features of a tuberculinodiagnosis on a Mantoux reaction 2 THOSE in modern conditions

In spite of the fact that from the moment of opening M. Tuberculosis has passed more than 100 years, in a number of the countries the basic method for primary mass screening of the population for tuberculosis revealing continues to remain old enough, to modern measures, dermal tuberkulinovyj the test (Fingers of M.

A, 2010).

Creation of an effective and specific preparation for tuberculosis diagnostics originates from R.Kokh's works (Koch H.P., 1891), which in 1891г. Has allocated components M. Tuberculosis from concentrated kulturalnoj liquids. It was soon found out, that hypodermic introduction by a sick tuberculosis of extract M. Tuberculosis causes dermal reaction. In 1932 Seibert F.B., has received the cleared tuberculin - PPD. In 1941г a series PPD-WITH as the international standard of the cleared tuberculin has been confirmed, the CART together with UNICEF have organised manufacture of the cleared tuberculin (series RT23) for wide application. The main disadvantage of the cleared tuberculin is insufficient specificity because of the maintenance in it
The fibers meeting at micobacteria of various kinds. In Russia the dry cleared tuberculin received in 1939г is applied. M.A.Linnikovoj - the PPD-L tuberculin.

Intracutaneous test Mantu continues to remain one of the most widespread methods of diagnostics of a tuberculosis in the world at mass epidemiological inspections of the population on a tuberculosis. Now for carrying out of a mass tuberculinodiagnosis the Mantoux reaction 2 THOSE in standard delution for intradermal application (the order № 109 Ministries of Health of the Russian Federation, Mitinskaja L.A., 1998) is used uniform intradermal tuberkulinovaja.

The mass tuberculinodiagnosis with application intradermal tuberkulinovogo test Mantu with 2ТЕ in modern conditions keeps the urgency as a method, allowing to tap risk groups on disease by a tuberculosis among children. At children of younger age group about infitsirovannosti children MBT convincingly testify only giperergicheskie reactions to a tuberculin. Most informatinym intradermal test Mantu is at the age of 7-11 years and 12-14 years. According to inspection at the phthisiatrician stably high indicator of a bend becomes perceptible from 11 years, from 12 years the share giperergicheskih is enlarged and accruing reactions to a tuberculin, the appreciable share of children infected with micobacteria of a tuberculosis more of 2-years (Zubova E.D., Motanova L.N, 2011) becomes perceptible. Was marked by intensive development of allergology, genetics, gene engineering, molecular biology, immunology that has allowed to establish properties of a tuberculin second half XX century and to decipher the Mantoux test mechanism.

As the tuberculin represents a total extract of antigens M. Tuberculosis, it predetermines low level of specificity of reaction
Mantu. At the expense of a complex of the general mikobakterialnyh the antigens which are present at a tuberculin, the positive Mantoux test does not tap differences between activly breeding and latent forms of disease (an asymptomatic carriage). Allergic implications, the dermal diseases, the transferred infections, specific features of sensitivity of a skin that complicates interpreting of results (Kiselyov V. I, etc. 2008 can influence result of reaction, Lebedeva L.V., Grachev With.

G, 2007, Andersen P. Munk M.E., 2000).

For Russia where bacterination of newborns is spent universal BTSZH, application dermal tuberkulinovogo the test at mass epidemiological inspections continues to remain sistemoobrazujushchim a quality monitoring behind tuberculosis diffusion.

In due course collected more and more data about low informativnosti Mantoux tests (Steenhuis T.J., van Aalderen W.M., Bloksma N., 2008).

The existing tuberculinodiagnosis is limited in the possibilities, as:

1) possesses low specificity at vaccinated children - with its help it is impossible to distinguish postvaccinal from an infectious allergy, and the postvaccinal allergy remains after an inoculation within 10 years and more (Lebedeva L.V., Grachev Of this year, 2007).

2) it is impossible to distinguish an active tubercular infection from the becoming infected transferred in the past or local tubercular process (Lee Elsie, Holzman Robert S, 2002).

3) possesses low sensitivity at an active tuberculosis - to 15­50 % of negative reactions (Fiallbrant H., 2008).

Last years it became obvious, that implication postvaccinal and (or) a nonspecific allergy bring appreciable uncertainty in
Process of diagnostics of a tubercular infection by means of dermal tuberkulinovogo the test. A principal cause of it is the preparation for reaction statement - a tuberculin which contains a full set mikobakterialnyh antigens which cause allergic and false positive reactions, first of all at BTSZH - the vaccinated people. At carrying out of a Mantoux reaction with 2ТЕ as method of early revealing of a tuberculosis VI group of the dispensary account at the phthisiatrician is formed.

Tuberkulinovye assays are immunologic reactions of a hypersensibility of the slowed down type (Ado A.D., 1978; Haitov R. M, 2002; Comstock G., V., Woolpert S., 1999; Edwards A., 2003).

For response including at a tuberculosis, action T-helpera is starting. Differentiation T-helperov, in turn, is supervised by cytokines. Key cytokines for Th1 the answer, are ИЛ-2 and interferon at. As a result of Th1 carry out functions of the cellular immunity, realised by specific macrophages and tsitotokicheskih lymphocytes. Th2 develop a complex of cytokines, promotes development IgE and realisation of other processes of implication of allergic reactions; ИЛ-5 is the factor of growth and a differentiation of eosinocytes and the growth factor In - cells; among a wide spectrum of effects ИЛ-6 - support of development and a proliferation of V-cages and their descendants forming antibodies. Th2 are helpers of the humoral immune answer. Between Th1 and Th2 there are antagonism relations. Overweight of type Th is fixed, as defines the form of the immune answer prevailing at present (Haitov R. M, 2002; Levashev J.N., Repin J.M., 2006; Cantrell D., 1996; Romagnani S., 1997). The TM-profile of cytokines (Levashev J.N., Repin J.M., 2006) is More characteristic for tubinfitsirovannyh persons.

Now often there are difficulties of interpreting of a Mantoux reaction at children and teenagers (Herz U, Gerhold K, Gruber C, et al., 1998; Kimura M, Converse P.J., 1999).

The tuberculosis at children of early age is characterised in 36,8 % giperergicheskoj and in 26,4 % by the expressed reaction by results of a Mantoux reaction. Tubercular contact in 37,1 % of cases is taped at registration giperergicheskih reactions of Mantoux reactions with 2 THOSE. During too time at teenagers sick of a tuberculosis can doubtful Mantoux reactions with 2 THOSE (Zahovaeva E.N., Ovsjankina E.S., Staheeva L.B., 2003) are observed.

The mass tuberculinodiagnosis forms risk groups on disease by a tuberculosis, children with "bend" tuberkulinovyh assays make 57-71 % of them (Sirenko I.A., Podoprigora N.M., 2006).

Now the number of children from families of migrants and refugees (Ovsjankina E.S., 2003) was enlarged.

Search of specific antigens to M. Tuberculosis has led to development in vitro diagnostics of the tubercular infection based on an antigene - stimulirovannoj of an induction of gamma interferon (ИНФ-y) (Andersen P. Munk M.E., Pollock J.M., Doherty T.M., 2000, Pai M., Riley L.W., Colford J.M., 2004). Various techniques of definition of emission ИНФ-y (IGRA Interferon Gamma Release Assay) have shown high selectivity, but insufficient specificity of a method in TV-infection diagnostics (Pai M., Kalantri S., Dheda K., 2006). Besides, statement IGRA demands the difficult laboratory

The equipment and the highly skilled personnel. The specified reasons and high cost of the test have limited application IGRA to the advanced countries. This test has been recommended to diagnostic application only as additional to tuberkulinovoj to assay (Mazurek G.H., Jereb J., Lobue P., 2005 Natinal Collaborating Center for Chronic Conditions, 2007).


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Scientific source Ahmerova Tatyana Efimovna. IMMUNODIAGNOSIS OF DIFFERENT MANIFESTATIONS OF TUBERCULOSIS INFECTION IN CHILDREN. Thesis for the degree of candidate of medical sciences. SAMARA - 2014. 2014

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