[Comparison of the data of computed tomography and bacteriological studies in the complicated forms of primary tuberculosis in children and adolescents].

OBJECTIVE: To establish the causes of bacterial excretion in complicated primary tuberculosis in children and adolescents, by comparing the data of computed tomography and the results of bacteriological studies. MATERIAL AND METHODS: The material of the study was data on 36 children and adolescents with complicated primary tuberculosis, including 14 and 22 children and adolescents with and without bacterial excretion, respectively. All the children and adolescents underwent computed tomography and bacteriological studies encompassing luminescence microscopy and sputum and bronchial and gastric wash cultures for Mycobacterium tuberculosis. RESULTS: The bacterial excretion group showed a preponderance of a tuberculous process concurrent with the involvement of lung tissue and intrathoracic lymph nodes. Bacterial excretion was detected in the primary tuberculosis complex (50%), generalized tuberculosis process with the involvement of a few organs and systems (14.3%), and caseous pneumonia (7.1%). Bacterial excretion was accompanied by the tuberculous involvement of intrathoracic lymph nodes in 28.6%. In Group 1, sputum cultures and luminescence microscopy were carried out in all the children. At the same time, the most effective result was yielded by sputum culture that showed Mycobacterium tuberculosis in 78.6%; luminescence microscopy revealed mycobacteria in only 35.7% of cases. In 72.7% of the children and adolescents without bacterial excretion, the tuberculous process was located in the intrathoracic lymph nodes, without involving lung tissue in the pathological process. In the other 27.3%, the computed tomographic pattern of changes corresponded to that of the primary tuberculosis complex; in their presence, the tuberculous process ran with lymphogenic dissemination in 54.5% of cases and with bronchopulmonary involvement in 22.7%. In Group 2, a sputum culture was done in only 36.4% of the children and adolescents; microscopy was carried out in all. CONCLUSION: When computed tomography reveals the disseminated forms of primary tuberculosis with the concomitant involvement of lung tissue and intrathoracic lymph nodes in the presence of lung destructive changes, with the involvement of a few organs and systems in the pathological process, it is necessary to use all bacteriological studies, including culnolecular genetic methods, in order to establish the etiology of existing changes.

[Monitoring of drug resistance in Mycobacterium tuberculosis in the Republic of Sakha (Yakutia)].

The paper analyzes the detection rate of drug-resistant (DR) Mycobacterium tuberculosis (MBT) in Yakutia. The proportion of DR MBT strains taken from bacterial isolating patients with pulmonary tuberculosis was found to be 70% and to have no tendency for decrease. The structure of DR MBT deteriorated due to the increase in multidrug-resistance (MDR). MDR in MBT was recorded in 45-50% of cases. Examination of lung resection specimens from patients with abacillary tuberculosis identified a population of typical MBT. The authors regarded this phenomenon as latent MBT carriage. The specific feature of this population is that it preserves a high metabolic activity in latency; DR was established in 76.3% of patients. Its most malignant form - MDR was established in a third (31.6%) of the patients. Under certain conditions, this mycobacterial infection may be of epidemic value in the spread of MBT in general and MDR strains in particular. Solution of the problems associated with the surgical treatment of patients with MDR tuberculosis may be beneficial in diminishing the most dangerous reservoir of tuberculous infection. Surgical intervention in MDR tuberculosis is one of the basic treatments.

[Phthisiobacteriological service in the Republic of Sakha]. / Sostoianie ftiziobakteriologicheskoí sluzhby v Respublike Sakha.

The paper shows it expedient to decentralize the bacteriological service system by setting up a wide net of laboratory rooms at district antituberculosis dispensaries, as shown in the Republic of Sakha (Yakutia). The establishment of a branched network of bacteriological rooms and the introduction of procedures of centralized preparation of yolk culture media as an intermediate products allowed the cohort of tuberculosis and risk groups to be bacteriologically studied to a greater extent.

[Characteristics of bacterial excretion in pulmonary tuberculosis patients residents of the Yakut region]. / Kharakteristika bakteriovydeleniia u bol'nykh tuberkulezom legkikh--zhitelei Iakutii.

The present state of bacilli excretion in the Yakut area and its certain social aspects are characterized, the detection rate of M. tuberculosis in pulmonary tuberculosis and the sex-age structure are subjected to analysis. Data on the primary and secondary drug resistance, type appertainance of the causative agent and the result of a disinfectant work in the infection foci have been studied in 511 patients having copious bacilli excretion.

[Bacteriologic examination for tuberculosis in subjects from a group at risk]. / Bakteriologicheskoe obsledovanie na tuberkulez lits iz grupp riska.

Laboratory methods were used to test the samples taken from 55,068 people for M. tuberculosis. Inoculation of diagnostic material for M. tuberculosis was accompanied in a number of cases by a parallel method of luminescent microscopy for the same purpose. Methods of examining the patients with non-specific lung and genitourinary diseases were developed. They consist in a preliminary step-by-step selection of diagnostic material by means of luminescent microscopy and the use of these rapid techniques, like indicator strips, making it possible to examine a great number of population within a short period of time. The expenses of step-by-step laboratory examination of risk group subjects are 4.8 times lower than those incurred with routine methods of bacteriological screening.

[An immunologic method for identification of M. tuberculosis and M. bovis (BCG) based on the use of monoclonal antibodies]. / Immunologicheskii metod identifikatsii M. tuberculosis i M. bovis (BTsZH) na osnove primeneniia monoklonal'nykh antitel.

Monoclonal antibodies interacting with specific selectivity with human tubercle bacilli (monoclonal antibodies of the cell producing strain 62D) and bovine tubercle bacilli (BCG) (monoclonal antibodies of the cell producing strain 60D) were produced with hybridoma technology. A rapid, productive and safe procedure for identification of M. tuberculosis and M. bovis (BCG) was developed on the basis of solid phase enzyme immunoassay. The immunological procedure was compared with the biochemical (niacin) method for identification of mycobacteria. The immunological procedure was shown to be reliable and promising for practical use.