Rare case of Visceral form of Infectious Mononucleosis in Irkutsk Region

Infectious mononucleosis (MI) is caused by the Herpes viridae family of viruses. Currently, most researchers assign a leading role to the Epstein-Barr virus. In present time there are no unified clinical classification of infection mononucleosis, but many authors recognize the visceral form which involves cardiovascular system, adrenal glands, lungs, central neural system and others organs. The article describes a clinical case of MI in the 28-year-old patient. She applied for medical help with complaints of fever up to 39 °C, weakness in the legs and arms, weight loss and received symptomatic treatment on an outpatient department. After 2 months on the background of deterioration, she was hospitalized in an infectious diseases hospital with severe symptoms of intoxication, lymphoproliferative syndrome, myocarditis, pericarditis, hepatitis, polyneuropathy with quadriparesis, hypochromic anemia, thrombocytopenia. She was consulted by an oncologist and diagnosed with cervical cancer. Laboratory confirmation was obtained – Epstein-Barr virus was detected in the blood. Against the background of antiviral therapy, a regression of clinical symptoms was achieved in a week. The patient was transferred to a oncological hospital. It is recommended to examine patients with high fever of unknown etiology on myocardial infarction for the timely appointed etiotropic therapy

Characteristics of new cases of infiltrative pulmonary tuberculosis in patients having HIV infection with multidrug resistance of the pathogen according to multi-layer spiral computed tomography

Background. Identification of the characteristics of the pulmonary tuberculosis process using multi-layer spiral computed tomography (MSCT) in patients with tuberculosis and HIV infection is important in the diagnosis of tuberculosis, determining the dissemination of the process and its dynamics during treatment. The aim. To determine the initial characteristics and dynamics of infiltrative tuberculosis according to MSCT in patients with and without HIV infection, with and without multidrug resistance (MDR) of Mycobacterium tuberculosis who were treated in a hospital. Materials and methods. 126 patients aged 19–59 years with tuberculosis, combined with HIV infection and without HIV infection were examined. For statistical processing, we used MS Excel (Microsoft Corp., USA) software package. Results. Patients with tuberculosis and HIV infection in comparison with patients with tuberculosis and without HIV had more expressed intoxication syndrome and respiratory impairement in the clinical picture (p < 0.00001). Patients with coinfection were more likely to suffer from alcohol (p  <  0.05) and drug addiction (p < 0.001). According to MSCT, the pathological process in HIV-positive patients with pulmonary tuberculosis was more disseminated (p < 0.05), included severe intrathoracic lymphadenopathy (p < 0.0001), more common pleural lesions (p < 0.005), less common destructive changes (cavities) (p < 0.001) and outcomes in form of fibro-cavernous tuberculosis (p < 0.01). Process regression was slower in patients with tuberculosis and HIV (p < 0.005). According to MSCT, extensive lung damage, intrathoracic lymphadenopathy were  more often found in patients with MDR in coinfection (p  <  0.05). Cavities and fibro-cavernous tuberculosis outcomes were more common in patients with tuberculosis without HIV infection and with MDR (p < 0.05). Conclusion. MSCT provides detailed information about the pathological process in the lungs and its dynamics under the treatment of tuberculosis and HIV infection

Multi-Drug Resistance of Mycobacterium Tuberculosis – the Problem of Modern Phthisiology

The 21st century is characterized by the exacerbation of the problem formation and spreading of drug-resistant strains throughout the world. Genetic mutations of Mycobacterium tuberculosis lead to the formation of drug-resistant forms because of long-term use of anti-tuberculosis drugs. The Russian Federation is among the top three countries with a high burden of tuberculosis with multidrug resistance (MDR). The estimated number of cases of tuberculosis with MDR in the Russian Federation was 60,000, which corresponds to half the burden of the European Region in 2015. In the Irkutsk region from 2014 till 2018 the proportion of TB cases with MDR cases increased from 15.2 % to 18.3 %. According to the reference laboratory of the Irkutsk Regional Clinical Tuberculosis Hospital, a significantly higher level of MDR among primary diagnosed was registered in the cities (27.7 %) and the lowest in rural areas of the region (16.5 %). Among the cohorts of patients with tuberculosis, the highest proportion of MDR was in the northern territories of the region (43.1 %), in Irkutsk district (41.2 %) and in large cities, including Irkutsk (38.5 %). Positive correlations were established between cohort of primary diagnosed TB with MDR and among populations in areas with high morbidity along the railway (r = 0.91; p = 0.00001), in the Irkutsk region (r = 0.89; p = 0,00008), and also in the Irkutsk city (r = 0.91; p = 0.00002). This is probably due to the influence of reservoir of tuberculosis infection formed in these localities. The regulatory documents of the Ministry of Health of the Irkutsk Region was developed on the basis of the data obtained, and they include recommendations for improving the diagnosis of tuberculosis in the region using fast and accelerated microbiological diagnostic methods

Viability of causative pathogen in patients with drug-sensitive and drug-resistant forms of respiratory tuberculosis

To predict outcomes of tuberculosis we investigated the viability of Mycobacterium tuberculosis (MTB) in relation to drug resistance of strains and clinical manifestations of tuberculosis. During the study on solid Löwenstein - Jensen medium, we determined the speed, growth rate and drug resistance of MBT in 5945 cultures, isolated from the sputum of patients with pulmonary tuberculosis - residents of the Irkutsk region (2193 -from newly diagnosed patients, 3752 - from previously treated patients). The criterion of high viability of MBT was the growth rate of >100 colonies over 20 days; and low viability corresponded with the growth rate of 30 days. 2171 cultures (36.5 %) had high viability of MBT strains, 3021 (50.8 %) - low, and 753 (12.7 %) cultures had average degree of viability. A high degree of pathogen viability was more often determined in newly diagnosed patients with tuberculosis of intrathoracic lymph nodes (all patients with HIV-infection without antiretroviral therapy), fibrotic-cavernous and infiltrative tuberculosis. Among previously treated patients with tuberculosis the high viability of MBT was often determined in patients with fibrous-cavernous and infiltrative tuberculosis, and caseous pneumonia. Cultures from previously treated patients with tuberculosis of intrathoracic lymph nodes had low degree of viability. The number of drug-sensitive strains was 1992, drug-resistant ones - 3953, including 1430 strains with multidrug resistance. We have found that 37.5 % drug-resistant strains associated with a high degree of viability (multidrug resistance - 38.5 %), it's was more often than the drug-sensitive (35.4 %; p < 0.01)

Опыт использования краткосрочных курсов химиотерапии в лечении туберкулеза с множественной лекарственной устойчивостью возбудителя у детей с разным ВИЧ-статусом

The objective: to study the time frames and efficacy of treatment for tuberculosis with confirmed and suspected multiple drug resistance (MDR) in children with different HIV status.Subjects and methods. The method of continuous sampling was used in the study which included 21 children with MDR tuberculosis, they all had been exposed to MDR TB and were treated in hospital. 3 children had concurrent HIV.Results. The duration of the intensive care phase in HIV negative children (19 people) made: 60 doses – 1 (5.3%) child, 90 doses – 11 (57.9%) children, 120 doses – 2 (10.5%) children, 180 doses – 3 (15.8%) children, 240 doses – 1 (4.3%) child. The duration of the continuation phase was the following: 120 doses – 1 (4.3%) child, 150 doses – 1 (5.3%) children, 180 doses – 12 (63.1%) children, 270 doses – 1 (5.3%) children, 320 doses – 3 (15.8%) children.The duration of the intensive phase of treatment in 3 children with concurrent MDR TB and HIV infection made 180 doses in 2 (66.6%) children and 240 doses in 1 (33.4%) child. The continuation phase included 180 doses in 2 (66.6%) children and 320 in 1 (33.4%) child respectively.Outcomes of the main course of chemotherapy were favorable in the majority of the cases - inflammatory changes resolved, focuses consolidated and fibrosis formed in the lung tissue.Conclusion. Should children have negative results of sputum tests, the treatment is prescribed based on the results of drug susceptibility tests of the index case. If limited tuberculous lesions are diagnosed, the duration of treatment of children with MDR can be shorter. The outcomes of short-course treatment in children with tuberculosis are favorable, changes in the lungs have resolved and thickened more frequently. In children with HIV infection, low adherence to HIV treatment in socially disadvantaged families requires long-term directly observed tuberculosis chemotherapy combined with antiretroviral therapy.Цель исследования: изучить сроки и эффективность лечения туберкулеза с установленной и предполагаемой множественной лекарственной устойчивостью (МЛУ) возбудителя у детей с разным ВИЧ-статусом.Материалы и методы. В исследование методом сплошной выборки включен 21 ребенок, больной туберкулезом с МЛУ (все из очагов МЛУ-туберкулеза) находившийся на стационарном лечении. У 3 детей имелось сочетание с ВИЧ-инфекцией.Результаты исследования. Длительность фазы интенсивной терапии у детей с ВИЧ-негативным статусом (19 детей) составила: 60 доз – 1 (5,3%) ребенок, 90 доз – 11 (57,9%) детей, 120 доз – 2 (10,5%) ребенка, 180 доз – 3 (15,8%) ребенка, 240 доз – 1 (4,3%) ребенок. Длительность фазы продолжения лечения: 120 доз у 1 (4,3%) ребенка, 150 доз у 1 (5,3%) ребенка, 180 доз у 12 (63,1%) детей, 270 доз у 1 (5,3%) ребенка, 320 доз у 3 (15,8%) детей.Длительность фазы интенсивной терапии у 3 детей при сочетании МЛУ-туберкулеза и ВИЧ-инфекции была 180 доз у 2 (66,6%) детей и 240 доз ‒ у 1 (33,4%) ребенка. Фаза продолжения составила 180 доз у 2 (66,6%) детей и 320 ‒ у 1 (33,4%) ребенка соответственно.Исходы основного курса химиотерапии в большинстве случаев хорошие – рассасывание воспалительных изменений, уплотнение очагов и фиброзирование легочной ткани.Заключение. У больных туберкулезом детей при отсутствии бактериовыделения лечение назначается по результатам тестов на лекарственную чувствительность у источника инфекции. Ограниченность выявленного туберкулезного процесса позволяет сокращать срок лечения детей и при МЛУ возбудителя. Исходы укороченных курсов лечения у детей с туберкулезом благоприятные, чаще рассасывание и уплотнение изменений в легких. У детей с ВИЧ-инфекцией низкая приверженность к лечению ВИЧ-инфекции в социально неблагополучных семьях требует длительно

Tuberculosis features in federal districts of the Russian Federation

Background. The retrospective assessment of key indicator levels and their trends at the start point of new strategy realization for tuberculosis control in Russia is an important predictor of the global program implementation to reduce the burden of this infection. Materials and methods. We analyzed incidence, prevalence and mortality among general and children population in Russian federal districts, in European and Asian regions, and in countries having a common border with Russia. Results. Presented material confirms the wide spread of tuberculosis in Russia, where the average annual incidence rate for 2005-2015 was 71.9 ± 2.5 0/0000, which attributes Russia to average-burden country. The most important characteristic of the studied period was a stable decreasing tendency of the key TB indicatorsformed by 2015. However, enormously uneven distribution of TB incidence, prevalence and mortality in some federal districts reveals different starting points of the regions. Relatively favorable territories include Central and Crimean Federal Districts, and the most unfavorable are Siberian and Far Eastern Federal Districts. The TB incidence significantly increases from West to East. Revealed unfavorable increasing tendency of children TB in combination with the trend described above indicates active transmission of TB infection in the Asian part of Russia. We also revealed the likelihood of mutual influence of migratory exchanges of Russian border regions and neighboring countries, which most strongly manifests on territories with low and medium TB incidence rates

Диагностика остеопенического синдрома. Остеопенический синдром у больных бронхиальной астмой

Osteopenic syndrome in chronic obstructive pulmonary diseases including bronchial asthma represents actual and insufficiently studied area of medical science in view of ambiguous data on influence of glucocorticosteroid therapy and inflammation as basic pathogenetic mechanisms of bronchial asthma on bone metabolism. This review covers issues of pathogenesis and diagnosis of secondary osteopenic syndrome in patients with bronchial asthma.Остеопенический синдром при хронических обструктивных заболеваниях легких, в том числе и при бронхиальной астме, представляет собой актуальную и малоизученную область медицинской науки ввиду неоднозначных данных о воздействии глюкокортикостероидной терапии и воспаления как основного патогенетического механизма бронхиальной астмы на костный метаболизм. В настоящем обзоре освещены вопросы патогенеза и диагностики вторичного остеопенического синдрома у больных бронхиальной астмой

SYMPTOMS OF TUBERCULOSIS IN HIV POSITIVE CHILDREN AND THE IMPACT OF PREVENTION ON THE DEVELOPMENT AND COURSE OF THE DISEASE

The objective of the study: to compare the clinical and X-ray signs of tuberculosis in HIV positive and HIV negative children, to identify factors that are more common in HIV infected children in the region with a high prevalence of both infections. Subjects and methods. 264 children with tuberculosis, and 41 children with HIV infection and tuberculosis undergoing inpatient treatment were enrolled in the study, which was the retrospective study of medical records. The patients underwent standard clinical and X-ray examinations, and microbiological tests. Results. Disseminated forms of tuberculosis (39.1%), tuberculous meningoencephalitis (4.9%) were more frequent in the HIV positive children, while in HIV negative children, it made 1.9 and 0.4% respectively. Among HIV positive children, 34% had several sites of tuberculosis, and 19.5% suffered from generalized forms. In HIV positive children, tuberculosis was more often detected in the infiltration phase, it was accompanied by severe intoxication symptoms, while when taking anti-tuberculosis therapy in combination with ART, they had more rapid positive changes