1. THE PRINCIPLES OF CLINICAL

EXAMINATION

DETERMINATION:

deficiencies in body weight, pale face, glossy eyes and wide pupils, dystrophic skin changes, long and narrow chest, widened intercostal spaces, acute supracostal angle, lagging (wing-shaped) shoulder blades - usually seen in patients with late-stage tuberculosis. On the fingers and toes, there is a drumstick-like deformity of the terminal phalanges and changes in the shape of the nails (as clockwork). In children and adolescents, shoulder scars after BCG vaccination are examined.

1. THE PRINCIPLES OF CLINICAL

EXAMINATION

PALPATION:

skin, lymph nodes, often lagging of the affected half of the chest during breathing, soreness of pectoral muscles, atrophy of shoulder girdle and chest muscles, significant displacement of mediastinal organs (palpation according to tracheal position) are noted. Vocal trembling: normal, amplified (over an area of thickened lung in infiltrative and cirrhotic tuberculosis, over a large cavern with a wide draining bronchus), weakened (with air or fluid in the pleural cavity, atelectasis, massive pneumonia with bronchial obturation).

1. PRINCIPLES OF CLINICAL

EXAMINATION

PERCUSSION

The lung and thorax are relatively coarse in infiltrative and cirrhotic lobular lesions, pleural fibrosis, spontaneous pneumothorax, acute exudative pleurisy, pulmonary atelectasis (boxy sound or shortened pulmonary sound).

1. PRINCIPLES OF CLINICAL

EXAMINATION

AUSCULTATION:

1.Weakened breathing (pleurisy, pleural fusion, pneumothorax).

2.Rigid or bronchial breathing (infiltration of lung tissue).

3.Amphoric breathing (over a giant cavern with a wide draining bronchus).

4.Rattling in the lungs.

5.Pleural friction murmur.

2. LABORATORY RESEARCH METHODS

1.GENERAL BLOOD TEST.

2.GENERAL URINALYSIS.

3.BIOCHEMICAL BLOOD TEST.

4.BLOOD COAGULATION TESTS.

5.HORMONAL TESTS.

6.MICROBIOLOGICAL TESTS.

7.IMMUNOLOGICAL TESTS. SEROLOGICAL TESTS: ANTIGEN DETECTION, ANTIBODY DETECTION (AFA) AND TUBERCULIN PROVOCATION TESTS.

8.MOLECULAR BIOLOGICAL TESTS (PCR).

MICROBIOLOGICAL TESTS

Bacterioscopic method (sputum microscopy according to Ziehl-Nielsen, luminescent microscopy), cultural method (culture on Lowenstein-Jensen and Finn-2, Nova, A-6, A-9 media, etc.) - after 33 days the appearance of MBT growth.

MBT GROWTH INTENSITY:

(+) - 1 - 20 CFU in vitro (scanty bacterial release);

(++) 20 to 100 CFU in vitro (moderate bacterial proliferation);

(+++) >100 CFU in vitro (abundant bacteriuria).

There are automated MBT culturing systems: MGIT- BACTEC - 960 and MB/Bact. - 11 - 19 days appearance of MBT growth.

3. TUBERCULINODIAGNOSTICS is a set of diagnostic tests to determine specific sensitization of the body to MBT using tuberculin, an autoclaved infiltrate of MBT cultures.

TUBERCULIN is an incomplete antigen (hapten) that cannot cause disease or develop immunity to it, but causes a specific response related to delayed allergy and is highly specific. A specific reaction can only occur if the organism has been previously sensitised to MBT by spontaneous infection or by BCG vaccination.

THE CHALLENGES OF MASS TUBERCULIN-

DIAGNOSIS:

1.Identification of children and adolescents with tuberculosis.

2.Identification of persons at risk of TB disease for follow-up with a TB doctor (persons newly infected with MBT with "virage" TB tests, with increasing TB tests, with hyperergic TB tests, with TB tests at moderate and high levels for a long time), if necessary - For preventive treatment.

3.Selection of children and adolescents for BCG revaccination.

4.Determination of epidemiological indicators for tuberculosis (population infectiousness, annual risk of infection).

THE PURPOSE OF INDIVIDUAL

TUBERCULIN-DIAGNOSIS:

1.Differential diagnosis of postvaccination and infectious allergy (GST).

2.Diagnosis and differential diagnosis of tuberculosis and other diseases.

3.Determination of the "threshold" of individual sensitivity to tuberculin.

4.Determination of tuberculosis process activity.

5.Evaluation of treatment efficacy.

CONTRAINDICATIONS TO THE MANTOUX

TEST FROM 2 TE:

1.Skin diseases, acute and chronic infectious and somatic diseases (including epilepsy) during exacerbation.

2.Allergic conditions, rheumatism in acute and sub-acute phases, bronchial asthma, idiosyncrasies with marked skin manifestations during exacerbation.

3.Quarantine for childhood infections in children's

communities.

4.An interval of less than 1 month after other prophylactic vaccinations (DPT, measles vaccinations, etc.).