No abstract

According to the WHO data, tuberculosis still represents a serious public health problem worldwide. Deterioration of socioeconomic conditions in the population complicates epidemic situation for tuberculosis in Russia, thus leading to increase in acute progressive and complicated forms of tuberculosis in children and, consequently, to worsening structure of its clinical forms. Objectives: to determine associations between certain HLA-DRB1 alleles and risk of tuberculosis development in children. We examined 188 children aged from 3 to 14 years with various manifestations of tuberculous infection. Along with thorough examination of the patients, including multi-spiral CT scans of chest, we undertook genotyping of HLA-DRB1 alleles. Activity of tuberculous infection was determined by a set of immunological tests, i.e., tuberculin skin test, DIASKINTEST ® (recombinant allergen of tuberculosis-DIASKINTEST ®). X ray diagnostics was performed with multi-spiral «Aquilion-32» computed tomograph (Toshiba), according to standard procedures. Molecular genetic typing of HLA-DRB1 alleles was performed by polymerase chain reaction (PCR-SSP), using standard commercial kits PROTRANS Ceclerplate System Protrans HLA-DRB1*. The children were divided into two groups: I group, 90 healthy children, II group, 98 children with tuberculosis. A comparisons group consisted of healthy donors (n = 346). Statistical processing of genetic material included evauation and analysis of the following parameters: frequency distribution of the antigen (F), χ 2 criterion for significance (chi-square), the relative risk ratio (RR), etiologic fraction (EF), preventive fraction (PF). Children of the II group had significantly higher *04 allele HLA-DRB1*, as compared with control group (36.7% vs. 21.1%, χ 2 = 10.08; р < 0.01). This finding may suppose a predisposal of these allele carriers to development of tuberculosis. At the same time, the rates of *07 (14.3% vs. 27.5%, χ 2 = 7.15, р < 0.01) and *15 (18.4% vs. 28.3%, χ 2 = 3.92; р < 0.01) HLA-DRB1* alleles were significantly lower, thus suggesting a protective effect of this allele. *04 allele seems to be a predisposing factor, whereas *07 and *15 alleles are protective for development of tuberculosis in children.

Cutaneous tuberculosis is a clinically and morphologically heterogeneous group of skin diseases directly or indirectly caused by mycobacteria of the tuberculosis complex, occupying the 5th place among all localizations of extra-pulmonary tuberculosis. Manifestations of cutaneous tuberculosis are extremely diverse and depend on the immune status and ways of penetration of mycobacteria into the skin. Skin involvement can occur as a result of exogenous inoculation, contiguous spread from an adjacent focus, or hematogenous spread from other foci. Family cases of disseminated cutaneous tuberculosis are described. A combination of several clinical forms of cutaneous tuberculosis — scrofuloderma, tuberculosis cutis lichenoides (moniliformis scrophulosorum) and lupus — are observed in a 5 year old child with a family history of tuberculosis. The issues of pathogenesis and advanced methods of diagnosis of cutaneous tuberculosis are also discussed.

Внедрение иммунологических тестов нового поколения, основанных на развитии реакций in vitro или in vivo на применение специфических пептидов ЕSAT-6 и CFP-10, позволило изменить представление о диагностике латентной туберкулезной инфекции, а также улучшить диагностику туберкулеза в детской и взрослой практике. Представлен анализ отечественных исследований, проведенных за последние десять лет, по изучению информативности внутрикожной пробы с аллергеном туберкулезным рекомбинантным. Доказана высокая диагностическая значимость пробы, сопоставимая с признанными в мировой практике IGRA-тестами. Сегодня проба с АТР в виде отечественного препарата диаскинтест внедрена в России не только во фтизиатрическую практику, но и в практику педиатров, пульмонологов и инфекционистов.