Methods for detecting tuberculosis

Mass tuberculin diagnostics

Mass tuberculin diagnostics is carried out with the help of RM with 2 tuberculin units (RM with 2 TE) to children and adolescents vaccinated against tuberculosis, once a year, starting from 1 year; children and adolescents not vaccinated against tuberculosis - every 6 months, from the age of 6 months to receiving the vaccination. The tasks of mass tuberculin diagnostics are as follows:

• identification of tuberculosis patients of children and adolescents;
• identification of persons at risk of tuberculosis, for follow-up at a phthisiatrician and, if necessary, for prophylactic treatment (for the first time infected with the MBT - the turn of tuberculin samples, persons with tuberculin samples, persons with hyperergic tuberculin tests, persons with tuberculin tests , long-term at a moderate and high level);
• selection of children and adolescents for booster revaccination;
• the definition of epidemiological indicators for tuberculosis (the infection rate of the ILO population, the annual risk of infection with the Office).

Fluorography

Fluorography is carried out by teenagers, students (in schools, higher and secondary special educational institutions), working, unorganized. The survey is conducted at the place of work or study, for working in small businesses and unorganized - in polyclinics and anti-tuberculosis dispensaries.

The following contingents are subject to fluorography:

• adolescents from 15 to 17 years - annually, in the future - according to the scheme of examination of the adult population - once in 2 years;
• decreed contingents (they are forbidden to work in these specialties if tuberculosis is detected in decreed contingents) - every 6 months;
  • persons working in institutions where they raise, educate or treat children and adolescents under the age of 18;
  • employees of dairy cuisines, catering and trade enterprises;
  • hairdressers, bath attendants, urban transport workers, taxis, conductors of wagons, airplanes, librarians, domestic workers, nannies, seafarers on the ships of the sea and river fleet, persons manufacturing and selling children's toys;
• adolescents who have come to educational institutions from other regions of Russia and CIS countries (if fluorography has not been provided or since it was held more than 6 months);
• before the birth of the child in the first 6 months of pregnancy, fluorography is carried out by all persons who will live with the child in the same apartment.

Bacteriological examination

Bacteriological examination of children and adolescents suffering from such diseases:

• chronic respiratory diseases (examine sputum);
• chronic diseases of the urinary system (urine);
• meningitis (for the presence of MBT, examine the cerebrospinal fluid and fibrin film).

Detection in case of contact examination

If any case of an active form of tuberculosis is detected (a sick person, a sick animal), it is mandatory to send a consultation to a TB specialist and monitored in TB dispensaries in the IV group of dispensary records of children and adolescents of all ages:

• consisting of household (family, related) contact;
• living in the same apartment;
• living on one staircase;
• living on the territory of a tuberculosis facility;
• Living in families of livestock keepers with tuberculosis of farm animals or working in dysfunctional farms on tuberculosis.

Identification when seeking medical help

When seeking medical help, tuberculosis is detected in 40-60% of older children and adolescents, in the vast majority of young children (up to 1 year). In this case, as a rule, the most common and severe forms are found. Almost all infants with tuberculosis come first to general medical departments with diagnoses of "pneumonia", "ARVI", "meningitis". In the absence of positive dynamics from treatment, suspicion of tuberculosis arises, after which the children are hospitalized in a specialized children's tuberculosis department.

At present, adolescents (students in secondary specialized educational institutions, working, unorganized) should be examined by X-ray (fluorography) in the following cases:

• at any reference to the doctor, if the fluorography was not carried out in the current year;
• often and long-term ill patients are examined during an exacerbation, regardless of the timing of the previous fluorography;
• when referring to a doctor with symptoms suspected of tuberculosis (pulmonary diseases of protracted course - more than 14 days, exudative pleurisy, subacute and chronic lymphadenitis, erythema nodosum, chronic diseases of the eyes, urinary tract, etc.);
• before the appointment of phthisiotherapy treatment;
• before the appointment of glucocorticoid therapy, in the case of its long-term use isoniazid 10 mg / kg / day, not less than 3 months, carry out PM with 2 TE 4 times a year.

Identification of tuberculosis in the setting of a general medical network

In institutions of the general medical network, primary differential diagnosis of tuberculosis with diseases of non-tubercular etiology is carried out. To do this, perform the following actions:

• collection of an anamnesis of susceptibility to tuberculin in previous years and information on immunization with BCG vaccine;
• carrying out individual tuberculin diagnostics (Mantoux test with 2 TE PPD-L);
• phthisiatric consultation;
• on the recommendation of the phthisiatrician - conducting clinical tuberculin diagnostics, bronchological, radiologic studies, etc.

Identification of tuberculosis in an anti-tuberculosis dispensary

The TB dispensary serves as a specialized health care institution that organizes and carries out anti-tuberculosis care in the administrative district. One of the tasks of the TB dispensary is the organization of a primary clinical examination of children and adolescents at risk for tuberculosis (0, IV and VI groups of dispensary records). The following diagnostic tests are included in the compulsory diagnostic minimum of a survey conducted in an anti-TB dispensary:

• anamnesis collection and physical examination of children and adolescents at risk of tuberculosis;
• clinical blood and urine tests;
• individual tuberculin diagnostics;
• laboratory diagnostics (general clinical tests of blood and urine);
• bacteriological diagnostics (luminescence microscopy and culture of urine, sputum or smear from the throat on the MBT three times);
• X-ray tomographic examination.

Monitoring of children from risk groups and patients with tuberculosis is carried out by a pediatrician in the conditions of a pediatric clinic and phthisiopaediatric of an antituberculous dispensary in the community.

Risk groups for tuberculosis in the pediatric area

The tasks of the pediatrician are as follows:

• identification of risk factors for tuberculosis;
• study of the nature of sensitivity to tuberculin according to the RM with 2 TE:
  • studying the level of the RM with 2 TE;
  • studying the dynamics of the RM with 2 TE.

Risk factors that contribute to the development of tuberculosis in children and adolescents.

• Epidemiological (specific):
  • contact with tuberculosis patients (both close family or apartment contact, and casual);
  • contact with tuberculosis patients with animals.
• Medico-biological (specific):
  • Ineffective vaccination with BCG (vaccination effectiveness of BCG is estimated by the size of the post vaccination sign: in case of a vaccinal scar less than 4 mm, or lack thereof, immunity is considered insufficient).
• Medico-biological (nonspecific):
  • hyperergic sensitivity to tuberculin (according to the Mantoux reaction with 2 TE);
  • concurrent chronic diseases (urinary tract infections, chronic bronchitis, recurrent obstructive bronchitis, bronchial asthma, allergic dermatitis, chronic hepatitis, diabetes mellitus, anemia, neuropsychiatric pathology);
  • frequent ARVI in the anamnesis - the so-called group of often ill children.
• Age-sex (nonspecific):
  • younger age (up to 3 years);
  • prepubertal and adolescence (13 to 17 years);
  • in adolescence, girls are more often ill.
• Social (nonspecific):
  • alcoholism, drug addiction among parents;
  • stay of parents in places of deprivation of liberty, unemployment of parents;
  • homelessness of children and adolescents, getting children into orphanages, orphanages, social centers and other similar institutions, depriving parents of parental rights;
  • large families, single parent family;
  • migrants.

Indications for referral to phthisiatric are as follows:

• children and adolescents in the early period of primary tuberculosis infection (a turn), regardless of the Mantoux reaction with 2 TE and the presence of risk factors for tuberculosis;
• children and adolescents with Hyperergic Mantoux reactions with 2 TE, regardless of the presence of risk factors for tuberculosis;
• children and adolescents with an increase in the size of the Mantoux papule with 2 TE for 6 mm or more, regardless of the Mantoux reaction with 2 TE and the presence of risk factors for tuberculosis;
• children and adolescents with a gradual increase in sensitivity to tuberculin for several years, with the formation of moderate intensity and pronounced Mantoux reactions with 2 TE, regardless of the presence of risk factors for tuberculosis;
• children and adolescents with monotonous sensitivity to tuberculin in the presence of moderate intensity and pronounced Mantoux reactions with 2 TE in the presence of two or more risk factors for tuberculosis;
• children and adolescents from social risk groups with a pronounced reaction to tuberculin (papules 15 mm or more).

Information required when sending children and adolescents to a phthisiatrician:

• date of vaccination and revaccination of BCG;
• annual results of PM with 2 TE from birth to the moment of referral to the TB officer;
• Presence, prescription of contact with patients with tuberculosis;
• results of a fluorographic examination of the environment of the child;
• suffered acute, chronic, allergic diseases;
• previous examinations at the phthisiatrician;
• results of clinical and laboratory examination (general analysis of blood and urine);
• the conclusion of appropriate specialists in the presence of concomitant diseases;
• a social anamnesis of a child or adolescent (living conditions, material support, migratory anamnesis).

[1], [2], [3], [4], [5], [6], [7], [8], [9], [10],