п е р с о н и ф и ц и р о в а н н ы е п о д х о д ы к в ы б о р у р е ж и м а х и м и о т е р а п и и т у б е р к у л е з а о р г а н о в д ы х а н и я у д е т е й и з э п и д е м и ч е с к и х о ч а г о в т у б е р к у л е з а с м н о ж е с т в е н н о й л е к а р с т в е н н о й у с т о й ч и в о с т ь ю в о з б у д и т е л я

The objective: to analyze the course of the new coronavirus infection (COVID-19) in children with active respiratory tuberculosis. Subjects and methods. The article describes results of retrospective analysis of the course of the new coronavirus infection in 25 children (3-12 years old) with active respiratory tuberculosis during the outbreak of COVID-19 in an in-patient TB unit.Results. 24 (96%) persons got infected after the close exposure to the coronavirus infection, and 1 (4%) child didn't get infected. The diagnosis was verified by polymerase chain reaction (detection of RNK of SARS-CoV-2) in 33.3%, by enzyme immunoassay (detection of IgG antibodies to SARS-CoV-2 in 1 month after quarantine removal) in 100%. 58.3% of children with respiratory tuberculosis (14 people) infected with coronavirus infection had minimal respiratory symptoms, that did not differ from signs of other respiratory viral infections; clinical manifestations of the disease were completely absent in 41.7% (10) patients. Coronavirus pneumonia was diagnosed in 4 (16.7%) children who suffered from COVID-19, they had no clinical signs of lower respiratory tract disorders and no body temperature increase; 3 patients had no signs of respiratory viral infection; in all cases, the lung damage detected by computed tomography didn't exceed 10%. In 2 months after the removal of quarantine, no IgG antibodies to SARS-CoV-2 were detected in 2 out of 10 examined children (20.0%), thus there was a chance for re-infection. No mutual aggravating effect of coronavirus infection and tuberculosis was revealed in their combination over the entire observation period (4 months).

Рассмотрена одна из актуальных проблем, связанных с изучением социальных аспектов детского туберкулеза,-обоснование содержательных критериев выделения типов семей с различным социальным статусом� Цель исследования-сравнительное изучение социального портрета различных типов семей с детьми и подростками, больными туберкулезом органов дыхания, на основе дифференцированного подхода к определению уровня социальной адаптации семьи� Изучены социальные характеристики семей 239 детей и подростков, которые находились в 2016-2017 гг� на обследовании и стационарном лечении в ФГБНУ «ЦНИИТ»� В результате дифференцированного подхода к определению социального статуса выделены две группы: благополучные семьи (49,4%) и семьи социального риска (50,6% случаев)� В результате сравнительного анализа выделенных типов семей, имеющих больных туберкулезом детского и подросткового возраста, выявлена их социально-экономическая неоднородность� Объединяющими характеристиками выделенных типов семей как с детьми, так и подростками, были образовательный уровень родителей и особенности трудовой занятости отцов� Остальные критерии (состав семьи, занятость матерей, жилищно-бытовые условия, размер дохода) достоверно различались в семьях детей и подростков� Показана необходимость комплексного анализа социальных характеристик семьи для определения ее социального статуса�

The objective of the article: to demonstrate the peculiarities of tuberculosis in young children and the high probability of the transition of primary tuberculosis in a child from a sociopathic family to a chronic process due to the absence of medical supervision after chemotherapy. The article describes a clinical case demonstrating the influence of dysfunctional social risk factors on the development of chronic primary tuberculosis in a child. The authors provide a detailed information of medical care to the child, including surgery.

Objective: to familiarize doctors with one of the rare variants of primary immunodeficiency – chronic granulomatous disease. The authors present a case of late diagnosis of chronic granulomatous disease in a 10-year-old child. The doctors missed the development of complications after BCG vaccination in the form of axillary lymphadenitis on the left (BCGitis), which led to the development of disseminated BCG infection, regarded as an infectious tuberculous process. The onset of chronic granulomatous disease occurred at the age of 10 months (paraproctitis complicated by an anal fistula). The assumption of the presence of immunodeficiency arose in connection with the recurrent course of pneumonia at the age of 4-5 years, but was regarded as a manifestation of a tuberculous infectious process. At the age of 8, during the protracted course of nonspecific polysegmental pneumonia, primary immunodeficiency without specific clinical form was diagnosed on the basis of the results of a comprehensive immunological examination. At the age of 10, chronic granulomatous disease was verified using a study of spontaneous and stimulated chemiluminescence of neutrophils and the results of a genetic study.