[Immunological parameters in the assessment of the activity of a specific process in Mycobacterium tuberculosis-infected children and patients with intrathoracic lymphatic tuberculosis].

The data of a comprehensive study of 86 children aged 6 to 14 years, who were examined and treated at the Research Institute of Phthisiology for various manifestations of tuberculous infection: 25.6% with infected Mycobacterium tuberculosis with varying specific sensitization; 34.9% with minor forms of intrathoracic lymphatic tuberculosis (ITLT), 39.5% with disseminated processes into the intrathoracic lymph nodes, are analysed. Of the greatest informative value in the determination of the activity of tuberculous infection are RM V, VI, VII, and VIII dilutions in combination with immunological parameters of specific immunity: blast transpormation reaction (BTR) to PPD, a complex of serological reactions, IL-8, and lysosomal cationic test (LCT). Most children with ITLT showed a significant cellular response to PPD in the BTR test. It should be noted that on admission to the clinic, neutrophilic granulocytes were functionally inadequate in all the children as shown by LCT. The currently available immunological tests used in combination with the existing methods in the diagnosis of ITLT adequately evaluate the activity of tuberculous infection in children.

[Optimization of chemotherapy regimens in children with primary pulmonary tuberculosis].

The efficiency of treatment was analyzed in 142 children aged 3-14 years who had local forms of primary pulmonary tuberculosis. Therapy was performed according to regimens 3 and 1, by using individual dosage regimens depending on the extent and severity of a specific process, the presence of complications, and age-related features. In minor tuberculosis, solitary calcifications being detected without signs of the activity of tuberculous infection, the basic course of therapy was 6-8 months; it was performed using 2 drugs in individual cases. In disseminated and complicated processes, eliminated intoxication and visible X-ray inflammatory changes were observed in 58.8-61.7% of children by months 3-4 of treatment, which required a longer intensive phase, by administering 3 drugs in the continuation phase till 6-9 months.

[Approach to diagnosing tuberculosis of intrathoracic lymph nodes of a paraaortic group in children].

A hundred and seventeen patients aged 3 to 14 years, with suspected tuberculosis of intrathoracic lymph nodes (ILN) of a paraaortic group in the phase of calcination, were examined at the Clinic of Childhood Pulmonary Tuberculosis, Saint Petersburg Research Institute of Phthisiology. The comprehensive examination made the diagnosis of tuberculosis be cancelled in 35% of cases and confirmed in 65%, by determining the phase and extent of a specific inflammation. In 8.5% the local manifestations of the disease were absent along with the significant symptoms of intoxication and with the activity of tuberculous infection, which gave grounds to establish the diagnosis of tuberculous intoxication. Despite the fact that computed tomography revealed aortic ligament calcification, enlarged mediastinal lymph nodes were detected in 35%. High tuberculous infection activity and mediastinal ILN lesion in different phases of the specific inflammation were found in 15.4%, which was indicative of the chronic course of inflammation. The first detected isolated calcification in the paraaortic group of lymph nodes was diagnosed in 5.9%. The use of the presented complex, the diagnostic efficiency of which was 98%, significantly enhanced the diagnosis and reduced the number of errors in making the diagnosis.

[Estimation of the specific sensitization in a child and other immunological parameters in tuberculosis of intrathoracic lymph nodes during therapy].

The data of a comprehensive study of 86 children aged 6 to 14 years, who were examined and treated at the Research Institute of Phthisiology for various manifestations of tuberculous infection: 25.6% with infected Mycobacterium tuberculosis with varying specific sensitization; 34.9% with minor forms of intrathoracic lymph node tuberculosis (ILNT), and 39.5% with disseminated processes into the intrathoracic lymph nodes. RM V, VI, VII, and VIII dilutions are of the greatest informative value in the determination of the activity of tuberculous infection. Most children with ILNT showed a significant cellular response to PPD in the LBT test, The LCT test revealed that neutrophilic granulocytes were functionally inadequate in all the children. The currently available immunological tests used in combination with the existing methods adequately evaluate the activity of tuberculous infection in children.

[The pathomorphism and diagnosis of tuberculosis of intrathoracic lymph nodes in children]. / Patomorfoz i diagnostika tuberkuleza vnutrigrudnykh limfaticheskikh uzlov u detei.

In the past decade, the leading form of specific lesion in children is tuberculosis of intrathoracic lymph nodes, whose proportion in the pattern of clinical forms is as high as 85.7%. The period of 1990 to 2002 showed a 3-fold increase in the detection of bilateral lesion involving more than 3 groups of lymph nodes; the specific processes were complicated by 3.5 times more frequently. The proportion of generalized forms of primary tuberculosis increased from 5 to 15%. Inclusion of mediastinal computed tomography into a package of studies significantly evaluates the magnitude of enlargement of lymph nodes. The polymerase chain reaction test for MBT DNA in the diagnosis of tuberculosis of intrathoracic lymph nodes in the absence of bacterial isolation yields a positive result in 73.3% of the children, which is an additional tool in the comprehensive study, which verifies the activity of a tuberculous process.

[Principles in the diagnosis of primary and occult manifestation of tuberculous infection in children]. / Printsipy diagnostiki nachal'nykh i malovyrazhennykh proiavlenii tuberkuleznoi infektsii u detei.

An algorithm of complex examination is proposed for early diagnosis of tuberculosis in children with different manifestations of tuberculous infection. The results of clinical and laboratory studies of 209 children by using the most informative values in its diagnosis may establish it in 81.8% of cases in the outpatient setting. While revealing high specific sensitization, some signs of functional disorders or 1-2 direct X-ray signs of an intrathoracic lymph nodal response were detected in 53.1% of the children with suspected tuberculosis, this condition may be interpreted as a borderline between Mycobacterium tuberculosis infection and disease.

[Strategy of the management of children with lesions of intrathoracic lymph nodes during the calcinosis phase]. / Taktika vedeniia detei s porazheniem vnutrigrudnykh limfaticheskikh uzlov v faze kal'tsinatsii.

To verify the diagnosis of tuberculosis of the intrathoracic lymph nodes (paraaortal group) in calcination phase in hospital setting using tuberculin diagnosis, tomography, immunological and serological tests, clinical examination, epidemiological history, 70 children aged 3-15 years were examined. It was found that 58.6% of the children had 2-3 signs of tuberculosis activity. Therefore, they need 6-month antituberculous treatment in the sanatorium. 35.7% had no signs of active tuberculosis and can be followed up outpatiently. 5.7% exhibited more than 5 signs of tuberculosis activity and must be treated basically for 8-10 months in hospital.

[Current problems of childhood tuberculosis]. / Aktual'nye voprosy ftiziopediatrii,

Unsatisfactory antituberculous activity of specialized service has of late provoked a noticeable growth in pediatric cases of tuberculosis. The improvement of early diagnosis and combined treatment is among measures to correct the situation.

[Clinical and immunogenetic aspects of children with local and multiple forms of primary tuberculosis]. / Klinicheskaia i immunogeneticheskaia kharakteristika detei s lokal'nymi i mnozhestvennymi formami pervichnogo tuberkuleza.

Immunogenetic examination of 146 preschool children with local and multiple tuberculous lesions and 148 controls found out the key role of unfavourable premorbid background (low-quality BCG vaccine, family contacts, associated diseases) in the disease onset. General trends in systemic immunity shifts are characterized. These depend on the age, inflammation phase, severity of clinical symptoms. Representation of antigens HLA DR2, DR5, Cw2, Cw4 indicates that a child has a 5-9 times greater risk to develop tuberculosis. These data should be allowed for in forming groups of higher risk among children.

[Immunogenetic grounds for the development of local forms of primary tuberculosis in children]. / Immunogeneticheskie predposylki razvitiia lokal'nykh form pervichnogo tuberkuleza u detei.

The ++clinico-immunogenetic status of children with local forms of primary tuberculosis was analysed. Examination included 99 children aged 4-14 years with pulmonary tuberculosis. The control group comprised 51 children who has negative tuberculin tests and no intercurrent diseases. The HLA composition was determined by the A, B, C and DR loci. The HLA-DR2 representation is responsible for a high specific process risk and HLA-A11 and HLA-B15 can be characterized as antigens causing a resistance to tuberculosis infection.

[Clinical significance of HLA phenotype in childhood tuberculosis]. / Klinicheskoe znachenie HLA-fenotipa pri tuberkuleze u detei.

According to HLA system (loci A, B, C, DR), examination findings of 171 children aged between 1 and 15 years with different clinical manifestations of primary tuberculosis (including 49 with a pulmonary type of tuberculosis in different stages of inflammation, 46 with osteoarticular lesions of tuberculous etiology and 76 with generalized forms of tuberculosis) indicate a significant rise in the incidence of HLA-B7, B14 antigens. Moreover, the incidence of HLA-B14 antigen increases sharply as the degree of clinical manifestations and severity of inflammatory changes become more evident. In intrathoracic adenopathy, the presence of HLA-DR, DR2 antigens seems to promote earlier clinico-roentgenologic manifestations and a more serious course of an inflammatory process. In combined osteoarticular processes of specific etiology, an increase in the incidence of HLA-DR5, DR7 antigens is significant. The most evident drop in the immune T-system indices is traced in subjects bearing HLA-DR2 antigen. The given fact makes it possible to proceed on the assumption that genetically controlled immune response factors play a certain role in pathogenesis of tuberculosis.