[Monitoring of chemotherapy in patients with pulmonary tuberculosis by the blood bacteriostatic activity-determining test].

The paper gives the results of studies to determine blood bacteriostatic activity (BBA) in the use of a patient's autostrain and semiliquid medium versus the clinical and laboratory parameters of the course of a process in 101 patients with pulmonary tuberculosis. There is evidence for the relationship of the BBA to the sensitivity to isoniazid and the structure of drug resistance. The zero values of BBA correspond to the severest course of the disease. The efficiency of treatment is much higher in patients with high and moderate BBA. The latter's determination using the semiliquid medium permits an objective evaluation of the efficiency of chemotherapy, identification of patients with a poor prognosis, and then choice of an individual treatment regimen on day 7 after the test just before obtaining the data on drug sensitivity.

[Some regularities of an immune response in patients with pulmonary tuberculosis and drug-resistant Mycobacterium strains].

Clinical and immunological studies were conducted in 62 patients with infiltrative pulmonary tuberculosis and 53 with disseminated one. As drug resistance and viability of mycobacteria increased, an immune response was found to develop as the humoral type and cellular immunity was suppressed. A more marked reduction in the activity of T helper cells type 1 of an immune response and the neutrophilic granulocytic system was revealed in patients with disseminated pulmonary tuberculosis. The maximum suppression of cell immunity was found in patients with multidrug-resistant mycobacterial strains. The observed changes in an immune response and in the production of cytokines (IL-2, IL-8) are informative signs correlating with deterioration of a specific process. Mycobacterial drug resistance and its suppressed cell immunity make chemotherapy policy difficult. The findings identify patients with mycobacterial drug resistance and high viability as a group of priority in the context of immunomodulator therapy.

[Immunogenetic aspects of the course and treatment of pulmonary tuberculosis].

The paper presents the clinical, X-ray, and laboratory characteristics of patients with pulmonary tuberculosis. Both general regularities and differences in the frequency of alleles of the HLA-DQB1* locus have been revealed in the groups of patients with pulmonary tuberculosis as compared with healthy individuals. There are specificities associated with the risk of pulmonary tuberculosis and the variants of the course of infection; thus, allele 05 of the HLA-DQB1* locus is positively associated with the incidence of tuberculosis. Specificity 03 of the HLA-DQB1* locus has been ascertained to be associated with the poor course of the disease. The most pronounced immunological changes have been observed in patients with the poor course of the disease, who are the carriers of specificity 05 of the HLA-DQB1* locus. The totality of immunological parameters and the data of genetic studies provide a basis for using the selective immunomodulator rIL-2 (roncoleukin) in the most seriously ill patients who are carriers of specificity 05.

[A role of the HLA-DRB1* genotype in the complex therapy of pulmonary tuberculosis].

It is as for now evident that in-depth researches of the genotype of a patient are needed to enhance the efficiency of therapeutic measures. The purpose of the present study was to enhance the efficiency of complex antituberculous therapy, by genetically identifying the allelic polymorphism of the HLA-DRB1* gene in a person who had ill with tuberculosis. The material of the study was the results of a followup and treatment of 100 patients with pulmonary tuberculosis. The subject of a special study was the molecular typing of the HLA genes of the DRB1* locus by polymerase chain reaction (PCR-SSP). The findings suggest that an individual approach to choosing treatment regimens (chemotherapy and pathogenetic therapy) for patients with pulmonary tuberculosis, by taking into account the HLA-DRB1* genotype enables one to enhance the efficiency of treatment in the major clinical and X-ray parameters.

[Approach to diagnosing tuberculosis of intrathoracic lymph nodes of a paraaortic group in children].

A hundred and seventeen patients aged 3 to 14 years, with suspected tuberculosis of intrathoracic lymph nodes (ILN) of a paraaortic group in the phase of calcination, were examined at the Clinic of Childhood Pulmonary Tuberculosis, Saint Petersburg Research Institute of Phthisiology. The comprehensive examination made the diagnosis of tuberculosis be cancelled in 35% of cases and confirmed in 65%, by determining the phase and extent of a specific inflammation. In 8.5% the local manifestations of the disease were absent along with the significant symptoms of intoxication and with the activity of tuberculous infection, which gave grounds to establish the diagnosis of tuberculous intoxication. Despite the fact that computed tomography revealed aortic ligament calcification, enlarged mediastinal lymph nodes were detected in 35%. High tuberculous infection activity and mediastinal ILN lesion in different phases of the specific inflammation were found in 15.4%, which was indicative of the chronic course of inflammation. The first detected isolated calcification in the paraaortic group of lymph nodes was diagnosed in 5.9%. The use of the presented complex, the diagnostic efficiency of which was 98%, significantly enhanced the diagnosis and reduced the number of errors in making the diagnosis.

[Today's tuberculosis: the specific features of its pathogen, clinical picture, and treatment].

Clinical Mycobacterium tuberculosis (MBT) strains (their genotype, drug resistance, and virulence) and the characteristics of their caused processes were studied. More than a half the studied MBT isolates belonged to the genetic family Beijing. As compared with mycobacteria of individual genotypes, they showed a significantly higher rate of multidrug resistance, polyresistance, and a high virulescence and caused more common and frequently progressive pulmonary lesions requiring the use of large-dose isoniazid and second-line drugs and early surgical treatment.

[Characterization of destructive pulmonary tuberculosis (by the results of a clinicomathematical analysis)].

The results of examination of 56 patients with destructive pulmonary tuberculosis, which involved the study of biochemical parameters characterizing different stages of an inflammatory process, as well as clinical and X-ray findings were analyzed, by applying various multivariate statistical methods. This approach was shown to be promising for estimating the severity of the process and for specifying the stage of development of an inflammatory process in some patients.

[Immunological parameters and mycobacterial biological properties in infiltrative pulmonary tuberculosis].

Thirty-one patients with infiltrative pulmonary tuberculosis were clinically and immunologically examined. A relationship was found between the definite immunological parameters and the biological properties of mycobacteria. The higher viability of mycobacteria and the increase in the drug resistance have been shown to be associated with the decreased activity of lymphocytes and the suppressed production of interleukin-2, which suggests a decrease in the activity of type 1 T helper cells and a significant increase in the synthesis of tuberculosis antibodies with the lower serum concentrations of circulating immune complexes. This is an informative indicator of a severe specific process, as previously established. Moreover, the authors show certain differences in the changes of immunological parameters in patients with infiltrative pulmonary tuberculosis with varying mycobacterial properties. Thus, the results of the performed study make investigators pay a particular attention to the immunopathogenetic value of the biological properties of Mycobacterium tuberculosis.

[Role of a comprehensive genetic prognosis in the treatment and prevention of respiratory tuberculosis in adolescents].

The paper presents the results of a follow-up and treatment of 75 adolescents with pulmonary tuberculosis. It assesses the predictive value of different alleles of the gene HLA-DRB1 and the genotype of Mycobacterium tuberculosis for the clinical course of pulmonary tuberculosis in the adolescents. An algorithm of examination of an adolescent with tuberculosis has been developed, by using a complex of genetic parameters. A differential approach to tuberculosis prevention and treatment regimens is presented by taking into account of genetic characteristics of gross and microorganisms.

[Etiopathogenetic therapy in adolescent patients with drug-resistant Mycobacterium tuberculosis in respiratory tuberculosis]. / Etiopatogeneticheskaia terapiia bol'nykh tuberkulezom organov dykhaniia podrostkov s lekarstvennoi ustoichivost'iu mikobakterii tuberkuleza.

The progress and efficiency of different therapy regimens for respiratory tuberculosis and the genotyping of Mycobacterium tuberculosis (MBT) were clinically analyzed in 46 adolescents. The pathogen of the disease was MBT of the Beijing family in 20 patients and the individual genotype of MBT in 22 patients. It has been ascertained that MBT of the Beijing genotype (80%) was more commonly recorded in secondary tuberculosis, both MBT of the Beijing family (59.0%) and the individual genotype of the pathogen (41%) were in primary tuberculosis. When MBT of the Beijing family had been infected, progression was diagnosed as being 3 times more frequently [n = 12 (54.5%)] family than that with individual genotype infection [n = 3 (13.6%)]. Therapy regimens have been developed by taking into account drug resistance and the genotype of MBT, the degree of inactivation of GINK and bacteriostatic blood activity, their clinical efficiency proved.

[The pathomorphism and diagnosis of tuberculosis of intrathoracic lymph nodes in children]. / Patomorfoz i diagnostika tuberkuleza vnutrigrudnykh limfaticheskikh uzlov u detei.

In the past decade, the leading form of specific lesion in children is tuberculosis of intrathoracic lymph nodes, whose proportion in the pattern of clinical forms is as high as 85.7%. The period of 1990 to 2002 showed a 3-fold increase in the detection of bilateral lesion involving more than 3 groups of lymph nodes; the specific processes were complicated by 3.5 times more frequently. The proportion of generalized forms of primary tuberculosis increased from 5 to 15%. Inclusion of mediastinal computed tomography into a package of studies significantly evaluates the magnitude of enlargement of lymph nodes. The polymerase chain reaction test for MBT DNA in the diagnosis of tuberculosis of intrathoracic lymph nodes in the absence of bacterial isolation yields a positive result in 73.3% of the children, which is an additional tool in the comprehensive study, which verifies the activity of a tuberculous process.

[The activity of alpha2-macroglobulin and its forms in patients with destructive pulmonary tuberculosis]. / Aktivnost' alpha2-makroglobulina i ego form u bol'nykh destruktivnym tuberkulezom organov dykhaniia.

A hundred and three patients with destructive pulmonary tuberculosis were examined. These patients had heterodirectional changes in the serum levels of alpha2-macroglobulin (MG) and its forms. The lowering of the level of the F-form of the inhibitor outstripped the decrease in the activity of total alpha2-MG and it was detectable in the lobar processes with moderate symptoms of intoxication and with the inoculation of adjacent segments. The preservation of the low total activity of the inhibitor and its forms during antituberculous therapy characterize a diminished process. The high content of the S form of alpha2-MG is a feature in patients showing positive changes before and 2 months after treatment whereas the changes in total alpha2-MG and its F form may vary. Whether it is expedient to study the fractional composition of alpha2-MG is determined by the heterodirectionality of changes in its S and F forms depending on the pattern of a process.

[Pulmonary tuberculosis caused by Mycobacterium tuberculosis of different genotypes]. / Tuberkulez legkikh, vyzvannyi Mycobacterium tuberculosis razlichnykh genotipov.

A relationship of the clinical picture of destructive pulmonary tuberculosis to the genotype, drug resistance, and virulence of Mycobacterium tuberculosis (MBT) strains was studied. As compared with the processes induced by individual genotypes, pulmonary tuberculosis caused by MBT from the family Beijing was found to be characterized by more marked clinical symptoms, multisegmental lung tissue lesions with multiple decay cavities, by low bacteriostatic blood activity, abundant bacterial isolation, and progression. MBT of the Beijing genotype were characterized by higher rates of resistance to antituberculous drugs and their combinations than were the strains of individual genotypes; they have a high virulence, which is likely to enhance their transmissibility and to determine the poor course of a specific process.

[Combined therapy of pulmonary tuberculosis by using recombinant interleukins]. / Kompleksnaia terapiia tuberkuleza legkikh s primeneniem rekombinantnykh interleikinov.

The use of roncoleukin in the combined therapy in patients with pulmonary tuberculosis caused by drug-resistant Mycobacterium tuberculosis (MBT) led to better immunological parameters and therapeutic efficiency: by month 3 of therapy, there was abacillation (69.2% versus 33.3% in the control) (p < 0.05), decay cavities closed by months 6 to 7 (59.0% versus 23.1%). The immunotropic effect of betaleukin on chemotherapy promoted accelerated involution of a specific process with the least pronounced residual changes in the lung tissue; by the end of an inpatient stage of therapy, the proportion of patients with minor residual changes (Type I and Type II) was 72.5% in the experimental group versus 36.8% in the control one (p < 0.05).

[Parameters of acquired immunity and cation proteins of neutrophilic granulocytes in pulmonary tuberculosis]. / Pokazateli priobretennogo immuniteta i kationnye belki neitrofil'nykh granulotsitov pri tuberkuleze legkikh.

Clinical and immunological studies of 61 patients with pulmonary tuberculosis have indicated that the status of acquired and congenital (natural) immunity assessed by the intra- and extracellular levels of cation proteins of neutrophilic granulocytes is different in different clinical forms of pulmonary tuberculosis. The found correlations suggest that there is a relationship between the factors of acquired and congenital immunity and that cytokines are involved in the regulation of specific inflammation. More active degranulation of azurophilic granules of neutrophils occurs due to myeloperoxidase. Unlike other forms, fibrocavernous pulmonary tuberculosis shows a negative correlation between intra- and extracellular content of cation proteins. The findings make it possible to use the parameters of congenital immunity for more detailed characterization of an immune response in tuberculosis, which may be essential in developing new pathogenetic therapy regimens.