MEMORABLE DATES
The article tells the history of World Tuberculosis Day as well as the history of preserving the heritage of Robert Koch in Russia and Europe. On March 24, 1882, Robert Koch presented the results of his research on the etiology of tuberculosis. This research has made it possible to diagnose and treat the "white plague" which remains the deadliest infection in the world still killing more people than cholera, malaria, AIDS, and COVID-19.
ORIGINAL ARTICLES
The article analyzes the organization of work of N.V. Postnikov Samara Regional Clinical TB Dispensary in 2020. The special procedure has been developed for COVID-19 tests in patients referred to TB department. All cases of the new coronavirus infection (COVID-19) in tuberculosis patients that occurred in the Samara region in 2020 (n = 31) were studied. Infection control activities are the following: separate filter boxes have been provided for personnel and patients in each department; two observational departments have been organized where patients are admitted depending on the type of medical care. The polymerase chain reaction has been used to examine patients for COVID-19 before admission to TB hospital for planned medical care, and express tests for immunoglobulins M and G have been used when patients were admitted in an emergency. Of the 30 cases of intravital detection of concurrent infections (tuberculosis + COVID-19), in 56.7% (17 people), COVID-19 was treated in the in-patient unit specializing in treatment of the new coronavirus infection, and in 43.3% (13 people), treatment was outpatient; lethality made 1/30 (3.33%).
The objective of the study: to study the course and clinical outcomes of spontaneous pneumothorax (SP) in patients with lung injury due to COVID-19.
Subjects and methods. Clinical and radiation data of 11 patients (above 18 years old) with SP due to COVID-19 were retrospectively analyzed, they all were treated in the thoracic surgery department. COVID-19 was confirmed in all patients by laboratory tests. According to the chest computed tomography, the patients had signs typical of viral pneumonia and SP.
Results. The surgical treatment of SP that included thoracocentesis on the pneumothorax side and closed drainage of the pleural cavity allowed resolving the pneumothorax and inflating the lung fully in 10/11 patients within 4 days on average (max = 7 days) from the moment when the surgery was done. The lethal outcome was in 1/11 (9.1%) patient which occurred 1 day after the diagnosis and successful drainage of the bilateral SP, the patient had symptoms of acute cardiovascular failure.
The objective of the study: to identify respiratory diseases specifying the proportion of HIV-positive patients who have to be admitted to the pulmonology department of an emergency hospital.
Subjects and methods. All cases admitted to the pulmonology department of Emergency Relief Hospital no. 2, Omsk, from 2016 to 2019 were analyzed.
Results. Among patients admitted to the pulmonology department of the emergency hospital in 2016-2019, pneumonia was the most frequent nosology – from 51.6% (2017) to 63.2% (2019) followed by chronic obstructive lung disease – from 29.1% (2016) to 18.1% (2019). The average duration of hospital stay for pneumonia increased from 9.2 (2016) to 15.4 days (2019) that could be indicative of more severe cases due to the increased proportion of HIV positive patients from 22.4% (2016) to 49.1% (2019). Of pneumonia with the detected pathogen, cases of bacterial pneumonia were the most frequent, but in 2019 there was a significant (up to 19.3%) increase in pneumocystosis pneumonia. The frequency of lung cancer diagnostics ranged from 1.2% (2018) to 2.1% (2017 and 2019), which was associated with the low quality of early diagnosis and admission to hospital due to development of complications. The frequency of pulmonary tuberculosis detection in the pulmonology department tends to decrease every year – from 5.3% (2016) to 3.3% (2019), while the average duration of hospital stay before tuberculosis is diagnosed ranges from 4.9 ( 2016) to 5.9 days (2018). Among diagnosed tuberculosis patients, the proportion of HIV-positive people grows up every year – from 31.6% (2016) to 87.2% (2019).
The objective of the study: to assess the tolerability of anti-tuberculosis drugs (TB drugs) in children with respiratory tuberculosis and exposure to multiple and extensive drug resistant tuberculosis treated by individual chemotherapy (CT) regimens.
Subjects and methods: Totally, 89 children (2-12 years old) with respiratory tuberculosis, they all were exposed to multiple and extensive drug resistant tuberculosis. Patients were divided into three groups: Group 1 (17 patients) – minor forms, the chemotherapy regimen consisted of 3 TB drugs, Group 2 (35 patients) – limited lesions, the chemotherapy regimen consisted of 4 TB drugs, Group 3 (37 patients) – the disseminated disease, the chemotherapy regimen consisted of 5 TB drugs. The following TB drugs were used in Group 1: Pto ‒ in 94.1%, Z ‒ in 76.5%, PAS ‒ in 76.5%, Am – in 35.3%, E – in 17.6%, and Cs – in 5.9% of cases. In Group 2: PAS – in 94.3%, Z – in 80.0%, Pto – in 68.6%, Am – in 48.6% and Fq – in 45.7%, Cs ‒ in 37.1%, and E – in 25.7% of cases. In Group 3: Z – in 97.3%, PAS – in 89.2%, Pto – in 81.1%, Fq ‒ in 73.0%, Am – in 70.3%, Cs – in 51.4%, and E – in 37.8% of cases.
Results. In general, chemotherapy was well tolerated by 50.6% (45 people) of children, and poorly - by 49.4% (44 people), p> 0.05. Toxic reactions were observed statistically significantly more often versus allergic ones: 63.6 ± 7.3% (28 persons) and 36.4 ± 7.3% (16 persons), p < 0.05. The culprits drugs causing toxic reactions were prothionamide (24 patients), pyrazinamide (2 patients), cycloserine (1 patients), and levofloxacin (1 patients), toxic reactions - amikacin (16 patients). Adverse reactions statistically significantly more often occurred when five-component regimen (67.6 ± 7.7%) was used versus three- and four-component regimens (29.4 ± 11.4 and 40.0 ± 8.3%, respectively), p <0.05.
The objective: to assess the state of arterial stiffness and the level of albuminuria in patients with chronic obstructive pulmonary disease (COPD) and to investigate the presence and nature of the association of the studied parameters with clinical and laboratory parameters of COPD.
Subjects and methods. 70 patients with COPD were examined, they all were divided into 4 groups depending on severity of clinical symptoms and number of exacerbations suffered in the previous 12 months. Additionally to standard examinations, albuminuria level, the pulse wave velocity in aorta (PWVa), and cardio-ankle vascular index (CAVI) were assessed.
Results. The increased albuminuria level was registered in 51.4% of patients mainly suffering from frequent exacerbations. The increased CAVI and PWVa also prevailed in individuals with a high frequency of exacerbation and their higher levels were found in 37.1% and 14.3% of patients, respectively. PWVa and CAVI values were found to be associated with albuminuria level and clinical and laboratory parameters of COPD.
The objective of the study: to analyze the frequency of admission of tuberculosis patients to general medical units, to describe medical and social parameters of patients – sources of tuberculous mycobacteria which form a nosocomial center of tuberculosis infection.
Subjects and methods. The following sources of information were used: Reporting Form no. 8 on Active Cases of Tuberculosis, data from the Annual Reporting Form on Analysis of Infectious Diseases Carrying drawn up by City Center for Medical Prevention in Yekaterinburg, Register of Infectious Diseases (Form no. 060/y), and 74 documents of Medical File of the Patient Receiving In-Patient Treatment (Form no. 003/y) for tuberculosis patients admitted to a therapy department of the city hospital.
Results. Despite the decreasing tuberculosis incidence among Yekaterinburg residents, there was no significant decrease in the frequency of hospital admissions of patients with this disease to general medical units. Of all tuberculosis patients admitted to general medical units, 40.0 ± 2.7% were admitted to therapy departments. Duration of stay in a therapy department of tuberculosis patients excreting tuberculous mycobacteria made more than 7 days for 70% of such cases before they were discharged. The destruction phase was diagnosed in 56.8 ± 5.8%, 13.5 ± 4.0% had massive bacterial excretion documented by sputum microscopy. The frequency of TB/HIV co-infection made 43.2 ± 5.8%.
Conclusion. In a therapy department, there is a high risk of getting infected with tuberculosis infection among patients and personnel who are exposed to a tuberculosis case.
The objective: to increase the effectiveness of treatment of patients with tuberculous spondylitis by using short course pre-operative anti-tuberculosis therapy.
Subjects and methods. Experimental and clinical studies have been performed. The experiment was carried out on 40 guinea pigs by making a model of tuberculous spondylitis in 30 of them. In the clinic, the effectiveness of short course pre-operative anti-tuberculosis therapy with second line drugs, radical decompression plastic interventions using a sliding titanium cage was studied in 30 patients with tuberculous spondylitis versus 30 patients in whom classical methods of preparation and surgical intervention were used.
Results. The created model of experimental tuberculous spondylitis made it possible to study parameters of the clinical and morphological course of the disease. The results obtained substantiated the effectiveness of short course pre-operative anti-tuberculosis therapy without the risk of generalization of the disease after radical surgery.
The method of surgical treatment of tuberculous spondylitis used in patients and utilizing telescopic titanium cages against the background of short course pre-operative anti-tuberculosis therapy, taking into account the drug resistance of Mycobacterium tuberculosis and therapy continuation after surgery, significantly improved the frequency of excellent treatment results (up to 54.0% versus 32%). At the same time, the period of preparation for radical surgery was significantly reduced, the frequency of complications went down to 13.3% versus 33.3%, the period of in-patient treatment decreased to 96 ± 12 bed-days versus 190 ± 21 (p < 0.01), and the chances of social rehabilitation of operated patients improved.
The objective of the study: to analyze the changes in tuberculosis incidence among children not vaccinated with BCG taking into account clinical and epidemiological indicators.
Subjects and methods. The data of 66 children who were not vaccinated with BSG and developed tuberculosis were analyzed. The data were obtained from medical files of St. Petersburg TB Dispensary from 2006 to 2019 inclusive.
Results. From 2006 to 2019 in St. Petersburg, 66 children not vaccinated with BCG fell ill with tuberculosis, of them, 44 (66.7%) cases were detected in 2013-2019, and the major reason (22.7%) of the lack of BCG vaccination was the unmotivated refusal of parents.
The incidence of complicated course of tuberculosis in unvaccinated children made 45.4%. In the structure of medical contraindications to BCG vaccination, HIV infection was the most prevalent (58.2%), including both as prenatal exposure to the mother and HIV positive status of the child.
In 61.4% of cases, unvaccinated children who developed tuberculosis were exposed to adult tuberculosis patients.
The lethal outcome (for the period 2013-2019) was registered in 3/44 children, all under 1 year, all had a congenital pathology which made the cause of death.
REVIEW
The review presents data from 55 publications about specific parameters of iron metabolism in the human body including those ill with tuberculosis. It describes processes aimed at isolating iron from pathogens and promoting the acquisition of iron by pathogens from the host. A decrease in the level of iron circulating in the blood serum in the case of tuberculosis is primarily a component of the systemic inflammatory response and belongs to the mechanisms of innate immunity that limit the reproduction of an infectious agent in the human body. However, its true deficiency can be involved in the decrease in the level of circulating iron.
ISSN 2542-1506 (Online)