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Ninety adolescents suffering from tuberculosis with primary drug resistance (PDR) in Mycobacterium tuberculosis (MBT) were followed up. All the patients had active, marked processes, mainly infiltrative tuberculosis in the phase of decay and dissemination. MBT resistance to 3 drugs or more was detected in most patients (62.3%). Multidrug resistance was 32.2%. The course of the disease was chiefly favorable. An exacerbation of the process occurred during therapy in 6.6% of patients. In patients with PDR, abacillation occurred in 100% of cases and the decay cavities closed in 86.6% by the end of the course of therapy. The PDR patients received treatment with both first- and second-line drugs, had surgery, collapsotherapy, laser therapy, and physiotherapeutic treatments, and lidase. Treatment of patients with drug-resistant tuberculosis presents severe difficulties. However, good results can be achieved in most patients, by applying an individual approach to each patient and determining the optimum chemotherapy regimens and pathogenetic treatments.

The long-term results of treatment in adolescents with drug-resistant tuberculosis were studied. Forty-one patients were examined 1.5-5 years after discharge from hospital. Thirty-nine of the 41 patients were found to have good outcomes of the disease without exacerbations and recurrences. A recurrence was detected in 2 (4.9%) patients. Prior tuberculosis did not affect lifestyle and choice of a profession in 36 (87.8%). There were limitations in the choice of a profession in 3 (7.3%) patients (they were students of culinary colleges).

Forty-nine adolescents with active pulmonary tuberculosis were followed up to assess the biological chip test for the detection of rifampicin resistance in Mycobacterium tuberculosis (MBT). Rifampicin resistance (rpo B gene mutation) was detected in 22 (44.9%) patients. Disseminated processes were detected in a larger proportion of the patients with rifampicin resistance than in those with MBT susceptibility (63.6 and 40.7%, respectively (p < 0.05). Comparison of the data on MBT resistance and susceptibility, which had been obtained by bacteriological studies (nutrient medium cultuvations) and the biological chip test, revealed their agreement in 50% of the cases. A response could be showed after 2-3 months in the former case and after 2-3 days in the latter case. With the biological chip test, the resistance of MBT to rifampicin was additionally established in 38.7% of the patients with negative cultivation tests on admission and during therapy. Follow-ups have demonstrated that MBT resistance to rifampicin preserves longer with the biological microchip test than that with nutrient medium cultivation.

The paper is dedicated to the anniversary of Professor V. I. Puzik, Honored Science Worker. It gives the data of morphological studies from her dissertation and some sections of the dissertations supervised by V. I. Puzik. The paper also presents data on the diagnosis, clinical picture, and treatment of tuberculosis in adolescents. The problems of early detection, differential diagnosis, the significance of concomitant diseases and social factors in the course of tuberculosis are discussed. Emphasis is placed on the importance of drug resistance in adolescent patients with tuberculosis, which has been revealed in 63.3% of cases. Complex treatment with essential, reserve, and combined antituberculous drugs is recommended in relation to the sensitivity of Mycobacterium tuberculosis. It is also advisable to treat concomitant diseases and to prescribe pathogenetic agents enhancing the body's overall resistance.

Ninety adolescents with bacterial isolates of active forms of pulmonary tuberculosis were followed up. Drug resistance of Mycobacteria tuberculosis was revealed in 57 (63.3%) patients. Primary resistance was determined in 43 (47.7%) patients. The patients had not received antituberculous agents. Complete or partial coincidence of MBT resistance and sensitivity with the data of an infection focus. The course of tuberculosis during adequate treatment by using essential and reserve agents in the adolescents with varying MBT resistance was different. In patients (n = 18) resistant to 1-2 agents, the course of the disease little differed from that in those patients with drug-responding tuberculosis, except for later closure of decay cavities. In patients resistant to 3 drugs or more showed a slow course of the disease with significant residual changes in most patients.

The data are presented on 138 adolescents with active, advanced tuberculosis. M. tuberculosis were detected in the sputum and bronchial lavage of 75(54.3%) adolescents. 32 patients had M. tuberculosis resistant to drugs. 28 untreated patients demonstrated primary drug resistance (37.5%). Intensive combined treatment with consideration of bacterial resistance, administration of reserve drugs, wide spectrum medicines bring about positive results, but in patients with drug resistance positive dynamics is slow.

The paper presents the follow-up data on 171 adolescents with active pulmonary tuberculosis. Extensive, complicated processes were encountered in 30% of patients. Chemotherapy was used in relation to the severity of disease, to the presence of decay and bacterial isolation, to the sensitivity of Mycobacteria tuberculosis. Most patients received routine treatment regimens including four (n = 66) or three (n = 51) drugs. The treatment involved auxiliary drugs (tarivid, protionamid, amykacin). Pathogenetic treatments (lidase therapy, laser blood radiation, magnetic therapy) were employed. Comorbidity was also treated. Good results were achieved in 95.4% of patients. Hospital treatment decreased by 1.5-3 months.

The paper deals with the detection of carbohydrate metabolic disturbances in adolescents with tuberculosis and analyzes their impact on the course of a specific process. Borderline carbohydrate metabolic disorders were identified in 10.8% of the 130 patients examined. A trend for tuberculosis to run less favourably was found in patients with carbohydrate metabolic disturbances than in those without these disorders; however, there was no significant difference between the groups. Fourteen tuberculosis adolescents with diabetes mellitus were followed up. Their concurrence showed a severe course. In 33.2% of patients, the course of tuberculosis was poor, by progressing to fibro-cavernous tuberculosis.

In 25 of 44 teenagers suffering from acute and progressive tuberculosis, intravenous blood laser radiation was included into its multimodality treatment following 2-4 weeks of the initiation of chemotherapy. The use of laser enhanced the efficiency of treatment, accelerated positive changes by 1.5-2 months by major clinical and laboratory indices, made the disease run smoothly and caused less pronounced residual changes in the lung.

The phenotype of haptoglobin (Hp) was determined and Hp and alpha 1-antitrypsin (alpha 1-AT) were many times measured in the sera of 131 adolescents with first identified tuberculosis. The phenotype of Hp was found to produce no effects on tuberculosis morbidity among adolescents, but Hp2-2 carriers fall ill more frequently if they have a baseline gastrointestinal abnormality. In tuberculosis patients with Hp2-2, resolution of infiltrative changes in the lung tissue occurs less rapidly than in those with other Hp variants. Great increases in the serum levels of alpha 1-AT, which reflects the severity of tissue damages, suggest a less favourable prognosis. By the end of sixth-month continuous combined drug therapy, an inflammatory reaction diminishes and the synthesis of acute phase reactants (APR) becomes normal in patients without baseline lung tissue decay. In the presence of the latter, the intensity of inflammation considerably decreases in the first 3 months of combined drug therapy, then becomes steady-state at a definite level, which is potentiated by continuous invasion of proteolytic enzymes. APR monitoring more accurately assesses the time course of therapy-induced changes in the process.

Isoniazid concentrations were measured in the serum, liver, and lungs of the animals 1, 3, 6, and 24 hours after administration of isoniazid in a dose of 10 mg/kg via various routes (orally, intramuscularly, and lymphotropically--into the pretracheal cellular space) guinea-pig blood and organs in the experiment on 36 guinea-pigs. Within the first 1-3 hours after intramuscular injection of isoniazid, its concentrations in the serum and lungs were higher than those with other routes of administration. With lymphotropic and oral routes, the levels of the drug were very similar in all the studied media in the first 6 hours, but later its hepatic accumulation after lymphotropic administration proved to be considerably lower than via other routes. The lymphotropic injection of isoniazid provides its therapeutic concentrations in the blood and in the lung and simultaneously creates prerequisites for reducing the incidence and severity of hepatotoxic adverse reactions.

Two experiments were conducted on 36 guinea-pigs. One of them examined the morphology of the distribution of the intravital stain trypan black with isoniazid 1, 3, 6, 24, and 48 hours after their administration into the subcutaneous fat of the neck and axilla. It demonstrated that the agents came from the subcutaneous fat largely to the intrathoracic lymph nodes and lungs via the lymphatics in a retrograde way. The other experiment on 16 healthy guinea-pigs indicated that 1, 2, and 3 months after lymphotropic administration (into the pretrachea and axilla), an infiltrate appeared and increased at the site of drug administration, which became larger after 3 months of lymphotropic injection, and after discontinuation it is completely resolved and the tissue structures of the subcutaneous fat recovered.

Regional lymphotropic therapy involves the administration of a antituberculous drug (isoniazid or canamycin) into the pretracheal cellular space or subaxillary region on the damage ipsilateral side with daily alternations of injection sites. A hundred and thirty two patients with active tuberculosis types (mainly infiltrative) who form two equal groups: main (lymphotropic therapy) and control (routine treatments) were followed up. Lymphotropic therapy is well tolerated by patients, particularly in the presence of concurrent gastrointestinal diseases, produces no adverse reactions, promotes more rapid resolution of infiltrative changes and elimination of intoxication signs. A more rapid positive dynamics in the main group than that in the control one allows the duration of hospital stay to be reduced by 2-2.5 months.

Follow-up study of 106 adolescents with advanced and complicated tuberculosis revealed causes and risk factors of the severe disease: late detection and treatment, massive infection, inadequate initial treatment, drug resistance of M. tuberculosis, poor tolerance of chemotherapy, presence of associated diseases and chronic infection foci, harmful habits. Of importance is also age-sex factor, absence of BCG revaccination, low quality of preventive, diagnostic and therapeutic service, inadequate hygienic education of adolescents.

Tuberculous antigens and antibodies, antigens and antibodies to pneumococcus, haemophilus bacteria. Klebsiella pneumonia, proteus bacteria were determined in 100 adolescents (87 with tuberculosis and 13 with nonspecific lung diseases). Specific antigens and antibodies were detected in 62% of tuberculous and 7.7% of nontuberculous patients. The most pronounced immune response to M. tuberculosis antigens and antibodies as well as to nonspecific flora was registered in patients with long-term and disseminated processes. Immunological investigations are thought an important tool in diagnosis, differential diagnosis of tuberculosis and planning combined treatment policy.

The authors analyse the data obtained on 366 tuberculous adolescents treated in the central Research Institute of Tuberculosis in 1989-1990. Active disease occurred in 30% of them. As evident from larger proportion of infiltrative tuberculosis with destruction and dissemination, the incidence rate of which had grown from 11.5% in 1989 to 40% in 1992 and of caseous pneumonia (the growth, respectively, from 7.7% in 1990 to 25% in 1992), clinical patterns of tuberculosis takes a more serious course. Of late, caseous pneumonia in adolescents has been characterized by an acute onset, loss of weight against severe intoxication, pronounced bacterial discharge, shifts in blood and immunity indices, associated affections. Most of the adolescents were infected in their family who had failed to receive BCG revaccination. Adequate combined treatment has resulted in favourable outcomes which, however, have been often accompanied by defective healing.

The authors present the data on special features of the course of tuberculosis in adolescents having other diverse conditions such as nonspecific pulmonary diseases and congenital abnormalities, prior acute respiratory diseases and concurrent iron deficiency anemia. The combination of tuberculosis with other diseases results in a longer course of tuberculosis with slow clinical and X-ray dynamics and in a number of cases (++prior acute respiratory diseases) in bouts of the specific process. The favourable outcomes of the disease are determined by the correct combined treatment of tuberculosis and concurrent diseases. When tuberculosis runs along with congenital abnormalities the effectiveness of treatment is achieved by surgical methods after specific chemotherapy.

The paper deals with the data of follow-up of adolescents with disseminated pulmonary processes of different etiology. Among the patients who were treated in the department during the last 10 years disseminated processes amounted to 3.3%, with disseminated pulmonary tuberculosis being recorded in 1.3% and dissemination of the nontuberculous etiology in 2% of the patients. Mucoviscidosis, metastasis, of the thyroid cancer, histiocytosis X, toxoplasmosis and echinococcosis were among the disseminations of the nontuberculous etiology. Basic diagnostic criteria have been determined.

Data are given on the examination of 23,507 schoolchildren, students of specialized secondary and technical vocational schools covering 13 regions of the country. It has been found that tuberculosis contamination of adolescents is 30-33%, on average, but it varies considerably depending on the general epidemiologic situation at the place of residence, and the social status of adolescents. As compared to schoolchildren, tuberculosis contamination and the frequency of tuberculin reaction reversion are higher in students of technical vocational schools. The importance of BCG vaccination in adolescents, as the main method for tuberculosis is prevention, is substantiated. About 30% of adolescents, on average, are subject to revaccination. It is concluded that children and adolescents should be revaccinated twice: at 6-7 years (1st form) and 14-15 years (8-9th form).

Observation findings concerning 112 adolescents with tuberculosis are presented. The patients were divided into 2 groups. Group 1 included 61 cases with primary forms of tuberculosis and without lung tissue destruction or bacillary excretion. The best part of this group was affected by tuberculosis of intrathoracic lymph nodes and focal tuberculosis. Group 2 consisted of 51 patients with primary tuberculosis in addition to lung tissue destruction or bacillary excretion. Most of these patients had infiltrative tuberculosis. Their treatment regimens were standard ones. The patients of group 1 are recommended to have a 6-month hospital management and a subsequent additional treatment at a sanatorium for 3 months. The period of the in-patient chemotherapy of group 2 should be no less than 9 months plus 3 months of additional treatment at a sanatorium.