Comorbid conditions in phthisiology: The basis of interdisciplinary collaboration between pediatricians and phthisiologists (literature review and commentaries)

Abstract

Comorbid conditions in pediatric and adolescent phthisiology determine the need for interdisciplinary collaboration between healthcare professionals in different areas of expertise both at the stage of disease diagnosis and during tuberculosis treatment. This review is aimed to systematize the knowledge of pediatricians in different areas of expertise about comorbid conditions in tuberculosis (causes, risk factors for their development, options for timely diagnosis, impact of forced polypharmacy on the development of drug complications). The data of available methodological documents and published articles on the issue are systematized. The article presents groups at high risk for developing TB disease among patients with somatic pathology, the possibilities of modern diagnostic techniques based on a comprehensive medical examination with due account for the diagnostic algorithm and treatment regimen for a particular disease. If there is a reason to suspect tuberculosis in primary health care facilities and prior to prescribing immunosuppressive drugs, the minimum mandatory diagnostic examination in risk groups is set forth. The importance of key techniques for the detection and diagnosis of tuberculosis in children and adolescents including those with immunocompromised diseases is emphasized: Mantoux test using 5 tuberculin units (TU) of purified protein derivative (PPD)-L, a test with recombinant tuberculosis allergen (RTA), diagnostic tests assessing release of interferon gamma by T-lymphocytes in vitro during selective screening), computed tomography, detection of Mycobacterium tuberculosis in any diagnostic samples. Attention is paid to the impact of forced polypharmacy on the drug complications and treatment failures in patients with comorbidities, which requires collaboration between healthcare professionals in different areas of expertise to provide adequate selection of anti-tuberculosis therapy taking into account comorbidities. This approach to the management of patients with chronic somatic pathology allows for the prevention or early detection of tuberculosis.