Problemy tuberkuleza i boleznei legkikh最新文献

The structure of tuberculosis patients with HIV infection who died from any causes, other than tuberculosis, in the Sverdlovsk Region in 2000-2006 did not differ from that of patients with concurrent pathology who died from tuberculosis. The general health care facilities had revealed tuberculosis during life in most patients who died from terminal-stage HIV infection; at death these patients had endstage HIV infection which tuberculosis joined to 4 years or more after HIV infection registration. A fatal outcome in 88.1% of the patients died from the terminal stage of HIV infection was observed within the first year after tuberculosis detection, in half the cases the background disease being generalized tuberculosis at autopsy; every two patients discharged microorganisms during life, drug resistance in the causative agent of tuberculosis was found in every three patients. Half the patients who died from other causes, other than HIV infection and tuberculosis lost their life within the first year after registration of the tuberculous process. Lifetime bacterial discharge was recorded in half the patients; drug resistance of Mycobacterium tuberculosis has developed a third of the patients with comorbidity who died from other causes, other than tuberculosis and HIV infection. The volume of lifetime specialized care for HIV infection to deceased patients with comorbidity had been inadequate. The importance of the problem of notification of cases, when the autopsy background disease was tuberculosis in comorbidity patients not included into the regional tuberculosis morbidity and mortality statistics, will increase with further development of the epidemics of tuberculosis and HIV infection to the Svedlovsk Region.

In 2000 to 2006, one hundred and fifty-eight patients with active nephrotuberculosis, including 24 without obstructive uropathy, 70 with obstruction at the level of the upper ureter third, and 64 with that at the level of the lower ureter third, were examined. It was shown that papillites, pyonephroses, and specific paranephritis were prevalent when a specific process extended to the upper ureter third. Involvement of the lower ureter third resulted in the most significant renal destruction that was bilateral in 75% of cases with a large proportion (51.4%) of complete organ destruction and complications of the underlying disease. The effectiveness of organ-removing operations was higher in ureteritis of the upper third of the ureter and that of reconstructive operations was higher in ureteritis of the lower third. Surgical treatment for nephrotuberculosis in distal obstruction induced no regression of renal failure in 24% of cases, its progression being observed in 8%. Every five patients were reoperated on; more than 29% of the patients underwent bilateral operations; the proportion of organ-removing interventions turn to be highest.

The effectiveness and safety of treatment with vobenzyme supplemented to the standard antibiotic therapy have been compared in 60 patients. Addition of vobenzyme to the standard antibiotic therapy significantly reduces the number and degree of respiratory symptoms has a pronounced effect on the activity of inflammation, leads to a more complete reversal of pulmonary parenchymatous infiltration on a roentgenogram, contributes to the achievement of the maximum efficiency of treatment, and substantially diminishes residual respiratory symptoms of pneumonia economically expediently and safety at a late follow-up.

The efficiency of combined treatment with retrosternal lymphotropic administration of drugs and pneumoperitoneum was comparatively analyzed in 148 new cases of destructive pulmonary tuberculosis. Both methods were applied during combined chemotherapy in a study group of 48 patients. In Group 2 (n = 54), lymphotropic procedure was employed alone during standard chemotherapy; in Group 3 (n = 46), only pneumoperitoneum was used in combination of chemotherapy. In 40 patients, pulmonary tuberculosis was acutely progressive. Drug resistance was identified in 81.7%, including multidrug resistance in 27.7%. With the combined use of retrosternal lymphotropic therapy and pneumoperitoneum, bacterial excretion ceased in 96.2% of new cases of drug-resistant tuberculosis; decay cavity resolved in 80.8%. The proposed therapeutic technology used in patients with persistent bacterial excretion and decay cavities after ineffective 4-9-month treatment could achieve abacillation in 90.9% of patients and resolve decay cavities in 77.3%. Retrosternal drug injection reduces a risk for complications due to bronchial tuberculosis involvement when pneumoperitoneum is applied.

The paper analyzes whether it is possible to predict a risk for postoperative empyema, by studying a totality of characteristics of a patient, a pathological process, and the properties of MBT in 46 patients with progressive fibrocavernous tuberculosis. It also shows it actual to accomplish this task with a prediction accuracy of 89.5-100%, by simultaneously taking into account both the bacteriological properties of MBT (the magnitude of Mycobacterium tuberculosis excretion and viability) and different combinations of serum biological parameters that reflect the activity of an inflammatory process.

A total of 254 Mycobacterium tuberculosis strains were used in the study. Among them, there were 183 ethambutol (EMB)-resistant strains, 13 multidrug resistant ones, but EMB-sensitive, and 39 strains sensitive to rifampicin (RIF), isoniazid (INZ), and EMB. All the strains were analyzed for genetic changes in three loci: embB306, rpoB, and katG/inhA promoter, which were associated with the formation of resistance to EMB, RIF, and INZ, respectively. The Mycobacterium tuberculosis strains were obtained from pulmonary tuberculosis patients living in the Central Region of the Russian Federation. Resistance to RIF, INZ, and EMB was revealed by the absolute concentration test. The inhibitory concentration (IC) of EMB was determined for all the strains. Genetic changes in the above loci were estimated by mini-sequencing, followed by mass-spectrometry recording MALDI-TOF products. The relative low frequency of embB306 mutations was observed among the EMB-resistant strains (about 41.5%). Mutations in codon 306 were detected only in strains with EMB IC > or = 2 mg/L. A statistical significant association was found between the frequency of embB306 mutations and the multidrug resistant phenotype. A combination of these mutations with the traditional genetic markers of multidrug resistance may be used for the more effective detection of multidrug-resistant strains.

The results of treatment in patients with tuberculosis are low. Within the first 3-4 months of therapy, lung caverns are closed in 12-26% of patients. The length of tuberculosis inpatient treatment is 79 days, as provided by the state guarantees of rendering free treatment, and the proposals to reduce the number of beds are not substantiated. It is necessary to optimally restructure a bedspace and to bring it into proper sanitary position.

By applying the interferon-gamma (IFN-gamma) induction technique in the whole blood samples exposed to short-term (22-24-hour) incubation in the presence of Mycobacterium tuberculosis antigens--PPD tuberculin and specific recombinant ESAT-6 lacking in the cells of vaccine BCG and other non-tuberculous mycobacteria, the authors studied the groups of children and adolescents with a negative Mantoux test (n = 31), with postvaccine BCG allergy (n = 40), as well as patients with primary tuberculous infection (n = 84) and those with pulmonary tuberculosis (n = 44). Patients with primary tuberculous infection and a high sensitivity (94%) and a high specificity (97%) may be differentiated from children and adolescents with postvaccinal allergy when the recombinant ESAT-6 antigen and the critical IFN-gamma level (greater than 70 pg/ml) detectable in the plasma samples after incubation with the antigen. It has been also shown that in adolescents with local forms of pulmonary tuberculosis specific IFN-gamma induction may be suppressed in number of cases, which is ascribed to decreased specific immunity.

The current approaches to training pediatric phthisiatricians (phthisiopediatricians) are described. In the authors' opinion, completion of a clinical residency in not only phthisiology, but also in pediatrics is optimal to this group of specialists. The training programs for pediatric phthisiatricians differ in relation to the basic specialty: a phthisiatrician or a local phthisiatrician. Topical improvement may be made more frequently, it aims at upgrading qualification in more specialized section on phthisiology, and it is intended not only for pediatric phthisiatricians, but also for pediatricians of children's health care facilities. Training cycles in Moscow upgrades the quality of antituberculous work at the children's facilities. Difficulties in organizing the retraining of physicians of other specialties in phthisiology need normative resolution.