Examination of patients with tuberculosis

Tuberculosis in children is characterized by a pronounced polymorphism of clinical manifestations, the absence of strictly specific symptoms, which creates significant difficulties in diagnosis. There is not a single clinical sign, characteristic only for tuberculosis. Often in children, the initial manifestations of tuberculosis infection are expressed only in behavioral changes, common symptoms of intoxication. Therefore, the main condition for timely and correct diagnosis is a comprehensive examination.

Carefully collected anamnesis

Find out all the factors that contribute to the development of the disease: the presence and nature of the source of infection (duration of contact, the presence of bacterial excretion, whether the patient is treated with tuberculosis);

• availability, multiplicity and effectiveness of vaccinations against tuberculosis;
• dynamics of annual tuberculin reactions (according to Mantoux (PM) c2TE);
• presence of concomitant diseases (chronic diseases of the respiratory system, urinary system, gastrointestinal tract, psychoneurological pathology, allergic diseases, diabetes mellitus):
• social, migratory anamnesis (socially maladjusted children and adolescents, persons without a definite place of residence, refugees, immigrants).

Objective inspection

The following signs are revealed in children and adolescents:

• symptoms of intoxication (pallor, dry skin, periorbital cyanosis, decreased turgor and elasticity of tissues, appetite, body weight, lag in physical development, hypertrichosis of the extremities and back, etc.);
• paraspecific reactions (micropolymphadenitis, blepharitis, allergic keratoconjunctivitis, unsharply expressed hepatosplenomegaly, systolic murmur in the region of the heart of a functional nature, erythema nodosum, etc.);
• local signs of damage to organs and systems (respiratory organs, urinary system, central nervous system, damage to peripheral lymph nodes, skin, bone system).

All possible symptoms of the disease can be combined into two leading clinical syndromes:

• syndrome of common disorders (intoxication syndrome);
• pulmonary syndrome.

The syndrome of common disorders includes asthenoneurotic reactions (weakness, fatigue, irritability, sleep disturbance, deterioration in school performance, decreased appetite, body weight, low-grade fever, etc.), functional disorders of various organs and systems (abdominal pain, heart, legs, headache, nausea, the appearance of tachycardia, systolic noise, changes in blood pressure, etc.) and paraspecific allergic reactions (keratoconjunctivitis, blepharitis, fluke, erythema nodosum, polyserositis).

Pulmonary syndrome includes the presence of the patient's so-called thoracic complaints, the main ones - coughing, hemoptysis, dyspnea, chest pain while breathing. The mandatory clinical minimum, conducted in conditions of an anti-tuberculosis institution, is a set of measures for diagnosing manifestations of tuberculosis infection and differential diagnosis of tuberculosis with other diseases. It includes the following steps:

• survey and accumulation of information;
• analysis of information on the reliability, information, specificity;
• the construction of a diagnostic symptom complex;
• a presumptive diagnosis;
• differential diagnostics;
• clinical diagnosis;
• verification of the correctness of the clinical diagnosis.

The stage of examination and accumulation of information includes anamnesis, complaints, physical examination, radiation (radiological and ultrasonic), laboratory and bacteriological (microscopy and culture of sputum, rinsing of stomach and urine for mycobacterium tuberculosis [MBT]).

Indication for examination of tuberculosis of children and adolescents seeking medical help: subfebrile condition of unclear etiology for 4 weeks or more, unmotivated cough, hemoptysis, dyspnea and chest pain during breathing, the appearance of paraspecific allergic reactions, protracted pneumonia and exudative pleurisy (more 4 weeks), inflammation of the peripheral lymph nodes (lymphadenitis), ineffective treatment of chronic somatic diseases of the respiratory system, kidneys, etc.

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