Dispensary group patients with tuberculosis. Groups of accounting tuberculous patients in the dispensary. Groups of dispensary accounting and observation with pulmonary tuberculosis in children and adults
Very insidious disease is tuberculosis. It can be infected with both an adult and a child. Therefore, any citizen of our country must necessarily undergo a survey that will identify or refute the presence of my infection with mycobacterium.
If infection or results are confirmed, the patient receives a direction to the tubdy scan. This is an institution where additional surveys will be carried out and, if necessary, appointed comprehensive treatment. At the same time, there are certain groups of dispensary accounting with tuberculosis, which are designed to individualize each patient or falling into a patient's risk group. Groups are assigned, according to regulatory medical documents. Their qualifications will be considered in this article.
Quick definition
Panel of dispensary accounting for tuberculosis are peculiar cells that imply different shape Diseases and severity of his flow. Before the therapy of the patient's phthisiar (a doctor involved in the diagnosis and treatment of tuberculosis), according to the law, is obliged to attribute a person to a specific group. This makes it possible not only to officially diagnose, but also to assign individual treatment to the patient, which helps to quickly stop all the symptoms and increase the chances of the speedy recovery.
There are four groups of dispensary accounting with tuberculosis that are divided into subgroups. Patient belonging to one of them should be based only on therapeutic and epidemiological principle. At the same time, the Ministry of Health of the Russian Federation on a regular basis revises all the available groups and makes changes.
Regulates all groups of dispensary accounting under tuberculosis Order No. 109. The document was adopted back in 2003, and in 2017 some changes have undergone. In particular, it is said that all events aimed at combating tuberculosis are justified and appropriate.
Consider the accounting groups and the affiliation of patients to them. All of them, as already mentioned, four:
1. The first. This group includes all healthy people. The category of patients is subject to inspection once a year. The research complex includes:
- general analysis blood and urine;
- blood test on glucose;
- gynecological examination for women;
- ECG for people over 40 years old;
- fluorographic examination.
2. Second. Patients who have suffered non-complicated diseases. If the patient was revealed by an angina, then the observation of it should last one month, with pneumonia - one year, and after glomerulonephritis - two years.
3. Third. This is ranked here all patients having chronic diseases In the remission stage.
4. Fourth. People with chronic pathologies that are in the stages of exacerbation.
In the dispensary of children and adults implies small differences. People who have reached majority are regular surveys in order to identify the disease at an early stage and successfully treat it.
Why put on account
Groups of dispensary accounting for tuberculosis in adults are necessary not only for the classification of patients. Putting a person to record and determine it in the appropriate group, pursuing such goals:
- Creation of individual cells of patients with similar symptoms and severity of the disease. This makes it possible to competently observe the patients and regularly examine them, according to the approved schedule.
- Accurate observation of the dynamics, in the process of translation of the patient from one group to another.
- Saving a patient's time and a doctor with a clear distribution of a specialist visits and a period required treatment.
- Fast solutions when choosing treatment tactics.
- Timely appointment of different procedures and events.
- Removal from accounting for challenging diseases of patients.
- Easy when conducting relevant documentation.
What is dispensary
The dispensary helps to quickly identify the sick people and appoint them competent therapy. For this, special institutions have been created - anti-tuberculosis dispensaries. Their fundamental tasks are:
- Planning the rational control of tuberculosis in the attached area of \u200b\u200bservice.
- Development and implementation of activities aimed at preventing the development of the disease.
- Timely identification of sick.
- Official registration of all patients, as well as people belonging to the risk area.
- Organization of patients therapy, which includes outpatient chemotherapy.
What do the observation groups mean
In dispensarization, patients can be found in which tuberculosis develops, or there are good doubts in its absence, but the diagnosis has not yet been confirmed. In this case, people are also distributed to certain cells and carry out additional surveys or continue to observe with unspecified genesis.
Group 0.
Pretty insidious disease is recognized tuberculosis. Dispensary accounting helps doctors to fully examine a person and make it a diagnosis or disprove it. Group 0, for example, includes people who correspond to the following characteristics:
- uncomplicated activity of the tuberculosis process, requiring differential diagnosis;
- an unclear diagnosis requiring additional examination, which will help determine the localization of the disease and its form.
This group in turn is divided into subgroups:
- 0-a. It includes all patients who have not been confirmed by the fact of the presence of mycobacteria in the body.
- 0 b. The people who are required to be accurate diagnostics are credited, followed by the assignment to the appropriate cell. Also, the Group is meant for such cases when the presence of tuberculosis is in question, but it is observed:
- incomprehensible changes on x-rays;
- positive samples of the Mantu reaction.
Only after a complete examination of the patient, he was diagnosed or completely refuted the presence of tuberculosis.
Group 1.
People with an active form of the disease are counted for this cell. In this case, the localization of pathology does not matter. Inside it is also a division:
- 1A group of dispensary accounting. Tuberculosis was revealed for the first time.
- 1B group. Patients whose disease recurrenced.
In this case, patients of these subgroups are also classified. This is important because the disease can be dangerous for others, then treatment must be carried out at mandatory. Patients are divided as follows:
- Mycobacterium is detected in the urine, sputum and feces.
- Analyzes do not allocate mycobacterium. In this case, the patient does not have microorganisms that would actively stand out into the environment.
- The treatment was not started after the examination or was interrupted.
Group 2.
According to the orders of the Ministry of Education of the Russian Federation at number 109, 2, the group of dispensary accounting on tuberculosis is assigned to patients who have been revealed by the active form of tuberculosis and there are other chronic pathologies. Localization of the disease does not take into account. This group is divided into separate subspecies:
- 2a. Doctors rank patients who have a cure, but for this it will require serious and long-term therapy.
- 2b. Tuberculetes who seriously launched their disease. Phthisiators warn that it is no longer possible to cure such pathology, even if you use the strongest anti-tuberculosis techniques.
Dispensary accounting is intended to protect people from such a situation and help in time to notice the problem.
Group 3.
The control cell includes 3 tuberculosis can be cured, but it may appear again, therefore, such patients require special care. People ranked in this group can expect supportive therapy and regular inspection.
Group 4.
Persons who are constantly or often in contact with sick, are counted for 4 groups of dispensary accounting with tuberculosis. This is the so-called risk group. She also has a certain classification:
- 4a. The group includes people who have contact with sick at home or in production.
- 4b. All employees of tubed scanners and other medical institutions, where patients with tuberculosis are constantly being automatically falling into this group. They regularly hand over the necessary analyzes and undergo appropriate diagnostic procedures.
It is clear that this group does not have a detected disease, but can always be infected. Therefore, accounting for such people is carried out very careful and strict.
Groups of dispensary accounting in childhood
Prevention of the occurrence of the disease, as well as early diagnostics in childhood produced through vaccinations BCG.which is postponed in the hospital, and the Mantu samples, which must be carried out by all kids visiting educational institutions. It is necessary to understand that the risk of disease increases significantly upon contact with the pesting adults.
Groups of dispensary accounting for tuberculosis in children are exhibited on the basis of the sample Mantu. If the reaction is positive, then the child is counted to the 6th cell of observation.
At the same time, the group is divided into subspecies:
- 6a. This includes children who have explicit signs of a starting disease.
- 6b. Believe the kids who are recorded too explicit or active reaction to the manta sample.
- 6B. Babes are counted for the group who have increased or individual sensitivity to tuberculin.
Regardless of which group of dispensary accounting with tuberculosis in children was exhibited, the form of a detected illness is important. If pathology is seen on early stagesthen it usually refers to reversible, which significantly increases the chances of full cure. In this case, the child can be completely removed from the dispensary accounting.
How is the transition
Inside groups there may be shifts and movements. It can speak both about the deterioration of the state and about the positive dynamics. So that a person is included in the first group, a number of signs are needed:
- Loosity of a part of a light infiltrative nature. In this case, the phase of the decay should be observed and mycobacteria is allocated.
- The surveys revealed tuberculosis of the left kidney, where mycobacteria is also allocated.
The patient can be translated into the second group, if the course of the disease was unfavorable or was absent at all, therefore the pathology adopted a cavernous form.
The patient can be attributed to the third group. At the same time should be observed the following signs:
- The disease affected the lower share of the right lung. Residual changes are extensive and extended far beyond the main part of the defeat.
- The right light is amazed from above. Residual changes are diagnosed with no more than 3 cm in diameter.
Thus, any changes in the form of the disease and its localization entail the patient's translation into another group of dispensary accounting.
conclusions
All the considered groups have their own feature. But before you include or translate a patient from one cell to another, you need to hold a number of diagnostic events. The division of patients into groups facilitates the work of the phthisiatra and makes it possible to quickly trace the dynamics of the development of pathology.
It is a global problem, its decision is a national task. Accounting for patients is carried out in special territorial institutions of the district, urban, regional importance. For the distribution of patients into groups of dispensary accounting with tuberculosis, clinical and epidemiological indicators take into account.
Distribution of patients
The dispensarization is a set of measures aimed at detecting and preventing outbreaks of tuberculosis, elimination of mass infection.
Directions of work institution:
The organizational office is planning methods of anti-tuberculous events, in practice, analyzes their effectiveness.
The need to register
The decision to put a person on dispensary accounting takes a special medical commission. On the decision of the College of Doctors, the patient is reported in writing, approved by the Ministry of Health of the Russian Federation (Ministry of Health).
The observation of the patient's condition, the effectiveness of treatment is carried out both in stationary and outpatient conditions, regardless of the patient's consent. Such measures are designed to prevent an increase in infection among a healthy population.
Terms of observation with tuberculosis of lungs are strictly regulated by the RMS decisions. A person becomes registered at the place of residence. If the address of the registration is changing, the patient is obliged to report this to the relevant authorities within 10 days.
The main objective of statistical observation at the state level is to prevent tuberculosis distribution.
Group accounts for adult patients
In adults, there are 5 groups for which patients are separated. Such identification is based on the epidemiological and therapeutic principles.
Adult groups:
- "0" - the assumption of the presence in the body of tuberculosis, the activity of the disease is not established, an additional, more in-depth diagnosis is supposed.
- "1" is an active form of infection. "1A" - primary diagnosis, "1b" - recurrent tuberculosis, "1B" - the disease does not bother or unknown the effectiveness of previously conducted therapy.
- "2" - chronic tuberculosis in the active stage. "2a" - with timely treatment Perhaps complete recovery, "2b" - the cure of infection is impossible.
- "3" - the cure of the disease, regardless of the presence of residual complications.
- "4" - in contact with sick tuberculosis. "4a" - in everyday life, "4b" - at work (doctors).
According to the recommendations of WHO, patients of groups 1-4 must be treated, and not just observation. From the category of cliserization, people are excluded who have diagnosed primary tuberculosis, and they successfully passed the therapeutic course. If after the completion of chemotherapy the patient recovered, it is transferred to the 3rd group. On average, one course of treatment lasts from 6 to 9 months, two courses - 1-2 years.
People who in contact with the sick and part of the risk are intensively observed within 12 months. Persons who cannot establish the activity of the pathological process, consist of a dispensary accounting for 3 months. Patients with minor residual phenomena are observed for 3 years.
If the effects of tuberculosis lungs are more severe, the person is taking into account the 10 years. When tuberculus is detected more than 4 cm, the patient liver cirrhosis is observed for life.
Purpose of observation groups for children
Children's and teenage groups of dispensary surveillance:
According to WHO statistics, children with intoxication are recorded in the "Tuberculosis of Unidentified Localization" section. The term of treatment in should not exceed 2 years. Children with residual phenomena regardless of age are observed in the phthisiatra to adulthood (up to 18 years). If the child is in contact with the methodor of mycobacteria, it is observed during the whole time. After completing the contact, the dispensarization stops in a year.
Period of observing children with hypereaction on a tuberculin sample from 1 to 2 years. The same is observed in the absence of BCG vaccinations from the child. If simply increased sensitivity or individual intolerance to the drug for intradermal sample, then in this case the observation does not exceed 6 months.
Dispensarization in a complex with prophylactic measures reduces the number of cases of the disease, recurrence. The support of the state, the creation of the state special programs, sufficient financing. To isolate the tuberculosis epidemic, not only qualified health care, but also consciousness of citizens.
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13.2. Dispensary observation of adults
Contingents of adults subject to dispensary accounting consist of four groups:
0 (zero) group - persons with unspecified activity of the tuberculosis process and in need of differential diagnostics to establish a diagnosis of tuberculosis of any localization;
0a Subgroup - clarification of the activity of the tuberculosis process. Observation of at least three months, a complex of diagnostic measures is carried out, according to testimony of test chemotherapy;
0B subgroup - differential diagnosis tuberculosis and other diseases. Observation period 2 - 3 weeks when carrying out a complex of diagnostic measures.
The examination of the group includes a radiograph, tomogram, an ultrasound (with urogenital tuberculosis), bactering, sowing before enrolling in the group, in the future at least 1 time per month. The purpose of the account is to establish a diagnosis.
1 group - patients with active tuberculosis of any localization;
1a subgroup - patients with first identified disease. The term of observation is no more than 24 months from the date of registration;
1B subgroup - with recurrent tuberculosis. Observation period - no more than 9 months.
1B subgroup - patients who interrupted the treatment or not examined at the end of the course of treatment (the result of their treatment is not known).
In both subgroups, patients with bacterial excretions and without bacteria.
The frequency of visiting the dispensary with an outpatient treatment is at least 1 time in 10 days, after stationary or sanatorium treatment - at least 1 time per month. The group holds a comprehensive main course of treatment. The ray surveys of the patients with tuberculosis of the respiration organs during the course of chemotherapy are carried out in the intensive phase at least 1 time in two months, research on the MBT - at least 1 time per month, as well as before the transition to the transition to the phase of the continuation, to the continuation phase by testimony at the end 2 months of chemotherapy and in the future - according to the testimony. The radiation methods of examination and research on the MBT are repeated before the completion of the course of treatment. Upon completion of the course of chemotherapy, the examination is carried out at least 1 time in 6 months. Patients with extrapulmonary tuberculosis are examined by testimony, but at least 1 time in 6 months. The purpose of observation in the group is to achieve clinical cure and translation to the III group of accounting 85% of patients after an effective main course of treatment, but no later than 24 months from the moment of taking into account. Transfer of patients in group II - no more than 10% of the number I group.
Group II - patients with active forms of tuberculosis with chronic flow.
II and a subgroup - patients who, as a result of intensive treatment, a clinical cure can be achieved. The duration of observation in the dispensary is not limited, individual complex chemotherapy is carried out, visiting the dispensary is determined by the condition of the patient and the treatment carried out;
II B subgroup - patients with a far-sighted process, the seraction of which cannot be achieved by any methods and which need a lining, symptomatic treatment and periodic (if indications) of anti-tuberculosis therapy.
The ray surveys of the patients with tuberculosis of the respiratory system during the course of chemotherapy are carried out in the intensive phase at least 1 time in 2 months, research on the MBT - at least 1 time per month; before the transition to the transition to the continuation phase; In the continuation phase, radiation methods and research on the MBT at the end of its 2nd month and later - according to the testimony. The radiation methods of examination and research on the MBT are repeated before the completion of the course of treatment. Upon completion of the course of chemotherapy, the examination is carried out at least 1 time in 6 months. Patients with extrapulmonary tuberculosis examine the testimony, but at least 1 time in 6 months. These include patients translated from the first group. These patients need to be systematic observing and conducting community and medical and preventive measures, since the favorable course of the process is not yet a guarantee of cure. The purpose of observation in the group is the achievement of clinical cure tuberculosis every year in 15% of patients after translating to the subarror. In the NB subgroup, the duration of observation is not limited, held medical eventsextending life, surgical and sanatorium treatment according to the testimony. Visiting the dispensary is determined by the treatment and condition of the patient. Radiation research methods and research on MBT are carried out according to indications, but at least 1 time in 6 months. The purpose of the accounting in the subgroup is an increase in the life expectancy of patients, a decrease in the spread of tuberculosis infection.
III Group - Persons healing from tuberculosis of any localization with large and small residual changes or without residual changes. Terms of observation in the dispensary of persons with large and small residual changes, in the presence of aggressive factors - 3 years; with small residual changes without gagging factors - 2 years; Without residual changes - 1 year. A comprehensive examination of patients is held
No less often 1 time in 6 months. Conducting anti-infertion courses of chemotherapy according to indications, sanatorium and general fascination treatment. Reliable research methods, a study of sputum, urine and other diagnostic material before enrollment in the group, in the future at least 1 time in 6 months. With clinical well-being, withdrawal and translation under observation in the polyclinic of the general treatment network, followed by medical examinations 2 times a year for 3 years after removal from the accounting.
IV Group - Persons in contact with sources of tuberculosis infection.
IV A subgroup - persons consisting in domestic and industrial contact with an infection source. The observation duration is determined by the cure time of the patient plus one year after the cessation of contact with the bacteria.
IV B subgroup - persons who have professional contact with sources of infection.
A comprehensive survey is conducted 2 times a year. In the first year after the identification of the source of the infection, the chemoprophylaxis rate is carried out within 3 - 6 months, according to the testimony, the chemoprophylaxis is carried out, generalifying activities that contribute to the improvement of immunity, including sanatorium treatment, anti-epidemic events in the focus. The duration of observation in 1.UB subgroup is determined by the working term in conditions of professional contact plus one year after its termination. Comprehensive examination is carried out 2 times a year: the first time - the radiograph of the organs chest, blood and urine tests, for women additionally - inspection of the gynecologist; The second time - inspection by a doctor-dispensarizer; laboratory, radial, tool methods Studies on the testimony. It is necessary to monitor compliance with safety, annually a coherent treatment course, chemoprophylaxis (according to indications). Apply radiation research methods, sputum, urinary tests, urine and other diagnostic material before enrollment in the group, in the future at least 1 time in 6 months. The overall incidence of contact persons in barillary foci and professional contact persons should not exceed 0.25% of the average annual number of group.
The basic concepts used by observing patients with tuberculosis. Under the active tuberculosis process understands the specific inflammatory processcaused by the mycobacterium tuberculosis (MBT) and the determined complex of clinical, laboratory and radiographic signs.
The concept of tuberculosis of dubious activity is denoted changes in the lungs and other organs whose activity seems to be unclear.
The chronic course of active forms of tuberculosis is a long, more than 2 years, the course of the disease, in which clinical and radiological and bacteriological signs of the activity of the tuberculosis process are preserved.
Clinical cure is the disappearance of all signs of an active tuberculous process as a result of the main course of comprehensive treatment.
The aggravation is a manifestation of new signs of the activity of the tuberculosis process after a period of improvement or enhance the signs of the disease when observed in the I and II groups before the diagnosis of "clinical cure".
The recurrence understands the emergence of signs of active tuberculosis in individuals who previously undermined tuberculosis and cured from it, observed in the third group or discontinued due to recovery.
Control questions
1. What is the tactics of observing adult patients in the 0 accounting group?
2. What contingents of patients belong to the II group of accounting in adults?
3. List the criteria for setting adult patients with accounting in the I group.
4. What contingents belong to the IV group of children and adolescents?
5. What events are carried out in the II group of accounting for children and adolescents?
Tuberculosis can cause two representatives of the family Mycobacteriaceae.detachment ActinomyceTales: M.Tuberculosis and M.Bovis. In addition, sometimes mentioned M.Africanum - microorganism occupying an intermediate position between M.TUBERCULOSIS and M.Bovisand in rare cases, the cause of tuberculosis on the African continent. The above microorganisms are combined into the complex M.TUBERCULOSISwhat is actually synonymous M.TUBERCULOSISSince two other microorganism is relatively rare.
Man is the only source M.TUBERCULOSIS. The main way to transmit the infection is the air-drip path. Rarely infection may be due to the use of milk infected M.Bovis. There are also cases of contact infection from pathologists and laboratory personnel.
Usually, long-term contact with the bacteritor is needed for the development of infection.
Selection of therapy mode
Clinical forms of tuberculosis have little effect on the chemotherapy technique, the value of the bacterial population is greater importance. Based on this, all patients can be divided into four groups:
I. Patients with for the first time identified pulmonary tuberculosis (new cases) with positive results of the study of smears, heavy abacillary tuberculosis of the lungs and heavy forms of extrapulic tuberculosis.
II. This category includes persons with a relapse of the disease and those who have no treatment given the expected effect (positive wet smear) or was interrupted. At the end of the initial phase of chemotherapy and, with a negative smear, sputum proceed to the continuation phase. However, when mycobacteria is found in wet, the initial phase should be extended for another 4 weeks.
III. Patients suffering from pulmonary tuberculosis with limited defeat of parenchyma and having negative sputum strokes, as well as patients with non-heavy extrapulic tuberculosis.
A significant part of this category is children who have pulmonary tuberculosis almost always flows against the background of negative sputum swabs. The other part is the patients infected in adolescence, which developed primary tuberculosis.
IV. Patients with chronic tuberculosis. The effectiveness of chemotherapy of patients in this category is even currently low. It is necessary to use reserve preparations, the duration of treatment and the percentage of HP increases, high voltage is required from the patient itself.
Therapy schemes
Standard ciphers are used to designate treatment circuits. The entire treatment rate is reflected in the form of two phases. The figure standing at the beginning of the cipher shows the duration of this phase in months. The number at the bottom after the letter is set, if the drug is prescribed less than 1 time per day and denotes the multiplicity of reception per week (for example, E 3). Alternative preparations are denoted in brackets. For example, the initial phase 2HRZS (E) means the daily intake of isoniazide, rifampicin, pyrazinamide in combination or with streptomycin, or with ethambutol for 2 months. After the initial phase is completed, under the negative result of the microscopy, the sputum smear is proceeding to the phase of continued chemotherapy. However, if, after 2 months of treatment, mycobacteria is found in the smear, the initial phase of treatment should be extended by 2-4 weeks. The continuation phase, for example, 4HR or 4H 3 R 3, isoniazide and rifampicin are used daily or 3 times a week for 4 months.
Table 3. Example of four-component Tuberculosis therapy (in adults)
under direct observation, including 62 doses of drugs
| The first 2 weeks (daily) | |||
| Isoniazid | 0.3 g | ||
| Rifampicin | 0.6 g | ||
| Pyrazinamide | 1.5 g when body weight is less than 50 kg |
2.0 g with body weight 51-74 kg |
2.5 g with body weight more than 75 kg |
| Streptomycin | 0.75 g when body weight is less than 50 kg |
1.0 g with body weight 51-74 kg |
|
| 3-8 weeks (2 times a week) | |||
| Isoniazid | 15 mg / kg | ||
| Rifampicin | 0.6 g | ||
| Pyrazinamide | 3.0 g when body weight is less than 50 kg |
3.5 g with body weight 51-74 kg |
4.0 g with body weight more than 75 kg |
| Streptomycin | 1.0 g when body weight is less than 50 kg |
1.25 g with body weight 51-74 kg |
1.5 g with body weight more than 75 kg |
| 9-26 weeks (2 times a week) | |||
| Isoniazid | 15 mg / kg | ||
| Etambutol | 0.6 g | ||
Chemotherapy modes lasting less than 6 months
Some researchers report good results of 4- and even 2 months of chemotherapy courses of light forms of tuberculosis. However, most experts do not recommend discontinuous treatment earlier than 6 months.
Therapy of multiple resistant tuberculosis
In each case, it is desirable to determine the sensitivity of mycobacteria to anti-tuberculosis drugs. In the case of detection of resistance to drugs I, alternative preparations are used, such as fluoroquinolones (ophloxacin, ciprofloxacin), aminoglycosides (kanamycin, amikacin), cappeomycin, ethionamide and cycloserine.
Repeated course of therapy
The approach to the repeated course of therapy depends on the following circumstances:
- The recurrence after indemitis is usually evidenced that preceding treatment was stopped prematurely. At the same time, in most cases, the sensitivity of the pathogen is preserved and a positive effect is observed when appointing standard initial therapy.
- Recurrement is due to resistance to isoniazid. In this case, a re-course of rifampicin chemotherapy in combination with two other anti-tuberculosis drugs is assigned to which sensitivity is preserved, a total duration of 2 years.
- Recurney after irregular reception of anti-tuberculosis drugs is often caused by stable mycobacters. At the same time, it is necessary to rate the sensitivity and purpose of drugs, the sensitivity to which is saved.
- With the intended resistance, the treatment mode is changed with the use of drugs, the sensitivity to which is allegedly saved.
- Multiple resistance to the most "powerful" drugs -
Chapter 17 Organization of anti-tuberculous service and dispensary observation of children and adolescents
The basis of the children's tuberculosis service in Russia is control over prevention, early detection of the disease and effective treatment Children, patients with tuberculosis.
The testing of tuberculosis is a much more reasonable and economical event than the treatment of the already developing disease. All sections of the work of phthisiators for the prevention, detection, the dispensary observation and treatment of patients with tuberculosis are carried out according to the order of the Ministry of Health of the Russian Federation? 109 of 2003
To prevent tuberculosis in children, the following activities are needed: Improving the methods of anti-tuberculosis immunization, identification and chemieme rate of persons with an increased risk of tuberculosis disease, protection of children from tuberculosis infection (sanitary prevention), the use of measures aimed at strengthening the body's protective forces, increasing their nonspecific resistance (social Prevention) and much more.
Specific intradermal vaccination of the newborn in the hospital and the revaccination of the BCG in the hospital and the revacitation of the BCG are 7 and 14 years old. All children at birth should get vaccinated against tuberculosis.
Indications and contraindications to vaccination of newborns and revaccination against tuberculosis are reflected in the section "Vaccinoprophylaxis of tuberculosis".
One of the main methods of preventing tuberculosis in children is chemoprophylaxis, which is divided into primary (introduction of anti-tuberculosis drugs with healthy, uninfected children) and secondary (the introduction of drugs with healthy, but infected tuberculosis persons). Indications for chemoprophylaxis or preventive (preventive) treatment should be installed only by a phthisiathater doctor. Modes and scheme preventive treatment Refilled in the appropriate section of the manual.
Children who are in contact with patients with tuberculosis and animals have the greatest danger of tuberculosis. For this category of the population, there are special methods of preventive measures, which are carried out by phthisiarators of anti-tuberculous dispensaries and doctors of the general treatment network (see section: "Work in the foci of tuberculosis").
The main method of diagnosing and detecting tuberculosis infection in children around the world is tuberculinidiagnosis. In Russia, Tuberculin is used for this purpose standard dilution With 2t. Tuberculinidiagnosis as a specific diagnostic test applies with mass surveys of the population on tuberculosis, as well as in clinical practice To diagnose tuberculosis. With mass examinations of the population on tuberculosis tuberculinidiagnostics, used for timely detection of patients infected with tuberculosis, persons with an increased risk of disease (for the first time infected, with hypergic and increasing reactions on tuberculin), for the selection of contingents to be revaccinated against tuberculosis, to determine the infection and risk of contamination of the population In order to analyze the epidemiological situation on tuberculosis. For these purposes, a single intradermal tuberculin test manta with 2 tuberculin units (2 of those) of purified tuberculin (PPD-L) is used in standard dilution (allergen tuberculous purified liquid in standard dilution for intradermal use) is a finished form. In order to clinical diagnostics in anti-tuberculous dispensaries and hospitals, except for the Mantu sample with 2, the purified tuberculin in standard dilution can be used to sample Mantu with various doses of tuberculin and other methods of sensitivity to tuberculin (graduated skin sample, subcutaneous Koch sample, determination of tuberculin titer, Eosinophilic tuberculin, hemo- and proteinotuberkulin, immunotuberculin samples, etc.). For this purpose, dry purified tuberculin and alttoberculin (at) are used. In differential diagnostic cases, also under the conditions of a dispensary or hospital in the presence of a negative test of Mantu C 2, the PDD-L can be putting a manta sample from 100 those PPD-L or in dilution 1: 100 at. With the negative result of the last sample, in most cases, the body can be considered free from tuberculosis infection. The method of examination of children is reflected in the section "Mass tuberculinidiagnosis".
17.1. Contingents of children and adolescents, nailed by anti-tuberculosis dispensary
This grouping is united for children of early, older and adolescents. The contingents of children and adolescents subject to discsoring are distributed to the following 5 main groups.
Zero Group - 0
In the zero group, children and adolescents are observed to clarify the nature of positive sensitivity to tuberculin and / or for differential-diagnostic measures to confirm or eliminate tuberculosis of any localization.
First Group - I
In the first group, observed patients with active forms of tuberculosis of any localization, highlighting 2 subgroups:
first-a (i-a)- patients with common and complicated tuberculosis;
first-b (i-b)- Patients with small and uncomplicated tuberculosis forms.
Second group - n
In the second group, observed patients with active forms of tuberculosis of any localization with the chronic course of the disease. Patients can be observed in this group with the continuation of treatment (including individual) and more than 24 months.
Third Group - III
In the third group, children and adolescents are taken into account with the risk of recurrence of tuberculosis of any localization. It includes 2 subgroups:
third-A (III-A)- first identified patients with residual posttuberculosis changes;
third-b (III-b)- Persons translated from I and II groups, as well as III-A subgroups.
Fourth Group - IV
In the fourth group, children and adolescents are in contact with sources of tuberculosis infection take into account. It is divided into 2 subgroups:
fourth-A (IV-A)- Persons from family, related and apartment contacts with bacteriasels, as well as from contacts with bacteriasels in children's and teenagers
institutions; Children and adolescents living in the territory of tuberculosis institutions;
fourth-b (IV-b)- Persons from contact with patients with active tuberculosis without bacteries; From family of livestock breeders working on dysfunctional on tuberculosis of farms, as well as from families having patients with tuberculosis of farm animals.
Fifth group - V
In the fifth group, children and adolescents are observed with complications after anti-tuberculosis vaccinations. Highlight 3 subgroups:
fifth - A (V-A)- patients with generalized and common defeats;
fifth-b (V-b)- patients with local and limited lesions;
fifth - in (V-B)- Persons with inactive local complications, both for the first time identified and translated from V-A and V-B groups.
Sixth Group - VI
In the sixth group, there are persons with elevated risk of local tuberculosis. It includes 3 subgroups:
sixth-A (VI-A)- Children and adolescents in the early period of the primary tuberculosis infection ("turning" tuberculin reactions);
sixth-b (VI-b)- previously infected children and adolescents with a hypeergic reaction to tuberculin;
sixth-in (VI-B)- Children and adolescents with amplifying tuberculin sensitivity.
The procedure for dispensary observation and accounting for children's and adolescent contingents of anti-tuberculosis institutions is presented in Table. ? 11-12.
Table 11.The procedure for dispensary observation of contingents of children and adolescents, registered with the tuberculosis institutions of the Russian Federation
Notes.
1. When identifying active tuberculosis, "virats" tuberculin reactions and hypeERgia in children and adolescents need to examine all family members within 2 weeks.
2. The medical and social risk factors are: the absence of BCG vaccination at birth, concomitant chronic pathology, the presence of a source of sustainable stamps of MW, socio-dezadapted, multi-fashioned, low-income families, migrants and refugees.
3. Children and adolescents from I-A groups can be admitted to the teams in the presence of the following mandatory criteria: pronounced positive dynamics; The absence of mycobacterium tuberculosis with bacterioscopic studies and 3-multiple negative crops on mycobacterium tuberculosis; Closing disintegration cavities.
4. Persons who have revealed the increase in tuberculin sensitivity, during the first 3 months are observed in the zero group. In the VI-in group of accounting, they are translated only with further increasing sensitivity or presence of medicine-social risk factors.
5. Patients with active tuberculosis in the presence of anamnesis, clinical and radiological and other data indicating communication with anti-tuberculosis vaccination are observed in V-A and V-b groups accounting. In the V-to group, they are translated after cure only while maintaining residual posttuberculous changes.
6. B. I-A group Accounting isolate patients with a decay of lung tissue and bacteria.
7. Residual post-club changes in the respiratory bodies in children and adolescents are defined as:
Minor: single calcinates in lymph nodes and lungs, fibrosis within the same segment;
Moderately pronounced: small calcinates in several groups lymph nodes, a group of dense and calcined foci in the lungs, fibrosis within the share of or 1-2 segments in both lungs;
Pronounced: Massive calcination in several groups of intractable lymph nodes, foci in the lungs, pneumosclerosis in 2-3 fractions or in 1 share with the presence of bronchiectasis.
Table 12.Scheme of examination of children and adolescents for dispensary accounting
Notes.
1. Patients with tuberculosis of respiratory organs during hospitalization should be examined by specialists in extractive tuberculosis.
2. To all persons observed in groups of dispensary accounting with pathology in urine and / or / or a history of kidney diseases, regardless of the group of dispensary accounting, 3-fold urine studies per MW are carried out.
3. Children over 10 years and adolescents during dynamic observation after completing the course of treatment in groups I, II, III, as well as when observing groups IV, V, VI, low-base digital X-ray equipment can be used.
4. When increasing the sensitivity to tuberculin in the process of dispensary monitoring of IV and VI, unplanned X-ray compound examination of the chest organs is shown.
5. All children with I and Sh-a groups Accounting are subject to ultrasound Research (Ultrasound) organs abdominal cavity (in the VI group by testimony).
