Problemy tuberkuleza i boleznei legkikh最新文献

Forty-one pulmonary tuberculosis patients (32 males and 9 females) excreting Mycobacterium tuberculosis (MBT) with extensive drug resistance to antituberculous drugs were examined. The process was first detected in 14.6% of the patients. At the previous stage of treatment, the vast majority of patients (85.4%) received antituberculous drugs. Fibrocavernous tuberculosis was a predominant form (73.1%). The acutely progressive course of the process was observed in 29.3% of patients. Lung destructive changes and bacterial excretion were revealed in all (100%) patients. Resistance to streptomycin, isoniazid, rifampicin, and fluoroquinolones was seen in all (100%) patients. The fact that in this cohort of patients the resistance of MBT to reserve drug, such as kanamycin, amikacin, and cycloserine, is observed at a rather high rate (from 58.5 to 73.1%) is concerned about. For evaluation of the efficiency of treatment, all the examinees were divided into 2 groups, which were equal in clinical and laboratory characteristics. Group 1 patients (n = 19) were given chemotherapy regimen 2b (in new cases of tuberculosis) and individual chemotherapy regimens. Collapse therapy was additionally used in the treatment of Group 2 patients (n = 22). After 3-month chemotherapy, negative sputum was established in 4 (9.8%) and 6 (14.6%) patients in Groups 1 and 2, respectively. Following 6-month therapy, MBT excretion ceased in 13 (31.7%) and 15 (36.6%) patients in Groups 1 and 2, respectively. After 3- and 6-month therapy, decay cavity closure occurred in 2 (4.8%) and 7 (17%) Group 1 patients and in 4 (9.8%) and 15 (36.6%) Group 2 patients, respectively (p < 0.05).

The paper shows how a tuberculosis monitoring system is under development at the level of the Russian Federation subject--the Belgorod Region. The tuberculosis monitoring system allows an effective control of both tuberculosis-controlling measures determined by the existing normative documents and orders and supplementary measures to enhance the effectiveness of tuberculosis control in the region. Tuberculosis monitoring should be further improved at the regional region by the sections: outpatient visit, antiepidemic measures in the foci; children's sanatorium work, cohorts to be examined by a physio pediatrician.

Retrospective analysis of the data available in the reporting form 0-89/y-[cyrillic letter: see text] and information analytical tables for Moscow tuberculosis monitoring) over 7 years on all notified new cases of tuberculosis among 15-17-year-old children has indicated that it is necessary to change the procedure for detecting tuberculosis for this age group of children in order to improve the early diagnosis of the disease. The Mantoux test is likely to be rather effective in examining adolescent schoolchildren and students from secondary specialized establishments and ineffective among unorganized young people and in migrants' families. Planned fluorography is of rather informative value in all the groups under study if there is a timely referral for examination. The authors consider whether it is worth making a tuberculosis 2 TE PPD-L in organized collective bodies (schools, colleges, etc.). Other groups of children may undergo only digital small-dose fluorography. Unorganized children above 10 years of age who lack annual Mantoux test results must be referred for digital small-dose fluorography. Refusal to undergo fluorography is justifiable only if there is no tuberculin sensitivity or evident symptoms of intoxication. In the megapolis, due to uncontrolled migration, a lawmaker must consolidate the statute on that mandatory control should be exercised over 15-17-year-old adolescents who must undergo fluorography during their each visit to a health care facility, on entering an educational establishment, or on employment. On consulting a physician, the adolescent who has undergone fluorography 6 months before must have it again.

The data of a comprehensive study of 86 children aged 6 to 14 years, who were examined and treated at the Research Institute of Phthisiology for various manifestations of tuberculous infection: 25.6% with infected Mycobacterium tuberculosis with varying specific sensitization; 34.9% with minor forms of intrathoracic lymphatic tuberculosis (ITLT), 39.5% with disseminated processes into the intrathoracic lymph nodes, are analysed. Of the greatest informative value in the determination of the activity of tuberculous infection are RM V, VI, VII, and VIII dilutions in combination with immunological parameters of specific immunity: blast transpormation reaction (BTR) to PPD, a complex of serological reactions, IL-8, and lysosomal cationic test (LCT). Most children with ITLT showed a significant cellular response to PPD in the BTR test. It should be noted that on admission to the clinic, neutrophilic granulocytes were functionally inadequate in all the children as shown by LCT. The currently available immunological tests used in combination with the existing methods in the diagnosis of ITLT adequately evaluate the activity of tuberculous infection in children.

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.

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.