The socio-economic risk factors of tuberculosis in conditions of a high migration in trans-border region

Tuberculosis is a classic example of an infectious disease linked with social determinants of the health. The survey includes information about the risk factors, socio-economical status pulmonary tuberculosis patients from a high tuberculosis burden trans-border region: Chisinau and Balti city and Western Ukraine Chernivtsi region

Tuberculosis and hard-to-reach group – migrant population

Department of Pneumophtysiology, Nicolae Testemitsanu State University of Medicine and Pharmacy Chisinau, the Republic of Moldova, Department of Phthysiology and Pulmonology, Bukovinian State Medical University, Chernivtsi, UkraineBackground: The Republic of Moldova reports the biggest incidence of tuberculosis and the biggest rate of migrants among European Region countries. For the most of migrants the risk for TB development is correlated with social risk factors (low life conditions, overcrowding, disruption from the health care services), epidemiological risk factors (infectious contact) and biological features (young age, male sex, some physiological conditions, associated diseases). Risk factors association is more evident than the severity of one risk factor. The review study was conducted using relevant scientific resourses. Conclusions: TB is a big challenge worldwide. Despite high trends of migration noted in the 20th century the phemonen of migration as a risk factor for TB development is studied insufficienly. Immigrants are the majority of TB patients in high-income countries. The irregular emigrants are the most of TB patients from high-burden countries. Radiological and immunological screening in pre-departure phase is the most important procedure for decreasing of TB rates by providing latent TB infection treatment. Raising awareness among migrants about TB, emphasizing that diagnosis and treatment are free of charge and independent regarding migration status are important TB control actions performed in this hard-to-reach population

Вклад молекулярно-генетического метода в выявление туберкулеза

Department of Pneumophtysiology, Nicolae Testemiţanu State University of Medicine and Pharmacy, Department of Family Medicine, Nicolae Testemitanu SUMPh, Medical Territorial Association Botanica, Chisinau, Medical Territorial Association Buiucani, ChisinauTuberculosis detection represents the major challenge in actual health care system of the Republic of Moldova. The aim of the study was the assessment of the features and risk factors of 101 patients with pulmonary tuberculosis detected in the frame of the primary health care of Chisinau city and diagnosis confirmed by molecular genetic method GeneXpert MTB/Rif. The research results established that more frequently were detected patients with lack of health insurance and poor social economical state. The risk factors such as chronic alcoholism, drug consumption, and history of detention, migration and comorbid state were identified in a low proportion. Despite the fact that high risk groups such as persons with tuberculosis contact and HIV infected individuals must be detected by active screening, they were detected predominantly by passive way. Despite the fact, that severe and extensive clinical radiologic forms predominated in patients detected by addressing, the treatment success rate was without differences compared with patients detected by active screening. .Depistarea tuberculozei reprezintă o provocare majoră pentru sistemul actual de sănătate al Republici Moldova. Scopul cercetării a fost evaluarea particularităţilor şi a factorilor de risc a 101 pacienţi cu tuberculoză pulmonară, depistaţi în cadrul asistenţei medicale primare din municipiul Chişinău şi cu diagnostic confirmat prin metoda molecular-genetică GeneXpert MTB/RIF. Rezultatele studiului au confirmat că mai des au fost depistaţi pacienţi neasiguraţi, cu o stare socioeconomică precară. Factorii de risc precum alcoolismul cronic, consumul de droguri, istoricul de detenţie, migraţia şi comorbidităţile au fost identificaţi într-un număr redus. În pofida faptului că grupele cu risc înalt, precum persoanele cu contact tuberculos şi cele infectate HIV, trebuie să fie depistate prin screening activ, acestea au fost depistate mai frecvent pasiv. Deşi formele clinico-radiologice severe şi extinse au predominat la pacienţii depistaţi prin adresare, rata succesului terapeutic nu s-a diferenţiat de cea a pacienţilor depistaţi prin screening activ.Выявление туберкулеза является серьезной проблемой для нынешней системы здравоохранения Республики Молдова. Целью исследования было определить особенности и факторы риска 101 пациентов с туберкулезом легких, выявленных в рамках первичной медико-санитарной помощи города Кишинэу и с подтвержденным диагнозом молекулярнo-генетическим методом GeneXpert MTB/Rif. Было установлено, что чаще всего были выявлены пациенты без медицинской страховки и со сниженным социально-экономическим статусом. Факторы риска, такие как хронический алкоголизм, употребление наркотиков, тюремное заключение, миграция, сопутствующие заболевания, были установлены у несколько случаев. Вопреки рекомендации активного выявления групп повышенного риска, включавшие людей с туберкулезным контактом и ВИЧ-инфицированные лица, они были обнаружены преимущественно пассивным путем. Несмотря на то, что тяжелые и обширные клинико-рентгенологические формы преобладали у пациентов, выявленных при обращении, доля успешно вылеченных было одинаково по сравнению с долей пациентов, выявленных активным путе

Impact of drug resistance on the tuberculosis treatment outcome

Background. The standard treatment of a new case of multidrug-resistant tuberculosis (MDR-TB) according to WHO recommendations in the Republic of Moldova is performed since 2005 showing a low treatment succes. Actually the treatment success rate increased due to excluding of MDR-TB patients from the general cohort. The major rate of patients with low outcome is represented by the failed and lost to follow-up cases. The purpose of the study was to assess the impact of multidrug-resiatnce and MDR-TB on the tuberculosis treatment outcome. Materials and methods. A retrospective selective, descriptive study targeting social, demographic, economic and epidemiological peculiarities, case-management, diagnostic radiological aspects and microbiological characteristics of 187 patients with pulmonary tuberculosis registered during 2013–2015 distributed in two groups: 1st group (61 patients) with established multidrug-resistant strains using conventional cultural methods and the 2nd group (126 patients) with MDR-TB. Results. Multidrug-resistance was established more frequently in new cases and MDR-TB in two thirds of retreated patients. No difference was identified in gender and age distribution, social, economical, educational characteristics; case-management assessment identified a similar proportion of patients revealed by general practitioners and specialists, with low rate of screened high risk groups. All patients from the multidrug-resistant group began the standard treatment for drug-responsiveness tuberculosis before drug susceptibility testing and one third of MDR-TB group was treated from the onset with the DOTS-Plus regimen. Highest success rate was identified in the new-case subgroups of both groups and higher rate of died patients was determined in the retreated subgroups. Such a low rate of patients aggrevates the resistance. Conclusions. Early diagnosis, drug responsiveness testing and raising awareness among about treatment compliance will improve disease outcome

Соціально-економічні фактори ризику розвитку туберкульозу в умовах високої міграції в транскордонному регіоні

Tuberculosis is a classic example of an infectious disease linked with social determinants of the health. The survey includes information about the risk factors, socio-economical status pulmonary tuberculosis patients from a high tuberculosis burden trans-border region: Chisinau and Balti city and Western Ukraine Chernivtsi region.Туберкулез является классическим примером инфекционного заболевания, связанный с социальными детерминантами здоровья. Исследование включает в себя информацию о факторах риска, социально-экономический статус больных туберкулезом легких с высоким бременем туберкулеза трансграничного региона: Кишинев и город Бельцы и Западная Украина, Черновицкая область.Туберкульоз є класичним прикладом інфекційного захворювання, пов'язаний із соціальними детермінантами здоров'я. Дослідження включає в себе інформацію про фактори ризику, соціально-економічний статус хворих на туберкульоз легень із високим тягарем туберкульозу транскордонного регіону: Кишинів і місто Бєльци і Західна Україна, Чернівецька область

Влияние резистентности к лекарственным препаратам на результаты лечения туберкулеза

The purpose of the study was to assess the impact of multidrug-resistance and MDR-TB on the tuberculosis treatment outcome. Conclusions. Early diagnosis, drug responsiveness testing and raising awareness among about treatment compliance will improve disease outcome. Мета дослідження полягала в тому, щоб дати оцінку впливу полі- і мультирезистентності на результати лікування туберкульозу. Висновки. Рання діагностика, тестування чутливості до лікарських засобів і підвищення обізнаності про дотримання режиму лікування покращує результат захворювання. Цель исследования состояла в том, чтобы дать оценку влияния поли- и мультирезистентности на результаты лечения туберкулеза. Выводы. Ранняя диагностика, тестирование чувствительности к лекарственным средствам и повышение осведомленности о соблюдении режима лечения улучшают исход заболевания

Загальні адаптивні реакції і вираженість ендогенної інтоксикації у хворих на туберкульоз легень

Objective was the comparative analysis of general nonspecific adaptive reactions (RANG) and the expresiveness of endogenous intoxication in various forms of pulmonary infiltrative tuberculosis. Materials and methods. RANG structure, intoxication indices and plasma level of circulating immune complexes were assessed at 374 new pulmonary infiltrative ТВ cases. Results and discussion. Standard treatment enhanced RANG structure only in limited forms of pulmonary ТВ. Despite of concludent diminishing of intoxication indices in both groups, the high level of circulating immune complexes at the end of intensive treatment phase, demonstrated the insuficient immune adaptive and desinstoxication activity of the standard regimen. Conclusions. The standard ТВ treatment demonstrated an unsuficient immune restoring action, necessitating the association of immune adaptive drugs. Мета роботи – порівняльний аналіз загальних неспецифічних адаптивних реакцій і інтоксикаційних показників у хворих на інфільтративний туберкульоз легень. Матеріали та методи. Імунологічні показники і загальні адаптивні реакції були проаналізовані у 374 пацієнтів з інфільтративним туберкульозом легень. Результати та обговорення. Показано ефективність протитуберкульозного впливу на структуру адаптивних реакцій у хворих з лімітованими процесами. Незважаючи на зменшення інтоксикаційних показників в обох групах, високий рівень імунних циркулюючих комплексів у момент завершення інтенсивної фази хіміотерапії показує недостатню імуноадаптивну і дезінтоксикаційну ефективність стандартного протитуберкульозного лікування. Висновки. Стандартне протитуберкульозне лікування демонструє недостатню ефективність імунного відновлення, вимагаючи асоційованих імуноадаптивних препаратів