RESPIRATORY TUBERCULOSIS IN ADOLESCENTS MASKED AS COMMUNITY-ACQUIRED PNEUMONIA: CLINICAL OBSERVATIONS

Absence of pathognomonic signs of tuberculosis (TB) of the respiratory system and the diversity of its clinical manifestations reduce the alertness of primary health care (PHC) physicians to this problem, which in its turn leads to belated TB diagnosis. Most often initial diagnosis is “community-acquired pneumonia” at the onset of the disease. An algorithm for interdisciplinary interaction between pediatricians and TB specialists in cases of suspected TB of the respiratory system is proposed. The reasons for untimely detection of TB and diagnostic errors in PHC units are presented using the clinical cases. Absence of suspicion of TB in the presence of its predictors (contact with a TB patient, results of skin immunological tests); development of pulmonary disease outside the season of viral infections in patients who are not included in the risk group according to their frequency and in patients from socially problematic living conditions; incorrect interpretation of the clinical and radiological picture and the course of the disease at its onset are the main reasons for late diagnosis. Conclusion: identifying TB in children and adolescents when seeking medical help is the final part of the diagnostic journey of patients, since opportunities to diagnose the disease at earlier stages of its development were missed. The results of the presented observations indicate the need for interdisciplinary interaction between pediatric physicians and TB specialists for timely diagnosis of TB.