[Tuberculosis and HIV infection: detection, follow-up, treatment: Moscow data].

The paper describes the follow-up and treatment of patients with tuberculosis concurrent with HIV infection in Moscow in 2004-2005. Major epidemiological parameters, such as morbidity, mortality, and prevalence of this comorbidity, are given. Analysis of these indices suggests that the epidemic situation associated with tuberculosis concurrent with HIV infection became worse in the past 2 years. As compared with 2004, in 2005 the number of such patients increased from 294 to 445, including that of first detected patients rose from 123 to 174. In this group of patients, there was a preponderance of young males aged 29 to 39 years. Most patients with this pathology suffered from drug addiction and alcoholism and other concomitant diseases. The bulk of them were unemployed and disabled. In the HIV-infected, the clinical forms of tuberculosis were severe with a predominance of acute and disseminated processes; the rate of drug resistance, including multidrug resistance, was high, which made treatment difficult and resulted in high mortality.

[Criteria for clinical recovery and the evaluation of the efficiency of treatment in patients with respiratory tuberculosis in Moscow].

Criteria for clinical cure have been analyzed and the efficiency of treatment evaluated in patients with respiratory tuberculosis in Moscow. If today's official criteria for the efficiency of treatment have been ascertained to preserve in treating the first detected patients, a phthisiological service will completely lose an objective control of this section of work in several years. The only criterion that gives some idea of the results of treatment in first detected patients is currently to transfer them to dispensary register group III. However, when the results of interim treatment stages are unknown, conditions are created for utter arbitrariness in the time of the transfer (this happens at present). It is necessary to hold today's existing major criteria (cessation of bacterial isolation and closure of decay cavities) for evaluating the efficiency of treatment in first detected patients (who are largely inpatients) and to add one more criterion (disappearance of Xray signs of active tuberculosis manifestations); moreover, the magnitude of major or minor residual tuberculous changes should be, of course, taken into account after a basic course of chemotherapy.

[Results of implementation of the subprograms "Goal-oriented medical examination of the Moscow population for early tuberculosis detection"].

The implementation of the subprograms "Goal-oriented medical examination of the Moscow population for early tuberculosis visage a differential screening of the population in relation to the risk of tuberculosis; fitting of health care facilities with current digital fluorographic equipment; improvement of an epidemiological screening of patients with tuberculosis. Over 7 years of implementation of the Program, advances were made: the population's coverage with preventive examinations increased by 11%; that of detively; the active detection of patients with respiratory abnormalities and those with pulmonary tuberculosis increased by 2.0 and 2.4 times, respectively; the proportion of tuberculosis patients actively detected rose by 1.5 times; 151 digital fluorographs and 11 X-ray units were purchased; a program for machine fluorography study accounting was worked out.

[Organization of detection of patients with tuberculosis in Moscow].

The authors studied the X-ray detection of patients with tuberculosis in Moscow over 5 years (1997-2001). The subject of the study was the Moscow population numbering about 7 million people to undergo fluorographic examinations and a group of new cases (more than 12,000) of pulmonary tuberculosis. The study has provided the following data: The most patients with pulmonary tuberculosis are detected in the polyclinics, general somatic and mental hospitals, and psychoneurological nursing homes; they amount to 74.8, 22, and 3.2%, respectively. The leading detection method among Moscow adults and adolescents is currently fluorography that detects 83.7% of the patients. The highest proportion in the structure of clinical forms is infiltrative pulmonary tuberculosis that amounts to 52.6%. Next is focal tuberculosis (14.9%); then in the descending order: disseminated tuberculosis (14.6%); tuberculosis of intrathoracic lymph nodes (4.1%); tuberculoma (3.9%), pleuritis (3.3%), caseous pneumonia (2.9%), cavernous and fibrocavernous tuberculosis (1.8%), and cirrhotic tuberculosis (0.5%). There are 69.3 of males and 30.7% of females in the structure of new cases of pulmonary tuberculosis. The unemployed able-bodied persons account for 34.5%, workers, 14.7%, disabled, 12.7%, and pensioners, 10.8%. Patients with pulmonary tuberculosis are most frequently detected in social risk groups. With this, the highest detection rate per 1000 examinees is 29.1% in homeless persons and 26.9% in migrants. In medical risk groups, tuberculosis is more frequently identified in patients with mental diseases, chronic nonspecific respiratory diseases, and alcohol and drug users (8.7, 5.3, and 2.5, respectively per 1000). In an epidemiological risk group, the highest detection rate is noted among persons who are in contact with patients with tuberculosis (5.4 per 1000). Examination of risk-group patients who amounted to 32.2% of those undergone fluorography detects 62.9% of patients with tuberculosis.

[Aspects of the Moscow fluorographic services status and possible approaches to its reorganization]. / Nekotorye aspekty sostoianiia fliuorograficheskoi sluzhby Mosvy i vozmozhnye podkhody k ee reorganizatsii.

Due to the fact that modern digital fluorographic plants have been introduced into medical practice, it is necessary to elaborate new organizational and technological forms of work during fluorographic survey. For this, 1-2 Moscow okrugs completely equipped with digital fluorographic plants should be used to examine their actual capacities and on this basis to develop guidelines for detection of chest diseases by applying this new technological equipment. While organizing mass surveys by using digital fluorographs, it is necessary to take into account the definite conditions: health care facilities must be equipped with a uniform digital fluorograph; for continuity in work and information exchange, the software of all fluorographs must be unified within the city; a personified electronic fluographic card catalogue must be provided by identifying decreed contingents and tuberculosis risk groups; digital fluorographs must be fitted with the programmes that permit one to keep records and accounts in accordance with the approved official statistical forms; the database must be compatible in all users for prompt exchange of information on modem communication and for transmission of the results of a survey on diskette carriers; a fluorographic center wherein the fluorograms of individuals with suspected tuberculosis should be collected and deciphered (by modem communication or on diskette information carriers) must be set up on the basis of one of the tuberculosis dispensaries.

[Endogenous reactivation of tuberculosis as a result of reversion of persistent mycobacterial L-forms]. / Endogennaia reaktivatsiia tuberkuleza kak rezul'tat reversii persistiruiushchikh L-form mikobakterii.

Detection of L-transformed variants of M. tuberculosis and the study of qualitative-quantitative characteristics of isolated mycobacterial population provided additional information to available clinical x-ray evidence on the followed up patients. This allows more accurate estimation of reactivation risk, indications to chemotherapy and correction of follow-up policy.

[Characteristics of qualitative changes in the Mycobacteria population during the treatment of middle-aged and elderly patients with newly detected pulmonary tuberculosis]. / Osobennosti kachestvennykh izmenenii mikobakterial'noi populiatsii pri lechenii bol'nykh pozhilogo i starcheskogo vozrasta s vpervye vyiavlennym tuberkulezom legkikh.

Clinicobacteriological investigations were applied to 142 new cases of pulmonary tuberculosis at the age of 60 to 89 years. The control group consisted of 132 patients of young and middle ages (from 17 to 40 years). The form of the process, its extent and the character of the destructions in them were the same as those in the elderly and senile patients. It was shown that the pathogen bacterial forms in the elderly and senile patients were much more frequent than L-forms of M. tuberculosis (67.6 and 42.9 per cent, respectively). The tubercle bacilli were mainly isolated from pure cultures (45.8 per cent). L-transformants of M. tuberculosis in the elderly and senile patients were markedly less frequent than in the patients of the control group (69.7 per cent) with analogous forms of tuberculosis. The frequency of L-forms and their rapid reversion into the initial bacterial form of M. tuberculosis (28.0 per cent) and the same period of isolating both the bacterial and L-forms were the distinctive features of the L-forms isolated from the elderly and senile patients. It was suggested that L-forms of M. tuberculosis played an important role in reactivation of the specific process.

[Isolation of mycobacteria L forms as a prognostic criterion of recurrence and aggravation of tuberculosis in patients with extended residual tuberculous lesions of the lungs]. / Vyiavlenie L-form mikobakterii kak prognosticheskii kriterii retsidivov i obostrenii tuberkuleza u bol'nykh s bol'shimi ostatochnymi tuberkuleznymi izmeneniiami v legkikh.

To elucidate the role of tubercle bacilli L-forms in tuberculosis relapsing and aggravation in patients with extended residual lesions in the lungs, 117 patients mainly with extended and neglected destructive tuberculosis of the lungs were observed for a period of 5 to 7 years with using microbiological and clinico-roentgeno-laboratory examinations. Analysis of the immediate and remote results of the treatment showed that in the group of the abacillary patients according to the routine microbiological investigations who continued to isolate L-forms of tubercle bacilli at the background of remaining destructive cavities in the lungs aggravations and relapses amounted to 46.6 per cent. The etiological role of the L-forms was proved by absolute identity of the biological properties of the L-form revertants isolated from in vitro subcultures and tubercle bacilli, isolated from the patients during the process relapsing.

[Use of the CO2 laser in endobronchial pathology]. / Ispol'zovanie CO2-lazera pri éndobronkhial'noi patologii.

Endoscopic therapy by CO2-laser of the "Skalpel-1" type through the Friedel breathing bronchoscope is analyzed. The treatment was performed in 40 patients with various endobronchial affections such as tumors, fistulas due to tuberculosis of the intrathoracic lymph nodes, specific and nonspecific stump inflammation, mycotic lesions of the stump mucosa, foreign bodies, cicatricial stenosis of the bronchi, scleroma of the trachea and bronchi, hemorrhage. High efficiency of endoscopic laser bronchoscopy was shown.

[Clinical picture and course of newly detected pulmonary tuberculosis in elderly and senile patients, discharging L-forms of Mycobacterium tuberculosis]. / Klinika i techenie vpervye vyiavlennogo tuberkuleza legkikh u bol'nykh pozhilogo i starcheskogo vozrasta, vydeliaiushchikh L-formy Mikobakterii tuberkuleza.

One hundred and forty two new cases of pulmonary tuberculosis of elderly and senile ages were observed clinically. In terms of the vegetating mycobacterial population, all the patients were divided into 3 groups. It was shown that pronounced clinical and x-ray signs of pulmonary tuberculosis were characteristic of the patients isolating only bacterial forms of the pathogen (group 1). Intensive chemotherapy of the patients of that group was the most efficient. At the same time lethality in that group was the highest. In the patients isolating both the bacterial forms and the L-forms of the pathogen (group 2), the clinical signs of the disease were similar to those in the patients of group 1. However, the time-course of their clinical, x-ray and laboratory indices was slower and the therapy results were less satisfactory than in the patients isolating pure cultures of tubercle bacilli. In the patients isolating only L-transformed variants of tubercle bacilli (group 3), the clinical symptoms were characterized by their latent onset and torpid course. The treatment results in the patients of that group were not sufficient.