Pediatric tuberculosis is a health problem of special significance because it is a marker for current transmission of tuberculosis in society. The research aimed at analyzing the peculiarities of detection and course of pediatric extrapulmonary tuberculosis (EPTB) taking into account the profile of drug resistance. A retrospective study of medical charts of children with EPTB (n = 47; 1st group) and pulmonary tuberculosis (PTB) (n = 49; 2nd group) aged 0-15 for 2013-2020 has been conducted. 2 subgroups with EPTB were identified separately: resistant (EPRTB) (n = 23) and sensitive (EPSTB) (n = 24). Results and discussion. The frequency of EPTB was 9.8%. Tuberculosis of peripheral LN (40.5%), CNS (27.7%), bones and joints (23.4%) was significantly more often diagnosed, than other lesions. Almost half of children with EPTB had a miliary distribution. In 44.7% of children with EPTB contact with a patient with tuberculosis was not established. EPRTB was significantly more common among children under 1 and up to 3 years of age than EPSTB. The resistance to combination of HR (73.6%) was found more often than to HRES (10.5%), HRS, H and Z (5.3% each; p<0.01). In 73.9% of children with EPRTB was detected when seeking medical care, in 13.0% the time to diagnosing lasted 6 months. Among children with EPRTB, gradual course was more frequent and in 47.8% intoxication syndrome was dominating. 78.3% of children with EPRTB were not vaccinated. Conclusion. The above indicates the need to intensify preventive measures against tuberculosis among children, especially at risk groups, make monitoring of contacts and their treatment.

The aim: To study the structure of clinical forms of tuberculosis (TB) which are combined with the comorbidities, to prevent the development, and to improve the diagnostics of TB among children with nonspecific diseases. Materials and methods: A retrospective, selective research of 330 cards of children for the age group from 0 to 15 years old who were treated on local forms of pulmonary and extrapulmonary TB in a specialized pediatric department for the last 30 years was conducted. Results: Among 92.9 % children with comorbidities, the specific process of respiratory system was detected. Every seventh child has developed generalized forms of pulmonary TB. 43.8 % of children had extrapulmonary TB. In the structure of comorbidities among children with extrapulmonary TB were observed iron deficiency anemia, the diseases of digestive and endocrine systems, malnutrition, cachexia and rickets. The iron deficiency anemia was accompanied by TB of the peripheral LN and TB of the CNS. TB of the rare localization and TB of the CNS were combined with diseases of the digestive system. At pulmonary TB were detected infectious and parasitic diseases. The concomitant pathology of the respiratory and cardiovascular systems was often detected with the TB of intrathoracic LN, and concomitant pathology of the eyes, ears and CNS – with primary tuberculosis complex. The variety of comorbidities and extrapulmonary TB has led to the diagnostic errors and prolonged stay of children in several somatic hospitals. Conclusions: To prevent the development of TB among children with non-specific diseases, it is necessary to strengthen anti-TB measures among them.

Background. The problem of studying lipid metabolism in patients with tuberculosis is of interest to scientists around the world. The purpose of the study - to investigate lipid profile in pulmonary tuberculosis patients with concurrent insulin resistance. Materials and methods. Forty-one patients with pulmonary tuberculosis were examined. Insulin resistance index (HOMA-IR), total cholesterol level (TC), triglycerides (TG) level, high density lipoprotein (HDL) cholesterol, low density lipoprotein (LDL) cholesterol, very-low-density lipoprotein (VLDL) cholesterol and atherogenic index (AI) were measured. Results. Group 1 - 26 patients with tuberculosis and insulin resistance (HOMA-IR ˃ 2.7); Group 2 – 15 patients with tuberculosis without insulin resistance (HOMA-IR ˂ 2.7). Group 1 patients had severe course of TB with fever, severe fatigue and weakness, profuse sweating, weight loss, cough and shortness of breath. Median TC indices differed at significant level (p = 0.012): group 1 - 4.82 mmol/l, group 2 - 4.25 mmol/l. TG level was higher in group 1 patients - 1.32 mmol/l than in group 2 patients - 1.28 mmol/l. LDL cholesterol values were higher in group 1 patients - 3.2 mmol/l vs 2.5 mmol/l in group 2. The AI was higher in group1 (p = 0.005): 3.9 units against 2.8 units in group 2 patients. Conclusions. Insulin resistance in pulmonary tuberculosis patients was associated with severe course of the disease, severe clinical manifestations and impaired external respiration. Pro-atherogenic disorders of lipid metabolism in pulmonary tuberculosis patients with concurrent insulin resistance can be considered as the degree of endogenous intoxication.

Aim. To study clinical and epidemiological aspects of pathomorphosis of extrapulmonary tuberculosis clinical forms. Materials and Methods. Retrospective analysis of 138 case histories in children aged to 15 years, obtaining extrapulmonary tuberculosis treatment in a specialized children's hospital during 1988-2015 was carried out. Among them, in 103 children, clinical forms of extrapulmonary tuberculosis combined with respiratory tuberculosis and in 35 children independent forms of extrapulmonary tuberculosis were found. Studied stage (1988-2015) was divided into 3 periods: I – 1988-1997, II – 1998-2007, III – 2008-2015. During 2008-2015, incomparison to previous periods, the number of cases of peripheral lymph node tuberculosis (PLN), meninges and central nervous system tuberculosis, bones and joints tuberculosis, and ocular tuberculosis decreased. In 2008-2015, the share of combined forms of meninges and central nervous system tuberculosis and ocular tuberculosis remained at 1998-2007 level. During 2008-2015, skin tuberculosis was not diagnosed. Nevertheless, in 2008-2015, in6.8±10.2 % of cases extrapulmonary tuberculosis combined with miliary tuberculosis, and in 5.8±10.4 % of cases the process characterized by lethal outcome, moreover 4.9±10.7% from them – in recent years. It is important that during period I, in 19.6±13.2 % of cases extrapulmonary tuberculosis combined with respiratory tuberculosis in reverse development phases, during period II – in 12.9±19.3 % of cases, during period III – in 23.8±21.2 % of cases. Conclusion. Despite the reduction, extrapulmonary tuberculosis combined with severe forms of respiratory tuberculosis, which led to lethal outcome in children in 5.8±10.4% of cases. Tuberculosis epidemiological situation worsening, reversion of severe forms of tuberculosis with the development of extrapulmonary one and several organs injuries in children shows the necessity of social, preventive and therapeutic measures intensification among children.

Objective — to analyze the peculiarities of detection and course of various clinical forms of extrapulmo­nary tuberculosis (EPTB), the profile of drug resistance of the Mycobacterium tuberculosis (MBT) among children of different ages. Materials and methods. We retrospectively analyzed the medical data of 47 children aged 0 to 14 with local forms of EPTB, hospitalized in the pediatric department of Lviv TB hospital from 2013 to 2020. Children were divided into groups: up to 1-year-olds (19 children; group I), 2—9 year-olds (19 children; group II) and 10—14-year-olds (9 children; group III). Results and discussion. It was found that children under 1 year of age were more likely to live in rural areas than in urban areas (78.9 vs. 21.1 %; p < 0.01). Resistant forms were diagnosed among 49.0 % of children. Among children of the first year of age this number reached 73.7 %, which is probably more often than among children aged 2—9 (26.3 %; p < 0.01). The numbers of multidrug-resistant TB (MDR-TB) and the risk of MDR-TB among children under one year of age were 35.7 and 28.6 %, respectively. The most common clinical form of EPTB was TB of peripheral lymph node (PLN) regardless of age (40.4 %). Only TB of PLN and TB of meningeal and CNS were found among children under 1 year of age. Among children aged 2—9, TB of PLN and TB of bone and joints were probably more common than all other localizations. TB of bones and joints among children aged 10—14 was more common than TB of eyes and skin. The proportion of TB of meninges and CNS in group I was probably higher compared to groups II and III (p1 < 0.01; p2 < 0.05). At the same time, TB of bones and joints among children of groups II and III was diagnosed significantly more often than in group I (p1 < 0.01; p2 < 0.05).In 89.4 % of cases EPTB was combined with pulmonary TB (PTB). Among children under one year of age, miliary PTB was diagnosed probably more often than other clinical forms (p < 0.05). Bilateral lesions were probably more common among children under one year of age than in children aged 10—14 (77.8 vs. 28.6 %; p < 0.05). Unilateral lesions were more common among children aged 10—14 than in children up to one year of age (22.2 vs. 71.4 %; p < 0.05). Children under 1 year of age and 2—9-year-olds were significantly more likely to be diagnosed with EPTB when seeking medical care than during examination of contact persons (63.2 vs. 26.3 %; 68.4 vs. 31.6 %; all p < 0.05) and during the preventive examination (10.5 % and 0; all p < 0.01). Also, EPTB was found more often among children aged 10—14 (66.7 vs. 0; p < 0.01). It was found that only 36.8 % of children of group I, 42.1 % of children of group II and 33.3 % of children of group III were sent to a specialized hospital after visiting the clinic.Patients under 1 year of age and 2—9-year-olds compared with children aged 10—14 were significantly more likely to have a combination of clinical manifestations of intoxication and bronchopulmonary syndromes (47.4 and 31.6 % vs. 0; p1 < 0.05; p2 < 0.01). At the same time, intoxication syndrome was significantly more common among children aged 10—14 than among children under one year of age (88.9 vs. 26.3 %; p < 0.01). Lack of vaccination was significantly more common among children under one year of age than in the following age groups (94.7 vs. 57.9 and 44.4 %; both p < 0.05), and the proportion of ineffective vaccinations was significantly higher among children aged 10—14 than in children under 1 year of age (55.6 vs. 5.3 %; p < 0.05). Conclusions. These data indicate the need to intensify preventive TB measures among children of different ages, as well as the need for enhanced control over vaccination, regular screening, monitoring of contacts among the adult population and their controlled treatment.