[Multidrug pulmonary tuberculosis: sociomedical features and the efficiency of inpatient treatment].

Case histories of 147 patients with new-onset destructive pulmonary tuberculosis (PT) (infiltrative, disseminated, fibrocavernous) with the pathogen of the disease showing multidrug resistance (MDR) were analyzed, by evaluating the efficiency of treatment involving sputum abacillation after termination of the inpatient stage of treatment. A control group included 220 patients with PT of the similar lesion and clinical forms, who preserved drug resistance (DR) to antibacterial agents. Most patients with MDR disseminated destructive PT are young people aged 36.6 +/- 1.6 years, this disease-associated disabled individuals (65.3%), alcoholics (48.3%), opium addicts (11.5%), ex-prisoners (26.5%), single, homeless; more frequently suffer from gastrointestinal (40%) and chronic nonspecific lung (24.5%) diseases. The course of MDR PT is significantly more commonly complicated by the development of respiratory failure (48.9%) and hemoptysis (6.1%) (in DR PT 19.1 and 2.3%, respectively). In terms of negative smear tests and the results of sputum cultures, the abacillation rates were 70.1 and 67.3%, respectively (in DR PT, these were 88.18 and 86.34%, p = 0.01). A negative reaction of sputum occurred in 42.1% of patients at 2-3 months of treatment while its culture did in 46.2% at 4-5 months. In the control group wherein drug sensitivity of M. tuberculosis was preserved, sputum abacillation occurred in the larger proportion of the patients within the first 2 months (in 68.6 and 56.3% of cases with sputum smear and culture, respectively). The efficiency of inpatient therapy is greatly affected by short-term treatment caused by voluntary withdrawal and irregular uses of antituberculous drugs, mainly due to alcoholization.

[Immune pathology in pulmonary tuberculosis].

The data of modem literature and the results of original investigations on mechanisms of immunopathological alterations in tuberculosis infection are presented. The role of cellular and humoral parts of immunity in pathogenesis of pulmonary tuberculosis is discussed and cytokine-mediated mechanisms of disorders in a specific immune response are analysed.

[Functional activity of phagocyte blood cells in pulmonary tuberculosis].

The characteristics of the functional activity of phagocyte blood cells in patients with destructive pulmonary tuberculosis caused by medicinal sensitive and medicinal resistant infective agents were studied. In the process of pulmonary tuberculosis, irrespective of the medicinal sensitivity of infective agents before and during treatment, a decrease in the phagocytic activity of neutrophil granulocytes and the level of the expression of Fcgamma- and C3b-receptors on monocytes with a simultaneous increase in the spontaneous production of oxygen metabolites in neutophils and a rise in the adsorptive capacity of monocytic cells were observed.

[Peripheral blood mononuclear leucocytes in patients with drug-sensitive and drug-resistant pulmonary tuberculosis].

The authors studied functional characteristics of mononuclear leucocytes in patients with drug-sensitive and drug-resistant pulmonary tuberculosis. The study found decrease of the number of C3b- and Fcchi-receptorpositive monocytes and increase of their saturation activity in both categories of pulmonary tuberculosis before and after antituberculous therapy. The study revealed increase of interferons alpha and chi production and, at the same time, decrease of tumor necrosis factor alpha, which was more prominent in cases of drug-sensitive tuberculosis, and depression of interleukin 2 secretion, more prominent during chemotherapy in cases of drug-resistant tuberculosis.

[Cytokine-producing activity of peripheral mononuclear leukocytes in patients with pulmonary tuberculosis before and during chemotherapy].

The paper presents the results of a study of spontaneous and stimulated production of TNF-alpha, INF-gamma, INF-alpha, IL-2 by peripheral mononuclear leukocytes in patients with disseminated destructive drug-resistant pulmonary tuberculosis. It also shows marked changes in the levels the studied cytokines in relation to the type of a stimulant (lipopolysaccharide, phytohemagglutinin, tuberculin) and during antituberculous chemotherapy.

[The cytogenic status of peripheral lymphocytes in pulmonary tuberculosis before and during chemotherapy].

The cytogenic status of peripheral lymphocytes was studied in 67 patients with drug-sensitive pulmonary tuberculosis. The latter was found to be attended by cytogenetic disorganization whose signs were present before and 2 months of intensive chemotherapy. In pulmonary tuberculosis, structural disorganization in the lymphocytic chromosomal apparatus was characterized by the elevated levels of cells and with changes in the structure and number of chromosomes. They are most pronounced in infiltrative and disseminated tuberculosis than in caseous pneumonia, as well as 2 months after rather than before chemotherapy. Patients with infiltrative pulmonary tuberculosis had also decreased lymphocytic activity of DNA reparation, followed by its normalization after a course of chemotherapy.