TUBERCULIN DIAGNOSTICS: HISTORY AND PROSPECTS

In the review, the characteristics of tuberculin preparations and the results of their long-term use are given. It has been shown that in the conditions of mass vaccination of BCG and the spread of HIV infection with high sensitivity, the diagnostic value of these preparations is significantly reduced. The isolation of “virulence antigens” from virulent Mycobacterium tuberculosis (absent in BCG) led to the creation and application in the last 10 years of new tests and preparations for the diagnosis of tuberculosis, including its latent form. There are in vitro tests (IGRA tests) based on the determination of the content of interferon-gamma or sensitized lymphocytes of its excretory in an infected or infected person with tuberculosis. Despite the high sensitivity and specificity of these tests, due to their high cost and other disadvantages, they are not applicable for mass screening. The solution to the problem was the creation of a new tuberculin - allergen of tuberculous recombinant (Diaskintest®), consisting of ESAT6-CFP10 protein. Analysis of the results of a large-scale marketing study of this allergen showed its high specificity, which allowed to recommend a diaskintest for mass tuberculin diagnostics in place of purified tuberculin in children older than 7 years. The prospect of increasing the sensitivity of the allergen of a tuberculous recombinant may include the inclusion of other antigens present in the preparation of virulent mycobacterium of tuberculosis.

Averbakh M.M., Gergert V.Ya., Litvinov V.I. Hypersensitivity of delayed type and infectious process. [Povyshennaya chuvstvitel’nost’ zamedlennogo tipa i infektsionnyy protsess]. Moscow: Meditsina; 1974. (in Russian)

Oumaguchi A. Studies on mechanisms of tuberculin hypersensitivity. I. The relation between the functions of cells mediating tuberculin-type hypersensitivity (TTH) and the infiltrating cells in skin reaction. Kekkuru.1982; 57(2): 59-71.

Averbakh M.M., Litvinov V.I. Immunological basis of anti-tuberculosis vaccination. [Immunologicheskiye osnovy protivotuberkuleznoy vaktsinatsii]. Moscow; 1970: 3-221. (in Russian)

Bullock W.E. Anergy and infection. Adv. Intern. Med. 1975; 21: 149-73.

Lurie M.G., Abramson S., Heppleton A.G. On the response of genetically resistent and susceptible rabbits to the qualitative inhalation of human type tubercle bacilli and the nature of resistance to tudtrculosis. Exp. Med. 1952; 95: 119-34.

Kalmykova G.N., Shcherbakova V.P. Influence of biological preparations on the formation of postvaccinal hypersensitivity of delayed type in BCG immunization. Problemy tuberkuleza. 1978; 56(1): 78-9. (in Russian)

Luetkemeyer A.F., Charlebois E.D., Flores L.L., Bangsberg D.R., Deeks S.G., Martin J.N., Havlir D.V. Comharison of an interferon-gamma release assay with tuberculin skin testing in HIV-infected individuals. Am. J. Respir. Crit. Care Med. 2007; 175(7): 737-42.

Klevno N.I., Aksenova V.A. BCG tuberculosis vaccine: immunological and clinical efficacy in children born to HIV-infected women. BIOpreparaty. Profilaktika, diagnostika, lechenie. 2018; 18(2): 114-20. doi: https://doi.org/10.30895/2221-996X-2018-18-2-114-120. (in Russian)

Alexandrova E.R., Morozova T.I., Parolina L.E., Doctorova N.P. Interpretation of complex cohort evaluation of tuberculin diagnostics results. Problemy tuberkuleza i bolezni legkih. 2008; 85(7): 23-6. (in Russian)

Selitskaya R.P., Solov’eva I.P., Zolotova L.A. Influence of immunosuppressants on immunity organs in the development of destructive pulmonary tuberculosis. Problemy tuberkuleza. 1978; 56(8): 56-63. (in Russian)

Boussiotis V.A., Tsai T.E., Yunis E.J., Thim S., Delgado J.C., Daschtr C.C. et al. IL-10-produsing T-cells suppress immune responses in anergic tuberculosis patients. J. Clin. Invest. 2000; 105(9): 1317-25.

Seibert F.B., Glen J.T. Tuberculin purified protein derivative: Preparation and analysis of a large quantity for standard. Amer. Rev. Tuberc. 1941; 44: 9-25.

Levy D.T., Yablokova T.B., Sapundzhieva E. Study of the specific activity of various tuberculin ointments. In: Introduction of new methods for the prevention, diagnosis and treatment of tuberculosis and their effectiveness. [Vnedreniye novykh metodov profilaktiki, diagnostiki i lecheniya tuberkuleza i ikh effektivnosti]. Alma-Ata; 1980: 75-80. (in Russian)

Gupta K.C. Landi S. Isolation, сharacterisation and biological properties of a tuberculin-active peptidoglycan isolation from the culture filtrate of Mycobacterium tuberculosis. Infect. Immun. 1980; 27(2): 344-50.

Pimm M.V., Baldvill R.W.Liposomal encapsulation augments delayed hypersensitivity reaction to tuberculin protein. Med. Microbiol. 1984; 18: 429-32.

Levy D.T., Yablokova T.B., Radionova R.N., Landa-Geller B.A. Development of a new national standard for purified tuberculin mammals. In: Standarty, shtammy i metody kontrolya bakteriynykh i virusnykh preparatov. [Standarty, shtammy i metody kontrolya bakteriynykh i virusnykh preparatov]. Moscow, 1979: 83-6. (in Russian)

Sapundzhieva E., Tsonchev D. Characteristics of the protein in the Bulgarian protein isolate for tuberculin PPD. Epidemiologiya, mikrobiologiya i infektsionni bolesti. 1980; 27(1): 68-73. (in Bulgarian)

Magnusson J.H., Bentson M.W. Preparation of purified tuberculin RT 23. World Health Organ. 1958; 19(5): 829-43.

Turcotte R., Des Ormeaux Y. Influence of the age of mycobacterial cultures on the protein and carbohydrate composition on tuberculins. Can. J. Microbiol. 1972; 18(5): 637-45.

Edward Z.B., Palmer C.E. Epidemiological studies of tuberculin sensitivity. 1. Preliminary results with purified derivatives prepared from atypical acid-fast organisms. Amer. J. Hyg. 1958; 68: 213-31.

Levy D.T., Jablokova T.B. Comparative study of biological potencies of different tuberculins. BCG vaccines and tuberculins. Academia Kiado, Budapest.1986; part B: 581-4.

Guld J., Bentzon M.W., Bleiker M.A., Griep W.A., Magnusson M., Waaler H. Standardization of a new batch of purified tuberculin (PPD) intended for International use. Bull. World Health Organ. 1958; 19(5): 845-951.

Magnusson M. Das tuderculin Herstellung, Reinigung, Standardisierung und chemischtrer Aufbay. In: Infertions - Krankheiten und ihre Errwger. V. 4. Part 11. Jena: VEB Gusta Fischer Verlag; 1967.

Magnusson M. PPD of mammalian. Memorandum on stabilising diluents, containing tween-80, for tuberculin, and a New Working preparation of PPD, Purified tuberculin, RT23. Bull. World Health Organ. BS. 1959; 21: 448.

Castañón-Arreola M., Lópes-Vidal Y. A second-generation anti TB vaccine is long overdue. Ann. Clin. Microbiol. Antimicrob. 2004; 3(3): 10. doi: 10.1186/1476-0711-3-10.

Miller S.D., Jones H.Е. Correlation of lymphocyte transmission with tuberculin skin-test sensitivity. Amer. Rev. Resp. Dis. 1973; 107(4): 530-8. doi: 10.1164/arrd.1973.107.4.530.

Nilsson B.S., Magnusson M. Comparation of the biological activity of tuberculins by the use of lymphocyte culture. Am. Rev. Respir. Dis. 1973; 108(3): 565-70. doi: 10.1164/arrd.1973.108.3.565.

Nye P.M., Price J.E., Revancar C.R., Rook G., Stanford J.L. The demonstration of 2 types of suppressor mechanism in leprosy patients and their contacts by quadruple skin-testing with mycobacterial reagent mixtures. Leprosy. Rev. 1983; 54(1): 9-18.

General Monograph 3.3.1.0023.15 Tuberculin purified (PPD) (allergen tubercle purified). The State Pharmacopoeia of Russian Federation [Gosudarstvennaya farmakopeya Rossiyskoy Federatsii]. 13rd ed. V. 3. Moscow; 2015. (in Russian)

Comstock G.W., Edwards L.B., Philip R.N., Winn W.A. A comparison in the United State of America of two tuberculins, PPD-S and RT 23. Bull. World Health Organ. 1964; 31(2): 161-70.

Deil R., Loddenkemper R., Meywald-Walter K., Gottschalk R., Nienhaus A. Comparative performance of tuberculin skin test, QuantiFERON-TB-Gold in tube assay, and T-Spot.TB Test in contact investigations for tuberculosis. Chest. 2009; 135: 1010-8.

Aksenova V.A., Levi D.T., Aleksandrova N.V., Kudlay D.A., Baryshnikova L.A., Klevno N.I. Pediatric TB: Modern methods for prevention and early diagnostics. Doctor.Ru. 2017; 15(144): 9-15. (in Russian)

Slogotskaya L.V., Bogorodskaya E.M. Comparative description of immunological tests for tuberculous infection detection. Mass screen ingopportunities. Tuberkulez i bolezni legkikh. 2016; 94(5): 5-16. (in Russian)

Meisner A.F., Ovsyankina Ye.S., Stakheyeva L.B. Detection of tuberculosis in Moscow adolescents. Problemy tuberkuleza i bolezney legkikh. 2009; 86(1): 40-5. (in Russian)

Bogorodskaya E.M., Belilovsky E.M., Puchkov K.G., Senchikhina O.Yu., Shamuratova L.F. Morbidity of tuberculosis of young children in the city of Moscow and the factors affecting it. Tuberkulez i sotsial’no-znachimyye zabolevaniya. 2014; (5): 16-23. (in Russian)

Volchkova I.L., Kazimirova N.E., Pankratova L.E. Use of Diaskintest for selection of children and adolescents with latent tuberculous infection for preventive treatment. Tuberkulez i bolezni legkikh. 2015; (5): 64-5. (in Russian)

Sapozhnikova N.V., Istomina E.V., Starshinova A.A., Panteleev A.M., Zhuravlev V.Yu., Chernohaeva I.V. et al. Impact of latent tuberculous infection among groups of the advanced risk of developing tuberculosis. Tuberkulez i bolezni legkikh. 2015; (7): 123. (in Russian)

Starshinova A.A., Korneva N.V., Ananiev S.M., Dovgalyuk I.F., Ilyina N.I., Plakhtienko M.V. Comparison of diagnostic value of immunological testing (T-SPOT.TB and Mantoux test with 2 TU) in the diagnostic of latent tuberculosis infection in children with allergy in the medical history. Tuberkulez i bolezni legkikh. 2015; (7): 133-4. (in Russian)

Styblo K. The relationship between the risk of tuberculosis infection and the risk of developing infectious tuberculosis. Bull. Int. Union. Tuberc. 1985; 60: 117-9.

Watkins R., Brennan R., Plant A. Tuberculin reactivity and risk of tuberculosis: a review. Int. J. Tuberc. Lung. Dis. 2000; 4: 895-903.

Slogotskaya L.V., Bogorodsakaya E.M., Levi D.T., Seltsovsky P.P. Comparison of efficacy of Diaskintest®, a skin test with a recombinant tuberculosis allergen, used for 10 years and Mantoux tuberculin sensitivity test used for 110 years. BIOpreparaty. Profilaktika, diagnostika, lechenie. 2017; 17(2): 67-77. (In Russian) doi: https://doi.org/10.30895/2221-996X-2017-17-2-67-77.

Cole S.T., Brosch R., Parkhill J., Garnier T., Churcher C., Harris D., Gordon S.V. et al. Deciphtring the biology of Mycobacterium tuberculosis from the complete genome sequence. Nature. 1998; 393(6685): 537-44.

Mahairas G.G., Sabo P.J., Hickey M.J., Singh D.C., Stover C.K. Molecular analysis of genetic differences between Mycobacterium bovis BCG and virulent M. bovis. J. Bacteriol. 1996; 178(5): 1274-82.

Lewis K.N., Liao R., Guinn K.M., Hickey M.J., Smith S., Behr M.A. et al. Deletion of RD1 from Mycobacterium tuberculosis mimics bacille Calmette-Guérin attenuation. J. Infect. Dis. 2003; 187(1): 117-23. doi:10.1086/345862.

Harada N. Characteristics of a diagnostic method for tuberculosis infection based on whole blood interferon-gamma assay. Kekkaku. 2006; 81(11): 681-6.

Diel R., Goletti D., Ferrara G., Bothamley G., Cirillo D., Kampmann B. et al. Interferon-γ release assays for the diagnosis of latent Mycobacterium tuberculosis infection: a systematic review and meta-analysis. Eur. Respir. J. 2011; 37(1): 88-99.

Diel R., Loddenkemper R., Niemann S., Meywald-Walter K., Nienhaus A. Negative and positive predictive value of a whole-blood interferon-γ release assay for developing active tuberculosis: an update. Am. J. Respir. Crit. Care Med. 2011; 183(1): 88-95. doi: 10.1164/rccm.201006-0974OC. Epub 2010 Aug 27.

Machingaidze S., Verver S., Mulenga H., Abrahams D.A., Hatherill M., Hanekom W., Hussey G.D. et al. Predictive value of recent QuantiFERON conversion for tuberculosis disease in adolescents. 2012; 186(10): 1051-6. doi: 10.1164/rccm.201206-1134OC.

Nguyen D.T., Teeter L.D., Graves J., Graviss E.A. Characteristics associated with negative interferon-γ release assay results in culture-confirmed tuberculosis patients, Texas, USA, 2013-2015. Emerg. Infect. Dis. 2018; 24(3): 534-40. doi: 10.3201/eid2403.171633.

Luetkemeyer A.F., Charlebois E.D., Flores L.L., Bangsberg D.R., Deeks S.G., Martin J.N. et al. Comparison of an interferon-gamma release assay with tuberculin skin testing in HIV-infected individuals. Am. J. Respir. Crit. Care Med. 2007; 175(7): 737-42.

Soysal A., Torun T., Efe S., Gencer H., Tahaoglu K., Bakir M. Evaluation of cut-off values of interferon-gamma-based assays in the diagnosis of M. tuberculosis infection. Int. J. Tuberc. Lung Dis. 2008; 12(1): 50-6.

Zwerling A., van den Hof S., Scholten J., Cobelens F., Menzies D., Pai M. Interferon-gamma release assays for tuberculosis screening of healthcare workers: a systematic review. Thorax. 2012; 67(1): 62-70. doi:10.1136/thx.2010.143180.

Ringshausen F.C., Schablon A., Nienhaus A. Interferon-gamma release assays for the tuberculosis serial testing of health care workers: a systematic review. J. Occup. Med. Toxicol. 2012; 7(1): 6. doi: 10.1186/1745-6673-7-6.

Kiazyk S., Ball N.B. Latent tuberculosis infection: an overview. Can. Commun. Dis. Rep. 2017; 43(3-4): 62-6.

Saracino A., Scotto G., Fornabaio C., Martinelli D., Faleo G., Cibelli D. et al. QuantiFERON®-TB Gold In-Tube test (QFT-GIT) for the screening of latent tuberculosis in recent immigrants to Italy. New Microbiol. 2009; 32(4): 369-76.

Pan L., Jia H., Liu F., Sun H., Gao M., Du F. et al. Risk factors for false-negative T-SPOT.TB assay results in patients with pulmonary and extra-pulmonary TB. J. Infect. 2015; 70(4): 367-80. doi: 10.1016/j.jinf.2014.12.018.

Auguste P., Tsertsvadze A., Pink J., McCarthy N., Sutcliffe P., Clarke A. Comparing interferon-gamma release assays with tuberculin skin test for identifying latent tuberculosis infection that progresses to active tuberculosis: systematic review and meta-analysis. BMC Infect. Dis. 2017; 17(1): 200. doi: 10.1186/s12879-017-2301-4.

Chiappini E., Bonsignori F., Accetta G., Boddi V., Galli L., Biggeri A., De Martino M. Interferon-γ release assays for the diagnosis of Mycobacterium tuberculosis infection in children: a literature review. Int. J. Immunopath. Pharmacol. 2012; 25(2): 335-43.

Rose M.V., Kimaro G., Nissen T.N., Kroidl I., Hoelscher M., Bygbjerg I.C. et al. QuantiFERON®-TB gold in-tube performance for diagnosing active tuberculosis in children and adults in a high burden setting. PLoS One. 2012; 7(7): e37851. doi: 10.1371/journal.pone.0037851.

Lewinsohn D.M., Leonard M.K., LoBue P.A., Cohn D.L., Daley C.L., Desmond E. et al. Official American Thoracic Society/Infectious Diseases Society of America/Centers for Disease Control and Prevention Clinical Practice Guidelines: diagnosis of tuberculosis in adults and children. Clin. Infect. Dis. 2017; 64(2): 111-15. doi: 10.1093/cid/ciw778.

Brock I., Munk M.E., Kok-Jensen A., Andersen P. Performance of whole blood IFN-gamma test for tuberculosis diagnosis based on PPD or the specific antigens ESAT-6 and CFP-10. Int J. Tuberc. Lung Dis. 2001; 5(5): 462-7.

Kiselev V.I., Paltsev M.A., Perelman M.I., Baranovsky P.М. Scientific justification and creation of the allergen of the tuberculosis recombinant (protein CFP10-ESAT6) - preparation «DIASCINTEST». In: Paltsev M.A., ed. The skin test with the preparation “DIASCINTEST” - new opportunities for identification of tuberculosis infection. [Kozhnaya proba s preparatom “DIASKINTEST” - novyye vozmozhnosti identifikatsii tuberkuleznoy infektsii]. Moscow: Meditsina, 2010: 40-54. (in Russian)

Aksenova V.A., Levy D.T., Klevno N.I., Senchikhin P.V., Dolzhenko E.N., Baryshnikova L.A. at al. Detection of tuberculosis and tactics of dispensary surveillance of persons at risk for TB disease using a skin test with the preparation “DIASCINTEST”. In: Paltsev M.A., ed. The skin test with the preparation “DIASCINTEST” - new opportunities for identification of tuberculosis infection. [Kozhnaya proba s preparatom “DIASKINTEST” - novyye vozmozhnosti identifikatsii tuberkuleznoy infektsii]. Moscow: Meditsina, 2010: 107-20. (in Russian)

Aksenova VA, Levi DT. Tuberculosis in children and adolescents. BIOpreparaty. Profilaktika, diagnostika, lechenie. 2012; (1): 22-7. (in Russian)

Slogodskaya L.V. Ovsyankina ES, Kochetkov Ya.A., Staheeva L.B. Infection of children and adolescents with tuberculosis is a century - old sight. Tuberkulez i bolezni legkikh. 2011; 88(3): 21-8. (in Russian)

Slogodskaya E.V., Tuntarova L.M., Voloshina E.P., Senchikhina O.Yu., Kyarimova S.I. Work in the foci of tuberculosis infection in student groups. In: Bogorodskaya E.M., Seltsovskii P.P. Foci of tuberculosis infection in the megalopolis: identification, identification, elimination. [Ochagi tuberkuleznoy infektsii v megapolise: vyyavleniye, identifikatsiya, likvidatsiya]. Moscow: MSCBT; 2015: 144-55. (in Russian)

Ovsyankina E.S., Slogodskaya E.V., Gubkina M.F. Recommendations for the use of skin test with preparations of the allergen tuberculosis recombinant 0.2 mg in 0.1 ml solution for intradermal administration (DIASCINTEST®) to identify tuberculosis infection in children and dispensary observation in anti-tuberculosis facilities. Guidelines. [Rekomendatsii po primeneniyu kozhnoy proby s preparatami allergen tuberkuleznyy rekombinantnyy 0,2 mg v 0,1 ml rastvor dlya vnutrikozhnogo vvedeniya (DIASKINTEST®) dlya identifikatsii tuberkuleznoy infektsii u detey i dispansernogo nablyudeniya v protivotuberkuleznykh uchrezhdeniyakh. Metodicheskiye rekomendatsii]. Мoscow: MNPTSBT; 2010. (in Russian)

Ovsyankina E.S., Slogodskaya E.V., Gubkina M.F. Recommendations for the use of skin test with preparations of the allergen tuberculosis recombinant 0.2 mg in 0.1 ml solution for intradermal administration (DIASCINTEST®) to identify tuberculosis infection in children and dispensary observation in anti-tuberculosis facilities. Guidelines. [Rekomendatsii po primeneniyu kozhnoy proby s preparatami allergen tuberkuleznyy rekombinantnyy 0,2 mg v 0,1 ml rastvor dlya vnutrikozhnogo vvedeniya (DIASKINTEST®) dlya identifikatsii tuberkuleznoy infektsii u detey i dispansernogo nablyudeniya v protivotuberkuleznykh uchrezhdeniyakh. Metodicheskiye rekomendatsii]. Мoscow: MNPTSBT; 2010. (in Russian)

Aksenova V.A., Levi D.T., Aleksandrova N.V., Kudlay D.A. Current tuberculosis incidence among children; medicines for prevention and diagnosis of TB. Profilaktika, diagnostika, lechenie. 2017; 17(3): 145-51. (in Russian)

Korneva N.V., Starshinova A.A., Ovchinnikova Yu.Z., Dovgalyuk I.F. Comparison of Mantoux test results with 2 TE and Diaskintest for various manifestations of tuberculosis infection. Tuberkulez i bolezni legkikh. 2013; 90(6): 49-50. (in Russian)

Dolzhenko E.N., Sheykis E.G., Seregina I.V. Diagnostic opportunities of tuberculous recombinant allergen for screening for tuberculous infection in adolescents of Rayzan region. Tuberkulez i bolezni legkikh. 2015; (6): 56-7. (in Russian)

Barmina N.A., Baryshnikova L.A., Shurygin A.A., Reykhardt V.V. Latent tuberculous infection screening using recombinant tuberculous allergen. Tuberkulez i bolezni legkikh. 2016; 94(5): 56-60. https://doi.org/10.21292/2075-1230-2016-94-5-56-60. (in Russian)

Titlova I.V., Sharipova O.M., Azamatova M.M., Pleshakova A.V., Kuznetsova O.V. Analysis of the sensitivity of the Mantoux test and diaskintest in children and adolescents with active tuberculosis. VI All-Russian Scientific-Practical Conference with International Participation “Actual issues of prevention, diagnosis and treatment of tuberculosis in children and adolescents.” [VI Vserossiyskaya nauchno-prakticheskaya konferentsiya s mezhdunarodnym uchastiyem “Aktual’nye voprosy profilaktiki, diagnostiki i lecheniya tuberkuloza u detey i podrostkov”]. Sochi; 2018. Available at: http://www.humanhealth.ru/images/conference/29-31_03_2018_Sochi/Tezisy.pdf (in Russian) (accessed 27 July 2018).

Fatykhova R.Kh., Alekseev A.P. Detection of tuberculosis in adolescents: immunodiagnostics or fluorography? VI All-Russian Scientific-Practical Conference with International Participation “Actual issues of prevention, diagnosis and treatment of tuberculosis in children and adolescents.” [VI Vserossiyskaya nauchno-prakticheskaya konferentsiya s mezhdunarodnym uchastiyem “Aktual’nye voprosy profilaktiki, diagnostiki i lecheniya tuberkuloza u detey i podrostkov”]. Sochi; 2018. (in Russian) Available at: http://www.humanhealth.ru/images/conference/29-31_03_2018_Sochi/Tezisy.pdf (accessed 27 July 2018).

Kopylova IF, Efimova IV The importance of the response to the allergen tuberculosis recombinant in assessing the effectiveness of treatment of tuberculosis in children. VI All-Russian Scientific-Practical Conference with International Participation. “Actual issues of prevention, diagnosis and treatment of tuberculosis in children and adolescents.” [VI Vserossiyskaya nauchno-prakticheskaya konferentsiya s mezhdunarodnym uchastiyem “Aktual’nye voprosy profilaktiki, diagnostiki i lecheniya tuberkuloza u detey i podrostkov”]. Sochi; 2018. (in Russian) Available at: http://www.humanhealth.ru/images/conference/29-31_03_2018_Sochi/Tezisy.pdf (accessed 27 July 2018).

Ovsyankina E.S., Gubkina M.F., Panova L.V., Yukhimenko N.V. Analysis of the effectiveness of tuberculin skin tests for diagnosing tuberculosis infection in children and adolescents. Voprosy prakticheskoy pediatrii. 2015; 10(5): 36-43. (in Russian)

Hoff S.T., Peter J.G., Theron G., Pascoe M., Tingskov P.N., Aggerbeck H. et al. Sensitivity of C-Tb: a novel RD-1-specific skin test for the diagnosis of tuberculosis infection. Eur. Respir. J. 2016; 47(3): 919-928. doi: 10.1183/13993003.01464-2015.

Vladimirsky M.A. Immunological methods for tb infection diagnostics in children and adolescents. challenges and opportunities. Immunologiya. 2018; 39(1): 61-6. doi: 10.18821/0206-4952-2018-39-1-61-66. (in Russian)

Plekhanova M.А., Аksenova V.А., Tkachuk А.P., Patsula Yu.I., Krivtsova L.А., Kolomeets А.N. Evaluation of specific antigens at the early stage of tuberculous infection in children. Tuberkulez i bolezni legkikh. 2017; 95(1): 27-33. doi: 10.21292/2075-1230-2017-95-1-27-33. (in Russian)