Methods for detecting tuberculosis

Mass tuberculin diagnostics

Mass tuberculin diagnostics are carried out using a 2-tuberculous unit test (2-TU test) for children and adolescents vaccinated against tuberculosis once a year, starting at 1 year of age; for children and adolescents not vaccinated against tuberculosis, once every 6 months, starting at 6 months of age until vaccination. The objectives of mass tuberculin diagnostics are as follows:

• identification of children and adolescents with tuberculosis;
• identification of individuals at risk of developing tuberculosis for subsequent observation by a phthisiatrician and, if necessary, for preventive treatment (individuals infected with MBT for the first time - a turn in tuberculin tests, individuals with an increase in tuberculin tests, individuals with hyperergic tuberculin tests, individuals with tuberculin tests that have been at a moderate or high level for a long time);
• selection of children and adolescents for BCG revaccination;
• determination of epidemiological indicators for tuberculosis (infection of the population with MBT, annual risk of infection with MBT).

Fluorography

Fluorography is performed on teenagers, students (in schools, higher and secondary specialized educational institutions), workers, and unorganized people. The examination is performed at the place of work or study, for those working in small enterprises and unorganized people - in clinics and tuberculosis dispensaries.

The following groups are subject to fluorography:

• adolescents from 15 to 17 years old - annually, then - according to the examination scheme for the adult population - once every 2 years;
• decreed contingents (if tuberculosis is detected in decreed contingents, they are prohibited from working in these specialties) - once every 6 months;
  • persons working in institutions where children and adolescents under 18 years of age are raised, educated or treated;
  • workers in dairy kitchens, public catering establishments and trade;
  • hairdressers, bathhouse attendants, public transport workers, taxis, train and airplane conductors, librarians, domestic workers, nannies, crew on sea and river vessels, people who make and sell children's toys;
• teenagers who arrived at educational institutions from other regions of Russia and the CIS countries (if fluorography was not provided or more than 6 months have passed since it was performed);
• Before the birth of the child, in the first 6 months of pregnancy, fluorography is performed on all persons who will live with the child in the same apartment.

Bacteriological examination

Children and adolescents suffering from the following diseases are bacteriologically examined:

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

Detection by contact testing

When any case of active tuberculosis is detected (a sick person, a sick animal), they are required to be referred for consultation to a phthisiatrician and observed in anti-tuberculosis dispensaries in the IV group of dispensary registration of children and adolescents of all ages:

• in household (family, relative) contact;
• living in the same apartment;
• living on the same landing;
• residing on the territory of a tuberculosis institution;
• living in families of livestock breeders who have farm animals sick with tuberculosis or who work on farms with a high tuberculosis risk.

Detection when seeking medical care

When seeking medical help, tuberculosis is detected in 40-60% of older children and adolescents, and in the vast majority of young children (under 1 year). As a rule, the most common and severe forms are detected. Almost all young children with tuberculosis are first admitted to general somatic departments with diagnoses of pneumonia, acute respiratory viral infections, and meningitis. If there is no positive dynamics from treatment, tuberculosis is suspected, after which the children are hospitalized in a specialized children's tuberculosis department.

Currently, adolescents (students in secondary specialized educational institutions, workers, unorganized) must be examined radiologically (fluorographically) in the following cases:

• at any visit to a doctor, if fluorography was not performed in the current year;
• Those who are frequently and long-term ill are examined during periods of exacerbation, regardless of the timing of the previous fluorography;
• when contacting a doctor with symptoms suspicious of tuberculosis (protracted pulmonary diseases - more than 14 days, exudative pleurisy, subacute and chronic lymphadenitis, erythema nodosum, chronic diseases of the eyes, urinary tract, etc.);
• before prescribing phthisiotherapeutic treatment;
• Before prescribing glucocorticoid therapy, in case of its long-term use, isoniazid is prescribed at 10 mg/kg/day for at least 3 months, RM is performed with 2 TE 4 times a year.

Detection of tuberculosis in a general medical network institution

In general medical network institutions, primary differential diagnostics of tuberculosis with diseases of non-tuberculous etiology is carried out. For this, the following actions are performed:

• collection of a history of tuberculin sensitivity for previous years and information on immunization with the BCG vaccine;
• conducting individual tuberculin diagnostics (Mantoux test with 2 TE PPD-L);
• consultation with a phthisiatrician;
• on the recommendation of a phthisiatrician - conducting clinical tuberculin diagnostics, bronchological, radiological examinations, etc.

Detection of tuberculosis in the conditions of the anti-tuberculosis dispensary

The tuberculosis dispensary serves as a specialized healthcare institution that organizes and provides tuberculosis care to the population in the administrative district. One of the tasks of the tuberculosis dispensary is to organize the primary clinical examination of children and adolescents from risk groups for tuberculosis (0, IV and VI groups of dispensary registration). The mandatory diagnostic minimum of the examination conducted in the conditions of the tuberculosis dispensary includes the following studies:

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

Monitoring of children from risk groups and patients with tuberculosis is carried out by a pediatrician in a children's clinic and a phthisiopediatrician at a tuberculosis dispensary at the place of residence.

Risk groups for tuberculosis in pediatrics

The pediatrician's tasks are:

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

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

• Epidemiological (specific):
  • contact with people sick with tuberculosis (both close family or apartment contact, and casual);
  • contact with animals sick with tuberculosis.
• Medical and biological (specific):
  • ineffective BCG vaccination (the effectiveness of BCG vaccination is assessed by the size of the post-vaccination mark: if the vaccination scar is less than 4 mm or is absent, immune protection is considered insufficient).
• Medical and biological (non-specific):
  • hyperergic sensitivity to tuberculin (according to the Mantoux reaction with 2 TE);
  • concomitant chronic diseases (urinary tract infections, chronic bronchitis, recurrent obstructive bronchitis, bronchial asthma, allergic dermatitis, chronic hepatitis, diabetes mellitus, anemia, psychoneurological pathology);
  • frequent acute respiratory viral infections in the anamnesis - the so-called group of frequently ill children.
• Age-gender (non-specific):
  • younger age (up to 3 years);
  • prepuberty and adolescence (13 to 17 years);
  • During adolescence, girls are more likely to get sick.
• Social (non-specific):
  • alcoholism, drug addiction in parents;
  • parents' stay in places of imprisonment, parents' unemployment;
  • homelessness of children and adolescents, children being placed in orphanages, children's homes, social centers and other similar institutions, parents being deprived of parental rights;
  • large family, single-parent family;
  • migrants.

Indications for referral to a phthisiatrician are as follows:

• children and adolescents in the early period of primary tuberculosis infection (virage), regardless of the Mantoux reaction indicators 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 reaction papule from 2 TE by 6 mm or more, regardless of the Mantoux reaction indicators from 2 TE and the presence of risk factors for tuberculosis;
• children and adolescents with a gradual increase in sensitivity to tuberculin over 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 who have a pronounced reaction to tuberculin (papule 15 mm or more).

Information required when referring children and adolescents to a phthisiatrician:

• date of BCG vaccination and revaccination;
• annual results of RM with 2 TE from birth until referral to a phthisiatrician;
• presence and duration of contact with tuberculosis patients;
• results of fluorographic examination of the child's environment;
• history of acute, chronic, allergic diseases;
• previous examinations by a phthisiatrician;
• results of clinical laboratory examination (general blood and urine tests);
• conclusion of relevant specialists in the presence of concomitant diseases;
• social history of the child or adolescent (living conditions, financial security, migration history).

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