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FEATURES OF CLINICAL MANIFESTATIONS OF TUBERCULOSIS IN CHILDREN
WITH HIV INFECTION
Mamadiyorova M.A.
Samarkand state medical institute
Phthisiology chair
Academic advisor - S.A. Khodzhaeva
Purpose.
Study of the peculiarities of the course of tuberculosis in children with HIV infection.
Materials and methods.
We examined 54 children treated in the pediatric department of the
clinic of the center of phthisiology and pulmonology over the past three years, with the presence
of HIV infection and intrathoracic tuberculosis (IHT). The age of the surveyed ranged from 1 year
to 14 years, 77.7% of them were from 2 to 6 years old. There were 35.2% girls, 64.8% boys.
Results and discussion.
In 77.7% of children, tuberculosis was detected during preventive
examination of HIV-infected children, in 22.2% - HIV infection was detected during anti-
tuberculosis therapy. According to the level of CD cells, the patients were divided into 2 groups.
The 1st group included 18 children with a slight decrease in the level of CD cells, and the 2nd - 36
children with a progressive severe degree of immunodeficiency. Most of the examined children of
the 2nd group were diagnosed with disseminated (37%) and generalized (20.3%) primary
tuberculosis. Limited forms of VHT were registered 2 times more often in children in group 1 with
moderate immunodeficiency (18.5 ± 5.5 and 9.3 ± 3.8%). All children with TB / HIV have
generalized adenopathy and hepatomegaly.
More pronounced hepatomegaly with liver enlargement by 5 cm or more was observed 5
times more often in the group of children with severe immunosuppression. Despite severe
hepatomegaly, a biochemical blood test in most patients established the activity of liver enzymes
at the upper limit of the norm. Only 12.9% of children had moderate fermentaemia, which returned
to normal after 2-3 months of chemotherapy. Weight deficiency was observed in 94.5% of the
examined children and had a direct dependence on the degree of immunodeficiency. Increased div
temperature in 64.8% of children with TB / HIV was characterized by inconsistent, prolonged
febrile condition. Catarrhal changes in the lungs were noted in 38.9% of children on admission.
Growth retardation was 1.4 times more often observed in the group of children with severe
immunodeficiency.
In 20 surveyed children of preschool age (3-5 years old), colloquial speech was not
developed, there was no independent walking skill. Shifts in the hemogram in the form of a decrease
in the level of hemoglobin were noted in 88.9% of the examined children, in 51.8% - moderate
leukocytosis within 8-12 thousand, in 64.8% - neutrophilic shift to the left, in 96.2% of children -
accelerated ESR within the range of20-70 mm / hour. Mycobacterium tuberculosis was found in
sputum in 11.1% of children. The results of the Mantoux test with 2TE were negative in 87.1% of
children.
Radiographically, in children from the 2nd group, the volume of the lesion of the
intrathoracic lymph nodes was more extensive, and 2 times exceeded the volume of the lesion in
children of the 1st group. A complicated course of tuberculosis was established in 61.1% of
children: in 21.5% of patients - atelectasis of individual segments of the lungs, in 15.7% - pleurisy,
in 90.1% - foci of seeding in the lung tissue.
Findings.
The clinical course of TB / HIV in children is distinguished by the multifaceted clinical
signs of the disease with a predominance of the general intoxication syndrome. Due to the high
frequency of detection of polylymphoadenopathy against the background of intoxication syndrome,
children with HIV infection require a thorough X-ray and tomographic examination.
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