[The course of a process and the efficiency of treatment of pulmonary tuberculosis patients excreting Mycobacterium tuberculosis with extensive drug resistance to antituberculous drugs].

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).

[Organization of timely detection of pulmonary tuberculosis in an investigatory isolation ward].

The purpose of the study was to evaluate the efficiency of fluography (FLG) as a technique for the timely detection of cases of pulmonary tuberculosis in an investigatory isolation ward. According to the WHO data, at early detection stages the bacteria-discharging persons should constitute about 80% of all cases. Analysis of the first FLG films made in 22,973 prisoners in 2005-2007 revealed abnormalities in 7.6% of the convicts and tuberculosis-associated changes in 77% of cases. Sputum smear luminescence microscopy and culture for Mycobacterium tuberculosis in 115 patients showed that the persons who discharged bacteria were 72.2% of the patients. The data suggest that FLG is highly effective in timely identifying cases of pulmonary tuberculosis.

[Drug-resistant pulmonary tuberculosis at the penitentiaries].

In recent years, the penitentiaries of Russia have tended to show some stabilization of some tuberculosis indices. In 2006, its morbidity and mortality versus 1999 decreased by 3 times and amounted to 1387 and 79 per 100,000, respectively. The spread of its drug-resistant forms has a considerable impact on the deterioration of the tuberculosis epidemic situation. At present the number of patients with primary drug resistance of the total number of bacterial-discharging persons is more than 50%; multidrug resistance is observed in more than 20% of cases. The use of chemotherapy regimen IIb using fluoroquinolones in the intensive-phase chemotherapy in the treatment of destructive pulmonary tuberculosis allowed Mycobacterium tuberculosis polyresistance to isoniazid and rifampicin in combination with other first-line antituberculous agents and multidrug resistance to be overcome in 87 and 79.5% of cases, respectively.

[Efficiency of a new standard chemotherapy regimen in the treatment of patients with recurrent pulmonary tuberculosis].

The efficiency of conventional chemotherapy regimens was comparatively studied in 75 patients with recurrent pulmonary tuberculosis. In the patients with recurrent pulmonary tuberculosis, conventional chemotherapy regimen "2b" including isoniazid, rifampicin, pyrazinamide, ethambutol, fluoroquinolone (ofloxacin, ciprofloxacin, and levofloxacin), and canamycin (amikacin) versus conventional chemotherapy regimen "2a" including isoniazid, rifampicin, pyrazinamide, ethambutol, and streptomycin could cease bacterial isolation after 3-month therapy, as evidenced by sputum microscopy (86.1 and 62.5%, respectively; p < 0.05). Cavity closure was more frequently observed after 6-month chemotherapy using regimen "2b" (76.7 and 48.0%, respectively; p < 0.05). In patients with recurrent pulmonary tuberculosis who isolated Mycobacterium tuberculosis (MBT) resistant to isoniazid and other antituberculous drugs (exclusive of rifampicin), 3-month use of conventional regimen "2b" led to cessation of bacterial isolation (as evidenced by the inoculation test) in 66.7% of cases; but this did not occur with conventional regimen "2a" in any case. Similarly, 3-month use of regimens "2b" and "2a" in patients isolating MBT resistant to rifampicin and other agents (exclusive of isoniazid) resulted in the cessation of bacterial isolation in 80 and 0% of cases, respectively. In multidrug resistance, these parameters were 11.1 and 0%, respectively.

[Organization of antituberculous care in penitentiary facilities]. / Organizatsiia pritovotuberkuleznoi pomoshchi uchrezhdeniiakh ugolovno-ispolnitel'noi sistemy.

The paper presents the organizational aspects of antituberculous care delivered at penitentiary institutions of the Russian Federation. The priorities of development, including the interaction with civil public health care of Russia and the continuation of tuberculosis-controlling activities jointly with international organizations, are identified.