Examination of tuberculosis patients

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

A carefully collected anamnesis

All factors contributing to the development of the disease are determined: the presence and nature of the source of infection (duration of contact, presence of bacterial excretion, whether the patient is being treated for tuberculosis);

• availability, frequency and effectiveness of vaccinations against tuberculosis;
• dynamics of annual tuberculin reactions (according to the Mantoux reaction (RM)c2TE);
• the presence of concomitant diseases (chronic diseases of the respiratory system, urinary system, gastrointestinal tract, psychoneurological pathology, allergic diseases, diabetes mellitus):
• social, migration history (socially maladapted children and adolescents, homeless persons, refugees, migrants).

Objective examination

The following signs are detected in children and adolescents:

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

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

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

The syndrome of general disorders includes asthenoneurotic reactions (weakness, rapid fatigue, irritability, sleep disturbances, deterioration of school performance, loss of appetite, body weight, subfebrile temperature, etc.), functional disorders of various organs and systems (pain in the abdomen, heart, legs, headache, nausea, the appearance of tachycardia, systolic murmur, changes in blood pressure, etc.) and paraspecific allergic reactions (keratoconjunctivitis, blepharitis, phlyctena, erythema nodosum, polyserositis).

Pulmonary syndrome includes the presence of so-called chest complaints in the patient, the main ones being cough, hemoptysis, shortness of breath, chest pain when breathing. The mandatory clinical minimum carried out in the conditions of an anti-tuberculosis institution is a set of measures for diagnosing the manifestations of tuberculosis infection and differential diagnosis of tuberculosis with other diseases. It includes the following stages:

• survey and accumulation of information;
• analysis of information for reliability, informativeness, specificity;
• construction of a diagnostic symptom complex;
• 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 (X-ray and ultrasound), laboratory and bacteriological (microscopy and culture of sputum, gastric lavage and urine for Mycobacterium tuberculosis [MBT]) examination methods.

Indications for examination for tuberculosis in children and adolescents seeking medical care: subfebrile temperature of unclear etiology for 4 weeks or more, unmotivated cough, hemoptysis, shortness of breath and chest pain when breathing, the appearance of paraspecific allergic reactions, prolonged pneumonia and exudative pleurisy (more than 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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