Congenital tuberculosis. Video: Prevention of tuberculosis. Reasons for the increase in incidence. Tuberculosis of unspecified localization

© S.I. Kochetkova, T.N. Tataurova, 2002
UDC 616.24-002.5-053.1/2
Received January 14, 2002

S.I.Kochetkova, T.N.Tataurova

State Medical Academy, Nizhny Novgorod

A case of congenital tuberculosis in a newborn child

Congenital tuberculosis is rare, but pediatricians and obstetricians-gynecologists should be aware of the possibility of its occurrence in a child. According to the literature, there is currently information about the description of one thousand cases of intrauterine infection of the fetus (Yanchenko E.N., Greimer N.S., 1999).

Infection of the fetus occurs mainly in two ways: hematogenous, transplacental or through ingestion and aspiration of amniotic fluid, mucus from the birth canal infected with Mycobacterium tuberculosis.

With the hematogenous route of intrauterine infection, mycobacteria penetrate from the mother to the fetus through the umbilical vein, entering the liver, or through the ductus venosus Auranzii into the right heart and lungs. An important prerequisite for the hematogenous route of infection is damage to the placenta by mycobacteria, however, the vessels of the placenta in a pregnant woman are mostly thrombosed and the fetus is uninfected. The transplacental route of spread of infection is especially likely in disseminated forms of tuberculosis in the mother (in hematogenous outbreaks of tuberculosis in pregnant women). Cases of intrauterine infection have been described during hematogenous outbreaks of tuberculosis in pregnant women in the form of exudative pleurisy and spondylitis. With the hematogenous route of infection, the primary affect is formed in the liver with the involvement of regional lymph nodes of the portal of the liver, mesenteric and, less often, intrathoracic lymph nodes.

In the second way - alimentary - a child becomes infected when the birth canal is infected, most often in women suffering from genital tuberculosis, and therefore they often experience infertility, so congenital tuberculosis of this origin is rare. With latent tuberculosis of the female genital organs, pregnancy proceeds outwardly normally and infection occurs on the latest dates pregnancy or during childbirth. With the alimentary route of infection, the primary focus is formed in the lungs, middle ear, and intestines.

The clinical picture of congenital tuberculosis is diverse and is determined by its genesis, the nature of the pathological process in the mother, the duration of pregnancy, the severity and virulence of the infection.

If the fetus is infected early, the mother will experience a miscarriage or stillbirth. If pregnancy continues, children are born premature, with malnutrition. In the absence of contraindications, children are vaccinated with the BCG vaccine. But by the end of the second week, their condition worsens, appetite decreases, lethargy, drowsiness, fever, weight loss, dyspepsia appear, the liver, spleen, peripheral lymph nodes become enlarged, and respiratory failure increases. Jaundice, hemorrhagic syndrome, and neurological symptoms are possible.

The diagnosis of congenital tuberculosis is difficult to make. Differential diagnosis is carried out with intrauterine, generalized, mycoplasma infections, pneumocystis, sepsis, congenital syphilis, HIV infection.

We present an observation of the disease of a newborn child who died from congenital generalized tuberculosis.

Roman B. was born on July 3, 1999 in maternity hospital No. 4 from his second pregnancy, in term labor. The mother, a gypsy, was not observed in the consultation. Apgar score - 9 points. The condition at birth is satisfactory. Weight - 2850 g, height - 46 cm. Head circumference - 33 cm, chest circumference - 34 cm. Applied to the chest on the 2nd day. The umbilical cord fell off on the 3rd day. 05.07 done BCG vaccination.

The mother voluntarily left the maternity hospital on the 4th day after birth. She felt unwell at home and had a fever.

On the 5th day, the child was taken to Children's City Hospital No. 1 by his father with complaints of the child's anxiety and an increase in body temperature to 38°C. Its mass was 2680 g.

The condition on admission was moderate severity, the cry was loud, there was tremor of the limbs. Meningeal symptoms- negative. Skin - with an icteric tint, clean; acrocyanosis, pastiness lower section belly. Peripheral lymph nodes are small, elastic, mobile. Large fontanelle - 232 cm, does not bulge, nasal breathing difficult. Percussion over the lungs revealed tympanitis, breathing was harsh, and no wheezing was heard. Respiration rate - 50 per minute, heart sounds - rhythmic, clear, heart rate - 140 per minute. The stomach is swollen. The umbilical wound is under the crust. The liver protrudes 2 cm from under the costal arch.

General blood test: Hb - 199 g/l; color pok. - 0.94; er. - 6.3·1012/l; thrombus - 365·109/l; le. - 9.4·109/l; stick eater. - 14%; segmented. - 53%; eosis -2%; lymph. - 25%; monoc.-8%; ESR - 14 mm/h.

General urine analysis: no color; transparent; full; protein - 0.099‰, le. - 2-4 in point of view, cylinders - hyaline.

The Mantoux reaction with 2 TE is negative. X-ray of the chest upon admission - swelling of the pulmonary fields, decreased transparency in the medial sections, against which the pulmonary pattern and the right root are not differentiated.

Total bilirubin - 224 mmol/l, increased due to free bilirubin - 209 mmol/l; increased AST - 1.56 units; AlAT - 1.25 units; LDH - 41.4 units; glutamine transferase - 2.49 units. Metabolic acidosis in the blood; pH - 7.15; glucose - 5.8 mmol/l.

No microflora was detected in the blood, urine, or liquor. Mycobacterium tuberculosis was not isolated from the root of the tongue.

A diagnosis of acute viral infection, hyperbilirubinemia was made. Genesis is not clear. Perinatal encephalopathy, acute period are noted; hypertension syndrome.

Treatment was prescribed: cefazolin - 150,000 units. 2 times intramuscularly, immunoglobulin, detoxification therapy, trental, riboxin, cytochrome, choleretic.

The child's condition gradually worsened. WITH

On the 3rd day of hospital stay, he became more restless, temperature 38-39°C, in the lungs there were moist fine rales, tachycardia, muffled heart sounds, the liver was enlarged.

On the 6th day of stay in the intensive care unit, a painful cry and throwing back of the head appeared. Cerebrospinal fluid examination: colorless; transparent; Pandi reaction +; protein - 0.26‰; cytosis 22/3; lymph. - 5%; neutral - 1%.

The child's mother was admitted to maternity hospital No. 4 again on July 16. The woman's condition was extremely grave, with high fever. A diagnosis of “postpartum endometritis, sepsis, septic pneumonia” was made. X-ray examination of the chest organs was not performed.

On July 20, an operation was performed - extirpation of the uterus and tubes.

21.07 has arrived death with symptoms of respiratory and heart failure. Pathological diagnosis - hematogenous disseminated tuberculosis with damage to the lungs, liver, spleen, lymph nodes, and uterus. Complications - sepsis, septicopyemia, DIC syndrome.

On July 23, the maternity hospital informed the children's hospital that the mother had died, the pathological diagnosis was disseminated tuberculosis.

The child’s condition, despite intensive detoxification and antibacterial therapy, continued to deteriorate: lethargy, acrocyanosis, heat, liver and spleen enlarged. Cephobid and gentamicin and hormonal therapy were prescribed.

26.07 consulted with a phthisiatrician. A Mantoux test with 2 TE, a repeat X-ray tomogram, a spinal puncture, and an examination of the root of the tongue for Mycobacterium tuberculosis were performed.

X-ray findings - bilateral pulmonary edema, right-sided pneumonia, segmental atelectasis of the right lung, pneumothorax on the left, cardiopathy. Cerebrospinal fluid analysis: protein 0.85‰; cytosis - 63/3; lymph. - 4%; neutral - 16%; Pandey's reaction ++++; glucose - 2 mmol/l.

The phthisiatrician was again consulted about the supposed etiology of the child’s disease, isoniazid 20 mg per 1 kg of body weight, streptomycin, rifampicin suppositories were prescribed, but the child’s condition progressively worsened and on the 23rd day of hospital stay, death occurred due to symptoms of increasing respiratory and heart failure .

Clinical diagnosis - intrauterine infection, sepsis, septicopyemia, purulent meningitis, bilateral pneumonia, pulmonary and cerebral edema, necrotizing ulcerative enterocolitis, ascites, hepatitis, probably of tuberculous etiology. Perinatal encephalopathy.

Pathological conclusion - congenital hematogenous (transplacental) tuberculosis with damage to internal organs: liver, lungs, lymph nodes, spleen, kidneys, complicated by multiple organ failure. Swelling of tissues and membranes of the brain. Venous congestion and dystrophic changes parenchymal organs.

Of course, the described case of the death of a child from congenital tuberculosis is rare in practice. In this observation, the pregnant woman was not observed in the antenatal clinic; she had never previously undergone an X-ray examination. In the maternity hospital, an anamnesis was not collected to determine risk factors for the development of tuberculosis (possible contact with a patient with tuberculosis, complaints and condition during pregnancy). Upon re-admission to the maternity hospital, was the diagnosis of “septic pneumonia?” without x-ray examination chest organs.

Due to the unknown diagnosis of the mother and the absence of contraindications, the child was vaccinated with the BCG-m vaccine, which accelerated the course of tuberculosis infection.

Only on the third day did the maternity hospital report the death of the mother and the results of the pathological examination. A phthisiatrician consulted on the 5th day, and specific therapy was prescribed during a second consultation on the 7th day, when the child was in intensive care in critical condition. in serious condition. The child was sent for a pathoanatomical autopsy with a diagnosis of sepsis, intrauterine infection, septicopyemia, bilateral pneumonia, ulcerative necrotizing enterocolitis, hepatitis of possible tuberculous etiology. Meanwhile, the epidemiological history made it possible to make a diagnosis of congenital tuberculosis as a priority.

The described case clearly illustrates how important it is for pediatricians and obstetricians to remember the possibility of tuberculosis in the mother and child in order to take timely measures.

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 in different countries the world is different. In economically developed countries, tuberculosis is much less common than in developing countries. This fact further confirms the importance of the influence of the social factor in development of this disease. Every year scientists conduct hundreds of different scientific research 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 not due enough efficient work 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 last decade Tuberculosis affects 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, scientifically confirmed information has appeared that they exist in 74 different types. 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.

Koch stick

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 survive well in unfavorable conditions. external environment. 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 concentrations pathogens in 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 secretes 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.

Most common way 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 personal hygiene.

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

Large cattle is 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, the development of the disease is caused by different mechanisms infection. In pediatric practice, this is mainly a combination of airborne and contact and household methods 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 ranks in the morbidity structure of this infectious pathology leading position. Accompanied by the development of specific changes in the lung tissue, less often in inflammatory process bronchi and trachea are involved. 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.

X-ray photo of tuberculosis in children

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 involvement in infectious inflammation renal tissue. 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.

X-ray of the kidneys

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 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 have strong pressure on 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. 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 violates general health 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.

One more characteristic manifestation diseases in 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 specific symptoms diseases.

A long-term illness leads to the fact that the child lags significantly behind his peers in terms of physical and mental health. 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.

Making a diagnosis this state, relying on the persistent preservation 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, you should carry out timely diagnosis diseases. 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.

It is possible to determine tuberculosis infection, which is not accompanied by the appearance of symptoms, or a latent form of the disease using special laboratory and instrumental methods diagnostics

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 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 great that it can make it very difficult clinical diagnostics diseases.

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.

Help install correct diagnosis in this case they can only alternative methods diagnostics

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. Decreased appetite leads to strong weight loss, and ultimately leads to retardation 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 appear under the eyes and dark circles. 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 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 syndrome while standing 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 the erythema nodosum 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. Lab tests consist of conducting tuberculin tests. Tuberculin diagnostics helps determine delayed-type increased sensitivity to specific proteins of Mycobacterium tuberculosis. According to its chemical structure, tuberculin is special substance, which is a purified tuberculosis toxin. Introducing it into a child’s body cannot lead to the baby becoming infected with tuberculosis.

• 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 deoxygenated 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 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 the appointment of several medicines simultaneously.

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

Due to the fact that microbes quickly mutate and change their properties, the three-component tuberculosis treatment regimen was replaced by a four-component one. It is currently used to treat babies infected with susceptible strains. This treatment regimen includes the use of streptomycin or kanamycin, rafabutin or rifampicin, isoniazid or ftivazid, as well as pyrazinamide or ethionamide. may cause the child to develop multiple side effects, since it includes quite a lot of strong antibiotics of the latest generations.

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 caloric 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 when the baby has pathological formations in the lungs, which occur with 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.

– an infectious disease caused by Mycobacterium tuberculosis when it passes from an infected mother to the fetus during pregnancy. It manifests itself as respiratory failure in the newborn, lethargy and poor appetite, fever, hepatosplenomegaly, and in a third of cases meningitis is associated. To make a diagnosis, tuberculin tests are performed, laboratory test blood, the pathogen is also detected in urine and other biological fluids. The basis of treatment for congenital tuberculosis is anti-tuberculosis drugs, while treatment of organ failure and immunotherapy is carried out.

Congenital tuberculosis is an extremely rare pathology in modern pediatrics. Several hundred cases of intrauterine infection of the fetus have been reliably recorded. The causative agent of the infection, Mycobacterium tuberculosis, was first isolated and described by Robert Koch in 1882; in 1890, he also obtained tuberculin, which is still used in the diagnosis of the disease. Mycobacteria are highly resistant to any external influences, including physical, chemical, and temperature disinfection methods.

Congenital tuberculosis is more common in developing countries, in socially disadvantaged families. The relevance of congenital tuberculosis is due to the increase in the overall incidence of tuberculosis among the country's population. In addition, the absence of symptoms from birth and nonspecific clinical signs make timely diagnosis difficult. This, in turn, increases the risk fatal outcome from congenital tuberculosis.

Causes

The causative agent of the disease is Mycobacterium tuberculosis. Infection of the fetus occurs in utero. As a rule, the woman herself becomes ill during pregnancy; cases of congenital tuberculosis, when the mother suffered an infection shortly before pregnancy, are more rare. The only entry point for mycobacteria is the placenta. The tuberculosis bacillus penetrates the blood vessels of the placenta and thus ends up in the fetal bloodstream. With the blood, the bacteria enter the liver, where the primary focus of infection is formed, often affecting regional lymph nodes. From there, the pathogen spreads to all tissues.

Congenital tuberculosis can also develop from aspiration of amniotic fluid, which contains mycobacteria, if infiltrates on the placenta are opened directly into the amniotic fluid. The aspiration route of infection is characterized by the formation of a primary focus in the lungs, intestines, and middle ear. The risk of contracting congenital tuberculosis increases if the mother has concomitant pathologies, especially those that reduce immunity, for example, HIV infection, as well as in the presence of unfavorable social factors(poor housing and sanitary conditions, antisocial lifestyle, etc.).

Symptoms of congenital tuberculosis

If the fetus becomes infected with mycobacteria during the first trimester of pregnancy, a miscarriage or stillbirth usually occurs. In other cases, the child is usually born premature or low birth weight. In the first days specific clinical manifestations There are no congenital tuberculosis. Symptoms begin to appear only 3-4 weeks after birth. Increasing respiratory failure is noted; in severe forms, respiratory distress syndrome develops. Characterized by lethargy or restlessness poor appetite, temperature rise to febrile.

Congenital tuberculosis is accompanied by hepatosplenomegaly, and jaundice occurs. Lymphadenopathy is detected in approximately 40% of children with congenital tuberculosis. In 30% of cases, meningitis occurs, causing the head to tilt back and neck stiffness. Increased excitability or depression of the central nervous system is possible. Every fifth patient with congenital tuberculosis experiences discharge from the external ear canals. Hemorrhagic syndrome and papular rashes on the skin are rare.

Diagnosis of congenital tuberculosis

Diagnosis of the disease is complicated by the delayed manifestation of signs of infection and largely nonspecific symptoms. The pediatrician may suspect congenital tuberculosis based on the mother's medical history. If the diagnosis was made to a woman during pregnancy, the child after birth should be kept separate from the mother until intrauterine infection is completely eliminated. When the first symptoms of congenital tuberculosis appear, a physical examination reveals rapid breathing, an increase in the size of the liver and spleen, jaundice and fever may be noted. Enlarged lymph nodes are palpated: subclavian, axillary, etc.

Blood tests show signs of inflammation and hyperbilirubinemia, and anemia is often diagnosed. On a chest x-ray, disseminated foci of opacity are observed, which indicates the accumulation of mycobacteria in the lungs. Tuberculin tests (Mantoux test, Diaskin test) are positive, but the pathogen may not be detected in biological fluids (blood, urine, sputum) for several more weeks. An ultrasound of the internal organs is performed - this can detect hepatosplenomegaly and a focus of tuberculous inflammation in the liver. Neurosonography is necessarily included in the complex of diagnostic measures. If meningitis is suspected, a spinal puncture and cerebrospinal fluid analysis for the content of mycobacteria are performed.

Treatment of congenital tuberculosis

Treatment of the disease begins from the moment of diagnosis accurate diagnosis, but there are exceptions here. In severe forms of congenital tuberculosis, tuberculin tests may give negative results, however, if the diagnosis is confirmed in the mother, it is possible to begin treatment of the child without laboratory confirmation, only parental consent is required. In all cases of congenital tuberculosis, hospitalization and consultation with a phthisiatrician are indicated. Forms of the disease with severe organ failure and neurological impairment require treatment in a pediatric intensive care unit.

Etiotropic therapy is carried out, anti-tuberculosis drugs are prescribed: isoniazid, rifampicin, pyrazinomide, ethambutol, kanamycin. Chemotherapy for congenital tuberculosis consists of several stages. First, 3-4 drugs are prescribed simultaneously for a period of several months, followed by control tests. Dosages are calculated strictly based on the child’s weight. Then 1-2 drugs are left for another 4-5 months. The total duration of specific therapy for congenital tuberculosis can be up to 8-9 months. After the end of the intensive therapy phase, the child is transferred to an anti-tuberculosis dispensary, where he is observed until the end of the entire course of treatment.

Simultaneously with specific therapy desensitizing and antihistamines, immunotherapy and B vitamins. With severe respiratory failure oxygen therapy is indicated. If a secondary one joins bacterial infection, in particular meningitis, antibiotic therapy is carried out. Depending on the location of the foci of infection, specialized specialists are involved in the treatment of congenital tuberculosis: neurologist, otorhinolaryngologist, gastroenterologist.

Prognosis and prevention

The prognosis is generally favorable, except for complicated forms of congenital tuberculosis. With appropriate therapy, infiltrates in the lungs resolve, recovery occurs on average after 9-12 months. In a quarter of cases, the disease ends with the formation of nodes and calcifications in the lymph nodes, most often intrathoracic. Prevention of congenital tuberculosis includes early diagnosis of infection in pregnant women, especially if these are women from socially disadvantaged families. When the diagnosis of the expectant mother is confirmed, it becomes possible appointment therapy before birth.

The presence of the disease in a pregnant woman does not mean that the fetus is infected. For this, tuberculosis of the placenta is mandatory, since mycobacteria are transmitted transplacentally. Therefore, timely therapy can reduce the risk of congenital tuberculosis. Early diagnosis is facilitated by annual fluorography. Important role pregnancy planning plays a role if a woman’s active form of tuberculosis is confirmed earlier.

Tuberculosis is an infectious disease caused by the tuberculosis bacillus (Koch), affecting not only the lungs, but also many organs and systems. We are used to hearing about tuberculosis in adults, although manifestations in children are often more dangerous and have an irreversible outcome. Many people have heard about the Mantoux test, but not all parents understand its necessity and purpose.

Causes of tuberculosis in children

The development of this terrible disease in children is caused by the same microorganism (tuberculosis bacillus) as in adults. But a baby can become infected not only through contact with a sick person through airborne droplets, but also while in the womb of a mother suffering from tuberculosis. Pathogenic bacilli are found almost everywhere and are very resistant to external influences. But this does not mean that everyone who inhales the stick will suffer from tuberculosis. Whether a child develops a disease or not does not depend on the proximity of contact with the patient or the severity of his illness. The primary factor is the baby’s health, which depends on nutrition (is there enough protein and vitamins?), living conditions (cold rooms with high humidity increase the risk of bronchopulmonary diseases). Children who suffer chronic diseases With frequent exacerbations, have reduced immunity and increased susceptibility to pathogens.

Manifestations of tuberculosis in children

Children most often develop a special type of tuberculosis - primary. It differs in that not only the lungs are affected, but also many other organs and systems. This is due to the characteristics of a growing organism and an unformed immune system, which are not able to quickly limit the pathological focus of infection. The disease is more severe than in adults, often developing into severe forms (meningitis, sepsis). After the infection has penetrated, the first signs become noticeable no earlier than six months later. The microorganism spreads quite quickly due to the high sensitivity of the child’s body to the tuberculosis bacillus and to the products of their vital activity.

First to appear general symptoms illness - weakness, malaise, headache, slight increase in body temperature, often in the evening, and after a while you may notice a rare dry cough. Since the microbe spreads through the lymphatic system, one of the signs of the disease will be palpable enlarged lymph nodes. Sick children gain weight poorly, and then lose weight, and growth slows down. Following these changes, the baby's development, school performance and mental state inevitably suffer. Such babies sweat profusely and periodically have an elevated body temperature for no apparent reason. The desire to play with peers is becoming less and less due to increased fatigue and constant lethargy. The liver and spleen may become enlarged.

With congenital lesions and infants the disease is most severe, often acquiring severe generalized forms (sepsis). In preschool children, the course of the disease has a more favorable prognosis with the most frequent development of lung damage. The disease in adolescents occurs with the same symptoms as in adults.

Diagnosis of tuberculosis in a child

Detection of the disease is difficult because tuberculosis does not have clear specific symptoms and develops slowly and over a long period of time. Almost all symptoms are characteristic of some other disease, which often leads to incorrect diagnosis and untimely treatment. It is important for parents to pay attention to the duration of the child’s cough and temperature. For any long-term lung diseases (cough for more than 3 weeks), the child is referred to a phthisiatrician who can recognize tuberculosis in time.

Every year, all children undergo a Mantoux test, in which tuberculin is injected intradermally, and then the papule (red spot at the injection site) is measured after 48 and 72 hours. Of course, this is not a diagnostic method that gives a 100% answer. Despite the fact that he often gives false results, its performance is worth relying on. If the red spot is less than 5 mm, then the child’s body has not yet encountered the stick, and if it is more than 10 mm, there has been contact (the test is positive). In all children who have been vaccinated with BCG, the test should be positive, which indicates the correct functioning of the immune system. But highest value for the diagnosis of tuberculosis, tuberculin tests have a turn - an increase in the red papule by more than 5 mm compared to last year. If a deviation is identified, a consultation is scheduled with a TB specialist, who conducts a more in-depth examination. You should not be subject to prejudice: if you have been assigned to appear at the TB dispensary, then you are obliged to visit it. This serious disease, and it’s better to be on the safe side a thousand times than to risk the child’s health and miss the disease.

A more modern method is an intradermal test with the drug Diaskintest, which detects the presence of an immune response specifically to pathogenic microorganisms, and not to those that were administered when vaccinating a newborn. After intradermal administration of the drug, the result is assessed after 3 days. If the papule is more than 5 mm, the child is advised to undergo further examination by a phthisiatrician.

X-ray of the lungs may reveal calcifications and enlarged lymph nodes. A more accurate description of changes in the lungs is provided by computed tomography of the chest organs.

At ultrasound examination abdominal organs may detect an enlarged liver, spleen, lymph nodes, kidneys.

In children with suspected tuberculosis, sputum and urine are collected for culture on special nutrient media. If the tuberculosis bacillus is present in these environments, it grows and multiplies, which makes it possible to make a diagnosis with a high degree of probability.

Bronchoscopy is prescribed to identify pathological changes in the bronchi. At the same time, in bronchopulmonary system a special tube with a magnifying system is inserted, which allows the doctor to see even small changes in the walls of the bronchi.

If tuberculous meningitis is suspected, a spinal puncture is performed to collect and examine cerebrospinal fluid.

A general analysis of blood and urine does not reveal changes specific to tuberculosis, but an increase in the number of lymphocytes and the erythrocyte sedimentation rate can be detected.

Treatment

Treatment of children with tuberculosis is always carried out in a hospital. The mainstay of treatment is taking antibiotics according to a special regimen. As a rule, at least three drugs are prescribed simultaneously. Treatment is long-term, often more than 6 months. Be sure to increase the calorie intake and include foods rich in animal protein in the diet. After confirmed recovery, such children are shown Spa treatment in dry climates and periodic courses of antibiotics (chemotherapy) to prevent the disease from returning. Damaged tissue in children recovers better and faster than in adults, and antibiotic treatment is well tolerated. The room in which the child was located must be disinfected with chlorine-containing preparations.

Tuberculosis is a serious infectious disease that frightens many people and forces them to constantly undergo tuberculin testing. Adding to the concern is the fact that Koch's bacillus can infect not only adults; tuberculosis in children is also not uncommon. Moreover, childhood pathology is much more complicated than adult pathology, therefore, if you notice its signs in children, parents should immediately consult a doctor. An unformed body cannot adequately fight back the disease, so the infection attacks the body’s tissues faster and more effectively. To avoid complications of tuberculosis, the pathology must be diagnosed as quickly as possible and treatment started.

Infected children develop a variety of symptoms and signs. The primary tuberculosis complex includes the so-called symptoms of intoxication. While the foci of pathology have not yet become visible, the patient exhibits tuberculosis intoxication, and its intensity depends on the severity of the infection. If bacteria are just starting to spread throughout the body, then infectious symptoms tuberculosis in children manifests itself more noticeably.

Symptoms of intoxication include:

• general weakness;
• slight increase temperature for a long period of time;
• decreased appetite;
• causeless weight loss;
• constant poor health;
• increased sweating;
• developmental problems;
• pale skin;
• disorders of the autonomic nervous system, which are manifested by increased effusion on the palms and soles of the feet, rapid heartbeat, sudden changes moods.

Tuberculosis infection in children provokes a weak gradual development of intoxication symptoms, which distinguishes it from acute respiratory viral infections, which require little time for strong manifestations of intoxication symptoms.

Previously, pulmonary tuberculosis in children was accompanied by fever in its classic manifestation, but today the disease often occurs without fever.

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• Congratulations! The likelihood that you will develop tuberculosis is close to zero.

  But don’t forget to also take care of your body and undergo regular medical examinations and you won’t be afraid of any disease!
  We also recommend that you read the article on.

• There is reason to think.

  It is impossible to say with certainty that you have tuberculosis, but there is such a possibility; if it is not Koch bacilli, then there is clearly something wrong with your health. We recommend that you undergo a medical examination immediately. We also recommend that you read the article on detecting tuberculosis in the early stages.

• Contact a specialist urgently!

  The likelihood that you are affected by Koch bacilli is very high, but it is not possible to make a diagnosis remotely. You should immediately contact qualified specialist and undergo a medical examination! We also strongly recommend that you read the article on detecting tuberculosis in the early stages.

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Is your lifestyle associated with severe physical activity?

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   How often do you take a tuberculosis test (eg Mantoux)?

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   Do you carefully observe personal hygiene (shower, hands before eating and after walking, etc.)?

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   Do you take care of your immunity?

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   Have any of your relatives or family members had tuberculosis?

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   Do you live or work in an unfavorable environment(gas, smoke, chemical emissions from enterprises)?

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   How often are you in damp, dusty or moldy environments?

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   How old are you?

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   What gender are you?

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   Have you recently felt very tired for no particular reason?

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    Have you been feeling physically or mentally unwell lately?

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    Have you noticed a weak appetite lately?

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    Have you recently noticed a sharp decline in your healthy, plentiful diet?

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    Have you recently felt an increase in body temperature for a long time?

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    Are you having trouble sleeping lately?

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    Have you noticed yourself lately? increased sweating?

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    Have you noticed yourself looking unhealthy lately?

One of the very first symptoms to appear is paraspecific reaction syndrome. Primary tuberculosis in children causes the body to produce special antibodies, which cause the Koch bacillus to pass from the blood to the macrophage system. Such cells are located in many human organs, which is why symptoms often appear in different parts of the patient’s body.

The paraspecific reaction does not manifest itself in the body for long; often such symptoms in children disappear after a couple of months. However, the disappearance of paraspecific reactions does not mean getting rid of the disease, since its treatment takes much more time.

To the symptoms of tuberculosis on early stage In children, the following changes in the body are considered:

A real paraspecific reaction is not inflammation due to tuberculosis infection, but a concentration of cells in certain organs, which becomes a consequence of the tuberculosis pathogen entering the body.

The types of symptoms depend on the location of the tuberculosis, the extent of the infection, and the presence of complications. Tuberculosis infection of different organs in children causes different symptoms.

Tuberculosis infection affects the functioning of the entire body, but the main blow falls on the organ where the infection spreads.

Tuberculosis has many forms that affect how the disease develops. Depending on the acquired form, there are various features pathologies in children. The pathology of the primary form occurs in the first year after infection, although these periods are very vague. If the period of development of primary tuberculosis is very short, then most likely the disease destroys the body too quickly. In most cases, harmful bacteria infect the lymph nodes, and the characteristics of the development of the pathology depend on the characteristics of this infection, possible complications and duration of treatment.

Exist different kinds tuberculosis in children, so consider the classification of tuberculosis:

1. Tuberculosis intoxication is becoming quite common. This form appears when initial stages diseases when full-fledged foci of infection have not yet formed in the body. Feeling unwell accompanied by loss of appetite and a slight but constant increase in temperature in the evening. The patient's mood often changes, a rapid heartbeat and headaches appear. If there are any manifestations of tuberculosis intoxication, the child’s body is subject to detailed examination to identify infected areas.
2. Primary tuberculosis complex of the lung. Tuberculosis bacteria enter lung tissue, forming a small inflammation that becomes the focus of the disease. Over time, the inflammation spreads to the area of ​​the intrathoracic lymph nodes. Most often, this form of pathology has good self-healing abilities. The BCG vaccine, which is currently publicly available, can prevent the development of a lesion. According to statistics, vaccinated children are less likely to develop this form of pathology. Natural resistance to the disease will also be useful in the fight against tuberculous inflammation.
3. Tuberculous infection of the intrathoracic lymph nodes. Most cases of childhood tuberculosis are caused by infection of the intrathoracic lymph nodes. When a small number of nodes are infected without particularly noticeable symptoms, the pathology occurs in an uncomplicated form. During treatment, hyaline appears in the lymph nodes, and dead tissue is replaced by lime capsules (calcifications). If the infection proceeds with complications, then the infection spreads to nearby areas. In most cases, complications appear when a child becomes infected in the first years of life. This happens due to incompletely formed organs, undeveloped defense mechanisms, and immature immunity. Clinical picture This disease is expressed quite clearly.
4. Tuberculous bronchoadenitis. The disease spreads to the visceral thoracic lymph nodes. The trachea and bronchial nodes are also susceptible to infection. With this form of the disease, the lymph nodes of the lung root begin to become inflamed. At the beginning of the disease, the child develops intoxication syndromes, and as the pathology develops, the patient coughs in two tones due to compression of the bronchi. Babies often experience suffocation, accompanied by cyanosis, uneven breathing, swelling of the nasal wings and retraction of the space between the ribs. To make the baby feel better, the baby is placed on his stomach and the infected lymph node is pushed forward.
5. Congenital tuberculosis. This form is extremely rare, but, nevertheless, such cases are known. Congenital pathology means that the fetus was infected during pregnancy from the mother. In most cases, a woman becomes infected during pregnancy, but sometimes a pathology suffered shortly before pregnancy also affects the fetus. The baby has noticeable difficulty breathing, inactivity, loss of appetite, elevated temperature, enlarged liver and spleen, and sometimes inflammation of the membranes of the brain and spinal cord.
6. Infiltrative tuberculosis. This form of the disease is secondary, inflammation appears on the lungs with the formation of infiltrates, and the lesions undergo caseous decay. The patient suffers from symptoms of intoxication, overheating of the body, and intense cough. Additional signs of infiltrative tuberculosis are pain in the side and coughing up blood. Every second patient with this disease suffers from an acute form of the disease. Asymptomatic development of the disease also occurs, and transitional states are possible between these two options.
7. 
   Miliary tuberculosis. This diagnosis indicates acute form diseases. With miliary tuberculosis, the capillaries are the first to suffer, and then tubercles appear on the organs, and both the lungs and other organs suffer from this pathology. This form is most common in adolescents and children, and adults get it much less frequently. The main symptoms of miliary tuberculosis: wet cough, constant weakness in the body, shortness of breath and fever. These symptoms are intermittent and either worsen or subside.
8. Tuberculous meningitis is characterized by inflammation of the membranes of the brain due to the entry of pathological pathogens into them. This form is one of the forms of extrapulmonary tuberculosis. The symptoms of such a disease appear sharply, and from the onset of infection until the full development of the disease, meningitis does not show any signs. As the disease progresses, the patient begins to notice overheating of the body, headaches, vomiting, problems with cranial nerves, confusion and typical symptoms of simple meningitis. The advanced form often causes loss of consciousness and even paralysis.
9. Pulmonary tuberculosis is uncommon in children; most of those who become ill at the time of infection have already passed adolescence. Once in the lungs, the pathogen causes inflammation of the lung tissue. Inflammation causes fever and frequent cough. Other symptoms depend on the extent and severity of the disease. This form of pathology is difficult to cure, but timely determination of the presence of the disease will greatly simplify the task. If a person becomes infected with pulmonary tuberculosis Small child, then infectious foci infect other organs of the child.
10. Tuberculosis of unspecified localization is assumed when the patient has tuberculosis intoxication, but no local changes are observed. If doctors do not detect infection in any organs, then all that remains is to make such a diagnosis. Most often, this form of the disease is found in children due to the body’s sensitivity to allergic manifestations. Symptoms develop slowly and become chronic. Parents rarely notice the disease in time, so doctors have to treat an already advanced form. Also, such a diagnosis is possible if the form of extrapulmonary tuberculosis is incompletely diagnosed.
11. Tuberculosis of the osteoarticular system. This disease is always accompanied by pulmonary tuberculosis. The disease affects the growth cartilage and affects the joints and spine. The patient develops purulent inflammation, accumulation of pus in the tissues, small but deep wounds, and when the spinal cord is compressed, paralysis is also possible.
12. Renal tuberculosis is one of the most common forms of extrapulmonary tuberculosis. The infection is brought by blood during primary tuberculosis. First, the infection affects the medulla, causing cavities and foci of decay to appear, and then moves deep into the kidneys and spreads to neighboring organs. After getting rid of the disease, scars remain on the body.

With the development of local tuberculosis forms, an exacerbation of paraspecific reactions is observed. Also, the pathology has a good potential for independent healing.

With the development of science and medicine, many ways to diagnose tuberculosis have emerged.

The most effective of them:

1. Mantu sample. For this diagnostic method, the subject is given an injection of tuberculin, which contains a small amount of the disease strain. Based on the body's reaction, the doctor determines whether the patient's immunity is able to resist tuberculosis. A manta sample is carried out annually. A good analogue Diaskintest is considered such a tuberculin test.
2. Fluorographic examination. Using special radiation, the equipment shows a multi-layered image of the lungs.
3. X-ray examination. When positive results, the above research methods, radiography is prescribed. Such diagnostics are needed to confirm the diagnosis and determine the form of the disease.
4. Bacteriological research. The patient's sputum is examined using special equipment. In our country, such diagnostics are not particularly popular, unlike in Europe.
5. Bronchoscopy. This procedure is difficult to carry out, but it gives very accurate results, so it is used mainly because of the vague results of other diagnostic methods.

To accurately determine the presence of the disease and its form, it is necessary to go through several methods of diagnosing the disease.

Prevention of tuberculosis in children

Tuberculosis is an unpleasant pathology, and this concerns not only the consequences of the disease, but also its infectiousness. This disease is transmitted in many ways, but the main method of infection is airborne. This feature makes even simple communication with an infected person dangerous.

Of course, it is impossible to completely protect yourself from tuberculosis infection, but there are some preventive measures that will help significantly reduce the risk of infection.

Such measures include:

• carrying out tuberculin tests and vaccinations against tuberculosis;
• conversations on the dangers of the disease and conversations about the risks of contact with infected people;
• monitoring children at risk (living in an area with a large number of infected people or constantly in contact with a sick person);
• providing infected people with conditions for treatment and limiting their contact with healthy children and adults.

The most effective tuberculosis prevention is considered to be BCG vaccination and the Mantoux test. Some parents, fearing complications after vaccination, refuse to give their children such injections. Such actions endanger not only the health, but also the lives of children, and complications occur extremely rarely and in most cases do not pose a serious threat. Thus, there is much more benefit from vaccinations than harm, and such measures have already saved many lives.

The causative agent of tuberculosis is Koch's bacillus, which penetrates the human body and begins to slowly destroy the infected system. In most cases, the bacterium enters the body through airborne droplets, but there are other ways for Koch's bacillus to infect a person. The majority of sick children became infected due to communication with a sick person due to the bacteria entering first into the air and then into the child’s respiratory tract.

There are also the following causes of infection:

• through digestive system due to food obtained from sick animals;
• infection of the conjunctiva of the eye;
• transmission of infection to a child from a pregnant woman through the placenta or due to damage to the placenta during childbirth.

There are also reasons that contribute to the development of the disease in children. Most often, it is a weak immune system that allows infection to develop in the body.

The immune system becomes vulnerable due to the influence of such factors:

• congenital predisposition;
• infections chronic;
• stressful situations;
• poor nutrition.

The causes of tuberculosis are different, but the risk of infection in children in unfavorable living conditions is much greater than in children from prosperous families.

Nowadays, treatment of tuberculosis in children follows several scenarios. The doctor compares the degree of development of the disease, the condition of the body and possible consequences, choosing a more appropriate treatment method.

There are two types of treatment:

1. Treatment with chemotherapy. If tuberculosis is detected, it is mandatory to take anti-tuberculosis drugs. Often, a patient takes several types of medications at once, which the doctor selects individually for each patient. The duration of chemotherapy varies depending on the form of the disease, the body's response and the presence of complications. On average, therapy is carried out for six months, but there are cases when the patient takes medications for several years.
2. IN running forms tuberculosis, drug treatment alone is not enough, and then the patient is exposed to surgical intervention. However, surgical removal of tuberculosis does not replace drug treatment, they complement each other.

Treatment for a child is prescribed only by his doctor. Neglecting medical prescriptions leads to a slowdown in recovery, and sometimes negates all efforts, so parents are obliged to follow all the doctor’s recommendations. Additional treatment methods are also possible if they do not contradict medical prescriptions. So, some parents supplement the treatment traditional medicine or prayer for tuberculosis.

Quiz: How susceptible are you to tuberculosis?

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Time is over

• Congratulations! Are you OK.

  The probability of getting tuberculosis in your case is no more than 5%. You are completely healthy man. Continue to monitor your immunity in the same way and no diseases will bother you.

• There is reason to think.

  Everything is not so bad for you; in your case, the probability of getting tuberculosis is about 20%. We recommend that you take better care of your immunity, living conditions and personal hygiene, and you should also try to minimize the amount of stress.

• The situation clearly requires intervention.

  In your case, everything is not as good as we would like. The probability of infection with Koch bacilli is about 50%. You should immediately contact a specialist if you experience first symptoms of tuberculosis! It is also better to monitor your immunity, living conditions and personal hygiene, and you should also try to minimize the amount of stress.

• It's time to sound the alarm!

  The probability of infection with Koch sticks in your case is about 70%! You need to consult a specialist if any unpleasant symptoms appear, such as fatigue, weak appetite, or a slight increase in body temperature, because all of this may turn out to be symptoms of tuberculosis! We also highly recommend that you undergo a lung examination and do medical test for tuberculosis. In addition, you need to take better care of your immunity, living conditions and personal hygiene, and you should also try to minimize the amount of stress.

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