Antituberculosis care of children and adolescents in tuberculosis risk groups

Because of deterioration of epidemiological situation by tuberculosis, individuals from tuberculous infection foci and social risk group require special care. It is important to integrate efforts of phthisiatric and general therapeutic and prophylactic services in detection of tuberculosis in children and adolescents, to create controlled conditions for conduction of antituberculous measures.     

三种分子诊断技术对儿童肺结核的诊断价值

目的 探讨三种分子诊断技术对儿童肺结核的诊断效能,为儿童肺结核的诊断寻求简单、快速、准确的新方法。方法 搜集哈尔滨市胸科医院儿童结核科、哈尔滨市儿童医院呼吸科、哈尔滨医科大学附属第一医院儿科2016年9月至2018年6月收治的2个月至14周岁的疑似肺结核患儿共186例,最后临床诊断肺结核者119例,其中低龄儿54例(45.4%),年长儿65例(54.6%);非结核病者67例,其中低龄儿31例(42.3%),年长儿36例(53.7%)。应用实时荧光定量PCR(real-time fluorescen quantitative PCR,FQ-PCR)、实时荧光核酸恒温扩增检测技术(simultaneous amplification and testing,SAT)和耐药基因芯片技术分别检测患儿胃液和痰液(年长儿)中的结核分枝杆菌,评价各方法的诊断效能。结果 以临床诊断为标准,FQ-PCR、SAT、耐药基因芯片检测胃液中MTB的敏感度分别为81.51%(97/119)、 78.15%(93/119)、73.11%(87/119),特异度分别为86.57%(58/67)、98.51%(66/67)、92.54%(62/67),Kappa值分别为 0.653、0.709、0.603。3种方法检测年长儿胃液中MTB的敏感度分别为 80.00%(52/65)、73.85%(48/65)、67.69%(44/65),特异度分别为75.00%(27/36)、97.22%(35/36)、88.89%(32/36);检测年长儿痰液中MTB的敏感度分别为 47.69%(31/65)、41.54%(27/65)、36.92%(24/65),特异度分别为88.89%(32/36)、 97.22%(35/36)、91.67%(33/36),各方法检测的敏感度胃液均高于痰液,差异均有统计学意义(χ ²值分别为14.696、13.898、12.334,P值均为0.000),各方法检测的特异度胃液和痰液之间差异均无统计学意义(χ ²值分别为2.347、0.000、0.158,P值分别为0.126、1.000、0.691);胃液总的阳性检出率为87.69%(57/65),痰液总的阳性检出率为58.46%(38/65),两者差异有统计学意义(χ ²=14.114,P=0.000)。 结论 FQ-PCR、SAT、耐药基因芯片检测儿童疑似肺结核患者的胃液和痰液中结核分枝杆菌的敏感度高、特异度强,对儿童肺结核的诊断具有重要价值。     

结核分子生物学诊断技术的研究进展

结核病是严重危害人类健康的全球性传染病之一,我国是结核病高发区,且近年结核病发病率有逐年增加的趋势;另外由于AIDS的蔓延和各种原因引起的免疫缺陷,导致不典型结核分枝杆菌感染的发病率也逐年增加。早期诊断、早期治疗和合理治疗是治疗结核病的关键。目前临床上常用的结核病诊断方法有细菌学涂片抗酸染色、活检病理诊断和体液或组织培养。细菌学涂片和活检病理抗酸染色找到抗酸杆菌可以确诊结核,     

First-phase insulin response in young healthy children at genetic and immunological risk for Type I diabetes

AIMS/HYPOTHESIS: A reduced first-phase insulin response to intravenous glucose is perceived as a sign of far-advanced deterioration of beta-cell function during the development of Type I (insulin-dependent) diabetes mellitus, but data on insulin responses at the onset of diabetes-related autoimmunity are lacking. We studied the first-phase insulin responses of small children soon after observed seroconversion to autoantibody positivity. METHODS: In the Type I Diabetes Prediction and Prevention Study newborn infants are screened for HLA-DQB1-associated genetic risk for Type I diabetes and those with increased risk are followed-up for the emergence of islet-cell antibodies. If antibodies are detected, autoantibodies to three other antigens (insulin, GAD65 and IA-2) are also measured. To measure first-phase insulin responses, intravenous glucose tolerance tests were carried out in 52 (1 to 5-year-old) children who had recently seroconverted to islet-cell antibody positivity. RESULTS: The first-phase insulin response was subnormal (<38 mU/l, the 5(th) percentile of insulin responses of 20 islet-cell antibody negative healthy children at this age) in 22 of the 52 children (42%). Stepwise multiregression analysis showed that islet-cell antibody greater than 20 JDFU (p=0.0005), insulin autoantibodies (p=0.0009) and an increasing number of positive autoantibodies (p=0.0011) were independent predictors of low first-phase insulin response. CONCLUSION/INTERPRETATION: A decreased first-phase insulin response could be an early phenomenon in the course of prediabetes in young children, implying a rapid autoimmune destruction or loss of function of beta cells as well as possible metabolic compensation mechanisms, since 11 out of the 22 high risk children remain nondiabetic for a considerable period of time despite low insulin responses.     

Formation of population groups with a higher risk of tuberculosis

During the years when tuberculosis was diagnosed among all age, sex, social and occupational groups of the population, methodological approaches to the organization of antituberculosis care based on annual antituberculosis preventive activities and covering practically all populations were the only proper measures bringing about their own positive results. Nowadays the annual preventive activities should be launched in those population groups where cases of tuberculosis are detected most frequently. To classify risk factors directly responsible for tuberculosis endemia, questionnaires were sent to 477 newly diagnosed adult patients. The obtained data were computer processed. Unfavourable social and biomedical factors, including alcoholism, unsatisfactory economic, working and living conditions, contact with tuberculosis patients, concurrent diseases and other social factors, have a decisive effect on the tuberculosis morbidity.     

Determination of risk factors for tuberculosis in children having contact with tuberculosis patients]

Analysis is given of the specific and nonspecific features in 100 tuberculosis patients and 500 children aged under 7 years having contact with tuberculosis patients. A complex of factors with a high prognostic value was defined from the set of the studied features and a scale for determining the tuberculosis risk in children was constructed. Estimating the risk degree by a prognostic table, allows one to define children at a high and maximal infection risk for the individual choice of preventive measures.     

Computerized tomography of the lungs and mediastinum in children with tuberculosis risk

Computed tomography (CT) was made in 75 children and adolescents infected with M. tuberculosis. As shown by x-ray, they had normal lungs and mediastinum. The children comprised a group of tuberculosis risk and had undergone regular check-ups for tuberculosis. CT has detected tuberculosis of the intrathoracic lymph nodes (ITLN) in 28(37.3%) children. Adenopathies were discovered in 8 anatomic groups, being more frequent in retrocaval, tracheobronchial, pulmonary and paratracheal. 25 children were diagnosed to have minor form of ITLN tuberculosis (nodes size 6-10 mm), 3 children had more prominent adenopathy up to 20 mm in diameter. Three groups of preventive policy are identified: with minor tuberculosis of ITLN, intrathoracic micropolyadenopathy and normal CT picture of the lungs and mediastinum.     

Making up tuberculosis risk groups from decreed contingents

The paper provides materials to make up risk groups from decreed contingents by using the database developed and introduced in the Novomoskovsk district, as well as a programme for rapid determination of the risk of tuberculosis. This procedure reduces a scope of fluorographic surveys among the decreed contingents, as well as their expenditures by 60%. Moreover, it may be useful for professional choice in the employment of the decreed persons, which may promote a decrease in the incidence of tuberculosis among them.     

Association of various genetic markers with tuberculosis and other lung diseases in Tuvinian children

Setting: Heredity factors influence susceptibility to tuberculosis and other lung diseases. Recent immunogenetic studies have confirmed the genetic predisposition to lung diseases in different populations. Precise knowledge of genetic aspects of disease susceptibility is important for improvement of public health.Objective: The aim of our research was to study the distribution of certain genetic markers in Tuvinian children suffering from tuberculosis and other lung diseases and to compare it with that in ethnically- and age-matched healthy donors. HLA-A, -B, -C and -DR antigens have been defined serologically by lymphocytotoxic assay, and variants of polymorphic protein loci Hp, Tf, Gc, ESD, ACP, PGM1, ADA, PGD have been defined by electrophoresis.Results: It was demonstrated that in Tuvinian children with tuberculosis the frequencies of HLA-DR2 and HLA-DRw53 antigens are increased in comparison with healthy donors. In children with non-tuberculous chronic lung diseases with allergic components the frequency of HLA-Al, -B5 and -B8 antigens and of genetic variants Hp2-2 and ESD1-1 was elevated.Conclusion: HLA complex genetic factors influence susceptibility to tuberculosis and other lung diseases in Tuvinian children.