Problemy tuberkuleza i boleznei legkikh最新文献

The content of cytokines, the levels of antibodies (Ab) to proinflammatory cytokines and fetoproteins (FP) in serum, as well as the effects of fitohemagglutinin and FP on the level of cell production of cytokines into the conditioned medium were studied in relation to the pattern of a response of mononuclear cells (MNC) to FP. With the positive reaction of MNC to FP, estimated by an increment of CD9* cells and detectable in grades 2-3 dysplasias, the anti-inflammatory effect with lower anti-inflammatory cytokines was shown to be achieved due to elevated Ab levels, which may compensate for the low content of IL-4 and IL-10. With FP, there was an increase in the cell production of IL-10 that is known to stimulate antibody formation in the early phase of tumor growth, as evidenced by the association of the levels of Ab to FP with the grade of dysplasia.

The authors examined 51 patients aged 37.74 +/- 2.17 years who had tuberculous pleurisy and aged 49.8 +/- 4.6 years who had nonspecific pleurisy. Group 1 comprised 18 patients with isolated tuberculous exudative pleurisy. Group 2 included 13 patients with tuberculosis complicated by tuberculous pleurisy. Group 3 consisted of 10 patients with nonspecific exudative pleurisy. Catarrhal endobronchitis was the leading form of tracheo-broncheal tree lesion among patients with tuberculous exudative pleurisy (n = 20 (64.5%)). The activity of adenosine deaminase (ADA) was 2.18 +/- 0.73, 2.41 +/- 0.80, and 2.47 +/- 1.52 U/l in Groups 1, 2, and 3, respectively. Thus, the measurement of bronchoalveolar fluid ADA separately from other parameters is of no informative value in the differential diagnosis of the etiology of pleurisy. While analyzing the parameters, the authors introduced the coefficient of ADA (CADA) that was calculated using the formula: K(ADA) = ADA/cytosis. In patients with tuberculous pleurisy, K(ADA) was 0.65 +/- 0.17 (this was 0.52 +/-0.13 in isolated tuberculous exudative pleurisy and 0.84 +/- 0.36 in tuberculous exudative pleurisy complicated by pulmonary tuberculosis (p < 0.05), and 0.20 +/- 0.06 in nonspecific pleurisy (p < 0.05). The ADA coefficient of 0.52 or more confirms the tuberculous etiology in isolated pleurisies and permits a differential diagnosis to be made between specific and nonspecific pleurisy with and without lung changes.

The paper provides the analysis of the prevalence rates of tuberculosis among children and adolescents in the Russian Federation, which has been made on the basis of the data available in official reporting forms Nos. 8, 33 (approved by the Resolution of the Russian Statistics Agency on November 11, 2005), and 47 (approved by Resolution No. 175 of the Russian Statistics Agency on September 10, 2002). Correlations between epidemiological indices have been calculated and assessed. The age-related features of the occurrence and course of tuberculosis have been studied among various age groups of children. It is concluded that in this situation in order to improve the epidemic situation among children and adolescents, emphasis should be primarily placed on the activation of intersectoral interaction of primary health care and tuberculosis service: to actively attract general practitioners, local pediatricians and therapists to prophylaxis in children.

The paper presents data on vaccine prophylaxis in Russia. A sophisticated analysis of the data available in the literature on approaches to vaccination against tuberculosis in different countries of the world is provided. The results of the studies made by Russian investigators to develop different regimes of BCG re-administrations an their frequencies are given. The fact that it is necessary to change a tuberculosis prophylaxis calendar under the present conditions, by keeping in mind the age of a child and the epidemic situation in the country's region, has been established. A particular section is dedicated to the problem associated with the occurrence of complications in response to tuberculosis vaccine. Based on the Federal Center data on complications due to BCG/ BCG-M, the authors provide information on the incidence and pattern of complications occurring in Russia. As compared with 1995, the incidence of postvaccination complications slightly changed (21.1 in 100,000 in 1995 versus 20.3 in 2002-2003). In the children inoculated at a maternity hospital, postvaccination lymphadenitis was observed 2 times more frequently than in those vaccinated at a polyclini (77.1 and 37% of cases, respectively) and cold abscesses were 3.3 times less frequently than those inoculated at the polyclinic (19.1 and 63% of cases, respectively). The study has ascertained main reasons for the higher incidence of severe complications as BCG ostitis.

The clinical characteristics of pulmonary tuberculosis and its detection methods were studied in patients with hyperergic (Group 1, n = 84) and another (Group 2, n = 75) tuberculin susceptibility. The groups were identical in clinical, X-ray, and laboratory characteristics. The major clinical forms were infiltrative (35.2%) and thoracic lymphatic tuberculosis (34%). Mass tuberculin diagnosis revealed 64.7% of children with hyperergic susceptibility, which confirms the topicality of this technique in the early detection of tuberculosis in children. This technique was realized in adolescents with hyperergic susceptibility to a lesser degree (12.1%). Overall, 55.9% of patients with hyperergic tuberculin susceptibility (mainly adolescents) were identified by X-ray studies performed routinely and if there were clinical indications. In these cases, individual tuberculin diagnosis was used when X-ray changes were found.

A hundred and forty children aged 13 to 17 who had new-onset active pulmonary tuberculosis were examined. There was a predominance of infiltrative tuberculosis (63.6%) in the pattern of its clinical forms. The processes were more frequently disseminated (79.3%) with lung tissue decay in every two patients (55.1%) and bacterial discharge in every three patients (39.3%). Among the new cases of pulmonary tuberculosis, the proportion of its multidrug resistance was 7.9%. The routine regimens were used for treatment. The efficiency of intensive-phase (IF) treatment was evaluated in 85 patients, including 18 patients receiving chemotherapy (CT) (HRZ/E/S) regimen 3 (Group 1), 45 having CT (HRZ/E/S) regimen 1 (Group 2), and 22 having CT (HRZE[A][Fq]/[Pt]) regimen 2B (Group 3). Clinical laboratory, Xray, and microbiological findings were criteria for evaluating the efficiency of IP CT. Abacillation occurred in all cases by month 4 of therapy. By and large, the efficiency of IF CT was 90.6% in new cases of pulmonary tuberculosis among old-age children and adolescents. In patients with disseminated processes, it ranged from 81.8% (Group 3) to 91.1% (Group 2) depending on the extent of lung tissue damage. The efficiency of therapy was as high as 100% in patients with circumscribed processes. Polyresistant resistance of Mycobacterium tuberculosis (MBT) to chemical agents, including multidrug resistance (7.9%), was a main reason of ineffective IF treatment (9.4%) in new cases of pulmonary tuberculosis among old-age children and adolescents. Overall, the actual use rate of routine CT regimens was 65.9% in new cases of pulmonary tuberculosis and adolescents. Uncontrolled adverse reactions to antituberculous drugs and drug resistance in MBT were reasons for deviations of routine regimens (modifications, use of individual regimes).

Chemotherapy for disseminated tuberculosis by the schemes regulated by the Order "On Improvement of Tuberculosis-Controlling Measures in the Russian Federation" issued by the Ministry of Health of the Russian Federation under No. 109 on March 21, 2003, leads to the regression of intoxication syndrome and the normalization of general blood analysis parameters in most patients, provides bacterial excretion cessation in 72.7% of the patients and decay cavity closure in 53.8%. The extent of the process, the presence of multiple decay cavities, and the detection of drug resistance are the main causes of ineffective treatment in patients with disseminated tuberculosis.

Silicotuberculosis is an independent disease that arising in patients with silicosis from exacerbation of old tuberculous foci in the lung, less frequently in the lymph nodes and other organs. In silicotiberculosis, there are common secondary tuberculosis forms that are located mainly in the lung, which are rarely accompanied by a rapid progression. Characteristic morphological signs of early, nodal and nodular silicosis are observed. Silicotuberculosis is an independent disease that arises in patients from an exacerbation of old tuberculous foci in the lung, less frequently in the lymph nodes and other organs. In silicotuberculosis, there are usually secondary tuberculosis forms that are located mainly in the lung, which are rarely accompanied by a rapid progression. The characteristic morphological signs of early, nodal, and nodular silicosis are observed. Thoracic and abdominal lymph nodes, lymphatic and blood vessels, the bronchi and pulmonary surfactant system were explored. In silicosis, tuberculosis, and silicotuberculosis, silicon levels and spodograms of some visceral organs were studied and trace elements were determined in the lung.