Childhood tuberculosis: main signs, treatment and prevention. Ministry of Health of the Kirov Region How to diagnose tuberculosis in children

Anyone can get tuberculosis. In children, this disease is quite severe and can cause numerous complications. This article will tell you what parents should know about this dangerous pathology.

What it is?

An infectious disease of internal organs that is caused by mycobacteria is called tuberculosis. This pathology occurs in both adults and children. Many parents believe that only children from socially disadvantaged families can get tuberculosis. However, this is a big misconception. Every child has a risk of contracting this infection.

The prevalence of this infection varies in different countries of the world. In economically developed countries, tuberculosis is much less common than in developing countries. This fact further confirms the importance of the influence of social factors in the development of this disease. Every year, scientists conduct hundreds of different scientific studies aimed at finding new drugs that will help cope with the adverse symptoms of the disease.

The susceptibility of the child's body to various infections is quite high. This is due to the insufficient functioning of the immune system. WHO experts believe that coping with massive outbreaks of tuberculosis in the population can only be done by preventing new cases of the disease in adults. They identify several countries that are most unfavorable in terms of the development of this dangerous infection in them. According to statistics, in these countries, by adolescence, more than 70% of children are infected with mycobacteria.

Tuberculosis is a rather dangerous disease. More than 1.5 million people die from this infection every year. Child mortality from tuberculosis is also quite high. This trend suggests that the incidence of this infection should be closely monitored.

In the last decade, tuberculosis affects from 1 to 10 out of 100,000 children. Most cases of the disease occur in Asia and Africa. In our country, pulmonary tuberculosis is a fairly common pathology.

Since Soviet times, various government medical programs have been carried out to reduce the incidence of this infection. Currently, the situation regarding this disease cannot be called prosperous. Doctors note that the disease in children is quite severe and has an unfavorable tendency to develop an infectious process not only in the lungs, but also in other internal organs.

There is historical evidence that the first cases of tuberculosis were recorded in the Ancient World. Scientists were able to establish from the remains and bones of some pharaohs that they had signs of tuberculosis. This infectious disease has worried doctors for many centuries.

During the Middle Ages, he was often called “consumption.” This popular name quite accurately conveys the essence of the disease - a person, having fallen ill, begins to weaken (waste away).

For quite a long time, doctors believed that tuberculosis affected only the lungs. However, this is not at all true. Modern laboratory instruments have made it possible to establish other localizations of this dangerous disease. Even hair and nails can be involved in this pathological process.

Quite often, lesions of internal organs are combined. The inflammatory process in this infectious pathology is specific. It causes special morphofunctional disorders that do not occur in other infections. A similar type of inflammation also occurs during syphilis and leprosy.

Scientists distinguish several stages in the development of the disease. They differ significantly from each other not only in the development of unfavorable symptoms, but also in the characteristics of morphological disorders that arise during the disease process.

More information about the causative agent of infection

The microorganisms that cause this disease were first identified at the end of the 19th century. This discovery was made by the outstanding scientist of those years, Robert Koch. This scientific breakthrough gave rise to the popular name for the causative agent of the disease, which also became known as “Koch’s bacillus.”

Several centuries ago, scientists knew about only one type of mycobacteria. Currently, there is scientifically confirmed information that they exist in 74 different species. They are widespread not only among the human population, but are also present in water, soil and in some animals.

Pathogenic microorganisms that cause tuberculosis can be of different subtypes. The main causative agent of this infectious pathology in humans is Mycobacterium tuberculosis. This subtype of mycobacteria includes several other types of microorganisms that differ from each other mainly in the degree of manifestation of virulent properties and their pathogenicity.

The virulence of microorganisms and the initial state of the child’s body determine how severe the disease will be in the baby or whether it will be limited to carriage. The causative agents of this infection are perfectly preserved in unfavorable environmental conditions. They are highly resistant to most acids.

In their shape, mycobacteria look like elongated rods. They do not exceed 10-12 microns in length. The end sections of the microorganism's body are slightly rounded, which makes them look like barrels or sticks.

In the external environment, mycobacteria remain immobile, but do not form spores. The special structure of cell walls, which protect bacteria from unfavorable environmental influences, allows them to maintain their vital activity for a long time without losing their pathogenic properties.

On the outside, these microbes are surrounded by a dense shell, which consists of several layers. Such cellular protection is like “armor” that protects microorganisms from the effects of disinfectants.

The main properties of mycobacteria are contained in tuberculoproteins. These are special proteins that cause certain immunological reactions on the part of the child’s immune system. This systemic response of the child’s body is called delayed-type hypersensitivity. This is a very specific mechanism for the development of immune inflammation.

The presence of certain lipids in the cellular structure of bacteria makes them more tolerant to the effects of various external chemicals and biologically active components that are released by the immune system in response to these microbes entering the body.

Exposure to alcohol and some strong alkalis also does not have a detrimental effect on microorganisms. Infectious agents are perfectly preserved in house dust. They can exist in it for several months.

There are a huge number of scientific experiments showing that mycobacteria are perfectly preserved in milk. They can remain viable for several months in soil and water.

It is important to note that boiling has a detrimental effect on microorganisms. However, to completely kill them, it is necessary to boil water or other liquid containing tuberculosis pathogens for 5-10 minutes.

Under unfavorable environmental conditions, microbes enter a certain “dormant” state. At this time they are called L - form of mycobacteria. When they enter a child’s body in conditions favorable for their life, they quickly recover and begin to exert their negative effects.

Some external factors and chemicals still have a detrimental effect on the microbes that cause tuberculosis. Disinfection using chlorine-containing products helps reduce the concentration of pathogens in the room. Quartz treatment, carried out according to a special regime, also has a pronounced detrimental effect against mycobacteria.

The causative agents of tuberculosis infection can be classified as microorganisms that multiply for a long time. This morphological feature influences the course of the disease, as well as the duration of appropriate treatment.

The reproduction cycle of one mycobacterial cell is about 18-20 hours. For staphylococcal flora this time period is much shorter - 8-10 minutes. The morphological peculiarity of the cellular structure of microbes and the rather slow rate of reproduction lead to the fact that areas of inflammatory infiltration begin to form in the affected internal organs. This is a consequence of the granulomatous process.

Externally, such areas look like numerous tubercles, which can be of very different sizes. These formations are quite susceptible to decay.

How can a child become infected?

The most common culprit of infection in children is a sick person suffering from the active stage of tuberculosis. During this period of illness, he usually releases a large number of mycobacteria into the environment, so direct contact with such an infected person significantly increases the risk of possible infection with tuberculosis.

The most common method of infection is airborne. The baby can become infected during conversation or close contact.

Infection with tuberculosis infection in public transport is quite common. Sharing utensils, toys and household items also contributes to possible infection with tuberculosis.

Adults who have active tuberculosis infection and release mycobacteria into the environment can infect a child through a kiss or a warm hug.

There are other ways of transmitting infection. They arise in situations where a person infected with tuberculosis has tuberculous lesions of some internal organs. So, with an infection of bones and lymph nodes, infection occurs through contact and household contact. In this case, mycobacteria enter the skin of a sick person through open fistulas.

With tuberculosis of the skin and nails, infection can occur when simple rules of personal hygiene are violated.

In some cases, a child can become infected with this infection by drinking contaminated water or milk.

Cattle are also a possible source of infectious pathology. Drinking unboiled milk from farms can cause the baby to develop tuberculosis.

In young children, the most common route of infection is the alimentary (food) route. The habit of putting dirty hands into your mouth on the street or while playing in the sandbox with other children can also lead to possible infection.

Cases of congenital tuberculosis are also quite common in pediatric practice. In this case, infection occurs at the stage of intrauterine development: the baby becomes infected with a tuberculosis infection while in the womb.

But a mother infected with tuberculosis does not always give birth to a baby with signs of the disease. If the pregnancy proceeds quite smoothly and without pathologies, then the risk of infection of the unborn child is significantly reduced.

Mixed infection is quite rare. In this case, different mechanisms of infection lead to the development of the disease. In pediatric practice, this is mainly a combination of airborne and contact-household methods of transmission of infection.

Clinical forms

Mycobacterium tuberculosis can affect a variety of internal organs. This causes the emergence of a huge variety of very different clinical forms of the disease. Features of the course of the disease largely depend on the initial localization of the infectious process, as well as the state of the child’s immune system.

Doctors distinguish several clinical variants of tuberculosis infection:

Respiratory organs

This form occupies a leading position in the structure of the incidence of this infectious pathology. It is accompanied by the development of specific changes in the lung tissue; less often, the bronchi and trachea are involved in the inflammatory process. As a rule, this form of the disease is diagnosed spontaneously - during an X-ray of the lungs and much less often at outpatient appointments with a doctor.

Lymph nodes

It is also a fairly common pathology in children; in adults, this form of tuberculosis is much less common. The risk of infection is high in babies with HIV infection. Most often, groups of cervical and axillary lymph nodes are involved in the infectious process, however, other peripheral lymph nodes can also be affected. Establishing a final diagnosis is impossible without a puncture.

Kidney

This form of the disease is quite rare in children. Characterized by the involvement of renal tissue in infectious inflammation. A long course of tuberculosis leads to the appearance in a child of signs of functional disorders in the functioning of the kidneys. Delayed or incorrectly selected treatment contributes to the appearance of multiple complications in the baby, one of which is the development of renal failure.

Bones

A fairly common clinical variant in pediatric TB practice. Persistent tuberculosis of bones and joints often leads to disability in the child. Tuberculous changes can develop in almost all anatomical structures of the skeletal system. Quite often the disease is detected in the later stages of development.

Intrathoracic lymph nodes

A fairly common form of the disease, especially in young children. The pathological process can be unilateral or bilateral. Enlarged intrathoracic lymph nodes exert strong pressure on the nearby bronchi, which leads to the appearance of corresponding symptoms in the child. The first signs of the disease are often recorded in children aged 2-3 years.

Nervous system

This clinical variant of the disease is perhaps one of the most severe. It is characterized by the development of tuberculous meningitis or meningoencephalitis in a child. The course of these pathologies is quite severe, characterized by the appearance of quite unpleasant symptoms that significantly affect the baby’s well-being. Most often, this form of the disease occurs in infants.

Gastrointestinal tract

Another favorite location for the activity of mycobacteria in a child’s body is the intestines and mesenteric lymph nodes. This pathology occurs rarely in children. Children suffering from AIDS are more susceptible to this form of the disease. In some cases, this clinical variant of tuberculosis occurs in children with severe immunodeficiency states, which are quite severe.

Eye

In pediatric practice, cases of this type of tuberculosis are extremely rare. The development of tuberculous conjunctivitis or keratitis is often facilitated by a pronounced decrease in immunity or multiple diseases of the internal organs. Children with visual pathologies are also at increased risk.

How does tuberculosis intoxication manifest?

Doctors distinguish several periods in the development of this pathological condition. The early period of tuberculosis intoxication in children and adolescents is manifested primarily by severe disturbances of nervous activity. A sick child becomes more nervous, develops a nonspecific headache, fatigue, and absent-mindedness. Children attending school note that they cannot concentrate on the school curriculum and do not learn the educational material well.

Upon careful examination of the child, you may notice some changes in appearance. A sick baby becomes paler and apathetic.

As a rule, the child develops a persistent low-grade fever. The body temperature rises to 37-37.5 degrees. Long-term low-grade fever significantly affects the general well-being of the child. The baby's appetite sharply decreases, and problems with sleep duration may occur.

In some cases, especially in thin babies, the liver and spleen can be easily felt. A sick child may develop bowel problems, which most often manifest as persistent constipation.

As a rule, by the end of the first month from the moment of primary infection, a specific manifestation of tuberculosis appears - turn of the tuberculin test. This reaction is manifested by a positive tuberculin test and helps to recognize the disease at fairly early stages.

Another characteristic manifestation of the disease in the early period is the appearance of specific skin formations. This pathological condition is called erythema nodosum. It is characterized by the appearance of bright red spots, which are localized mainly on the legs.

These skin rashes are usually preceded by a fairly high increase in body temperature. Often this unfavorable symptom occurs in children aged 5-6 years.

The second period of development of tuberculosis intoxication is its transition to a chronic form. This period is extremely unfavorable, as it is already accompanied by the appearance of persistent morphofunctional disorders, leading to the development of specific symptoms of the disease.

A long-term disease leads to the fact that the child lags significantly behind his peers in terms of physical and mental development. The sick child looks rather pale and emaciated.

Pathological changes in the lymph nodes lead to persistent functional disorders. When palpating peripheral lymph nodes, it is possible to determine the compaction of their structure, as well as changes in size.

In some cases, lymph nodes become pebble-like in density. Chronic tuberculosis intoxication is usually accompanied by damage to 6-9 adjacent groups of lymph nodes. This pathological condition is called micropolyadenia.

The diagnosis of this condition is made based on the persistent persistence of positive tuberculin tests. In this case, one year must pass from the moment of the first turn.

In some cases, there is a pronounced increasing dynamics. Tuberculin tests in an infected child only increase every year. Such dynamics must be assessed by a pediatric phthisiatrist.

In the chronic version of tuberculosis intoxication, numerous pronounced morphological abnormalities in the internal organs are already observed. Quite often they occur in the bone marrow, peripheral lymph nodes, as well as the liver, spleen and gastrointestinal tract.

The chronic period differs from the early period in the severity of all symptoms. In later stages, they occur more vividly and greatly disturb the baby’s well-being.

Reduced appetite during chronic tuberculosis intoxication leads to the fact that the baby loses a lot of kilograms. This contributes to a pronounced lag in physical development. The child's muscle mass noticeably decreases. Such babies look asthenic and quickly lose weight.

The baby's skin loses moisture and becomes drier to the touch. Skin turgor is noticeably reduced.

The thickness of the subcutaneous tissue also decreases noticeably due to a pronounced decrease in appetite.

The child’s well-being is noticeably depressed by constant changes in body temperature. Usually its values ​​during this period vary from 37 to 37.5 degrees. In some cases, fever and chills may occur.

The child's mood and behavior change noticeably during this period. A long-term illness leads to changes in the child’s mental personality type.

Noisy active games with friends do not bring satisfaction and joy to the child. A sick child tries to spend more time with himself. Even habitual activities can lead to excessive fatigue.

A sick child can hardly exercise and gets tired after a short walk.

The chronic period of tuberculosis intoxication is quite dangerous, as it is accompanied by the development of numerous persistent disorders. To prevent it, timely diagnosis of the disease should be carried out. Only timely prescribed and carried out treatment will contribute to the regression of the disease.

If you suspect that your baby has signs of tuberculosis, you should immediately consult a pediatric phthisiatrician.

Tuberculosis infection, which is not accompanied by the appearance of symptoms, or a latent form of the disease can be determined using special laboratory and instrumental diagnostic methods.

Symptoms

During the incubation period, there are no specific symptoms of the disease. For tuberculosis infection this time is usually ½ to 4 months.

There is evidence in the scientific literature that in some cases the incubation period was even several years. The duration of this time is determined by the individual morphological characteristics of the pathogen, as well as the initial parameters of the immunity of the infected baby.

Tuberculosis has different masks. The variety of symptoms can be so enormous that it can significantly complicate the clinical diagnosis of the disease.

Some forms of the disease are virtually asymptomatic. It is important to note that tuberculosis infections that occur without the appearance of adverse clinical signs are quite common in children.

In this case, only alternative diagnostic methods can help establish the correct diagnosis.

The following symptoms are characteristic of tuberculosis infection:

• Persistent increase in temperature. This symptom persists at almost all stages of the disease. In most cases, body temperature does not rise above 37.5 degrees. Febrility occurs only in severe cases of the disease. An increase in temperature exhausts the baby and significantly worsens his well-being.
• Severe weakness and fatigue. The child becomes quite emotional and quickly gets irritated over small things. Some kids have unmotivated outbursts of anger. Quite often, sick children develop various depressive states.
• Loss of appetite. This symptom accompanies all periods of the disease. A decrease in appetite leads to severe weight loss, and ultimately leads to a lag in physical development. In severe cases, affected babies can lose up to 40% of their weight.
• Increased sweating. This symptom most often occurs at night. In phthisiatric practice, this clinical sign is often called the “collar symptom”, since increased sweating occurs mainly in the neck area. In some cases, hyperhidrosis is profuse.
• Severe dry skin and pathological brittleness of nails. A fairly common manifestation of tuberculosis infection is the appearance of areas of increased peeling on the skin. In adolescence, this symptom often resembles seborrheic dermatitis.

• Enlargement and hardening of lymph nodes. Almost all groups of peripheral lymph nodes are involved in the infectious process. They become dense to the touch and accessible to palpation. The affected lymph nodes increase in size several times. In severe cases, enlarged lymph nodes become visible when viewed from the side.
• Pronounced pallor of the skin. Babies' skin becomes thinner with clearly visible blood vessels. Bruises and dark circles appear under the eyes. In some cases, areas of acrocyanosis also appear around the nasolabial triangle. The long course of tuberculosis leads to the fact that the child’s fingers take on the shape of drumsticks, and the nails have the appearance of a “watch glass”.

• Cardiopalmus. Tachycardia occurs not only during physical activity, but also at complete rest. Some babies experience aching and tingling sensations in the chest area.
• Pain in the joints. This symptom is very nonspecific. Quite often it occurs with tuberculosis of the musculoskeletal system. Joint pain can appear even at rest, without making active movements. Young children experience increased pain when standing up or crawling.
• Characteristic skin rashes, also called erythema nodosum. This form of the disease is characterized by the appearance of bright red spots that can itch and cause severe discomfort to the child. As erythema nodosum develops, the spots change color and acquire a blue tint. Adverse symptoms usually persist in babies for 3-4 weeks.

How does it manifest in newborns?

You can get tuberculosis at any age. The first signs of the disease sometimes occur even in newborn babies. The appearance of symptoms in this case is very nonspecific. This depends on the initial location of the tuberculosis focus. If there is an infection in the respiratory system, the child develops clinical signs associated with impaired respiratory function. Tuberculosis of the internal organs is accompanied by the appearance of a variety of symptoms, which may manifest as discomfort or pain in the abdomen, abnormal bowel movements or loss of appetite.

Diagnostics

Only TB specialists can make a final diagnosis of tuberculosis. Initially, for this purpose, doctors conduct a clinical examination of the baby, which in some cases makes it possible to establish signs of the disease. The diagnosis is confirmed by the results of laboratory and instrumental studies. This examination is carried out in a TB clinic. Laboratory tests consist of tuberculin tests. Tuberculin diagnostics helps determine delayed-type increased sensitivity to specific proteins of Mycobacterium tuberculosis. According to its chemical structure, tuberculin is a special substance that is a purified tuberculosis toxin. Introducing it into a child’s body cannot lead to the baby becoming infected with tuberculosis.

In many countries around the world, a test for an increased reaction to purified tuberculin is carried out for children from 4 to 14 years of age. It helps to establish a wide variety of clinical variants of the disease, including latent forms.

To carry out the Mantoux test, tuberculin is used in a special dilution. It is administered intradermally at a dose of 0.1 ml or 2 TU. An antigenic substance is injected into the area of ​​the middle third of the forearm.

To evaluate the results, doctors use certain criteria:

• Negative the reaction is considered to be the absence of a red bright spot in the area where the needle was inserted.
• Doubtful sample- this is the appearance of a spot of hyperemia, up to ½ cm in size.
• If the reaction is positive skin papule exceeds 5 mm in size.
• In case of hyperergic reaction the size of the red spot at the injection site exceeds 17 mm or a bubble (vesicle) is formed, filled from the inside with serous fluid.

All positive and hyperergic reactions require mandatory additional diagnostic methods to exclude signs of tuberculosis in the child. These studies are necessary to determine normality or pathology.

In complex clinical cases it is necessary to carry out PCR diagnostics. This method has high sensitivity and specificity, which makes it possible to determine the presence of mycobacteria in a child’s body quite accurately.

The most modern examination method used to diagnose tuberculosis is called spot research. This immunological test has been carried out in Russia since 2012.

The material for the study is venous blood. It usually takes 3-4 days. The information content of this test ranges from 95 to 98%, and sensitivity varies from 85 to 98%.

A modern and accurate alternative to conventional diagnostic tests for tuberculosis - carrying out Diaskintest. The use of this method makes it possible to identify both active and latent forms of the disease. The essence of the study is the introduction of protein allergens into the skin to determine a specific immune response. A positive result of this test indicates that the child’s body is already familiar with the infectious agent introduced into it.

Parents are often mistaken in considering Diaskintest a vaccination. It's not like that at all. This study is carried out for diagnostic purposes only and is necessary to establish the correct diagnosis. The result is assessed 2-3 days after the allergen is introduced.

In a child who has not had a previous infection with tuberculosis, no red spots or swelling will appear at the injection site.

Treatment

Various combinations of anti-tuberculosis drugs are used to treat the disease. These medications are prescribed for continuous use: omissions and short-term discontinuation of these medications are not permissible. The duration of treatment usually ranges from 6 months to several years.

Tuberculosis therapy is carried out in special TB hospitals. For the treatment of tuberculosis infection, multicomponent treatment is prescribed. It involves prescribing several medications at once.

The first treatment regimen, which was used to eliminate the adverse manifestations of the disease in our country, was three-component. It included taking three first-line drugs: streptomycin, isoniazid and para-aminosalicylic acid. For quite a long time, such treatment was successfully used in phthisiology and brought positive results.

Due to the fact that microbes quickly mutate and change their properties, the three-component tuberculosis treatment regimen was replaced by a four-component one. It is currently used to treat babies infected with susceptible strains. This treatment regimen includes the use of streptomycin or kanamycin, rafabutin or rifampicin, isoniazid or ftivazide, and pyrazinamide or ethionamide.

In some cases, the four-component therapy regimen does not bring the desired result. In such a situation, TB specialists add fluoroquinolone derivatives to treatment. This treatment regimen is used in the most difficult cases of tuberculosis, when there is pronounced resistance of microbes to the effects of various drugs.

Application of five-component treatment can cause numerous side effects in a child, since it includes quite a lot of strong antibiotics of the latest generations.

Hormonal drugs are rarely used to treat tuberculosis. These drugs have a strong immunosuppressive effect, which significantly worsens the further prognosis of the disease.

Typically, prednisolone is prescribed only to eliminate the dangerous complications of tuberculosis intoxication, which is accompanied by the development of meningitis or meningoencephalitis. As a rule, hormones are prescribed only as a course of treatment for 5-7 days.

For many centuries, doctors have been talking about the importance and effectiveness of spa treatment young patients suffering from tuberculosis.

A combination of various physiotherapeutic techniques, a balanced high-calorie diet and fresh air help to significantly restore a child’s body weakened during illness.

It is advisable that the child undergo such treatment every year: this is an excellent prevention of the progression of the disease. If drug therapy is ineffective, doctors may recommend surgical treatment.

Indications for operations are determined by the attending physician. Most often, operations are performed if the baby has pathological formations in the lungs, which arise from pulmonary tuberculosis and are called cavities. After the operation, the child is prescribed restorative treatment.

Clinical examination of children with tuberculosis is carried out taking into account their distribution into clinical registration groups. Currently there are 7 groups. Children and adolescents are monitored by a pediatric TB specialist until they reach the age of 18 years. For each dispensary group there is a certain frequency and timing of tests for the isolation of mycobacteria and preventive treatment.

Watch in the next video the program “Live Healthy” with Elena Malysheva, dedicated to tuberculosis.

Tuberculosis in children begins with severe weakness. Children gain weight poorly and become overly irritable. If a student falls ill, parents may notice a decrease in academic performance, poor perseverance and inattention. The temperature rises to low-grade levels, although it is often higher. The lymph nodes become inflamed and become dense and large. When conducting a tuberculin test, the answer is always positive. All these signs indicate that Koch’s bacillus has entered the body, which leads to severe intoxication. Children are often diagnosed with chronic tuberculosis intoxication. If parents notice the symptoms of the disease in a timely manner and consult a doctor, the prognosis is very good. With adequate treatment, the child’s body copes well with this infection.

First signs

The first signs of tuberculosis in children may resemble a respiratory disease, so parents do not take them seriously. Such signs include fever, hacking cough, severe weakness and apathy. If such symptoms do not disappear within a few weeks, but rather worsen, then tuberculosis can be suspected.

At the early stage of tuberculosis in children, some symptoms are very specific and characteristic of all forms of this disease:

• Sudden weight loss.
• Enlarged lymph nodes.
• Weakness, apathy and irritability.
• Poor appetite.
• Abnormal sweating, which is often accompanied by chills.

If the pathology has become chronic, then other symptoms appear.

• The child is developmentally behind his peers.
• The skin becomes pale and dry to the touch.
• Sleep is disturbed.
• The liver is noticeably enlarged.
• The child is in a state of mild euphoria.

In addition, childhood tuberculosis also has specific symptoms of the disease, which can be used to determine where the source of infection is localized. The most common form of tuberculosis is pulmonary; it occurs with the following characteristic symptoms:

• Abnormal weakness - the child looks tired even after a night's sleep, school performance worsens, appetite decreases and absent-mindedness is observed.
• Unhealthy appearance - the patient is excessively thin and pale, he has an unhealthy blush and a painful shine in his eyes.
• Elevated temperature – the temperature remains subfebrile for a long time or episodes of causeless increases in temperature to high levels are periodically observed. Mostly, hyperthermia occurs at night, and the child sweats a lot and suffers from chills.
• An important symptom of early stage pulmonary tuberculosis in children is a cough that does not go away for more than 3 weeks. It starts out dry and then becomes wet.

Another sign of tuberculosis infection is coughing up blood. If parents notice that there is blood in the sputum that the child coughs up, they must urgently call an ambulance. This sign indicates the onset of pulmonary hemorrhage, which poses a great threat to the patient’s life.

If a child begins to lose weight for unexplained reasons, parents should tell the doctor. This phenomenon may be the first sign of tuberculosis.

Signs of the disease in children under one year of age

Infancy, according to medical concepts, lasts up to one year. Tuberculosis at this time can be either acquired or genetic.

Symptoms of tuberculosis in infants may vary slightly, but there are basic signs that should make parents suspect something is wrong.

• Deterioration of health – lethargy, apathy, sleep and appetite disturbances.
• Breathing problems. In infants, this may manifest as periodic bouts of coughing or choking.
• Recession of the chest on the side of the lung lesion - such a deviation can be noticed by a doctor after conducting a special test.

A sick child quickly loses weight, this is especially noticeable if the baby is not yet 3 years old and his body weight is already small.

The baby refuses to eat, has a hard time crying, and does not actively respond to the appearance of his parents or new toys. The cough becomes more intense and frequent, which disturbs sleep.

Tuberculosis in infants is especially dangerous. This is explained by the fact that the disease is not always diagnosed on time, so treatment begins untimely and the recovery period is delayed.

Symptoms in preschool children

Diagnosis of an infectious disease in children under 7 years of age is greatly facilitated. Therefore, in this case, tuberculosis in children is treated in a timely manner and recovery is observed faster than in infants.

In children over 5 years of age, symptoms are more pronounced. In addition, preschoolers can already tell their parents what worries them and where it hurts. The first symptoms of the disease in such children do not indicate infection of the lungs. Most often there is a deterioration in health. The child complains of weakness, he becomes less active and does not want to participate in outdoor games. After a while, parents may notice that the baby has lost his appetite, and he sleeps very restlessly. The baby's weight gradually decreases.

Next comes cough, shortness of breath and other symptoms of tuberculosis in children, which indicate a problem with the respiratory organs. Parents may notice that one part of the sternum seems to be sunken. This indicates damage to the respiratory organs on that side.

A sick child is placed in hospital treatment and any contact with other people is limited. The diagnosis can only be confirmed by conducting a detailed examination. For this, x-rays, the Mantoux reaction, a detailed blood test and some other diagnostic methods can be used.

Tuberculosis is still considered a dangerous disease that can lead to the death of a child. Parents should understand that the earlier the disease is diagnosed, the better the prognosis.

Symptoms in teenagers

Symptoms of tuberculosis in children 7 years of age and adolescents are somewhat different from signs of the disease in infants and preschoolers. The main symptoms of tuberculosis in adolescents are as follows:

• Severe weakness and apathy are quickly accompanied by pain in the sternum.
• Coughing attacks become more frequent and intense.
• There is shortness of breath. Moreover, it happens even in a state of complete rest. This greatly disrupts the child's life.

In older children, parents notice changes in the shape of the breasts. It becomes sunken or one section of the sternum sinks in on the side of the affected organ.

Changes are also observed on the skin. The epidermis becomes thin and vulnerable. Unexplained wounds and abrasions often appear on different parts of the body. Hemoptysis and enlarged lymph nodes are often observed.

To diagnose the disease, a special test is often performed. The same tests are done periodically at all stages of treatment.

Other signs of tuberculosis

Pulmonary tuberculosis in children is usually very severe, but the infection can also affect other organs, which is manifested by characteristic symptoms.
Signs of tuberculosis of other forms in the earliest stages in children can be confused with other pathologies, so when making a diagnosis, the doctor must consider all possible options for the disease:

• If tuberculosis has affected the membrane of the brain, then a depressive state is observed. As the disease progresses, these symptoms include dizziness, nausea and frequent convulsions. The disease, detected at a late stage, is very difficult to cure. There is a high probability of death. Most often, this pathology is observed in children whose family has a person infected with Koch's bacillus.
• Tuberculosis of the digestive system is manifested by dyspeptic symptoms. This may include constipation or frequent diarrhea, blood in the stool and unexplained vomiting. With this form of the disease, the temperature can rise to high levels.
• Tuberculosis of joints and bones is manifested by limited mobility, pain with any movement, as well as fairly frequent fractures. If the disease is not cured in a timely manner, the patient begins to limp over time.
• Tuberculosis of the genitourinary organs is accompanied by severe back pain and pain when urinating. Blood streaks are found in the urine.
• With skin tuberculosis, there is a significant increase in lymph nodes, the appearance of seals on the skin and abscesses. With this form of the disease, the skin becomes thinner, so abrasions are often observed.

Only an experienced doctor can make a correct diagnosis. If you have tuberculosis, it is strictly forbidden to self-medicate; all actions must be agreed upon with a TB doctor.

Girls who suffered from tuberculosis of the genitourinary system in childhood may be infertile in adulthood!

Types of tuberculosis in children

In young children, not only pulmonary tuberculosis is often diagnosed, but also other forms of this dangerous pathology. Tuberculous meningitis, miliary tuberculosis, primary tuberculosis complex and many other forms of the disease can be diagnosed. The main cause of the disease is considered to be contact with an infected person and lack of BCG vaccination.

Meningitis caused by Koch's bacillus

In this form of the disease, the membranes of the brain are affected. In children, the disease is extremely severe and progresses quickly. There are regular headaches, lethargy and sudden mood swings. If this form of tuberculosis in children is not treated, then after two weeks the patient’s condition becomes very serious. The child often begins to vomit, have problems with bowel movements, inflamed eyes and a very slow pulse.

If Koch's bacillus leads to meningoencephalitis, then certain areas of the brain that are responsible for different functions are affected. In this case, to make a diagnosis, it is necessary to perform a cerebrospinal fluid analysis and be sure to conduct a computed tomography scan. Tuberculous meningitis often occurs in conjunction with other pathologies, so when diagnosing the disease, the doctor must conduct a series of studies to identify viruses and pathogenic fungi in the body.

Full recovery usually takes more than a year. During this time, the child is hospitalized several times and undergoes complex treatment. Be sure to treat concomitant pathologies, if any. The most important component of treatment is sanatorium-resort therapy. Children after tuberculosis are sent to health resorts, which are located in coniferous forests or not far from them.

During the recovery period after tuberculosis, the child should eat well and walk a lot in the fresh air. The baby must be protected from various infections.

Primary tuberculosis complex

This condition occurs with high fever, severe cough and chest pain. Breathing is very difficult, shortness of breath is observed. The child has a decreased appetite and a noticeable loss of strength. When listening, wheezing is detected from the source of infection. The disease is confirmed based on x-rays and computed tomography data.

The infection can be transmitted from a sick person to a healthy person. It is worth considering that Koch's wand is quite tenacious. Treatment is carried out using special medications and physiotherapeutic procedures.

In this form of the disease, the body is extensively affected by the tuberculosis bacillus. The disease is very severe, mainly affecting the respiratory organs, spleen and urinary tract. There are two forms of miliary tuberculosis.

1. Acute sepsis - traditional research methods do not help diagnose the disease. The symptoms are quite vague, so most often the patient dies within a couple of weeks from the onset of the disease.
2. Acute miliary tuberculosis - manifested by acute intoxication and difficulty breathing. The patient has a high temperature. Initially, the infection is localized, but if treatment is not carried out, extensive damage occurs.

If a patient with this form of tuberculosis undergoes an ultrasound of the internal organs, then an enlargement of the liver and spleen is noticeable. Blood and urine tests are required to assess the condition of the whole body. With this form of the disease, tuberculin tests often show false data.

Is this form of tuberculosis curable in children? Yes, this disease can be treated, but the patient must take several anti-tuberculosis drugs at the same time, which are very toxic. At the same time, physiotherapy is carried out, immunomodulators and vitamin complexes are prescribed. The duration of such treatment is at least six months.

Young children are more susceptible to miliary tuberculosis than adolescents and adults. In them, the infection affects small areas of the organs.

Tuberculosis of the thoracic lymph nodes

In this form of the disease, the respiratory organs are extensively affected. The disease occurs with weight loss, poor appetite, excessive nervous excitement and decreased motor activity. The main symptoms include insomnia and abnormal sweating, especially at night.

To diagnose the disease, the patient is sent for X-rays of the respiratory organs and blood tests. In the first three months of treatment, strong anti-tuberculosis drugs are used. If the prescribed therapy is effective, then after a while the doctor may reduce the amount of medications the patient takes.

Tuberculosis of peripheral lymph nodes

The nodes that are most susceptible to infection are those located in close proximity to the neck. They become mobile and painful, often filled with necrotic mass. When the lymph node is heavily filled with pus, it ruptures and in its place a purulent fistula forms, which scars a little later. The body temperature may be more than 40 degrees, the patient is bothered by headaches and general weakness.

For diagnosis, a fluid sample is taken from the affected lymph node, a chest x-ray is taken, and a tuberculin test is performed.

Treatment for this form of the disease can be medication or surgery. To speed up recovery, lymphotropic therapy can be used. This treatment method minimizes the risk of relapse.

Prevention of tuberculosis in children consists of timely BCG vaccination. The first vaccination is carried out in the maternity hospital, and revaccinations, according to indications, are given at 7 and 14 years of age. Parents should monitor the health of their children and immediately consult a doctor at the slightest suspicious symptoms. It must be remembered that tuberculosis is easier to treat in the early stages.

The most common infectious disease in the world is tuberculosis. Its insidiousness lies in the long incubation period, during which foci of inflammation - granulomas - appear in the internal organs of a person. It is most difficult to diagnose the disease in newborns and children of primary preschool age, since in the first stages the symptoms are similar to a cold.

In medicine, the disease is classified as socially dangerous due to the annual increase in the number of patients. The only method that allows a timely and accurate diagnosis to be made is a PCR test, and it is recommended to perform it after three times of sputum culture.

In childhood and adolescence, tuberculosis of the intrathoracic lymph nodes, which belongs to the primary form, is more common (the body was affected by Koch's bacillus for the first time). Characterized by a long course.

If the baby’s first signs are detected and proper treatment is started, then recovery occurs in 2–3 months. In the absence of drug therapy, the pathogenic process can last up to several years, changing stages of exacerbation to periods of remission.

Transmission routes:

• Airborne - a common route of infection of the body with Koch's bacillus. 80% of children and adults are infected in this way. The bacterium enters a healthy body through contact with a sick person. This can happen in public transport, a store, or a kindergarten. Wherever an infected person releases pathogenic bacteria through talking, coughing or sneezing.
• Airborne dust – infection through this route occurs less frequently. In order for the microorganism to enter the lungs of a healthy person, you need to inhale dust to which Koch's bacillus has stuck.
• Nutritional – infection occurs through consumption of meat and dairy products from infected animals. This is a relatively rare route of infection, but if a kindergarten or school does not check the supplied products or does not do heat treatment, then the chances of contracting the disease increase. The same applies to public catering establishments. The nutritional route is a common method of infecting children, because infection occurs through unwashed hands: while playing in the sandbox or after traveling in public transport, if the child puts dirty fingers into his mouth, and Koch’s stick is already stuck to them. Subsequently, tuberculosis of the intrathoracic lymph nodes may develop.
• Transplacental – infection of children occurs if at the time of birth the mother had tuberculosis in the genital tract. In this case, the baby is infected, and the disease is classified as congenital.
• Mixed – infection often occurs in places where there is a concentration of patients who secrete Koch’s bacillus.

How to recognize tuberculosis in children

In almost every clinical case, the symptoms of tuberculosis in children at an early stage are regarded by parents as a common cold. Depending on the severity, their manifestation may be clear or blurred.

The first of them: decreased activity, apathetic state, cough and slight increase in body temperature. If after 21 days the symptoms do not go away, this may indicate infection with Koch's bacillus, so a careful differential diagnosis is required, including PCR analysis.

Common symptoms of the initial stage include the following:

• the baby gets tired quickly;
• motor activity decreased, lethargy appeared;
• no appetite;
• There is no weight gain, but weight loss is observed;
• the skin has acquired an unhealthy pale color;
• the patient's condition is anxious and irritable, sleep is disturbed;
• lymph nodes are slightly increased in size.

Upon completion of the initial stage, the following symptoms are added to the above symptoms:

• nighttime increase in body temperature with increased sweating and fever;
• a persistent dry cough has become wet and does not go away for more than 3 weeks;
• with prolonged coughing, sputum is discharged, sometimes mixed with blood (in this case, parents should immediately call emergency help).

Signs of chronic tuberculosis in children

Often in children of primary school age, six months or a year after the change from a negative to a positive indicator, intoxication may occur. A condition in which an infection develops in the body, but the exact location of its location cannot be determined.

Symptoms of intoxication:

• inhibition of physical development;
• weight loss;
• increased sweating;
• the temperature remains within the subfebrile range for a long time;
• general weakness;
• the skin is pale and the cheeks are bright pink;
• eyes shine;
• the liver is enlarged.

However, the presence of all or several symptoms does not allow a definitive diagnosis. To set it up, you need to consult a phthisiatrician who will prescribe an examination. Most often this is a chest x-ray and a blood test; PCR diagnostics can also be included. This complex is often sufficient to determine the presence of infection.

Types of tuberculosis in children

Tuberculosis of unspecified localization

The disease is characterized by the development of a pathogenic infection, but no visible changes occur in any internal organ. Most often it is diagnosed in early childhood, when the child attends kindergarten or primary school, and in adolescence (up to 14 years). This is due to the instability of the growing organism to pathogenic microorganisms.

The peculiarity of the form is that although it occurs frequently, it is rarely diagnosed in the early stages. Due to the absence of external changes in the child’s behavior, parents simply do not notice the onset of the disease, which over time becomes chronic, diagnosed by blood tests and PCR.

Respiratory tuberculosis

The following types are distinguished.

Tuberculosis of intrathoracic lymph nodes – classified as a common form of primary lesion. Occurs in infants. Characterized by damage to the intrathoracic lymph nodes (unilateral or bilateral).

Lymph nodes increase excessively in size and put strong pressure on the bronchi of children, and therefore the disease occurs in severe form in infants. It is diagnosed by collecting an anamnesis, which determines the likelihood of contact with a sick person, as well as by the results of x-rays and blood tests.

Primary tuberculosis complex – another form of primary tuberculosis, often diagnosed in children who do not attend preschool and school institutions. The first signs of the complex are intoxication, which may be complicated by impaired bronchial patency.

A characteristic feature of the complex is single or multiple lesions of the intrathoracic lymph nodes, vessels and areas of the lungs. In some cases, the lesion is complex. This form must be differentiated from specific and nonspecific inflammatory processes occurring in the lungs. To do this, the patient is prescribed a blood and sputum test and x-ray.

Focal damage to the lungs by tuberculosis – may be primary or secondary. Most often occurs in children aged 10 to 14 years. Pathogenic bacteria affect the left or right lung, and the source of inflammation is localized within two segments of the organ, no larger than 10 millimeters in size, usually at the apex of the lung. It can be detected on an x-ray; a blood test and sputum culture are additionally prescribed.

Infiltrative form – secondary infection is rare in children who attend kindergarten. More often the disease manifests itself in the early school period. The x-ray shows the lesion - the lung is filled with fluid, there are dead areas. It is diagnosed mainly during a routine examination (fluorography); a blood test and sputum culture are also prescribed.

Disseminated pulmonary tuberculosis – occurs at any age in children and adults. It occurs in severe form and can be primary or secondary. Due to the fact that more than two segments of the lung are affected, widespread lesions are visible on the x-ray; sometimes there are cavities formed by tissue necrosis, this leads to thinning of the lung walls. For diagnosis, a clinical blood test, sputum culture and radiography are prescribed; in some cases, PCR diagnostics are prescribed.

Tuberculous pleurisy – infection of the serous membrane of the lungs is often unilateral. The disease can act as a complication of any form or be independent. When diagnosed in childhood, it is mainly of a primary nature. Teenagers are more susceptible to pleurisy.

Pulmonary tuberculoma – in extremely rare cases it occurs in small children under the age of 6 years, but if tuberculoma begins to develop while attending kindergarten or school, then over time it will go into the active stage, which is characterized by damage to an area of ​​the lung no more than 10 millimeters. The lesion is covered with fibrous tissue interspersed with calcium. Diagnosis includes blood tests and x-rays. Treatment most often involves surgery.

Bronchial tuberculosis – a difficult form to diagnose in patients of young childhood due to the need to perform not only a blood test, but also bronchoscopy. The infection affects the bronchi and is common in other forms.

Caseous pneumonia – the most severe form of lung damage; It practically does not occur in children of primary preschool and school age. A characteristic symptom is widespread necrosis of lung tissue.

Extrapulmonary tuberculosis

Often found in children of preschool and primary school age. Infection occurs in approximately 30% and is a secondary form. The peculiarity is that diagnosis is difficult, which is due to nonspecific symptoms of the initial stage.

The infection can progress in any internal organ, so the final diagnosis is made after histological examination and clinical tests of urine and blood.

Miliary tuberculosis

A very severe and common form, in which damage to blood vessels and capillaries occurs, where tubercles of tuberculosis subsequently form, with the active release of Koch's bacillus into the sputum. When a healthy person comes into contact with a patient with miliary tuberculosis, 100% infection occurs.

Infected child and visiting kindergarten

Many parents are concerned about the issue of children who have been diagnosed with tuberculosis attending kindergarten and school. It is important to understand the difference between an infected person and a sick person.

Doctors assure that those infected with tuberculosis can attend preschool and school institutions. Such children have a positive Mantoux reaction, but are in no way contagious and do not pose a danger to their peers in kindergarten and school.

A child infected with tuberculosis is at risk. Under the influence of pathogenic factors, for example, with a decrease in immunity, the body will stop fighting infection, which will lead to illness. And even then, the sick child cannot attend kindergarten and school, because he is contagious and must undergo dispensary treatment.

Diagnostic methods

If, during a medical examination before entering kindergarten or school, there is a suspicion of tuberculosis of the intrathoracic lymph nodes or another form, the pediatrician refers the patient to a phthisiatrician.

The most commonly used way to determine infection is the Mantoux test. If the teenager’s age allows (15–17 years), then fluorography is prescribed.

Laboratory studies involve the study of biological materials (blood, urine, sputum, throat swab, etc.) for the isolation of Koch's bacillus. Also, for clarification, ELISA and PCR diagnostics may be prescribed.

Mantoux test

An injection method for diagnosing pediatric patients, allowing to determine the presence of infection in the body. The result could be as follows:

Blood analysis

An enzyme immunoassay shows the presence of antibodies to Koch's bacillus in the patient's blood. The effectiveness of the study is low, and results can be obtained the next day.

A general blood test is done as part of a differential diagnosis, which makes it possible to determine the presence of inflammatory processes. Infection is indicated by an increase in the number of leukocytes and rod neutrophils.

PCR diagnostics

A modern method for clarifying the diagnosis and determining the presence of pathogenic microorganisms. PCR (polymerase chain reaction) is almost 100% accurate. Using PCR research, you can detect not only tuberculosis, but also many viral, chlamydial and bacterial reactions.

To carry out PCR, a three-fold culture of the stomach contents for tuberculosis is required. Diagnosis is performed in a hospital setting.

Treatment of children diagnosed with tuberculosis

If there is evidence of Koch bacillus infection in young children, they are observed by a pediatric TB specialist. Upon reaching 3 years of age, patients are placed under the supervision of a phthisiatrician at the dispensary.

To avoid the infection of the infected person, chemoprophylaxis is performed (taking anti-tuberculosis medications for 3 months). During treatment, the baby should be shown to the doctor once every 10 days, and once every six months upon completion of the course.

Treatment of tuberculosis in children is always complex and takes place in several stages:

1. Stationary observation.
2. Sanatorium treatment.
3. Clinical examination.

The duration of treatment depends on the form and severity of the disease. On average it takes about two years. In many ways, the speed of recovery of patients of younger childhood depends on how the parents organized the diet - it is necessary to include daily consumption of high-calorie foods. Also, the child needs a lot of time in the fresh air, it is better if it is a wooded or sea region.

If a child has a severe tuberculosis reaction, there is no need for hospitalization. The doctor prescribes monotherapy on an outpatient basis. The treatment period is about 3 months, most often tubazid or ftivazid is prescribed.

Children with severe tuberculosis reactions are monitored at the dispensary for 1 year. After this time, it is necessary to undergo a medical examination, take a blood test and PCR. If the indicators are negative, the child is removed from the register.

If the examination results are positive, complex therapy is prescribed, including two to four drugs. The treatment is staged: intensive therapy is performed first, and supportive therapy is performed at the final stage.

If after 6–8 months of intensive treatment the child still has obvious residual symptoms, surgery may be required.

Lifestyle of children during treatment

If a child has been diagnosed with tuberculosis of the intrathoracic lymph nodes or another form of primary disease, it is very important during the treatment process to follow the correct daily routine and review the patient’s diet.

The first step is to take care to eliminate such negative factors:

• fatigue - if the baby is able to do any work or play, these activities need to be sedentary and do not take away the strength necessary to restore the body;
• stress — the life of a child with such a serious illness should be filled with joyful moments; any stressful situation has a detrimental effect on the recovery process;
• starvation - even in the absence of appetite, you need to explain to the patient how important it is to eat properly and nutritiously;
• hypothermia - including hardening of the body during the period of treatment should be completely avoided;
• exposure to the sun - with prolonged exposure to sunlight and ultraviolet radiation during the disease process, destruction of lung tissue occurs;
• crowded places - in addition to the fact that the patient can infect someone, he himself can catch an additional disease, this is due to the low protective ability of the body;
• vaccination - including planned, required by age, if the child goes to kindergarten or school, then the vaccination can be done after recovery;
• performing surgical interventions - if they were prescribed before the disease, then most likely the surgeon will suggest rescheduling the operation;
• treatment traditional medicine .

Meals should be balanced and dietary - table No. 11:

• daily calorie intake is at least 3000–4000;
• a large amount of protein foods - meat, beans;
• calcium - cottage cheese, dairy products;
• vitamins - fruits and vegetables.

Subject to the nutritional rules of dietary table No. 11, the patient receives a full complex of essential vitamins, micro- and macroelements. But at the same time, favorable conditions are created for the restoration of damaged lungs and other organs. The functioning of the immune system improves.

You need to avoid eating spicy and fried foods, as well as dishes with a lot of spices. It is necessary to reduce the consumption of sweets, because Koch's bacillus grows actively in an environment with high glucose levels.

Rehabilitation period and prevention

During the rehabilitation period after recovery, parents should ensure that the child sleeps for at least 3 hours during the day every day. If he previously attended sports sections in kindergarten or school, it is recommended to temporarily suspend classes.

It is strictly forbidden to stay in the sun for a long time, but the hardening procedure can be resumed. It is very good if, during the rehabilitation period, parents take care of purchasing a ticket to a health sanatorium that specializes in the recovery of patients after tuberculosis.

• Routes of transmission and classification of childhood tuberculosis
• Prevention of tuberculosis in children

If you notice the first signs of tuberculosis in children in time and provide appropriate treatment, the child’s body can easily cope with this disease. The tuberculosis bacterium was discovered in 1882 by Robert Koch. The source of the disease is usually a patient with tuberculosis.

Persons at risk include children with a disrupted nutritional system or obvious systematic malnutrition, receiving insufficient amounts of vitamins, living in poor living conditions and constantly overworked. The disease has a wave-like character, it subsides and recurs again.

Basically, a visit to a pediatric phthisiatrician is caused by a positive result of the Mantoux tuberculin test, which is performed on the child at the local clinic. But a positive Mantoux reaction does not at all mean that the child has tuberculosis. In most cases, this is only a tendency to reduce resistance to tubinfection, which is a signal for more careful monitoring of the child’s physical development and health.

Koch's bacillus, which is the causative agent of tuberculosis, can enter a child's body in several ways. In 95% of cases, a child becomes infected through airborne contact with an infected person. 5-6% of infections occur through contact through shared use of infected clothing, toys, dishes, etc. The alimentary route of infection (through the intestines) accounts for about 2% of all cases of the disease. The possibility of infection of the fetus with tuberculosis occurs either when the placenta is affected by tuberculosis, or when the damaged placenta becomes infected during childbirth by a sick mother. This route of infection with tuberculosis is extremely rare.

The highest risk of developing tuberculosis in children is through family or household contact with a persistent bacilli shed. Newborns and young children are more seriously ill than older children and adults. Adolescence is also a critical point, since during this period the neuroendocrine apparatus undergoes restructuring and the body’s protective properties decrease. As a rule, the disease takes hold of a child unnoticed: months and years can pass from the moment of infection to the development of the disease; in the initial stage, tuberculosis is asymptomatic or with a small number of symptoms. Diagnosis of childhood tuberculosis is complicated by the extreme diversity of clinical manifestations.

Classification:

1. Primary tuberculosis intoxication: early, chronic.
2. Respiratory tuberculosis.
3. Tuberculosis of other organs.

In children, the most common forms of primary tuberculosis are: bronchoadenitis, tubintoxication. Newborns and infants suffer from meningitis and milliary forms of tuberculosis, and preschool children suffer from osteoarticular and glandular forms. At school age, tubintoxication is most often encountered with a favorable outcome.

Tubintoxication occurs during primary infection of the body and is a separate clinical form with functional disorders and objective symptoms, but without local detection.

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Primary and chronic symptoms of tuberculosis in children

Symptoms of the onset of the disease are non-specific, but they can draw attention to changes in the child’s health. The first include:

• increased fatigue;
• the appearance of excessive irritability;
• loss of appetite;
• sleep disturbance;
• loss of cheerfulness and mobility;
• pale skin;
• the appearance of frequent headaches;
• stopping weight gain or weight loss;
• periodic increase in body temperature to 37.1-37.5 ° C;
• slight enlargement of lymph nodes
• allergies - erythema nodosum, flinctinous conjunctivitis.

The first symptoms of tuberculosis in children, which are chronic, appear within 6-12 months after the tuberculin test. At this moment the following signs appear:

• delay in physical development;
• weight loss;
• increased sweating;
• prolonged moderate increase in temperature;
• the appearance of malaise and weakness combined with the appearance of euphoric states;
• Pink cheeks stand out against the background of pale skin;
• a glassy shine appears in the eyes;
• Palpation can detect liver enlargement.

The appearance of all these symptoms does not prove the presence of Koch's bacillus in the body. To make an accurate diagnosis, it is necessary to prescribe a laboratory blood test and an x-ray of the lungs. These types of diagnostics allow you to accurately diagnose the presence or absence of tuberculosis.

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Clinical forms of tuberculosis in children

1. and joints. This form of the disease is characterized by very slow development. Mainly hip or knee joints. The child begins to complain of pain when moving, followed by a change in gait and lameness. If the described symptoms appear, it is necessary to immediately undergo an examination, since timely treatment can prevent the negative consequences of this disease (lifelong lameness, hump).
2. Pulmonary form of tuberculosis. The pulmonary form of tuberculosis in childhood is less common. This infection is accompanied by a prolonged increase in temperature. Pulmonary tuberculosis is more difficult to cure, but still quite possible. Cases of unfavorable dynamics, which lead to the breakdown of lung tissue and the development of lesions in other organs, are quite rare and occur mainly in young children. Therefore, starting from an early age, the child must be carefully protected from this disease and great attention must be paid to strengthening the body’s defenses.
3. Tuberculosis of the bronchial glands in children. This form of tuberculosis occurs most often in children. Bronchial glands are located in the thoracic region, where the bronchi and large blood vessels pass. The largest number of them is concentrated at the very root of the lungs. can get there along with the bloodstream and form an inflammatory tuberculosis focus. Tuberculosis of the bronchial glands in children has various manifestations. It can begin like the flu, with a cough and fever, and the malaise, as a rule, drags on for a longer period than with the flu. Therefore, if there is a prolonged cough and high temperature, it is necessary to immediately examine the child with a doctor for tuberculosis infection. In some cases, tuberculosis of the bronchial glands begins latently and develops gradually. As with chronic tuberculosis intoxication, changes occur in the child’s behavior: lethargy, increased fatigue, and whims appear. As the disease progresses, a cough occurs, the child turns pale and loses weight.
4. Tuberculosis of the lymph nodes. The tuberculosis bacillus can affect the peripheral lymphatic system. One of the symptoms of this disease is a significant increase in lymph nodes (micropolyadenia). The nodes become soggy and fester. Pus flowing outward forms fistulas that do not heal for a long time. This form of tuberculosis can manifest itself in skin lesions (scrofuloderma). Scrofuloderma is a painless spherical node, 1-3 cm in diameter, located deep in the subcutaneous fatty tissue. Subsequently, this node also turns into an ulcer. To prevent the progression of this disease, you should immediately visit a specialist even if the lymph nodes are slightly swollen or tumors appear on the skin.
5. Tuberculosis of the meninges. Tuberculous meningitis affects children more often than adults and is a fairly serious disease. The disease does not manifest itself immediately and develops over 2-3 weeks. The child develops lethargy and anxiety, loss of appetite, headaches and fever, followed by vomiting and convulsions. The most susceptible to this disease are children from families in which there is a constant bacilli excretion in an open form. For a long time, medicine was powerless against this form of the disease, which in most cases was fatal. Now, with the help of timely started antibacterial therapy of the new generation, the child can be cured.

Tuberculosis in children is a big problem in pediatric practice. Symptoms of tuberculosis in children are not specific. Signs of tuberculosis in children at each stage of the disease have their own colors and manifestations. in children includes vaccination and chemoprophylaxis.

The human body most often encounters tuberculosis infection in childhood and subsequently never emerges from this encounter without harm. hide in the organs of the reticuloendothelial system (macrophage system) and in the future may become the culprits of the disease. The interaction of the tuberculosis bacillus with the child’s body is a rather complex process. Symptoms of tuberculosis in children at each stage have their own colors and manifestations.

(MBT) have a complex metabolism, which ensures their variability and high stability in the external environment and living organisms. Under the influence of strong immunity (in this case, special T-lymphocyte cells) and/or chemotherapy, they transform into the L-form and coexist with the human body for years without causing disease. Tuberculosis bacilli enter the child’s body most often aerogenously, much less often with contaminated food products from sick animals and through the skin. In 50% of cases, sick relatives become the culprits for the development of tuberculosis in children. Even short-term contact with a sick person is dangerous for a child.

Rice. 1. View of a tuberculosis bacillus in an electron microscope.

Rice. 2. Mycobacterium tuberculosis in a sputum preparation (electronogram, negative contrast).

How does tuberculosis develop in children?

The beginning of the interaction of Mycobacterium tuberculosis with the child’s body

Tuberculosis in children begins from the moment MBT enters the nasopharynx, first into the mucous and then into the submucosal layer. The tuberculosis bacillus is lymphotropic, which is why it quickly enters the lymphatic system. First, into the pharyngeal lymphoid ring, which in a child is very rich in lymphoid tissue. The fight against MBT begins with phagocytes and tissue macrophages. Having swallowed the mycobacterium and are unable to destroy it, the fighters against the infection die (incomplete phagocytosis). Bacteria multiply and spread through the lymphatic system, which communicates with the bloodstream. The infection, without proper resistance, enters the bloodstream (bacteremia).

The immune system receives a signal about the infectious agent and its cells (T-lymphocytes) begin to prepare for battle. The body begins to produce antibodies (produce and train T-lymphocytes), which takes about 2 months. becomes positive for the first time in my life. The clinic at this moment is determined by the number of pathogens. Symptoms of tuberculosis in children during this period are similar to those with acute respiratory infections. The smaller the child, the brighter the clinical picture of the disease, but the body temperature will never be very high and the child will remain active.

General symptoms of tuberculosis in children during this period:

• slight increase in body temperature,
• nervousness and anxiety.

Local symptoms of tuberculosis in children during this period:

• positive Mantoux reaction for the first time in life (“Virage” of tuberculin tests).

Rice. 3. The photo shows tuberculosis in a child - the skin of the back of the head and ears is affected.

What happens in a child’s body after antibodies are produced?

After the production of antibodies, MBT leave and are fixed in the RES (reticuloendothelial system - macrophage system). Scattered throughout the body (its cells are located in the endothelium of the blood vessels of the liver, spleen, and bone marrow), it brings the child’s body into a state of biological equilibrium, when the microorganism is hidden, but has not disappeared. It is restrained by antibodies - trained T-lymphocytes (killers or “killers”). They cut the bacterium in half, thus destroying it. The clinic at this moment is determined by the number of pathogens. Symptoms and signs of tuberculosis in children during this period are caused by paraspecific reactions (accumulation of certain groups of cells in response to the introduction of MBT) and tuberculosis intoxication. The child is subject to mandatory examination in a specialized institution and treatment.

How the disease develops

If the bacteria are not destroyed, then by the 6th month, single MBTs begin to multiply and destroy tissue. The symptoms of intoxication in the child are increasing. Around bacteria and caseosis (damaged tissue), a shaft of cells of a certain type is formed (a tuberculous tubercle is formed). And then, by the 1st year from the moment of the first encounter with tuberculosis infection, each MBT already produces microcaseosis and microproliferation (clumps of cells). MBT continue to multiply, the tubercles merge, and local ones appear.

Symptoms of intoxication increase even more. An important sign of tuberculosis during this period is the presence of paraspecific reactions. Foci of tuberculosis most often appear in the intrathoracic lymph nodes and lungs. Tuberculosis in children most often manifests itself as damage to the intrathoracic lymph nodes and lungs. With a good outcome, the lesions resolve, but more often they grow into fibrous tissue and calcify. If calcification is incomplete and the office does not die, but turns into L-forms, then later under unfavorable conditions they can cause disease. The disease tends to heal itself.

The Mantoux reaction can be performed at different periods of development of the tuberculosis process, which developed at the first meeting with the child’s body. In all cases of the first positive result, the child is sent for consultation to a phthisiatrician.

Sometimes parents refuse to perform the Mantoux test, ignore visiting a medical facility, and explain the child’s weight loss and lack of appetite with all sorts of reasons, but not with tuberculosis infection. Then the child begins to develop local forms of tuberculosis. Parents will take such a child to a phthisiatrician themselves, but with tuberculosis, which will require long-term treatment and recovery.

The medical network identifies the period of primary tuberculosis infection using the tuberculin diagnostic method (Mantoux test). If a “turn” of a tuberculin reaction is detected, the child is immediately sent to a TB doctor, who monitors the child for 1 year and, if necessary, prescribes the necessary treatment.

If a child is left without proper attention from doctors, he may develop primary tuberculosis.

Upon successful completion of the period of primary tuberculosis infection, the child will subsequently be considered “not infected with tuberculosis for the first time in his life” with a lifelong positive Mantoux test.

• On average, in children from 1 to 12 years of age, the infection rate is 25–30% and then increases annually by 2.5%.
• In children aged 12–14 years, this figure is 40–60%.
• By the age of 30, 70% of the adult population is already infected.

Rice. 4. Very often, treatment of tuberculosis in children is carried out in sanatoriums.

Symptoms of tuberculosis in children

Rice. 5. At the slightest suspicion of tuberculosis, the child should be consulted by a TB doctor.

Symptoms of tuberculosis in children are not specific. The clinical picture consists of symptoms of intoxication, local symptoms and the presence of paraspecific reactions. Symptoms of tuberculosis in children during the period of primary tuberculosis infection are caused by paraspecific reactions (accumulation of certain groups of cells in response to the introduction of MBT), tuberculosis intoxication and fever. Symptoms of tuberculosis in children during the development of local forms of tuberculosis depend on the volume of tissue damage, the amount of molten caseous masses and the development of complications.

General symptoms of tuberculosis in children

1. Symptom of intoxication

Symptoms of intoxication appear during the development of primary tuberculosis infection, when there are no visible focal lesions. They come in varying degrees of severity and depend on the stage of the tuberculosis process. If the process of MBT multiplication is underway, then the symptoms of intoxication are significantly expressed. With the reverse development of the disease, the symptoms of intoxication begin to weaken and disappear altogether.

Symptoms of intoxication include:

• deterioration in general health,
• low-grade body temperature,
• loss of appetite,
• weight loss,
• weakness,
• sweating,
• developmental delay, pale skin,
• neurovegetative disorders, which is manifested by sweating of the palms and feet (distal dyshidrosis), tachycardia, excitability or depression, tachycardia.

Symptoms of intoxication in children appear gradually and are not as severe as with ARVI.

2. Fever

Currently, typical fever is very rarely observed in children and adolescents.

Rice. 6. Constant coughing that develops into a cough is a sign of tuberculosis in a child. A cough indicates damage to the bronchi, which are always involved in the process during the development of pulmonary tuberculosis.

3. The first signs of tuberculosis in children are paraspecific reaction syndrome

Paraspecific reactions occur during primary tuberculosis in children, when, after the formation of antibodies, MBT leave the blood for the organs of the RES (reticuloendothelial system - macrophage system). Its cells are found in various parts of the body - lymph nodes, spleen, liver, in the walls of blood vessels, connective tissue. Changes can be registered in a variety of organs of the child. They manifest themselves in the form of vasculitis, serositis, arthritis, erythema nodosum and enlarged lymph nodes.

True paraspecific reactions are not tuberculous inflammation, but the accumulation of certain groups of cells in the above organs in response to the introduction of MBT.

A true paraspecific reaction takes place within 1.5 – 2 months. Tuberculosis takes much longer to treat. Very often, paraspecific reactions appear when there are local forms of tuberculosis.

In children, paraspecific reactions are characterized by the following changes:

• On the part of the eyes, a paraspecific reaction most often manifests itself in the form of blepharitis or conjunctivitis, or a combination of both. The paraspecific reaction always occurs violently, with lacrimation and photophobia. The Mantoux test is not given to children with such manifestations. First you need to consult an ophthalmologist.
• On the part of the joints, a paraspecific reaction occurs under the guise of arthritis.
• On the part of the skin, a paraspecific reaction manifests itself in the form of annular erythema, which is most often localized on the skin of the front part of the leg, less often on the skin of the hands, buttocks, and ankles (the area closer to the heel). The child needs to be examined throughout!
• The reaction of enlarged lymph nodes is always present. Enlarged lymph nodes are painless and mobile. It is always the group of lymph nodes that enlarges, not just one lymph node. At the beginning of the process they have a soft consistency, then – elastic; in the chronic course, the lymph nodes are dense, like “pebbles”.

Rice. 7. Paraspecific reaction in tuberculosis - phlyctena.

Rice. 8. Paraspecific reaction in tuberculosis – keratoconjunctivitis.

Rice. 9. Paraspecific reaction in tuberculosis – erythema nodosum.

Rice. 10. Positive Mantoux reaction.

Local symptoms of tuberculosis in children

Symptoms of tuberculosis in children with the development of local forms depend on the localization of the process, the volume of tissue damage, the amount of molten caseous masses and the development of complications. Thus, tuberculosis in children, which occurs with damage to the bronchi, will always be accompanied by a cough (a slight cough to a severe cough).

• If the pleura is affected, the main symptom will be chest pain and shortness of breath.
• If the kidneys are damaged, dysuria and pain in the lumbar region occur.
• If peripheral lymph nodes are affected, there is swelling and painlessness.
• If the spine is affected, there is a change in the child’s behavior, anxiety, decreased motor activity, pain in the spine and the appearance of deformity.
• When the intestines are damaged, the phenomena of intestinal dyskinesia occur.
• If intra-abdominal lymph nodes are affected - pain in the umbilical region, poor appetite, periodic nausea and vomiting, unstable stool.

Morphology of the tuberculosis process

Rice. 11. Multiple calcifications in the lung tissue during the reverse development of tuberculosis.

Tuberculosis in children can develop in any organ: lungs, bronchi, pleura, lymph nodes, kidneys, bones, joints, intestines, etc. And everywhere the same process develops - “cold” tuberculous inflammation. It is based on the formation of a granuloma (“bump”). More than 100 diseases are known that are accompanied by the formation of granulomas, but only with tuberculosis in the center of each tubercle there is necrosis - tissue damage.

As the disease progresses, the tubercles merge with each other, forming a fairly extensive destruction of tissue in the center - cheesy necrosis (dead tissue in tuberculosis looks like a soft white cheesy mass). After the breakthrough of caseous masses, decay cavities are formed. A huge amount of MBT comes out with the caseous masses, which settle in the underlying tissues, affecting them. The infection, through the blood and lymph, begins to spread throughout the body, seeding other organs. With the reverse development of the disease, the lesions and lymph nodes become denser due to hyalinosis (a type of modified protein resembling hyaline cartilage).

The affected surrounding tissues transform into fibrosis and cirrhosis. The decay cavities “close” and scar tissue appears in their place. Calcium salts are deposited in areas of caseous necrosis.

Forms of tuberculosis in children

Primary tuberculosis in children develops during the first year from the moment of infection with MTB (primary infection). The shorter the period from the onset of infection to the manifestation of tuberculosis, the worse the prognosis. Having increased lymphotropicity, MBT most often affects the lymph nodes. Their defeat determines the entire clinical picture of the disease, the nature of complications and the time of recovery. Paraspecific reactions during the period of appearance of local forms of tuberculosis are highly developed. The disease tends to heal itself.

Tuberculosis intoxication

Tuberculosis intoxication appears during the development of primary tuberculosis infection, when there are no visible focal lesions. The general condition gradually begins to deteriorate, appetite worsens, and low-grade body temperature appears in the evenings. Neurovegetative disorders are manifested by increased excitability or depression, tachycardia and headache. The child is immediately subject to a comprehensive examination by a phthisiatrician.

Rice. 12. Lack of appetite and weight loss are the first signs of tuberculosis in children.

Primary complex in the lung

It is believed that with this form of tuberculosis, MBT enters well-ventilated areas of the lung tissue. At the site of bacterial penetration, an inflammatory process the size of a millet grain develops. The lesion gradually increases in size, and mycobacteria penetrate through the lymphatic tract into the intrathoracic lymph nodes, where caseous changes develop. This is how the primary tuberculosis complex is formed. The primary tuberculosis complex in most cases is prone to self-healing.

Widespread use and increased body resistance to infection in children today do not allow the outbreak to develop. A fibrous capsule is formed along the periphery of the lesion, and calcium salts are deposited in the lesion itself and the lymph nodes. The disease often develops in unvaccinated children and in children from foci of tuberculosis infection.

Rice. 13. In the photo, tuberculosis in a child is the outcome of the primary tuberculosis complex. The radiograph shows a single calcified lesion and calcifications in the lymph nodes of the root of the left lung.

Tuberculosis of intrathoracic lymph nodes

92% of all childhood tuberculosis is caused by damage to the intrathoracic lymph nodes. If several lymph nodes are affected, and the clinical picture shows mild symptoms, then they speak of uncomplicated tuberculosis. During treatment, the capsule of the lymph nodes undergoes hyalinization, and in areas of necrosis, a process of calcification occurs. In a complicated course, the infection spreads to neighboring lymph nodes and structures. Up to 70% of complications occur between the ages of 0 and 3 years. Reasons for this:

• imperfect system of anatomical structures (narrow bronchi, lack of cartilage),
• imperfect defense mechanisms,
• unformed immune system.

The clinic is clearly expressed.

Rice. 14. The photo shows a child with tuberculosis. The intrathoracic lymph nodes are affected. An X-ray of the lungs shows enlarged lymph nodes in the root of the right lung.

Rice. 15. An X-ray of the lungs shows enlarged lymph nodes in the roots of the lungs.

Rice. 16. The radiograph shows a group of calcified lymph nodes on both sides.

Bronchial tuberculosis

The infection enters the bronchus from the lymph nodes through the interstitial tissue. The interstitial tissue in childhood is not perfect. It does not fully perform its protective function (it does not contain infection). Most often, large bronchi and bronchi of the 1st, 2nd and 3rd order are affected. As the disease develops, disturbances in bronchial obstruction appear with the appearance of areas of hypoventilation up to the development of atelectasis (collapse of lung tissue). Nonspecific inflammation occurs very quickly in these areas. If the area of ​​atelectasis becomes infected with MBT, then a terrible complication occurs - caseous pneumonia, causing death in 40% of cases.

Caseous pneumonia can eventually transform into fibrous-cavernous tuberculosis. In the best case, under the influence of the development of cirrhosis, the area of ​​atelectasis turns into a fibrous cord. If bronchial patency is not restored within a week, then the airiness of the affected area of ​​the lung tissue will never be restored and the child will remain disabled for life.

Rice. 17. The photo shows a child with tuberculosis. The bronchi are affected. The radiograph shows atelectasis: the upper lobe of the right lung has collapsed and decreased in volume.

Pulmonary tuberculosis

In the lung tissue, lesions occur from single foci (focal tuberculosis) to the spread of infection throughout the entire lung fields (disseminated tuberculosis). The clinical picture of the disease depends on the area of ​​damage to the lung tissue, bronchi and pleura. Areas of decay (decay cavities) may appear in the lung tissue.

Rice. 18. The photo shows a child with tuberculosis. Acute form of disseminated pulmonary tuberculosis.

Tuberculous pleurisy

When infection enters the pleura, tuberculous pleurisy occurs, which accounts for up to 70% of all childhood pleurisy. Often the effusion into the pleural cavity is insignificant and clinically manifests itself poorly. Practically does not occur in children under 2 years of age. Very rare in children aged 2 to 6 years. With significant effusion, fever, chest pain and shortness of breath appear. The prognosis is favorable.

Extrapulmonary forms of tuberculosis in children

As a rule, the disease occurs when the infection spreads through the lymphatic tract or bloodstream. The process develops as a result of a sharp weakening of the immune system, poorly performed vaccination or its absence, unfavorable living conditions and concomitant diseases.

Tuberculous meningitis

Occurs in the absence of vaccination against tuberculosis at the birth of a child. Currently, the disease is extremely rare.

Tuberculosis of the osteoarticular system

The system is always combined with lung damage. It is characterized by damage to the growth cartilage and extensive changes in the affected joints and spine. The disease is accompanied by the appearance of abscesses, purulent leaks and fistulas and is often complicated by paralysis that occurs as a result of compression of the spinal cord by destroyed vertebrae or abscesses. In the last 10 years, complications after vaccination began to appear in the form of limited damage to bone tissue.

Rice. 19. The photo shows a child with tuberculosis. On the x-ray of the lumbar spine, the red circle shows typical damage to the vertebral bodies due to tuberculosis.

Rice. 20. The photo shows a child with tuberculosis. The photo shows tuberculosis of the right hip joint in an 11-year-old patient. The head of the femur is completely destroyed.

Rice. 21. Tuberculous trochanteritis. Extensive destruction of the greater trochanter of the femur.

Rice. 22. The photo shows a child with tuberculosis. The patient spares his leg and crooks his pelvis.

Rice. 23. The photo shows a child with tuberculosis. The spine of a 9-year-old child is affected. The picture shows almost destroyed vertebral bodies. Kyphosis.

Rice. 24. The photo shows spinal tuberculosis (side view).

Rice. 25. The photo shows spinal tuberculosis (rear view).

Rice. 26. The photo shows tuberculosis in a child - tuberculosis of the diaphyses of long bones (Spina ventosa tuberculosa). The disease is more common in childhood. The short tubular bones of the hands and feet are affected. Less commonly, long tubular bones.

Kidney tuberculosis

Accounts for up to 50% of all forms of extrapulmonary tuberculosis. The infection enters the kidneys through the bloodstream during the period of primary tuberculosis infection. First, the medulla is affected, where cavities and foci of decay are formed. Next, the process moves to the calyces and pelvis, bladder and ureters. During healing, a large number of scars are formed.

Rice. 27. The photo shows a child with tuberculosis. The left kidney is affected. A cavity is visible in the upper pole.

Tuberculosis peripheral lymph nodes

The disease is most often caused by bovine mycobacteria. Affected are the cervical (83% of cases), submandibular, axillary lymph nodes (11%), and inguinal (5%).

Rice. 28. The photo shows a child with tuberculosis. The submandibular lymph nodes are affected.

Abdominal tuberculosis

It is observed very rarely. Tuberculosis affects the intestines, intra-abdominal lymph nodes and serous membrane.

Rice. 29. The photo shows the consequences of tuberculosis in a child. Cicatricial changes are visible on the skin after treatment of tuberculosis of the submandibular lymph nodes.

The Mantoux test is a method for early detection of tuberculosis

Today, tuberculin diagnostics is the only method for detecting tuberculosis in children at an early stage. Tuberculin is a drug that is made from cultures of filtrates of tuberculosis bacilli or from the pathogens themselves. Being an incomplete antigen (hapten), it only causes an allergic response. The waste products of pathogens sensitize the body. Allergens are sensitized T-lymphocytes. They are located in organs and tissues. This means that it takes time to complete a full reaction. The phase during which a papule forms lasts 72 hours.

Mass tuberculin diagnostics are carried out by the general medical network. Its task is as follows:

1. Identify people infected with tuberculosis.
2. Identify a risk group with a “turn” of tuberculin reactions.
3. Select individuals for vaccination.
4. Identify changes in the nature of the Mantoux reaction.

Individual tuberculin diagnostics are carried out for persons registered at an anti-tuberculosis dispensary.

Rice. 30. In the photo, a medical worker administers tuberculin.

Rice. 31. The photo shows Mantoux’s reaction. Measurement of papules 72 hours after tuberculin administration.

Tuberculosis, being a dangerous infectious disease, was considered incurable in the recent past. Millions of people died from it every year. Mandatory vaccination of children and the availability of effective drugs helped doctors control the infection.

The main measure to prevent tuberculosis is vaccination and chemoprophylaxis.

BCG vaccination is the basis for the prevention of tuberculosis in children

Anti-tuberculosis vaccination is the main component in the fight against childhood tuberculosis in the Russian Federation. 64 countries around the world have now made vaccination a mandatory component in their efforts to prevent the development of tuberculosis. For the first time in 1919, the French scientist A. Calmette and C. Guerin created the BCG strain, which was used to vaccinate people. In 1921, the first child was vaccinated.

• A vaccine is being prepared from a strain of live and weakened mycobacterium tuberculosis, which has practically lost its damaging properties.
• The vaccine is injected intradermally into the upper third of the arm and causes the body to produce antibodies.
• The effect of the vaccine weakens by the 4th year.
• The first vaccination is carried out in the maternity hospital on the 3rd – 7th day from the birth of the child.

If for some reason the vaccine was not administered in the maternity hospital, vaccination will be carried out at the clinic. The second vaccination is given to children 7 years old (first graders). Full immunity is formed within a year. The creation of immunity is indicated by the scar formed as a result of vaccination. It is fully formed by 9–12 months.

• If the size of the scar is 5 - 8 mm, then the protection index against tuberculosis is from 93 to 95%.
• If the scar is 2 – 4 mm, then the protection index is reduced to 74%.
• If the scar is 10 mm and deformed, this means that complications arose during the administration of the vaccine and immunity was not developed.

The vaccine prevents the development of meningitis and miliary tuberculosis, that is, those forms of tuberculosis that are spread through the blood. The incidence of complications from vaccination is 0.1%. Complications manifest themselves in the form of cold abscesses, superficial ulcers, BCG-itis (regional lymphadenitis, osteitis, conjunctivitis), keloid scars. It is very rare that a generalized BCG infection develops.

Rice. 32. Vaccination in the maternity hospital.

Rice. 37. The photo shows a complication of BCG - a keloid scar after vaccination.

Rice. 38. The photo shows a complication of BCG - ulcerative necrotizing tuberculosis of the skin after vaccination.

Prevention of tuberculosis in children

1. The main measure to prevent tuberculosis is vaccination.
2. Close dispensary observation and treatment of children for their foci of tuberculosis infection.
3. Increasing parental responsibility for children's health.
4. Formation of a healthy lifestyle in children.

Tuberculosis in children is a rather dangerous disease. Parents should know that refusal to be vaccinated against tuberculosis deprives the child of the right to protection against infection!

Tuberculosis in children is a pressing problem today. The source of infection for children is almost always adults, the incidence of which is currently still very high in the Russian Federation. Despite the fact that the symptoms of tuberculosis in children and the first signs of the disease are not specific, parents should always be wary if their child develops intoxication and low-grade body temperature, loss of appetite and weight loss. Prevention of tuberculosis in children is one of the main components of Russian healthcare. And parents should be responsible for the health of their children and form a healthy lifestyle for them.

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