[Development of tuberculosis in children and adolescents in extreme circumstances]. / Razvitie i techenie tuberculëza u detei i podrostkov v ékstremalnykh usloviiakh.

The screening for tuberculosis among children and adolescents living in seismically dangerous regions, from families of the refugees and migrants has elicited a dramatic deterioration of tuberculosis-related epidemiological situation not only in the disaster regions, but in Armenia on the whole. The number of children and adolescents with active pulmonary and CNS tuberculosis has been growing. The disease is characterized by frequently occurring severe, disseminated and generalized forms with distruction and bacterial discharge. More cases have been detected of tuberculous meningitis, caseous pneumonia with manifest tuberculous intoxication, family tuberculosis.

[The course and outcome of tuberculous meningitis in cases of detection of Mycobacterium tuberculosis in the cerebrospinal fluid]. / Techenie i iskhody tuberkuleznogo meningita pri obnaruzhenii mikobakterii tuberkuleza v spinnomozgovoi zhidkosti.

The cases of M. tuberculosis detected in cerebrospinal fluid of the patients with tuberculous meningitis being under observation during 1968-1987, are analysed. The second decade (1978-1987) witnessed a greater percentage of M. tuberculosis found in the cerebrospinal fluid of the patients (including children, adolescents and adults). Children and adolescents constituted the majority of the cases. M. tuberculosis agents were detected by means of bacterioscopy and inoculation in 33.3 and 66.7% of the patients, respectively. In 15.5% of the cases, primary resistance to antibacterial drugs was revealed. The detection of M. tuberculosis in the cerebrospinal fluid is now considered to be an unfavourable factor indicating the severity of the disease and entailing, to a certain extent, its adverse outcome. Antibacillary drug resistance of the M. tuberculosis strains isolated from cerebrospinal fluid may serve as an aggravating condition. As a rule, the disease in these cases has a serious course, making the treatment much more difficult and causing unfavourable outcomes.

[The course and outcome of tuberculous meningoencephalomyelitis]. / Techenie i iskhody tuberkuleznogo meningoéntsefalomielita.

Nineteen patients aged 8 months to 62 years suffering from tuberculous meningoencephalomyelitis were followed up from 1968 to 1987. The given pattern of tuberculous meningitis was established to occur mostly in adults. In children and adolescents the disease onset was mostly acute or subacute, whereas in adults, it was progressive. It was also established that as a rule children and adolescents manifested a descending pattern of meningoencephalomyelitis whereas adults an ascending one. The disease was marked by clinical polymorphism, creating certain difficulties for early diagnosis. Tuberculous meningoencephalomyelitis still remains the most rarely occurring and severe disease involving the meninges and central nervous system. It is not infrequently associated with the development of irreversible complications, thus being a cause of disability and high enough lethality.

[Acute disseminated pulmonary tuberculosis at the present time]. / Ostryi disseminirovannyi tuberkulez legkikh s sovremennykh usloviiakh.

During the period from 1968 to 1987, 50 children, adolescent and adult patients with acute disseminated tuberculosis of the lung were examined in a Republican Tuberculosis Hospital. It was concluded that the number of patients with that form of tuberculosis increased within the last 10 years and the classic form of acute disseminated tuberculosis undergone reversion. The onset and process of such tuberculosis were acute and had the classic characteristics in the children. In the adults, they were observed less frequent. The onset of the disease and its signs in the adults were rarely pronounced. The x-ray picture was typical in all the cases. Children under 5 years from tuberculous infection foci with defective vaccination or not vaccinated at all predominated among the patients. It was demonstrated that in all the age groups the central nervous system was the most frequent localization site of acute disseminated tuberculosis. In the majority of the patients the disease detection was late and the outcomes were severe.

[The course and outcome of tuberculous meningitis in adults]. / Techenie i iskhody tuberkuleznogo meningita u vzroslykh.

The course and outcomes of tuberculosis of the central nervous system (CNS) in adults were studied comparatively within two 10-year periods i.e. from 1968 to 1977 and from 1978 to 1987. It was shown that within the last 10-year period the number of the adults with tuberculous meningitis had lowered while the proportion of the adults with tuberculosis of the CNS among all the patients with that form of tuberculosis had remained unchanged. There was no increase in the number of the patients of the elderly and senile ages. Acute onset of the disease as well as asymptomatic and atypical onsets and courses were recorded. It was stated that association of tuberculosis of the CNS with active pulmonary tuberculosis became more frequent. Higher levels of neutrophilic-lymphocytic pleocytosis as compared to the previous ones, marked hypoglycorrhachia and more frequent isolation of mycobacteria from the liquor were noted. No increase in the efficacy of the treatment was stated. The death rate did not change. The situation should be explained by the incidence of common forms of pulmonary tuberculosis including fibrocavernous and disseminated tuberculosis, insufficient prophylaxis, the incidence of concomitant diseases, sometimes acute onset of the disease, asymptomatic process of the disease, inattention of physicians as to possible incidence of tuberculous meningitis.