[Outcomes of pulmonary tuberculosis in patients without bacterial isolation (according to sputum microscopy data)].

The composition, the outcomes of treatment and a follow-up were analyzed in 4 954 first detected adult patients with pulmonary tuberculosis and the baseline negative results of a sputum test for acid-resistant mycobacteria, with the involvement of not more than a lobe. The basic course of therapy yielded clinical and X-ray effects in 83.6% of cases. In the late period of a follow-up, the rate of clinical cure was 93.4%; that of death from tuberculosis, formation of chronic incurable forms of the process, and recurrent tuberculosis was 1.4, 0.9, and 0.9%, respectively. Treatment interruption, multidrug resistance, social disadaption of patients, and severe comorbidity were responsible for the poor outcomes of timely detected tuberculosis.

[Compulsory hospitalization of non-compliant patients with tuberculosis].

The procedure and results of forced treatment per curiam were analyzed in 584 bacteria-discharging persons registered as Group 1 patients to be examined in the tuberculosis facilities of the Kemerovo Region in 2004 to 2007. If a package of measures for forcing the patient to be treated is ineffective, a phthisiatrician draws up documents for court. By the decision of the court, the patient is conveyed by justice officers to a tuberculosis hospital. Judicial practice provides a means of substantially enhancing the efficiency of treatment in this socially compromised group of patients with predominantly destructive processes. Among those who had voluntarily come to the hospital just before or after sentence pronouncement, bacterial discharge cessation and decay cavity closure were achieved in almost 90% of cases; clinical resolution was observed in two thirds. At the same time, there is a group of patients, in whom the existing system of measures has proven to be ineffective. There are serious gaps in the legislation of the Russian Federation, which impede the bringing of patients with tuberculosis, the homeless in particular, to compulsory hospitalization. Legislation should be perfected in this area.