[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).

[The specific features of the course of pulmonary tuberculosis in young Tuvinians in relation to some antigens of the HLA complex].

The study covered 127 new-onset pulmonary tuberculosis patients aged 18-30 years. Disseminated, focal, and infiltrative tuberculosis were found in 10.2, 22, 46.5, respectively and caseous pneumonia were present in 21.3%. Lung cavities were detectable in 92 patients and bacterial excretion was in 90% patients, Mycobacterium tuberculosis strains susceptible to all anti-tuberculous drugs were revealed in 10% of cases; monoresistant, polyresistant, and multidrug resistant strains were found in 6.7, 34.4, and 48.9%, respectively. Chemotherapy was performed in accordance with Order No. 109 issued by the Ministry of Health of the Russian Federation on March 21, 2003. Following 12 months of therapy, sustained cessation of bacterial excretion and closure of lung cavity could be achieved in 49.6% of the patients and a decelerated trend in the specific process with the a high proportion of progressive tuberculosis was noted in 50.3%. Immunogenetic studies have shown a positive correlation of HLA-B27, Cw4, and the specificity of HLA-DRB1*13 with the extent of the tuberculous process and the severity of lung tissue damages. If a patient with tuberculosis had these genetic markers, the specific process could reliably take a severer form, with the involvement of 1 lobe or more in both lungs and with cavitation. In addition, HLA-17 and the specificity of HLA-DRB1*15 were, on the contrary, associated with the milder course of tuberculosis and the less extent of the specific process.

[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.

[The detection and diagnosis of pulmonary tuberculosis in an investigatory isolation ward].

The purpose of the study was to examine the implication of radiation and microbiological methods in the timely detection and diagnosis of pulmonary tuberculosis in untried prisoners in an investigatory isolation ward. Fluorographic films made in 12,298 convicts were analyzed. Abnormal fluorograms were revealed in 14 and 7.7% of the untried prisoners in 2005 and 2006, respectively; the changes were tuberculosis-associated in 70.2% of cases. Fluorescence microscopy and inoculation were used to carry out sputum tests for Mycobacterium tuberculosis in 41.1% of the convicts with abnormal fluorograms and complaints about productive cough. Early diagnosis of pulmonary tuberculosis was made by microscopy in 14.9% of the prisoners; the diagnosis of tuberculosis was verified by the inoculation test in 34.5% of negative microscopy patients. In the remaining patients, the diagnosis of tuberculosis was based on X-ray studies and the results of treatment.

[New-onset pulmonary tuberculosis patients with schizophrenia: course and efficiency of treatment].

To investigate the specific features of the course and efficiency of treatment, the authors examined 72 patients with new-onset pulmonary tuberculosis and schizophrenia versus 68 new-onset pulmonary tuberculosis patients without mental diseases. Tuberculosis has been found to be identified in 66.7% of schizophrenics by lung fluorography made at a mental hospital or specialized dispensary. This mainly diagnoses the circumscribed forms of the disease with a low bacterial discharge, drug resistance, and cavitation while in nonschizophrenics, pulmonary tuberculosis is detected in 33.3% of cases in general health care network facilities. Following 9 months, complex treatment of pulmonary tuberculosis in schizophrenics succeeded in ceasing bacterial discharge, as shown by microscopy and sputum cultures, in 94.4 and 84.5% of cases, respectively. However, in schizophrenics receiving chemotherapy for tuberculosis, adverse reactions are revealed in 63.9% of cases, with this the incidence of these reactions depends not only on antituberculosis drugs, but also on drugs taken by patients for schizophrenia. Schizophrenic patients with pulmonary tuberculosis need an individual approach to treating the patient, longer treatment, intermittent use of antituberculosis agents, regular clinical and laboratory monitoring of the development of side effects, and complex pathogenetic treatment.

[Differential diagnosis of pulmonary tuberculosis and community-acquired pneumonia].

The purpose of this investigation was to enhance the efficiency of differential diagnosis of pneumonia and pulmonary tuberculosis. A hundred and fifty-nine adult patients were examined. These included 78 patients with pulmonary tuberculosis and 81 with community-acquired p neumonia. The clinical features of infiltrative pulmonary tuberculosis (n = 48) and mild community-acquired pneumonia (n = 51) were compared. The course of caseous pneumonia (n = 30) was compared with that of moderate and severe community-acquired pneumonia (n = 30). Significant differences in the manifestations of the intoxication and bronchopulmonary syndrome were not found in patients with community-acquired pneumonia and infiltrative pulmonary tuberculosis. Physical studies showed that in patients with community-acquired pneumonia, moist rale (54.9%) and crepitation (11.8%) were prevalent, but in those with infiltrative tuberculosis rale was absent in 60.4% of cases and the pattern of respiration was unchanged in 79.2%. Chest X-ray studies indicated that in patients with community-acquired pneumonia, lower lobar inflammatory changes were predominant in 62.8% of cases whereas in those with infiltrative pulmonary tuberculosis the process was mainly bilateral (43.8%) with the presence of destructive changes (83.3%) and bronchogenic dissemination (66.7%). In patients with caseous pneumonia, the intoxication syndrome was more significant than in those with severe community-acquired pneumonia. Chest X-ray studies demonstrated that in patients with caseous pneumonia, specific changes were bilateral with the involvement of 2 lobes or more, with destruction and bronchogenic dissemination while in those with community-acquired pneumonia, the pulmonary processes were predominantly bilateral (76.6%) at the lower lobar site (36.7%).

[Infiltrative pulmonary tuberculosis: course and efficiency of treatment].

The purpose of the investigation was to study the course of and the efficiency of treatment for new-onset infiltrative pulmonary tuberculosis. Two hundred and two patients with this condition were examined. Among the 202 patients, 15 (7.4%), 49 (24.3%), and 46 (22.8%) patients had lobular, rounded, and cloud-like infiltrates, respectively. 31 (15.3%) patients had periscissuritis and 61 (30.2%) had lobitis. The extent of infiltrative pulmonary tuberculosis within 1 segment was encountered in 19.3% and more frequently in the presence of rounded and lobular infiltrates; the specific process in 2 segments was detected in 24.3% of cases and more frequently when rounded and cloud-like infiltrates were observed. In periscissuritis and lobitis, the process occupied 1 lobe in 87.1 and 44.3% of cases, respectively, and 2 lobes or more in 34 (55.7%) patients. Infiltrates were located in the upper lobe in 167 (82.7%) patients, in Segment IV in 21 (10.4%), Segment IX in 6 (3%), Segment X in 5 (2.5%). The signs of lung tissue decay were detected in 140 (69.3%) persons. Decay cavities of less than 2 cm, 2-4 cm, and more than 4 cm in diameter were found in 56 (40%), 62 (44.3%), and 22 (15.7%) patients, respectively. Mycobacterium tuberculosis (MTB) was detected in 13.3, 46.9, 54.4, 70.9, and 83.6% of the patients who had lobular, rounded, and cloud-like infiltrates, periscissuritis, and lobitis, respectively. The drug-sensitive MBT population was seen in 58.4% of the patients; the drug-resistant MBT population was detected in 18.1% of the patients: in 14.3% with a lobular infiltrate, in 10% with a rounded infiltrate, in 28.6% with a cloud-like one, in 21.4% with perscissuritis, and in 15.7% with lobitis. Multi-drug MBT resistance was ascertained in 3.5% of the patients. Bacterial isolation ceased in 100% of the patients with a lobular infiltrate after 1-month therapy, in 47.8 and 52.2% of those with a rounded infiltrate after 1- and 2-month therapy, respectively, in two thirds and one third of the patients with a cloud-like infiltrate after 1- and 2-month therapy, respectively, in 45.4 and 31.8% of those with periscissuritis after 1- and 2-month therapy, respectively, and in 45.1 and 11.8% of cases of lobitis after 1- and 4-month therapy, respectively.

[Scintigraphy in tuberculosis patients with concomitant nonspecific infection].

The data of clinical, X-ray, and radioisotopic pulmonary scintigraphic studies were analyzed in 119 patients with tuberculosis. In patients with pulmonary tuberculosis concurrent with nonspecific infection, impaired pulmonary capillary blood flow may occur in the area of lesion in 60.8% of cases. Concomitant chronic bronchitis observed in half of the patients of this group is an important pathogenetic point of this unfavorable tendency resulting in increased fibrosis in the lung. Less effective treatment of the underlying diseases is another factor contributing to a reduction in pulmonary capillaries during therapy.

[Diagnostic features of recurrent respiratory tuberculosis].

In 1998-2001, prophylactic examinations revealed recurrences of respiratory tuberculosis in 70.1-69.8% of cases; among the persons having pronounced posttuberculosis changes, the recurrences being, on the contrary, detected in 61-70% of cases on their visits to health care facilities for the symptoms of inflammatory bronchopulmonary disease. The recurrences of respiratory tuberculosis in the past years (1999-2001) are characterized by their predominant development in intact lung tissue and in the presence of minor residual tuberculosis-induced changes (64.8%) while those in the previous years (1991-1993) occurred in 64.9% in the presence of pronounced residual changes. In 14.6% of patients, recurrent pulmonary tuberculosis are identified by detecting Mycobacterium tuberculosis in the sputum in the absence of clinical, X-ray, and laboratory data on the activity of residual tuberculosis-induced changes. Thus, 18.7% and 19.6% of focal and infiltrative tuberculosis, respectively, and 66.7% of tuberculomas are detected. Common severe forms (disseminated, fibrocavernous, caseous pneumonia) are found in 66.7-100% of cases on referral to therapeutic institutions.

[Leukinferon in combined therapy for acute pulmonary tuberculosis]. / Leikinferon v kompleksnoi terapii ostroprogressiruiushchego tuberkuleza legkikh.

Experiments on 140 CBA and C57BL/6 mice and studies of 163 patients with acute pulmonary tuberculosis have indicated that leukinferon has a immunomodulating effect on morphological reactions in the lung and on the clinical course of the disease. They have shown that leukinferon plays an important role in the activation of exudate macrophages and in the acceleration of their differentiation in experimental tuberculosis and that there is a rapid elimination of Mycobacterium tuberculosis from the involved organs without production of the L-forms of the causative agent when immunomodulation is used. At months 2-3, the patients with acute pulmonary tuberculosis showed the accelerated processes of detoxification, abacillation, infiltrate resolution, and decay cavity closure during hemo- and immunomodulation with the normalized production of cytokines (gamma-interferon and tumor necrosis factor-alpha). During 6-month therapy, a severe pulmonary process was arrested in 84% of cases and some patients were operated on (76% in the comparison group). The morphological effect of leukinferon was to increase mononuclear infiltration and to normalize a lung connective tissue response, by further decreasing the rate of inflammation.

[Effectiveness of artificial pneumothorax in the treatment of patients with pulmonary tuberculosis with multiple drug-resistant Mycobacteria]. / Effektivnost' iskusstvennogo pnevmotoraksa v lechenii bol'nykh tuberkulezom legkikh s mnozhestvennoi lekarstvennoi ustoichivost'iu mikobakterii.

The efficiency of treatment was compared in 2 groups of patients with destructive pulmonary tuberculosis and isolation of multidrug resistant Mycobacteria. In 43 patients of a study group, artificial pneumothorax (AP) was used during chemotherapy with reserve drugs while 43 patients of a control group received chemotherapy alone. AP was shown to be highly effective in treating patients with destructive pulmonary tuberculosis who isolated multidrug resistant Mycobacteria. Moreover, by the end of 12-month therapy, AP in combination with chemotherapy ensured cessation of bacterial isolation in 88.7% and cavernous closure in the lung in 86.8%, which was almost twice higher than that with therapy with reserve antituberculous drugs.

[Role of lymphocytes and corticosteroids in the pathogenesis of caseous pneumonia]. / Rol' limfotsitov i kortikosteroidov v patogeneze kazeoznoi pnevmonii.

A complex of clinical, X-ray, cytochemical, immunological, and biochemical studies of total 11-OCS, its free forms and separation of free hydrocortisone and corticosterone in the fractions was performed in 52 patients with caseous pneumonia. The patients with caseous pneumonia were found to have the phenomena of dyscorticism, which were characterized by the predominance of the concentration of corticosterone over that of hydrocortisone in the peripheral blood. These changes were proportional by the decreases in the activity of major energy enzymes and in the functional activity of lymphocytes. Under these conditions, the predominance of peripheral blood corticosterone levels determines the increased inflammatory potential and neutralizes the biological effects of hydrocortisone. The detected dyshormonal metabolic and functional changes form the essence of the pathogenesis of caseous pneumonia and the extent of caseous lung tissue necrosis. Under the influence of chemotherapy, complex disintoxication treatment in combination with prednisolone, there is a marked trend of the peripheral blood concentration of hydrocortisone to increase, for metabolism and lymphocytic functional activity to become normal.

[Efficacy of chemotherapy in patients with the newly detected complicated destructive pulmonary tuberculosis]. / Effektivnost' khimoterapii u bol'nykh s oslozhnennym techeniem vpervye vyiavlennogo destruktivnogo tuberkuleza legkikh vpervye vyiavlennogo destruktivnogo tuberkuleza legkikh.

A hundred and fifty-six patients with first detected destructive pulmonary tuberculosis were examined. 43.6% of the patients were found to have various complications: bronchial tuberculosis and exudative pleurisy were more common. All the patients received conventional chemotherapy. The studies have demonstrated that the efficiency of chemotherapy during the complicated course was less than in the uncomplicated one: closure of decay cavities was observed in 69.4% of the patients with specific lesion of the bronchial system, in 78.8% of those with a complication, such as exudative pleurisy (in 81.8% with uncomplicated course). In these groups of patients, cessation of bacterial isolation, as verified both bacterioscopically and culturally, was slower.

[X-ray characteristics of disseminated pulmonary tuberculosis]. / Rentgenologicheskaia kharakteristika disseminirovannogo tuberkuleza legkikh.

The X-ray pattern of disseminated pulmonary tuberculosis is considered in terms of examination findings in 98 patients. Under the present-day conditions, the X-ray pattern of disseminated tuberculosis is more commonly characterized by a combination of focal shadows of varying diameters with a prevalence of foci of this or that size. Symmetrical areas of infiltration (14.3%) and relatively symmetrical systems of decay cavities (6%) were a major abnormal shadow. A total of 76% had a destructive process. There was a predominance of generalized processes with medium and large cavities.

[Pneumonia in patients from a tuberculosis dispensary]. / Pnevmoniia u bol'nykh protivotuberkuleznogo dispansera.

In their everyday practice phthisiologists have to make a differential diagnosis and to treat patients with pneumonia who account for 2.7% of the patients treated at tuberculosis hospital. The main reason of diagnostic errors in patients with pneumonia in general hospitals is that the compulsory diagnostic minimum is not observed and the patients' sputum is not tested for acid-resistant Mycobacteria. The paper analyzes the results of treatment in 20 patients with pneumonia in the contagious isolation wards of the tuberculosis hospital, who were in-effectively treated in the outpatient setting. Multimodality treatment with broad-spectrum antibiotics, including rifampicin and streptomycin, aerosols, and physiotherapy may completely resolve infiltration and eliminate the clinical manifestations of the disease in 19 patients.