The objective: to analyze the course of the new coronavirus infection (COVID-19) in children with active respiratory tuberculosis. Subjects and methods. The article describes results of retrospective analysis of the course of the new coronavirus infection in 25 children (3-12 years old) with active respiratory tuberculosis during the outbreak of COVID-19 in an in-patient TB unit.Results. 24 (96%) persons got infected after the close exposure to the coronavirus infection, and 1 (4%) child didn't get infected. The diagnosis was verified by polymerase chain reaction (detection of RNK of SARS-CoV-2) in 33.3%, by enzyme immunoassay (detection of IgG antibodies to SARS-CoV-2 in 1 month after quarantine removal) in 100%. 58.3% of children with respiratory tuberculosis (14 people) infected with coronavirus infection had minimal respiratory symptoms, that did not differ from signs of other respiratory viral infections; clinical manifestations of the disease were completely absent in 41.7% (10) patients. Coronavirus pneumonia was diagnosed in 4 (16.7%) children who suffered from COVID-19, they had no clinical signs of lower respiratory tract disorders and no body temperature increase; 3 patients had no signs of respiratory viral infection; in all cases, the lung damage detected by computed tomography didn't exceed 10%. In 2 months after the removal of quarantine, no IgG antibodies to SARS-CoV-2 were detected in 2 out of 10 examined children (20.0%), thus there was a chance for re-infection. No mutual aggravating effect of coronavirus infection and tuberculosis was revealed in their combination over the entire observation period (4 months).
The objective: to develop differentiated approaches to the choice of timing of surgical treatment of intrathoracic lymph node tuberculosis (ITLNTB) in children during the increasing incidence of multiple drug resistant tuberculosis (MDR-TB).Subjects and Methods. 52 patients of 2-12 years old had their intrathoracic lymph nodes removed at different stages of anti-tuberculosis therapy. All children had massive (more than 10-15 mm) conglomerates in their intrathoracic lymph nodes. Additionally to changes in intrathoracic lymph nodes, 12 people had active tuberculous changes in the lungs or bronchial tuberculosis.Results. 5 patients were operated before chemotherapy, 35 patients after 2 months of treatment, and 12 patients underwent surgery afterwards. The elective surgery was performed in 51 children, and 1 child had surgery before the start of chemotherapy due to vital indications (the threat of breakthrough of caseous masses into the trachea).Planned surgical treatment in children with tuberculosis of intrathoracic lymph nodes should be carried out within the following timing: before the start of anti-tuberculosis therapy in the absence of clinical, laboratory and radiological signs of the disease being active; as soon as possible from the start of chemotherapy (it is enough to focus on the results of the first CT control after 2 months of treatment (there should be no tendency to involution of pathological changes) in the presence of minimal signs of tuberculosis activity). The choice of timing of planned surgical treatment is individual and determined by the timing of stabilization of pulmonary changes or the cure of bronchial tuberculosis (after 6, 9, 12 months) in patients with newly diagnosed active tuberculosis of intrathoracic lymph nodes in combination with lung and/or bronchial lesions. The development of life-threatening complications is an absolute indication for emergency surgery.
Objective: to familiarize doctors with one of the rare variants of primary immunodeficiency – chronic granulomatous disease. The authors present a case of late diagnosis of chronic granulomatous disease in a 10-year-old child. The doctors missed the development of complications after BCG vaccination in the form of axillary lymphadenitis on the left (BCGitis), which led to the development of disseminated BCG infection, regarded as an infectious tuberculous process. The onset of chronic granulomatous disease occurred at the age of 10 months (paraproctitis complicated by an anal fistula). The assumption of the presence of immunodeficiency arose in connection with the recurrent course of pneumonia at the age of 4-5 years, but was regarded as a manifestation of a tuberculous infectious process. At the age of 8, during the protracted course of nonspecific polysegmental pneumonia, primary immunodeficiency without specific clinical form was diagnosed on the basis of the results of a comprehensive immunological examination. At the age of 10, chronic granulomatous disease was verified using a study of spontaneous and stimulated chemiluminescence of neutrophils and the results of a genetic study.
The article presents scientific approaches to the solution of actual problems of chemotherapy for children and adolescents tuberculosis with multiple pockets and extensively drug-resistant TB (MDR/XDR) pathogen to anti-TB drugs has the source of infection and the patient himself. The urgency of the problem determines: increase in the adult population of the M. tuberculosis with the specified allocation stability, the need for the drug susceptibility test of the source of infection to choose a starting chemotherapy regimen is determined by the negative M. tuberculosis status in the diagnostic material of the majority of children and adolescents. Patient-specific approach to chemotherapy is necessary subject to age limitations when choosing antituberculous drugs. Particular attention is paid to chemotherapy after surgical treatment. The results of scientific research carried out in accordance with WHO guidelines; indicate the possibility to shorten the duration of chemotherapy and to reduce the number of drugs in the treatment regimen without decreasing treatment efficacy.
ФГБОУ ВО «Российский национальный исследовательский медицинский университет им. Н. И. Пирогова» МЗ РФ, г. Москва, РФ Цель исследования: оценить эффективность ориентированной на пациента химиотерапии у детей с ограниченным туберкулезом органов дыхания из эпидемических очагов туберкулеза с множественной/широкой лекарственной устойчивостью (МЛУ/ШЛУ) по результатам ближайших и отдаленных наблюдений, определить критерии эффективности химиотерапии при таких процессах. Материалы и методы: всего 39 пациентов (3-12 лет) с туберкулезом внутригрудных лимфатических узлов, очаговым туберкулезом легких. По результатам рандомизации сформировано две группы больных с различными режимами химиотерапии: 1-я группа (20 человек)-5 препаратов в интенсивную фазу / 4 препарата в фазу продолжения, 2-я группа (19 человек)-4 препарата в интенсивную фазу / 3 препарата в фазу продолжения. В комбинацию препаратов включали только те, к которым была сохранена лекарственная чувствительность возбудителя у источника инфекции. Проведена оценка эффективности химиотерапии по данным ближайших (в процессе проведения химиотерапии) и отдаленных наблюдений (через 1 и 2 года после окончания лечения). Продолжительность интенсивной фазы химиотерапии и общего лечения в группах были одинаковы: 1-я группа-3,5 ± 0,5 и 10,5 ± 0,5 мес. соответственно; 2-я группа-3,1 ± 0,6 и 10,0 ± 0,6 мес. соответственно. Результаты. Эффективность химиотерапии, ориентированной на пациента, в обеих группах подтверждена результатами ближайших наблюдений и отсутствием рецидивов заболевания при наблюдении через 1 и 2 года после окончания химиотерапии. Выводы. Предложенные режимы химиотерапии могут использоваться при лечении детей с ограниченными процессами из эпидемических очагов туберкулеза с МЛУ/ШЛУ как альтернативные по отношению к стандартным режимам.
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