[Efficiency of treatment for recurrent tuberculosis and its influencing factors].

The efficiency of category II DOTS chemotherapy was studied in 353 patients with recurrent tuberculosis. The latter was verified by a positive sputum smear test in 232 of them and this test was negative in 121. A control group consisted of 79 first detected patients. The results of the treatment for recurrences were substantially worse than those in new-onset tuberculosis. These have recently improved. Mycobacterium tuberculosis resistance to drugs was responsible for failing therapy. The worse results were obtained when the disease was multidrug resistant. Other reasons, social risk factors in particular, leading to incompliance lowered therapeutic effectiveness.

[The specific features of bacillary excretion and drug sensitivity in Mycobacterium tuberculosis in patients with recurrent pulmonary tuberculosis].

Data on 485 patients with recurrent pulmonary tuberculosis were studied. At the beginning of the study, all the patients underwent a triple sputum smear test and sputum was cultured in 338 cases. Among persons with a negative smear, sputum inoculation yielded Mycobacterium tuberculosis (MBT) in 50%. By taking into account these observations, bacillary excretion was detected in 72.2%. It was established most frequently by both methods (42%), slightly less frequently by the smear test (38%) and inoculation (20%). Drug resistance in MBT was revealed almost equally frequently in bacillary recurrences in patients with positive and negative sputum smear tests (68 and 62.3%, respectively). The bulk of the strains obtained were found to be polyresistant as well as quite often multiresistant. In the group of patients who had received chemotherapy by the WHO standards at primary detection of tuberculosis, polyresistance and multiresistance were encountered significantly more frequently in those who had been treated in previous years. The resistance of MBT to various drugs was also studied. Recommendations are given on the basis of the results of the study.

[Prevalence of recurrent respiratory tuberculosis in the tense epidemic situation].

The authors studied the rates of respiratory tuberculosis morbidity and recurrences in 6 towns of Kazakhstan, in half of them for 3 years. The study covered 4779 new cases of tuberculosis and 1150 patients with its recurrences; chemotherapy was performed in accordance with the DOTS strategy in 255 patients (Group I) and by the routine procedures in 895 (Group 2). The study has demonstrated that the rate of recurrences may be one of the criteria for assessing the tension of the tuberculosis epidemiological situation. The high rate of morbidity corresponds to that of recurrences. Recurrences are of fundamental value for forming a contingent of patients with tuberculosis. They are more significantly more frequently accompanied by bacterial isolation than new-onset tuberculosis. In Group 1, recurrences occur thrice less frequently than those in Group 2; however, the rate of the latter tends to decrease.

[Mycobacterium tuberculosis resistance in newly diagnosed patients and in patients with disease relapse]. / Rezistentnost' mikobakterii tuberkuleza u vpervye vyiavlennykh bol'nykh tuberkulezom i pri retsidivakh zabolevaniia.

The frequency rate of resistance of Mycobacterium tuberculosis (MBT) was investigated in 273 patients with primary diagnosis and in 117 patients with relapses, who were registered with tuberculosis of respiratory organs, during 2000-2001, at a TB prophylactic center. Resistance was detected in 12.5 and 17.1% of the obtained cultures, respectively. Mono-resistance was found, from among 54 patients with stable strains, in 25.9% of cases, while multi-resistance, which was detected more often in relapses rather than in persons with primary diagnosis, was found in 50% of cases. The efficiency of treatment depended on a number of preparations, to which there was MBT resistance. The best results were obtained in cases of mono-resistance, the worst ones--in cases of multi-resistance. The latter is an indication for changing the standard chemotherapy scheme. The treatment of primarily diagnosed patients turned out to be more effective as compared to that of patients with relapses.

[Results of introduction of extended WHO program for detection and treatment of patients with tuberculosis of the respiratory organs]. / Rezul'taty vnedreniia rasshirennoi programmy VOZ po vyiavleniiu i lecheniiu bol'nykh tuberkulezom organov dykhaniia.

Data on 283 new cases of tuberculosis receiving an intensive course of controlled, short-term, and WHO-standardized chemotherapy were studied. Mycobacteria tuberculosis were detected in 71.4% of patients by bacterioscopy, predominantly in tuberculosis dispensaries. In the general health care facilities, fluorography remains to be the method of choice in detecting tuberculosis. The factors increasing a risk for tuberculosis were established in most (71.7%) patients, social disorientation being most common. After the intensive stage of treatment, sputum smear conversion was achieved in 87.2% of the patients. Before the end of treatment, the majority of patients (72%) subsequently quitted a follow-up for these and those reasons. After completion of maintenance therapy, recovery was achieved in 81% without taking into account the patients with sputum smear conversion but with remaining decay cavity. The poor course and recurrences were encountered mainly in socially disoriented persons or in the presence of other risk factors, in compliance, and preserved caverns after termination of chemotherapy. A number of recommendations are made.

[New cases of pulmonary tuberculosis treatment within DOTS strategy]. / Lechenie bol'nykh vpervye vyiavlennym tuberkulezom legkikh v rezhime DOTS-strategii.

Treatment outcomes were analyzed in 216 patients of whom 119 patients received the DOTS treatment, 97 had conventional therapy. No bacterial isolation was found in 88% of patients, decay cavities became closed in 61%. Due to the DOTS therapy, sputum conversion was achieved in 93% of cases, no Mycobacteria tuberculosis being found in 70.2% of cases after 2-month therapy. Decay cavities could not be identified in 80% by the end of chemotherapy.

[Effects of infrared laser irradiation on immunologic reactivity of patients with infiltrative pulmonary tuberculosis]. / Vliianie infrakrasnogo lazernogo izlucheniia na immunologicheskuiu reaktivnost' bol'nykh infil'trativnym tuberkulezom legkikh.

Influence of chemo- and laser therapy on the state of immunologic reactivity was studied in 38 patients with infiltrative pulmonary tuberculosis. It was found that the arsenide-gallium laser used in combined therapy of infiltrative pulmonary tuberculosis produces an immune-stimulating action and has a favourable effect on the course and outcomes of the disease. Infra-red laser radiation produces most favourable effect when it is used two times.