studying of clinical efficiency of bacterination BTSZH in group of children of sick HIV-infections (В23)

Among children with a HIV-infection, inoculated by a tubercular vaccine, 9 persons from 45 have been vaccinated BTSZH already after an extract from a maternity home in various terms: aged до1 year-2 of children, 1-1,5 years - 3 children and at the age of 1,6-2 years (is more senior 18 months) - 4 children.

HIV-infection it has been taped (except one - in 9 months) at 3 children at the age of 3-5 years and at 5 at the age of 6-11 years. At 5 children of a HIV-infection ustayonovlena before disease by a tuberculosis and at 4 children - on disease tuberyokulezom, and from them at 3 patients has been taped miliarnyj a tuberculosis, one child has died in 3 months of the treatment beginning aged 3г.8мес. (Vak -

tsinirovan in 1,5 years). Thus, vaccinated children from a HIV - an infection because of a late establishment of a HIV-status (after vaktsinayotsii), besides, absence of observation over children, born from women with a HIV-infection, late diagnostics of a HIV-infection even at vaktsinirovanyonyh BTSZH children resulted not only in disease by a tuberculosis, but also geyoneralizatsii process.

We have carried out the analysis of influence of vaccine BTSZH on a current of tubercular process at children with a HIV-infection.

Considering, that influence on a current of tubercular process, structure of forms of a tuberculosis besides bacterination BTSZH can render age rebenyoka, contact presence (massiveness of an infection), in table 7.10 these risk factors at vaccinated and not vaccinated children of group V23 as the quantity of children vaccinated BTSZH, was dostayotochno representative are presented.

Girls and boys there was a peer quantity among vaccinated and not vaccinated BTSZH, contact with sick of a tuberculosis is established more, than at half of children - in 66,7 % and 60,9 % of cases accordingly.

Among vaccinated was a little bit less children at the age of 0-2 years, in comparison with not vaccinated BTSZH - 26,7 % and 35,9 % sootvetstyovenno (ОШ=0,31; Dee 0,11 0,85).

In group of children, sick HIV-infections (В23), we did not become privoyodit terms of becoming infected MBT at vaccinated and not vaccinated BTSZH as tuberkulinovye assays often were negative in moyoment tuberculosis revealings, and their dynamics in the anamnesis practically not otrayozhena from - for irregular observations in medical institutions.

Table 7.10

The characteristic of children of groups V23 on a sex, age and contact presence

Besides, at vaccinated children positive reaction to a Mantoux reaction could be a consequence of postvaccinal immunity (low chuvstviyotelnost to a tuberculin at children with a HIV-infection complicates differentsiyoalnyj the diagnosis of the nature of hypersensitivity of the slowed down type).

We result the analysis of methods of revealing of a tuberculosis at vaktsinirovanyonyh and not vaccinated BTSZH, considering, that to some extent the method vyjavyolenija reflects a current of tubercular process.

Methods of revealing of a tuberculosis essentially did not differ at vaktsiyonirovannyh and not vaccinated BTSZH children (table 7.11).

In half of cases a tuberculosis at vaccinated and nevaktsinirovan - nyh children, taped under complaints and clinical implications of disease (on appealability) - in 51,1 % and 46,9 % of cases accordingly (the difference is not authentic). On contact third of patients among vaccinated and not vaccinated though contact is established more, than at half of children and in that and other case that is probably bound to absence of a dispensary observation just at third of patients was taped.

Table 7.11

Methods of revealing of a tuberculosis at children of group V23

Tuberkulinovye assays were more often negative at children, not vaktsiyonirovannyh BTSZH - 42,2 % and 26,75 % (ОШ=2,0; Dee 1,2-3,5). Probably, nayosloenie infectious immunity on postvaccinal (BTSZH) strengthens sensitivity to a tuberculin, being shown by a positive take on a Mantoux reaction. At 2 patients process has been taped at radiological isyosledovanii thorax organs in the Center AIDS concerning low soyoderzhanija CD4 lymphocytes as at children contact has not been come into, the Mantoux reaction was negative.

Thus, as a whole, both among vaccinated, and among not vaccinated BTSZH, every second child was taped on obrashchaemoyosti, that assumes presence of widespread processes at children in nezayovisimosti from bacterination BTSZH.

As vaccine BTSZH possesses the big protective effect at early age, the analysis of methods of revealing of a tuberculosis at children in various age groups is presented in table 7.12.

Table 7.12

Methods of revealing of a tuberculosis at children В23 depending on age

As a whole significant differences in methods of revealing of a tuberculosis in razyolichnyh age at vaccinated and not vaccinated BTSZH children were not. However the tuberculosis at vaccinated children in comparison with nevaktsiyonirovannymi was less often taped at the reference with complaints at the age of 0-2 years (8,8 % and 17,2 %; ОШ=0,45; Dee 0,33-0,73), and more often at the age of 3-6 years (31,1 % and 18,8 %; ОШ=2,95; Dee 0,5-1,2). Probably, at children of early age bacterination BTSZH in respect of depression of risk of occurrence of serious forms of a tuberculosis mattered, but reliability of results to judge difficult because of mayolenkoj samples of children of this age. A tuberculosis at the age of 7-14 years in poyolovine cases, taped on appealability irrespective of presence or otyosutstvija bacterinations BTSZH.

Essential differences in structure of clinical forms of a tuberculosis at children who vaccinated and have been not vaccinated BTSZH, also it is not taped (table 7.13).

Table 7.13 Structure of forms of a tuberculosis at children of group V23

The smooth current of a primary tuberculosis met less, than at poyoloviny children and approximately identical frequency at vaccinated and not vaccinated BTSZH: in 46,6 % and 40,6 % of cases accordingly (> 0,05). The share of patients with disseminirovannym and miliarnym plural lokaliyozatsii (generalised) tuberculosis among vaccinated and vaktsiyonirovannyh BTSZH authentically differed (28,9 % and 20,3 %; 0,05).

For children of early age disseminirovannyj or a generalised tuberculosis diagnosed as at vaccinated, and not vaktsinirovanyonyh BTSZH, and with identical frequency - 4,4 % and 4,7 % of cases. A little bit more often, than at children of early age, disseminirovannyj a tuberculosis vstreyochalsja at the age of 7-14 years - 8,9 % and 6,3 % of cases, but are more rare, than at the age of 5-6 years - 15,6 % and 9,4 % of cases at vaccinated and not vaccinated sootyo
vetstvenno. The risk of development disseminirovannogo process was enlarged with the years patients as among vaccinated BTSZH children: at the age of 0-2 years disseminirovannyj the tuberculosis met in 16,6 %, at the age of 3-6 years - in 30,4 % and at the age of 7-14 years - in 40 % of cases (ОШ=1,74; Dee 1,12-3,96; ОШ=1,92; Dee 1,04 5,1), and among not vaccinated: at the age of 0-2 years disseminirovannyj the tuberculosis met in 13,0 %, at the age of 3-6 years - in 18,8 % and at the age of 7-14 years - in 44,4 % of cases (ОШ=1,54; Dee 1,02-3,76; ОШ=3,47; Dee 1,14-6,7). The tuberculosis vnelegochnoj localisations met seldom in both cases.

Thus, as a result of the analysis of data on bacterination BTSZH deyotej, born from women with a HIV-infection, the diseased subsequently tuyoberkulezom, differences in clinical efficiency BTSZH at children who have not caught a HIV (R75) and caught HIV as a result perinatalnoj of transmission (sick HIV-infections - В23) are taped.

Clinical efficiency BTSZH is confirmed at children, not infitsiroyovannyh a HIV (group R75), received vaccine BTSZH in maternity home: it has not been taped cases disseminirovannogo a tuberculosis and tubercular meninyogita whereas at children who have been not vaccinated BTSZH of this group, registriroyovalis cases disseminirovannogo a tuberculosis and a tubercular meningitis, and the risk of development of the last above at children of early age (0-2 years) in relation to children is more senior 3th years (ОШ=3,08; Dee 1,5-7,3; r