[Identification of tuberculosis pathogens in clinical material using the polymerase chain reaction]. / Identifikatsiia vozbuditelia tuberkuleza v klinicheskom materiale s pomoshch'iu metoda polimeraznoi tsepnoi reaktsii.

The authors examined the possibility of detecting M. tuberculosis cells in various types of diagnostic material (sputum, blood, bone marrow, bronchoalveolar lavage fluid) from tuberculosis patients using polymerase chain reaction (PCR). The developed PCR-based test systems helped detect M. tuberculosis in 48 (90.6%) out of 53 tuberculosis patients, in contrast to much slower microbiological methods which permitted detection of Mycobacteria in only 21 (39.6%) patients. High specificity and virtually no false-positive results of PCR were demonstrated in testing diagnostic material from patients with chronic nonspecific pulmonary diseases and from children with lympholeukemia and anemia.

[Molecular characteristics of multiresistant clinical strains of Mycobacterium tuberculosis isolated in Russia]. / Molekuliarnaia kharakteristika polirezistentnykh klinicheskikh shtammov Mycobacterium tuberculosis iz Rossii.

The efficiency of tuberculosis control programs is largely determined by methods for rapid diagnosis of the agent. In comparison with the traditional methods, new molecular technologies for characterization of mycobacteria appear to be more promising, because the result can be obtained in almost no time. Sixty-five strains of M. tuberculosis isolated in various regions of Russia were investigated. Drug resistance and strain appurtenance of this sample were determined by classical (absolute concentrations method, IS6110-RFLP) and modern molecular genetic methods (detection of mutations in rpo B gene, DRE-PCR). The spectrum of mutations of the rpoB gene associated with rifampicin resistance was evaluated by direct sequencing. Mutations involving codons 531 (62.7%), 526 (18.6%), and 516 (10.2%) of rpoB gene predominated in the studied sample. The studied strains were discriminated into 52 individual strains by IS6110-RFLP and DRE-PCR typing. Analysis of the resultant genetic variants showed the predominance of M. tuberculosis family W. The efficiency of combined approach to screening for M. tuberculosis is discussed.

[Current problems of pulmonary tuberculosis]. / Sovremennye problemy tuberkuleza legkikh.

There has been recently a rise in tuberculosis morbidity rates in the countries of Western and Eastern Europe, in the USA. At the same time high tuberculosis morbidity and mortality rates have remained in the developing countries. Along with tuberculosis endogenic reactivation in adults, there is exogenic superinfection is observed, which causes tuberculosis, including that by multidrug resistant mycobacteria. In the latter, patients were found to have a prolong disease which is characterized by acute progressive forms. This leads to a downward trend in therapeutical efficiency. The high onset drug resistance requires that a combination of 4 or 5 antituberculous agents should be used early in the disease.

[Clinical aspects and characteristics of the course of most common nonpulmonary localizations of sarcoidosis]. / Klinicheskaia kartina i osobennosti techeniia naibolee chasto vstrechaiushchikhsia vnelegochnykh lokalizatsii sarkoidoza.

The most extrapulmonary sites of the sarcoidosis erythema nodosum, such as peripheral lymph nodes, skin, subcutaneous fat, heart, liver, spleen, and kidney are described in the paper. During a follow-up of 502 patients with sarcoidosis in 1986-1993, the incidence of sarcoidosis of extrapulmonary site was 18.9%. Erythema nodosum is regarded as a nonspecific allergic syndrome. Sarcoidosis of extrapulmonary site is characterized by multiple involvements, suppressed T-cell immunity, recurrence, which requires adequate treatment and continuous monitoring.

[The outlook for developing recombinant vaccines based on mycobacteria]. / Perspektivy razrabotki rekombinantnykh vaktsin na osnove mikobakterii.

The paper provides the data available in the literature on the present-day direction in exploitation of recombinant vaccines on the basis of Mycobacterium spp. Special attention is paid to the nature of shuttle vectors for Mycobacterium spp. and E. coli.

[Effects of millimetric electromagnetic waves on regional blood flow and effectiveness of multimodal therapy of patients with pulmonary tuberculosis]. / Vliianie élektromagnitnykh voln millimetrovogo diapazona na regionarnyi krovotok i éffektivnost' kompleksnoi terapii bol'nykh tuberkulezom legkikh.

The impact of millimetric electromagnetic radiation (MER) on the natural history of the disease was studied in 54 patients with various types of pulmonary tuberculosis. The patients were treated using wavelengths of 6.4 and 7.1 mm on a YAVOR device. Following 10 sessions of MER therapy used in combination with specific drugs, caverns were found to close in 50% of patients at months 2-3 of therapy and in the controls at months 5-6. Infiltrative changes at the site of lesion resolved at weeks 2-3 of MER exposure, but in the controls at months 1-2 of drug therapy. In 5 (10%) out of 54 patients, regional blood flow parameters became normal, 27 (50%) patients were ascertained to have a partial improvement and 22 (40%) had no changes. No changes were seen in the controls as long as 2 weeks either.

[Isolation and study of the morphological properties and immunogenicity of filterable forms of Mycobacterium tuberculosis]. / Vydelenie i izuchenie morfologicheskikh svoistv i immunogennosti fil'truiushchikhsia form Mycobacterium tuberculosis.

The experimental study made on 185 guinea pigs revealed that during the chemotherapy of destructive tuberculosis the typical bacterial forms of M. tuberculosis rapidly disappeared, but the cavities of destruction were retained and the presence of the filter-passing forms of M. tuberculosis, along with antigenemia and specific cell-mediated and humoral immunity could be detected. The use of repeated biological subculturing resulted in the reversion of the filter-passing forms of M. tuberculosis to their typical bacterial forms; simultaneously the increase of antigenemia (from subculture to subculture) and the enhancement of immune responsiveness occurred.

[Genomic polymorphism in Mycobacterium tuberculosis strains]. / Issledovanie genomnogo polimorfizma shtammov Mycobacterium tuberculosis.

Different genomic fingerprinting techniques (universal probes, such as rRNA genes, phage M13 DNA, IS 6110 probe) have been used to investigate the genomic polymorphism of Mycobacterium tuberculosis strains isolated in different geographical regions of Russia and in some CIS countries. As shown with the use of these techniques and a specially developed PCR-mediated system for genetic typing, M.tuberculosis strains are genotypically heterogeneous in regions with a sporadic level of tuberculosis morbidity and genotypically homogeneous in regions with elevated morbidity and mortality levels. The evaluation of the effectiveness of the genetic typing of M.tuberculosis with the use of different genomic fingerprinting techniques has made it possible to propose the optimum 3-stage scheme for the differentiation of M.tuberculosis strains: (1) the typing of all isolated strains of the PCR-mediated test system; (2) the typing of several selected M.tuberculosis strains with the use of 1S 6110 probe (2-3 strains of each detected PCR-RFLP [correction of PLRF] genotypes); (3) the typing of M.tuberculosis strains, containing 1 copy of 1S 6110 or not containing such sequence, with the use of probes (phage M13 DNA) detecting hypervariable sequences in M.tuberculosis genomes.

[Is sarcoidosis a chronic persistent infection?]. / Iavliaetsia li sarkoidoz khronicheskoi persistiruiushchei infektsiei?

The study carried out with the use of microbiological diagnostic methods has revealed that in 67% of cases specimens obtained from sarcoidosis patients for analysis contain different forms of mycobacteria (typical Mycobacterium tuberculosis and granular forms of mycobacteria). The content of typical and granular forms of mycobacteria detected in diagnostic specimens has been shown to differ, depending on the clinical form of sarcoidosis: as a rule, in cases of the sluggish course of sarcoidosis granular forms of mycobacteria are detected, while during the exacerbation of the disease and in cases of the acute course of newly diagnosed sarcoidosis the proportion of typical M.tuberculosis increases. To verify M.tuberculosis with greater certainty, two highly sensitive and specific amplification test systems have been developed on the basis of polymerase chain reaction. In this article the goals of microbiological and molecular genetic investigations which may jointly give direct proofs of the etiological importance of mycobacteria in sarcoidosis are considered and discussed; sarcoidosis may probably be regarded as chronic persistence infection.

[The results of treating fibrous-cavernous tuberculosis in patients with different genetic markers]. / Rezul'taty lecheniia fibrozno-kavernoznogo tuberkuleza u bol'nykh s razlichnymi geneticheskimi markerami.

Overall 221 patients with fibrous-cavernous tuberculosis were examined. In patients carrying Hp 2-2 haptoglobin and HLA DR2, the disease runs an unfavourable course more frequently. Among the patients with Hp 2-2, the positive dynamics was attained by the 6th month of the treatment in 44.1%, among those with HLA DR2 in 42.3% of cases while in patients carrying the two genetic markers at a time, in only 32.4% of cases. Patients with Hp 2-2 and HLA DR2 require special attention of the treating physician since the very first day of the disease and use of every possible treatment methods.

[Clinical variants of the course and the characteristics of the x-ray changes in extrinsic allergic alveolitis--tobacco growers' disease]. / Klinicheskie varianty techeniia i kharakteristika rentgenologicheskikh izmenenii pri ékzogennom allergicheskom al'veolite--"bolezni tabakovodov".

Analysis is made of the clinical varieties and x-ray changes in the lungs in 143 persons engaged in tobacco growing. The immunological studies revealed sensitization to tobacco antigen in all the patients. Pointing to the polymorphism of the x-ray appearance the authors group at the same time the main signs into the x-ray symptom complexes: emphysematous interstitial, parenchymatous interstitial and pneumonic. Preliminary analysis indicates that the x-ray symptom complexes thus distinguished correlate with the main clinical varieties of the disease which may run its course by the type of obstructive bronchitis, bronchial asthma and recurrent pneumonias.

[Use of plasmacytapheresis in combined modality therapy of patients with fibrosing alveolitis]. / Primenenie plazmotsitafereza v kompleksnom lechenii bol'nykh fibroziruiushchimi al'veolitami.

The authors describe the results of examination of 67 patients with exogenous allergic and idiopathic fibrosing alveolitis. Of these, 42 patients underwent plasmocytapheresis in addition to corticosteroid therapy. The clinical improvement, positive x-ray dynamics of pulmonary lesions, normalization of the altered laboratory indicators were noted in 39 out of the 42 patients treated with the use of plasmocytopheresis and in 15 out of 25 who received pharmacotherapy alone. The use of plasmocytapheresis at the inpatient stage of the treatment enabled the dose of corticosteroids to be reduced by 26% of the initial on the average in 3/4 of the patients and subsequent hospitalization requirement to be noticeably decreased. Plasmocytapheresis did not produce any complications.

[X-ray diagnosis of histiocytosis X]. / Rentgenologicheskaia diagnostika gistiotsitoza X.

The results of a dynamic x-ray study of 27 patients suffering from histiocytosis X with lung involvement were analyzed; the study was supplemented by CT in 4 cases. X-ray semiotics of the disease was investigated with relation to its stage. X-ray symptom complexes were defined: interstitial, interstitial-granulomatous, and focal (tumorous). The authors have emphasized the fact that the small focal-cystic and pneumothoracic x-ray variants of the disease, described in literature, are not nosological entities but reflect only its stage and complications.

[Opportunities for the evaluation of the secondary reaction of antituberculosis drugs by several indicators, determined in the blood of patients with tuberculosis of the lungs]. / Vozmozhnosti otsenki pobochnogo deistviia protivotuberkuleznykh preparatov po nekotorym pokazateliam, opredeliaemym v krovi bol'nykh tuberkulezom legkikh.

Some bioenergetic patterns were studied in blood and blood plasma of patients with pulmonary tuberculosis as well as--in rats after long-term daily administration of rifampycin and isoniazid at therapeutic doses. A series of bioenergetic patterns, estimated simultaneously, enabled to detect the side reactions caused by chemotherapy before occurrence of clinical symptoms. Correlation was analysed between these patterns and the routine biochemical tests used for evaluation of the drug side effects. A scheme describing relationship between amino acid transamination in blood plasma and reactions of energy metabolism is presented. The scheme shows the sequence of activation of various enzymatic reactions in blood plasma after an increase in consumption of tissue energy resources in various tissues.

[The metabolic correction of erythrocyte function in patients with pulmonary tuberculosis complicated by pulmonary heart failure]. / Metabolicheskaia korrektsiia funktsional'nogo sostoianiia éritrotsitov u bol'nykh tuberkulezom legkikh, oslozhnennym legochno-serdechnoi nedostatochnost'iu.

In 80 patients with pulmonary tuberculosis aggravated by stage I-IIB cardiopulmonary insufficiency, the multimodality therapy included vektarion improving the ventilation/perfusion correlations (29 patients) and the combination of metabolic correctors (glutamevit and riboxin) (51 patients). The population analysis of peripheral blood erythrocytes (by the method of acidic erythrograms), the fractional composition of hemoglobin, the concentration of 2,3-diphosphoglycerine acid and the isozymic spectrum of LDH in erythrocytes served as methods of the treatment efficacy control. The treatment with vektarion noticeably reduced hypoxemia which was accompanied by positive shifts in erythrocyte metabolism and in the hemoglobin spectrum, producing but a negligible action on the population composition of erythrocytes. The combination of the metabolic correctors exerted a lesser effect on the fractional composition of hemoglobins, producing a well-defined positive action on erythrocyte function, decelerating the processes of their ageing. It is concluded that the highest positive effect may be produced by the combined use of all the three drugs bearing in mind their action mode.

[HLA antigens in lung diseases]. / Antigeny HLA pri bolezniakh legkikh.

Altogether 337 patients with tuberculosis, 63 patients with sarcoidosis, 41 with exogenous allergic alveolitis, and 36 with chronic bronchitis were examined. Four hundred and 30 healthy persons comprised the control group. It was established that HLA genes play an important part as factors which control the level of susceptibility to some pulmonary diseases (tuberculosis, sarcoidosis, exogenous allergic alveolitis). Hypersusceptibility to different pulmonary diseases is associated with different HLA genes, namely with HLA-B14 in tuberculosis, HLA-B7 in sarcoidosis, and with HLA-B8 in exogenous allergic alveolitis. The susceptibility to pulmonary diseases may be under polygenic control; in particular during tuberculosis, both HLA-B14 gene and HLA-B15 gene play a role in the resistance control. The development of a disseminated chronic process coupled with disintegration may be associated with the latter gene, which may be due to a lower resistance. It stands to reason that in addition to HLA genes, other genetic systems are likely to determine the character of susceptibility to tuberculosis.

[X-ray semiotics of the morphological and functional changes in chronic bronchitis]. / Rentgenosemiotika morfologicheskikh i funktsional'nykh izmenenii pri khronicheskikh bronkhitakh.

The authors analysed structural disorders of a pulmonary pattern in patients with non-obstructive, obstructive and purulent bronchitis. Characteristic x-ray symptom-complexes were singled out for each clinical variant of the disease. In addition to roentgenomorphological changes functional disorders showing changes of biomechanics in patients with chronic bronchitis were revealed at roentgenopneumopolygraphy.

[Clinical manifestations of extrinsic allergic alveolitis--a disease of tobacco growers]. / Klinicheskie proiavleniia ékzogennogo allergicheskogo al'veolita- al'veolita--bolezni tabakovodov.

Clinicoroentgenological and functional manifestations of exogenic allergic alveolitis (EAA) have been studied in 143 patients. The disease is often masked and runs in the form of chronic nonspecific bronchopulmonary inflammation. The presence of antigen-dependent symptom complexes associated with involvement of other organs characterizes EAA more specifically. Finally, the disease progresses to parenchymatous interstitial fibrosis. Pulmonary ventilation and blood oxygen saturation are reduced.

[The use of prostaglandin E2 (prostenon) in broncho-obstructive syndrome of patients with pulmonary tuberculosis]. / Primenenie prostaglandina E2 (prostanona) pri bronkhoobstruktivnom sindrome u bol'nykh tuberkulezom lëgkikh.

PGE and PGF2 alpha were measured by radioimmunoassay in bronchoalveolar lavage fluid obtained from the affected and contralateral lung of 86 patients with different forms of pulmonary tuberculosis. The findings were correlated with parameters of external respiration. Bronchial obstruction (BO) was found to entail lower values of PGE in the intact lung though higher PGE2 alpha levels near the focus. To normalize the proportion PGE/PGF2 alpha in the respiratory tracts, 24 tuberculous patients with BO received adjuvant ultrasound inhalations of PGE2 (prostenon). The course of 10 daily procedures produced positive shifts in bronchial patency in 3/4 of the patients. This positive trend was still demonstrable two months later. Prostenon anti-BO effect proved the highest in new-onset tuberculosis, in tuberculosis-induced intoxication and in moderate BO.