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structure of clinical forms of a tuberculosis at children with a HIV-infection

In structure of clinical forms at children about 14 years inclusive are elderly the tuberculosis of organs of breath with a primary lesion vnut - rigrudnyh lymphatic knots-75-80 of % [7,74] prevails.

On a share of patients with a primary tubercular complex it is necessary from 2,5 to 10 %. [87, 98]. Remained 8­10 % are distributed between secondary forms of a tuberculosis and a tuberculosis vnelegochnoj localisations.

In table 4.9 data of our research are cited and taped osobenyonosti structures of clinical forms of a tuberculosis at children, sick HIV - by an infection (1 group) in comparison with structure at children with perinatalnym konyotaktom on a HIV-infection (2 group) and at children from population (3группа).

As a whole in structure of clinical forms the tuberculosis VGLU - 61,5 % of cases prevailed, the share sick of a primary tubercular complex made 18,2 %, a tuberculosis vnelegochnoj localisations (without a lesion of organs of breath)

- 2,0 % and focal and infiltrativnym (secondary forms) a tuberculosis - 4,7 %; 3,6 % of cases made other forms of a tuberculosis and the diseases caused by not tubercular micobacteria. However the parity of clinical forms in groups was various. The share of patients with tuberculosis VGLU was larger in 2 group - 74,2 % and a little bit less in 1 group and 3 group - 57,2 % and 55,8 % sootyovetstvenno. Partly the difference in shares speaks age differences: 2 group of patients in the majority included children early and preschool vozrasyota (97,9 %), only 2 children were at the age of 7 and 8 years (an explanation in 2 head), toyogda as in 1 and 3 groups of children were more senior 7лет 17,5 % and 55,8 % accordingly. The share of children of advanced age (12-14 years) in 1 group made 2,5 % and in 3 group

- 26 %, at this age can arise secondary forms of a tuberculosis (a reactivation of an endogenous infection though the role and a superinfection plays).

At early and preschool age the share sick of tuberculosis VGLU prakyoticheski did not differ in 2 group and 3 group - 85 % (36 children from 42 it vozrasyota) 76 % (72 children from 95) accordingly. There is a share bolyonyh tuberculosis VGLU of this age in 2 group - 62 % (85 of 137) a little bit less, that is bound to ascending of a share of patients with other processes, including disseminirovanyonymi. Distinctive line in structure of forms of a tuberculosis was high enough share of patients with are primary a tubercular complex in 1 and 2 groups isyosledovanija: 18,7 % and 21,7 % of cases accordingly whereas in 3 group their share has made 13,7 % of cases (ОШ=1,45; Dee 0,95-3,6; ОШ=1,74; Dee 1,05 4,3). There is a basis to believe, that at children born from women, sick HIV - an infection, absence is artificial framed antituberculous immuniyoteta (have been vaccinated BTSZH 41 % of children of 1 group, 15,5 % - 2 groups and 98,95 % - 3 groups), makes certain impact on processes of an early hematogenic dissimination and formation mikobakterialnyh the thrombuses playing opredeyolennuju a role in a pathogenesis of occurrence of a pneumonic site - "affect" - in a pulmonary tissue. A primary tubercular complex diagnosed preimuyoshchestvenno for children of early and preschool age in 1 and 2 group (at 23 patients from 31 and 19 of 21), and at the age of 7-14 years - in 3 group (at 8 из13 children).

Feature of structure of clinical forms of a tuberculosis consisted in much prevyyoshajushchej shares of patients disseminirovannymi and miliarnymi plural loyokalizatsii (generalised) processes in 1 group sick (sick HIV - an infection).

Structure of clinical forms of a tuberculosis at children of investigated groups

Table 4.9

Research group Age group

(Years)

Clinical forms of a tuberculosis In total children
Tuberculosis of intraheaps - nyh lymph nodes Primary tuberkulyozyonyj a complex Disseminirovannyj tuyoberkulyoz (miliarnyj) The generalised Secondary (focal, infiltrativnyj) Meningitis Abdominal /

Spondylitis

mikobakterioz Tuberculosis perifericheyoskih lymphatic uzyolov Exudative pleuritis
abs. % abs. % abs. % abs. % abs. % abs. % abs. % abs. % abs. % abs. % abs. %
1 group 0-2 35 21,1 11 6,6 7 4,2 2 1,2 2 1,2 - - 57 34,3
3-6 50 30,0 12 7,2 11 6,6 5 3,0 - - - - 1 0,6 1 0,6 - - 80 48,2
7-14 10 6,0 8 4,9 5 3,0 2 1,2 - - 1 0,6 2 1,2 - - 1 0,6 29 17,5
Total 95 57,2 31 18,7 23 13,9 9 5,4 - - 1 0,6 3 1,8 3 1,8 1 0,6 166 100
2 group 0-2 38 39,2 13 13,4 - - 1 1,0 1 1,0 /1 1,0 - - - - 54 55,6
3-6 34 35,1 6 6,2 - - 1 1,0 41 42,3
7-14 - - 2 2,1 2 2,1
Total 72 74,2 21 21,7 - - 2 2,1 1 1,0 1 1,0 - - - - 97 100
3 group 0-2 6 6,3 6 6,3
3-6 30 31,6 5 5,2 1 1,1 - - 36 37,9
7-14 17 17,9 8 8,4 5 5,3 - - 17 17,9 - - - - 1 1,1 5 5,3 53 55,8
Total 53 55,8 13 13,7* 5 5,3 - - 17 17,9 - - - - 2 2 5 5,3 95 100,0
AND T ABOUT G ABOUT 220 61,5 65 18,2 28 7,8 11 3,1 17 4,7 1 0,3 2 0,6 3 0,7 5 1,4 6 1,7 358 100

98

The serious forms of a tuberculosis bound with hematogenic rasprostrayoneniem of an infection and occurrence disseminirovannyh of processes with porayozheniem of many organs and systems of an organism, met equally seldom at children 2группы and 3группы.

In 2 group of patients processes are diagnosed for 4 children (4 %) serious, svjazanyonye with hematogenic diffusion of an infection. So at 2 patsienyotov the generalised tuberculosis with miliarnoj dissemina - tsiej in lungs with a lesion central nervous systems (meningitis) and an eye (chorioretinitis), mesenteric lymph nodes is diagnosed. The meningitis of a tubercular aetiology is diagnosed for 1 child of 8 months. To serious gematogenyonym processes can carry and the tubercular spondylitis which has developed at one child of 2th years. All these children have not been inoculated against a tuberculosis. In 3 group disseminirovannye processes are diagnosed at 5 sick (5,3 %). As the occurrence reason disseminirovannyh processes at patients of this group duration and intensity of contact to a sick tuberculosis, fading of postvaccinal antituberculous immunity as it is children could serve were more senior 5 years from family contact.

Predilection to generalisation of a tubercular infection was observed mainly in 1 group at sick HIV-infections that is caused, most likely, not only long contact with tubercular infektsiyoej, by its massiveness and virulentnostju, but also expressed immunodefitsityonym a condition arising against a HIV-infection about what it is detailed izyolozheno in the following chapter.

So, in 1 group disseminirovannyj (acute) tuberculosis diagnostiroyovan at 23 sick (13,9 %), a generalised tuberculosis - at 9 sick (5,4 %). The generalised tuberculosis was characterised at 7 of 9 children socheyotaniem miliarnoj dissiminations in a pulmonary tissue and a lesion of others oryoganov and systems (only at two children it has not been noted the dissimination centres in a pulmonary tissue), therefore further we will unite to these shares
Patients in one - 32 patients with disseminirovannym and generalised tuyoberkulezom, that has made 19,3 % from all patients of 1 group.

Thus, practically at every fifth sick HIV - by an infection it is taped disseminirovannyj or generalised tuberkuyolez. Frequency of the serious processes bound with limfo-HEMATOGENIC rasproyostraneniem of an infection, at sick HIV-infections in 4,8 times exceeded chasyototu similar processes in 2 group (19,3 % and 4,0 %; ОШ=3,8; Dee 1,75­8,2; p

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Scientific source KLEVNO HOPE IVANOVNA. TUBERCULOSIS At CHILDREN, SICK HIV-INFECTIONS (prevalence, features of clinical implications, diagnostics, treatment, preventive maintenance). The dissertation on competition of a scientific degree of the doctor of medical sciences. Moscow - 2015. 2015

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Other medical related information structure of clinical forms of a tuberculosis at children with a HIV-infection:

  1. INTRODUCTION
  2. THE TABLE OF CONTENTS
  3. INTRODUCTION
  4. clinical aspects of a tuberculosis, sochetannogo with a HIV-infection
  5. 1.5.1. Bacterination
  6. the characteristic of a clinical material
  7. radiological implications of a tuberculosis at children from a HIV - an infection
  8. structure of clinical forms of a tuberculosis at children with a HIV-infection
  9. features of a current of a tuberculosis, sochetannogo from a HIV - an infection, at early and late stages of a HIV-infection
  10. features of a current of a tuberculosis, sochetannogo from a HIV - an infection at different level of the maintenance With І) 4-cells in peripheric blood