Predictors of tuberculosis infection among children and adolescents with positive results of a skin test with recombinant TB allergen

Introduction. In the context of a decrease in the tension of the epidemic situation on tuberculosis in Russia, it remains relevant to search for new ways to increase the effectiveness of preventive anti-tuberculosis measures among children and teenagers, taking into account an integrated approach to assessing all risk factors for tuberculosis in various age groups of the child population.

Objective. Tо study the complex characteristics of groups at increased risk of tuberculosis among children of different ages who have positive results of a skin test with a recombinant tuberculous allergen (АТR).

Materials and methods. The study retrospectively included 392 patients aged 2–17 years with a positive ATR test result. The рatients were randomized by age into 3 groups: in the 1st group there were 87 children 2–7 years old, in the 2nd group 182 children aged 8–14 years were included, in the 3rd group included 121 patients 15–17 years. The children did not have clinical and radiological signs of active tuberculosis and were HIV-negativ.

Result. Among children and adolescents with a positive result of the test with ATR, social risk factors for developing tuberculosis (unfavorable living conditions, lack of permanent employment in 86.3% of parents) were determined. It was found that children living in families with low social status were dominated by contact with patients with multidrug resistance of the pathogen (MDR-TB), more than half of children (53.1%) had comorbidities. In 13.3% of children, small calcifications were detected in the lungs, in the intrathoracic lymph nodes.

Conclusion. Among children 2–7 years old with positive results of the test with ATR, a complex of risk factors for the development of tuberculosis prevails: low material security in every second family, alcohol and drug dependence of parents in every third family, contact with MDR-TB patients in 56.5% of children, high incidence of concomitant pathology (in 67.4% of children).

1. Aksenova V.A., Gordina A.V. Issues of tuberculosis in children and adolescents in the Russian Federation. Tikhookeanskiy meditsinskiy zhurnal = Pacific Medical Journal. 2021;(1):80–84. (In Russ.) https://doi.org/10.34215/1609-1175-2021-1-80-84.

2. Vаsilyevа I.А., Belilovsky E.M., Borisov S.E., Sterlikov S.А. Multi drug resistant tuberculosos in the countries of the outer world and in the Russian Federation. Tuberkulez i bolezni legkikh = Tuberculosis and Lung Diseases. 2017;95(11):5–17. (In Russ.) Available at: https://www.tibl-journal.com/jour/article/viewFile/998/999.

3. Ravilone M.K., Korobitsyn A.A. Elimination of tuberculosis is a new WHO strategy in the era of sustainable development goals, the contribution of the Russian Federation. Tuberkulez i bolezni legkikh = Tuberculosis and Lung Diseases. 2016;94(11):7–15. (In Russ.) https://doi.org/10.21292/2075-1230-2016-94-11-7-15.

4. Aksenova V.A., Klevno N.I., Kavtarashvili S.M. Focus of tuberculosis infection as a risk of developing multidrug-resistant tuberculosis in children. Tuberkulez i bolezni legkikh = Tuberculosis and Lung Diseases. 2018;96(1):11–17. (In Russ.) https://doi.org/10.21292/2075-1230-2018-96-1-11-17.

5. Aksenova V., Sevostyanova T., Belilovskiy E., Borisov S., Slogodskaya L., Shamuratova L. TB detection in children in Moscow (Russia) as in low TB incidence region. Eur Respir J. 2018;52:PA2734. https://doi.org/10.1183/13993003.congress-2018.PA2734.

6. Aksenova V.A., Baryshnikova L.A., Klevno N.I., Kudlay D.A. Screening of children and adolescents for tuberculosis infection in Russia – past, present, future. Tuberkulez i bolezni legkikh = Tuberculosis and Lung Diseases. 2019;97(9):59–67. (In Russ.) https://doi.org/10.21292/2075-1230-2019-97-9-59-67.

7. Krasnov V.A., Revyakina O.V., Filimonov P.N., Stepanov D.V. Tuberculosis: general regularities of the epidemic process in Russia and beyond the Urals. Tuberkulez i bolezni legkikh = Tuberculosis and Lung Diseases. 2016;94(10):5–11. (In Russ.) https://doi.org/10.21292/2075-1230-2016-94-10-5-11.

8. Ali M. Treating tuberculosis as a social disease. Lancet. 2014;383(9936): 2195. https://doi.org/10.1016/S0140-6736(14)61063-1.

9. Ducked S., Sharma N., Chopra K.K., Khanna A., Kumar R. Sociodemographic profile and treatment outcomes in pediatric TB patients attending DOTS centers in urban areas of Delhi. Indian J Tuberc. 2018;66(1):123–128. https://doi.org/10.1016/j.ijtb.2018.06.006.

10. Aksenova V.A. (ed.). Tuberculosis in children and adolescents. Moscow: GEOTAR-Media; 2007. 269 p. (In Russ.) Available at: https://elibrary.ru/item.asp?id=19539308.

11. Nechaeva O.B. Tuberculosis in children of Russia. Tuberkulez i bolezni legkikh = Tuberculosis and Lung Disease. 2020;98(11):12–20. (In Russ.) https://doi.org/10.21292/2075-1230-2020-98-11-12-20.

12. Thomas T.A. Tuberculosis in children. Pediatric Clinicsof North America. 2017;64(4):893–909. https://doi.org/10.1016/j.pcl.2017.03.010.

13. Kudlay D.A., Starshinova A.A., Dovgalyuk I.F. Recombinant tuberculous allergen: 10 years of experience in the use of the test in children and adolescents in the Russian Federation (meta-analysis data). Pediatriya. Zhurnal im. G.N. Speranskogo = Pediatrics. Journal named after G.N. Speransky. 2020;99(3):121–129. (In Russ.) https://doi.org/10.24110/0031-403X-2020-99-3-121-129.

14. Kudlay D.A. Biomarkers and immunological tests. Experimental and clinical parallels of latent tuberculosis infection. Tuberkulez i bolezni legkikh = Tuberculosis and Lung Diseases. 2020;98(8):63–74. (In Russ.) Available at: https://tubercules.org/wp-content/uploads/2021/01/biomarkery-iimmunologicheskie-testy.-eksperimentalno-klinicheskie-parallelilatentnoj-tuberkuleznoj-infekczii.pdf.

15. Slogotskaya L.V. Bogorodskaya E.M. Comparative characteristics of immunological tests for the detection of tuberculosis infection. Mass screening opportunities. Tuberkulez i bolezni legkikh = Tuberculosis and Lung Diseases. 2016;94(5): 5–16. (In Russ.) https://doi.org/10.21292/2075-1230-2016-94-5-5-16.

16. Slogotskaya L.V., Bogorodskaya E.M., Shamuratova L.F., Sevostyanova T.A. Effectiveness of screening of tuberculosis infection in children and adolescents in Moscow in 2019 based on the algorithm for the use of an intradermal test with a recombinant tuberculous allergen (ESAT-6 / CEP-10). Tuberkulez i bolezni legkikh = Tuberculosis and Lung Diseases. 2021;99(1): 15–25. (In Russ.) https://doi.org/10.21292/2075-1230-2021-99-1-15-25.

17. Sotneva I.B. Experience in the use of recombinant tuberculous allergen for mass examination for tuberculosis of children and adolescents in the Nizhny Novgorod region. Voprosy prakticheskoy pediatrii = Issues of Practical Pediatrics. 2017;(4):43–48. (In Russ.) https://doi.org/10.20953/1817-7646-2017-4-43-48.

18. Aksenova V.A., Levi D.T., Aleksandrova N.V., Kudlay D.A., Baryshnikova L.A., Klevno N.I. Pediatric tb: modern methods for prevention and early diagnostics. Doktor.ru 2017;15(144):9–15. (In Russ.) Available at: https://journaldoctor.ru/upload/iblock/800/1.pdf.

19. Starshinova A.A., Dovgalyuk I.F., Yablonsky P.K. Immunodiagnostics of tuberculosis: ten years of experience in the use of immunological tests in Russia. Tuberkulez i bolezni legkikh = Tuberculosis and Lung Diseases. 2019;(5):58–65. (In Russ.) https://doi.org/10.21292/2075-1230-2019-97-5-58-65.

20. Stasko E.Y. Analysis of the use of a skin test with a recombinant tuberculous allergen as a screening method for tuberculosis infection in children older than 7 years in the Penza region in 2014–2016. Tuberkulez i bolezni legkikh = Tuberculosis and Lung Diseases. 2018;(3):29–34. (In Russ.) https://doi.org/10.21292/2075-1230-2018-96-3-29-34.

21. Fatykhova R.Kh., Alekseev A.P. Effectiveness of screening examinations of the child population for the presence of tuberculosis infection in the Republic of Tatarstan. Tuberkulez i bolezni legkikh = Tuberculosis and Lung Diseases. 2016;(6):39–42. (In Russ.) https://doi.org/10.21292/2075-1230-2016-94-6-39-42.

22. Auguste P., Tsertsvadze A., Pink J., Courtney R., Seedat F., Gurung T. et al. Accurate diagnosis of latent tuberculosis in children, people who are immunocompromised or at risk from immunosuppression and recent arrivals from countries with a high incidence of tuberculosis: systematic review and economic evaluation. Health Technol Assess. 2016;20(38):1–678. https://doi.org/10.3310/hta20380.

23. Cohen A., Mathiasen V. D., Schön Т., Wejse С. The global prevalence of latent tuberculosis: a systematic review and meta-analysis. Eur Respir J. 2019;54(3):1900655. https://doi.org/10.1183/13993003.00655-2019.

24. Getahun H., Matteelli A., Abubakar I., Aziz M.A., Baddeley A., Barreira D. et al. Management of latent Mycobacterium tuberculosis infection: WHO guidelines for low tuberculosis burden countries. Eur Respir J. 2015;46(6):1563–1576. https://doi.org/10.1183/13993003. 01245-2015.

25. Reeves A., Basu S., McKee M., Stuckler D., Sandgren A., Semenza J. Social protection and tuberculosis control in 21 European countries, 1995–2012: a cross-national statistical modelling analysis. Lancet Infect Dis. 2014;14(11):1105–1112. https://doi.org/10.1016/S1473-3099(14) 70927-2.

26. Pai M. Innovations in tuberculosis diagnostics: progress and translational challenges. EBioMedicine. 2015;2(3):182–183. https://doi.org/10.1016/j.ebiom.2015.01.018.

27. Ovsyankina E.S., Panova L.V., Poluektova F.G., Viecelli E.A., Hiteva A.Y. Adolescent tuberculosis: a medico-social portrait taking into account the epidemic risk factor of disease development. Voprosy prakticheskoy pediatrii = Clinical Practice in Pediatrics. 2018;13(2):32–38. (In Russ.) Available at: https://www.phdynasty.ru/upload/medialibrary/fd1/fd1abcb5a247ff75845ac200d7f1450d.pdf.

28. Plekhanova M.A., Aksenova V.A., Krivtsova L.A. Personified early diagnosis and prediction of the course of tuberculosis infection in children with the allocation of predictors of latent tuberculosis infection and tuberculosis. Tuberkulez i bolezni legkikh = Tuberculosis and Lung Diseases. 2021;99(1):33–39. (In Russ.) https://doi.org/10.21292/2075-1230-2021-99-1-33-39.

29. Popkova G.G., Smerdin S.V., Plekhanova M.A. Significance of epidemiological risk factors for tuberculosis in children and adolescents in modern conditions. Tikhookeanskiy meditsinskiy zhurnal = Pacific Medical Journal. 2021;(1):37–41. (In Russ.) Available at: https://www.tmj-vgmu.ru/jour/article/view/2159.

30. Mezentseva A.V., Tyulkova T.E., Chugaev Yu.P., Kamaeva N.G., Dolmatova I.A. Activity of the tuberculous process in the detection of calcifications in the intrathoracic lymph nodes and lungs in children. Tuberkulez i bolezni legkikh = Tuberculosis and Lung Diseases. 2017;(1):11–16. (In Russ.) https://doi.org/10.21292/2075-1230-2017-95-1-11-17.