MONITORING OF THE RELEASE OF CANDIDA FUNGI IN CHILDREN WITH PULMONARY TUBERCULOSIS

Abstract

Relevance: tuberculosis infection is still a danger to the population, despite all the measures taken in
relation to it. According to published data from the World Health Organization (WHO), in 2014, 9.6
million people were identified with new cases of tuberculosis and 1.5 million people died from this
infection associated with this disease [1]. The burden of tuberculosis (TB) in children and adolescents
remains very significant. Every year, several million children and adolescents worldwide become
infected with tuberculosis after contact with a contagious tuberculosis patient, and the risk of
progression of tuberculosis infection into tuberculosis disease in this group is higher than in adults [2].
Infants and young children are at high risk of severe and disseminated disease associated with
death or long-term disability, while adolescents usually develop adult-type pulmonary tuberculosis,
which is highly contagious and contributes to constant transmission within the community. The main
challenges include reducing missed opportunities for TB prevention, of which there were many, and
increasing the detection of cases of the disease, especially among young children [3].
More than 1.5 million children and adolescents (0-19 years old) become ill with tuberculosis annually
(11% of the total number of estimated cases), with the highest proportions falling on young children
(<5 years old) and older adolescents (15-19 years old). years) [ 4,5]. The burden of childhood and
adolescent TB varies by country and region [6].
As it is known, tuberculosis patients belong to the risk group for the development of opportunistic
mycoses, in relation to children, the risk of developing candida infection increases as a result of
prolonged antibiotic therapy, unformed immunity in the younger age group and hormonal changes in
the adolescent body, etc.
Invasive candidiasis is a clinical condition that usually occurs in patients with immunosuppression and
in patients with general defects of the immune system. Candida albicans is the most common fungal
pathogen capable of causing infections ranging from mild lesions of the skin and mucous membranes
to invasive diseases affecting several organs. Deep candida infections rarely occur in healthy hosts, but
the incidence increases significantly in patients with immunosuppression [7].
Candida albicans is still the most common fungus causing infections in immunocompromised patients
[8]. The prevalence of pulmonary tuberculosis coinfection with Candida is about 15-32% in various
studies [9]. The most common type of these fungi (from 9 to 80%) is C. albicans, which is a mucous
membrane found in the usual normal microflora of the digestive tract.
Candida albicans has evolved as a potentially pathogenic fungus, and not as a harmless guest in the
mucous material of patients with bronchopulmonary diseases, which can increase complications in
these diseases. Kali et al. [8] found that 40% of cases of Candida co-infection are represented by C.
albicans (59%), followed by C. tropicalis (20%) and C. glabatra (20%) [10].
The purpose of the study: to monitor the frequency of Candida fungi excretion in tuberculosis
patients of children and adolescents undergoing specialized treatment at the National Scientific Center
of Phthisiopulmonology of the Ministry of Health of the Republic of Kazakhstan (NSCP of the
Ministry of Health of the Republic of Kazakhstan).
Materials and methods of research: as is known, microscopic examination and cultivation of
clinical samples for the diagnosis of fungal infection are the gold standard. In our article, we analyzed
the results of a cultural method of studying clinical material in patients of the pediatric pulmonary
department of the NSCP of the Ministry of Health of the Republic of Kazakhstan in Almaty for a
three-year period.
The study of the species composition of isolated strains of fungi of the genus Candida was carried out.
For intraspecific identification of fungi of the genus Candida, chromogenic media are used in the
reference laboratory of the NSCP of the Ministry of Health of the Republic of Kazakhstan. This agar
allows you to identify fungi of the genus Candida by the presence of color, each type of fungi of the
genus Candida is characterized by its own color.
Results of the study: a total of 532 cultures of Candida fungi were isolated from the clinical material
of tuberculosis patients in the period 2020-2022. The distribution by analyzed years was as follows:
2020 -126 (23.7%), 2021 - 216 (40.6%), 2022 – 190 (35.7%) (Figure 1).