Search

The paper presents the results of studying the clinical and immunological efficacy of the immunomodulator polyoxidonium in the preventive treatment of tuberculosis in children and adolescents in combination with antituberculous drugs. The study was performed in 50 children and adolescents from the most threatened tuberculosis risk groups (tuberculosis contact and tuberculosis-infected) who needed preventive antituberculosis treatment with one or two drugs for 3-6 months. The use of polyoxidonium in the study group (n = 21) could reduce the time of preventive treatment to 2 months and cause no progression of tuberculin reaction or signs of intoxication and acute respiratory disease. The administration of antituberculous drugs only in 29 children was followed by tuberculin reaction progression in 46-57% of children, which required preventive treatment for as many as 6 months. The immunological effect of polyoxidonium appeared as elevated T-cell levels, the activation of neutrophil phagocytosis and bactericidity. Inclusion of polyoxidonium into the preventive treatment of tuberculosis has shown a higher efficiency of complex preventive therapy and a reduction in the time of using antituberculous drugs for the prevention of tuberculosis, which is very important, bearing in mind fact that there may be adverse reactions when antituberculous treatment is long used.

The paper presents data on vaccine prophylaxis in Russia. A sophisticated analysis of the data available in the literature on approaches to vaccination against tuberculosis in different countries of the world is provided. The results of the studies made by Russian investigators to develop different regimes of BCG re-administrations an their frequencies are given. The fact that it is necessary to change a tuberculosis prophylaxis calendar under the present conditions, by keeping in mind the age of a child and the epidemic situation in the country's region, has been established. A particular section is dedicated to the problem associated with the occurrence of complications in response to tuberculosis vaccine. Based on the Federal Center data on complications due to BCG/ BCG-M, the authors provide information on the incidence and pattern of complications occurring in Russia. As compared with 1995, the incidence of postvaccination complications slightly changed (21.1 in 100,000 in 1995 versus 20.3 in 2002-2003). In the children inoculated at a maternity hospital, postvaccination lymphadenitis was observed 2 times more frequently than in those vaccinated at a polyclini (77.1 and 37% of cases, respectively) and cold abscesses were 3.3 times less frequently than those inoculated at the polyclinic (19.1 and 63% of cases, respectively). The study has ascertained main reasons for the higher incidence of severe complications as BCG ostitis.

The paper provides the analysis of the prevalence rates of tuberculosis among children and adolescents in the Russian Federation, which has been made on the basis of the data available in official reporting forms Nos. 8, 33 (approved by the Resolution of the Russian Statistics Agency on November 11, 2005), and 47 (approved by Resolution No. 175 of the Russian Statistics Agency on September 10, 2002). Correlations between epidemiological indices have been calculated and assessed. The age-related features of the occurrence and course of tuberculosis have been studied among various age groups of children. It is concluded that in this situation in order to improve the epidemic situation among children and adolescents, emphasis should be primarily placed on the activation of intersectoral interaction of primary health care and tuberculosis service: to actively attract general practitioners, local pediatricians and therapists to prophylaxis in children.

Special geoinformation technologies (GIS), a new method for the pictorial data presentation as space-time ratios, have emerged in the past decade. The paper considers the theory of geoinformation analysis and the possibilities of applying GIS for tuberculosis monitoring. GIS may be effectively used in phthisiology only provided that the routine procedures for tuberculosis detection are practiced widely. GIS analysis may assist in detecting tuberculosis when contacts cannot be monitored in the usual fashion. Its results may be used to correct tuberculosis-controlling measures towards their point application. Extended studies can answer to what extent, the efficiency of tuberculosis-controlling measure will increase when they are used in the most possible tuberculosis transmission areas determined by the GIS techniques.

A hundred and thirteen case histories of patients with isolated and generalized forms of abdominal tuberculosis were analyzed. The patients' age was 15 to 79 years; there were 86 (76.1%) males and 27 (23.9%) females. The patients were admitted more frequently from other tuberculosis facilities (66.7%) and less frequently from general hospitals (33.3%). In 62 (54.9%) cases, abdominal tuberculosis showed a complicated course. The residents of Moscow and its region, predominantly the unemployed (85.8%), prevailed in the structure of detected patients with abdominal tuberculosis. In the period of 2001 to 2004, there was a rise in the incidence of new-onset abdominal tuberculosis, its rate increased from 4.4 (2001) to 8.3% (2004) of the total number of patients admitted to Moscow clinical hospital No. 7 for extrapulmonary tuberculosis admitted. This gives no way of considering this site of tuberculosis to be rare. In the structure of abdominal tuberculosis, its generalized forms were prevalent (86.7%), which was associated with the late detection of abdominal tuberculosis and the significant increase in the number of HIV-infected patients from 14.3 (2000) to 33.3% (2004). Abdominal organ lesions were more frequently observed in severe generalized pulmonary processes, such as disseminated (45.1%), infiltrative (18.6%) or fibrocavernous (15.9%) tuberculosis. An algorithm of diagnosis of abdominal tuberculosis and the rates of its detection by various studies are presented in the paper. Abdominal tuberculosis was diagnosed in 8.9% of cases by noninvasive comprehensive examination methods, in 18.6% by laparoscopy, and in most cases (57.5%) intraoperatively. In socially dysadapted persons, postmortem abdominal tuberculosis was detected in 15% of cases.

The paper shows the research directions of the staff of the laboratory of pathomorphology and electron microscopy, which cover the period from 1924 to the present time, which can be conventionally divided into 4 stages associated with the leading role of the laboratory's heads: Prof. V.G. Shtefko (1924-1945), Prof. V.I. Puzik (1945-1974), Prof. O.A. Uvarova (1974-1980), and Prof. V.V. Yerokhin (1980 up to the present time). The laboratory's researches are the productive path of phthisiomorphology. The tasks of the laboratory have been associated with the problems to be solved by the institute. This applies the morphology, pathogenesis, classification of tuberculosis, and changes in inflammatory reactions in response to the altered Mycobacterium tuberculosis and to specific and pathogenetic actions on tuberculosis. New living conditions give the laboratory's researchers new tasks that require their solution at a new technological level.

The paper presents the main points of the authors' own concept of the centralization of mycobacteriological service in large towns of the Russian Federation. The main points of step-by-step organizational and methodological measures required to solve this problem are described in detail. Consecutive measures to realize the proposed mycobacteriological service centralization model originated in January 2004 on a model of the Moscow Eastern Administrative District with 1380 thousand inhabitants are described.

The paper describes the results of radiometric BACTEC assay of drug susceptibility of Mycobacterium tuberculosis strains, isolated from 81 new cases of tuberculosis, to first- and second-line antituberculosis drugs in four administrative areas of the North-Western Federal District of the Russian Federation. The results of determination of drug susceptibility to the antituberculosis drugs by the absolute concentration method and the BACTEC method are also compared. Primary drug resistance has been revealed in 58.0%; multidrug resistance in 34.6%. Comparison of the results of determination of drug susceptibility by the methods revealed no significant discrepancy between both methods; however, the procedure for drug susceptibility to some drugs requires improvement.

The paper analyzes the epidemic situation associated with tuberculosis and AIDS in the Republic of Kalmykia and shows the high incidence (21.2%) of tuberculosis in the HIV infected. The authors propose a classification of tuberculosis and AIDS according to the clinical manifestations and outcome of a disease. Tuberculosis associated with HIV infection has been established to run most severely in socially unfavorable groups of patients. The timely and regular preventive treatment of tuberculosis in the development of immunosuppression (CD4, 200 cells or less) makes it possible to postpone and, at times, prevent the development of a tuberculous process in these patients. Combined antiviral therapy permits more effective treatment of tuberculosis.

The paper presents the results of the assessment of the quality of cultural detection and determination of Mycobacterium tuberculosis (MBT) sensitivity at Russia's public health laboratories, which has been made by the Federal System for External Assessment of the Quality of Clinical Laboratory Studies in 2002-2003. The "Bacteriological Detection" Section involved 102 laboratories, of them 57 laboratories also participated in the section "Detection of Drug Resistance". Sixty-three laboratories operated as part of specialized tuberculosis-controlling service facilities and 39 laboratories worked as part of general medical care therapeutic-and-prophylactic institutions. A set of 5 lyophilized samples containing 2.5 x 10(6) M. tuberculosis H37Rv (n = 1); 2.5 x 10(4) M. tuberculosis H37Rv (n = 2); M. fortuitum (n = 1); E. coli in the mixture with autoclaving-killed M. tuberculosis H37Rv (n = 1). 77% of the laboratories could detect in the cultural sample with a high content of M. tuberculosis, by obtaining a correct result; 85% revealed MBT if only in every three MBT-containing samples; 15% of the laboratories could not find MBT in none of the three positive samples. 12% of the laboratories took the growth of microorganisms in the M. fortuitum-containing sample for that of M. tuberculosis. 58% of the laboratories obtained correct results if only in one sample containing M. tuberculosis H37Rv; 42% reported the detection of resistance to one or several antituberculous drugs in the samples containing the drug-sensitive strain H37Rv (a false drug resistance). All the results of determination of drug resistance (DR) in the M. fortium-containing sample were correct. The findings suggest that it is necessary to increase the professional competence of laboratory personnel to the level that ensures the adequate of fulfillment of the standard protocols for detecting MTB and determining DR, which have been introduced by the Ministry of Health of the Russian Federation through its order No. 109 on March 21, 2003.

The paper presents the results of the tuberculosis situation in the penitentiaries of the Republic of Buryatia. It analyzes organizational measures for prevention of tuberculosis and its early detection in the prisoners and reflect the main reasons of the spread of tuberculous infection in the reformatories. The paper also shows the interdepartmental interactions of the medical service of the Ministry of Justice of the Russian Federation in the Republic of Buryatia with the Republican Tuberculosis Dispensary in notifying and controlling the patients who are in the reformatories, as well as the mechanisms of deporting the accused and convicts who suffer from tuberculosis.

According to the data of the WHO European Regional Office, Russia is now among the countries of Europe, in which tuberculosis and HIV infection are a most pressing problem. In this connection, it has been necessary to promptly determine measures to improve the epidemiological situation. For their elaboration within the high-leveled working tuberculosis group, the ad hoc group "Tuberculosis in patients with HIV infection" working jointly with WHO specialists has been set up in Russia. This paper gives the basic activity lines required for organizing the systems of prevention, epidemiological surveillance, detection of tuberculosis, medical and diagnostic antituberculous aid to patients with HIV infection in Russia.

The paper substantiates and provides evidence for that it is necessary to use summarized estimates to characterize the tuberculosis endemic situation. Some individual epidemiological indices are inadequately estimated to give a correct idea of epidemiological well-being. By using his own method for deriving an integral estimates, the author has analyzed the dynamics of the tuberculosis situation in Russia in 1985 to 2003. Two turning points have been established in the dynamics of the epidemic situation: 1) improvement up to 1991 inclusive and 2) a subsequent deterioration up to 2002, thereafter the epidemic situation had tended to improve. A correlation matrix has been derived, which reflects a correlation of integral estimates with individual epidemiological indices.

The paper presents the basic sections of the nonspecific prevention of tuberculosis. The main objective, tasks, and methods for solving the latter are formulated for each section. Emphasis is placed on the social and age groups of the population while doing sanitary and educational work. Attention is given to that it is necessary to evaluate the efficiency of implementation of educational programs, which is important for making amendments when the epidemic situation and the population's sanitary education change.

The review paper presents data on the epidemiological features of extrapulmonary tuberculosis in Russia and other countries and on diagnostic problems. It considers the papers of the authors who propose different measures to enhance the efficiency of diagnosis of extrapulmonary tuberculosis.

The paper proposes a principle of following up patients from tuberculosis facilities, which is based on the patients' need for treatment rather than on the duration of monitoring of cure stability. The proposed scheme of dispensary registration may focus phthisiologists' attention on the patients who really need a follow-up. The use of the scheme in tuberculosis facilities will enhance the efficiency of treatment in patients and reduce the rate of tuberculosis reactivation in patients registered as risk group ones.

The paper shows a poor prognosis of tuberculosis spread among HIV-infected patients in Russia for the years immediately ahead. Recommendations are given how to organize a tuberculosis controlling care to patients with HIV infection by taking into account its stages by aspects, such as prevention, diagnosis, medical examination, and treatment.

The paper provides the data of comprehensive epidemiological and clinical studies made at the Clinic of Tuberculosis in Children and Adolescents. Research Institute of Phthisiopulmonology, I. M. Sechenov Moscow Medical Academy, Ministry of Health of the Russian Federation, in the past 15 years and dedicated to extrapulmonary tuberculosis in children and adolescents with tuberculosis. Due to the specific features of manifestations of extrapulmonary tuberculosis in childhood and adolescence and to the existing system of prevention and early detection of the disease in children and teenagers in the Russian Federation, the number of children with severe generalized extrapulmonary tuberculosis is not on the rise despite that the epidemiological situation has aggravated in the past 15 years. The clinical features of most common forms of extrapulmonary tuberculosis are shown and measures for their monitoring proposed.

The paper shows how to detect an epidemiological chain of spread of tuberculosis in the Barents Sea Region. RFLP typing of Mycobacterium tuberculosis strains may serve as an important tool in detecting an infection source and drawing up epidemiological chains of tuberculosis spread. Cross infection may occur in tuberculosis cure hospitals, which shows it necessary to delimit fluxes of tuberculosis patients into health care facilities.

The paper analyzes the results of implementation of the WHO recommendations on detection ad treatment of patients with tuberculosis in 1997-1999. A total of 8901 individuals with symptoms of suspected pulmonary tuberculosis were examined in this period. Sputum smear microscopy revealed acid-resistant bacteria (ARB) in 293 (3.3%) of the patients, including in 167 (57%) with their verification at clinical diagnostic laboratories of general health care units. A therapeutical success was achieved in 81.9% of the new cases of pulmonary tuberculosis who had ARB, in 85.7% of the patients without ARB, and in 72% with recurrent tuberculosis.

The paper proposes procedures for analyzing and predicting the rates of total morbidity due to tuberculosis and the time of its cure. Original procedures for identifying the factors that most substantially influence total tuberculosis morbidity rates (incidence rates) are described. A statistically significant regression equation was derived to predict tuberculosis morbidity in the cities and towns of the Rostov region (the determination rate R2 = 0.95; the mean weighed predictive error is no more than 5%, with 1-2% in the cities). A total approach to statistical assessment of the impact of concomitant diseases on the clinical recovery rates is proposed. Estimates indicated that there is alpha negative statistically significant correlation between the rapidity of recovery and the presence of concomitant pathology (alcoholism). A statistical correlation between the indices of regression of active tuberculosis was assessed. In 96% of cases, transition of active tuberculosis to inactive one can be judged from the values of only two factors. A functional relationship has been derived, which defines the onset of the phase of inactive tuberculosis with accuracy sufficient for practical purposes.

The paper presents guidelines in treating tuberculosis in children from the experience gained in Russia and other foreign countries. Emphasis is laid on the necessity of applying a comprehensive approach to the treatment whose main constituents are sanitary and dietary regimens, etiotropic and pathogenetic therapies, prevention of exacerbations or treatment of concomitant diseases. It is important to use antituberculous agents rationally by determining a standard treatment regimens for patients with various somatic diseases. Of great value is the pattern of organization of a therapeutical process at different stages (institutional treatment at a hospital, day hospital, or sanatorium and outpatient treatment), which secures continuity and accordingly enhances the efficiency of treatment as a whole.

The paper deals with organizational measures for detection and treatment of homeless persons with tuberculosis in Saint Petersburg. A total of 1653 homeless tuberculosis patients were followed up in 1991-1997. There was high incidence of tuberculosis in homeless persons (30 detected per 1000 examinees. All agencies, facilities, and services should participate in detecting and treating tuberculosis among homeless subjects. Large-scale solution of this problems requires a package of measures by providing additional funds stipulated by a regional goal-oriented tuberculosis control programme.

The paper outlines the results of following up 50 infants and preschool children who had contacts on their families. The major sources of infection were equally both their mother and their father. The children were found to have pronounced active processes. The most severe types of tuberculosis were common in infants in whom general, military tuberculosis and tuberculous meningitis along with complicated types in intrathoracic lymph node tuberculosis were detected. There was more commonly a phase of dissemination and decay in infants. Severe types of tuberculosis were encountered in the families having a combination of many unfavourable factors, both medical and social ones. Among the children who had fallen ill, 32% were detected on their visits to polyclinics of upon admissions to general hospitals.

In recent years, there has been a rise in tuberculosis morbidity among children and adolescents in Russia. Society's social problems which contribute to the accumulation of an uncontrolled infection reservoir that is unknown to the antituberculous service system. The reservoir is formed primarily among children and adolescents who are brought up in socially disadapted, migrants' refugees, or homeless families, among delinquent children and adolescents. The existing complex of antituberculosis measures is under way only among permanent residents. In this connection, antituberculous measures in the above risk groups are to be improved. Some specific proposals are given in the paper.