APPLICATION OF THE T-SPOT TEST IN THE DIAGNOSIS OF TB INFECTION IN CHILDREN AND ADOLESCENTS WITH CONCOMITANT INFECTIOUS PATHOLOGY
- Authors: Sergeicheva E.1,2
-
Affiliations:
- ФГАОУ ВО РНИМУ им. Н.И. Пирогова Минздрава России
- ГБУЗ "МНПЦ борьбы с туберкулезом ДЗМ"
- Issue: Vol 11 (2022): Materials of the XVIII International Burdenkov Scientific Conference on April 14-16, 2022
- Pages: 608-610
- Section: Фтизиатрия
- URL: https://www.new.vestnik-surgery.com/index.php/2415-7805/article/view/7164
Cite item
Full Text
Abstract
Relevance: Diagnosis of tuberculosis infection is difficult due to the lack of specific clinical and radiological signs of the disease. In the presence of contraindications from skin immunological tests, alternative methods of examination are used.
Objective: To evaluate the significance of the T-Spot.TB test in the diagnosis of tuberculosis infection in children and adolescents with medical suspensions for infectious diseases.
Materials and Methods. During the study, 137 medical records were examined and analyzed. Criteria of inclusion in the study: age from 1 to 17 years, presence of medical rejections of skin immunologic tests.
Results and their discussion. In 40% of the cases the children were not regularly examined for tuberculosis infection. Coronovirus infection, infectious mononucleosis, frequently recurrent herpes simplex virus dominated the structure of infectious pathology. As a result of examination of children by T-spot, 58% of children were negative and 38% were positive. In 31% of children with positive T-spot after additional examinations microcalcinates in the lung tissue were revealed, in 4% of children residual changes after tuberculosis were revealed.
Conclusions: T-Spot.TB plays an important role in the diagnosis of tuberculosis infection in children and adolescents who have medical withdrawals from skin immunologic tests. Every third child with infectious pathology was not examined for tuberculosis every year. Coronovirus infection and herpes simplex virus predominate in the structure of infectious pathology in children and adolescents. A positive T-Spot.TB test result is an indication for preventive therapy.
Keywords
Full Text
Relevance: Diagnosis of tuberculosis infection is difficult because of the lack of clinical and radiological signs of the disease, but its detection is necessary to identify individuals who need to be monitored by phthisiatricians and receive the necessary treatment. Because of high tuberculosis prevalence in Russia, Ministry of Health of Russian Federation recommends that children aged from 1 to 17 be examined annually for tuberculosis infection. Screening for tuberculosis infection is usually done using intradermal tests. If intradermal tests are contraindicated in children and adolescents, alternative methods of examination may be prescribed.
Objective. To evaluate the significance of the T-SPOT.TB test in the diagnosis of tuberculous infection in children and adolescents with medical suspicion of infectious diseases.
Materials and methods. During the study the data of medical records and own observation of 137 patients of paediatric phthisiatric department of MNPC of South-West Administrative District were studied and analyzed for the period of 2020-2021. The age of children from 1 year to 17 years with temporary or permanent medical rejections of skin immunological tests examined by the T-SPOT.TB test served as inclusion criterion of the study. Statistical analysis of the data was performed in Microsoft Excel 2019 and STATISTICA programs. The critical level of significance of differences was 5%.
Results and discussion. The results revealed that 40% (55) of the children were not examined regularly by skin immunological tests due to medical withdrawals due to infectious diseases. Sixty percent(82) of the children had evidence of annual tuberculosis screening. In the structure of infectious pathology of those examined by T-spot test, the following prevailed: coronavirus infection 39.4%(54), frequently recurrent herpes simplex virus 23.4%(32), suffered infectious mononucleosis 20%(27), acute intestinal infections - 11%(15), HIV infection - 5%(7), Lyme disease 1.2%(2).
As a result of examination 58% (79) of children had negative T-spot result, uncertain - 4% (6), positive - 38% (52).
All children with a positive T-spot were prescribed a comprehensive examination with chest CT, ultrasound of the abdomen and kidneys, clinical blood tests, general urinalysis. Of the 52 children, 31%(16) had microcalcinates in the lungs, 4%(2) had residual changes after tuberculosis in the presence of calcinates in the intrathoracic lymph nodes, in 65(34%) no changes were detected.
Conclusions. Thus, in spite of the fact that the test T-Spot.TB is not recommended for use in the obligatory phthisiatric complex of examination, it plays an important role in the diagnostics of tuberculosis infection in children and adolescents having medical rejection of skin immunologic tests. The study revealed a lack of regularity of immunodiagnostics (skin tests) among children with concomitant infectious pathology. Coronovirus, herpes infections and infectious mononucleosis prevailed among infectious pathologies leading to medical withdrawals from skin tests. A positive result on the T-SPOT.TB test in children and adolescents when no local tuberculosis process was detected was the basis for preventive chemotherapy, thereby reducing the risk of developing tuberculosis.
About the authors
Elena Sergeicheva
ФГАОУ ВО РНИМУ им. Н.И. Пирогова Минздрава России; ГБУЗ "МНПЦ борьбы с туберкулезом ДЗМ"
Author for correspondence.
Email: SergeichevaElena89@yandex.ru
ORCID iD: 0000-0003-3589-2531
ассистент кафедры фтизиатрии; участковый врач-фтизиатр
Russian Federation, г. Москва, ул. Островитянова, 1; г. Москва Севастопольский проспект 26, к 1