[Drug resistance of Mycobacteria tuberculosis in patients with new-onset pulmonary tuberculosis].

Statistics for the last 6 years show a trend to growing number of new cases with tuberculosis of the lungs with drug-resistant pathogen. In recurrent tuberculosis multiple drug resistance (MDR) was three times higher than in new cases. Treatment efficacy depended on MDR and patients' compliance. The results of the basic treatment course were unstable: many patients had exacerbation within 3-4 years after therapy, many patients died, especially those with M. tuberculosis resistant to many drugs.

[To the problem of abacillary caverns in patients with pulmonary tuberculosis]. / K voprosu ob abatsilliarnykh kavernakh u bol'nykh tuberkulezom legkikh.

Less interest has been recently shown in the so-called openly negative syndrome in patients with pulmonary tuberculosis, which occasionally results in healing of tuberculous caverns to form a cystoid cavity. The materials presented in this paper suggest that in the 1960s the openly negative syndrome occurred after chemotherapy in 8.7% of the patients registered at a tuberculosis facility for destructive pulmonary tuberculosis. This syndrome persists for 3 years or more (according to the data of bacterioscopy, sputum inoculation and biological test on guinea pigs). Of great interest are the data of histological study made under the head of Prof. V. I. Puzik on experimental animals. The absence of specific reactions in response to a biological test and the presence of significant lymphoid focal and diffuse infiltration in the lungs, hyperplasia of follicles of the spleen and lymph nodes allow them to be regarded as immunomorphological reactions in response to the protein components of destroyed Mycobacterium tuberculosis (MBT). The long existing openly negative syndrome is also presented observed in patients with pulmonary tuberculosis but only in those who isolate MBT sensitive to antituberculous agents. In this connection, it is not inconceivable that special reparative processes that do not result in the long (3 years or more) existing openly negative syndrome in patients with destructive pulmonary tuberculosis who isolate resistant MBT forms.

[Some aspects of tuberculosis prophylaxis care under current socioeconomic conditions]. / Nekotorye aspekty raboty protivotuberkuleznogo dispansera v slozhivsheisia sotsial'no-ékonomicheskoi situatsii.

The paper deals with 4-year work of a tuberculosis dispensary that serves over 1 million residents of Moscow. It presents the causes of late detection of tuberculosis, the specific features of the socioeconomic status and those of the clinical picture of the disease in relation to the "channel" of detection, as well as the structure of identification of Mycobacterium tuberculosis resistance in new and old cases of tuberculosis and also analyzes the efficacy of treatment by the DOTS methods in new cases of pulmonary tuberculosis who have complete a full 6-month treatment course.

[Present-day clinical and social characteristics of newly diagnosed patients with pulmonary tuberculosis]. / Sovremennaia kliniko-sotsial'naia kharakteristika vpervye vyiavlennykh bol'nykh tuberkulezom legkikh.

The present clinical and social characteristics of new cases with pulmonary tuberculosis show some features. The clinical characteristics of patients in 1995 to 1997 indicate an increased number of patients with disseminated, frequently bilateral processes and acute tuberculosis which is largely associated with the decline in preventive fluorographic surveys of the population including those who have contacted bacteria-isolating patients. There were 61.3% with pulmonary symptoms among those who visit physicians and 62.1% among those from the foci of tuberculous infection. Social aspects of the study demonstrate that there is a great number of young patients (56.4% of those under 39-49 years) and a high proportion (81.1%) of able-bodied patients among both males and females. There was an increase in the proportion of patients having higher education (43.7%) and a decrease in laboring patients (21.4%). This is most likely to be associated with the fact that many patients did not work by the profession they had been trained. There was a higher proportion (43.0%) of the patients having different poor working conditions and patterns. In these years, the patients' financial position deteriorated. It was slightly better in the employed than in the unemployed. However, in both groups the bulk of the patients had income per head in the family at the subsistence level or lower (56.2 and 21.6% in the unemployed and employed, respectively. These data were assessed by the guidelines made by the State Statistics Committee of the Russian Federation and the RF Ministry of Labour. It should be noted that the nutritional quality did not correspond to the optimal composition ratio of dietary foods and it was characterized by the high content of less valuable foods, carbohydrates, low levels of protein and vitamins. Poor social aspects in characteristics of patients were undoubtedly to be associated with a greater number of patients with severe, frequently progressive forms of tuberculosis although they had received specific chemotherapy.

[Analysis of tuberculosis morbidity in the southeastern district of Moscow]. / Analiz zabolevaemosti tuberkulezom v Iugo-Vostochnom okruge Moskvy.

The present-day poor epidemiological conditions are marked by an increase in tuberculosis detection rates (1.43%) with low coverage (28.0%) of the population with preventive fluorographic surveys and a high proportion (39.0%) of young patients (aged 18-39 years) among new cases. The shares of advanced and acute forms of tuberculosis were 7.2 and 11.4%, respectively. A decay phase was detected in 50.6%, 52.6% of patients isolated bacteria. In children, tuberculosis morbidity increased by 28.6% mainly among the unregistered extrafamilial contacts. Most patients (75.8%) detected upon their referral to the polyclinics and general hospitals had a high proportion of extrapulmonary tuberculosis. Thus, the above trends of morbidity show its high potential level.

[Recurrence of pulmonary tuberculosis: in- and outpatient data]. / Retsidiv tuberkuleza legkikh po kliniko-dispansernym dannym.

Diagnosis recrudescent pulmonary tuberculosis shows different flaws: on the one hand, the progression of early untreated tuberculosis can be mistaken for a recrudescence, on the other, changes are interpreted as a recrudescence if there is no clinical and X-ray evidence for the reactivation of the process. All cases of recrudescent tuberculosis should be reexamined by a medical commission, which allows the above errors to be avoided. If a patient with chronic alcoholism and mental disease has recrudescent tuberculosis, a narcologist and psychiatrist must participate in working out a comprehensive treatment policy.

[Efficacy of clinical follow-up of patients with tuberculosis of the respiratory organs in terms of their cure under present-day epidemiological conditions]. / Effektivnost' kliniko-dispansernogo nabliudeniia v probleme izlecheniia bol'nykh tuberkulezom organov dykhaniia v sovremennykh epidemiologicheskikh usloviiakh.

A total of 884 newly detected patients with tuberculosis of the respiratory organs with degradation were followed up for 9 years (1987-1995). Control group consisted of 1419 patients with respiratory tuberculosis without degradation. As a result of treatment, the destruction focus was healed in 3 years in 73.4% patients and bacteria no longer released in 77.4%. Remote results (after 3, 6, and 9 years) indicate that adequate treatment helps attain cure during the second and third year of the follow-up. Untimely transfer of the patients into inactive groups (40.4% after 3 years) leads to early relapses of tuberculosis, and thus groups of chronic patients are formed both among tuberculosis patients with initially detected destruction and without it (4.5 and 2.2%, respectively). The number of clinically cured patients by the end of the ninth year was 56.6 and 77%, respectively; 7.4 and 4.7% patients were still registered in the active groups.

[Long-term follow-up of newly diagnosed patients with destructive pulmonary tuberculosis]. / Otdalennye rezul'taty dispansernogo nabliudeniia za vpervye vyiavlennymi bol'nymi destruktivnym tuberkulezom legkikh.

The authors present 6-year follow-up results for 884 new cases with destructive respiratory tuberculosis. The patients were from a high risk group by social, disease form and associated disease criteria. The majority of the cases (90%) were detected at diagnostic x-ray outpatient examinations. There is a rise in destructive tuberculosis detection rate in general hospitals. Treatment response rate for destructive tuberculosis may be assessed as high: bacterial discharge ceased in 90.5%, caverns closed in 86.5%, 39.2% were cured within 3 years, 33.3% improved, chronic forms developed in 10.9%, lethal outcomes occurred in 16.6% of treated patients. For 6 years the number of complete responses did not grow much.

[Formation of dispensary contingents of adults with cured pulmonary tuberculosis and their follow-up]. / Formirovanie dispansernykh kontingentov s izlechennym tuberkulezom legkikh u vzroslykh i nabliudeniia za nimi.

The case histories of 5394 subjects who were registered in a number of Moscow. Tuberculosis Dispensaries during 1976-1988 were studied. These subjects belonged to groups III-VII and were earlier struck off the register. In Formation of groups III-VII of dispensary registry, there is an early establishment of the clinical recovery of pulmonary tuberculosis, therefore the patients with an uncured or progressive process are included in these groups. Reactivation of actually cured tuberculosis was found only in 70.7% of the subjects and the rest had an active process which has been misinterpreted as cured or as hyperdiagnosed reactivation. The main causes of the early establishment of clinical recovery, failure to establish the onset of reactivation and its hyperdiagnosis were the inadequate examination of X-ray positive subjects before their enrollment in III-VII groups, during follow-ups and striking-off, as well as errors in dispensary tactics, i. e. inadequate pre-enrollment in the O-group and diagnostic treatment. Tests for M. tuberculosis by repeated inoculation and tomography should be used in all cases in establishing clinical cure, forming Groups III-VII, following up the patients, and striking off.

[The reactivation of pulmonary tuberculosis in persons in registry groups III and VII and those removed from dispensary observation]. / Reaktivatsiia tuberkuleza legkikh u lits III i VII grupp ucheta i sniatykh s dispansernogo nabliudeniia.

Clinicoroentgenological findings on 3262 patients registered in groups III and VII of the dispensary observation were studied for a period of 12 years and 425 cases of tuberculosis relapses were analyzed. On the basis of the data it was suggested to divide tuberculosis relapses into real reactivation (65.6 per cent) and pseudoreactivation (26.4 per cent). Pseudoreactivation of tuberculosis in 46.4 and 42.0 per cent of the patients was diagnosed because of mistakes of roentgenologists and phthisiologists, respectively. Diagnosis of tuberculosis pseudoreactivation in 11.6 per cent of the patients was associated with diagnostic difficulties. 8 per cent of the pseudoreactivations interpreted as relapses referred to overdiagnosis of tuberculosis activity. Therefore, real reactivation of pulmonary tuberculosis was only in 2/3 of the patients.