Changes of abdominal organs in children with tuberculosis infection detected by ultrasound diagnostics

BACKGROUND: Ultrasound diagnostics of abdominal organs is an early method of detecting functional and structural changes in tuberculosis infection before the manifestation of clinical manifestations. Currently, there are no uniform criteria for interpreting the sonographic pathology of parenchymal organs in tuberculosis infection in children, which requires its analysis.

AIM: The aim is to determine the frequency and nature of sonographic changes in abdominal organs in children with tuberculosis infection, as well as their dynamics against the background of chemotherapy.

MATERIALS AND METHODS: 192 patients aged 6 months — 14 years of tuberculosis department of City Children’s Infectious Hospital No. 3 for the period 2019–2021 were examined. 3 groups of patients were identified: group 1 — 92 children with active tuberculosis of the respiratory organs; group 2 — 52 children with residual post-tuberculosis changes; group 3 — 48 children with latent tuberculosis infection from tuberculosis risk groups. Comprehensive examination of patients included evaluation of the results of immunodiagnostics (Mantoux test with 2TE and test with recombinant tuberculosis allergen), multispiral computed tomography of the chest, laboratory tests. Ultrasound examination of the abdominal organs was prescribed to children in the diagnosis of tuberculosis infection and on the background of anti-tuberculosis therapy after 3 and 6 months.

RESULTS: Sonographic changes of the liver (reactive and/or intrahepatic cholestasis and/or hepatomegaly) were observed in children with active tuberculosis in 40.2 ± 5.1% of cases, in children of group 3 — in 35.4 ± 6.9% of cases and less often in children of group 2 — in 17.3 ± 5.3% of cases (p < 0.05). Changes of the gallbladder (violations of bile outflow and/or shape changes) in children with active tuberculosis were visualized in 73.9 ± 4.6% of cases, in children of group 3 (60.4 ± 7.1%), less often in children of group 2 (55.8 ± 6.7%, p < 0.05 for group 1). Changes of the pancreas were reactive and were more often observed in children of group 1 (in 14.1 ± 3.5%) than in children of group 2 (5.8 ± 3.2%, p < 0.05) and group 3 (4.2 ± 2.9%). Changes of the spleen were more often detected in children with active tuberculosis (in 17.4 ± 4.0%) than in children of group 2 (5.8 ± 3.2%, p < 0.05) and group 3 (2.1 ± 2.1%, p < 0.05). During chemotherapy, there was an increase in the number of sonographic changes of the liver and gallbladder by 2–3 months, which was due to the undesirable effects of anti-tuberculosis drugs.

CONCLUSIONS: Ultrasound diagnostics of the abdominal organs allows the most timely diagnosis of changes in the abdominal organs in children with tuberculosis infection, which allows individualizing pathogenetic therapy, if necessary, tuberculosis chemotherapy regimen.