ABSTRACT
BACKGROUND: Tuberculosis (TB) control in Georgia follows the World Health Organization-recommended DOTS strategy, and has reached global TB control targets in the treatment of susceptible TB; however, the management of drug-resistant forms of TB still represents a serious problem. A countrywide drug resistance survey (DRS) found that the prevalence of multidrug-resistant TB (MDR-TB) was respectively 6.8% and 27.4% in new and previously treated TB cases. OBJECTIVE: To determine the prevalence of and risk factors for drug resistance among TB patients to improve case management and control of drug-resistant TB. METHODS: Extensive social, clinical and bacteriological data were collected from patients hospitalized at the National Centre for Tuberculosis and Lung Diseases, Georgia, between 2005 and 2007. RESULTS: Of 605 patients, resistance was observed in 491 (81.2%); MDR-TB was found in 261 (43.1%; 51/222 [23%] new cases and 210/383 [55%] previously treated cases), monoresistant TB in 130 (21.5%), poly-resistant TB in 67 (11.1%) and extensively drug-resistant TB in 33 (5.5%). Female sex, living in the densely populated capital, family TB contact and previous TB treatment were associated with risk of MDR-TB. CONCLUSIONS: These findings confirm the necessity of improving infection control measures and of standardized treatment for drug-resistant TB patients.
Subject(s)
Drug Resistance, Multiple, Bacterial , Inpatients/statistics & numerical data , Tuberculosis, Multidrug-Resistant/epidemiology , Adult , Antitubercular Agents/therapeutic use , Bacteriological Techniques , Cross-Sectional Studies , Female , Georgia (Republic)/epidemiology , Humans , Infection Control , Logistic Models , Male , Middle Aged , Mycobacterium tuberculosis/isolation & purification , Odds Ratio , Population Density , Prevalence , Risk Assessment , Risk Factors , Sex Factors , Sputum/microbiology , Tuberculosis, Multidrug-Resistant/diagnosis , Tuberculosis, Multidrug-Resistant/drug therapy , Tuberculosis, Multidrug-Resistant/prevention & control , Urban PopulationABSTRACT
Functional activity of peripheral blood NK-cells was studied in 85 patients aged 18 to 72 years with active destructive tuberculosis of the lungs. There was detected a significant decrease in the activity of the NK-cells them. The most pronounced decrease was observed in the patients over 50 years. The changes in the functional activity of the NK-cells during chemotherapy correlated with the time course of the tuberculosis process. The results of the study provided the use of the NK-cell activity index in addition to the other indices in estimation of the patients immunity status and control of the treatment efficacy. For correction of immunodeficiency detected by the NK-cell activity early use of immunostimulating agents in the combined therapy of the patients with destructive tuberculosis of the lungs was required.
