Progressive and acute forms of tuberculosis in young children

Factors involved in the development of acute tuberculosis in the form of miliary tuberculosis in 6 infants and meningeal tuberculosis in 24 infants as well as factors involved in progression of primary tuberculous infection in 8 infants without affection of the meninx but with fatal outcomes were studied. The most severe processes were shown to be more frequent in 1- and 2-year-olds being in family contacts with persons isolating tubercle bacilli (81.6 per cent), not vaccinated or defectively vaccinated with the BCG vaccine (78.9 per cent), not subjected to chemoprophylaxis (93.5 per cent) and chemotherapy (96.2 per cent) because of late tuberculosis diagnosis before hospitalization. It is recommended to improve tuberculosis control in the foci where infants are registered, to improve vaccinal prophylaxis and chemoprophylaxis to markedly increase the level of the knowledge of the general pediatrician with respect to early diagnosis of tuberculosis, to increase sanitary education of the population, including knowledge of the nature of tuberculosis.     

儿童肺结核CT影像分析

目的 探讨儿童肺结核的CT平扫及增强的影像表现特征。 方法 回顾性分析2008年7月至2011年8月在我院住院的69例结核病患儿,临床症状、PPD试验及影像学表现均符合结核病特征,经抗结核治疗后复查,患者临床症状及肺部病灶均有所好转。收集患儿的影像学资料,对其进行分析。 结果 69例患儿的CT不同影像表现为：原发性肺结核（8例）包括原发综合征（5例）和胸内淋巴结结核（3例）,原发综合征表现为肺内的原发结核病灶、结核性淋巴管炎及淋巴结炎,此型与胸内淋巴结结核的CT平扫均可见纵隔、肺门及腋窝多发肿大淋巴结,增强扫描不均匀强化或淋巴结中心干酪坏死区无强化,边缘环形强化的特点。原发性血行播散性肺结核（10例）表现为两肺大小、密度、分布均匀一致的粟粒状影合并纵隔淋巴结肿大。原发性肺内浸润性结核病灶和干酪性肺炎（43例）的影像表现为2个肺叶散在分布的结节状、斑片状影,还有甚至双肺多叶多段广泛分布的结核病灶,在结节状、斑片状、大片状结核病灶的基础上形成干酪性肺炎、空洞。结核性胸膜炎（8例）可见不同程度的渗出性胸腔积液及胸膜增厚粘连等表现。 结论 CT平扫及增强对于诊断儿童肺结核,明确肺内各种病灶形态,轻微病灶、隐匿病灶、微结节及干酪性肺炎等具有一定价值,可为临床诊断提供重要依据。     

Neurological manifestations of tuberculosis

One hundred and forty-four new cases of pulmonary tuberculosis were examined. The examination revealed the following neurological syndromes: vegetovascular dystonia, disseminated cerebral microsymptoms, focal lesion of the brain, sensory polyneuropathy. The presence of positive specific basophilic degranulation reactions and intracutaneous tuberculin test suggests that the body shows allergic reactions in response to Mycobacteria tuberculosis. And since connective tissue that presents in the vessels and tunics in the nervous system is involved into a pathological process in allergy, neurological disorders are always secondary in tuberculosis and due to the primary vascular wall lesion that following the type of secondary allergic vasculitis.     

Risk factors of the development of destructive forms of pulmonary tuberculosis in children

Data are presented on the follow-up of 120 children between the ages of 3 months and 14 years with different forms of destructive pulmonary tuberculosis. The factors responsible for the origination of destructive tuberculosis include the absence or improper conduction of BCG vaccination, contact with patients sick with active pulmonary tuberculosis at the moment of detection or primary contamination, the absence of systematic and high-quality tuberculosis diagnosis; childhood infectious diseases, pneumonias, bronchitis, untimely diagnosed poorly and well manifested forms of intrathoracic tuberculosis in children of the risk groups.