Combination of pulmonary tuberculosis and herpetic infection children
Introduction. The WHO estimates that millions of children become infected with Mycobacterium tuberculosis each year, and more than a million develop tuberculosis (TB). Most children are able to immunologically contain or neutralize the pathogen without developing pathology. Our country ranks 4th in the world in the incidence of adult tuberculosis, and fifth in the incidence of children among 53 regions controlled by the WHO European Office. The average estimated incidence of children in Ukraine is 37.4 per 100 thousand children, and exceeds the official figure by 4.5 times.Materials and methods. The study involved 50 children, including 35 sick children, with microbiologically and radiologically confirmed diagnosis of "pulmonary tuberculosis", who received anti-tuberculosis chemotherapy in the pediatric ward of KNP CHOR "OKPTD №7" and 15 healthy children. Patients with respiratory tuberculosis and persons in the control group underwent a comprehensive clinical and instrumental and laboratory examination. The mean age of patients in the main group was 10.3 ± 3.1 years. The control group was completely comparable in age and sex with the main group. Mandatory methods were: chest radiography, bacteriological examination, general clinical examination of blood and urine. To detect herpesvirus antigens, we used the method of detecting pathogens directly in smears of cells of biological material examined by fluorescent antibodies using indirect immunofluorescence using a Primo Star microscope manufactured by Carl Zeiss (Germany) and specific monoclonal murine antibodies Inc. "Immunogen Sp. Zoo" (Poland).Results & discussion. In 23 children from the main clinical group, the diagnosis of TB was established during routine tuberculin testing, and in four cases - with the simultaneous detection of a familial tuberculosis infection. In 11 children the diagnosis of TB was established during the examination of persons in contact with a TB patient and in 4 children the verification of TB became possible after a routine fluorographic examination. Only in 7 cases the diagnosis of TB was established after the parents sought medical help. It should be noted that in the group of examined patients with tuberculosis of the respiratory organs of children, the most common clinical forms were: tuberculosis of the intrathoracic lymph nodes (40%), primary tuberculosis complex (33%). Tuberculous pleurisy, infiltrative pulmonary tuberculosis, disseminated tuberculosis, and focal pulmonary tuberculosis were significantly less common.Latent herpesvirus infection was detected in patients with pulmonary tuberculosis, with HHV4, HHV5 and HHV6 being the most common pathogens. The next most frequently detected was HHV1.2. Herpesvirus infection caused by herpes simplex viruses was found in 40% of children with respiratory tuberculosis, which significantly exceeded the frequency of herpes infection caused by herpes simplex virus in the control group (16%). There were no statistically significant differences in the presence of latent herpesvirus infection caused by HHV3 in patients with respiratory tuberculosis and the control group. The most pronounced differences, almost 4.5 times between the group of children with respiratory tuberculosis and the control group were found in mixed herpesvirus infections. Herpesvirus mixed infection was diagnosed in 53% of children with respiratory TB, which is significantly higher than in the control group. Analysis of the infection of the surveyed by individual members of the family Herpesviridae revealed features. More than half of children with respiratory tuberculosis were infected with Epstein-Barr virus (80%), cytomegalovirus (53%) and human herpes virus type 6 (62%). Among children with intrathoracic lymph node tuberculosis, almost all had a latent herpesvirus infection caused by Epstein-Barr virus. On the other hand, in the control group there were no significant differences between the levels of virus infection, and its level in this group did not exceed 12% on average, in addition, herpesvirus mixed infection occurred in only 3 children. In the control group there was a combination of only two representatives of herpesviruses, while in children with TB simultaneously detected three or more viruses from the family Herpesviridae. Conclusion. Thus, the obtained results indicate that the involvement of herpesvirus agents in the pathogenesis of the tuberculosis process can disrupt the course of the "normal" specific infectious process and lead to its progression. There is an association between respiratory tuberculosis and latent herpes mixed infection, which identifies it as an additional risk factor in addition to medical-biological and socio-economic factors and requires further study. Key words: tuberculosis, Mycobacterium tuberculosis, Latent herpesvirus infection, immunological imbalance.
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