PRINCIPLES OF DIAGNOSIS AND THERAPY OF DRUG-INDUCED LIVER INJURY IN CHILDREN WITH TUBERCULOSIS

Drug-induced liver injury is a disease that occurs during the administration of medications, which is controlled or has a positive  dynamics after the drug administration is discontinued, and the renewed prescription of which causes a relapse of clinical and laboratory signs of liver injury. No unified diagnostic criteria have been developed yet. We used the following diagnosis criteria: any excess  of the levels of total bilirubin, direct bilirubin, transaminases; temporary association with administration of medications; ruling out  other causes of liver injury.

Results. 114 children with tuberculosis, aged 3 to 14, were examined. Drug-induced liver injury during the anti-TB therapy was diagnosed in 77 (67.5%) children. In almost half of the cases (37 children, 48%), the liver injury was asymptomatic and was diagnosed  with a biochemical blood test. The most common clinical manifestation of pathology include dyspeptic syndrome (in 42.9% of children), less frequent one is abdominal pain syndrome (in 29.9%). The most common biochemical variant of drug-induced liver injury  (in 64% of children) was a mixed variant (increased levels of transaminases and bilirubin). Also cytolytic syndrome was pronounced  in 54% (in 31 of 57 children) of cases.

Conclusions. Drug-induced liver injury during the administration of potentially hepatotoxic drugs should be actively detected by a  control biochemical blood test every 2 weeks. Early detection of minimal clinical and laboratory symptoms of liver injury in patients  with tuberculosis and timely initiation of treatment will allow controlling quickly liver injury, reducing the number of cases of cancellation of TB treatment, improving the outcome and prognosis for both tuberculosis and hepatic conditions.

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