The majority of children and adolescents with drug-resistant tuberculosis (MDR-TB) were detected when they applied to various institutions of the general medical network - in 68 (56.7%) cases, in the control group they were detected in most cases - 79 (67.5% ) during a routine examination. When contacting various medical institutions with breast complaints, 38 (32.5%) children were identified. Tuberculin diagnostics revealed that hyperergic reactions (the size of the tuberculin reaction 15-21 mm) to the introduction of tuberculin were observed in 58 (48.3%) children and adolescents with drug-resistant tuberculosis, normergic (6-14 mm) - in 62 (51.7 %), that is, it can be noted that this contingent responded adequately to the tuberculin Mantoux reaction with 2 TE PPD-L. Patients with a newly diagnosed process in 112 (96.6%) cases reacted positively to the Mantoux test with 2 TE. Thus, a hyperergic reaction was observed in 45 (38.5%) patients with newly diagnosed respiratory tuberculosis. A positive reaction (from 5-10 mm) was noted in 39 (33.3%) patients, normal (11-14 mm) in 33 (28.2%), and only in 3 (2.6%) patients a reaction to the introduction of tuberculin was negative. Looking ahead, it can be noted that these children were found to have common, generalized processes that could lead to a decrease in general immunity, in 2 children out of three leading to a lethal outcome of the disease.
Comparative analysis of post-vaccination signs of BCG in both groups showed that they were absent in 25 (20.8%) patients with MDR-TB, 49 (40.8%) patients had one post-vaccination scar, 46 (38.3%) %) adolescents.
Consequently, in 79.1% of cases, the vaccination period was more than 5 years. It should be noted that 50% of children and adolescents with drug-resistant tuberculosis (main group) who did not have post-vaccination scars developed the most severe forms of tuberculosis, with a tendency to generalization and complications in the form of bronchial tuberculosis (62.9%), with an outcome in cicatricial stenosis and deformity, concomitant tuberculous pleurisy, tuberculosis of the tongue and pulmonary hemorrhage (47.7%).
Most of the newly diagnosed patients (control group) (89.7%) were vaccinated with BCG vaccine in maternity hospitals, however, 21 (17.9%) patients did not develop a post-vaccination scar, and 12 (10.2%) sick young children did not develop at all. were not vaccinated due to the lack of BCG vaccine in the first year of life of these children.
58 (49.5%) newly diagnosed patients had one post-vaccination scar of BCG, of which 12 (20.7%) children under 6 years old who did not receive the first revaccination, the remaining 46 (79.3%) children were more older, they were not revaccinated in connection with the tube. infection. Twenty-seven (23.1%) children and adolescents with tuberculosis had two BCG scars. Of 53 adolescents aged 15-17 years, 31 (58.5%) patients did not receive the second revaccination. Thus, the majority of adolescents with respiratory tuberculosis (58.5%) were not revaccinated with BCG, and young children (28.2%) of the control group were not vaccinated with BCG, which contributed to infection and further development of the disease.
Analysis of information on the presence of contact among patients with MDR TB showed that 40 (33.3%) children and adolescents were from foci of death from drug-resistant forms of tuberculosis. From close family contact with patients with MDR, patients where the mother was ill, 34 (28.3%) children were identified, the father - 25 (20.8%), brother or sister - 30 (25.0%) children. No tuberculosis contact with a patient with tuberculosis was established in 18 (15.0%) cases, family contact was noted in 12 (10.0%), with a classmate and a teacher in 3 (2.5%) cases, respectively.
Thus, the vast majority of patients had close family contact with a patient with MDR-TB in 89 (74.2%) cases, which led to the emergence and development of drug-resistant forms of tuberculosis in them. Among the newly diagnosed patients, tuberculosis contact was denied or it was not established in 62 (53.0%) cases. 26 (22.2%) children and adolescents had close family contact with a sick bacteria-releasing agent. From family contact, 19 (16.2%) children fell ill, with a teacher, a neighbor - 2 (1.7%) teenagers. In 9 (7.7%) children and adolescents with pulmonary tuberculosis, contact with the patient was the most ominous - the family center of death of a patient with multidrug-resistant tuberculosis.
More than half of the patients 66 (56.4%) were infected with MBT in the period from 1 to 3 years, however, only 34 (29.0%) sick children received chemoprophylactic treatment, the remaining 83 children (71.0%) who needed preventive treatment, in order to prevent infection and the development of the disease, did not receive it. That is, the selection among children and adolescents into the “risk” group for tuberculosis was not carried out at the proper level.
During the first year of infection, 51 (43.6%) patients were identified by fluorography. When a tuberculous process was detected by fluorography and in the absence of bacterial excretion, the differential diagnostic algorithm was carried out in 79 (67.5%) patients, and in 38 (32.5%) patients, it was not carried out, since the specific etiology of the disease was not in doubt.
Upon admission to the hospital, after a thorough examination of children and adolescents, it was determined that patients in the main group (120 with MDR-TB) had a variety of pronounced clinical symptoms with signs of tuberculous intoxication (71.4%) and complaints of cough (50.6 %). Catarrhal phenomena in the lungs were determined in 36.9% of children and adolescents.
Patients of the control group (117 - newly diagnosed patients) in 40.0% of cases complained of cough with the release of mucopurulent or purulent sputum. An increase in body temperature to febrile and subfebrile figures was noted in 31.0% of cases, weight loss and loss of appetite - in 37.0%, weakness - in 38.0%, night sweats - in 26.0%, chest pain - in 19.0%, shortness of breath during exercise - in 18.0% of cases. Catarrhal phenomena in the lungs in the form of hard or weakened breathing and the presence of various wheezing were detected in 12.5%, which was significantly lower than in MDR-TB patients (p <0.05). The above complaints were presented by patients, who were mainly admitted to the hospital in a state of moderate severity (43.0%) and severe (10.3%) condition. The contingent of children and adolescents who were admitted in a satisfactory condition did not generally present complaints, although 82.4% of them had one or another concomitant pathology.
