application of allergen tubercular rekombinantnogo for revealing and diagnostics of a tuberculosis at children with a HIV-infection

Last 10 years in world practice are activly used new diyoagnosticheskie the test systems developed on the basis of synthetic peptiyodov of fibers ESAT6 (early secreted antigenic target) CFP10 (culture filtrate protein), based on provodenii a quantitative estimation of emission interyoferona Y from lymphocytes of the integral blood received from the patient, under vozyodejstviem antigens from M.

In the Russian Federation, since 2009 (Order MZ SR the Russian Federation № 855 from October, 29th 2009г.), the domestic preparation - allergen tubercular rekombinantnyj for intradermal introduction, soyoderzhashchy fiber ESAT6-CFP10 (the commercial name of a preparation - DIA - ^SKINTESTj) is widely used. Test of the given test has shown, that the preparation possesses high sensitivity and specificity at identification infitsiyorovanija M. Tuberculosis also does not give positive takes at sensibiyolizatsii an organism micobacteria vaccine strain BTSZH and netuberkuyoleznymi micobacteria [41,106]. Besides, many researches poyokazano, that a positive take on introduction ^{DIASKINTESTAj} sviyodetelstvuet about activly metabolizing microbic population in orgayonizme (an active tubercular infection), that raises risk of development loyokalnogo a tuberculosis [101,112, 116].

Within the limits of our research on the basis of one of children's homes for deyotej, the sick HIV-infections which have remained without care of parents (S - Petersburg), according to Order MZ and SR № 855 and the instruction on application of preparation ^DIASKINTESTj, 29 children at the age from 2 till 6 years of both sexes (12 girls and 17 boys) besides tuberkulinovoj Mantoux reactions with 2ТЕ assay with allergen tubercular rekombiyonantnym (DIASKINTESTj) has been spent. At anybody from children of disease of a tuberculosis at the moment of research was not. All children at the moment of carrying out of assays had a safe immune status, average value CD4 T-limfotsitov soyostavilo 1200± 340 kl/mkl, the median has made 1230 cells. antiretrovirusyonuju (art) therapy received 14 of 29 children.

Results of immunologic assays are presented in table 4.18.

Table 4.18

Results of a Mantoux reaction with 2 THOSE and with preparation ^DIASKINTESTj at children, sick HIV-infections

From 29 children positive reactions to a Mantoux reaction were defined at 14 (48,3 %) children. Positive reaction is regarded as implication postvaktsiyonalnoj allergies at 12 children as has appeared a year later after provedenyonoj bacterinations BTSZH (an infiltrate was within 5-10 mm in diameter), inyofektsionnoj allergies (becoming infected MBT) - at 2 children at the age of 6 years.

Assay with preparation ^DIASKINTESTj was negative at all 29 children, sick HIV-infections, but not sick of a tuberculosis, that sootvetyostvuet to literary data and confirms the importance of assay with DIA - SKINTESTOM in revealing of an active tubercular infection (is not present lozhnoyopolozhitelnyh reactions).

Results of assay with allergen tubercular in comparison with rezulyotatami Mantoux reactions with 2ТЕ children with a HIV-infection, sick of a tuberculosis are presented to tab. 4.19.

Table 4.19

Results of assay with preparation ^DIASKINTESTj at children, sick HIV-infections, sochetannym with a tuberculosis

Assay with preparation ^DIASKINTESTj has been spent to 45 children with poyolozhitelnoj reaction to a Mantoux reaction with 2 THOSE.

Results of reactions to allergen tubercular rekombinantnyj at deyotej with a tuberculosis, sochetannym with a HIV-infection, practically coincide with results on a tuberculin. Positive reaction on DIASKINTESTj were defined at 48,9 % and at 55,6 % of children - on a tuberculin (p> 0,05), otritsatelyonyh results was 51,5 % and 44,4 % accordingly. At positive takes of assays high level of a specific sensibilization (giperer - gicheskie reactions) was a little bit more often taped on ^DIASKINTESTj - (28,9 %), than on a tuberculin (15,6 %). Average value of results of assays in mm dostoyoverno did not differ (p> 0,05).

At positive takes of assays high level of a specific sensibilization (giperergicheskie reactions) was a little bit more often taped on ^DIASKINTESTj - (28,9 %), than on a tuberculin (15,6 %). Average value of results of assays in mm authentically did not differ (p> 0,05).

As it has been shown above, the share negative tuberkulinovyh assays depends on the immune status of the patient and partly from the disease form (at disseminirovannom and a generalised tuberculosis frequency otritsayotelnyh reactions was larger).

We have carried out the analysis of results of assay with a preparation DIASKIN - testj depending on the form of process and the immune status at children with a HIV-infection (tables 4.20 and 4.21).

At children with disseminirovannymi processes the share negative reakyotsy on DIASKINTESTj was considerably above, than at children at dostayotochno the limited extent of a lesion (VGLU, PTK, others) - 85,7 % and 35,5 % (ОШ=12,0; Dee 8,07-22,7), as well as a share of negative reactions to a tuberculin - 85,7 % and 25,8 % (that corresponds to the data resulted in tab. 4.20).

Table 4.20

Character of sensitivity on DIASKINTESTj at sick HIV - an infection at various clinical forms of a tuberculosis (n = 45)

The analysis of results of character of sensitivity on ^DIASKINTESTj at sick of a tuberculosis, sochetannym with a HIV-infection depending on maintenance CD4 of lymphocytes in peripheric blood (table 4.21) pokayozal, that sensitivity to preparation ^DIASKINTESTj depended on number CD4 of lymphocytes, by analogy to sensitivity to a tuberculin. Among children with positive DIASKINTESTOM the share of positive reactions decreased with an excavation of an immunodeficiency and made at CD4> 500 kl/mkl - 77,3 %, at CD4> 350 kl/mkl - 18,2 %, at CD4