tibljТуберкулез и болезни легкихTuberculosis and Lung Diseases2075-12302542-1506Медицинские знания и технологии10.21292/2075-1230-2016-94-8-5-13tiblj-911Research ArticleОБЗОРЫREVIEWSВыявление микобактерий туберкулеза в крови пациентов с подозрением на туберкулезный сепсисDETECTION OF TUBERCULOUS MYCOBACTERIA IN THE BLOOD OF PATIENTS WHEN SUSPECTING TUBERCULOUS SEPSISЗиминаВ. Н.ZiminaV. N.

доктор медицинских наук, доцент кафедры инфекционных болезней с курсами эпидемиологии и фтизиатрии медицинского института,

117198, москва, ул. Миклухо-Маклая, д. 6

Doctor of Medical Sciences, Associate Professor at the infectious Diseases Department with training Courses on Epidemiology and Phthisiatry of the Medical institute,

6, Miklukho-Maklaya St., Moscow, 117198

vera-zim@eandex.ruМиковаО. Е.MikovaO. E.

аместитель главного врача по лечебной работе,

614088, г. Пермь, ул. Свиязева, д. 21

Deputy Head Doctor on treatment,

21, Sviyazeva St., Perm, 614088

mikovaoe@mail.ruОборинД. А.OborinD. A.

врач-бактериолог,

614088, г. Пермь, ул. Свиязева, д. 21

Bacteriologist,

21, Sviyazeva St., Perm, 614088

DAOborin@yandex.ruДегтяреваС. Ю.DegtyarevaS. Yu.

врач-инфекционист,

105275, москва, 8 ул. Соколиной горы, д. 15

15, 8 Sokolinaya Gora St., Moscow, 105275

degtyareva_svet@mail.ruВиктороваИ. Б.ViktorovaI. B.

кандидат медицинских наук, доцент кафедры фтизиопульмонологииб

654005, г. Новокузнецк, пр. Строителей, д. 5

Candidate of Medical Sciences, Associate Professor of Phthisiopulmonology Department,

5, Stroiteley Ave., Novokuznetsk, 654005

irinaviktoroff@mail.ruФГАОУ ВО «Российский университет дружбы народов»РоссияPeople’s Friendship University of RussiaRussian FederationГКУЗ ПК «Пермский краевой центр по борьбе и профилактике со СПИД и инфекционными заболеваниями»РоссияPerm Regional Center for Prevention and Control of Aids and Infectious DiseasesRussian FederationГБУЗ «Инфекционная клиническая больница № 2» ДЗМРоссияInfectious Diseases Clinical Hospital no.2, Moscow Health DepartmentRussian FederationГБОУ ДПО «Новокузнецкий государственный институт усовершенствования врачей» МЗ РФРоссияNovokuznetsk State Institute for Medical Post-Graduate TrainingRussian Federation201601082016948513Copyright © Зимина В.Н., Микова О.Е., Оборин Д.А., Дегтярева С.Ю., Викторова И.Б., 20162016Зимина В.Н., Микова О.Е., Оборин Д.А., Дегтярева С.Ю., Викторова И.Б.Zimina V.N., Mikova O.E., Oborin D.A., Degtyareva S.Y., Viktorova I.B.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.tibl-journal.com/jour/article/view/911

Рост числа больных ВИЧ-инфекцией с клиническими проявлениями сепсиса требует современных, быстрых и достоверных методов этиологической диагностики. Проанализированы 53 публикации, касающиеся разных клинических аспектов при МБТ-бактериемии, возможности и эффективности ее выявления. Согласно публикациям, МБТ в крови наиболее часто можно обнаружить у ВИЧ-позитивных больных с выраженным иммунодефицитом (СD4: 17-80 клеток/мкл) и наличии следующих клинико-лабораторных и рентгенологических признаков: фебрильная лихорадка, тяжелая анемия, паратрахеальная лимфаденопатия, милиарная диссеминация. Оправдано исследовать кровь для выявления МБТ у тяжелых ВИЧ-позитивных пациентов с подозрением на туберкулез при невозможности собрать мокроту или без явных признаков поражения легочной ткани. Наличие МБТ-бактериемии сопряжено с высоким (до 60%) уровнем летальности, незамедлительное назначение противотуберкулезной терапии может его снизить. АРВТ снижает вероятность развития туберкулезного сепсиса. Разработка или оптимизация тест-систем для быстрого выявления ДНК МБТ в крови является достаточно перспективным направлением в диагностике ургентного туберкулеза.

The increase in HIV patients manifesting clinical signs of sepsis requires up-to-date, rapid and reliable techniques for etiologic diagnostics.

The analysis has included 53 publications related to various aspects of tuberculous bacteriemia, resources for its detection and their efficiency. According to the publications tuberculous mycobacteria in blood can be detected in HIV-positive patients with severe immune suppression (CD4: 17-18 cells/mcl) and presence of the following clinical and laboratory and X-ray signs: fever, severe anemia, paratracheal lymphoadenopathy, miliary dissemination. It is feasible to test the blood in order to detect tuberculous mycobacteria only in the very ill HIV positive patients in whom tuberculosis is suspected and it is impossible to collect sputum and there are no obvious signs of pulmonary lesions.

The presence oftuberculous mycobacteria in blood isrelated to the high mortality level (up to 60%) and the immediate prescription of anti-tuberculosis therapy can reduce it. Antiretroviral therapy can reduce the chances of tuberculous sepsis development. Development and optimization of test systems for rapid detection of DNA of tuberculous mycobacteria in blood can be fairly promising for the diagnostics of the urgent tuberculosis.

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The authors declare that there are no conflicts of interest present.