Phthisiopediatrician

A doctor who carries out the prevention, diagnosis and treatment of tuberculosis in children is called a phthisiopediatrician.

Who is a phthisiopediatrician?

This is a doctor, a medical specialist, a graduate of a higher medical educational institution who specializes in pediatrics (childhood diseases) and, in particular, has a narrow focus on the treatment of tuberculosis diseases in children.

When should you contact a phthisiopediatrician?

A qualified phthisiopediatrician can determine whether a child has a tuberculosis infection long before conducting special tests. Therefore, you should contact this specialist if you notice the following symptoms in your child:

• fatigue, unmotivated tiredness, a sharp reluctance to play active games, whereas previously this brought the child pleasure;
• excessive emotionality, irritability, tearfulness;
• loss of appetite, even for those foods that were previously your favorites;
• excessive sweating;
• enlarged lymph nodes without pain;
• an increase in temperature, especially in the evening, up to 37.5°C;
• unnatural enlargement of the baby's liver and spleen;
• cough;
• the presence of signs of an inflammatory process in a blood test.

You should also contact a phthisiopediatrician if your child has been in contact with someone with tuberculosis, as well as for clarification regarding a tuberculin test or to decipher an X-ray tomogram.

A consultation with a phthisiopediatrician is necessary:

• children who have been diagnosed with a “turn” in sensitivity to tuberculin for the first time;
• children who have not received the BCG vaccine and who have a positive or questionable Mantoux reaction;
• children with a sharp increase in tuberculin sensitivity compared to the previous test (more than 6 mm);
• children with the formation of an infiltrate with a diameter of more than 12 mm at the site of the Mantoux test;
• children with hyperergic Mantoux reaction.

Such children should visit a specialist no later than a week after the Mantoux test.

What tests should be taken when visiting a phthisiopediatrician?

If you have made an appointment for your child to see a phthisiopediatrician, do not rush to take any tests: the doctor will decide what and when the child should take, and will also explain to you the appropriateness of certain tests.

If you are going to see a phthisiopediatrician because you are concerned about the child's X-ray or blood test results, be sure to take these reports with you. The doctor will evaluate the results and immediately explain whether you should worry. In such a situation, additional diagnostics may be required, which your child will have to undergo.

Standard examination procedure for a child with suspected tuberculosis:

• taking a blood test. If there is a disease - increased ESR, lymphopenia;
• conducting a sputum test for tuberculosis bacilli. In the presence of tuberculosis, they are found in sputum in varying quantities;
• setting up a tuberculin test. In the presence of tuberculosis pathology, a subcutaneous injection of 20 TE gives a hyperergic reaction;
• conducting an X-ray examination or tomography. If pathology is present, enlarged intrathoracic lymph nodes are detected;
• conducting a bronchoscopy - deformation of the respiratory tract is detected, sometimes a fistula or obstruction is noted.

What diagnostic methods does a phthisiopediatrician use?

The following methods can be used to detect tuberculosis infection in a child’s body:

• bacterioscopic method. This method includes the procedure of light microscopy using Ziehl-Neelsen staining, as well as luminescent microscopy using fluorochromes. The advantage of this method is the rapid receipt of results, as well as its cost-effectiveness;
• cultural method. Involves seeding pathological preparations most often on egg medium. For a more accurate result, seeding can be carried out on several different media, including liquid ones. The growth of pathogenic flora is observed for 10 weeks;
• biological test. The essence of this method consists of introducing pathological material into a highly sensitive species of guinea pigs;
• molecular genetic method. This method includes the PCR reaction and tuberculin diagnostics (Mantoux test);
• enzyme immunoassay method. This method of research demonstrates the amount of antigens and antibodies in the child's blood;
• conducting the Clinispot-TB test. This is the latest laboratory test that determines the number of T-lymphocytes that release γ-interferon during contact with tuberculosis bacilli antigens. This is a fairly highly sensitive method that allows detecting even isolated T-lymphocytes, which makes it possible to identify the latent course of the tuberculosis process, as well as the presence of such a process in children with a reduced immune response. The sensitivity of this test compared to the intradermal test is 96% compared to 69%.

Culture determination is difficult to perform in pediatric patients, but with the use of new diagnostic tests, it has become possible to make an accurate and timely diagnosis.

Among the additional research methods, the following should be highlighted:

• conducting a general blood and urine test;
• chest X-ray tomographic evaluation;
• Ultrasound of internal organs, including kidneys;
• Ultrasound of the lymph nodes.

What does a phthisiopediatrician do?

A phthisiopediatrician can engage in several types of activities, including:

• preventive measures;
• diagnostic procedures;
• therapy of tuberculosis diseases;
• educational and upbringing work;
• management and organizational activities;
• research work.

In addition, the competence of a phthisiotherapist may include:

• promotion of a healthy lifestyle and diet, maintenance of appropriate housing conditions, the importance of physical exercise and sports for the formation of a healthy nation;
• implementation of preventive measures to avoid the development of an epidemic or infection of healthy children who come into contact with carriers of the tuberculosis bacillus;
• early diagnosis, detection of typical signs of the disease, as well as asymptomatic and atypical manifestations of tuberculosis, based on propaedeutic and instrumental-laboratory methods;
• providing emergency care in critical conditions;
• participation in the hygiene education of children, especially in families where there is a patient with tuberculosis;
• organization of mass preventive and explanatory events, conducting them in pre-school and school educational institutions, children's clinics, hospitals and dispensaries;
• sanitary and specific prevention of tuberculosis infection.

What diseases does a phthisiopediatrician treat?

A phthisiopediatrician deals with all forms of tuberculosis infection that can be detected in children. The most common form of tuberculosis detected in childhood is the local form, in particular, the defeat of the intrathoracic lymph nodes: such pathology affects the lymph nodes of the roots of the lung and mediastinum.

Among other childhood infections that fall within the qualifications of a phthisiopediatrician, the following can be highlighted:

• pulmonary tuberculosis;
• generalized lymphohematogenous tuberculosis;
• tuberculous lesions of the central nervous system (manifestations of meningitis and tuberculoma);
• tuberculous form of leptomeningitis (damage to the spinal cord);
• tuberculous lesions of the lymph nodes (subclavian, cervical, axillary, tonsillar, etc.);
• tuberculous lesions of the skeletal system (signs of tuberculous spondylitis, dactylitis, arthritis);
• congenital form of tuberculosis, postnatal infection;
• tuberculous lesions of the urinary system, gastrointestinal tract, intra-abdominal lymph nodes, tuberculous etiology of peritonitis;
• tuberculous lesions of the skin, pericardium, tonsils, middle ear, etc.

A phthisiopediatrician knows how to conduct clinical examinations of a child with tuberculosis, how to make a diagnosis and identify the form of the disease, how to determine the contingent that is subject to mandatory monitoring for tuberculosis.

Advice from a phthisiopediatrician

To protect your child from accidentally becoming infected with tuberculosis, you need to follow some rules:

• If a person with tuberculosis infection is found in the child’s environment, he or she should be isolated and all necessary disinfection methods should be carried out in the room;
• Parents should not refuse to vaccinate their children, as well as to conduct tuberculin tests to detect tuberculosis bacilli. Such tests contain destroyed tuberculosis bacilli and are absolutely harmless to the baby;
• the child should live and spend time in places that meet generally accepted sanitary and hygienic standards. The child's room should be clean, light, and ventilated;
• It is necessary to provide the baby with healthy and nutritious food so that the growing body does not suffer from a lack of vitamins, and the child's immunity is able to resist various infections;
• It is necessary to teach a child to observe the rules of personal hygiene from childhood;
• allow your child to relax actively, play, sunbathe, walk in the park, and toughen up;
• Remember: products bought at spontaneous markets must be washed thoroughly, if possible, doused with boiling water. Milk bought from hands must be boiled.

A phthisiopediatrician advises: if you have any suspicions that your child has an infection, be sure to visit a doctor. The earlier the disease is detected, the more favorable the prognosis will be.