[Current aspects of pathogenetic therapy in tuberculosis].

The review presents principles of pathogenetic therapy in tuberculosis and current trends in pharmacotherapy: immunocorrection, prophylaxis, chemotherapy side effects management. Immunocorrection is illustrated by treatment with drugs of a polyvalent action - glutoxim and cyclopheron. Mechanisms of their immune action are outlined. As to hepatoprotection, remaxol is an effective hepatoprotecting medicine improving energy supply to hepatocytes and their membranes resistance to lipid peroxidation, reactivating enzymes of antioxidant defense. Remaxol has an antioxidant/antihypoxic action, is the most promosing metabolic corrector with hepatoprotective activity.

[Microbial spectrum of respiratory tract in patients with different pulmonary diseases].

AIM: To study microbial spectrum of respiratory tract in patients with pulmonary diseases. MATERIALS AND METHODS: Culture of sputum/bronchial lavage fluid (S/BLF) and bronchoalveolar lavage fluid obtained from 36 HIV-negative patients with infiltrative pulmonary tuberculosis (IT), 18 patients with community-acquired pneumonia (CAP), 18 patients with lung cancer (LC) was performed on 5% blood agar using method of serial dilutions. Following concentrations of microorganisms were considered as diagnostic: 10(6) CFU/ml--in sputum, 10(4) CFU/ml--in bronchial lavage fluid, 10(3) CFU/ ml--in bronchoalveolar lavage fluid. RESULTS: Nonspecific microflora in S/BLF was isolated 94.4% of patients (34--IT, 17--CAP, and 17-LC), and in bronchoalveolar lavage fluid - in 69.4%, 61.1%, and 77.8% of patients respectively. Nonspecific microflora was presented as both monoculture and microbial associations. In group of patients with IT, the most frequent were associations of bacteria from Nesseriaceae family and streptococci, streptococci and staphylococci, streptococci and fungi from Candida genus. In group of patients with CAP, monocultures of microorganisms were detected rarely, whereas, in contrast, microbial associations were detected more frequently. In patients with LC, monocultures of microorganisms were isolated from S/ BLF in 2 cases and from broncoalveolar lavage fluid--in 9 cases; associations were detected in overwhelming majority of patients, more frequently--combination of streptococci and Neisseria, streptococci and yeast-like fungi. In patients with IT and CAP, Streptococcus pneumoniae was the most frequently detected microorganism, whereas non-fermenting bacteria predominated in lavage fluid. Diagnostic titers from bronchoalveolar lavage fluid in patients with CAP were detected only for Acinetobacter calcoaceticus, Citrobacterfreundii, and Escherichia coli. S.pneumoniae and Staphylococcus spp. were most frequently isolated from S/BLF in patients with LC, whereas in broncoalveolar lavage fluid of such patients S. pneumoniae, Pseudomonas aeruginosa, and non-fermenting bacteria were detected in titers exceeding diagnostic threshold. CONCLUSION: Species composition of nonspecific microflora during IT, CAP, and LC was virtually the same; microorganisms were detected in equal proportions.

[Characterization of the current foci of tuberculous infection].

The epidemic foci formed by patients with tuberculosis in the Admiralteisky District, Saint Petersburg in 1994-2005 were surveyed. The study showed that the bulk of the foci had been formed by patients suffering from the clinical forms of tuberculosis without the chronic pattern of a process, that of first-grade epidemic burden. These are most commonly the foci of new-onset tuberculosis; the proportion of comers from other areas and confinement institutions was not greater than 15%. The one-year foci formed by the patients living in the communal flats made up their bulk. Under the conditions of a megapolis, the cases of small epidemic are extremely few and they do not affect the intensity of the bacillary nucleus in the population of the district. The contribution of the foci formed by the homeless and migrants to the formation of the bacillary nucleus was small, but showed a stable upward trend. Every five focus was that of drug-resistant tuberculosis and they were shown to tend to increase.

[The specific features of a pathogen in acutely progressive pulmonary tuberculosis]. / Osobennosti vozbuditelia pri ostro progressiruiushchem tuberkuleze legkikh.

Examination of 318 patients with different forms of acutely progressive pulmonary tuberculosis (APPT) revealed massive bacterial isolation in 181 patients of them. In one fourth of the patients, Mycobacterium tuberculosis (MBT) colonies grew during a month; the mean growth duration was 38.3 +/- 12.7 days, which was indicative of the viability of Mycobacteria and of their high virulence if they were isolated in large amounts. A hundred and thirty-three patients were found to be drug-resistant, which is one of the characteristics of present-day APPT. Such patients more frequently developed multidrug resistance. Sixty-three patients were ascertained to have secondary drug resistance, of them 41 patients were found to have drug resistance that progressed during APPT therapy.

[Effectiveness of the use of ultrasound irradiation of the spleen in patients with acutely progressive pulmonary tuberculosis]. / Effektivnost' primeneniia ul'trazvukovogo oblucheniia selezenki u bol'nykh ostroprogressiruiushchim tuberkulezom legkikh.

Sixty-three patients with acute progressive tuberculosis (APPT) underwent splenic ultrasound radiation (SUSR) (Group 1) for evaluation of the efficiency of the procedure. A hundred and twenty five patients with APPT were treated without SUSR (Group 2, controls). An experimental study was also conducted on 290 mice. SUSR was also used in the late first month of antituberculous chemotherapy. A procedure for SUSR is described in the paper. There were most favourable clinical and X-ray changes in Group 1 than in Group 2 just after SUSR and at the end of the treatment course. After the procedure (first control) all biochemical inflammation indices (medium molecular-weight molecules, adenosine deaminase, fibrinogen, sialic acids) were significantly decreased in Group 1. Immunological indices were insignificantly changed between groups and primary investigations. A study after two months of SUSR showed no differences in biochemical indices in the groups and in this period as compared to the control one. At the same time, the levels of CD cells, especially CD8+, were found to be lower in Group 2. In Group 1, the count of CD cells and their functional activity by the blast transforming reaction on PHA were stable and significantly higher than in Group 2. The experimental study demonstrated that the levels of medium molecular-weight molecules and the index of lung damage reduced after SUSR. The decrease in the count of MBT colonies and a positive response in the murine paw test, which is indicative of T-cell immunodeficiency, were detected one month following the procedure (distant control). So SUSR should be proposed as a new effective pathogenetic treatment for APPT.

[Diagnostic and prognostic significance of adenosine deaminase in acutely progressive pulmonary tuberculosis]. / Diagnosticheskoe i prognosticheskoe znachenie adenozindezaminazy pri ostroprogressiruiushchem tuberkuleze legkikh

The paper provides data on the serum levels of adenosine deaminase (ADA) in patients with acutely progressive pulmonary tuberculosis (APPT). The highest levels corresponded to the severity of the disease, high bacterial isolation, the extent of destructive and infiltrative changes in lung tissue, and endotoxemia. This indicates that ADA measurement is an additional criterion for assessing the health status in APPT patients and the magnitude of destructive processes. Moreover, the measurement is of prognostic value as it provides an objective assessment of the course of an acute progressive process an the efficiency of chemotherapy used.

[Total blood analysis in assessing status of patient with caseous pneumonia]. / Pokazateli obshchego analiza krovi v otsenke sostoianiia bol'nykh kazeoznoi pnevmoniei.

The relative and absolute parameters of blood cells were examined in patients with caseous pneumonia before and 2 and 4 months after treatment. The absolute count of stab neutrophils and monocytes proved to be most informative. The long-term presence of stab neutrophils indicated that these cells are of great importance in the antituberculosis immunity of patients with caseous pneumonia.

[Endocrinological parameters of patients with acute progressive pulmonary tuberculosis]. / Pokazateli éndokrinnogo statusa u bol'nykh ostro progressiruiushchim tuberkulezom legkikh.

Examining the levels of the hormones insulin and cortisole that play a significant role in nonspecific protection in tuberculosis indicates the heterodirectional pattern of changes in endocrinological parameters in relation to the clinical form of acute progressive tuberculosis. In drug-treated patients with caseous pneumonia, the high level of cortisole decreased and the content of insulin reached the lower normal range with 18.2% of cases having hypoinsulinemia. Patients with disseminated pulmonary tuberculosis had an inversely proportion ratio of the hormones, which reflected the specific features of acute progression of this clinical form. In acute progressive infiltrative tuberculosis, the levels of cortisole and insulin significantly increased during chemotherapy. Nevertheless, whatever changes were observed in hormonal levels, variations in the parameters indicate the long-term activity of specific inflammation in acute progressive pulmonary tuberculosis.

[Clinical characteristics of miliary tuberculosis today]. / Klinicheskaia kharakteristika miliarnogo tuberkuleza v sovremennykh usloviiakh.

Present-day miliary tuberculosis (MT) is characterized clinically. Changes in its classical presentation are found, i.e. in acuteness, sudden onset, intoxication. Generalized process with pulmonary and extrapulmonary miliary foci is accompanied with monopenia indicating profound disorders of phagocytic immunity in miliary tuberculosis.

[Differential diagnosis of acute atypical pneumonias and active pulmonary tuberculosis]. / Differentsialnaia diagnostika ostrykh nespetsificheskikh pnevmonii i aktivnogo tuberkulëza lëgkikh.

Nonspecific reactivity was assessed by the quantity of middle-mass molecules (MMM) and specific antibody formation in patients with acute pneumonias and active pulmonary tuberculosis. Tuberculous patients demonstrated a rise in the number of MMM in the plasma, serum, red cell membranes both in the total pool and in the oligopeptide fraction; higher plasmic toxemia, red cell and blood intoxication indices, blood toxemia rate. Antibody formation was more active in tuberculous patients.

[Expression of intoxication syndrome in patients with destructive pulmonary tuberculosis discharging Candida fungi]. / Vyrazhennost' intoksikatsionnogo sindroma u bol'nykh destruktivnym tuberkulezom legkikh, vydeliaiushchikh griby roda Candida.

The severity of intoxication in tuberculous patients with destructive forms was quantified as the number of middle-size molecules. Diagnostic criteria for Candida infection are provided in the range from Candida carriage to invasive candidiasis basing on enzyme immunoassay and bacteriological examinations findings. Candida carriage is shown to be of little relevance to the intoxication progress and severity, whereas mucosal dissemination on the bronchial tree and subsequent development of the mycotic lesion affect intoxication symptoms aggravating tuberculosis course.