the characteristic of a clinical material

The analysis of children sick of a tuberculosis on age and a floor is presented in tabyolitse 2.1.1 (the age periods are specified according to conditionally accepted

Norms of division on age in pediatric practice: children of early age - 0-2 years, children of preschool age - 3 6 years, children of school age - 7-14 years).

Table 2.1.1 Distribution of the sick children sick of a tuberculosis, on a floor and age

Age Research groups
1 group n=166 2 group n=97 3 group n=95
Floor M floor Floor



M floor Floor



M floor
n % n % n % n %
0-2 years 20 12,1 37 22,3 28 28,9 26 26,9 3 3,2 3 3,2


46 27,7 34 20,5 21 21,6 20 20,6 19 20,0 17 17,9


14 8,4 15 9,0 1 1,0 1 1,0 30 31,5 23 24,2
Total 80 48,2 86 51,8 50 51,5 47 48,5 52 54,7 43 45,3

As a whole from 358 sick of a tuberculosis the share of children at the age of 0-2 years sosta - twisted 32,7 % (117 of 358), at the age of 3-6 years - 43,8 % (157 of 358) and at the age of 7-14 years - 23,5 % (84 of 358). Thus, the greatest number of children in research is presented by children at preschool age (3-6 years), the smaller number of patients was at the age of 7-14 years. Boys there were 49,2 % (176 of 358) and girls of 50,8 % (182 of 358), that is approximately fifty-fifty.

In groups of research the parity of children who have ill with a tuberculosis on a floor essentially did not differ: in 1 group boys made 51,8 %, in 2 group - 48,5 %, in 3группе - 45,3 %.

However age differences in research groups were traced. In 1 group patients on age are presented as follows: children of early age have made 34,4 % (57 persons from 166); children doshkoyolnogo age have made 48,2 % (80 persons from 166); children of school age have made 17,4 % (29 persons from 166).

In 2группе: children of early age have made 55,8 % (54 persons from 97); children of preschool age have made 42,2 % (41 persons from 97); children schoolboys soyostavili 2,0 % (2 persons from 97).

In 3 group: children of early age have made 6,4 % (6 persons from 95); children of preschool age have made 37,9 % (36 persons from 95); children schoolboys soyostavili 55,7 % (53 persons from 95).

Thus, in I group of patients children at the age of 3-6 years (48,2 %), in 2 group - children at the age of 0-2 years (55,8 %), in 3 group - children in vozrasyote 7-14 years (55,7 %) prevailed. The Age difference is caused by a number of the reasons. Results of literary data and own analysis of diffusion of a tuberculosis, soyochetannogo with a HIV-infection, among children of 0-14 years in the Russian Federation (гл.3) show, that the highest prevalence of a HIV-infection is observed at children in vozrasyote from 0 till 7 years which therefore were ill with a tuberculosis of children most of all at this age: their share has made 82,6 % among all sick of a tuberculosis of I group with a small difference in shares at the age of 0-2 years and 3-6 years.

In II group the share sick of a tuberculosis at the age from 0 till 7 years has made 98 %, mainly it there were children of early age and younger preschool age - from 41 patients at the age of 3-6 years of 28 children were at the age of 3-4 years (68,3 %), the median has made 4,5 years. The given group is represented by children who consisted on the account apropos perinatalnogo contact on a HIV-infection. In vozyoraste 2th their years usually strike off the register as healthy children (not infected HIV), and the the child is more senior, the is less often mentioned in medical documents on a HIV-infection at mother (confidentiality of the information), thus, these children go as the diseased from the general population.

In III group of patients approximately in peer shares was children aged till 7 years (44,3 % and mainly children of 3-6 years as hospitalise in kliniyoku scientific research institute FP only children since 3th years) and 7-14 years (55,7 %.). From 53 children is elderly 714 years, at the age of 7-11 years there were 27 children (28,4 %), at the age of 12-14 years - 26 cheloyovek (27,4 %) which carry to children of advanced age when except the primary
Tuberculosis forms as children till 12 years, can have secondary forms tuyoberkuleza as at teenagers and adults.

Thus, proceeding from objective conditions, groups of children sick tuyoberkulezom, cannot be absolutely identical on age. In all groups of patients there was approximately identical a number of children at the age of 3-6 years: 48,2 %, 42,2 %, 37,9 % accordingly in I, II and III groups. Taking into consideration, that at children I and II groups and the majority of patients of III group primary forms of a tuberculosis, the analysis of features of a current of tubercular process at deyotej with a HIV-infection are diagnosed is possible.

The analysis of clinical forms of a tuberculosis in groups is presented in table 2.1.2. In all groups of research the tuberculosis intrathoracic limyofaticheskih knots (more than 50 %) prevailed. The primary tubercular complex more often diagnoyostirovali in I group (18,7 %) and II group (21,6 %), is more rare in III group sick (13,7 %). Disseminirovannyj and miliarnyj plural localisation (generayolizovannyj) a tuberculosis taped mainly in I group sick (19,3 %), whereas the tuberculosis with a hematogenic dissimination (including lesions tsenyotralnoj nervous system, a backbone) in II and III groups met in 4,2 % and 5,3 % of cases accordingly.

Focal and infiltrativnyj the tuberculosis met only at children of III group at the age of 12 14 years though children of this age were and in I group of patients. Probably, at children of 12-14 years with a HIV-infection predilection to development of primary forms of a tuberculosis as among adults the share of patients with a tuberculosis of intrathoracic lymph nodes against a HIV-infection [46 is enlarged, 49, 62] remains.

Table 2.1.2.

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

Clinical forms of a tuberculosis Groups of patients
I group abs. (%) II group abs. (%) III group abs. (%)
Tuberculosis of the intrathoracic 95 (57,2) 72 (74,2) 53 (55,8)

Lymph nodes
Primary tubercular complex 31 (18,7) 21 (21,6) 13 (13,7)
Disseminirovannyj a pulmonary tuberculosis (including. A meningitis, a spondylitis) 23 (13,9) 2 (2,1) 5 (5,3)
G eneralizovannyj a tuberculosis 9 (5,4) 2 (2,1) -
Other forms (including vnelegochnyj) 8 (4,8) 2 (2,1) 7 (7,3)
The secondary

(Focal, infiltrativnyj)

- - 17 (17,9)
In total 166 (100) 97 (100) 95 (100)

On a current of tubercular process (prevalence, complications etc.) to some extent can influence certain risk factors (besides the HIV-infection is the same risk factor): konyotakt with a sick tuberculosis (its duration, massiveness bakteriovydelenija at a source), absence bacterinations BTSZH (table 2.1.3).

Table 2.1.3.

Risk factors (contact, bacterination BTSZH) at children of investigated groups

Risk factor Groups of patients (abs. %)
I group abs. % II group abs. % III group abs. %
In aktsinirovany 45 (27 %) 15 (15,5 %) 94 (98,9)
Contact is established 119 (71,7) 89 (91,7) 69 (72,6)

Children were ill with a tuberculosis more often, being in the infection centres: contact is established more, than at 70 % of patients of 1 and 3 groups and practically at all children of 2 groups (91,7 %) that speaks age of children of this group - preimuyoshchestvenno early, and in this case the circle of contacts is limited also a source to tap
Easier. As to bacterination BTSZH: children of 1 and 2 groups in most cases nevaktsinirovany as till 2011 of a HIV-infection at mother was proyotivopokazaniem for the bacterination, children who have born from them [104,105]. More podyorobno the analysis of the centres of an infection and possible influence of absence of bacterination against a tuberculosis on a current of tubercular process is resulted in sootvetstyovujushchih heads of research.

Thus, already at a stage of a general characteristic of sick investigated groups it is possible to assume, that the current of tubercular process, structure kliyonicheskih forms in investigated groups will differ owing to age osoyobennostej, presence of bacterination BTSZH. The current of tubercular process at children, sick HIV-infections, will differ from that as at children with perinatalyonym contact on a HIV-infection, and at children sick of a tuberculosis from the general population as the HIV-infection is the factor of advance of a tubercular infection under certain circumstances. However all groups of patients mainly preschool and early school age of children, methods revealing and diagnostics of a tuberculosis at children unites, to mainly primary forms of a tuberculosis to a lesion intrathoracic lymphatic uzyolov, the established centre of a tubercular infection.


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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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