Tuberculosis in children is a risk of getting sick. Ministry of Health of the Kirov Region Child fell ill with tuberculosis

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:

Identify people infected with tuberculosis.
Identify a risk group with a “turn” of tuberculin reactions.
Select individuals for vaccination.
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. Guérin 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

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

Tuberculosis in children is a rather dangerous disease. Parents should know that refusing 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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Tuberculosis continues to be one of the most common infectious diseases dangerous to all people, especially children and adolescents. The infection affects any organ, often developing in a latent form. It is necessary to know what the first symptoms are and begin emergency treatment, as the disease gradually progresses, and severe and not always curable types of tuberculosis arise. In many countries of the world, including Russia, children are vaccinated with BCG. Parents must understand what its significance is, whether it needs to be done a second time, and in what cases.

Content:

Ways of infecting children with tuberculosis

Tuberculosis bacteria (Koch bacilli) are extremely resistant to environmental conditions. They are capable of remaining in the human body for a long time in a “dormant” state, when their vital activity is almost completely suspended. In this form, the infection is not sensitive even to the action of anti-tuberculosis drugs.

The active development of bacteria begins if favorable conditions are created, when the human body is weakened and the necessary immune protection is absent. In children, immunity is formed in several stages up to the age of 16, so children from birth are at risk of contracting tuberculosis. In addition, the ease of penetration of infection into a child’s body is explained by the physiological characteristics of the structure of the organs of the respiratory system. They have worse lung ventilation than adults, the cough reflex is poorly developed, and the glands that produce mucus in the bronchi are underdeveloped, which facilitates the penetration of bacteria.

The infection spreads by airborne droplets and enters the child’s body as follows:

During inhalation of street dust or the air of unventilated rooms, where Koch bacilli enter when a sick person coughs and sneezes. When coughing, bacteria can be detected at a distance of 2 m, and when sneezing - at a distance of up to 9 m. The infection enters the lungs and affects various tissues of the body. You can even become infected on public transport or in a store.
When consuming meat and milk from animals infected with tuberculosis. The spread of bacteria occurs through the esophagus.
When contaminated dust gets into the eyes, the infection affects the conjunctiva, lacrimal sacs, from where it spreads to other organs.
When contaminated dust is rubbed into the skin or gets into the child's mouth from dirty hands.

Tuberculosis most often affects children living in poor sanitary conditions (dirty, damp, unventilated rooms), lacking nutrition, and with weakened physical development. A child living under normal conditions but in contact with a sick person can also become infected. Tuberculosis in infants is especially dangerous, since in them the disease very quickly becomes active, which leads to serious consequences.

Classification of tuberculosis

Depending on the stage of development of the infection in the body, the following types of tuberculosis in children are distinguished:

primary;
respiratory tuberculosis;
tuberculosis of other organs (except for nails, teeth and hair, it can affect any organs).

There are early and chronic types of the disease. In young children, the primary form most often occurs. More severe forms of the disease develop faster and are more difficult to treat than in older children and adolescents.

The most dangerous for infants are tuberculous meningitis and miliary tuberculosis (damage to the lungs, lymph nodes, kidneys).

Video: Symptoms of tuberculosis in children. Diagnostics

How the disease develops

The appearance of the first symptoms of tuberculosis in children is associated with the entry of mycobacteria into the mucous membrane of the nasopharynx. From here they pass into the lymphatic system, where they interact with phagocytes (cells of the immune system that absorb bacteria). However, mycobacteria are able to multiply quickly, and the immune system cannot cope with them. Harmful rods enter the bloodstream and spread throughout the body.

First signs in children

During the first 2 months, the body produces antibodies to mycobacteria. During this period, the child exhibits the same symptoms as with acute respiratory infections (slight increase in temperature, cough, increased anxiety). The younger he is, the brighter the manifestations. Despite the illness, the baby remains active.

The Mantoux test for tuberculosis gives a positive reaction, which may indicate infection. The further development of the disease depends on the number of bacteria that are in the body. If there are few of them, then the antibodies destroy the bacteria. If the Mantoux test result is positive, the child is thoroughly examined and treated in a specialized hospital.

If there are a lot of bacteria, they continue to multiply, then after about six months the formation of so-called tuberculous tubercles begins (an accumulation of mycobacteria around foci of tissue necrosis). Gradually they merge, and separate areas of tissue damage are formed in the lungs and thoracic lymph nodes. In some cases, the tubercles resolve on their own, and the development of bacteria stops.

But most often, the lesions become calcified and become overgrown with fibrous tissue, which leads to the formation of scars. If the focus is completely isolated, bacterial death may occur. Otherwise, the disease goes into a latent (inactive, dormant) form. So-called “primary tuberculosis” occurs. From the moment of a positive reaction to the Mantoux test, the child in this case should be under medical supervision and undergo treatment for 1 year.

If you do not pay attention to the appearance of symptoms of tuberculosis in children (such as fever, cough, weight loss and others), and do not take Mantoux, then over time an active tuberculosis process will begin in various organs (secondary tuberculosis).

Most people go through the primary infection stage. By the age of 1-12 years, approximately 25-30% of children are infected. By the age of 14, this figure already reaches 50%. By age 30, about 70% of people are infected.

Symptoms of tuberculosis

They appear as a result of poisoning of the body with waste products of mycobacteria, as well as destruction of tissues of various organs.

Intoxication of the body. One of the first signs of tuberculosis is loss of appetite and weight loss. The baby is weakening and lagging behind in development. He has increased sweating. The palms and soles of the feet are always damp. The temperature constantly stays around 37.2°-37.5°. There is a rapid heartbeat, pallor with the appearance of an unnatural blush on the cheeks, glitter in the eyes, and a feverish state.

Symptoms of damage to individual organs. These include:

soreness and swelling of the lymph nodes;
cough, hemoptysis (with lung damage);
shortness of breath and chest pain (with damage to the pleura);
lower back pain and urination disorder (with kidney damage);
back pain, bone deformation, limitation of movements (in case of spinal disease);
nausea, vomiting, pain in the navel (if the intestines or lymph nodes located in the peritoneum are affected).

Paraspecific reactions. They are considered to be the first signs of tuberculosis in children. Such signs are conjunctivitis and inflammation of the eyelids, which are accompanied by photophobia and lacrimation. Joint pain occurs, which can easily be mistaken for arthritis. Ring-shaped red spots appear on the skin of the hands, buttocks, legs and other parts of the body.

In latent cases, tuberculosis infection can only be determined using the Mantoux test and blood tests. Parents can suspect the presence of tuberculosis in a child based on a combination of the following manifestations:

a temperature that does not subside for a long time does not exceed 38° (antipyretics do not help);
cough lasting more than 2 weeks;
weight loss, lack of appetite, weakness, blue under the eyes, unnatural blush, sparkle in the eyes;
absence of any reaction of the body to conventional antibiotics.

Lymph nodes in various areas of the body become enlarged. Gradually, from soft and elastic, they become more and more dense. The acute course of tuberculosis resembles the flu or pneumonia in its symptoms.

Manifestations of various forms of tuberculosis in children

Depending on the organ in which the development of tuberculosis infection occurs, there are several forms of tuberculosis that have specific clinical manifestations.

Tuberculosis of the intrathoracic lymph nodes. This disease occurs most often in children. In an uncomplicated course, the infection affects several lymph nodes, and there are no pronounced symptoms. Tuberculosis capsules become calcified, and further proliferation of mycobacteria does not occur. In a complicated form, the infection spreads to neighboring lymph nodes and tissues. This form often affects children under 3 years of age, who have the weakest immunity.

Tuberculosis of the bronchi. As a result of the disease, the passage of air through the bronchi is disrupted, resulting in purulent pneumonia, which often ends in death. If treatment is not started immediately after the onset of symptoms and a diagnostic test, irreversible changes in the structure of the bronchi will occur, and the child may become disabled.

Tuberculous pleurisy. This form occurs in children 2-6 years old. Manifested by elevated temperature (37.0°-37.5°), shortness of breath and chest pain. With timely treatment, recovery occurs.

Pulmonary tuberculosis. Focal tuberculosis (single lesions) or disseminated tuberculosis (in the form of many areas of tissue necrosis) may appear in the lungs. Symptoms of such tuberculosis occur mainly in adolescents 14-16 years old.

Tuberculosis of bones and joints. Leads to the destruction of cartilage in joints, as well as vertebrae. Purulent inflammation occurs, fistulas may form, and paralysis of the limbs may occur due to compression of the nerve endings in the spine.

Tuberculous meningitis. This type of disease is very rare in children who have not received the BCG vaccine. This type of disease is most severe in infants. Convulsions and paralysis occur. A protruding fontanel indicates increased intracranial pressure. The disease is indicated by the postures characteristic of meningitis, which the baby takes due to tension in the muscles of the neck and back.

Tuberculous kidney damage. Occurs in approximately half of cases of primary extrapulmonary tuberculosis. The lesion begins with the formation of cavities in the walls of the organ, spreads inward, and spreads to the bladder and urinary tract. After healing, adhesions and scars form.

Diagnostics. Mantoux test

The only method for reliable diagnosis of tuberculosis is to check the body's reaction to the Mantoux test (also called the Perquet test). The tuberculin reagent includes a mixture of antigens to tuberculosis bacilli. When it is introduced under the skin or applied to its surface in an organism infected with bacilli or vaccinated with the BCG vaccine, an allergic response to tuberculin occurs. It does not appear immediately, but within 72 hours.

At the site of tuberculin injection, swelling appears and a papule forms. After 3 days, use a ruler to measure the diameter of the seal. A negative test is when the papule is completely absent, and redness of no more than 1 mm in diameter is observed around the injection site.

If the redness is 2-4 mm and there is slight swelling, the test is considered doubtful. If the infiltrate is larger than 5 mm, the test is positive. A positive result does not mean that the child is necessarily sick. He is referred to a phthisiatrician for treatment if there is a patient with tuberculosis in the family or if there is a sharp increase in the papule to 10-16 mm.

A positive result in a child previously vaccinated with the BCG vaccine indicates that the vaccination was successful. If the result is negative, it means the vaccine was of poor quality.

The purpose of such an examination is to confirm the presence of tuberculosis infection or the existence of a risk of disease. In addition, the study allows you to determine whether the child needs to be vaccinated again.

To diagnose tuberculosis, biochemical and immunological tests of blood and sputum, and x-ray examination of organs are also used.

Treatment of tuberculosis

Treatment takes place in 2 stages. To eliminate the symptoms of tuberculosis in children, an intensive course of treatment is first carried out simultaneously with several drugs that suppress the action of both active and dormant mycobacteria. Microorganisms sometimes show resistance to some of them and get used to their action. Therefore, a group of such drugs is used at once.

The second stage of treatment is restorative. Medicines are prescribed to maintain the functioning of the affected organs and prevent the proliferation of remaining microorganisms. Treatment uses vitamin preparations and, in some cases, hormonal agents. The patient is recommended to have an increased calorie diet.

Prevention of tuberculosis in children

As Dr. E. Komarovsky emphasizes, there are various types of preventive measures aimed at combating tuberculosis. Measures that the state should take: high-quality vaccination of children, creation of normal sanitary conditions in institutions and public places, ensuring a decent standard of living and normal medical care. Measures that parents can take: maintaining cleanliness in the house, teaching the baby to observe the rules of hygiene, strengthening the immune system, hardening, good nutrition, walks in the fresh air.

How to protect your child from infection if you have a sick relative

All members of the patient’s family, including children, are periodically tested for the presence of mycobacteria in the body. If the risk of disease is high, preventive treatment is carried out. It is necessary to carefully ensure that the patient uses separate dishes (they must be disinfected), household and bath accessories, and has as little contact with children as possible.

The apartment must be frequently wet cleaned using antiseptic agents. In this case, it is especially useful for children to be in the clean mountain air, in a coniferous forest.

Video: Causes of tuberculosis. The role of vaccination

Importance of vaccination

The peculiarity of tuberculosis infection is that even its own antigens cannot cope with it. Immunity to this disease is not developed. Therefore, vaccinating children with the BCG vaccine is of great importance.

Doctors emphasize that there is no universal remedy that completely protects children from tuberculosis. However, vaccination protects against the occurrence of the most severe, deadly forms of the disease (disseminated, miliary, tuberculous meningitis).

The vaccine is available in the form of a solution containing live tuberculosis bacilli. It is administered on the 3rd day of the baby’s life, before he has time to enter an unfavorable environment that creates conditions for infection.

Revaccination is carried out only if the Mantoux test subsequently gives a negative result. If the child was not vaccinated with BCG in the maternity hospital (the parents objected or the child was born too weak), then it can be done later, again taking into account the result of the Mantoux test.

After a few weeks, a bubble filled with liquid appears at the injection site, which gradually dries out, leaving behind a scar several millimeters in diameter.

It is important to know: The vaccination site must not be treated with anything, combed, rubbed, or the crust removed from it.

Since live mycobacteria are administered, in rare cases complications arise due to their spread. Such complications may include skin ulceration, enlarged lymph nodes, and bone diseases. If signs of tuberculosis appear in a child or any complications after vaccination, you must immediately show him to a doctor and begin treatment with anti-tuberculosis drugs.

Video: Prevention of tuberculosis. Reasons for the increase in incidence

The first symptoms of tuberculosis in children

In children, tuberculosis usually begins with the appearance of weakness, they stop gaining weight, and become irritable. If a child is studying at school, he gets tired of classes more than healthy children, becomes absent-minded and often begins to lag behind in his studies. If you measure his temperature, you can note a slight increase (up to 37.5 ° C, and sometimes higher). These children also experience enlarged lymph nodes. Their tuberculin tests are positive. All these signs of the onset of tuberculosis are due to the fact that tuberculosis bacilli, entering the body and settling in the lymph nodes, secrete poisons (toxins), which have a harmful effect on the body.

The main form of tuberculosis in children is chronic tuberculosis intoxication. Children often suffer from this form of tuberculosis. If you carefully monitor the child, catch early signs of the disease that are subtle at first, and provide appropriate treatment in a timely manner, the child’s body usually copes well with this disease.

Tuberculosis of the bronchial glands in children

Tuberculosis of the bronchial glands is often detected in children. Bronchial glands are located in the chest in the place where the bronchi and large blood vessels pass; There are especially many of them at the very root of the lungs. Very often, tuberculosis bacilli are carried there by the bloodstream, as a result of which inflammatory tuberculosis foci are formed in the bronchial glands. When the bronchial glands are affected, the disease manifests itself in various forms. Sometimes the disease begins like the flu - the child’s temperature rises and a cough appears, and this condition usually drags on for a longer period than is observed with the flu. Therefore, if the cough does not go away and the temperature remains high, it is very important to immediately take the child to the doctor and examine him for tuberculosis.

But tuberculosis of the bronchial glands does not always begin acutely. In many children, especially schoolchildren, the disease develops gradually. First of all, as with chronic tuberculosis intoxication, the child’s behavior changes: he becomes lethargic, capricious and tired of school. As the disease progresses, the child develops a cough, turns pale, and begins to lose weight. Children get sick with pulmonary tuberculosis less often than with tuberculosis of the bronchial glands. In the place of the lungs where tuberculosis bacilli enter, an inflammatory process develops (tuberculosis foci). Such lung damage in children is most often accompanied by a prolonged increase in temperature.

Pulmonary form of tuberculosis

Pulmonary tuberculosis in children is more difficult to treat than tuberculosis of the bronchial glands. But still it is completely curable. You just need to start treatment on time and continue it long and persistently. Only in rare cases, pulmonary tuberculosis in children has an unfavorable course and can lead to the breakdown of lung tissue and the development of lesions in other organs. This unfavorable course is observed mainly in young children. That is why young children must be very carefully protected from tuberculosis and their bodies must be strengthened in case of infection.

Manifestations of lymph node tuberculosis

In children, especially young children, tuberculosis can affect peripheral lymph nodes, which, due to inflammatory foci formed in them, significantly increase in size. Often these nodes soften, suppurate, pus flows out, and fistulas that do not heal for a long time are formed. With these forms of tuberculosis, children sometimes have skin lesions (scrofuloderma). They first look like a small tumor that can be felt deep in the skin; then the tumor enlarges, softens and, just as when nodes are affected, the contents burst out, after which a fistula is formed.

In order to prevent a child from developing this form of tuberculosis, it is necessary to immediately consult a doctor at the slightest swelling of the lymph nodes or the appearance of a tumor on the skin in order to promptly determine the cause of the disease and begin treatment.

Damage to bones and joints due to tuberculosis

Tuberculosis often affects bones and joints. Bone and joint disease can develop very slowly, sometimes over years. Children with tuberculosis of the spine or tuberculosis of the joints (usually the hip or knee) complain of pain when moving at the very beginning of the disease. Then their gait changes or they begin to limp. If children experience the described phenomena or complaints, you should immediately consult a doctor. With early treatment, many of the severe consequences of this disease (for example, lameness or the appearance of a hump) can be avoided.

Symptoms of meningeal tuberculosis

Children are more likely than adults to develop tuberculosis of the meninges (tuberculous meningitis). This is a very serious disease. Signs of tuberculous meningitis do not appear immediately; the disease develops within two to three weeks. The child becomes lethargic, restless, loses appetite, complains of headaches, his temperature rises, then vomiting and convulsions appear.

Tuberculosis is an infectious disease of the body, the causative agent of which is the bacterium Koch bacillus, named after its discoverer. Symptoms of this disease do not develop immediately, that is, it has an incubation period of 3 months to 1 year.

This the disease is characterized by the presence of specific tuberculosis formations. The target organs can be the lungs, kidneys, brain, intestines, eyes. It affects both adults and children.

Childhood tuberculosis is especially dangerous, as it is more difficult to tolerate and has a lot of consequences.

The cause of tuberculosis is the contact of a child with a sick person. As a rule, this is one of the family members. The disease is transmitted by airborne droplets, household, nutritional means, as well as from mother to fetus. Contributing factors may include:

decreased immunity due to frequent colds, HIV infection, therapy with hormonal and antibacterial drugs;
lack of active immunity, which occurs if the child has not received the appropriate vaccination;
unfavorable social environment.

Pathogenesis of the disease

Mycobacterium tuberculosis has significant resistance both in the environment and in the human body.

Covered with a protective shell, the tuberculosis bacillus can exist in the body of the carrier and not cause disease, provided there is good immunity.

Invading the human body, mycobacteria first of all enters the lymphatic system, and lymphocytes are the first cells that fight it. If they fail to cope with the task, the pathogen enters the bloodstream and spreads to the organs through the bloodstream.

Settling in the target organ, the pathogen forms a caseous accumulation of cells in the form of a bump - a granuloma. It differs from granulomas that accompany other diseases by the presence in the center of a necrotic lesion that has the consistency of cottage cheese. When these formations burst, many Koch bacilli scatter throughout the body or enter nearby tissues of the affected organ. The burst formation begins to disintegrate, and then thickens, scars and calcifies, that is, becomes covered with calcium salts.

The first signs of tuberculosis in children

At the beginning of its development, the disease does not cause any symptoms, that is, it is in the prodromal phase. It can last from 6 months to a year.

The only sign may be a positive Mantoux reaction.

After a latent period, the child begins to show the first symptoms of the disease. They manifest themselves as tuberculosis intoxication:

decreased child activity;
dizziness, headaches;
poor appetite, weight loss;
temperature: against the background of low-grade fever, temperature flashes up to 39° flash;
increased sweating, especially at night. The palms and feet in particular sweat profusely;
enlargement of lymph nodes of several groups. They are soft and painless.

These primary signs are a manifestation of all types of tuberculosis.

Symptoms

After the stage of tuberculosis intoxication, the primary tuberculosis complex develops. It can form in any organ, but most often the lungs are affected.

In this case, bacteria, choosing the most well-ventilated area of the lungs, accumulate in it and cause an inflammatory focus. It grows, and pathogens move to nearby lymph nodes, causing inflammation there too. Typically, this process develops in children with low immunity. It can heal on its own.

Signs of pulmonary tuberculosis in children in the early stages of the disease are the same symptoms of intoxication, an increase in body temperature to 37.5°. Often the onset of the disease can be confused with a respiratory infection.

Patients experience shortness of breath and cough. A child’s cough with tuberculosis varies in duration – more than 3 weeks. At the beginning of the disease it is dry, then gives way to wet.

A characteristic sign is the production of sputum with blood.

These children are very thin, pale, and their cheeks are flushed. A painful shine appears in the eyes.

When the lymph nodes of the mediastinum and the roots of the lungs are involved in the process, bronchoadenitis develops. The above symptoms are accompanied by pain between the shoulder blades, rough, whistling exhalation as a result of compression of the bronchial tubes or trachea by enlarged lymph nodes.

Cough also accompanies this pathology. It is dry and paroxysmal, reminiscent of whooping cough. A venous pattern appears in the upper part of the chest.

Classification by localization

Tuberculosis is a disease that can affect any organs. It all depends on where the mycobacterium gets through the bloodstream. Depending on the affected system, there are several types.

Pulmonary tuberculosis , including:

Primary tuberculosis complex.
Bronchoadenitis.
Tuberculosis of the bronchi, lungs, upper respiratory tract y.
Tuberculous pleurisy.
Pulmonary tuberculosis:
- focal- formation of small lesion areas in the lung tissue (within 1 segment);
- cavernous- a cavity forms in the lungs without signs of inflammation;
- fibrocavernous. There is a compaction of the cavernous cavity and nearby lung tissues;
- cirrhotic- lung tissue is replaced by connective tissue, causing the lung to lose its elasticity;
- disseminated- a severe form of tuberculosis infection, in which multiple focal lesions appear in the lungs. Then the infection travels through the blood and lymph to other organs;
- miliary- a type of disseminated tuberculosis, in which multiple foci that form in the lungs are small in size;
- infiltrative- characterized by the formation of an area of inflammation in the lung tissue with necrosis in the center;
- tuberculoma- this is tuberculous inflammation in a capsule larger than 10 mm.

Symptoms and treatment of pulmonary tuberculosis in children depend on the location and severity of the process. But still, the signs of manifestation are similar to each other: cough, hemoptysis, shortness of breath, chest pain.

Meningeal tuberculosis . The most common form is tuberculous meningitis. In this case, damage to the membranes of the brain occurs. The process is accompanied by severe headaches, mood lability, high fever, vomiting, and muscle hypotension.

Tuberculosis of the musculoskeletal system in turn is divided into:

spinal tuberculosis— the process at the beginning of the disease is limited to 1 vertebra. Therefore, intoxication and pain syndromes are weakly expressed. As the process progresses, symptoms increase. Sharp pain of various types and tension in the spinal muscles appear. To reduce pain, a person takes a forced position. His posture and gait change. The chest is severely deformed, curvature of the spine develops;
joint tuberculosis characterized by pain in the affected joint area. The skin over it is dense, hot to the touch, and swelling is pronounced. First, there is difficulty in flexing and extending the joint, then it becomes completely immobile. The general condition is disturbed;
bone tuberculosis accompanied by pain in the bones, and, as a consequence, dysfunction of the organ. It should be noted that the cause of tuberculosis of the skeletal system, in addition to the general
The cause of tuberculosis is overload of the musculoskeletal system.

Kidney tuberculosis . Its symptoms are pain in the back, pain when urinating, blood in the urine, and a violation of the general condition.

Lupus. Among children, the most common skin symptom is tuberculous chancre: first a reddish lump appears on the skin, which then turns into an ulcer. It is painless, but the lymph nodes located near it become inflamed.

Another type of childhood skin tuberculosis is its change in the area of the affected lymph node. The skin over it becomes blue, then ulcerates. Such formations are painless. Small bumps may also appear on the face and neck. If you press on them, they turn yellow.

Tuberculosis of peripheral lymph nodes in children it is accompanied by painless enlargement. They are mobile. As inflammation increases, they rupture, forming a fistula with purulent discharge. Hyperthermia up to 40° and headaches appear. The submandibular, chin and cervical lymph nodes are most often affected.

Intestinal tuberculosis accompanied by abdominal pain, disturbances of intestinal motility, bloody stools, and hyperthermia. The general condition is also disturbed.

Tuberculosis of the eye causes decreased vision, photophobia, and tearfulness. Blackness or blurred vision and pain appear.

It is important to know that tuberculosis can occur in an open form, that is, with the release of Koch's bacillus into the environment, and, consequently, with further infection of people in contact with the patient. It can also be in a closed form, in which bacteria do not enter the external space.

Features of tuberculosis in children and adolescents

Tuberculosis for children – an extremely serious disease that leaves behind a number of complications.

Features of the course of tuberculosis in children under 2 years of age characterized by the particular severity of the process. As a rule, it is generalized. From the primary focus, pathogenic microorganisms travel through the bloodstream to other organs, significantly complicating the child’s condition. Such children often develop disseminated, meningeal tuberculosis and even sepsis.

In older children the immune system is more advanced. It allows you to localize the process, preventing its generalization. They are characterized by tuberculosis of the lymph nodes.

The younger the child, the worse he tolerates the disease. This is due to the peculiarity of the child’s body: its immune system is still immature, unformed, because of this it cannot fully resist infection.

The next critical age for the development of the disease is adolescence. It is also characterized by diffuse forms of infection, affecting the lungs and brain. This is due to hormonal surges that lead to an imbalance in the body, and, as a result, a reduced ability to resist the disease.

A form of the disease that occurs only in children is congenital tuberculosis.

Infection of the fetus occurs from a sick mother through the placenta or when the child swallows amniotic fluid. In this case, the pathogens of the disease are primarily transferred through the bloodstream to the baby’s liver, where the initial focus of the pathological process is formed.

These babies are born premature. After a month, the first symptoms of the disease begin to appear: hyperthermia, depression or anxiety. Symptoms of respiratory failure develop very quickly. Often the infection causes inflammation of the lining of the brain. In this case, there are signs of damage to the central nervous system, tension in the neck muscles, and discharge from the ears.

The most common type of childhood tuberculosis is damage to the lung tissue. Pulmonary tuberculosis in children occurs in 80% of cases. Therefore, the appearance of a cough in a child, which does not go away within a month, and an increase in temperature should alert parents and become a signal to examine the baby.

The most effective way to prevent tuberculosis is the BCG vaccine. It is a weakened strain of the tuberculosis bacillus. Vaccination for newborns is less aggressive. The BCG-M vaccine is used for it. The first vaccine against tuberculosis was made in France in the 20s of the 20th century.

Timing of BCG vaccination:

carried out in the maternity hospital for newborn babies on days 3-7 of life;
RV1 (that is, 1 revaccination) is carried out at 7 years;
RV2 is performed at 14 years of age in healthy children.

Immunity after BCG vaccination is formed after 2 months and protects the child from tuberculosis for 4 years. This is especially important for young children, since tuberculosis can be a fatal disease for them.

The vaccine is given intradermally in the upper outer third of the shoulder.. First, a slight swelling appears at the injection site. Then it turns into a pustule - a bubble with liquid. The pustule bursts, forming a small ulcer. The ulcer becomes crusty. After 6 months, a scar forms in its place. He should be 5-8mm in size. This indicates successful vaccination.

Sometimes after vaccination there is no trace left. This may indicate innate immunity to the disease.

Complications after receiving the tuberculosis vaccine may include::

cold abscess;
BCGit;
keloid scar.

Contraindications to BCG:

if among the child’s contacts there are patients with tuberculosis;
if the mother is diagnosed with HIV infection;
diseases of the nervous system;
any acute diseases;
immunodeficiency; neoplasms;
prematurity; body weight less than 2.5 kg;

The diagnosis of the disease is the Mantoux reaction. This is not a vaccine that protects your child from the disease. This is an indicator that shows whether the baby is sick or not.

The Mantoux test is placed in the middle third of the forearm. Tuberculin is injected, which is a filtrate of killed mycobacteria. It contains tuberculoprotein, which acts as an allergen. The drug is administered intradermally, and a “lemon peel” forms at the injection site.

The result is assessed no earlier than after 48 hours:

if a compaction (papule) less than 5 mm in size has formed at the injection site, this indicates a negative reaction;
5 mm-10mm – the reaction is doubtful;
if the size of the papule is more than 10mm, then the reaction is considered positive and may be a sign of tuberculosis.

It is advisable not to wet or rub the “button” formed after grafting.

It should be noted that a positive Mantoux test can be observed in healthy children within 1-2 years after BCG.

Contraindications for the Mantoux test:

hyperthermia;
allergies in the acute stage;
convulsions;
skin diseases;
quarantine.

Diagnosis and tests for tuberculosis

Diagnosis of the disease is aimed at identifying pathogenic bacteria in the body’s environments, as well as in target organs.

Early detection of the disease helps to cope with it in the shortest possible time with minimal damage to the body.

Diagnosis of tuberculosis in children is very rarely goes without the Mantoux reaction. It is carried out annually, starting from 1 year of age. It allows you to identify the disease in the early stages of the disease. And also those people who are carriers of this infection, but do not get sick themselves.

Other research methods include:

Fluorography, radiography, tomography.
Bacteriological method. It consists in identifying the pathogen in various environments of the body. First of all, it's phlegm. As well as punctate from the pleural and abdominal cavities, joints, and lymph nodes. For analysis, cerebrospinal fluid, contents of wounds and fistulas, blood, and urine can be used. The modern method of bacteriological research is PCR diagnostics. This is a fairly sensitive method. A small amount of bacteria is enough to carry it out. Suitable for studying any body fluids. It involves identifying the DNA of a bacterium. This procedure is so accurate that it can detect the disease when other tests are negative.
Bronchoscopy.
Biopsy of the affected organ. Most often performed during diagnostic operations, when other methods are of little value. Most often this is a biopsy of lymph nodes, as well as lung tissue when opening the chest.

Treatment

Treatment of tuberculosis in children quite long. It is aimed at suppressing the development of tuberculosis bacillus and restoring the affected organ.

Treatment of identified tuberculosis begins in a hospital when bacteria are concentrated in the extracellular space. The person is contagious.

Stage 1 of treatment – taking anti-tuberculosis drugs. These include: rifampicin, isoniazid, pyrazinamide, ethambutol and others. They are the most effective and least toxic. The treatment regimen must contain at least 3 such drugs. Antibacterial therapy is also used.

Also widely used physiotherapeutic treatment methods. For exudative and necrotic inflammation, UHF therapy, inhalation, and electrophoresis are indicated. In the future, ultrasound, magnetic therapy, and laser are used to resolve infiltrates, restore tissue, and heal wounds.

Required application immunostimulating drugs to increase the body's resistance to fight infection.

The patient must maintain an appropriate regimen, eat a balanced diet, and lead a healthy lifestyle.

When the stage of the disease enters a closed form, treatment of tuberculosis at home under the supervision of a phthisiatrician is allowed.

If conservative treatment is futile surgical methods are used. This may involve removing part of an organ or affected area.

Treatment of tuberculosis is a fairly extensive process that requires patience and correct implementation of all its stages. It is complex, that is, it affects the body from all sides in different ways. It must be remembered that the earlier the disease is detected, the easier and faster it is to cope with it.

Prevention of tuberculosis in children and adolescents

Prevention of tuberculosis for a child begins in the maternity hospital with the first BCG vaccination.

Vaccination is an important, and probably the most important step in preventing the development of the disease. And you shouldn't neglect it.

Boosting a child's immunity– the second most important stage of prevention. A balanced, fortified diet, hardening, proper work and rest mode are the key to a healthy life for a baby.

Also plays a role in preventing the development of the disease. early detection of infected people and their temporary isolation to prevent infection of a healthy part of the population.

Tuberculosis is a rather complex disease and, unfortunately, is highly contagious. Every year the number of people infected with this disease is growing. That is why so much attention is paid to tuberculosis prevention. After all, it is much better to strain the immune system than to endanger the life of a child.