How to recognize the first signs of tuberculosis in children. Tuberculosis bacillus in children - the first signs in the early stages Signs of tuberculosis in children

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.

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 typical for 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 sensitive 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 is a dangerous infectious disease caused by the tuberculosis bacillus (Koch bacillus). Most often it affects the lungs, although other organs may also be involved.

Currently, effective treatment regimens for this disease have been developed using anti-tuberculosis drugs, which must be taken exactly as prescribed by the doctor. Depending on the form of the disease, treatment can last from 3 to 9 months or more.
Tuberculosis remains one of the leading causes of death in the world. In Russia, the situation has also been worsening in recent years: the number of cases is growing, and hence the spread of Koch’s bacillus among the population. If unrecognized and untreated, tuberculosis can have fatal consequences. However, it is possible to prevent and cure it.

How does tuberculosis become infected?

Tuberculosis infection occurs through the lungs from a sick person who releases the bacilli into the external environment when coughing or sneezing. The tuberculosis bacillus is very stable and can survive in street dust for up to 2 months. A person who inhales infected air particles becomes exposed, and the bacillus settles in his body. Such a contact carrier may be among your environment, relatives and close people. According to scientists, up to 1/3 of the world's population are latent carriers of the tuberculosis bacillus.

Despite infection, most infected people do not develop tuberculosis. Only 5-10% of carriers develop an active form of tuberculosis during their subsequent lives, while in the rest the bacillus remains dormant under the control of the immune system.

In extremely rare cases, the tuberculosis bacillus can enter the body bypassing the lungs, for example, during BCG vaccination in the maternity hospital. Some children are born with very weak immunity and cannot resist even weakened strains of the bacillus. In this case, a tuberculous process may develop at the injection site, which parents usually notice by enlarged lymph nodes under the armpit on the side of the vaccine. This process does not spread to the lungs, but requires a full course of treatment.

Features of childhood tuberculosis

For a child's body, especially under 2 years of age, the tuberculosis bacillus is much more dangerous than for adults. In children, the percentage of the disease becoming active is much higher, and the risk of developing severe generalized forms is also very high: miliary tuberculosis, sepsis, tuberculous meningitis.

A major role in the development of tuberculosis is played not only by the fact that the bacteria enters the body, but also by the condition of the infected child. Strong predisposing factors are poor nutrition, vitamin deficiencies, exhaustion, constant stress and lack of sleep - in other words, unfavorable living conditions. This is why children from poor and marginalized families are most at risk of getting sick.

Symptoms of tuberculosis in children

Most often, pulmonary tuberculosis manifests itself as a cough. At the onset of the disease, it may resemble bronchitis or even a cold. However, instead of getting better after a week, the child continues to get sick, the cough gets worse, and the sputum may turn pink. The child looks exhausted, loses weight, and loses weight. The temperature rises in the evening, and during the day it can be normal.

Therefore, for any long-term lung diseases, the doctor must refer the child for examination to an anti-tuberculosis dispensary (PTD). The examination includes a thorough examination, x-rays of the lungs, detailed blood tests, sputum cultures, and may require a CT scan. You should not refuse to go to the PTD if you were referred by your local pediatrician - the child’s health is more valuable than prejudice.

Extrapulmonary tuberculosis (bone, articular, skin, etc.) manifests itself differently, depending on the site of introduction of the pathogen. An indispensable symptom is elevated temperature and enlarged local lymph nodes.

An important diagnostic criterion for tuberculosis is the Mantoux reaction. It shows whether the child has encountered the tuberculosis bacillus before. The diagnostic value of this method is far from 100%; false-positive and difficult to interpret results occur. Instead of Mantoux, nowadays there is a more modern method - an intradermal test with the drug Diaskintest.

Treatment of tuberculosis in children

For the treatment of tuberculosis, special regimens have been developed, which include special anti-tuberculosis drugs - “Tubazid”, “Ftivazid”, “PASK”, “Gink” and others. The duration of treatment ranges from 3 to 9 months, and sometimes more, depending on the form, as well as where the treatment will take place - at home or in a hospital. After this, it is recommended to go with the child to a sanatorium located in an area with a dry climate.

As a rule, children tolerate treatment well, and damaged lung tissue recovers faster than in adults. But it is worth noting that the medications taken can cause side effects such as dizziness, headache, fever, allergic rash, eosinophilia in the blood, abdominal pain, nausea, vomiting, flatulence. You should not be afraid of this, because the consequences of tuberculosis are much worse and more serious than the side effects of drugs.

Prevention of tuberculosis in children

In our country, due to the widespread prevalence of tuberculosis, all children in the maternity hospital are given the BCG or BCG-M vaccine (depending on whether there are adults in the child’s family who can excrete tuberculosis bacilli). This is a necessary primary prevention measure, which significantly reduces the risk of severe forms of tuberculosis (meningitis, sepsis) and reduces mortality from this infection.

However, BCG is not a panacea, and in order to avoid infection, a small child should be protected in every possible way from contact with potentially sick people: if possible, do not use public transport, avoid train stations and other public places, large crowds of people. If there is a relative in the family who is sick with an active form of tuberculosis, the child should not live in the same apartment with him or her and communicate until they completely stop excreting the tuberculosis bacillus.

At school, all children must receive a BCG booster vaccination, since immunity fades over time. To identify potential carriers of the tuberculosis bacillus, a Mantoux test is performed, an alternative to which can be a more modern test with Diaskintest. If you don’t want to do either one or the other, then a more expensive, but more accurate option is possible - PCR diagnostics using a blood test. If a rod is detected in the body, the PCR test will be positive.

Children with tuberculosis account for 16-19 people per 100 thousand healthy people. These statistics include those cases where the disease showed clinical signs. At the same time, infection with Koch bacillus (without symptoms) in Russia ranges from 15% to 60%, depending on the region. All this shows that tuberculosis in children and adolescents is a problem in domestic medicine.

Childhood tuberculosis is divided into two forms according to the method of penetration of bacteria. Primary - when the pathogen enters the body from the external environment. Secondary - when there are foci of bacterial growth in the body, and when they open, they release the pathogen into the blood. Normally, during chemoprophylaxis and vaccination, signs of tuberculosis do not appear in children. However, if prevention is not followed, tuberculosis develops in children.

What is childhood tuberculosis

Childhood tuberculosis differs in its course and characteristic symptoms, for this reason it is distinguished as a separate form of the disease. The special course of the disease is determined by low resistance and the inability of the child’s body to localize the disease.

Photo 1. Dry cough is a striking symptom of tuberculosis lung disease among children and adolescents.

A characteristic syndrome is tuberculosis intoxication, that is, when the disease occurs without a specific localization. The course of the disease depends on the age of the child and general health. The body of children under 2 years of age is not able to stop the spread of the pathogen, and the first vaccination should be carried out at an early age.

The causative agents of tuberculosis are transmitted to children in any possible way: nutritional, airborne, contact. Perhaps even intrauterine infection or during childbirth. The risk group includes children and adolescents who:

• are sick with HIV infection;
• suffer from diabetes;
• are sick with cancer;
• were not vaccinated;
• take hormonal drugs and cytostatics;
• use antibiotics for a long time;
• grow up in unfavorable families or in orphanages;
• live in unsanitary conditions.

Photo 2. Antibiotics are a key element of drug therapy in the treatment of tuberculosis diseases in children.

Signs of tuberculosis in a child

In children, four types of the disease are more often observed:

• latent form, at an early stage of the disease
• tuberculosis intoxication
• primary form
• tuberculous bronchoadenitis

In addition, classic adult forms of the disease are observed, when the lungs and other organs are affected. Up to 2 years of age, a child suffers from tuberculosis intoxication; in children over 2 years of age, the primary form and tuberculous bronchoadenitis are registered in 75% of cases. Symptoms vary depending on the clinical form.

Latent form

The latent form lasts up to 6 months, less often - up to a year. The course of the latent form of tuberculosis is divided into two stages:

1. The first phase has no external signs. Even diagnostics with the Mantoux test cannot detect the infection.
2. The second phase begins when a positive reaction to the Mantoux test appears. This moment is called the tuberculin turn.

The second phase is also asymptomatic, the child feels well. Due to the mildness of the form, treatment can be carried out on an outpatient basis. With treatment and favorable conditions, the infection can be suppressed, and tuberculosis goes away without clinically manifesting itself.

Photo 3. Diaskintest is a more accurate method for determining immunity to the tuberculosis pathogen than the Mantoux test.

Tuberculosis intoxication

In older children, this type of tuberculosis is considered intermediate and develops into the primary type and localized forms (usually bronchoadenitis). In this case, a clinical picture arises that has no characteristic signs. Main symptoms:

• high fatigue;
• decreased or complete lack of appetite;
• changes in higher nervous activity - lethargy and apathy or excitability;
• anemia;
• decreased muscle tone and skin turgor;
• peripheral lymph nodes increase by 5-6 mm;
• the liver and spleen may become enlarged;
• a prolonged low-grade fever appears - up to 37.5°C - for no apparent reason and fever.

This form is confused with a cold. More often it does not linger and turns into another type of tuberculosis. If this variant of the disease persists for a long time, chronic tuberculosis intoxication is diagnosed. This development is possible in children under 2 years of age.

Photo 4. High fatigue, lethargy and apathy in a child may be symptoms of the development of tuberculosis.

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Primary tuberculosis form

With this form, three characteristic signs develop:

• a focus of inflammation appears in the area of ​​infection;
• lymphadenitis;
• damage to local lymph nodes;

Photo 5. Tuberculous lymphadenitisThe child hasis an inflammatory lesion of the lymph nodes due to tuberculosis infection.

This type of damage is typical for young children. In a child over 2 years of age, this form is possible if the pathogen is highly virulent or the amount of infection was large. In 95% of cases, the symptoms are localized in the lungs, in which case the following are added to the symptoms:

• weakness;
• headache;
• temperature increase by 0.5-1°C;
• cough;
• dyspnea;
• fatigue;
• lack of appetite.

Tuberculous bronchoadenitis

In this form, foci of tuberculous lesions are localized in the intrathoracic lymph nodes, often at the root of the lung and mediastinum. In addition to general signs, such as low-grade fever and intoxication, characteristic symptoms appear:

• pain between the shoulder blades
• two-tone cough
• whistling noisy exhalation
• expansion of the vascular network in the upper chest

Photo 6. Tuberculous bronchoadenitis in children is characterized by a specific two-tone cough and noisy exhalations.

These symptoms appear due to compression of the lymph nodes, which are located inside the chest, near the bronchi, trachea and other parts of the respiratory system.

Features of the treatment of childhood tuberculosis

Basic rules of therapy: complex treatment, continuity and phasing. There are three stages of treatment:

1. Hospitalization or inpatient treatment of tuberculosis in children. It is carried out for most forms of tuberculosis, with the exception of the latent form. This is done so that TB doctors monitor the child’s condition. The great advantage of this stage is the isolation of the patient from healthy children, so that the infection does not spread.
2. Direction to the sanatorium. The referral is given after the clinical signs of the disease have disappeared and bacterial excretion has ceased. The first condition guarantees that the child in the sanatorium will not be in danger of relapse, and the second is a guarantee of the non-spread of the disease. Spa treatment promotes recovery thanks to a special relaxing atmosphere and physiological procedures.
3. Ambulatory treatment. Involves taking anti-tuberculosis drugs and observation at a dispensary. This is done due to the fact that the causative agents of tuberculosis multiply for a long time in a latent form in tubercles - connective tissue cysts. When these foci burst, they introduce new pathogens into the body. To monitor the patient’s condition and prevent exacerbations, it is necessary to observe a TB specialist for at least a year.

Chemotherapy includes the use of isopiazide, rifampicin, ftivazide and other drugs. The course of administration is from 2 to 3 months, after which the child switches to a maintenance dose. If after a course of treatment there is no recovery, then surgical treatment is resorted to, which includes the removal of foci of bacterial growth.

Photo 7. Bronchitis in a child caused by a tuberculosis infection is diagnosed by an experienced TB doctor.

Possible complications

With late therapy, infectious and inflammatory damage to the lung tissue appears. With insufficient treatment, foci of pathogen reproduction occur, which become overgrown with fibrous tissue or become calcified.

If these lesions are not detected and treated, then relapses occur with the development of atelectasis, collapse of lung tissue, and exudative pleurisy. All this makes further treatment of children with tuberculosis lengthy.

Photo 8. Fibrous-cavernous pulmonary tuberculosis is a form of the disease characterized by the breakdown of lung tissue.

Prevention of tuberculosis in children

Pediatric practice divides preventive techniques into two groups. The first includes methods that are used for children who have not had contact with tuberculosis patients. The second group of preventive methods is used if the child has had direct contact with a tuberculosis patient.

For uncontacted children

Nonspecific prevention - hygiene by the child himself and his relatives. Schools, kindergartens, and premises for children's groups are ventilated and disinfected. Staff undergo a medical examination every six months, including fluorography for tuberculosis.

Photo 9. Tuberculous pneumonia in a child over 12 years of age can be detected using an X-ray examination.

An effective method of prevention is identifying the disease in the early stages. To do this, a Mantoux test is done once a year, and children over 12 years old undergo fluorography.

Table of vaccination of children against tuberculosis by age.

In addition, vaccination is carried out using BSG. These are weakened bovine tuberculosis bacteria that are similar to human pathogens. The drug is injected under the skin in the scapular area. A stable immune system appears 2 months after vaccination and lasts 5-7 years.

Photo 10. To maintain the ruben’s immunity to tuberculosis pathogens, BCG revaccination is carried out at the age of seven and fourteen.

For contacted children

Nonspecific prevention consists of hospitalization and isolation of sick relatives, since the main source of infection is people. If tuberculosis is detected in an adult, his children may also be placed in a children's hospital. The hospital will allow him to monitor his condition.

Since fluorography in young children does not confirm the presence or absence of the disease (since there is no localization), preventive treatment with isoniazid is carried out without waiting for the first signs of tuberculosis disease in children. The course lasts six months, dosage - 5 mg/kg.

Video: More about childhood tuberculosis

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Tuberculosis is considered one of the most serious and dangerous diseases. This disease often affects not only the lungs, but also other vital organs without any symptoms. Sometimes parents mistake the signs of tuberculosis for manifestations of another disease - ARVI or influenza.

First of all, the disease poses a danger to infants, since diagnosing tuberculosis in children entails many difficulties. Doctors often spend months treating simple bronchitis or a respiratory viral disease, starting tuberculosis at an early stage. The only sure way to protect yourself from the disease is to follow preventive measures and not refuse vaccination.

The danger of tuberculosis is that at the initial stage of development there are absolutely no symptoms

What is tuberculosis and what is its danger to a child?

Tuberculosis in children is an infectious-inflammatory process in the internal organs and tissues of the body caused by the penetration of Mycobacterium tuberculosis. The infection spreads throughout the body, initially affecting the lungs and forming tuberculous tubercles in them.

Diagnosis and treatment of the disease largely depend on the age category of the patient. The disease is most critical for three ages - infants, infants under 3 years of age and adolescents.

This disease is difficult to identify; its symptoms are very similar to ordinary ARVI. Parents therefore turn to a specialist not at an early stage, but when the infection has already settled in the baby’s body. The only way to detect the disease in a timely manner is to regularly follow preventive measures.

If tuberculosis is detected in a timely manner, treatment of the baby will take no more than 2-3 months. Otherwise, the pathogenic process will last for months, moving from remission to an acute form.

Doctors distinguish three main groups of forms of tuberculosis:

• unspecified localization;
• respiratory tract;
• extrapulmonary lesions.

Tuberculosis of unspecified localization most often affects young children or teenagers. This form is usually detected months and sometimes years after infection, so it often develops into chronic tuberculosis. The main ways to diagnose it are a blood test or PCR.

Respiratory tuberculosis occurs in the mildest form and does not entail dangerous consequences. The incubation period lasts from several weeks to a year until the first manifestations of the disease occur.

Extrapulmonary tuberculosis is a secondary disease that affects various internal organs of the child:

1. Tuberculosis of the meninges is a disease that is extremely dangerous for the life of a child. In a child’s body, the disease is very severe and entails many unpleasant consequences - mental and mental retardation, paralysis, convulsions. Children under one year of age who have not been vaccinated with BCG are at main risk. The first symptoms are accompanied by elevated body temperature, intoxication of the body, headaches, and convulsions. With timely diagnosis and effective treatment, tuberculous meningitis resolves within a few months.
2. Tuberculosis of bones and joints affects the spine, as well as the hip and knee joints. The disease occurs with clearly defined symptoms – disturbances in the child’s movements and gait, accompanied by pain.
3. Tuberculosis of the kidneys is a fairly common form of the disease in adolescents. Due to the primary infection of the lungs, the infection penetrates through the blood into neighboring organs and most often affects the kidneys.
4. Tuberculosis of peripheral lymph nodes mainly occurs in children with HIV. The main symptom of the disease is enlarged lymph nodes. The child develops subcutaneous balls filled with pus.

How does the infection enter the body?

The initial manifestations of tuberculosis depend on how the bacillus entered the child’s body. Parents should be aware of the methods of infection in order to prevent the occurrence of the disease in their baby.

The most common type of infection is airborne transmission.

Mycobacteria enter in several ways:

• airborne, which is considered the most common when children are infected, since the Koch bacillus is transmitted by being in the same room;
• airborne dust, when a child inhales dust particles containing the tuberculosis bacillus;
• through certain food products, for example, when consuming meat or milk from sick animals;
• due to infection on mucous membranes or damaged skin;
• transplacentally, that is, through the placenta of an infected mother.

The first and subsequent symptoms of different forms of the disease

In medicine, it is customary to distinguish several types of tuberculosis of the respiratory organs, which manifest themselves with individual symptoms. The most famous type is tuberculosis of the intrathoracic lymph nodes. It occurs in children of any age. The infection affects the intrathoracic lymph nodes on one or both sides.

Accordingly, three forms are distinguished:

• The minor form of tuberculosis of the intrathoracic lymph nodes often occurs without any symptoms. One or more lymph nodes in the child’s body enlarge slightly. The most effective diagnosis of this disease is carried out not only by X-ray of the lungs for the presence of tuberculosis, but also by computed tomography.
• The infiltrative form most often manifests itself in school-age children. With the help of a photo X-ray of the lungs, where a significant amount of fluid and dead areas are clearly visible, the disease is very easy to identify. Clinical signs of this form are increased body temperature up to 38-39 degrees for 2 weeks, wet cough, muscle weakness, increased sweating.
• The tumorous form is the most dangerous form of tuberculosis of the intrathoracic lymph nodes. In the child’s body, several lymph nodes are damaged and pus forms in them. The disease develops with pronounced symptoms of intoxication, whooping cough and difficulty breathing.

With tuberculosis of the lungs and bronchi, the child will have a cough

Other types of respiratory tuberculosis are also known:

1. Primary tuberculosis complex is the primary form of tuberculosis. An inflammatory process develops in the affected organ, which spreads through the lymphatic tract. It can only be recognized by the attending physician based on the results of the patient's x-ray. The main signs are a clearly defined intoxication syndrome, a severe cough, sometimes with shortness of breath.
2. Focal pulmonary tuberculosis in children is a form of tuberculosis that mainly affects children over 10 years of age. The pathogenic inflammatory process is localized in the chest area. In this case, the baby may not be bothered by anything.
3. Pulmonary tuberculoma is a form of the disease in which the infection affects a large area of ​​10 mm of the organ. The only symptoms of pulmonary tuberculoma are a periodic wet cough with sputum.
4. Tuberculous pleurisy is characterized by clearly defined clinical symptoms. The first signs of the disease are pain in the chest, fever to febrile levels, and intoxication syndrome.
5. Bronchial tuberculosis is a form in which the source of inflammation is located in the bronchi. This disease is difficult to diagnose, since bronchoscopy has age restrictions. Its main manifestations are a strong, barking cough with sputum, which is not treated with mucolytics.
6. Caseous pneumonia is the most dangerous and severe form of tuberculosis. Fortunately, children are rarely affected by this disease. Caseous pneumonia entails many unpleasant symptoms - apathy, significant weight loss, severe shortness of breath.

Diagnostic methods

Diagnosis of tuberculosis during the incubation period allows it to be cured within a few months. Timely and effective therapy determines the mild course of the disease and guarantees its favorable outcome.

Infants who do not go to kindergarten or school where regular medical examinations are carried out should have a blood test at least once a year (we recommend reading:). Children whose pediatricians suspect tuberculosis are referred for consultation to a TB specialist. This doctor prescribes such preventive and diagnostic measures as:

• general and enzyme-linked immunosorbent blood tests, which detect inflammation in asymptomatic disease;
• Mantoux test;
• X-ray of the lungs in children under 15 years of age or fluorography for patients over 15 years of age, which is performed to visualize local changes in the photo;
• computed tomography or magnetic resonance imaging;
• ELISA and PCR studies that determine the causative agent of the pathogenic inflammatory process.

Technique for conducting a tuberculin test

Mantoux test

The Mantoux test is an injection of tuberculin under the skin. Tuberculin consists of pathogens that should cause an allergic reaction if there is an infection in the child’s body (we recommend reading:). Three days after the injection, the doctor visually determines its result:

• negative - the injection site has not changed in size (acceptable norm is an increase of 1 mm), redness and compaction were not detected (more details in the article:);
• controversial - at the injection site there is an increase of 2-3 mm, slight redness or thickening;
• positive - the sample has grown to 5-7 mm.

Blood analysis

Asymptomatic tuberculosis requires confirmation of the diagnosis, so first the pediatrician prescribes a general blood test, which reveals inflammation. If the result is positive, doctors refer the patient for an enzyme-linked immunosorbent assay to determine the presence or absence of tuberculosis antibodies. The patient receives the results of both tests on the day they are performed. This method cannot be considered particularly informative, unlike X-rays and PCR (we recommend reading:).

PCR diagnostics

The polymerase chain reaction is guaranteed to give an accurate result, which makes it possible to identify the disease at any stage of development, including during the incubation period.

The results of the study are given to the patient in a few days. This diagnostic method identifies the causative agent of the disease in the baby’s blood, urine or sputum, allowing it to be destroyed as soon as possible through drug therapy.

Treatment of tuberculosis

Therapy for a child with tuberculosis is largely determined by the form of the disease, as well as the age category of the child. This disease requires an individual approach to the prescription of medications, but there is a general treatment regimen.

The main method is chemotherapy using various groups of drugs. The use of antibiotics for the treatment of tuberculosis cannot be considered effective, since mycobacteria are not sensitive to their action. At the initial stage, doctors prescribe Isoniazid and Rifampicin to babies, adding Streptomycin or Ethambutol to them a month later. Anti-tuberculosis drugs are taken for at least 3 months, after which the TB specialist extends or stops the prescription depending on the form and stage of the disease.

In parallel with these drugs, children are prescribed immunostimulating drugs, and recommendations are also given regarding the prevention of the disease. At the end of the main course of treatment, the child may be given a ticket to a sanatorium, where he will continue physical therapy.

Incorrect treatment can have detrimental consequences. Firstly, ineffective therapy will not bring any benefit to the child and will lead to worsening of the disease, that is, damage to vital organs. Secondly, such treatment will contribute to the formation of a drug-resistant form of the disease, as a result of which pathogenic pathogens will stop responding to any, including effective, medications.

Lifestyle during treatment

During the treatment period, the child should walk a lot in the fresh air, but avoiding crowded places

For tuberculosis of the intrathoracic lymph nodes or any other primary form of the disease, it is very important to observe the following measures:

• Rest. Parents should prevent the baby from becoming overtired, since during treatment the body constantly requires strength to fight infection and actively recover.
• Proper diet. The child should get used to clearly organized three or four meals a day, depending on age. The disease often causes appetite disturbances, but parents should ensure that the baby does not miss a single meal during the day.
• Healthy diet. The diet of a sick child should be enriched with vitamins and minerals. Eating healthy vegetables and fruits along with basic foods is the key to recovery. During treatment, the child is put on diet No. 11, which excludes spicy and fried foods and also minimizes sweets.
• Avoiding crowded places where the baby can become infected again. A child suffering from tuberculosis should minimize visits to public places. Firstly, parents should not forget that he is a carrier of mycobacteria. Secondly, there is a possibility of re-infection with a new infection, since the little patient’s immunity is very weakened.
• Staying warm. The child needs to be provided with warmth, since hypothermia entails the emergence of a new disease that will be difficult for the body to cope with due to a decrease in its defenses.

Prevention of disease in children

Prevention of tuberculosis in children implies the following conditions:

• vaccination, including the first BCG vaccination in the maternity hospital, the Mantoux test and other preventive vaccinations;
• hardening children through regular walks in the fresh air in any weather;
• exclusion of communication with potentially infected people.