microbiological diagnostics of a tuberculosis at children, sick HIV-infections

For revealing and an establishment of the diagnosis of a tuberculosis etiological diagnostics - a finding of micobacteria of a tuberculosis in ljuyobom a biological material is very important. Besides, for successful treatment tuberkuyoleza it is very important to make a combination of antituberculous preparations to which sensitivity of micobacteria of a tuberculosis (MBT) is kept.

Before (tab. 4.5) we cited data on frequency of allocation MBT at sick of an intrathoracic tuberculosis with primary forms. In 1 group of a micobacterium have been found out at 25 (15,5 %), in 2 group - at 10 (10,5 %) and in 3 group - at 6 (8,4 %) patients.

More often bakteriovydelenie it was observed at intrathoracic lymph nodes sick of a tuberculosis (table 4.22) that can indirectly testify to a lesion of bronchuses (a tuberculosis of bronchuses, formation bronho-noduljarnyh fistulas) which are not diagnosed because of absence traheobronhoskopicheskih researches.

Table 4.22

Bakteriovydelenie at sick of an intrathoracic tuberculosis with primary forms in research groups

At children in third of cases the finding of micobacteria has been bound to a HIV-infection with disseminirovannymi processes though a source vydeleyonija MBT, most likely, were intrathoracic lymph nodes, priyovodjashchie to a lesion of bronchuses.

It is difficult to take away a sputum from children of thoracal age for research on MBT, therefore a material was having washed off with a nasopharynx, washout from bronchuses, seldom washing waters of a stomach (at 2 patients). In two children of a micobacterium have been found out in urine.

Taped MBT less often a method of luminescent microscopy - at 20 of 41 (48,8 %) and a little bit more often - kulturalnym a method - at 21 of 41 children (51,2 %). Medicinal fastness (LU) the originator to protivotuberkuyoleznym to preparations is taped at 10 (40 %) children of 1 group: at three - mnozhestyovennaja medicinal fastness (MLU), at one child - wide leyokarstvennaja fastness (SHLU), at other six children LU zaregistyorirovana to Isoniazidum (), to streptomycin (S) or to Kanamycinum () and them soyochetaniju (N S, S). At children of 2 groups LU it is established in 4 cases (40 %): at three - MLU and at two - to N S. At patients of 3 groups LU it has been taped at 2 children (33,3 %), in all two cases it was defined MLU.

In etiological diagnostics identification of micobacteria is very important. At 3 children with a micobacterium HIV-infection identifitsirovayony as not tubercular micobacteria (NTMB), that demanded treatment correction.

The tuberculosis of peripheric lymph nodes has been confirmed by histological research bioptata, and in the presence of a fistula - research on MBT in separated.

The resume

More serious current of tubercular process at children with a HIV - an infection can be bound to late revealing at them disease. More than in half of cases (53,0 %) a tuberculosis at children with a HIV-infection

133 it was taped under complaints (on appealability) unlike children without an infection HIV - (22,6 % - in 2 group and 25,6 % - in 3 group; r