Problemy tuberkuleza最新文献

Examining active tuberculosis in 38 infants has established the following features: the disease is characterized by predominantly (71%) classical forms of primary tuberculosis; moreover, a primary tuberculosis complex is more common (41.7%) than tuberculosis of intrathoracic lymph nodes (26.3%); by complicated tuberculosis in more than a third of the infants, by extrapulmonary tuberculosis in 23.7%, and by the affliction of 2 systems in 13.2%. Tuberculosis runs most severely in children under 1 year of age. The group at the highest risk for tuberculosis may include infants contacting patients with tuberculosis (65.8%), ill vaccinated infants with BCG (89.4%), infants with symptoms of intoxication and thoracic complaints (79.3%), and those with hyperergic and pronounced sensitivity to tuberculin.

Healthy individuals and patients with pulmonary tuberculosis were typed by HLA antigens A, B, and C. They were all Tyvians and lived in different regions of the Republic of Tyva. Examination was made in 128 and 85 healthy individuals and 62 and 55 patients with pulmonary tuberculosis from the Todzhinsky and Erzinsky districts of the Republic of Tyva, respectively. The healthy populations of the districts in question were found to differ in a number of Class 1 HLA antigens, such as A3, A10, A11, A28, B7, B27, Cw4. In the Todzhinsky district, tuberculosis morbidity rates were also ascertained to be positively associated with the HLA antigen B13 whereas in the Erzinsky district they were associated with the HLA antigen B12. The findings may be used to form tuberculosis-risk groups in the study districts.

The paper is dedicated to the anniversary of Professor V. I. Puzik, Honored Science Worker. It gives the data of morphological studies from her dissertation and some sections of the dissertations supervised by V. I. Puzik. The paper also presents data on the diagnosis, clinical picture, and treatment of tuberculosis in adolescents. The problems of early detection, differential diagnosis, the significance of concomitant diseases and social factors in the course of tuberculosis are discussed. Emphasis is placed on the importance of drug resistance in adolescent patients with tuberculosis, which has been revealed in 63.3% of cases. Complex treatment with essential, reserve, and combined antituberculous drugs is recommended in relation to the sensitivity of Mycobacterium tuberculosis. It is also advisable to treat concomitant diseases and to prescribe pathogenetic agents enhancing the body's overall resistance.

Less interest has been recently shown in the so-called openly negative syndrome in patients with pulmonary tuberculosis, which occasionally results in healing of tuberculous caverns to form a cystoid cavity. The materials presented in this paper suggest that in the 1960s the openly negative syndrome occurred after chemotherapy in 8.7% of the patients registered at a tuberculosis facility for destructive pulmonary tuberculosis. This syndrome persists for 3 years or more (according to the data of bacterioscopy, sputum inoculation and biological test on guinea pigs). Of great interest are the data of histological study made under the head of Prof. V. I. Puzik on experimental animals. The absence of specific reactions in response to a biological test and the presence of significant lymphoid focal and diffuse infiltration in the lungs, hyperplasia of follicles of the spleen and lymph nodes allow them to be regarded as immunomorphological reactions in response to the protein components of destroyed Mycobacterium tuberculosis (MBT). The long existing openly negative syndrome is also presented observed in patients with pulmonary tuberculosis but only in those who isolate MBT sensitive to antituberculous agents. In this connection, it is not inconceivable that special reparative processes that do not result in the long (3 years or more) existing openly negative syndrome in patients with destructive pulmonary tuberculosis who isolate resistant MBT forms.

To improve the organization of timely detection of recurrences of pulmonary tuberculosis under the present conditions assumes a differential approach to following up the persons recovered from tuberculosis or to observing them in the outpatient setting with emphasis on socially defective contingents.

The value of histological and histochemical studies in the diagnosis of a phase of tuberculosis progression or healing is shown. Electron microscopic study of tuberculous inflammation in different phases of its evolution evaluated the functional status of cellular elements of the lung and granuloma. The body's antituberculous resistance due to molecular genetic mechanisms is realized through intercellular interactions and macrophageal functions. Immune macrophages are characterized by a higher metabolic activity, they suppress the intracellular multiplication of Mycobacterium tuberculosis (MBT) and are more protected from their toxic action. The pathogenetic mechanisms responsible for caseous pneumonia were studied. Three stages of evolution of the process: Stage 1 is the breakdown of defense and adaptive mechanisms: disorganization of connective tissue and alveolar parenchyma; enhanced permeability of blood and lymphatic microvascular walls with developed interstitial and intraalveolar edema, plasma and fibrin exudation, fibrinoid swelling of collagenous fibers, and their lysis; occurrence of lung parenchymal microinfarcts and infarction-pneumonia; type 2 alveolocytic dysfunction with surfactant destruction; Stage 2 is the breakdown of local immunity; exudative and alterative tuberculous inflammation with involvement of immunocompetent organs; suppressed T-cellular immunity, a shift of a T helper/T suppressor ratio to the latter, lymphopenia; impaired intercellular interactions, cellular apoptosis in blood and inflammation areas, and suppressed granulomatous reaction; inhibited L transformation of Mycobacteria tuberculosis, intensive MBT multiplication in the foci of tuberculous inflammation, particularly those which are resistant to many antibiotic drugs, a larger number of associations of the nonspecific microflora and fungi. Stage 3 is caseous pneumonia and generalization of a tuberculous process: a predominance of an alterative reaction of inflammation; the presence of allergic and caseous and necrotic vasculitis, bronchiolitis, and endo-panbronchitis; depressed granulomatous reaction; the development of acute alterative sequestrating pneumoniogenic caverns. Histological, histochemical, and electron microscopic studies of tuberculous inflammation may specify the mechanisms of the pathogenesis of tuberculosis and may serve as the basis for early diagnosis of the disease and for timely correction of performed treatment in order to enhance its efficiency.

The data of autopsies (n = 431) and morphological (n = 52) and bacteriological (n = 47) studies of the operating material obtained from the lungs of patients with tuberculosis during 1980-1989 and 1990-1999 were analyzed at the Research Institute of Pulmonology and Phthisiology, Republic of Belarus. The analysis revealed an increase in the incidence of acutely progressive forms of pulmonary tuberculosis. Autoptic data indicated that in 83.7% of cases, acute progressive tuberculosis was associated with the development of caseous pneumonia as an independent tuberculous process (31.7%) and as a phase of ensuing development of other forms (52.0%). The distinctive morphological features of today's caseous pneumonia were as follows: a great extent of lesion, an unrestrained progression of a process, a predominance of an alterative-and-exudative component of tuberculous inflammation, a rapid decay and suppuration of caseous masses, no differentiation of caseous and pneumonic foci, and suppressed cellular reactions of tissue immunity. The morphological and bacteriological studies of the operating lung material from patients with pulmonary tuberculosis suggested that there was a predominance of a progressive disseminating process at the moment of surgery.

If the epidemiological situation is tense, new technologies should be developed and put into practice to enhance the efficiency of specific prevention, early detection, diagnosis and treatment of tuberculosis in children. There is evidence for the high efficacy and low reactogenicity of lower antigenicity-loading BCG-M vaccine that causes a 15-fold decrease in infant morbidity, as compared with that among non-vaccinated children, and this vaccine shows a 5-fold reduction in postvaccination complications as compared with BGC vaccine. The 26-year use of tuberculin diagnosis via Mantoux test with 2TE PPD-L during mass vaccination of children and adolescents has proved itself in early identification of tuberculosis and risk groups. A new risk group has been identified. This includes children with increasing tuberculin reactions; three-month intermittent chemoprevention with isoniazid reduces tuberculin sensitivity in the children and prevents tuberculosis in them. The developed short-term (6-9 months) courses of chemotherapy in preschool and school children by using drugs (isoniazid + rifampicin + pyrazinamide) yield the best healing without residual changes of uncomplicated forms of tuberculosis in 83 and 60% of the children with complicated events, respectively. The chemotherapy regimens have been divided into 4 groups of different dosage schedules.