Problemy tuberkuleza最新文献

The authors conducted a comprehensive study of 482 patients with suspected tuberculous spondylitis. The commonest diagnostic signs of some spinal diseases, similar to the clinical ones, were defined on clinical, X-ray, laboratory, and thermographic findings. This enabled a differentially diagnostic syndrome including 58 signs to be developed. The proposed syndrome is to facilitate the differential diagnosis of tuberculous spondylitis from spinal tumors, degenerative and dystrophic processes, and nonspecific osteomyelitis of the vertebral column.

The authentic data on the drug resistance of Mycobacterium tuberculosis can be obtained only provided that standard laboratory procedures and the unified standardized method for determining the resistance are used along with a compulsory outside quality control over the performance of this test. The supervisory activities of the researchers of the Central Research Institute of Tuberculosis (CRIT), Russian Academy of Medical Sciences, made in some regions of Russia included standardization of methods and their implementation quality control allowed them to reveal and to correct main errors in drug resistance testing. In this connection, this made it to record the true level of M. tuberculosis resistance to essential antituberculous agents in the areas investigated by the researchers of CRIT. Analyzing the data on the drug resistance of M. tuberculosis in the above areas leads to the conclusion that 2000 was marked by rather high rates of primary drug resistance; nearly a fourth of all new and prior cases of pulmonary tuberculosis studied for its drug resistance were carriers of a M. tuberculosis resistant to at least one antituberculous agent.

The patients with multiresistant tuberculosis were divided into 2 groups: the sensitivity of Mycobacteria tuberculosis to antituberculous drugs was evaluated in Group 1 by the methods of absolute concentrations and in Group 2 by biological microchips determining mutations in the rpo3 gene responsible for rifampicin resistance. The results of the drug sensitivity test were obtained after 3 months of treatment in Group 1 and several days prior treatment in Group 2. By taking into account the test results, reserve drugs was used in Group 2 patients. Subsequently, the results of the drug sensitivity tests carried out by the bacteriological method in Group 2 patients showed that isoniazid resistance was simultaneously noted if there were mutations in the rpo-B gene. Timely treatment with reserve drugs exhibited higher efficiency of treatment with its shorter duration in Group 2 than in Group 1.

In the Sverdlovsk Region, multidrug resistance was observed in greater than 8% of patients isolating bacteria mainly in the residents of cities, former prisoners, those having fibrocavernous tuberculosis complicated by chronic nonspecific lung disease (CNLD). Primary resistance was determined in 4.7%, secondary resistance developing in 57.4% of cases 3 years or longer after the initiation of treatment. The most common cause of multiresistant tuberculosis is irregular treatment, patients' discontinuation of some antituberculous agents, as well as scarce financing of a tuberculosis control service, which prevents the standard treatment regimens from using in tuberculosis. Death due to tuberculosis was largely occurred irregularly treated dwellers of cities, tuberculosis-induced disabled individuals, alcohol abusers, patients with CNLD, or having fibrocavernous tuberculosis resistant to 4-5 antituberculous agents.

Individuals become annually free from confinement places, among them 10.3-28.6% are ill with pulmonary tuberculosis. An average of only 35.6% of this contingent are registered at dispensaries in the territories. Their mortality rates within the first year of registration are 2.3 times higher than those registered at dispensaries of these territories. The authors show it necessary to accomplish cooperation between the health care facilities of the Ministry of Health of Russia and those of the Ministry of Justice of Russia.