Tuberculosis in young children symptoms. Symptoms and treatment of tuberculosis in children. Tuberculosis of the osteoarticular system

Symptoms of tuberculosis develop more intensely in children than in adults. This is due to the specific structure child's body, pulmonary system.

Symptoms at each stage of their development have their own colors and manifestations. If there is a suspicion of tuberculosis in a child, it is necessary to urgently carry out diagnostic measures to establish an accurate diagnosis.

The earlier this serious disease is detected, the more effective its treatment will be. Timely therapeutic measures in some situations can even save a child’s life.

Childhood tuberculosis- an infectious process that is triggered by the entry into the body of a pathogenic microorganism - Koch's bacillus. This pathology is tolerated much more severely by children than by adults.

This is due to the fact that children's immunity is not yet strong enough. It is difficult for him to resist the pathogenic microbe.

Tuberculosis affects not only the pulmonary organ. The infection can cause pathological conditions in the brain, skeletal system and other important structures of the child’s body. Each type of disease has different symptoms that are unique to it.

The most difficult thing is to identify the primary one. This is due to the fact that when carrying out diagnostic measures on infants it is impossible to use instrumental methods research. When a child turns 1 year old, the symptoms of tuberculosis in children begin to appear according to a certain algorithm.

Signs of illness in children under one year old

The first symptoms of tuberculosis in children begin to appear before the age of 1 year. The disease comes in two forms depending on the nature of its origin: congenital and acquired. Each type of tuberculosis has different symptoms.

Primary tuberculosis in children has the following symptoms:

• severe irritability;
• the child becomes lethargic and weak. There is apathy towards everything around;
• the baby stops eating normally;
• there is a sharp loss of body weight;
• arises increased sweating and chills. Especially at night;
• loss of sleep occurs.

The first signs of pulmonary tuberculosis in children:

• disorders in the respiratory system. May manifest as attacks of suffocation, coughing;
• confluence of one of the areas of the chest affected by a pathogenic microorganism;
• The cough may become chronic. Due to his attacks, the child suffers from insomnia.

These manifestations cannot be allowed to go away. It is necessary to urgently contact a medical institution for qualified medical care. If you do not start timely treatment, dire consequences can occur.

Symptoms of the disease from 1 year

The following signs of tuberculosis in children usually appear at 3-5 years of age. At the age of three it becomes much easier to diagnose pathological condition. At three years of age, instrumental examination methods are used.

In addition, children from 3 to five years old can already tell themselves what torments them and how long it lasts.

With pulmonary tuberculosis, the initial symptoms do not affect this organ. Observed general deterioration health status. The child develops severe weakness and gets tired very quickly. Physical activity decreases. After a certain time, the little patient loses sleep and appetite. As a result of this, he loses weight.

Soon the listed symptoms will be joined by coughing, attacks of suffocation and other signs of disorders in the respiratory system. The speed of their occurrence is individual for each child. On the chest, in the area of ​​the lesion, depressions are visible externally.

If you begin to suspect the presence of Koch's bacillus in your child's body, contact a specialized dispensary. After the diagnostic measures have been carried out, the specialist will either refute the diagnosis or confirm it.

In the second case, the child must be admitted to a hospital for round-the-clock medical observation.

Symptoms of the disease in children over 7 years of age

Every year, the symptoms of infection with tubercle bacilli become more pronounced.

At the age of 7-14 years, the following signs of the disease may appear:

• a strong feeling is added to the feeling of weakness and apathy pain syndrome in the area of ​​inflammation;
• coughing attacks become chronic. They are accompanied by the release of sputum;
• severe shortness of breath occurs even at rest;
• in certain situations may occur elevated temperature bodies.

The child experiences a sinking of the chest in the area affected by the disease. Disturbances occur on the skin. It takes on a sickly color. Its outer layer becomes thinner. Microscopic wounds and cracks appear.

In more rare cases, an increase in lymph nodes. Forcing hemoptysis. If any of the above symptoms occur, consult your doctor for a diagnosis.

Symptoms of the disease in adolescents over 14 years of age

In adolescents 14-15 years old, rarer symptoms may occur. It appears in the background concomitant diseases or with inflammation that began late. At a time when the child’s body was already greatly weakened.

Hemoptysis, as a rule, occurs in the last stages of the development of pathology. At the same time, the general condition does not change for the worse or better side. But when blood comes out along with a cough, the teenager experiences severe pain.

The lymph nodes in the armpits and neck are affected. Slightly less often in groin area in boys.

The last stage of development of the disease, in 80% of cases is accompanied by tuberculosis intoxication. This sign The disease develops after 14 years of age.

Tuberculosis intoxication

This pathological condition occurs when acute form diseases. With tuberculosis intoxication, a teenager cannot eat normally. This is due to the fact that it digestive system unable to perceive food.

A severe cough is accompanied by the release of sputum from blood clots. During this process, excruciating pain occurs. To determine the cause of this pathological condition, it is necessary to conduct special tests.

The child may lose functionality important organs. For example, losing hearing, vision, smell, etc. This occurs against the background of intensive spread of the pathogenic microorganism.

Disturbances in the neuro-vegetative system may be observed. Increased sweating of the palms and feet occurs. There is also a mental retardation and physical development, unhealthy pallor of the skin.

Signs of complications of tuberculosis in children

Tuberculosis can cause the development of many complications. It causes dysfunction of the heart organ, kidneys, liver, musculoskeletal system and other important structures of the human body. The symptoms of these pathological processes are varied. Depends on which organs or systems are affected.

The patient may experience disturbances in heart rate and pain in the heart area. An itchy sensation occurs in the upper and lower limbs. Pain syndrome in muscle tissue and joints. Pain in the liver, kidneys, spleen and other organs.

Pathologies associated with tuberculosis are more acute and painful. They differ in their duration.

To determine the source of the lesion, a thorough diagnosis is needed.

In rare cases, hormonal imbalance may occur in adolescents. As a result, the child gains excess weight. He may experience attacks of aggression and frequent mood swings. When these symptoms develop, diagnostic measures are necessary.

Local symptoms of Koch's stick

Symptoms of the development of various forms of tuberculosis depend on the location of the lesions. The volume of inflammation. Presence of concomitant diseases. For example, an illness that is accompanied pathological process in the bronchi, has a strong or moderate cough.

When the pleura is damaged, chest pain and shortness of breath occur. With foci of inflammation in the kidney organs - problems with urination, lower back pain. With pathology of the lymph nodes - severe swelling, edema.

When the skeletal base is damaged, the little patient becomes less active physically. His behavior changes. He becomes more restless. Severe pain occurs in the spinal region. Its deformation is observed.

Involuntary contractions of the stomach walls may occur. This leads to constipation or diarrhea. The child cannot perceive food.

When lymph nodes are affected abdominal cavity pain occurs around the navel. Lost appetite. The patient feels sick and vomits. Abnormalities in stool may occur.

Tuberculosis of the bronchial glands in children

This form of the disease can manifest itself in different ways. Tuberculosis can develop like FLU. The child begins to cough and the body temperature rises. But when infected with Koch's bacillus, this pathological condition drags on for a longer period than with a viral infection.

The disease may also develop slowly. The child experiences lethargy and increased fatigue. He becomes more moody. Over time, he begins to have coughing attacks, skin covering turns pale. The child begins to lose weight.

Brain tuberculosis in children

Brain tuberculosis (tuberculous meningitis) is a most dangerous disease. Its symptoms begin to appear only a few weeks after the infection enters the body. Tuberculous meningitis most often occurs in children whose families have people with an open form of the disease.

The child becomes lethargic and restless. He has no appetite at all. He complains of severe migraines and a feeling of nausea. The patient experiences constant vomiting, high body temperature, and convulsions.

For a long time, tuberculous meningitis was considered incurable disease. In most cases it ended fatal. But medicine does not stand still. On this moment There are special therapeutic techniques that can cure brain tuberculosis. But this will be possible only with timely treatment.

Tuberculosis is considered one of the most serious and dangerous diseases. This disease often affects not only the lungs, but also other vital organs without any symptoms. Sometimes parents mistake the signs of tuberculosis for manifestations of another disease - ARVI or influenza.

First of all, the disease poses a danger to infants, since diagnosing tuberculosis in children entails many difficulties. Doctors often spend months treating simple bronchitis or a respiratory viral disease, starting tuberculosis at an early stage. The only one the right way To protect yourself from the disease is to follow preventive measures and not refuse vaccination.

The danger of tuberculosis is that initial stage development there are absolutely no symptoms

What is tuberculosis and what is its danger to a child?

Tuberculosis in children is an infectious-inflammatory process in the internal organs and tissues of the body caused by the penetration of Mycobacterium tuberculosis. The infection spreads throughout the body, initially affecting the lungs and forming tuberculous tubercles in them.

Diagnosis and treatment of the disease largely depend on the age category of the patient. The disease is most critical for three ages - infants, infants under 3 years of age and adolescents.

This disease is difficult to identify; its symptoms are very similar to ordinary ARVI. Parents therefore turn to a specialist not at an early stage, but when the infection has already settled in the baby’s body. The only way to detect the disease in a timely manner is to regularly follow preventive measures.

If tuberculosis is detected in a timely manner, treatment of the baby will take no more than 2-3 months. Otherwise, the pathogenic process will last for months, moving from remission to an acute form.

Doctors distinguish three main groups of forms of tuberculosis:

• unspecified localization;
• respiratory tract;
• extrapulmonary lesions.

Tuberculosis of unspecified localization most often affects young children or teenagers. This form is usually detected months and sometimes years after infection, so it often develops into chronic tuberculosis. The main ways to diagnose it are a blood test or PCR.

Respiratory tuberculosis occurs in the most mild form and does not entail dangerous consequences. The incubation period lasts from several weeks to a year until the first manifestations of the disease occur.

Extrapulmonary tuberculosis is a secondary disease that affects various internal organs of the child:

1. Tuberculosis of the meninges is a disease that is extremely dangerous for the life of a child. In a child's body, the disease is very difficult and entails many unpleasant consequences - mental and physical retardation. mental development, paralysis, convulsions. Children under one year of age who have not been vaccinated with BCG are at main risk. The first symptoms are accompanied by elevated body temperature, intoxication of the body, headaches, and convulsions. At timely diagnosis With effective therapy, tuberculous meningitis resolves within a few months.
2. Tuberculosis of bones and joints affects the spine, as well as the hip and knee joints. The disease occurs with clearly defined symptoms – disturbances in the child’s movements and gait, accompanied by pain.
3. Tuberculosis of the kidneys is a fairly common form of the disease in adolescents. Due to the primary infection of the lungs, the infection penetrates through the blood into neighboring organs and most often affects the kidneys.
4. Tuberculosis of peripheral lymph nodes mainly occurs in children with HIV. The main symptom of the disease is enlarged lymph nodes. The child develops subcutaneous balls filled with pus.

How does the infection enter the body?

The initial manifestations of tuberculosis depend on how the bacillus entered the child’s body. Parents should be aware of the methods of infection in order to prevent the occurrence of the disease in their baby.

The most common type of infection is disease transmission by airborne droplets

Mycobacteria enter in several ways:

• airborne, which is considered the most common when children are infected, since the Koch bacillus is transmitted by being in the same room;
• airborne dust, when a child inhales dust particles containing the tuberculosis bacillus;
• through certain food products, for example, when consuming meat or milk from sick animals;
• due to infection on mucous membranes or damaged skin;
• transplacentally, that is, through the placenta of an infected mother.

The first and subsequent symptoms of different forms of the disease

In medicine, it is customary to distinguish several types of tuberculosis of the respiratory organs, which manifest themselves with individual symptoms. Most known species– tuberculosis of intrathoracic lymph nodes. It occurs in children of any age. The infection affects the intrathoracic lymph nodes on one or both sides.

Accordingly, three forms are distinguished:

• The minor form of tuberculosis of the intrathoracic lymph nodes often occurs without any symptoms. One or more lymph nodes in the child’s body enlarge slightly. Most effective diagnostics diagnosis of this disease is carried out not only through X-rays of the lungs for the presence of tuberculosis, but also using computed tomography.
• The infiltrative form most often occurs in children school age. With the help of a photo X-ray of the lungs, where a significant amount of fluid and dead areas are clearly visible, the disease is very easy to identify. Clinical signs of this form are increased body temperature up to 38-39 degrees for 2 weeks, wet cough, muscle weakness, increased sweating.
• The tumorous form is the most dangerous form of tuberculosis of the intrathoracic lymph nodes. In the child’s body, several lymph nodes are damaged and pus forms in them. The disease develops rapidly severe symptoms intoxication, whooping cough and difficulty breathing.

With tuberculosis of the lungs and bronchi, the child will have a cough

Other types of respiratory tuberculosis are also known:

1. Primary tuberculosis complex is the primary form of tuberculosis. An inflammatory process develops in the affected organ, which spreads through the lymphatic tract. It can only be recognized by the attending physician based on the results of the patient's x-ray. The main signs are a clearly defined intoxication syndrome, a severe cough, sometimes with shortness of breath.
2. Focal pulmonary tuberculosis in children is a form of tuberculosis that mainly affects children over 10 years of age. The pathogenic inflammatory process is localized in the chest area. In this case, the baby may not be bothered by anything.
3. Pulmonary tuberculoma is a form of the disease in which the infection affects a large area of ​​10 mm of the organ. The only symptoms of pulmonary tuberculoma are periodic moist cough with sputum.
4. Tuberculous pleurisy is characterized by clearly defined clinical symptoms. The first signs of the disease are pain in the chest, fever to febrile levels, and intoxication syndrome.
5. Bronchial tuberculosis is a form in which the source of inflammation is located in the bronchi. This disease is difficult to diagnose, since bronchoscopy has age restrictions. Its main manifestations are strong, barking cough with sputum discharge, which is not treated with mucolytics.
6. Caseous pneumonia is the most dangerous and severe form of tuberculosis. Fortunately, children are rarely affected by this disease. Caseous pneumonia entails many unpleasant symptoms - apathy, significant weight loss, severe shortness of breath.

Diagnostic methods

Diagnosis of tuberculosis in incubation period allows you to cure it in a few months. Timely and effective therapy determines the mild course of the disease and guarantees its favorable outcome.

Infants who do not go to kindergarten or school where regular medical examinations, you should conduct a blood test at least once a year (we recommend reading:). Children whose pediatricians suspect tuberculosis are referred for consultation to a TB specialist. This doctor prescribes such preventive and diagnostic measures as:

• general and linked immunosorbent assay blood, which reveals inflammation in asymptomatic disease;
• Mantoux test;
• X-ray of the lungs in children under 15 years of age or fluorography for patients over 15 years of age, which is performed to visualize local changes in the photo;
• computed tomography or magnetic resonance imaging;
• ELISA and PCR studies that determine the causative agent of the pathogenic inflammatory process.

Technique for conducting a tuberculin test

Mantoux test

The Mantoux test is an injection of tuberculin under the skin. Tuberculin consists of pathogens that should cause allergic reaction if there is an infection in the child’s body (we recommend reading:). Three days after the injection, the doctor visually determines its result:

• negative - the injection site has not changed in size (acceptable norm is an increase of 1 mm), redness and compaction were not detected (more details in the article:);
• controversial - at the injection site there is an increase of 2-3 mm, slight redness or thickening;
• positive - the sample has grown to 5-7 mm.

Blood analysis

Asymptomatic tuberculosis requires confirmation of the diagnosis, so first the pediatrician prescribes a general blood test, which reveals inflammation. At positive result doctors refer the patient for an enzyme immunoassay to determine the presence or absence of tuberculosis antibodies. The patient receives the results of both tests on the day they are performed. This method cannot be considered particularly informative, unlike X-rays and PCR (we recommend reading:).

PCR diagnostics

The polymerase chain reaction is guaranteed to give an accurate result, which makes it possible to identify the disease at any stage of development, including during the incubation period.

The results of the study are given to the patient in a few days. This diagnostic method identifies the causative agent of the disease in the baby’s blood, urine or sputum, allowing it to be destroyed as soon as possible through drug therapy.

Treatment of tuberculosis

Therapy for a child with tuberculosis is largely determined by the form of the disease, as well as the age category of the child. This disease requires an individual approach to prescription medicines, however there is general scheme treatment.

The main method is chemotherapy using various groups of drugs. The use of antibiotics for the treatment of tuberculosis cannot be considered effective, since mycobacteria are not sensitive to their action. On initial stage Doctors prescribe Isoniazid and Rifampicin to babies, adding Streptomycin or Ethambutol to them a month later. Anti-tuberculosis drugs are taken for at least 3 months, after which the TB specialist extends or stops the prescription depending on the form and stage of the disease.

In parallel with these drugs, children are prescribed immunostimulating drugs, and recommendations are also given regarding the prevention of the disease. At the end of the main course of treatment, the child may be given a ticket to a sanatorium, where he will continue physical therapy.

Incorrect treatment can have detrimental consequences. Firstly, ineffective therapy will not bring any benefit to the child and will lead to worsening of the disease, that is, damage to vital organs. Secondly, such treatment will contribute to the formation of a drug-resistant form of the disease, as a result of which pathogenic pathogens will stop responding to any, including effective, medications.

Lifestyle during treatment

During the treatment period, the child should walk a lot. fresh air, but avoiding crowded places

For tuberculosis of the intrathoracic lymph nodes or any other primary form of the disease, it is very important to observe the following measures:

• Rest. Parents should prevent the baby from becoming overtired, since during treatment the body constantly requires strength to fight infection and actively recover.
• Proper diet. The child should get used to clearly organized three or four meals a day, depending on age. The disease often causes appetite disturbances, but parents should ensure that the baby does not miss a single meal during the day.
• Healthy diet. The diet of a sick child should be enriched with vitamins and minerals. Use healthy vegetables and fruits along with basic foods is the key to recovery. During treatment, the child is put on diet No. 11, which excludes spicy and fried foods and also minimizes sweets.
• Avoiding crowded places where the baby can become infected again. A child suffering from tuberculosis should minimize visits public places. Firstly, parents should not forget that he is a carrier of mycobacteria. Secondly, there is a possibility of re-infection new infection, since the little patient’s immunity is very weakened.
• Staying warm. The child needs to be provided with warmth, since hypothermia entails the emergence of a new disease that will be difficult for the body to cope with due to a decrease in its defenses.

Prevention of disease in children

Prevention of tuberculosis in children implies the following conditions:

• vaccination, including the first BCG vaccination in the maternity hospital, the Mantoux test and other preventive vaccinations;
• hardening children through regular walks in the fresh air in any weather;
• exclusion of communication with potentially infected people.

Tuberculosis, like every disease, has its own signs and symptoms. They touch general condition the child and the results shown by the examination. It is impossible to say that any single symptom of tuberculosis in children is 100% a disease.

Sometimes parents are faced with the fact that if after Mantoux vaccination the trace is larger than the norm, children are suspended from school or prohibited from attending a group in kindergarten. The only “wrong” one doesn’t mean anything.

Mantoux can increase for many reasons.

• The graft was wetted or rubbed.
• They did whose condition was “borderline”, at the beginning or after the illness.
• In the presence of helminthic infestation.
• There is tuberculin, or the vaccination coincided with an allergy to another factor.

Symptoms of tuberculosis in children

The following are suspected in children (if they coincide in time of manifestation):

Each sign individually cannot be defined as a symptom of tuberculosis in children, but their combination should force you to consult a doctor.

If, upon further examination, a detailed blood test shows and an ultrasound of the internal organs shows that they are enlarged, we can talk about the disease.

This can only be determined by a doctor, after tests and examinations, including which were done with proper monitoring.

If there is an injection mark:

• at 2 years exceeds the size of the scar from BCG - vaccination against tuberculosis given at birth - by 6 mm, or a positive reaction;
• at 3-5 years the change becomes positive, or the spot itself with a formed papule of more than 12 mm;
• and by 7 it exceeds 14 mm, with an increase of 6 mm from the previous test,

then we can assume that this is a symptom of tuberculosis in children.

Tuberculosis infection

Most often, children become infected with Koch's bacillus - the tuberculosis bacillus - from adults suffering from the disease in an open form. It is quite possible to catch the infection through objects used by an infected person. Babies "absorb" infection from a sick mother.

The tuberculosis bacillus does not always attack the lungs. It spreads throughout the body through the bloodstream, settling in the spleen, liver, kidneys, brain and other organs, including the skeletal system.

You can see the symptoms of tuberculosis in children on x-rays. Photo - X-ray, will show a picture that will accurately tell you about the presence of cavities in the lungs. X-rays also show the process developing in the kidneys and skeletal system.

Sometimes the child does not notice the manifestations of the disease for a very long time. This happens if the disease begins with a sluggish form. Apart from excessive fatigue, which parents explain by children being overworked during classes, and weight loss, there are no other symptoms. Children complain that it hurts to walk, and they begin to look for arthritis and rheumatism. But there are cases of acute infection, when the symptom of tuberculosis in children takes the form of a seasonal viral infection, high T and cough appear, lymph nodes enlarge. All this lasts much longer than during the flu or acute respiratory infections.

If your fever and cough persist for more than a week, you should definitely call a doctor. After 2 weeks, streaks of blood may appear in the sputum released when coughing, and it will be more difficult to treat such a disease. Tuberculosis, detected at an early stage, is treatable and does not cause complications.

Tuberculosis is a disease that is transmitted primarily by airborne droplets. Its causative agent is Koch's bacillus. Tuberculosis can be called a social disease, because 80% of patients have enough low level life.

IN modern world It is not at all necessary to live on the street to get tuberculosis; everyone is at risk - both children and adults.

Tuberculosis in children is more severe than in adults. This is due to the fact that children are much more susceptible and weaker. It is about childhood tuberculosis that we will talk today. Let's find out what pulmonary tuberculosis is in children, how it develops and how it is treated.

Factors of infection and development of the disease

It is quite easy for a child to become infected with tuberculosis. The main route of infection is contact with the sputum of a sick person with an open form of the disease. When coughing, the patient sprays particles of sputum around himself, which fall on the people around him and settle on the floor and furniture.

A child can become infected by inhaling contaminated air, through contact with contaminated things, or by consuming contaminated products. Most often, the bacillus enters the child’s body through the oral cavity, but in rare cases, a transplacental route of infection is also possible.

The child’s mother must be extremely careful, follow all the doctor’s recommendations, and then the child has every chance of growing up completely healthy. Thus, the causes of tuberculosis in children are few - usually it is a simple disregard for hygiene or contact with an infected person.

Stages of the disease in children

Once in the body, the Koch bacillus affects the cells of the immune defense, and then the tissues of the body. T-lymphocytes also begin to work actively, but they are weak and die quickly.

As a result, it is through the fault of T-lymphocytes that necrotic tissues are formed, which are an excellent environment for the development of the disease.

Cells pass through the capillaries, which help the formation of tuberculous granulomas, increasingly expanding the focus of inflammation. The affected tissues die.

The body responds to MBT with tuberculous inflammation caused by three components:

• exudative;
• proliferative;
• damaging.

Each of these components is characterized by an individual process. During exudation, they leave the vessels cellular components, during proliferation they grow, and at the stage of destruction, cheesy necrosis is formed. These processes occur regardless of the form and location of the disease. Below we will look at the phases of tuberculosis in more detail.

Phases of tuberculosis during primary infection

At first, infection practically does not manifest itself in any way. Clinically, signs are either very scarce or non-existent. During this period, pathogens enter lymphatic system and organs of immunogenesis. It is at this time that the reaction to Mantoux becomes positive.

This is followed by a pre-allergic period (lasting 2 weeks), during which antibodies are formed. Despite the presence of Koch bacillus in the body, Mantoux is often negative.

The allergic period is characterized by fixation of infection on the organs of immunogenesis (these include the spleen, bone marrow, liver, lymph nodes). Lymphocytes accumulate around the office. There are no signs of intoxication yet, there is no damaging component, but the lymph nodes are already enlarged.

With proliferation, the number of lymphocytes around the office increases. They prevent the growth of the destructive process. The higher the immunity, the greater the number of lymphocytes “protecting” the infection. After six months, the destruction of surrounding tissues begins and a caseous-necrotic (destructive) component appears. Intoxication is still mild.

1 year after infection, mininecrosis with miniproliferation (proliferation of surrounding tissues) is observed, which is caused by each of the rods that enter the body.

Intoxication is pronounced, Mantoux is positive. Local forms of tuberculosis appear in children and adolescents, which treatment helps prevent. A sick child should visit a pediatric TB specialist.

If tuberculosis in a child subsides, points of caseous necrosis remain on his organs (lungs, bronchi, intestines, bones, lymph nodes), where inflammation was previously localized, which can become the cause of newly developed tuberculosis in adulthood. This trend is observed in 90% of cases.

Due to external factors, which reduce the strength of the immune system, it begins to react to the presence of mycobacteria in the body, sending there certain families of lymphocytes, namely macrophages. They begin to absorb harmful bacteria, but die, releasing special enzymes.

The latter liquefy the caseous tissue. With pulmonary tuberculosis, mycobacteria are released into the tissue and then into the surrounding space, and the patient becomes pathologically dangerous to other people.

Reversal of the disease

The healing process occurs after treatment or without it, if the sick child has enough strong immunity. In this case, the decay cavities begin to shrink and close, being replaced by scars. The process subsides and the infection stops its development (usually this occurs at 3, 4 and 5 years).

During the fight against MBT, lymphocytes begin to damage healthy tissue. In response, the body produces antipreases.

This process can be balanced, but if the immune system cannot cope, then the cirrhotic form of pulmonary tuberculosis begins.

Primary and re-infection

Like adults, childhood tuberculosis can take different forms, depending on when the child develops it. Each of the forms has its own subtypes, but not all of them develop in children or develop quite rarely. Therefore, we will limit ourselves to describing the most common types of each form of tuberculosis in children and adolescents.

General symptoms

First 1-2 weeks symptoms acute illness resemble symptoms of a cold. If they do not go away after 3 weeks, there is a risk of developing the disease. For the first 3 weeks, children suffer from a dry cough, but why does a wet cough with pinkish discharge begin?

Among the main signs of tuberculosis in children are:

Other symptoms that can be confused with other diseases include:

• when the meninges are damaged, convulsions, headaches, and vomiting are observed;
• intestinal tuberculosis is manifested by indigestion, vomiting, blood in the stool;
• tuberculosis of bones and joints causes pain when moving, increases the risk of fractures and lameness;
• tuberculosis genitourinary system reports pain in the lower back, high temperature, pain during urination and blood in the urine;
• the skin affected by the infection is thickened, the lymph nodes enlarge and rot, tearing the membrane.

How do the forms of the disease manifest themselves in children?

Pulmonary tuberculosis in children of the primary form occurs in the vast majority of infected people, in contrast to the secondary form, the occurrence of which in children is quite rare. For children under 2-4 years of age, pulmonary tuberculosis is especially dangerous and is much more difficult to tolerate than in adults.

In the period up to 4-7 years, the tendency to extensive infection is especially pronounced, since the action BCG vaccinations by this time it weakens, so complications are often observed. However, even under such conditions, with primary tuberculosis there is a high chance of the lesion shrinking or completely disappearing.

Tuberculosis of the intrathoracic lymph nodes is a primary infection. It is diagnosed in 80% of children with this disease. Specific changes are little pronounced, therapy gives positive dynamics. The tumorous (tumor-like) form has a more severe course and is more common in young children (up to 4-6 years).

Secondary tuberculosis is diagnosed in adolescents not so often; as a rule, these are young people who suffered a primary infection in childhood. It usually coincides with puberty and is diagnosed at 13-14 years of age. The symptoms coincide with the primary genesis. Infiltrative and focal pulmonary tuberculosis predominates.

Disseminated tuberculosis is rare in children and adolescents. It is preceded by a primary infection with a breakthrough of the lesion into the blood during sensitivity vascular system. The main reason for the appearance of this form is an endogenous decrease in immunity.

In early adolescence, the infection often occurs in the form of miliary tuberculosis, which also affects other organs along with the lungs.

The subacute form develops as the primary infection subsides, but sometimes manifests itself as a secondary form.

The chronic form of disseminated tuberculosis acquires fibrotic and tricky features, with seasonal exacerbations. Its outcome is usually unfavorable. Tuberculous pleurisy, which also sometimes occurs as a complication of secondary tuberculosis in a teenager, can be a complication of tuberculosis of the intrathoracic lymph nodes or a separate disease.

Separately, it is worth mentioning extrapulmonary tuberculosis. Studies have shown that over the past 15 years the percentage of extrapulmonary forms of the disease has decreased. In young children (from 1 to 5-7 years), tuberculitic meningitis and tuberculosis of the central nervous system are most often diagnosed, and in adolescents - tuberculosis of the peripheral lymph nodes and genitourinary system.

Treatment and prevention

Are vaccinated children at risk of infection? This vaccination does not protect the child from infection, but it significantly reduces this risk and does not allow the disease to pass from a closed form to an open one, and also helps to avoid severe complications in case of infection.

A vaccine with a weakened virus allows the body to develop immunity without infecting the child. Many doctors recommend vaccinating children, despite the presence of preservatives in the vaccine.

There are two types of treatment for tuberculosis in children and adolescents:

A doctor should advise how to treat a child if there is a tuberculosis infection. It has been noticed that children who began treatment in a timely and correct manner often recover, since their tissue regeneration occurs faster.

The consequences of tuberculosis, if detected in the late stages, are very severe and can lead to serious complications and even death. The consequences of treatment for tuberculosis, which sometimes lasts two to three years, can be both positive and negative. Chemotherapy in 15% of cases causes by-effect– toxic or allergic. Children who are at risk often suffer from it - with chronic diseases, overweight, prone to allergies.

The peculiarity of tuberculosis in children, first of all, is its danger to health. As mentioned above, in children under 5 years of age, tuberculosis bacillus causes more complications than in older children. However, in addition to age, factors such as poor nutrition, lack of vitamins, stress and lack of sleep play a major role in the development of the disease.

In conclusion, I would like to say that, despite the seriousness of this disease, there is always an opportunity to cure a child. The main thing is to constantly monitor his health, regularly check for tuberculosis, not self-medicate and strictly follow the doctor’s recommendations.

Children with tuberculosis account for 16-19 people per 100 thousand healthy people. These statistics include those cases where the disease manifested itself Clinical signs. At the same time, infection with Koch bacillus (without symptoms) in Russia ranges from 15% to 60%, depending on the region. All this shows that tuberculosis in children and adolescents is a problem in domestic medicine.

Childhood tuberculosis is divided into two forms according to the method of penetration of bacteria. Primary - when the pathogen enters the body from the external environment. Secondary - when there are foci of bacterial growth in the body, and when they open, they release the pathogen into the blood. Normally, during chemoprophylaxis and vaccination, signs of tuberculosis do not appear in children. However, if prevention is not followed, tuberculosis develops in children.

What is childhood tuberculosis

Childhood tuberculosis differs in its course and characteristic symptoms, for this reason it is isolated into separate form diseases. The special course of the disease is determined by low resistance and the inability of the child’s body to localize the disease.

Photo 1. Dry cough is a striking symptom of tuberculosis lung disease among children and adolescents.

A characteristic syndrome is tuberculosis intoxication, that is, when the disease occurs without a specific localization. The course of the disease depends on the age of the child and general health. The body of children under 2 years of age is not able to stop the spread of the pathogen, and the first vaccination should be carried out at an early age.

The causative agents of tuberculosis are transmitted to children in any possible way: nutritional, airborne, contact. Perhaps even intrauterine infection or during childbirth. The risk group includes children and adolescents who:

• are sick with HIV infection;
• suffer diabetes mellitus;
• sick oncological diseases;
• were not vaccinated;
• accept hormonal drugs and cytostatics;
• use antibiotics for a long time;
• grow up in unfavorable families or in orphanages;
• live in unsanitary conditions.

Photo 2. Antibiotics are a key element of drug therapy in the treatment of tuberculosis diseases in children.

Signs of tuberculosis in a child

In children, four types of the disease are more often observed:

• latent form, at an early stage of the disease
• tuberculosis intoxication
• primary form
• tuberculous bronchoadenitis

In addition, classic adult forms of the disease are observed, when the lungs and other organs are affected. Up to 2 years of age, a child suffers from tuberculosis intoxication; in children over 2 years of age, the primary form and tuberculous bronchoadenitis are registered in 75% of cases. Depending on the clinical form symptoms vary.

Latent form

The latent form lasts up to 6 months, less often - up to a year. The course of the latent form of tuberculosis is divided into two stages:

1. The first phase has no external signs. Even diagnostics with the Mantoux test cannot detect the infection.
2. The second phase begins when positive reaction to try Mantoux. This moment is called the tuberculin turn.

The second phase is also asymptomatic, the child feels well. Due to the mildness of the form, treatment can be carried out on an outpatient basis. With treatment and favorable conditions, the infection can be suppressed, and tuberculosis goes away without clinically manifesting itself.

Photo 3. Diaskintest more exact method determination of immunity to the tuberculosis pathogen than the Mantoux test.

Tuberculosis intoxication

In older children, this type of tuberculosis is considered intermediate and develops into the primary type and localized forms (usually bronchoadenitis). In this case, there arises clinical picture, which has no characteristic features. Main symptoms:

• high fatigue;
• decreased or complete lack of appetite;
• changes in higher education nervous activity- lethargy and apathy or excitability;
• anemia;
• decreased muscle tone and skin turgor;
• peripheral lymph nodes increase by 5-6 mm;
• the liver and spleen may become enlarged;
• there appears a long low-grade fever- up to 37.5°C - for no apparent reason and fever.

This form is confused with a cold. More often it does not linger and turns into another type of tuberculosis. If this variant of the disease persists for a long time, chronic tuberculosis intoxication is diagnosed. This development is possible in children under 2 years of age.

Photo 4. High fatigue, lethargy and apathy in a child may be symptoms of the development of tuberculosis.

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Primary tuberculosis form

With this form three develop characteristic signs:

• a focus of inflammation appears in the area of ​​infection;
• lymphadenitis;
• damage to local lymph nodes;

Photo 5. Tuberculous lymphadenitisThe child hasis an inflammatory lesion of the lymph nodes due to tuberculosis infection.

This type of damage is typical for young children. In a child over 2 years of age, this form is possible if the pathogen is highly virulent or the amount of infection was large. In 95% of cases, the symptoms are localized in the lungs, in which case the following are added to the symptoms:

• weakness;
• headache;
• temperature increase by 0.5-1°C;
• cough;
• dyspnea;
• fatigue;
• lack of appetite.

Tuberculous bronchoadenitis

In this form, foci of tuberculous lesions are localized in the intrathoracic lymph nodes, often at the root of the lung and mediastinum. In addition to general signs such as low-grade fever and intoxication, characteristic symptoms:

• pain between the shoulder blades
• two-tone cough
• whistling noisy exhalation
• extension vascular network in the upper chest

Photo 6. Tuberculous bronchoadenitis in children is characterized by a specific two-tone cough and noisy exhalations.

These symptoms appear due to compression of the lymph nodes, which are located inside the chest, near the bronchi, trachea and other parts of the respiratory system.

Features of the treatment of childhood tuberculosis

Basic rules of therapy: complex treatment, continuity and phasing. There are three stages of treatment:

1. Hospitalization or inpatient treatment of tuberculosis in children. It is carried out for most forms of tuberculosis, with the exception of the latent form. This is done so that TB doctors monitor the child’s condition. The great advantage of this stage is the isolation of the patient from healthy children, so that the infection does not spread.
2. Direction to the sanatorium. The referral is given after the clinical signs of the disease have disappeared and bacterial excretion has ceased. The first condition guarantees that the child in the sanatorium will not be in danger of relapse, and the second is a guarantee of the non-spread of the disease. Spa treatment promotes recovery thanks to a special relaxing atmosphere and physiological procedures.
3. Ambulatory treatment. Involves taking anti-tuberculosis drugs and observation at a dispensary. This is done due to the fact that the causative agents of tuberculosis for a long time multiply in a latent form in tubercles - connective tissue cysts. When these foci burst, they introduce new pathogens into the body. To monitor the patient’s condition and prevent exacerbations, it is necessary to observe a TB specialist for at least a year.

Chemotherapy includes the use of isopiazide, rifampicin, ftivazide and other drugs. The course of administration is from 2 to 3 months, after which the child switches to a maintenance dose. If after a course of treatment there is no recovery, then surgical treatment is resorted to, which includes the removal of foci of bacterial growth.

Photo 7. Bronchitis in a child caused by a tuberculosis infection is diagnosed by an experienced TB doctor.

Possible complications

With late therapy, infectious and inflammatory damage to the lung tissue appears. With insufficient treatment, foci of pathogen reproduction occur, which become overgrown with fibrous tissue or become calcified.

If these foci are not detected and treated, then relapses occur with the development of atelectasis, collapse of lung tissue, exudative pleurisy. All this makes further treatment of children with tuberculosis lengthy.

Photo 8. Fibrous-cavernous pulmonary tuberculosis is a form of the disease characterized by the breakdown of lung tissue.

Prevention of tuberculosis in children

Pediatric practice divides preventive techniques into two groups. The first includes methods that are used for children who have not had contact with tuberculosis patients. The second group of preventive methods is used if the child has had direct contact with a tuberculosis patient.

For uncontacted children

Nonspecific prevention - hygiene by the child himself and his relatives. Schools, kindergarten, premises for children's groups are ventilated and disinfected. Staff undergo a medical examination every six months, including fluorography for tuberculosis.

Photo 9. Tuberculous pneumonia in a child over 12 years of age can be detected using an X-ray examination.

Effective method prevention is the identification of the disease by early stages. To do this, a Mantoux test is done once a year, and children over 12 years old undergo fluorography.

Table of vaccination of children against tuberculosis by age.

In addition, vaccination is carried out using BSG. These are weakened bovine tuberculosis bacteria that are similar to human pathogens. The drug is injected under the skin in the scapular area. Persistent the immune system occurs 2 months after vaccination and lasts 5-7 years.

Photo 10. To maintain the ruben’s immunity to tuberculosis pathogens, BCG revaccination is carried out at the age of seven and fourteen.

For contacted children

Nonspecific prevention consists of hospitalization and isolation of sick relatives, since the main source of infection is people. If tuberculosis is detected in an adult, his children may also be placed in a nursery. medical institution. The hospital will allow him to monitor his condition.

Since in young children fluorography does not confirm the presence or absence of the disease (since there is no localization), then preventive treatment isoniazid, without waiting for the first signs of tuberculosis in children. The course lasts six months, dosage - 5 mg/kg.

Video: More about childhood tuberculosis

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