Peculiarities of the chemo­drug resistance of M. tuberculosis to anti­tuberculous medications among children and adolescents from multidrug­resistant tuberculous focies

Abstract

Objective — to study the peculiarities of the resistance of M. tuberculosis (MTB) to antimycobacterial drugs (AMBD) among children and adolescents living in multidrug-resistant tuber­culous focies. Materials and methods. 246 children were examined, 145 of them had drug-resistant tuberculosis (TB), 101 children — susceptible form of the specific process, and 102 adult patients who became the source of the disease. Microbiological study in children, adolescents and adults included: detection of MTB in sputum by smear microscopy, seeding on Levenstein—Jensen medium, typing of isolated MTB on BACTEC MGIT 960, determination of drug susceptibility test of MTB strains to AMBD I and II lines, and molecular genetic testing of sputum, including the Gene Xpert MTB/RIF method and the Hain Lifescience linear probe analysis. Results and discussion. Researches show that children under one year of age (29.8 %) and up to 4 years of age (73.1 %) are the most vulnerable to TB in the multidrug-resistant tuberculous focies. Study of the resistance profile of MTB in multidrug-resistant foci was found almost complete coincidence of the profile of the resistance of MTB in children with a source of infection. In particular, children from contact compared with sick adolescents are in 3.5 times more likely to be resistant to the combination of HRS, in 2.7 times — to HR, in 1.8 times — to HRE, in 2.7 times less often — to HRESZ, in 1.6 times — to HRES. In adolescents resistance is most often found to the combination of HRSE (66.1 %), HRESZ (13.6 %), in contrast to the source of TB infection and children. Extensive drug resistance is 2.8 times more common in adolescents than in children (14.1 % vs. 5.0 %, p > 0.01). Conclusions. Researches have shown a high risk of MDR-TB of lungs among children (42.7 %) from multidrug-resistant tuberculous focies. This indicates the need to improve the methods of obtaining respiratory samples to determine the susceptibility/resistance of MTB to AMBD. In the centers of multidrug-resistant tuberculosis infection, more than a third of children (35.8 %) were not vaccinated in the maternity hospital and no chemoprophylaxis was prescribed for contact persons.