Phthisiopathy

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

Who is a phthisiopaediatrician?

This is a doctor, a medical specialist, a graduate of a higher medical school that specializes in pediatrics (children's diseases) and, in particular, has a narrow focus on the treatment of tuberculosis diseases in children.

When should I go to a phthisiopaea?

A qualified phthisioperiatrist can determine the presence of tuberculosis infection in a child long before special studies are carried out. Therefore, it is worth turning to this specialist if you notice the following signs of the child:

• fatigue, unmotivated fatigue, a sharp reluctance to play mobile games, whereas previously this brought the child pleasure;
• excessive emotionality, irritability, tearfulness;
• loss of appetite, even to those foods that used to be the most loved;
• excessive sweating;
• an increase in lymph nodes in the absence of their soreness;
• increase in temperature, especially in the evening, to 37.5 ° C;
• unnatural increase in the baby's liver and spleen;
• cough;
• presence in the analysis of blood signs of the inflammatory process.

Also, the phthisiopathic referral should be made if the child has been in contact with a sick tuberculosis, as well as for clarification about a tuberculin test or for decoding an X-ray tomogram.

Consultation of a phthisiopaediatrician is necessary:

• children who first discovered a "turn" of susceptibility to tuberculin;
• children who have not been vaccinated with BCG, who have a positive or questionable Mantoux reaction;
• children with a sharp increase in tuberculin sensitivity compared to the previous sample (more than 6 mm);
• children with the formation at the injection site of a Mantoux infiltrate sample with a diameter of more than 12 mm;
• children with Hyperergic Mantoux reaction.

Such children should visit a specialist not later than a week after the Mantoux test.

What tests should I take when I call a phthisiopaea?

If you have recorded your child for an appointment with a phthisiopaedist, do not rush to take any tests: the doctor himself decides what and when to give the child, and also explains to you the feasibility of these or other studies.

If you go to a consultation with a phthisiopathist, since you are alerted to a picture or a result of a child's blood test, be sure to take these findings with you. The doctor will evaluate the results and immediately explain if you need to worry. Perhaps in this situation, you will need additional diagnostics, which your child will have to undergo.

The standard scheme for examining a child with suspected tuberculosis:

• taking a blood test. In the presence of the disease - increased ESR, lymphopenia;
• conducting a sputum smear test on tubercle bacilli. In the presence of tuberculosis, they are found in sputum in various amounts;
• setting tuberculin test. In the presence of tuberculosis pathology, a subcutaneous injection of 20 TE gives a hyperergic reaction;
• X-ray examination or tomography. In the presence of pathology, enlarged hilar lymph nodes are found;
• bronchoscopy - detect a deformation of the respiratory tract, sometimes detect fistula or obturation.

What diagnostic methods does the phthisiopaediatrician use?

To detect tuberculosis infection in a child's body, the following methods can be used:

• bacterioscopic method. To this method, one can include the procedure of light microscopy with application of Tsiol-Nielsen staining, as well as fluorescent microscopy using fluorochromes. The advantage of this method is the rapid receipt of results, as well as its cost-effectiveness;
• culture method. Implies the sowing of pathological drugs most often on the egg environment. For a more accurate result, sowing can be carried out on several different media, as well as on liquid media. The growth of the pathogenic flora is observed for 10 weeks;
• biological test. The essence of this method consists in the introduction of pathological material to the highly sensitive species of guinea pigs;
• molecular genetic method. This method includes the reaction of PCR and tuberculin diagnostics (Mantoux test);
• method of enzyme immunoassay. This method of investigation demonstrates the number of antigens and antibodies in the blood of the child;
• conducting a Clinispot-TB test. This is the newest laboratory test, which determines the number of T-lymphocytes that release ү-interferon during contact with antigens of tubercle bacilli. This is a highly sensitive method that makes it possible to detect even disparate T-lymphocytes, which makes it possible to reveal the latent course of the tuberculosis process, as well as the presence of such a process in children with a decrease in the immune response. The sensitivity of this test compared with the intradermal test is 96% compared with 69%.

The definition of culture is difficult to fulfill in patients of childhood, but thanks to the use of new diagnostic tests it became possible to accurately and timely diagnose.

Among the additional research methods should be:

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

What does the phthisiopaediatrist do?

The phthisioperdiatrist can engage in several activities, among them:

• preventive actions;
• diagnostic procedures;
• therapy of tuberculosis diseases;
• educational and educational work;
• managerial and organizational activities;
• research work.

In addition, the competence of a doctor-phthisiotherapist may include:

• Promotion of a healthy lifestyle and nutrition, maintenance of appropriate housing conditions, the importance of physical exercise and sports for the formation of a healthy nation;
• implementation of preventive measures in order to avoid the development of an epidemic or infection of healthy children in 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 techniques;
• emergency care in critical conditions;
• participation in the hygienic education of children, especially in families where there is a patient with tuberculosis;
• the organization of mass preventive and explanatory measures, their holding in preschool and school educational institutions, children's polyclinics, hospitals and dispensaries;
• sanitary and specific prevention of tuberculosis infection.

What diseases does the phthisiopaedist treat?

The doctor-phthisiopaediatrist deals with all forms of tuberculosis infection that can be detected in children. Most often in childhood, a local form of tuberculosis is detected, in particular, lesion of intrathoracic lymph nodes: this pathology captures the lymph nodes of the roots of the lung and mediastinum.

Among other childhood infections, which are included in the qualification of a phthisiopaediatrician, the following can be distinguished:

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

Doctor phthisiopathy knows how to conduct clinical studies of a child with tuberculosis, how to diagnose and identify the form of the disease, how to determine the contingent that is subject to mandatory control for tuberculosis.

Advice from a phthisiopaediatrician

To protect your child from accidental infection with tuberculosis, you must follow certain rules:

• if a patient with tuberculosis infection is found in the environment of the child, it should be isolated and all the necessary disinfection methods should be carried out in the room;
• parents should not refuse to vaccinate children, as well as from conducting tuberculin tests to identify bacilli of tuberculosis. Such samples contain destroyed tubercle bacilli and are absolutely harmless to the baby;
• the child must live and spend time in places corresponding to the generally accepted sanitary and hygienic standards. The child's room should be clean, light, ventilated;
• should provide the baby a healthy and nutritious diet, so that the growing body does not suffer from a lack of vitamins, and the immunity of the child was able to withstand various infections;
• it is necessary to teach the child to observe the rules of personal hygiene from childhood;
• Allow the child to relax actively, play, sunbathe, walk in the park, tempered;
• remember: products purchased in natural markets should be thoroughly washed, if possible, by boiling water. Milk, bought with hands, is subject to mandatory boiling.

The Phthisiopaediatrician advises: if you suspect any infection in your child, be sure to visit a doctor. The earlier the disease is detected, the more favorable the prognosis will be.