[Monitoring detection and treatment of new patients with pulmonary tuberculosis].

We estimated results of detection and treatment of TB patients registered in 2006 in 15 regions of RF under supervision of the Central Research Institute of Tuberculosis. The fraction of sputum positive patients increased in comparison with 2005. It ranged from 77.1% in Orel region to 35.2% in Astrakhan region. The primary MDR rate varied significantly from 2.5% in the Republic of Mordovia to 14.7% in Mary El (estimated level 5%). The frequency of efficient chemotherapy (evaluated from sputum microscopy data) increased in 8 regions and decreased in 7 ones. The efficiency varied from 69.0 to 81.1% in 9 regions (recommended level for 2007 68.5%). It amounted to 68.5% or higher (based on sputum culturing data) in Republics of Kalmykia and Tatarstan, Nizhny Novgorod, Saratov and Ul'yanovsk regions. TB mortality rate in 2006 exceeded the acceptable level of 2.5% in 13 regions and the frequency of refusals to continue chemotherapy was higher than 5% recommended for 2010 by the Global Fund Target Project in 10 regions. The efficiency of treatment in sputum-positive patients was frequently evaluated by X-ray in 3 regions with poorly organized microbiological services. TB treatment efficiency estimated from cavity closure was higher than 60% in 10 regions; it the remaining ones it varied from 36,3% (Nizhny Novgorod) to 52.2% (Vladimir). The system of evaluation being tested permits to accurately register new TB patients, objectively estimate effectiveness of their treatment, and reveal causes of its failure. Also, it makes possible corrections of therapeutic strategy on a trimestrial basis instead of postponing them till the end of the year. Introduction of cohort analysis combined with supervision of responsibility regions by specialists of relevant research institutions would increase efficiency of TB control in each subject of Russian Federation. Supervisory management appears to be an efficacious tool for monitoring implementation of the TB control Program.

[Nonspecific lung diseases in patients with pulmonary tuberculosis (issues of their prevalence, diagnosis and treatment)].

The paper gives data on the prevalence of nonspecific lung disease in patients with pulmonary tuberculosis, the specific features of diagnosis and treatment of their concomitance in 3453 patients with pulmonary tuberculosis. It shows the low detection rate of nonspecific lung diseases in patients with pulmonary diseases. The high error rate has been established in the diagnosis of pulmonary tuberculosis at health care facilities. There is evidence that the use of current therapy for bronchial obstructive syndrome with inhaled cholinolytics and beta2-agonists in patients with pulmonary tuberculosis causes a reduction in the intensity of respiratory symptoms and an increase in forced expiratory volume in one second.

[Role of health care facilities in verifying the diagnosis of respiratory tuberculosis by laboratory methods].

Reasons for laboratory misdiagnosis that is observed in general health care network (GHCN) and penitentiaries were studied. The clinical efficiency of the diagnosis of tuberculosis in the GHCN by the Ziehl-Neelsen method is largely determined by three major factors, each of which is fundamentally important in assessing the result. The first factor is the adequacy of making up a cohort of patients having the symptoms of productive cough in the course of 2-3 weeks or more who are to be examined for tuberculosis by laboratory studies. The second is the quality of a diagnostic material. The third is the quality of laboratory specialists' work. The paper shows it necessary to implement programs for the internal control and external assessment of the quality of laboratory studies and to optimize (centralize) the activities of laboratories under the conditions of a regional network.

[Monitoring of the detection of new pulmonary tuberculosis cases and the efficiency of their treatment in the area supervised by the Central Research Institute of Tuberculosis, Russian Academy of Medical Sciences].

The results of the detection and treatment of new pulmonary tuberculosis cases in 2006 were assessed in 15 subjects of the Russian Federation, supervised by the Central Research Institute of Tuberculosis, Russian Academy of Medical Sciences. As compared with 2005, in 2006 the proportion of bacteria-discharging individuals increased among the new cases of pulmonary tuberculosis and ranged from 77.1% in the Oryol Region to 35.2% in the Astrakhan Region. The frequency of multidrug-resistant MBT among the new cases of pulmonary tuberculosis (the expected frequency was 5%) showed a wide scatter and varied from 0.7% in the Republic of Ingushetia to 14.7% in that of Mariy El. The higher and lower percentages of patients receiving an effective course of chemotherapy, as shown by microscopy, were noted in 8 and 7 regions, respectively. Their scatter was 42.4% in the Nizhni Novgorod Region to 81.1% in the Republic of Mordovia. The efficiency of treatment, as evidenced by sputum culture, varied from 46.3% in the Nizhni Novgorod Region to 79.0% in the Republic of Mordovia. More than 3% of those who died from tuberculosis were recorded in 10 regions and more than 5% of those who discontinued a course of chemotherapy before the appointed time were notified in 8 regions. The cavity decay closure rate ranged from 36.3% in the Nizhni Novgorod Region to 52.2% in the Vladimir Region. Quarterly monitoring of the detection and treatment allows a precise registration of identified tuberculosis patients, objective assessment of the results of treatment, elucidation of reasons for ineffective chemotherapy, and corrections of a treatment process.

[Calculation of a risk for death due to tuberculosis in case of the Sverdlovsk Region].

Many factors influence the risk of death in patients with tuberculosis. The most significant factors are a clinical form of the disease, combinations, comorbidity, age, and the duration of death. The risk of death averaged 4.2% in patients with new-onset tuberculosis, 30.4% in those with recurrent tuberculosis, and 6.4% in the registered. In patients with new-onset tuberculosis, the highest risk of death was established in tuberculous meningitis, miliary tuberculosis, fibrocavernous tuberculosis, and complications of tuberculosis (such as hemorrhage, spontaneous pneumothorax) increased the risk of death by almost 10 times (40.2%) and progression of HIV infection to AIDS by 7 times. The risk of death was increased up to 9.2% in primary multidrug-resistant pulmonary tuberculosis and by 12.7% in acquired one.

[The results of work and experience of the Central Research Institute of Tuberculosis, Russian Academy of Medical Sciences, in the pilot areas in controlling, detecting, and treating tuberculosis (a cohort analysis)].

In the Russian Federation, the WHO program was launched in 1994 and it covered the whole country by 2005. Detection and therapeutic efficiency are suboptimal. The proportion of pulmonary tuberculosis averages 34.5% (21.0-61.0%). In terms of cessation of bacterial isolation, therapeutic efficiency averages 61.4% with a scatter of 37.4-75.0%. Social support has a considerable impact on the efficiency of treatment.

[Formation of the rate of mortality due to active tuberculosis in the areas in the charge of the Central Research Institute of Tuberculosis, Russian Academy of Medical Sciences].

Some areas in the charge of the Central Research Institute of Tuberculosis, Russian Academy of Medical Sciences, is marked by an increase in the morbidity rate among the residents from 1% in the Republic of Mordovia to 10.7% in the Ulyanovsk Region and by a decrease in the territorial rate. In 6 of 15 areas, tuberculosis mortality tends to increase, which is indicative of the strained tuberculosis epidemic situation in these areas. The rates of the proportion of patients who had died from active tuberculosis among those with new-onset tuberculosis, the deceased who had been followed up for as long as a year, and those who had not been followed up, which reflect the state-of-the-art of therapeutic and diagnostic work were studied.

[Impact of tuberculosis morbidity on the health indices of a special contingent of the reformatory system].

The reformatory system of the Ivanovo Region shows a tense epidemic situation due to tuberculosis that heads the list of morbidity and ranks second in mortality in the region. 90-92% and 8-10% of new cases of tuberculosis occur in the reformatories and solitary confinements, respectively, the intracell morbidity in the solitary confinements being not more than 8.5-9%. Regular semiannual fluorographic examinations reveal that in the pattern of clinical forms of tuberculosis, its prevalent "small forms" (focal tuberculosis and infiltrative tuberculosis of 1-2 segments of one lung without decay) are prevalent.

Tuberculosis in Russia and the problem of multiple drug resistance.

Tuberculosis cases in Russia doubled from 1991 to 2000, when the incidence reached 90 per 100,000; and Russian TB mortality rates are the highest in Europe. Implementation of WHO-recommended DOTS strategy is in the preliminary stages. The epidemiological data are presented as is the implementation strategy for stabilizing the epidemic.

Frequency of recurrence among MDR-tB cases 'successfully' treated with standardised short-course chemotherapy.

SETTING: Ivanovo Oblast, Russian Federation, 300 km north-east of Moscow, where a pilot DOTS TB control programme was implemented in October 1995. OBJECTIVE: To determine the frequency of TB recurrence among MDR (multidrug-resistant) patients who achieved treatment 'success' on standard short-course chemotherapy. METHODS: All patients with MDR tuberculosis, defined as resistance to at least isoniazid and rifampicin, who were declared 'cured' or 'treatment completed', were identified using the district register and traced whenever possible. Eligible patients underwent medical examination and, if necessary, chest radiography, sputum smear examination, culture and susceptibility testing. If the patient had died, the relatives were interviewed to try to determine the reasons for death. RESULTS: Of 18 patients eligible for analysis, five (27.8%) were documented to have recurrence (two of seven patients resistant to HRSE, one of five patients resistant to HRS and two of six patients resistant to HR). Patients receiving the Category I regimen were more likely to relapse than those receiving the Category II regimen (40% vs. 12.5%). The median time to relapse was 8 months; 2.46 recurrences were observed in 100 person-months (3.17 in category I and 1.3 in Category II patients). CONCLUSIONS: The frequency of TB recurrence among MDR-TB patients declared 'cured' after short-course chemotherapy is high. Improvements in treatment success, after removal of programme-related pitfalls in the treatment delivery process, must incorporate methods for early detection of MDR, along with adequate treatment regimens including second-line drugs. Culture-based bacteriological confirmation at the end of treatment is recommended.

[Organization of tuberculosis-controlling work and its efficiency in the penitentiaries of the Ivanovo Region]. / Organizatsiia protivotuberkuleznoi raboty i ee éffektivnost' v penitentsiarnykh uchrezhdeniiakh Ivanovskoi oblasti.

The incidence rate of tuberculosis is high in the penitentiaries of the Ivanovo Region and in 2000 it was 32 times greater than that in the Region (3122 versus 96.7 per 100,000). Fluorography remains to be the main method of detection of pulmonary tuberculosis. It is performed on day 3 of admission of jail, then every 6 months. Fluorography allows one to identify 85-90% of the patients with pulmonary tuberculosis. In the fluorgraphic interval, the sputum from patients with symptoms of suspected tuberculosis is tested by the Ziehl-Neelsen procedure, which makes it possible to detect more than 15% of the tuberculosis patients who isolate bacteria. The patients are treated with the routine regimens including 4 first-line drugs. In 1997-2000, the rates of bacterial isolation session and decay cavity closure were in the range of 82.1-93 and 66.7-87.5%, respectively. Integration with civil tuberculosis service, the social security administration of the region, and the regional branch of the red-cross society has proved to be highly effective. The proportion of patients with tuberculosis who continued their treatment in tuberculosis facilities after release increased from 51.1% in 2000 to 80% in 2001.

[Impact of introduction of the WHO tuberculosis-controlling recommendations adapted to the Russian conditions on the Russian statistical tuberculosis data]. / Vliianie vnedreniia adaptirovannykh k Rossiiskim usloviiam rekomendatsii voz po bor'be s tuberkulezom na otechestvennye statisticheskie pokazateli po tuberkulezu.

The authors share their experience in introducing the WHO tuberculosis-controlling recommendations adapted to the Russian conditions into the Republic of Mariy El, in the Ivanovo, Oryol, and Tomsk Regions. All the areas are marked by high rates of diagnosis of MBT in the clinical diagnostic laboratories of the general medical network, by the increased rates of detection of patients of tuberculosis who isolate Mycobacterium tuberculosis, by the enhanced efficiency of treatment of patients with tuberculosis, as shown by the Russian statistical data, by the lower rates of growth of the contingents of patients with tuberculosis or by their reduction.

Prevalence of extensively drug-resistant tuberculosis in Vladimir and Orel regions, Russia.

SETTING: Joint World Health Organization (WHO) projects in Vladimir and Orel regions, Russia. OBJECTIVE: To study the prevalence of extensively drug-resistant (XDR) tuberculosis (TB). METHODS: Drug susceptibility testing of second-line drugs (ofloxacin, kanamycin, capreomycin, ethionamide, cycloserine and para-aminosalicylic acid) was performed on isolates from multidrug-resistant TB cases from 1 January to 31 December 2006. RESULTS: In Orel, 16 (21.3%) of 75 tested isolates were XDR-TB; in Vladimir, 9 (4.9%) of 182 isolates were XDR-TB. Bilateral lung involvement was significantly associated with XDR-TB (prevalence ratio = 2.61, 95%CI 1.01-6.72). CONCLUSION: XDR-TB has emerged in Russia. It is crucial to prevent, diagnose and treat TB and MDR-TB more effectively.

[Ways of increasing the effectiveness of tuberculosis control]. / Puti povysheniia éffektivnosti protivotuberkuleznoi raboty.

Ways for improving quality of tuberculosis control at the present stage are discussed. The necessity for estimating the quality of the activities of medical institutions by the final results with respect to all the parameters is grounded. Such results should be the level of tuberculosis incidence, susceptibility to tuberculosis, death rate due to tuberculosis, temporary and stable invalidity.