Lymphocyte stimulation test in the diagnostics of adverse reactions to antituberculouse line 1 and 2 drugs.

Adverse drug reactions to anti-TB drugs (ADR) are found in 6-20% of patients and have various clinical manifestations and are detected in the lymphocyte stimulation test (LST), recorded by the incorporation on H3 thymidine, but nowadays it has significant limitations. We used LST with WST-1 reagent to detect ADR to the main 1-st and 2-nd line antituberculosis drugs in 11 tuberculosis patients who had ADR (6 - hepatotoxic reaction, 3 - blood eosinophilia and 2 - with joint pain syndrome). 6 people with tuberculosis contacts made up the control group. LST evaluation with WST-1 showed that in patients with a hepatotoxic reaction, the SI index was>2 and exceeded the values in the control group (3.28±0.59, 95% CI-1.16 and 0, 74±0.16, 95% CI - 0.31, respectively) upon stimulation of cell cultures with rifampicin alone but not with other drugs. Cell cultures stimulated with the PHA mitogen have SI >2 in ADR patients (mainly with hepatotoxic reactions). Control group SI was <2 (4,93±0.53, 95% CI - 1, 04 and 1.97±0.3, 95% CI - 0.59, respectively). We have not detected PPD-L cell cultures stimulation with WST-1 reagent both in the group of patients with ADR and the control group. In patients with eosinophilia and joint pain syndrome SI was low for all studied drugs and did not differ from the control group. The sensitivity of the LST test with WST-1 reagent is not sufficient to determine ADR to anti-TB drugs.

[Treatment and outcomes of tuberculosis with multidrug resistance of MBT in children and adolescents].

Eighteen patients with multidrug resistant Mycobacterium tuberculosis (MBT), including 4 (22.2%) children aged 12-14 years and 14 (77.8%) adolescents, were followed up. In 89% of cases, 5 drugs were included into the intensive phase of the chemotherapy regimen. The commonest causes limiting the use of the sixth drug were MBT resistance to essential and reserve drugs (41.2%), uncorrectable adverse reactions to the drugs to which sensitivity was retained (30.7%). The intensive phase lasted 5 months; the mean continuation phase was 5.5 months. The reduction in the latter is attributable to the surgical treatment in 38.9% of the patients with sustained decay cavities and bacterial isolation. Treatment should be complex, by applying different treatment options, such as chemotherapy, collapdotherapy, and surgical treatment. After complex treatment, bacterial isolation ceased in 94.4% of cases, decay cavities closed in 83.3%. There were pronounced residual changes in 66.6%.

[Chemotherapy for tuberculosis in children and adolescents: problems and ways of their solution].

Treatment of 329 patients aged 4-17 years who had first detected tuberculosis was analyzed. The clinical pattern is mainly represented by infiltrative, focal tuberculosis and tuberculosis of intrathoracic lymph nodes (94.5%) and, in single cases, by other forms of tuberculosis. Treatment was performed according to regimens I and III. The time of abacillation is 1-2 months shorter than positive X-ray changes. In this connection, the results of X-ray monitoring may be regarded as the leading criterion for completion of intensive care. Microbiological monitoring methods should be primarily used to evaluate the initial combination of chemotherapy. The active application of pathogenetic treatment modalities that promote the acceleration of reparative processes (physiotherapy in particular) generated the necessity of using 3 antituberculous agents in the phase of treatment continuation.

[The reserve drugs: their safety for children and adolescents].

For the treatment of children and adolescents with tuberculosis, the needs for reserve drugs are 24.0 and 48.6%, respectively. The main reason of the use of reserve drugs is intolerability of essential antituberculous drugs in children (16.4%), and resistance to these drugs in adolescents (40%). Overall, different types of intolerability events (allergic, toxic, toxicoallergic reactions) were observed in 27 (34%) of 79 children and in 46 (65%) of 70 adolescents. Adverse reactions to essential drugs were significantly more frequently observed than those to reserve drugs in both the children and the adolescents: in 96.3 and 3.7% (p < 0.001) and in 89.1 and 10.9% (p < 0.001) cases, respectively.

[Incidence of adverse reactions to chemotherapy and their types in adolescents with tuberculosis]. / Chastota razvitiia i vidy pobochnykh reaktsii na khimioterapiiu u podrostkov, bol'nykh tuberkulezom.

During treatment, 65.7% of the patients developed adverse reactions to antituberculosis drugs. Allergic reactions were most commonly associated with the use of streptomycin. The simultaneous inclusion of isoniazid, rifampicin, and pyrazinamide into the treatment regimens irrespective of the total number of drugs was found to increase the incidence of hepatotoxic reactions as compared with the regimens which do not contain a combination of these 3 drugs. Cycloserin may be given to adolescents with multidrug resistant tuberculosis. Glutaminic acid prevents the toxic effect of the drug on the CNS, therefore cycloserin may be prescribed for a long period (for as long as 9 months).

[Modern aspects of the combined treatment of pulmonary tuberculosis in adolescents]. / Sovremennye aspekty kompleksnogo lecheniia tuberkuleza legkikh u podrostkov.

The paper presents the follow-up data on 171 adolescents with active pulmonary tuberculosis. Extensive, complicated processes were encountered in 30% of patients. Chemotherapy was used in relation to the severity of disease, to the presence of decay and bacterial isolation, to the sensitivity of Mycobacteria tuberculosis. Most patients received routine treatment regimens including four (n = 66) or three (n = 51) drugs. The treatment involved auxiliary drugs (tarivid, protionamid, amykacin). Pathogenetic treatments (lidase therapy, laser blood radiation, magnetic therapy) were employed. Comorbidity was also treated. Good results were achieved in 95.4% of patients. Hospital treatment decreased by 1.5-3 months.

[Immunologic reactivity in the acute phase of a stroke]. / Immunologicheskaia reaktivnost' v ostrom periode insul'ta.

Examinations of the clinical and immunological state of 68 patients with the acute stage of cerebral stroke were carried out, and so were immunomorphological examinations of the spleen and the subclavicular lymph nodes in 36 of them whose disease ended in death. An analysis of the results obtained has shown that the immunological reactivity increases from the very first day of the disease. The authors believe that the early immunological response, especially in cases of brain infarction, is due to development of the cerebral stroke in a sensitized body. A rise of selective antibody titres depending on the character of the cerebrovascular disorder was noted: there were: anti-encephalic antibodies targeted at the malacia focus in cases of brain infarction, and antivascular, and to a lesser extent anti-encephalic antibodies in cases of a hemorrhagic stroke. The informative value of the complement fixation test was found to be greater than that of the hemagglutination inhibition test. High degrees of plasmatization of the splenic tissue and the presence of the anti-encephalic immune complexes in it, mainly in cases of brain infarction, also point to the activity of the immunogenesis in the acute stage of the cerebral stroke.