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).

Creation of a legal framework for immunodiagnosis of tuberculosis in paediatric practice in our country began in 1923, when the 2nd All-Russian Tuberculosis Congress and the 2nd All-Union Congress of Paediatricians were held. These congresses were known to approve the medicinal product label for the first tuberculosis diagnostic product Koch's alt-tuberculin. The product continued to improve; hence the method of tuberculin diagnosis has changed overtime. Starting from 2017, medical screening for TB in the paediatric population has been determined in Russia. TB is identified using various tuberculosis allergens according to the age group: a) immunodiagnostic examination of children aged 1–7 years is performed using a bacterial allergen with 2 tuberculin units of purified protein derivative-standard solution; b) immunodiagnostic examination of children aged 8–14 years is performed using the recombinant tuberculosis allergen derivative-standard solution; c) immunodiagnostic examination of children aged 15 through 17 years is performed using recombinant tuberculosis allergen derivative-standard solution or chest X-ray fluoroscopy. This review describes in detail the formation and development of the legal framework for screening for TB in the paediatric population in Russia. Detailed information on the current requirements for immunodiagnosis of TB in children and adolescents in accordance with the current legislation of the Russian Federation is presented. Issues of sanitary legislation, interdisciplinary interaction between primary health care facilities and anti-tuberculosis institutions are highlighted. Answers to the most frequently asked questions on the screening for TB in paediatric practice are provided.

The search for new opportunities for early detection of tuberculosis infection (TI) and prevention of tuberculosis (TB) in children from risk groups remains relevant. HIV infection is one of the highest risk factors for TB disease. According to the literature, the ELISPOT method is effective for detecting TI regardless of the presence of immunosuppression. In 2025, in vitro laboratory tests based on the assessment of T-lymphocyte interferon-gamma release (IGRA tests) were introduced into clinical practice in the Russian Federation. This case report demonstrates a case of generalized TB in a school-age child with HIV infection, which was first diagnosed at the age of 13 years when seeking medical attention with complaints. The child was hospitalized with a preliminary diagnosis: Crohn's disease, terminal ileitis, stenosing form, moderate severity, stenosis of the terminal ileum. HIV infection? Anamnestic, general clinical data, and results of additional examination methods (radiological, immunological, microbiological) did not allow confirmation of the etiological nature of TB; obtaining morphological data required an aggressive diagnostic approach. A positive IGRA test (blood test using the ELISPOT method) allowed confirmation of the presence of TI in the child and, in conjunction with clinical and radiological data, established the diagnosis of TB, followed by an effective course of anti-tuberculosis chemotherapy against the background of antiretroviral therapy (ART) and achievement of clinical cure. The positive dynamics of the immune status in the child led to the conversion of negative skin immunological tests for TI to positive, which clearly demonstrates the pathogenetic mechanism of various methods of immunodiagnosis of TI. Changes in approaches to TB screening of the pediatric population involve the use of in vitro tests based on the assessment of T-lymphocyte interferon-gamma release (IGRA tests). Immunodeficiency states of various origins are medical indications for laboratory tests using the ELISPOT method.

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Aim to implement a comprehensive approach to treatment of patients with tuberculosis in anti-tuberculosis medical organizations. Material and methods. Fifty-two patients and fourteen employees took part in the study. For psychodiagnostics, we used the "TOBOL" questionnaire, the diagnostics of professional "burnout" by K. Maslach, S. Jackson, the Wheel of Life concept by Paul J. Meyer. The data was analyzed using Mann Whitney U-test, Wilcoxon signed rank test. Results. The older patients had a tendency for excessive vigilance and aggressiveness in their attitude to the disease. The harmonious and anosognostic types of attitude to the disease were prevalent in patients with permanent employment. The medical workers demonstrated a high level of emotional burnout. The training aimed at prevention of burnout was the part of the study. After the training, the registered values of emotional exhaustion were reduced by 7 points, the depersonalization score shifted from high to average, the reduction of personal achievements score raised by 5 points. Conclusion. The age and social status can influence the type of attitude towards tuberculosis. Patients under 40 years of age with permanent employment have a more favorable prognosis of adherence to treatment and persistent clinical cure of tuberculosis. The introduction of an integrated approach to the provision of medical care with the mandatory presence of psychological support is relevant and necessary. This study substantiates the expediency of creating a psychological assistance office in a medical organization.

This article reviewed and systematized data from full-text publications on the development of TB infection in humans found in search engines scholar.google.ru, researchgate.net, MEDLINE, and the scientific electronic library eLIBRARY.RU. A 50-year literature search was conducted using the following keywords: Mycobacterium tuberculosis exposure, latent tuberculosis infection, latent microbiism, tuberculin sensitivity conversion, tuberculosis infection, diagnosis, children. 50 articles published by leading international and Russian specialists in phthisiology and pediatrics were reviewed. Data on current understanding of tuberculosis infection, 7P pediatrics, details of the subject of clinical diagnosis, and conversion of descriptions defining the state of infection with Mycobacterium tuberculosis were obtained. Due to absence of precise criteria/biomarkers for incipient tuberculosis, it is necessary to assess a risk for developing tuberculosis in children by specifying it in the clinical diagnosis description. It has been established that modern immunological skin tests (recombinant tuberculosis allergen test (Diaskintest, Russia) and laboratory (TigraTest®TV (Russia)) tests assessing release of interferon gamma by T-lymphocytes (IGRA-tests) in response to exposure to the specific antigen proteins ESAT6 and CFP10 are important criteria for increased risk for developing tuberculosis. To decide on the initiation of prophylactic anti-tuberculosis treatment, it is required to assess the degree of risk for developing TB. The authors proposed a system for assessing the degree of risk for developing TB in children based on risk factors and the results of IGRA-tests. Adding the degree of TB risk to the clinical diagnosis description in TB infection will ensure targeted interventions for target pediatric groups in accordance with the principles of a new trend in clinical and fundamental medicine – developmental pediatrics and health programming.