[Combined determination of spontaneous and antigen-induced production of cytokines for differential diagnostics of active tuberculosis of lungs and latent tuberculosis infection].

AIM: Choice of informative biomarkers for diagnostics of Mycobacterium tuberculosis infection and differential diagnostics of active tuberculosis (TB) of lungs and latent tuberculosis infection (LTBI). MATERIALS AND METHODS: 54 tuberculosis patients, 47 contact by TB, individuals and 43 healthy donors were examined. All the individuals included into the study had QuantiFERON-TB Gold In-Tube (Cellestis, Australia) carried out. Values of spontaneous (NIL) and antigen-induced (AG) production of 10 cytokines (EGF, MIP-1beta, VEGF, IL-2, IL-4, IL-6, IL-1alpha, IFN-alpha2, TGFalpha, TNFalpha) as well as sIL-2Ralpha and sCD40L using XMap technology were measured. IP-10 level was also determined in 48 individuals by using EIA. RESULTS: 6 out of 13 biomarkers distinguished active TB and LTBI. As a result of construction of a decision tree in JMP 9.0 program 3 most significant markers were selected. Use of combination of IFN(gammaAG-NIL), TGFalpha NIL and IL-6AG cytokines allowed to divide TB patients and contact individuals with sensitivity of 96.3% and specificity of 80.7% (AUC = 0.9). We also observed very high levels of IP-10 and IL-2 that correlated with IFN(gammaAG-NIL) (r = 0.71 and 0.79, respectively). CONCLUSION: IL-2 and IP-10 as well as IFNgamma may be used as helpful biomarkers as a first stage for diagnostics of (M.tb.) infection. At the second stage determination of IL-6, IFNgamma and TGFalpha for differential diagnostics of active TB and LTBI is proposed.

[Revealing of tuberculosis in an infectious diseases hospital of a megalopolis].

The advisory work of the phthisiatrician in an infectious diseases hospital was analyzed; the analysis revealed that in 2005 tuberculose changes of various degrees of activity had been revealed in 42.5% of examined patients, and 32.1% of them were subjects in whom tuberculosis of diferent localizations had been revealed for the first time. In 43.2% of the latter subjects, the reasons for hospitalization were "clinical masks" of tuberculose process (influenza, acute respiratory viral disease), while 48.6% were hospitalized for gastrointestinal infections and viral hepatitis. In 20.7% of cases tuberculosis was combined with HIV infection. In the infectious diseases hospital, 16.2% of patients with active tuberculosis died. Among the patients treated in the infectious diseases hospital during one year, the proportion of patients with active tuberculosis was 1.44%, the proportion of those in whom the process was revealed for the first time, was 0.75%. In Botkin infectious diseases hospital, there were approximately 6% of patients in whom tuberculose process was revealed for the first time in Saint Petersburg. The peculiarities of this group of patients in an infectious diseases hospital require not only tuberculose alertness, but also reinforcement of phthisiatric, radiological, and laboratory services.

[Steroidal leukocytosis and immediate results of treatment in patients with sarcoidosis].

The occurrence of steroidal leukocytosis at early stages of an observation may, to a certain extent, serve an objective criterion for predicting the pronounced immediate results of treatment in first detected patients with sarcoidosis (that of intrathoracic lymph nodes and the lung in particular) and thus makes it possible to judge the adequacy of therapy in the inpatient setting. When steroidal leukocytosis is absent, it is necessary to differentiately decide whether it is expedient to correct a hormonal therapy regimen in order to achieve the optimal results of its efficiency.

[Clinical analysis of reasons for the absence of bacterial isolation in new cases of destructive pulmonary tuberculosis].

Saint Petersburg has been marked by a reduction in the efficiency of Mycobacterium tuberculosis (MBT) detection in the past 5 years. This is suggested by negative changes in the ratio of the rate of detected bacterial isolation to the phase of lung decay in new cases of tuberculosis. This is largely due to the fact that before treatment, clinicians do not fulfil in full measure the regulated requirements for the choice of studies and for the frequency of examinations for MBT. Sampling for microbiological studies is made, by infringing the technological specifications. Highly informative methods for MBT detection are not frequently used in the above cases. This all hampers diagnosis and rational treatment in these patients.

[Causes of hospitalization of non-tuberculous patients in a tuberculosis hospital]. / Prichiny gospitalizatsiii neprofil'nykh bol'nykh v spetsializirovannyi tuberkuloznyi stantsionar.

In present epidemiological and economic conditions tuberculosis suspects should be hospitalized to specialized tuberculosis hospitals only after they are carefully examined for cancer of the lungs and lingering pneumonia. For this an obligatory diagnostic minimum should be introduced.

[Analysis of tuberculosis mortality in a general hospital of a large city]. / Analiz sluchaev smerti ot tuberkuleza v mnogoprofil'noi bol'nitse megapolisa.

In thanatogenesis of tuberculosis in emergency cases admitted to general hospitals in 1998-2000 predominated acute destructive prigressive forms which are most unfavourable epidemiologically. At autopsies tuberculosis is encountered 3 times more frequently. The diagnosis of tuberculosis is missed because of critical condition of the patients and their short stay in hospital due to early lethal outcome which doesn't allow adequate examination for tuberculosis.

[Causes of negative x-ray changes in the lungs of patients with tuberculosis]. / Prichiny otritsatel'noi rentgenologicheskoi dinamiki v legkikh u bol'nykh tuberkulezodm.

The study examines various manifestations and causes of negative X-ray changes (NXC) in the lung of patients with tuberculosis, which were observed by the authors in 7% of cases. Among the causes of NXC, there was a predominance (64.7%) of progressive tuberculosis caused 7 leading predisposing factors, whereas in other cases (35.3%). NXC were due to the addition (exacerbation) of concomitant abnormalities, to the occurrence of adverse reactions to antituberculous drugs, etc. The establishment of these causes facilitates the verification of a diagnosis and promotes the rational use of the bed fund of specialized hospitals.

[Centralized control of the quality of diagnosis and detection of tuberculosis without pulmonary destruction and bacterial discharge]. / Tsentralizovannyi kontrol' kachestva diagnostiki i vyiavleniia tuberkuleza bez destruktsii legkikh i bakteriovydeleniia.

The City Supervision Committee (CSC) has been set up in St. Petersburg to control detection, quality of diagnosis and treatment of new-onset cases of tuberculosis without destruction and bacterial discharge. The CSC members contributed to unification of diagnostic and activity status techniques, helped introduce retrospective survey of fluorograms, raise responsibility of practitioners. The CSC activity was found beneficial for antituberculosis institutions of a large city.

[Results of a combined use of the tuberculin provocation test and immunoenzyme analysis in phthisis]. / O rezul'tatakh kompleksnogo primeneniia vo ftiziatrii tuberkulino-provokatsionnoi proby i immunofermentnogo analiza.

In patients with early respiratory tuberculosis serum levels of specific antibodies were measured before and after Koch's test using an enzyme immunoassay (EIA). The latter was most informative in evaluating the baseline level of the antibodies to make a differential diagnosis of tuberculosis. When followed by EIA, the tuberculin provocative test enhances EIA sensitivity thus contributing to more effective detection of specific process of minor activity.

[Diagnosis and treatment of pleural lesions in sarcoidosis of the respiratory organs]. / Diagnostika i lechenie porazheniia plevry pri sarkoidoze organov dykhaniia.

Among the 2775 respiratory sarcoidosis patients who were examined over the last ten years 278 (10%) had pleural affections: thickening of interlobular pleura and pleural deposits (98.2%), exudative pleurisy (1.1%) and spontaneous pneumothorax (0.7%). The most common pleural affection was found in sarcoidosis of stages II and III (16.8 and 70.8%, respectively). The clinical manifestations in all forms of this pathology had poor symptoms. Complex therapy proved to be highly effective. It included use of corticosteroids, antioxidants and immunomodulators; massive exudative pleurisy was managed by pleural puncture and removal of exudate.

[Reasons complicating the diagnosis and determination of the tubercular activity of respiratory organs]. / Prichiny, zatrudniaiushchie diagnostiku i opredelenie aktivnosti tuberkuleza organov dykhaniia.

The analysis of 260 cases of doubtful diagnosis and the definition of tuberculosis activity in newly-discovered patients demonstrated that these difficulties frequently resulted from nonadherence to conventional organizational, remedial and diagnostic measures in addition to the absence of continuity in the work of personnel of different medical institutions.