За период наблюдения с 2010 по 2019 г. в Республике Саха (Якутия) отмечается устойчивая тенденция к снижению на 29,04% (p < 0,001) абсолютного числа впервые выявленных больных туберкулезом (ТБ) и повышение фактического охвата выполнением флюорографического (ФЛГ) обследования населения на 23,9% (p < 0,001). Увеличение доли охвата ФЛГ обследованием населения, подлежащего, но ранее не охваченного массовым профилактическим ФЛГ осмотром, за весь период наблюдения составило 51,8% (p < 0,001). Выявление больных ТБ из числа охваченных ежегодными профилактическими ФЛГ осмотрами увеличилось на 23,05% (p < 0,001), а также самообращение пациентов из числа ранее не охваченных ФЛГ обследованием снизилось на 39,5% (p < 0,05). При сравнительном анализе охвата населения плановым ФЛГ осмотром, который утверждается Министерством здравоохранения республики, и охвата фактическими ФЛГ обследованиями подлежащего населения не установлено существенных различий (p > 0,05) как на выявление больных ТБ при профилактических ФЛГ осмотрах, так и при самообращении пациентов в медицинские организации. Темп убыли выявления флюороположительных лиц в целом по республике составил 46,5% (p < 0,001). При этом выявление различной патологии органов грудной клетки (4540,50 ± 1306,91) оказалось в 14,3 раз выше, чем туберкулеза (337,87 ± 11,85). Выявление же туберкулеза (337,87 ± 11,85) и онкопатологии (226,50 ± 15,24) при проведении массовых профилактических ФЛГ осмотрах не имели существенных различий (p > 0,05). В целом выявление патологии органов грудной клетки (ОГК) при проведении массовых ФЛГ осмотров на 1000 обследований, за исключением ТБ, составило 8,20 ± 2,80 случаев, в то время как ТБ – 0,57 ± 0,90 (t = 7,90; p < 0,001). Ежегодно на ФЛГ обследование населения республики, без учета накладных расходов, в среднем было затрачено 169,9 млн руб., при обследовании флюороположительных лиц на установление заболевания ТБ – 4,7 млн руб. Таким образом, стоимость выявления одного больного ТБ без учета накладных расходов составила 545,4 тыс. руб. Профилактические ФЛГ обследования населения являются малорентабельными, но позволяют мониторировать в целом эпидемиологическую ситуацию по ТБ и своевременно принимать меры по ее стабилизации, косвенно отслеживать миграционные процессы населения.
Goal of the study: to analyze the tendencies in tuberculosis situation among children in Sakha Republic (Yakutia) for the last ten years when some new diagnostic tools have been introduced.Materials and methods. The analysis included data of official statistic reporting on tuberculosis (Form no. 33) among children in Sakha Republic (Yakutia) from 2005 to 2014. During this period of time tuberculosis was newly diagnosed in 647 children in the age from 0 to 14 years old. Their ethnicity, age, tuberculosis detection methods, clinical forms, frequency of bacillary excretion and types of complications were studied.Results. In 2005-2009 in Sakha Republic (Yakutia) the part of children among all new tuberculosis cases made 11.2% and in 2010-2014 it reduced down to 8.2%. The number of children who developed tuberculosis reduced by 51.5% in 2014 versus 2005 (2014 – 51, 2005 – 105 cases). Among new tuberculosis cases in children the exposure to tuberculosis was identified in 57.9% (2005-2009) and in 73.9% (2010-2014), which provided the evidence of severe burden of tuberculosis in the Republic. The part of children in age from 0 to 2 years old made 20.8% in 2005-2009 and 20.4% in 2010-2014. Children in the age from 7 to 14 years old developed tuberculosis the most often. In 2005-2009 tuberculosis was detected in children mostly by tuberculin tests (70.4%) and in 2010-2014 during examination after exposure to a tuberculosis case (43.6%) and less frequently by tuberculin tests (40.2%).
Goal: analysis of X ray diagnostics of tuberculosis in children staying in the specialized sanatorium in 2010-2015. Results. Every year from 19.1 to 66.7% of children suffering from active tuberculosis in Sakha Republic are detected through computer tomography in the specialized sanatorium for children.
Objective: to give an X-ray pattern of single lung foci revealed by computed tomography (CT) in children and adolescents examined for tuberculosis. Material and methods. The results of CT in 52 children and adolescents infected by Mycobacterium tuberculosis were analyzed. All the followed up children and adolescents underwent X-ray study using a two-slice spiral Somatom Emotion Duo (Siemens). The study used first the conventional chest spiral CT scanning procedure for children according to the Thorax Routine program and then reconstruction. Target spiral scanning of the area of interest was, if needed, carried out by employing high resolution CT with 2-mm thick images taken at 1.5-mm spacing. A maximal intensity project program was used to separate vessels and foci. Results. The single foci were encountered frequently in the lung of the examinees and characterized by a perilymphatic site; in 88.0% they were connected with the interlobular interstitium, interlobar fissure, and paracostal pleura; in 92.2% the foci were detectable in the subpleural and cortical parts of the lung, had a moderate intensity, well-defined outlines, and were 2–6 mm in size. At the same time, there were no pathological changes in the lymph nodes of the lung roots and mediastinum. The long-term (2-month-to-5-year) followup in this group of children indicated that there were no X-ray changes in the lung foci revealed by CT. Conclusion. The single foci in the lung of Mycobacterium tuberculosis-infected children without X-ray changes in the lymph nodes of the lung roots and mediastinum may be manifestations of the normal lung structure – these may be intrapulmonary lymph nodes. Further follow-up in this group of these children must be in agreement with the management tactics of those infected with Mycobacterium tuberculosis.
OBJECTIVE:To provide X-ray characteristics of mediastinal lymph nodes revealed by computed tomography (CT) in children and adolescents with uninfected Mycobacterium tuberculosis.MATERIAL AND METHODS:The basis of the study was the results of CT in 105 children and adolescents with uninfected with Mycobacterium tuberculosis. All the children and adolescents from a follow-up group underwent X-ray study using a two-slice spiral Somatom Emotion Duo CT scanner (Siemens). The study used a conventional procedure for chest scanning in children, by applying the Thorax Routine program.RESULTS:The study ascertained that Groups 1-3 intrathoracic lymph nodes were visualized in 73.3% of the children in normalcy and were not in 22.8%. In children, the normal size of the lymph nodes did not exceed 0.8 cm in diameter; they had a homogeneous structure and clearly defined, even outlines; their perinodular fat was unchanged. CT data showed that the sizes and number of visible groups of lymph nodes were unrelated to age.CONCLUSION:The upper diameter limit for normal mediastinal lymph nodes may be established to be 8 mm if there were no abnormal changes in the structure of lymph nodes and perinodular fat.
The authors proved high informative content of the computed tomography (CT), on the basis of the study of diagnostic informative content of radiographic research methods used in the survey of children and adolescents on primary pulmonary tuberculosis. CT diagnostic significance indicators exceed informative content of traditional radiographic techniques (radiography and linear tomography) in 2-2.5 times. A comparative assessment of radiation doses received during conventional radiological methods and CT is given. The authors revealed the dependence of the received radiation dose from the age, the highest radiation burden falls on young children and adolescents. In the result of the research, a high radiation dose at linear tomography at low diagnostic informative content was defined, thus indicating the need to abandon this method at testing children and adolescents to primary tuberculosis, in favor of CT.
OBJECTIVE To give an X-ray pattern of single lung foci revealed by computed tomography (CT) in children and adolescents examined for tuberculosis. MATERIAL AND METHODS The results of CT in 52 children and adolescents infected by Mycobacterium tuberculosis were analyzed. All the followed up children and adolescents underwent X-ray study using a two-slice spiral Somatom Emotion Duo (Siemens). The study used first the conventional chest spiral CT scanning procedure for children according to the Thorax Routine program and then reconstruction. Target spiral scanning of the area of interest was, if needed, carried out by employing high resolution CT with 2-mm thick images taken at 1.5-mm spacing. A maximal intensity project program was used to separate vessels and foci. RESULTS The single foci were encountered frequently in the lung of the examinees and characterized by a perilymphatic site; in 88.0% they were connected with the interlobular interstitium, interlobar fissure, and paracostal pleura; in 92.2% the foci were detectable in the subpleural and cortical parts of the lung, had a moderate intensity, well-defined outlines, and were 2-6 mm in size. At the same time, there were no pathological changes in the lymph nodes of the lung roots and mediastinum. The long-term (2-month-to-5-year) followup in this group of children indicated that there were no X-ray changes in the lung foci revealed by CT. CONCLUSION The single foci in the lung of Mycobacterium tuberculosis-infected children without X-ray changes in the lymph nodes of the lung roots and mediastinum may be manifestations of the normal lung structure--these may be intrapulmonary lymph nodes. Further follow-up in this group of these children must be in agreement with the management tactics of those infected with Mycobacterium tuberculosis.
Comparative analysis of radiological patterns of normal and abnormal, as a result of tubercoulous process, intrathoracic lymph nodes using the approach of computer tomography showed criteria used to diagnose primary tuberculosis in children and adolescent: quantity, groups and sizes of visualized intrathoracic lymph nodes. The results of study of tuberculous changes in lymph nodes due to age parameters are provided.
Analysis of complicated forms of pediatric primary tuberculosis is presented, based on x-ray findings of 45 patients, treated in the 'Phthisiatry' Research & Practice Center, Sakha Republic (Yakutia). The study revealed that clinical x-ray pattern of primary tuberculosis complex correlated with age factor. We observed that due to age-specific host responsiveness differences, a complicated clinical progression of primary tuberculosis complex occurred more often in adolescents and infants, and manifested as bronchopulmonary involvement with generalization of the process spreading to other organs and systems. In preschool and junior school age, an unfavorable tuberculosis progression was far rarer exclusion and manifested predominantly as lymphogenous seeding.
OBJECTIVE:To establish the causes of bacterial excretion in complicated primary tuberculosis in children and adolescents, by comparing the data of computed tomography and the results of bacteriological studies.MATERIAL AND METHODS:The material of the study was data on 36 children and adolescents with complicated primary tuberculosis, including 14 and 22 children and adolescents with and without bacterial excretion, respectively. All the children and adolescents underwent computed tomography and bacteriological studies encompassing luminescence microscopy and sputum and bronchial and gastric wash cultures for Mycobacterium tuberculosis.RESULTS:The bacterial excretion group showed a preponderance of a tuberculous process concurrent with the involvement of lung tissue and intrathoracic lymph nodes. Bacterial excretion was detected in the primary tuberculosis complex (50%), generalized tuberculosis process with the involvement of a few organs and systems (14.3%), and caseous pneumonia (7.1%). Bacterial excretion was accompanied by the tuberculous involvement of intrathoracic lymph nodes in 28.6%. In Group 1, sputum cultures and luminescence microscopy were carried out in all the children. At the same time, the most effective result was yielded by sputum culture that showed Mycobacterium tuberculosis in 78.6%; luminescence microscopy revealed mycobacteria in only 35.7% of cases. In 72.7% of the children and adolescents without bacterial excretion, the tuberculous process was located in the intrathoracic lymph nodes, without involving lung tissue in the pathological process. In the other 27.3%, the computed tomographic pattern of changes corresponded to that of the primary tuberculosis complex; in their presence, the tuberculous process ran with lymphogenic dissemination in 54.5% of cases and with bronchopulmonary involvement in 22.7%. In Group 2, a sputum culture was done in only 36.4% of the children and adolescents; microscopy was carried out in all.CONCLUSION:When computed tomography reveals the disseminated forms of primary tuberculosis with the concomitant involvement of lung tissue and intrathoracic lymph nodes in the presence of lung destructive changes, with the involvement of a few organs and systems in the pathological process, it is necessary to use all bacteriological studies, including culnolecular genetic methods, in order to establish the etiology of existing changes.
The authors have analyzed informative value of the main clinical and X-ray examinations, their scope and frequency in respect to age, tuberculosis stage and the disease pattern for children and adolescents on follow-up after treatment in special antituberculosis hospitals. A differential scheme of examination of followed-up tuberculous children and adolescent has been proposed which raises efficacy and cost of the follow-up, minimize exposure to X-rays.
The number and regularity of X-ray studies in adolescents with active chest tuberculosis in the Republic of Sakha (Yakutia) were analyzed. There was a high proportion of early X-ray examinations. The larger number (more than 80%) of X-ray studies were conducted for follow-ups of a specific process. In this connection, radiation load on adolescents from the examined groups was several times higher than the mean radiation dose for the population during X-ray examinations.
The follow-up and drug prophylaxis of 30 children who had been registered for a turn of tuberculin tests in 1993-1995 and subsequently ill with tuberculosis were analyzed. Among the causes of the disease there was a combination of 2 risk factors or more (epidemiological, age- and sex-specific, biomedical, clinical, genealogical, social), uncontrolled and ineffective drug prophylaxis, inadequate X-ray study in early tuberculous infection.
