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Tuberculosis and Lung Diseases

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No 11 (2014)
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REVIEWS

5-10 912
Abstract
The advances that have been made in the wide use of antiretroviral therapy in the past decade, which increase longevity and improve quality of life in treated patients with HIV infection are waning because of the high prevalence of tuberculosis among this population. According to the World Health Organization estimates, among 8.6 million tuberculosis patients globally in 2012, there were 1.1 million HIV-seropositive people, of them 320,000 died from different causes. In the Russian Federation, 29,708 patents were co-infected with tuberculosis and HIV in 2012, of them 5,292 died, including 1,152 persons from tuberculosis. HIV-seropositive persons fall ill with tuberculosis 20-30 times more frequently than HIV-negative ones. Consequently, the prevention of tuberculosis becomes the most important area in reducing its burden among the people living with HIV infection, particularly in the countries where these two infections are common. The purpose of this publication is to review the existing guidelines and the investigations conducted in different countries, including in Russia, to study the preventive use of antituberculosis drugs to reduce tuberculosis morbidity and mortality among the HIV-seropositive population.

ORIGINAL ARTICLES

11-17 507
Abstract
В Российской Федерации статистический учет больных туберкулезом органов дыхания (ТОД) с множественной лекарственной устойчивостью (МЛУ) возбудителя введен с 1999 г. по государственной статистической форме № 33. В то время страна была охвачена очередным периодом обострения эпидемической ситуации по туберкулезу ХХ в., вызванным политическими событиями и экономическими кризисами 1991-1992 гг., 1994 г., 1998 г., приведшими к изменению государственного строя страны. Благодаря принятым Правительством РФ мероприятиям, направленным на усиление борьбы с туберкулезом, эпидемическая ситуация по туберкулезу стала нормализоваться. Вместе с тем показатель МЛУ среди больных ТОД с 1999 по 2012 г. увеличился (табл. 1, 2, 3). У впервые выявленных больных рост произошел с 6,7 до 16,3%, среди контингентов на конец года – с 10,5 до 37,5%. Более того, чаще стали регистрировать случаи заболевания, вызванного микобактериями туберкулеза (МБТ) с широкой лекарственной устойчивостью. При наличии обширной литературы [1-3, 5, 18, 19 и др.], посвященной лекарственной устойчивости, не все причины ее возникновения и распространения объяснены.
18-22 2246
Abstract
Analyzing 360 case histories revealed the reasons for the untimely and late diagnosis of pulmonary tuberculosis in the general healthcare network facilities. The main reasons for its untimely and late diagnosis were lower alertness to pulmonary tuberculosis among the population and physicians; underestimation of clinicoanamnestic data; delayed and inadequate X-ray examination; violation of the requirements of Orders Nos. 109 and 690 by the Ministry of Health of the Russian Federation for the detection of tuberculosis by direct microscopy; low quality of sputum tests for acid-resistant mycobacteria in the general healthcare network. In conclusion, there are ways to remove shortcomings, the use of which will contribute to the timely detection of pulmonary tuberculosis.
23-29 2012
Abstract
Diagnosing tuberculosis in children is very difficult. There are no clear diagnostic criteria for intrathoracic lymph node (ITLN) tuberculosis, the most common form of tuberculosis in children (78%). Current immunological methods used in combination with computed tomography make it possible to characterize a child’s status more clearly and to establish a correct diagnosis. The positive results of immunological tests in the presence of Mycobacterium tuberculosis infection require a set of radiological examination. ITLN tuberculosis is characterized by the fact that one group or more contains single or multiple ITLNs that measure more than 5 cm and differ in structure and density in the presence of positive immunological tests (Diaskintest and QuantiFERON test).
30-36 5440
Abstract
The high-level risk factors influencing the development of tuberculosis were analyzed in children and adolescents. The results of the investigation suggest that the major specific risk factors of the disease are tuberculosis contact, residence in the foci unknown to tuberculosis facilities, none or ineffective vaccination. High conversion, hyperergy, and increasing tuberculin sensitivity suggest that there is a high probability of tuberculosis in this group of people. The nonspecific risk factors of the disease, first and foremost in tuberculosis contact, include early childhood and adolescence, social factors, concomitant diseases, such as diabetes mellitus, frequent acute respiratory viral diseases, hypotrophies, and diseases requiring long-term glucocorticosteroid therapy. Higher effective detection of bacillary patients, correct assessment of focal epidemic hazard, better quality of vaccination, and fitness training among children and adolescents at the stage of first medical aid assist in reducing the incidence of tuberculosis and improving the clinical structure of its morbidity, by preventing its generalized forms in children and adolescents.
37-41 475
Abstract

The rate of tuberculosis-concomitant urologic diseases in reproductive-aged women was 77.3% of cases. In women with tuberculosis, the risk factors of urologic diseases may include chronic female genital inflammatory diseases; sexually transmitted infections; menstrual dysfunctions; and female sex hormone imbalance.

All reproductive-aged women with extrarenal tuberculosis, irrespective of the location and pattern of a specific process, form a group at risk for urinary tract tuberculosis. The possibilities for the early diagnosis of urinary tract diseases in reproductive-aged women with tuberculosis may be effectively enhanced by comprehensive urological examination. Management tactics for this category of patients should be elaborated jointly with phthisiatrists. 

42-47 550
Abstract
The values of a number of biochemical markers in serum and pleural fluid (PF) were compared in 30 patients with tuberculous, malignant, or metapneumonic pleural effusions and hydrothorax. The levels of total protein (TP), albumin (A), cholesterol (C), triglycerides (TG), β-lipoproteins (β-LP), C-reactive protein (CRP), soluble fibrin-monomer complexes (SFMCs), stable nitric oxide (NO) metabolites, glucose (G), sodium (Na), and potassium (K) were measured in both media. The effusion/serum (E/S) ratio was calculated for each indicator. The high levels of TG, β-LP, and SFMCs were found to be specific to tuberculous effusions. Malignant effusions exhibited a low content of C and a high level of NO metabolites and a G concentration greater than that in the serum (E/S ratio > 1.0). In nonspecific (metapneumonic) pleurisies, EF showed a very low level of TG and a low E/S ratio for CRP. In hydrothorax, EF displayed the lowest absolute E/S ratio for TP, A, and CRP and the concentration gradient was absent for TG and G (the E/S ratio approached 1.0). The authors made a correlation analysis of an association between the same indicators in PF and serum and a relationship between different indicators in PF.
48-53 724
Abstract
Comprehensive morphological examination of surgical and biopsy samples from 148 patients and autopsy specimens from 181 deceased persons was made to determine a correlation between the level of immunosuppression and the microscopic signs of tuberculosis in patients with HIV-associated tuberculosis (HIV/TB). A relation was found between the count of CD4+ lymphocytes and the predominant type of a tissue inflammatory reaction. Insidious granulomatous inflammation and a preponderance of alterative and exudative components in the foci of tuberculous inflammation suggested that a delayed-type hypersensitivity response that was typical of tuberculosis gave way to an immediate-type hypersensitivity response and reflected severe immune system dysfunction. The lack of responsiveness of the macroorganism in the virtually complete absence of CD4+ lymphocytes observed during autopsy examination led to the acute progression and generalization of tuberculosis, by affecting all organs and systems.
54-57 2214
Abstract

Objective: to estimate the frequency of parenteral viral hepatitides (HB and HC) (PVH) in patients with tuberculosis in Moscow in relation to data on their incidence in the aggregate population of the capital.

Materials and methods. The authors analyzed the incidence of (acute, chronic) HB and HC (carriage) and tuberculosis in Moscow in 2009. A total of 24,220 cards for infectious patients (No. 089/y) and federal statistical follow-up forms (No. 2) were first processed to compare and search for personal data among the patients with tuberculosis and all forms of PVH and to establish the evidence of PVH and tuberculosis comorbidity.

Results. The infection of tuberculosis patients with parenteral hepatitis B and C viruses was ascertained to be 5.5 to 284.9 times higher (in relation to the form of a hepatitis course) than that in the aggregation population of Moscow, which suggests that PVH is of high significance for the tuberculosis patients and that it is necessary to improve a PVH prevention program among this cohort patients. Analysis of the sex-age structure shows that male tuberculosis patients in the 20-39-year-old group should be considered to be a special risk group that should attract special attention when implementing preventive measures. The tuberculosis mortality rate among mixed infected patients was 1.8-fold higher than among those who had PVH-uncomplicated tuberculosis.

Conclusion. The results of the investigations are suggestive of the evidence of PVH and tuberculosis comorbidity. The mixed forms of these infections in different combinations have been established to be accompanied by their severer clinical course and high death rates. 

58-63 863
Abstract
Fifty-five patients with infiltrative pulmonary tuberculosis and 45 with chronic fibrocavernous pulmonary tuberculosis were interviewed using a specially developed questionnaire. Interrelated vital and social fears were revealed. A tuberculosis patient’s fears may be used as a target for treatment motivation.
64-68 562
Abstract
The proinflammatory activity of bronchoalveolar lavage fluid (BALF) was investigated using the biological test system (donor blood) in 71 patients with lung cancer and inflammatory disease of respiratory organs (lung abscess, infiltrative tuberculosis, tuberculoma, fibrocavernous tuberculosis). The supernatant of BALF was purified by filtration through millipores and added to blood, and a nitroblue tetrazolium recovery test (HBT) was carried out. Hank’s balanced salt solution was used in the control. The proinflammatory effect of BALF was defined as a diformazan-positive neutrophil count ratio in the experimental and control samples (stimulation index). The inflammatory process developing in lung cancer was active, as suggested by the accumulation of neutrophils in the lung and by the high proinflammatory activity of BALF, which were comparable with the similar indicators in lung abscess and fibrocavernous tuberculosis.

CLINICAL OBSERVATIONS

69-71 591
Abstract
Периферическая лимфатическая система инфицируется микобактерией туберкулеза (МБТ) во время лимфогенной диссеминации, но не у всех пациентов развивается клинически документированное поражение лимфоузлов.

INFORMATION

72-75 455
Abstract
В г. Новосибирске, в Доме ученых Академгородка, с 18 по 20 июня 2014 г. прошла юбилейная научно-практическая конференция «Эффективное решение проблем туберкулеза: от научной идеи до медицинской практики», объединившая 353 участника.


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ISSN 2075-1230 (Print)
ISSN 2542-1506 (Online)