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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.

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.

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.

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.

Altogether 100 adolescents with TB detected on referral to general medical institutions were followed up. 30 patients with a clear-cut TB clinicoroentgenological pictures were referred to special hospitals. The rest 70 adolescents were followed up in general outpatients departments. The chief method of prehospital diagnosis verification was inefficacy of previous antiinflammatory therapy. 51 patients were not examined for tuberculosis (tuberculin test, chest x-ray, sputum investigation for tubercle bacilli, phthisiologist's consultation, etc.). Clinical evaluation showed that 47% had had previous contacts with tuberculosis patients, 33% demonstrated hyperergic sensitivity to tuberculin, in 21% the disease coincided with intensification of tuberculin reactions, 55% isolated tubercle bacilli. Initiated antituberculosis therapy alleviated the disease course in most of the patients. However, late diagnosis resulted in the formation of noticeable residual changes in a considerable proportion of patients. The results obtained indicate the necessity of close contacts between antituberculosis service and general health service to improve the effectiveness of adolescents therapy.