Tuberculosis (TB) in children under three years of age can progress rapidly; there is a high probability of generalization of the process, development of miliary tuberculosis and tuberculous meningoencephalitis. Vaccination against tuberculosis is one of the main methods of prevention.
The disease course in vaccinated children has proved to be milder, benign, without complications. Current specifics of tuberculosis process in young children evaluated depending on the previous anti-tuberculosis vaccination. It was established that in children of the younger age group the mean age of those with tuberculosis was 1.56 ± 0.58 years. Every fourth child was previously followed-up for contacts with TB patients, however, collection of a medical history revealed the fact of contact in 76.7% of cases.
Patients in 57.9% of cases were not vaccinated against tuberculosis. The main reason for the absence of immunization is perinatal contact with a HIV-infected mother. Complicated forms of mediastinal lymph node TB (61.7%), generalized tuberculosis (6.5%), bacterial shedding (11.7%), including massive (3.9%) and fatal (9.1%) cases, and are most often detected in children not vaccinated against tuberculosis.
Vaccinated patients have a higher incidence of hyperergic responses to the Mantoux test with 2 TU compared to a sample with allergen tubercular recombinant (ATR) test. In the absence of BCG vaccination, hyperergic responses to the ATR predominate. Previous BCG vaccination makes it difficult to use the Mantoux test to detect and diagnose tuberculosis in young children. At the same time, the intensity of responses to the ATR test is an indirect sign of tuberculosis severity in young children, since complicated and generalized forms of the disease are often accompanied by hyperergic responses.

The analysis of the incidence of tuberculosis in children 0-14 years old, teenagers 15–17 years old, as well as children under the age of 1 year in the period from 1990 to 2019 in the Stavropol Region. In the structure of clinical forms, generalized tuberculosis in children 0–1 years old registered in 35.1% of cases. For the observation period of 30 years, children in their first year of life accounted for 33.3% of all children who died due to tuberculosis.

The analysis of the epidemiological situation in the Altai Territory associated with tuberculosis. The influence of individual factors on the formation of the incidence rate of tuberculosis in children estimated. The epidemiological situation associated with tuberculosis in the Altai Territory remains unsuccessful. Due to the poor organization of treatment, a large contingent of sputum smear or culture positive patients has been formed in the region. The proportion of patients who died from active tuberculosis outside the hospital in the Altai Territory is 1.4 times higher than in the Siberian Federal District and 1.7 times higher in the Russian Federation. However, the level of primary infection of children and adolescents with mycobacterium tuberculosis, the incidence of tuberculosis in children and adults in contact with patients with tuberculosis is relatively low, which is a consequence of the poor preventive and diagnostic work of dispensaries in foci of tuberculosis. The ratio of tuberculosis incidence rates for children (0 to 14 years old) and adults is the second highest in the Siberian Federal District (1: 6) in the Altai Territory (1: 4.7).

Variants of the course of tuberculosis infection in 56 children aged 2 to 14 years who react negatively to a test with a recombinant tuberculosis allergen (ATR) were analyzed.. There were 3 groups: I – 28 children infected with MBT– 50.0% of cases; II – 17 children with newly diagnosed residual post-tuberculosis changes (OPTI) – 30.4% of cases; III group – 11 patients with active tuberculosis – 19.6% of cases.
All children underwent a comprehensive TB survey with the use of intradermal immunological Mantoux test with 2 TE and ATR, according to the testimony of a number of patients’ in vitro tests: QuntiFeron test (QFT), the test T-SPOT.TВ. Detection of tuberculosis infection in children with negative results of the sample ATR prevailed by mass tuberculinodiagnostics in children of all groups: in the I group – in 71.4 ± 8.7% of cases, in the II group – in 94.1 ± 5.9% of cases, but in patients of the III group less often - in 54.6 ± 15.0% of cases, which is explained by a large proportion of children identified by complaints – 27.3 ± 13.4% of patients (p < 0.05).
Tuberculosis disease occurred in the form of complicated forms of the primary period – in 45.5 ± 15.0% of cases, uncomplicated forms – in 27.3 ± 3.4% of cases, generalized lesions - in 27.3 ± 13.4% of cases. Diagnosis of a specific lesion occurred equally in the manifest phases of inflammation: infiltration, infiltration and decay (45.5 ± 15.0% of cases), and in the phase of ongoing reverse development (incomplete calcination - in 45.5 ± 15.0% of cases), one child had a combination of infiltration and calcination phases (9.1 ± 8.7% of cases).
Conclusion. In children with negative test with ATP, an individual comprehensive diagnosis of tuberculosis infection is necessary.

Clinico-epidemiological and medico-social characteristics of 34 children (0–17 years old) with new cases of HIV/tuberculosis coinfection, registered in the city of Moscow in 2004–2018 are presented. We clarified, that not only combination of some epidemiological, medical and biological, and social factors increase the risk of HIV/tuberculosis co-infection in children, but the lack of prophylaxis in the risk groups too.

Data on 1156 patients of department of reanimatology and intensive care for children (0–17 years old) in Moscow city research and clinical center for tuberculosis control (2000–2020 years) were analyzed.
The most part of patients had tuberculosis of intrathoracic lymph nodes – 34.2%, include 19.4% complicated by segmentary or lobar infiltrative and/or atelectical lesions. Infiltrative pulmonary tuberculosis diagnosed in 13.7% (with dissemination and lung tissue destruction – 8.1%); primary tuberculosis complex – in 8.6%; focal – in 3.2%. Tuberculosis with multiple localization obtained in 12.4%, one quarter from them – with central nervous system involvement. In 11 patients (26.2% of all patients with tuberculosis meningoencephalitis), there was the occlusive hydrocephaly development.
The analysis of 20-years’ experience of reanimatology and intensive care department for children allows us to stay: contemporary treatment of children with tuberculosis needs involvement of the different doctors of various specialties for the early detection and timely treatment of the threatening complication of tuberculosis. Bronchoscopic sanations, unloading lumbar punctures, surgery of occlusive hydrocephaly, infusion therapy, parenteral nutrition, prophylaxis of the infection complication, mechanical ventilation, общей анестезии are essential in the intensive care of children with tuberculosis. If the tuberculosis treatment is late started, no modern methods of the intensive care can prevent the unfavorable outcome.

Based on data from the in-patient phase of treatment of 907 patients with respiratory tuberculosis (TB), discharged in 2016–2018 from the leading clinics in Moscow, the effectiveness of surgical treatment (ST) was evaluated. Two groups were compared: with or without surgery for TB treatment (635 and 272, respectively).
Among the operated patients, there were more young people aged 25–39 years (52.6% vs 35.8%, p < 0.01) and fewer – aged 60 years and older (5.3% vs 15.9%, p < 0.01), a larger proportion of employed (46.8% vs 37.8%, p < 0.05) and non-workers (39.4% vs 28.7%, p <0.01), and a smaller proportion of disabled people and retirees (p < 0.05). Almost all (99%) patients with cavitary lesions of the lung tissue, who were prescribed ST had either tuberculoma (83.3%) or fibro-cavernous tuberculosis (FCTB, 16.2%), while in the other group of patients the proportion of such cases was equal to 20.1%.
The results showed the apparent effectiveness of ST at the time of discharge from the hospital. For all TB patients, as well as for patients with MDR TB, almost 91–93% of the caverns’ closure was achieved by ST in the 2nd month of treatment, while for the rest of the patients by the end of treatment – 51.5%, and in the 2nd month – only 12.7%.
During ST, the conversion of bacterial excretion occurred in all cases (100%) and in 95–98% of cases – already in the 3rd month of treatment. Moreover, without ST, bacteriological conversion occurred in 91.7% courses (p < 0.05), and for patients with tuberculoma or FCTB, respectively, in 85.7% and 71.4% of inpatient treatment courses (p < 0.05). For patients with FCTB without ST in the 3rd month of treatment, bacterial excretion stopped only in 21.4% of patients.
For patients with MDR TB, the considered indicator as a whole  did not give a significant improvement in ST: 100.0% and 89.9%, respectively, but at 2nd months of treatment, the values of the indicator for courses with ST were higher than without it: 84.2 % against 52.2%, p < 0.01.

The observational (retro- and prospective) open study of adverse events (AE) during etiotropic tuberculosis (TB) treatment with traditional reserve drugs (I group, 82 pts), with additional linezolid (II group, 77 pts) and linezolid plus bedaquilin (III group, 80 pts), provided in fully comparable by TB characteristics and co-morbidities patients, demonstrate, that new anti-TB drugs does not lead to increased frequency of AE (I group – 92,7%, II – 96,1%, III – 87,5%), seriously AE (I group – 14,6%, II – 18,2%, III – 11,3%), and does not cause the increased frequency of anti-TB drugs cancellation (I group – 58,5%, II – 55,8%, III – 51,3%). Inclusion of linezolid and bedaquilin in chemotherapy regimens does not change of AE spectrum and does not lead to significantly increased frequency of cardiotoxic, neurotoxic and myelotoxic AE. All this indicates the possibility of maximize the use of new chemotherapy regimens.

The medical high school generate one of the most massive and socially meaningful group of intellectuals. The pediatricians’ education in medical high school’s phthisiology department includes the system of professional knowledge, skills and abilities, development of clinical thinking. Basic knowledge, which students obtain during the education, determined by the current state of phthisiology, pulmonology, paediatrics and other related subjects, and by practical public health needs in tuberculosis control.

The lecture contains information оn age-related psychological features of children and adolescents, on styles of family education, and on creation of internal picture of the disease in children and adolescents with tuberculosis. The analysis of children’s and adolescents’ emotional needs during tuberculosis treatment and isolation from living environment, allows us to expand the repertoire of applied methods and techniques and make the treatment more comfortable for all the participations. The psychological education of tuberculosis control facilities stuff allows to achieve a better understanding when communicating with children, adolescents and authoritative for them adults.

In infancy M. tuberculosis dissemination is acute and accompanied by vivid clinical manifestation. One of the rare ones extra pulmonary localization in that age is skin tuberculosis. Skin lesion syndrome in disseminated (generalized) tuberculosis has the same pathological mechanisms as the other extrapulmonary syndromes. For the same reason we obtain the variety of manifestations and «blurriness» of the forms, which are specific for the skin tuberculosis. The presented clinical case demonstrate the difficulties of skin and soft tissue tuberculosis diagnostic and features of its treatment in infancy.

Clinical case of COVID-19/TB co-infection in 47 y. o. female with TB, diagnosed in 2005, after partial right lung resection in 2006 and 2012. In April 2019 TB relapse with XDR detected, in February 2020 – right-side pneumonectomy for fibrotic multichamber cavern. 03.04.2020 г. – right-side seven-rib thoracomyoplasty due to the right main bronchus stump failure. 10.04.2020 – intoxication and severe shortness of breath need for oxygen support. 12.04.2020 – positive smear from nasooropharynx for RNA of SARS-Cov-2. CT 13.04.2020 – in the singleleft lung severe viral pneumonia (CT-3). Therapy: lopinavir/ritonavir 400 mg + 100 mg every 12 hours for 14 days with recombinant alfa-interferon intranasal for 5 days. On 7th day of the treatment – the clinical improvement, normalization of body temperature, исчезла необходимость респираторной поддержки. CT on 7th and 14th days of treatment – positive changes up to complete resorption of pneumonia. On 11th and 14th days, – negative smears from nasooropharynx for SARS-Cov-2. The TB-treatment continued.