TB dispensary: ​​"Only one of the three tuberculosis patients is diagnosed"

TB dispensary: ​​"Only one of the three tuberculosis patients is diagnosed"

Describes Chief Children’s Phthisiatrician, Head of the Tuberculosis Department of the National Research Center for Phthisiopulmonology and Infectious Diseases of the Ministry of Health of Russia, Doctor of Medical Sciences, Professor Valentina Aksenova .

Consumption recedes

Lydia Yudina, “AIF Health”: Valentina Alexandrovna, there are frightening statistics. Every twenty minutes in the world one tuberculosis patient dies and 13 children die each day. Valentina Aksenova : This is averaged worldwide data. In our country, the situation is more prosperous. Morbidity in children last year decreased by 15%. Today, 3,000 children with TB are registered in Russia. In 2017, 5 children died. Basically, these are children with congenital tuberculosis or HIV infection, for which the mycobacterium is deadly.

However, this is not an excuse to rest on our laurels. In the world, 67 million children are infected with tuberculosis, who have a risk of getting sick in the future. According to WHO, we have only one of the three cases of childhood tuberculosis.

– Recently, it is often said that vaccination against tuberculosis is useless. Otherwise, how can you explain the fact that children are consumed with tuberculosis, who were vaccinated even in the hospital?

– Firstly, most unvaccinated children get sick. Secondly, the BCG vaccine does not protect against tuberculosis. The goal of the vaccination is to prevent complications if the child falls ill. In children, the mycobacterium does not fall into the lungs, as in adults, but into the lymphatic system and then into the blood, where it instantly multiplies. Therefore, an unvaccinated child quickly falls ill and dies. Vaccination cuts off the mibacteria from the lymphatic system and does not let it into the blood. Due to vaccination, we have almost no meningitis, bone tuberculosis and severe cases of the disease. Unfortunately, in recent years there has been a catastrophic reduction in the coverage of vaccination of newborns. In 2017, only 81% of babies were vaccinated, while at least 95% should be vaccinated.

Help required!

– Where do children most often get infected?

– Where adults suffer, children become infected. It is not accidental that phthisiatricians recommend having fluorography before all the family members who will be in contact with the child before delivery.

Another, but already mandatory requirement – all children entering educational institutions (which include kindergartens) should undergo immunodiagnosis. Otherwise, the child is not allowed to visit. It appeared not accidentally. One child with an active form of tuberculosis, admitted before the lessons by oversight, can infect half the class.

– You gave statistics that only one child in three has tuberculosis. Why?

– Tuberculosis is often asymptomatic. Symptoms appear when the lung starts to collapse, at the advanced stage of the disease. For the timely detection of the disease, a diagnostic standard was developed, which should be carried out annually. Babies under 7 years old undergo a Mantoux reaction. If it turns out to be positive, a diaskintest is set (a test with an allergen tubercular recombinant). If it turns out to be positive, the child goes to the TB specialist for further examination (computed tomography of the chest). However, if there are clinical symptoms of the disease (cough, which does not help drugs, night sweats, temperature) – this is an indication for an unscheduled examination for tuberculosis.

An X-ray or CT scan?

– Previously, the gold standard for testing for tuberculosis was considered fluorography, which does not give such an exposure as computed tomography …

– Fluorography shows widespread tuberculosis, but does not see small (less than 1 cm) foci of the disease. The peculiarity of childhood tuberculosis is that the body can cope with the infection itself. In such cases, the microfocus of tuberculosis is cut off (calcined). But the child becomes the carrier of a sleeping infection, which at any time can start the active process. Especially dangerous when the activation of tuberculosis occurs in adolescents: they have an extremely serious illness, up to the development of transient forms. Computed tomography allows you to identify microfocal tuberculosis, which previously eluded the attention of doctors.

– The Mantoux reaction often gives a false positive result. Why “button” will not be replaced with a diaskintest?

– These kinds of diagnostics have different tasks. The purpose of the Mantoux reaction is selection for vaccination (today revaccination is performed for children 7 years of age). Repeated vaccination is indicated only for those children whose Mantoux reaction is negative. Diaskintest is a method of early diagnosis of tuberculosis with a high degree of accuracy. A recent example. In college, a teenager with active tuberculosis, who was admitted without a certificate of health, was identified. 26 of his classmates were examined. Fluorography revealed tuberculosis in one, after applying diaskintest active tuberculosis at an early stage found in 19 people.

From the first sneeze?

– If a child has coughing with a tuberculosis, does this mean that the baby will get sick?

– After the first contact, nobody gets sick. Tuberculosis is a disease of the weak and unprotected. But if the child has a cold, is weakened, the chances of getting sick from him are greater. Therefore, close contact with the carrier of tuberculosis (for example, at home or at school) is a very disturbing situation. Risk groups are often children who are ill, adolescents and adolescents with obesity, who receive immunosuppressive therapy (which is prescribed for autoimmune diseases), children with congenital HIV infection.

– Can a healthy lifestyle protect against tuberculosis?

– A healthy lifestyle is a good help in the fight against infection. However, it can not be considered a 100% protection. No country has yet declared itself a zone free from tuberculosis. Mycobacterium is a very clever infection that can adapt to any living conditions. You can not forget about this!

5 tips of the chief phthisiatrist

How to protect a child from tuberculosis

To pass the vaccination against tuberculosis it is necessary in the maternity hospital, until the baby has got to the center of infection.
Domestic families need to be screened for tuberculosis before the baby returns from the hospital: the susceptibility of newborns to tuberculosis is 100%.
You pass the examination on tuberculosis in a timely manner. If there are clinical symptoms of tuberculosis – unscheduled and immediately.
Remember: infection is not a sentence. The course of occupational treatment with small doses of drugs protects a child from tuberculosis for 7-10 years.
If there is a patient with tuberculosis in the environment, exclude his contact with the child until he overcomes the active form of tuberculosis.

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