal option before starting hardening would be to consult a pulmonologist or phthisiatrician. This will allow you to determine an individual approach, as well as develop the least traumatic algorithm. With tuberculosis, strengthening the body by any means is of great importance. Therefore, you should not neglect any of the presented activities, including hardening, because they can be extremely useful for maintaining the child’s ideal health.

Additional prevention methods

The list of additional prevention methods that can be used at school and to prevent the likelihood of developing the disease includes the moderate use of traditional methods. They must be agreed upon with the attending physician. This will avoid allergic manifestations and other negative reactions from the body.

To prevent pulmonary tuberculosis in a child, an indispensable step is an annual visit to seaside resorts and special sanatoriums.

Such activities are useful for everyone, but especially for children, because they strengthen the body’s immunity and protective powers against any bacteria. To improve the effect in the first time after being cured of tuberculosis, it is permissible to visit sanatoriums more than once a year. The best option would be to do this 2-3 times within 12 months, if indicated.

Visiting seaside resorts is useful because it allows you to restore the functioning of the pulmonary system and improves the condition of the bronchial parenchyma. The exceptional impact of sea air with a large amount of iodine and other mineral components has long been appreciated by pulmonologists and phthisiatricians.

Preventive measures for tuberculosis in children are a long process that includes many methods. Each of them allows you to improve the functioning of the body and cope with bacteria that have entered the human body in the shortest possible time. Correct prevention will make it possible to eliminate complications and critical consequences of pulmonary tuberculosis in a child.

One of the signs of infection is a positive result after tuberculin is injected under the skin. Therefore, the prevention of tuberculosis in children consists of an annual Mantoux test. Other diagnostic methods are also used. However, Mantoux remains the most widespread and accessible test. The test allows you to determine whether a small organism is infected with the tuberculosis bacillus.

How to detect tuberculosis in a child? Adolescents and adults undergo fluorography, and in children the only method of early detection of the disease is tuberculin diagnosis. This preventive examination is carried out in kindergartens and schools annually.

Mantoux test - determination of hypersensitivity to tuberculin. This is the name of the extract obtained from Mycobacterium tuberculosis (MBT). After infection with bacilli or BCG vaccination, the body produces specific antibodies, which manifests itself in an immune response.

Tuberculin contains purified MBT toxin, not microbes, and therefore is not capable of causing disease.

The use of the Mantoux test is the injection of 0.1 ml of tuberculin into the skin of the inner surface of the middle part of the forearm. The result is usually assessed after 72 hours by measuring the compaction using a transparent ruler.

Mantoux test for tuberculosis - the norm in children and assessment of other results:

1. injection mark - negative reaction;
2. compaction up to 5 mm in size, redness - a questionable reaction;
3. papule with a diameter of 5 mm or more - a positive reaction;
4. a compaction measuring 1.7 cm or more, a bubble with liquid contents - an excessively strong reaction (hyperergic).

Results 3 and 4 are the reason for referral to a dispensary for examination. Thanks to tuberculin diagnostics, early detection of latent infection and active tuberculosis process is possible. However, a positive Mantoux test does not necessarily mean that the child has tuberculosis. The test reveals not only the active form of infection, but also the presence of the pathogen in the body.

Alternatives to Mantoux

No matter how many years tuberculin has existed, this drug has been criticized for its imperfections. In the miliary form of tuberculosis, which is often found in children, the reaction may be negative.

Russian drug for carrying out an immunological test - Diaskintest. The solution contains recombinant tuberculosis allergen. The drug is administered intradermally into the forearm of either hand. Check the result after 48–72 hours (on the second or third day).

The norm in children is the complete absence of redness, induration, and swelling. Only the injection mark, a colorless lump or a small bruise (1–2 mm) is noticeable. The appearance of hypermia is considered a false positive or questionable reaction. A papule of any size is a positive result. Hyperergic reaction - a papule with a diameter of more than 1.5 mm and a vesicle (vesicle).

The questionable result is explained by the inability of the immune system to adequately respond to the allergen.

In such cases, the following procedure is used. First, a Mantoux test is performed. If a positive or questionable result is obtained, the patient is sent to a tuberculosis clinic. The phthisiatrician checks the reaction using the subtest for tuberculosis in children (Diaskintest).

In addition, a quantiferon test is used to detect specific interferon, which is formed in the blood only in tuberculosis patients. A blood test for tuberculosis is usually performed on a child after a Mantoux and Diaskintest test.

There is a more expensive diagnostic created at the University of Oxford. This is a T-spot or spot test, which differs from the Mantoux test in its higher sensitivity. First, blood is drawn from a vein, then a kit is used to check the test results. At your appointment, a pediatrician or TB specialist will tell you how to test a child for tuberculosis without Mantoux using express diagnostics. There are fewer contraindications to this method than to tuberculin.

Disease Prevention

The most important direction in the prevention of tuberculosis in children is vaccination and revaccination with BCG. All persons over 15 years old undergo an annual preventive fluorographic examination. Tuberculosis develops over a long period of time, begins gradually, and its initial symptoms are similar to those of other infections. It often takes months from the moment of infection with mycobacteria to changes in the lungs.

Timely detection and treatment of tuberculosis in adolescents and adults helps reduce the risk of infection in young children.

If the results of a tuberculin test or diagnosis of tuberculosis in children without Mantoux are positive, the child is referred to a phthisiatrician. A doctor at an anti-tuberculosis dispensary interviews a young patient and parents about contacts with tuberculosis infection and complaints. The doctor examines the BCG scar, palpates the lymph nodes, and listens to the lungs.

The doctor takes into account the results of the Mantoux test in previous years and BCG vaccination. During the examination, the doctor pays attention to the height and weight of the child. With tuberculosis intoxication, the patient lags behind healthy peers in physical and mental development.

If a small patient is at risk, then the TB doctor prescribes laboratory tests for tuberculosis in children and a chest x-ray. Basic diagnostic methods allow us to determine the form of the disease.

After receiving the results of the examination, the doctor decides on the need for prophylactic administration of isoniazid (an anti-tuberculosis drug). If the disease is detected in an active form, they are referred for inpatient treatment. Prevention of tuberculosis is carried out in children and adolescents who have been in contact with the patient (taking isoniazid).

The source of infection is sanitized. The patient is isolated and the room is disinfected. The dishes are boiled, and the patient’s sputum is collected in special containers. Thorough daily cleaning of the premises using a soap and soda solution is necessary.

If a child in a family comes into contact with a patient with tuberculosis, then he needs sanatorium-resort treatment.

Methods for preventing tuberculosis in children. Mantoux test. updated: September 13, 2017 by: admin