Over the last decade, the positive trends in the demographic indicators of St. Petersburg are related, among the others, to the sustainable reduction of infant mortality, however the specifics of demography of a large city of federal importance is characterized by high migratory increase. Now the megalopolis is the region with the lowest infant mortality rates. This target demographic indicator is the pride of St. Petersburg and is closely monitored. Achievements in reducing of infant mortality were fulfilled through a system of work with pregnant women and newborns with low, very low and extremely low birth weight. Significant impact has also been adopted by the legislative acts, which, at present, are included into a single normative document — «Social code of St. Petersburg». The main purpose of the article is an extended analysis of the mortality rate due to transition to the new medical criteria of birth. The analysis demonstrates that the transition to the new criteria of live birth has made changes in the structure of infant and perinatal mortality, which requires further improvement and new approaches to the executive monitoring of this important social marker.

This review represents a modern view to the intestinal microbiocenosis and possibilities of influence on it with the means of prebiotic food components. Status of intestinal microbiota is one of the main factors of children health. As it was shown in the recent studies, certain constancy of microbiota of every individual in many respects is determined genetically. Intestinal microflora directly influence on the formation of the child immune system, provide protection from pathogens and participates in all types of metabolism. In its turn the intestinal microbiocenosis itself depends on the status of the macroorganism and exogenous factors, with nutrition being the most significant of them. As a matter of fact, there is a combined evolution of nutrition, intestinal microbiocenosis and intestinal mucous membrane with associated to it lymphoid tissue. Supplementation of nutritive components, contributing to vegetation of the «useful» microflora, with food is an effective mechanism of «dietary manipulation» of intestinal biocenosis. Biological effects of prebiotics are discussed in detail. Oligosaccharides of the breast milk have a number of biological effects, which exceed the limits of only prebiotic action. However including of prebiotic components with proved effects into children milk formulas and porridges adds these products prophylactic and therapeutic-prophylactic characteristics.

Aim: to perform retrospective evaluation of tocilizumab (TCZ) treatment every 2 and 4 weeks. Patients and methods: 33 children with systemic juvenile idiopathic arthritis (sJIA) were observed. Results: children, who need TCZ treatment every 2 weeks had more severe sJIA course. Patients which were treated every 4 weeks had higher TCZ efficacy, no new cases of macrophage activation syndrome (MAS), lower frequency of organ involvement and relapses during TCZ treatment. In 5 (20,8%) children of this group the TCZ-free remission was achieved, and in 3/5 children total drug-free remission lasted the maximum 1085 days was reached. Only 1 children in 4 weeks group developed relapse which leaded to re-start of TCZ treatment with the same efficacy as at first. No patients, who were treated every 2 weeks experienced TCZ-free remission. Also 4 cases of MAS were detected in children who had MAS before the start of TCZ. In 3/4 TCZ was discontinued but in 1 MAS TCZ accompanied with corticosteroids was prolonged. No new MAS cases were detected during this study. Infusion reactions lead to TCZ discontinuation were in 9,1%. 1 death (3,0%) during the trial. Conclusions: we offered the set of clinical and laboratorial criteria of high and low risk patients who need TCZ treatment every 2 and 4 weeks consequently.

Key words: systemic juvenile idiopathic arthritis, interleukine-6, tocilizumab.

Aim: to evaluate the impact of subcutaneous interferon β-1a on matrix metalloproteinases 3, 8, 9 (MMP), cytokines (tumor necrosis factor α — TNF α, and transforming growth factor β1 — TGF β1) levels in serum of children with relapsing-remitting multiple sclerosis. Patients and methods: the results of treatment of 32 patients with relapsing-remitting multiple sclerosis aged 12–18 years (22 girls and 10 boys) were analyzed. Treatment efficacy was assessed by the number of relapsing-remitting multiple sclerosis exacerbations during 12 months, MRI data, MMP and cytokines dynamics in serum. Results: statistical evidence acquired for MMPs, their tissue inhibitor and cytokines levels decrease (p < 0,005) in patients receiving therapy with subcutaneous INF β-1a. Conclusions: subcutaneous interferon β-1а is highly efficient in treatment of relapsing-remitting multiple sclerosis in children and adolescents.

Cystic fibrosis is a disease, which involves multiple organs and systems, and treatment of this disorder requires a complex approach (combination of medicinal and non-medicinal methods). Specialized medical care in centers for cystic fibrosis treatment allows to improve the patients’ rates of survivability and quality of life. This article contains information on the main drugs used nowadays in cystic fibrosis therapy. The authors describe the special characteristics of dornase alfa use in children of various age groups and detail the effects of this drug: powerful mucolytic, anti-inflammatory and antibacterial actions. The rationality of including of this drug into the basic therapy both with preventative and medicinal aims as soon as a patient is diagnosed with cystic fibrosis is substantiated. It is shown, that in cases of chronic Pseudomonas aeruginosa infections a patient’s condition can be stabilized with the means of continual tobramycin or sodium colistimethate inhalations, as well as the new powder form of tobramycin. It was noted, that in cystic fibrosis pancreatic enzyme can be effective only in forms of minimicrospheres. For the first time the new algorithm of complex treatment of this disease according to the symptoms and complications was offered by the authors.

 

The article contains evidence-based modern criteria for choosing specialized phenylalanine-free foods with L-amino-acids, designed for phenylketonuria treatment in patients of all age groups.

The authors analyzed etiological factors and special issues of diagnostics of inflammatory diseases of the pharynx associated with pain in children. According to etiological factors tonsillopharyngitis can be divided into two main forms: bacterial and viral. The prevalence of viral tonsillopharyngitis is respectively high and, in contrast to bacterial form, this one does not demand systemic antibacterial treatment. The article contains information on the main medicines used for topical treatment of viral inflammation of the pharynx: saline solutions and antiseptic agents. The most appropriate topical antiseptic drug for children with tonsillopharyngitis is combined ones with amylmetacresol and dichlorobenzyl alcohol, not lidocain-containing or nonsteroidal anti-inflammatory ones. The high analgesic effect of such combination is shown in various studies. Moreover, it was found, that hexylresorcinol and amylmetacresol inhibit sodium channels 10-20 times more intensely than lidocain. Significant analgesic effect of amylmetacresol/dichlorobenzyl alcohol is observed in 5 minutes after administration and its duration is 2 hours. Decrease of virulence of influenza A, respiratory syncytial and coronaviruses under exposure to amylmetacresol and dichlorobenzyl alcohol was also proved. Availability of several medicinal forms and its high pharmacological safety make this drug the most optimal for treatment of pain syndrome in tonsillopharyngitis in children.

One of the most important — the problem of treatment of fever in children with respiratory viral infections — is discussed in this article. It is fever as one of the first symptoms of disease which often frightens parents and leads to inappropriate and excess usage of antipyretic agents, which in its turn can cause unfavorable consequences. The authors represent their own data on frequency of antipyretic drugs usage in children with respiratory viral infections, as well as the answers of pediatricians to the questionnaires on methods of choice in temperature normalization. According to the modern Russian as well as European and American clinical guidelines on treatment of fever in children the management of selection of patients demanding antipyretic treatment is detailed, indications and contraindications to such therapy are described, the most effective methods of temperature normalization in children with acute respiratory infection are discussed. The authors suggested the data on recommended dosages of paracetamol, which were revised in 2011 by the UK Medicines Control Agency, to be very useful. The current information on advantages of ibuprofen in comparison to paracetamol in treatment of fever in children with respiratory viral infections is shown. The main target of this article is understanding and acceptance by pediatricians of the modern recommendation on differential and reasonable approach to administration of antipyretic drugs in children with respiratory viral infections.

Digestive dysfunctions are common in infants of the 1^st year of life. Pediatricians often recommend shifting one milk formula to another, but usually it has no positive results, only complicating the managing of such patients. The article demonstrates the modern views on etiology, pathophysiological mechanisms and principles of dietary therapy of regurgitations, functional constipations, intestinal colic and other gastro-intestinal dysfunctions in infants. One of the special characteristics of these disorders is the fact that they rarely occur as isolated symptoms and much more often — in different combinations with each other. On clinical examination of children with functional disorders neither morphological changes in gastro-intestinal tract, nor disturbances in enzyme-secretory function are found. At the same time minimal digestive dysfunctions have negative effect on life quality of the family, development rate and nutritive status of the child. One of the most effective methods of correction of such conditions is dietary measures.

The questions of organization of rational feeding of children in the first year of life with the use of industrial production of weaning foods are discussed. The article provides guidance on the timing and sequence of the introduction of complementary baby food in healthy children and children with alimentary disorders. The sequence of individual products and administration of individual meals depends on the health status, nutritional status of the child and the state of his digestive system. In the diet of the child should be used food and meals of industrial production, made of raw materials of high quality which meet the stringent hygienic requirements for safety parameters and have guaranteed by chemical composition. The article presents data on practical advice on the introduction of feeding in the Centre of breast feeding support and management of Tomsk.

Problem of effective and safe treatment and prophylaxis of acute respiratory tract infections is one of the most topical problems in clinical pediatrics. In this article the possibility of usage in treatment of acute respiratory viral infections an immunostimulating drug with antiviral action — pranobex. The author describes mechanisms of combined immunomodulatory and antiviral action of this drug, shows data on its efficacy and tolerability in children. The demonstrated data of literature review and the results of the author’s own studies evidenced that administration of inosine pranobex relieved symptoms of acute respiratory viral infection, prevent development of complications and restores the weakened immunity, allows decreasing of the requirements of other drugs and medicinal load to the organism. Characteristics of this drug widen the possibilities of pharmacotherapy of acute respiratory viral infections in children. Anaysis of publications on efficacy of this drug, as well as the author’s own data allow to recommend inosine pranobex for treatment of acute respiratory tract infections in frequently ill children, patients with chronic diseases (including allergic disorders of the respiratory tract) and intercurrent acute respiratory tract infections.

Atopic dermatitis is a chronic inflammatory cutaneous disease, which demands a prolonged treatment. A modern views on the main approaches to treatment of atopic dermatitis in children and adults are analyzed in this article. The treatment is based on the permanent use of emollients in order to achieve an anti-inflammatory effect — topical calcineurin inhibitors (tacrolimus and pimecrolimus), and short courses (5 days) of topical corticosteroids during relapses. For the 10-year period of topical calcineurin inhibitors usage in treatment of atopic dermatitis a great amount of experimental and clinical data have been accumulated. Two the most important changes and additions in the treatment of atopic dermatitis in recent times were related to a new hypothesis of proactive therapy with the use of topical tacrolimus and closing of «black box» warnings, associated to malignization risk due to the long-term usage of topical calcineurin inhibitors. Since atopic dermatitis is characterized by relapsing course, nowadays topical tacrolimus should be considered the most appropriate treatment approach, both in adults and children. The results of investigations confirmed more than 6-times decrease in relapse rate, as well as the significant improvement of quality of life, when the above-mentioned treatment scheme is used, both in children and adults.

Key words: children, atopic dermatitis, emollients, treatment, tacrolimus.

Recently probiotics have attracted more and more attention of clinicians and researchers. According to the results of numerous studies, these agents are effective in treatment of acute and chronic diseases of the gastro-intestinal system, and possibility of usage of such drugs in patients with allergic disorders and frequent respiratory tract infections is under active investigation. This review contains data on bifido- and lactobacteria usage in patients with the above-mentioned conditions. It was shown, that lactobacteria have little effect in prophylaxis and treatment of allergic diseases in infants younger 1 year of life, while their efficacy was observed in older patients. According to the results of clinical trials, probiotics with bifido- and lactobacteria decrease the frequency and severity of respiratory infections. Frequently and protractedly ill children are characterized by persistent combined viral-bacterial and viral-bacterial-fungal associations resistant to therapy. In the experimental studies it was established, that species and cultures of lacto- and bifidobacteria including into the composition of a new combined probiotic drug have antagonistic action to conditionally pathogenic causative agents, restore integrity of the intestinal epithelium and increase cytokine production by the immunocompetent cells. Moreover, there are data on antiviral action of lactobacteria. All these makes the above-mentioned combined probiotic a promising drug for complex therapy of frequently and protractedly ill patients with mixed infections.

Aim: to assess special characteristics of disease course, development of concomitant diseases and enzymatic status of gastro-intestinal tract in children with chronic gastroduodenitis, living over the territory of Kursk magnetic anomaly. Patients and methods: 120 children with confirmed diagnosis of chronic gastroduodenitis (among them 60 patients from Kursk and 60 patients from Zheleznogorsk) were performed complex clinical examination. Results: the prevalence of gastroduodenal disorders were 2,7 times higher among children from Zheleznogorsk, than among children from Kursk. Early beginning of chronic gastroduodenitis in children of Zheleznogorsk must be mentioned. The mean age of the onset of the disease in Kursk is 6,4±0,4 years, while in Zheleznogorsk — 5,0 ± 0,4 years (p <0,01). The most common concomitant diseases in Zheleznogorsk children were reactive changes of hepatobiliary system and combination of chronic gastroduodenitis with allergic pathology. On coprological test the majority of Zheleznogorsk patients had significantly higher content of fatty acids in faeces. Conclusions: the above-mentioned changes can be evidence of insufficient enzymatic activity of certain components of digestive juices. Children with chronic gastroduodenitis living over the territory of Kursk magnetic anomaly should be isolated into a separate group of patients. It will allow rational correction of standard schemes of treatment with accordance to established characteristics.

Aim: to study clinic-epidemiologic and immunologic characteristics of clinical manifestations of chronic adenoiditis associated with chlamydia infection in children. Patients and methods: 169 children aged from 3 to 15 years old administered to the ENT-department due to inefficacy of out-patient treatment were examined. In order to identify chlamydia structures and specific antibodies direct (polymerase chain reaction, direct immunofluorescence assay) and indirect (immunoenzyme assay) were used. Assessment of the cellular immunity was performed with the method of indirect immunofluorescence assay with monoclonal antibodies. Results: the authors showed a high contamination of the epithelium of pharyngeal mucous membrane with chlamydia infection, described cultural structure of the verified chlamydia and clinical manifestations as well as special characteristics of immune responseп of children with chronic adenoiditis associated with this infection. Conclusions: clinical manifestations of chronic adenoiditis in chlamydia-infected children does not have clear pathognomonic signs; there are special characteristics of immune reactivity in children with verified chlamydia infection, such as more prominent imbalance of T-cell immunity and less intensity of antibody response; association of chlamydia with extracellular bacterial infection aggravates imbalance of the immune system and leads to inhibition of the both forms of the immune response.

Aim: to study clinical manifestation of neurasthenia in adolescents with school disadaptation and to assess efficacy of deanol aceglumate in treatment of this disorder. Patients and methods: 64 adolescents aged from 14 to 17 years with neurasthenia were included into the study. Control group consisted of 64 practically healthy adolescents. Diagnostic methods: subjective scale for asthenia assessment (MFI-20), visual analogue scale for asthenia manifestations assessment (10-points scale), C. D. Spielberger’s state-trait anxiety test, vegetologic examination with A. M. Vein’s questionnaire, psychophysiological investigation with TOVA (Test of Variables of Attention), quantitative electroencephalography. Results: vegetative dysfunction, decrease of attention level and reaction speed, as well as increased level of reactive anxiety (reliably higher than in control group of healthy participants) was revealed. The results of quantitative electroencephalography demonstrated significant decrease of alpha-rhythm spectrum power in occipital leads in comparison with respective characteristic in the control group. The results of clinical and psychological studies, performed after the treatment course, showed high clinical efficacy of deanol aceglumate in this disorder in adolescents (the improvement was achieved in 44 (68,8%) of patients). Conclusions: deanol aceglumate in treatment of asthenic disorders in adolescents with school disadaptation is characterized by high efficacy. Due to absence of its influence on anxiety level, combination of this medicine with nonbenzodiazepine anxiolytics can be suggested to increase the efficacy of the treatment.

Aim: to investigate sFas-receptor and its ligand, sFas-L, cytochrome C and annexin V as the apoptotic markers in children with CKD to determine the renal cell apoptosis role in the progression of a renal disease. Patients and methods: 68 children with CKD 1–3 from 3 to 17 years were examined. Results: sFas-R, sFas-L, annexin V significant differed from normal value at all stages of CKD. Cytochrome C level was significantly higher than normal in children with CKD1. But tended to increase at and 2 and 3 stages correspondingly. Significant correlation was determinated between proteinuria and the combination of all four markers. Сomparing serum levels of apoptosis markers in children with non-immune disorders without renal dysfunction treated and iACE not treated and in patients with CKD-2 t a significant excess of the level of sFas-R in patients without iACE therapy was found. Conclusions: Fas-mediated and mitochondrial programmed cell death are implicated in development and progression of CKD. ACE inhibitors reduced the severity of apoptosis, primarily by inhibiting the activity of its Fas-mediated pathway.

Aim: to establish prognostic morphological criteria of complicated clinical course of Crohn’s disease in children. Patients and methods: morphometric and histological characteristics of the mucous membrane of the large intestine were studied in 27 patients with colitis form of Crohn’s disease on their first admission to a hospital. Results: the most informative predictive morphological criteria for unfavorable prognosis were the following: predominance of the non-active macrophages tending to aggregation in the lamina propria mucosae; destructive vasculitis; increase in the number of fibroblastic cells with the prevalence of the young forms. Non-active macrophages and immature fibroblasts under hypoxia conditions, associated with necrotizing vasculitits, are the factors which contribute to development of fibrosis in the mucous membrane of the large intestine. Conclusitons: unfavorable prognostic morphological criteria of Crohn’s disease were determined. These criteria allow using more aggressive treatment management («top-down» scheme) with early administration of steroid, cytostatic and anti-cytokine drugs in order to prevent the development of complications due to intestinal fibrosis.

Aim: to evaluate serum concentrations of cytokines (pro-inflammatory — interleukin 8 (IL8) and tumor necrosis factor α (TNF α); anti-inflammatory — IL 10; immunoregulatory — IL 6), α₂-macroglobulin (MG), its immune complexes (MG-IgG) and several other inflammatory markers (α₁-antitrypsin and lactoferrin) in healthy children aged from 2 to 12 years old and in patients with chronic adenoidits of the same age group. According to received data — to prove reasonability of usage of herbal drug with anti-inflammatory and immunostimulating effects in a complex treatment of children with adenoiditis. Patients and methods: 22 healthy children (control group) and 62 children with chronic adenoiditis (CA) were examined. Results: it was found that serum concentration of MG, MG-IgG, α₁-antitrypsin and IL 10 is significantly higher in children with CA. The level of lactoferrin is also increased. The abovementioned changes in coupled with tendency to decrease of IL 8 concentration in CA suggest that this condition is characterized mainly by compensated immune reactions according to Th₂-type. However, certain characteristics of protein and cytokine metabolism in CA contribute to chronization of pathological process, which clinically is manifested by prolonged torpid inflammation. Taking into account special features of CA pathogenesis and in order to increase efficacy of treatment of this disorder an herbal drug with complex action was used. Conclusions: including of the studied drug into the scheme of CA treatment increases efficacy of provided therapy and accelerates temps of convalescence. The drug is safe and can be used for prolonged periods of time.

Aim: to assess the influence of probiotic milk formula on the functional and nutritive status as well as the microbiocenosis of 32 infants of the 1st year of life. Patients and methods: 32 infants (15 — younger than 6 months and 17 — older than 6 moths) fed with artificial milk formulas were under the observation. The majority of mothers were primipara, with various pregnancy disorders. The infants were followed-up in out-patient clinics with different diseases: cerebral ischemia, perinatal injure of the nervous system, anemia and others. As a main basic food the children received powder adapted formula. In order to achieve the aim, from 2 to 3 feedings in infants’ diet have been changing to the powder adapted formula during 4 weeks. To assess the results the data of clinical examination and characteristics of coprological and microbiological tests were used. Results: weight gain in the majority of infants was more than 700 g for 1 month. In 8 children the symptoms of functional gastrointestinal disorders were arrested. Control coprolocical and microbiological tests in 1 month after the formula administration showed positive pre- and probiotic effects as increase of bifidobacteria titer in all the patients who had had their decreased levels, as well as decrease of the amount of patients with associations of conditionally-pathogenic flora. Conclusions: the investigated product has positive effect on the intestinal microbiota and contributes to arresting of various types of gastrointestinal disorders.

Causes of dysphonia in children and adolescents vary from genetic syndromes, congenital defects, diseases of various organs and systems and to non-observance of hygiene or voice overstrain. Complex examination can help to reveal such causes. Laryngeal endoscopy remains one of the most reliable methods of investigation, but non-invasive methods (acoustic voice analysis — AVA, electroglottography — EGG) are no less important. The more detailed specification of voice timbre disturbances (organic or functional, with psycho-emotional lability being the most common cause) can help choose the method of its correction. Complex homeopathic drugs are promising in treatment of dysphonia of various etiology in children. Aim: to assess reliability of non-invasive methods of voice examination (AVA and EGG) in treatment of functional dysphonia in children. Patients and methods: 100 patients with dysphonia aged from 3 to 15 years old were examined. All of them were performed laryngeal endoscopy, AVA and EGG. Results: both methods demonstrated reliable differences of characteristics, describing the quality of voice before and after the treatment. Conclusions: AVA and EGG reflect changes in voice quality during and after provided treatment (including complex homeopathic drugs) and can be used as unbiased criteria of treatment efficacy assessment.

Breast milk is an optimal food for infants of the first months of life, but there are certain contradictions to early onset of breastfeeding. These contradictions can be due to mothers or children causes. Maternal contradictions are: severe conditions and decompensation conditions, as well as several infectious diseases. Children contradictions include low Apgar score, severe prematurity, severe maxillofacial congenital defects, II–III stages of cerebral circulation disturbances, severe asphyxia. In all of these cases an appropriate adapted milk formula which meet all the modern standards and has a composition as much as possible close to the breast milk, should be chosen. Aim: to study tolerability of adapted milk formula in full-term infants at the age of 0–6 months old, administered to different medical facilities of the Russian Federation. Patients and methods: 3567 infants (among them 2849 from department of neonatal physiology and 718 — from general pediatric departments) were included into the open-label multicenter postmarketing clinical trial. Results: good tolerability of the milk formula was established in 3543 (99,3%) of infants, 24 (0,7%) of children had undesirable reaction in the form of erythema, which is not higher than the mean population values. Conclusions: milk formula has good tolerability and can be recommended as a primary feeding product for the healthy full-term infants if breast-feeding is impossible due to various causes.

The article covers the issues of etiology, clinical manifestations and treatment of acute otitis media in children. The author emphasized the high prevalence of this disease, listed the spectrum of causative agents and described clinical manifestations of otitis media. It was mentioned, that usage of topical antibacterial agents is a significant additional measure to systematic antibacterial treatment. Efficacy of one of such topical agents was assessed in this study. Unlike many other topical antibacterial agents, the studied drug does not have ototoxic side effect, therefore it can be used in perforated forms of otitits media. Application of this medication in perforated stage of acute purulent otitis media allows to intensify antibacterial action of systemic antibiotic and to increase the quality of treatment.

Influenza — is an acute viral infection, transmitted by droplet contact. Influenza virus is characterized by its ability to provoke yearly seasonal epidemics, which have great influence on all age populations and are a significant problem for the public health care. This disease can lead to development of severe complications, especially in infants. There are two methods of influenza prophylaxis — specific (vaccination) and non-specific (immunotropic agents). The article contains data on usage of the Russian antiviral agent, which stimulates non-specific protection against influenza virus and other causative agents of respiratory viral infections, especially in infants. A new powder form of the drug which can be used in children from the 1st year of life is represented in the article.

Tuberculin diagnostics — is a diagnostic method of detection of specific sensitization to Mycobactrerium tuberculosis (MBT). It is used as a specific test during mass population screening on tuberculosis (mass tuberculin diagnostics) and for individual examinations (individual tuberculin diagnostics). The aims of the mass diagnostics are: revealing of the patients contaminated with MBT for the first time; revealing of the patients with hyperergic and increasing reactions to tuberculin; selection of the population for vaccination against tuberculosis with weakened BCG vaccine in infants older than 2 months of life who had not been vaccinated after birth, as well for re-vaccination with BCG vaccine; early diagnostics of tuberculosis in children and adolescents; determination of epidemiological characteristics of tuberculosis (population contamination with MBT, yearly risk of contamination with MBT). On mass tuberculin diagnostics it is used only the united intradermal tuberculin Mantoux test with 2 tuberculin units (TU) of purified tuberculin in standard solution (prepared form). In the article the author discusses questions of tuberculosis diagnostics in children and adolescents, lists indications to mass tuberculin diagnostics with Mantoux test with 2 TU PPD and test with recombinant tuberculosis allergen. Advantages of both methods, which should be used in order to increase efficacy of tuberculosis diagnostics among children population, are described. It was concluded that switch to the mass screening of tuberculosis with the means of recombinant tuberculosis allergen is not rational under current conditions. The appropriateness of 2-steps examination (necessity of test with recombinant tuberculosis allergen after receiving a positive result of Mantoux test with 2 TU PPD) is explained.