Rapid tests detecting Mycobacterium tuberculosis and drug resistance which are universally implemented in medical practice has dramatically improved the diagnosis of rifampicin-resistant tuberculosis and shortened turnaround time thus enabling early etiotropic therapy. However, permanently increasing drug resistance of M. tuberculosis makes treatment less effective. Furthermore, long treatment courses are required due to low sterilizing activity of treatment regimens used for drug-resistant tuberculosis which leads to greater toxic effects, reduces patients’ adherence to treatment and consumes resources of medical care systems. Current phthisiology needs new effective medications and short treatment regimens, otherwise elimination of tuberculosis by 2050 is impossible. This review summarizes the information about treatment of drugresistant TB, including repurposed drugs, new medications and treatment regimens.
Background. Tuberculosis is an infectious socially significant disease. Apart from individual traits of the disease pathology, drug sensitivity and the availability of effective medicine and prevention, an important factor of its control is the patient’s social status. Social patient profiling in various locations across the country is vital for developing and deploying a high-quality and feasible tuberculosis care programme.Objectives. Social profiling of tuberculosis in St. Petersburg as an example of large urban area. Methods. We developed a questionnaire to assess 40 social parameters of a patient with tuberculosis. The study sample was representative and surveyed 666 (63.4%) and 704 (65.7%) patients with primary diagnosis in 2017 and 2018, respectively.Results. The survey showed almost no impact of external migration on tuberculosis epidemiology in St. Petersburg. Internal migrants counted 76 (11.4%) in 2017 and 96 (13.4%) in 2018, thus suggesting the majority of primary tuberculosis patients being permanent residents of St. Petersburg. The contribution of individuals with no fixed abode to the incidence rate was also insignificant, 2.4% and 1.9%. Most patients were unemployed people of working age, 236 (35.4%) in 2017, 261 (37.1%) in 2018. Incidence among students as a younger population was lowest, 2.1% and 2.8%. Smokers accounted for half of total patients, 370 (55.6%) and 368 (52.3%). One in five patients carried HIV infection, with half of them not receiving antiretroviral therapy. Patients with unfinished secondary education and residing in collective dwellings were significantly more frequent, whilst the proportion of persons with high income decreased. Over half of the patients had no family at primary diagnosis, and over a third had never been married.Conclusion. The social profile of primary tuberculosis in an urban area is as follows: single man, near 40 years old, permanent resident, unemployed, working-age, smoker, resides in private abode, has secondary or secondary vocational education, low to average income.
The analysis of the features of diagnostics of peripheral lymph nodes tuberculosis in modern conditions is carried out. For this 28 case histories of patients suffering from tuberculosis of peripheral lymph nodes were studied and 85,7% of them had a combination of tuberculosis and infection caused by the human immunodeficiency virus. All patients were undergoing biopsies or surgery of lymph nodes, and the material was examined using microbiological molecular, genetic and histological methods. 85,7% of patients had relapses with different periods of time, on average, 34 years, and repeated periods of tuberculosis activation. At all patients the lymph nodes were enlarged, mainly cervical (71,4%) and axillary (67,9%), the sizes of nodes varied from 1 to 5 cm, on average, 2,21,6 cm. In 78,6% cases tuberculosis of peripheral lymph nodes was characterized by fluctuation of nodes and the discharge of 30 to 80 ml of odorless creamy pus. It was found that tuberculosis of peripheral lymph nodes is part of a widespread tuberculous lesions especially at patients with tuberculosis associated with an infection caused by the human immunodeficiency virus. Tuberculosis of peripheral lymph nodes develops simultaneously with a specific lesion of other groups of lymph nodes intrathoracic (75%), intra-abdominal (57,1%), which allows to generalized tuberculosis of the lymphatic system. Fibrobronchoscopy showed in 35,7% patients residual bronchial tuberculosis changes, at 14,3% an active fistulous form of bronchial tuberculosis. Microscopy of biopsy material was negative at 78,6% of cases, while cultural examination revealed Mycobacterium tuberculosis in 100% and molecular genetic studies deoxyribonucleic acid of Mycobacterium tuberculosis in 64,3% patients.
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