Our results show that internationally recommended MDR-TB treatment regimens were infrequently used and that ART use and viral suppression was well below the target of 90%, reflecting the challenging patient population and the environment in which health care is provided. Urgent improvement of management of patients with TB/HIV in EE, in particular for those with MDR-TB, is needed and includes widespread access to rapid TB diagnostics, better access to and use of second-line TB drugs, timely ART initiation with viral load monitoring, and integration of TB/HIV care.
Primary ciliary dyskinesia (PCD) is a rare hereditary disease from the group of ciliopathies, which is based on a defect in the cilia ultrastructure of the respiratory epithelium and similar structures (sperm flagella, villi of the fallopian tubes, ventricular ependyma, etc.), leading to motor function impairment. The prevalence of the disease varies significantly around the world and is not known reliably in the Russian Federation.The aim of the review was to analyze literature data on modern approaches to the diagnosis and treatment of PCD.Methodology. The data of 90 articles and the opinions of experts providing care to patients with PCD were used.Results. The classic manifestations of PCD depend on age. The leading manifestations of the disease in patients with PCD are recurrent inflammatory diseases of the upper and lower respiratory tract (bronchitis, pneumonia), with the formation of bronchiectasis, damage to the ENT organs (chronic rhinitis, rhinosinusitis, nasal polyposis, repeated otitis media, progressive hearing loss). Currently, there is no single method which could serve as a “gold” standard for diagnosing PCD. The diagnosis of PCD is based on the characteristic clinical picture in combination with the results of special tests (nitric oxide in exhaled air, DNA diagnostics, high-speed video microscopy, transmission electron microscopy). The genetic diagnostics has not been developed sufficiently in the global practice yet and is unavailable in our country. The approach to the treatment of a patient with PCD should be multidisciplinary due to multiple organ lesions. According to the European consensus, the goal of PCD therapy is to restore or maintain normal lung function. There have been no randomized trials of treatment for PCD, and therefore all treatment recommendations are based on very low-level evidence or extrapolated from cystic fibrosis guidelines. Recommendations on mucolytic, antibacterial and anti-inflammatory therapy of PCD are given with consideration for the international and domestic experience.Conclusion. The development of a new version of clinical guidelines containing up-to-date relevant information will improve the diagnosis and treatment of PCD in the Russian Federation.
Stenotrophomonas maltophilia is a common opportunistic microorganism and an important respiratory pathogen in cystic fibrosis (CF). The aim of this study was to determine antimicrobial resistance phenotypes, sequence-types (ST) and genetic determinants of antibiotic resistance in S. maltophilia strains recovered from CF patients in Russia. S. maltophilia isolates recovered from 170 CF patients were analyzed. Minimum inhibitory concentrations of antibacterial agents were determined using Sensititre Gram Negative GNX2F plates and the results were interpreted according to Clinical and Laboratory Standards Institute (CLSI) criteria. Whole-genome sequencing (WGS) was performed on MGISEQ-2000 platform. SPAdes software, Galaxy, ResFinder, Integrall and PubMLST were used for analysis of WGS data. S. maltophilia strains were identified from 24/170 (14%) CF patients. In total, 25 isolates were detected, two strains were isolated from the same patient. The isolates belonged to 17 different STs, including 5 new STs; ST4 was the most prevalent ST. Resistance to ceftazidime was observed in 60% of strains, to ticarcillin-clavulanate - in 32%, to levofloxacin - in 24%, to trimethoprim/sulfamethoxazole - in 12% of strains. All isolates were susceptible to minocycline. All ST4 isolates were resistant or intermediate to ceftazidime and ticarcillin-clavulanate. In two isolates, the sul1 gene was detected. In one isolate, sul1 was part of a class 1 integron. The detected integron also contained the blaGES-7 and aac(6’)-Ib-cr genes. The ST4 sequence-type was the most prevalent ST among S. maltophilia strains recovered from CF patients in Russia. Antibiotic resistance genes, including sul1, blaGES-7, aac(6’)-Ib-cr, were detected in single strains.
More and more publications appear in the modern literature on the increase in the prevalence of non-tuberculous mycobacteria (NTMs), in particular, representatives of M. chelonae / Mycobacterium abscessus complex (MABSc). The paper presents data on the current classification of M. chelonae / Mycobacterium abscessus complex and its main representatives. The main data on the possible sources and ways of infection of MABSc patients in hospital are presented. The main features of cultivation on various nutrient media and their possible identification using modern methods are also indicated. The main risk factors for the development of mycobacteriosis in patients and the possible clinical picture are described. The prevalence of MABSc representatives in the structure of non-tuberculous mycobacteria isolated from clinical material from 483 patients from the Samara region was assessed for examination for tuberculosis, and the prevalence from 933 patients with cystic fibrosis (CF) from 55 regions of the Russian Federation from 2016 to 2019 was estimated. In total, as a result of the study, 316 NTM strains (65.4%) were isolated and identified in the first group of patients. M.abscessus was isolated and identified 10 strains and 5 strains - M.chelonae, which amounted to 3.2% and 1.6%, respectively, of all NTMs. In general, MABSc representatives were isolated in 3.1% of the examined patients. As a result of a screening study of patients with CF, 14194 microorganism strains from 933 patients were isolated and identified. Altogether M. abscessus was isolated and confirmed from 14 patients of different ages. Thus, the prevalence of MABSc among the examined patients with CF in the Russian Federation was 1.5%.
Муковисцидоз (МВ) продолжает оставаться од ной из актуальных проблем современной медицины. В настоящее время численность пациентов в цент рах по лечению МВ возрастает благодаря увеличе нию продолжительности жизни и введению неона тального скрининга. При этом доказано, что помимо базисной терапии заболевания, немаловажны про филактика и своевременная коррекция возможных осложнений.Длительно персистирующая инфекция нижних ды хательных путей при МВ и как следствие -необходи мость регулярного применения антибактериальных препаратов (АБП) неизбежно ведет за собой изме нения в составе кишечной микрофлоры. При нор мальной микрофлоре в желудочно кишечном тракте вырабатываются вещества с антибактериальной актив ностью (бактериоцины и короткоцепочечные жирные кислоты -молочная, уксусная, масляная), которые предотвращают внедрение патогенных микроорганиз мов, избыточный рост и развитие условно патогенной микрофлоры, обеспечивая достаточный уровень коло низационной резистентности. Наиболее выраженны ми антагонистическими свойствами среди нормаль ных обитателей толстой кишки обладают бифидо и лактобактерии, энтерококки и кишечная палочка. Дисбиотические изменения в кишечнике, связанные с применением АБП, на фоне имеющегося синдрома мальабсорбции могут привести к избыточному росту патогенной анаэробной микрофлоры, при этом наи большую опасность представляют токсигенные штаммы Clostridium difficile. В свою очередь, чрезмер ный рост C. difficile приводит к повышенной чувстви тельности энтероцитов к ее токсинам.C. difficile является классическим представите лем грамположительных спорообразующих облигат но анаэробных бактерий. Основными факторами патогенности данного микроорганизма являются экзотоксины, характеризующиеся наиболее выра женным прямым цитопатическим и энтеротоксичес ким эффектами. Известно, что токсин А, стимулируя гуанилатциклазу, повышает секрецию жидкости в просвет кишечника и способствует развитию диа реи. Токсин В обладает выраженным цитопатичес ким действием. Предполагается, что при воздей ствии токсина В, ингибирующего синтез белка в энтеро и колоноцитах, нарушается функция кле точных мембран. Это приводит к потере калия и раз витию электролитных нарушений SummaryThe aim of this study was to determine a rate of Clostridium difficile associated colitis in patients with cystic fibrosis (CF). Methods. Qualitative and quantitative bacteriological examination with identification of C. difficile toxins A and B production was done in 61 intestinal contents samples from CF patients who previously received antibiotics. Results. Various disorders of qualitative and quantitative composition of the intestinal microflora were found in 100% of patients. Testing for C. difficile toxins A and B production was positive in 5 (15.2%) of patients. Conclusion. These patients could have a high risk of pseudomembranous colitis development.
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