INTRODUCTION

Problem urgency

The case rate a tuberculosis in Russia among children, increased in the nineties last century, continues to remain strained and makes nearby 20 on 100 thousand children's population (Aksenova V.

Last years researches on allocation of antigens Mycobacterium tuberculosis which were absent in vaccine strain Mycobacterium bovis BCG have been executed. These antigens had appeared ESAT-6 and CFP-10. With the account of these data, in Russia preparation ^Diaskintestj (Diaskintest (DST) which represents rekombinantnyj fiber CFP-10 - ESAT-6, produced Escherichia coli BL21 (DE3)/pCFP - ESAT has been developed. Now the term - allergen tubercular rekombinantnyj in standard delution is used. It is intended for intradermal application in a dose of 0,2 mkg in 0,1 ml for revealing of hypersensitivity of the slowed down type as a result of becoming infected Mycobacterium tuberculosis. ^{Diaskintestjpri} intradermal introduction causes specific dermal reaction, as implication of hypersensitivity of the slowed down type. At persons with a vaccinal allergy reaction to a preparation is absent (Aksenova V. A, Ovsjankina E.S., 2010г., 2013г.).

The comparative characteristic of results of assay with preparation ^{Diaskintestjs} earlier known tuberkulinovymi assays at children with active forms of a tuberculosis is in a studying stage. This theme
Is actual now. A special problem soostavljajut data about presence of negative result ^{Diaskintestjpri} an active tuberculosis.

Research objective

To study features of an immunodiagnosis of various implications of a tubercular infection at children in modern conditions.

Research problems

To study clinical forms of a tuberculosis at children who have arrived on hospitalisation and results tuberkulinovoj of sensitivity on a Mantoux reaction of 2 THAT and assay Diaskintest ^j. To define correlation communication of Mantoux reactions 2 THOSE and ^{Diaskintestjpri} to diagnostics of a tubercular infection at children.

To study antituberculous activity of immune system and level stimulirovannoj production IFN-y in system of antituberculous immunity at children with for the first time taped tubercular infection and its value for the disease forecast.

To tap features of reaction of immune system at various forms and phases of a tubercular infection at children, and also at children with negative result ^Diaskintestj.

Scientific novelty of research

The immunodiagnosis of a tubercular infection at children has taped features of reaction as dermal Mantoux reactions 2 THOSE and with preparation Diaskintest ^j, and immunologic indicators of blood serum CD4 ⁺ - CD16 ⁺ - lymphocytes, IgE and level serumal IFN-y. Correlation communication of all studied indicators is taped, both at local forms of a tuberculosis, and at conversion tuberkulinovyh assays.

For the first time, at diagnostics of a tuberculosis at children level stimulirovannoj production IFN-y in the test - system with preparation Diaskintest ^j in vitro is studied and its role in an immunodiagnosis of a tubercular infection is defined.

Value of immunologic indicators CD4 ⁺ - CD16 ⁺ - lymphocytes, IgE in peripheric blood and production level stimulirovannogo IFN-y in the test - system with FGA and with preparation Diaskintest ^j in vitro are defined, allowing to prognosticate development of a tubercular infection in children.

Features of reaction of immune system at children with negative result ^{Diaskintestjpri} local forms of a tuberculosis and with conversion tuberkulinovyh assays are taped. For children, with suspicion on a tubercular infection, but with negative result of assay with preparation ^Diaskintestj, the algorithm of diagnostics is developed.

The practical importance of work

The received results can be used in practical work of doctors of phthisiatricians and doctors of the general practice at carrying out of early diagnostics of a tuberculosis at children.

In case of "bend" revealing tuberkulinovoj Mantoux reactions 2ТЕ, presence of risk factors on a tuberculosis (contact, a HIV-infection, noneffective bacterination, etc.), but, thus, on ^Diaskintestj, it is recommended to negative reaction doobsledovanie on a condition

Antituberculous immunity.

Offered complex of methods of the additional laboratory inspection, including definition of levels CD4 ⁺ - CD16 ⁺ - lymphocytes, IgE in peripheric blood and production level stimulirovannogo IFN-y in the test - system both with FGA, and with preparation Diaskintest ^®in vitro,
Gives possibility not only to raise quality of diagnostics of a tubercular infection, but also to estimate a condition of antituberculous activity of immunity.

The positions which are taken out on protection

At children who for the first time have arrived on hospitalisation in antituberculous unit, local forms, both primary, and a secondary genesis are taped. At an estimation tuberkulinovyh assays direct correlation connection of a Mantoux reaction 2ТЕ and ^Diaskintestj is established.

The complex of methods of the additional laboratory inspection, including definition of level CD4 ⁺ - CD16 ⁺ - lymphocytes, IgE in peripheric blood and production level stimulirovannogo IFN-y in the test - system with preparation Diaskintest ^®in vitro, will give possibility to estimate antituberculous activity of immune system at children and the forecast of development of a tubercular infection.

Children with various implications of a tubercular infection, both at local forms of a tuberculosis, and at conversion of a Mantoux reaction 2 THOSE, equally can have negative result on preparation ^Diaskintestj bound to features of reaction of immune system.

Work approbation

On a theme of the spent researches 21 scientific work, including 4 in the magazines recommended for publication VAK, 2 patents is published. Dissertation substantive provisions are reported and discussed at 9 congress of phthisiatricians of Russia (on June, 1-3st 2011г.), on postgraduate readings of the Volga region, 2012г., at inter-regional scientifically-practical conference with the international participation, devoted to the 130 anniversary of the report of R.Kokh about
The tuberculosis originator, Tver, 2012г., at 1 congress of association phthisiatricians (St.-Petersburg), 2012г., at the All-Russia scientifically-practical conference with the international participation on pressing questions of preventive maintenance, diagnostics and treatment of a tuberculosis at children and teenagers, Moscow, on March, 28-29th 2013г, the National congress on diseases of lungs (Kazan, 2013), were reported on scientifically - practical conferences in the Samara area (2011, 2012, 2013).

Introduction of results in practice

Materials of research and references following from them concerning diagnostics of a tubercular infection are applied in GBUZ "SOKPTD" Samara, GBUZ "TGPTD" by of Tolyatti. Results of research are applied at lectures to students, doctors, on a practical training for students of pediatric faculty of the Samara state medical university.

Volume and work structure

Dissertational work is presented on 129 pages, contains 32 tables, 7 drawings, including algorithm, 1 clinical example. The work structure includes introduction, the literature review, the head of the characteristic of patients in studied groups and applied methods of research, own results presented in 4 heads, discussion of the received results, conclusions and practical references. In the literature list 190 sources, including 121 of which domestic authors are presented.