FEATURES OF THE RESISTANT FORMS OF A SPECIFIC PROCESS AMONG CHILDREN AND TEENAGERS FROM THE MULTIDRUG-RESISTANT TUBERCULOUS INFECTION FOCI: CLINICAL PICTURE AND DIAGNOSTICS.

Among 256 patients examined, 145 were diagnosed with multidrug-resistant pulmonary TB: 67 children and 78 teenagers from the focies with the multidrug-resistant TB (the main group), and 111 patients (35 children and 76 teenagers) from the focies with a chemosensitive TB (the control group). Molecular genetic testing of sputum, including the GeneXpert MTB / RIF method and the Hain Lifesciences linear probe analysis, was used to diagnose MRTB. It was found that the pulmonary TB was by 4.7 times more often revealed among the children under 1 year old (23.8%) and among a half of the children under 4 years old (59.6%) being from the focies with the multidrug-resistant TB (the maint group) as compared to those being from the localities with the drug-susceptible TB (the control group). At the same time, 17-year old teenagers prevailed in the main group. The teenagers from the main group were by 1.6 times more often diagnosed with MDR-TB/RifTB than the children, while the risk of MDR-TB was by 3.7 times more often detected among the children. Pre-extensive drug resistance was detected in 5.0% cases (1 child) and extensive drug resistance was also revealed in 5.0% cases (1 child), both pre-extensive drug resistance and extensive drug resistance were by 2 times more often revealed among the teenagers. The microbiological study of sputum for the susceptibility/resistance of the mycobacterium tuberculous strains showed that the resistance to HRS and HR combinations was more often revealed among the children (by 3.5 and 2.7 times correspondingly) than among the teenagers, while the resistance to HRESZ and HRES was revealed less often (by 2.7 and 1.6 times correspondingly). The children from the focies with the multidrug-resistant TB infection were diagnosed with the miliary TB (by 3.4 times), fibrous-cavernous pulmonary TB(by 2 times) and disseminated TB (by 1.4 times) more often than in the control group. Meningocephalitis (4.9% - 4) and caseous pneumonia (2.9% - 2) were detected only in the main group of children. The teenagers were statistically more often diagnosed with the fibrous-cavernous TB (by 3.5 times), miliary TB (by 2.5 times) and caseous pneumonia (by 2.3 times), while the infiltrative TB was by 1.7 times less often revealed as compared to the control group. Most of the infected children (65.6%) and teenagers (61.5%) from the main group were diagnosed after visiting their family physicians. The moderate state was evident in 35.8% cases (24 children) and the severe state was revealed in 46.3% cases (31 children) in the main group. The frequent TB forms were detected among the children (44.7%) and teenagers (59.0%), however, the moderate and severe states were revealed among the children by 1.3 times more often than among the teenagers.