Актуальные вопросы клиники и диагностики туберкулеза кожи

The article presents data from 48 publications about clinical signs and diagnostics of cutaneous tuberculosis.Приведены сведения из 48 источников литературы по клиническим проявлениям и диагностике туберкулеза кож

Нетуберкулезные микобактерии во фтизиопульмонологической практике в Республике Узбекистан

The objective of the study: monitoring the spectrum of non-tuberculous mycobacteria isolated from patients who referred for medical care to the Republican Specialized Scientific and Practical Medical Center of Phthisiology and Pulmonology.Subjects and methods. The diagnostic procedure of ATS/IDSA was used to define if the patient suffers from mycobacteriosis. The following specimens were collected to isolate non-tuberculosis mycobacteria: sputum, bronchoalveolar lavage fluid, feces, pleural fluid, surgical and biopsy specimens, and urine. The following tests were performed: Ziehl-Nielsen microscopy, microscopy stained by auramine-O, cultures by Middlebrook 7H9 in BACTEC™ MGIT™ 960 System, Becton Dickinson, USA. Non-tuberculosis mycobateria were differentiated from mycobacterium tuberculosis complex using the sdmpt64 chromatographic test (SD Bioline TBAg MPT64 test, Korea). The non-tuberculosis species were defined by the hybridization technology of DNA* strips GenoType Mycobacterium AS/CM, version 1.0.Results. Of 14,544 patients with suspected respiratory tuberculosis, non-tuberculous mycobacteria were detected in 38 (0.26%) of them, 17 (44.7%) patients had Mycobacterium avium complex, in them there were 26 men (68.4%) and 12 (31.6%) women. Non-tuberculosis mycobacteria were isolated mainly from sputum – in 27 (71.2%) patients and urine – in 6 (15.7%) patients. In 26 (68.4%) patients, mycobacteriosis was caused by slow-growing non-tuberculosis mycobacteria, of which Mycobacterium avium complex prevailed – in 17 people as well as Mgordonae – in 8 patients. Rapidly growing non-tuberculosis mycobacteria were identified in 12 (31.6%) patients, they included M. fortuitum (5 cases) and M. chelonae (4) prevailed.Цель исследования: мониторинг спектра нетуберкулезных микобактерий (НТМБ), выделенных от пациентов, обратившихся за медицинской помощью в Республиканский специализированный научно-практический медицинский центр фтизиатрии и пульмонологии (РСНПМЦ ФиП).Материалы и методы. Критерием наличия у пациента микобактериоза служил диагностический алгоритм ATS/IDSA. Биологическим материалом, использованным для выделения НТМБ были мокрота, бронхоальвеолярная лаважная жидкость, кал, плевральная жидкость, операционный материал, биоптаты, моча. Микроскопическое исследование проводилось по методу Циля – Нильсена или с окраской аурамином-О, культивирование – в жидкой питательной среде Миддлбрук 7H9 в BACTEC™ MGIT™ 960 System, Becton Dickinson, USA. Дифференциацию НТМБ от микобактерий туберкулезного комплекса проводили при помощи хроматографического теста sdmpt64 (SD Bioline TBAg MPT64 test, Korea). Видовую принадлежность НТМБ определяли технологией гибридизации ДНК*стрипов GenoType Mycobacterium AS/CM версия 1.0.Результаты. Из 14 544 пациентов с подозрением на туберкулез органов дыхания НТМБ выявлены у 38 (0,26%), при этом Mycobacterium avium complex – у 17 (44,7%), среди которых было мужчин было 26 (68,4%), женщин – 12 (31,6%). НТМБ выделены преимущественно из мокроты – у 27 (71,2%) больных и мочи – у 6 (15,7%). У 26 (68,4%) пациентов микобактериоз был вызван медленнорастущими НТМБ, из них преобладали Mycobacterium avium сomplex – у 17 человек и Mgordonae – у 8. Быстрорастущие НТМБ выделены у 12 (31,6%) пациентов, среди них преобладали M. fortuitum (5 случаев) и M. chelonae (4)

Impact of pyrazinamide resistance on multidrug-resistant tuberculosis in Karakalpakstan, Uzbekistan.

SETTING: The World Health Organization (WHO) recommends the inclusion of pyrazinamide (PZA) in treatment regimens for multidrug-resistant tuberculosis (MDR-TB) unless resistance has been confirmed. OBJECTIVE: To investigate the association between PZA susceptibility and MDR-TB treatment outcome among patients treated with a PZA-containing regimen and whether the duration of the intensive phase of the PZA-containing regimen affected treatment outcome. DESIGN: We conducted a retrospective cohort study including all eligible MDR-TB patients starting treatment in 2003-2013 in the TB programme in Karakalpakstan, Uzbekistan. PZA drug susceptibility testing (DST) using liquid culture was performed, and outcomes were classified according to the WHO 2013 definitions. RESULTS: Of 2446 MDR-TB patients included, 832 (34.0%) had an available baseline PZA DST result, 612 (73.6%) of whom were PZA-resistant. We found no association between treatment success and PZA susceptibility (adjusted odds ratio [aOR] 0.86, 95%CI 0.51-1.44, P = 0.6) in patients treated with PZA. Furthermore, among patients with no baseline PZA DST result, no evidence was seen of an association between treatment success and PZA treatment duration (aOR 0.86, 95%CI 0.49-1.51, P = 0.6). CONCLUSION: Treatment of MDR-TB with a standard PZA regimen does not appear to improve treatment outcomes, regardless of PZA susceptibility or duration of treatment

Treatment and outcomes in children with multidrug-resistant tuberculosis: a systematic review and individual patient data meta-analysis.

CAPRISA, 2018.Abstract available in pdf

The topical issues of symptoms and diagnosis of cutaneous tuberculosis

The article presents data from 48 publications about clinical signs and diagnostics of cutaneous tuberculosis

Outcomes with a shorter multidrug-resistant tuberculosis regimen from Karakalpakstan, Uzbekistan

Background: In 2016, World Health Organization guidelines conditionally recommended standardised shorter 9-12-month regimens for multidrug-resistant (MDR) tuberculosis (TB) treatment. We conducted a prospective study of a shorter standardised MDR-TB regimen in Karakalpakstan, Uzbekistan. Methods: Consecutive adults and children with confirmed rifampicin-resistant pulmonary TB were enrolled between September 1, 2013 and March 31, 2015; exclusions included prior treatment with second-line anti-TB drugs, and documented resistance to ofloxacin or to two second-line injectable agents. The primary outcome was recurrence-free cure at 1 year following treatment completion. Results: Of 146 enrolled patients, 128 were included: 67 female (52.3%), median age 30.1 (interquartile range 23.8-44.4) years. At the end of treatment, 71.9% (92 out of 128) of patients achieved treatment success, with 68% (87 out of 128) achieving recurrence-free cure at 1 year following completion. Unsuccessful outcomes during treatment included 22 (17.2%) treatment failures with fluoroquinolone-resistance amplification in 8 patients (8 out of 22, 36.4%); 12 (9.4%) lost to follow-up; and 2 (1.5%) deaths. Recurrence occurred in one patient. Fourteen patients (10.9%) experienced serious adverse events. Baseline resistance to both pyrazinamide and ethambutol (adjusted OR 6.13, 95% CI 2.01; 18.63) and adherence <95% (adjusted OR 5.33, 95% CI 1.73; 16.36) were associated with unsuccessful outcome in multivariable logistic regression. Conclusions: Overall success with a standardised shorter MDR-TB regimen was moderate with considerable treatment failure and amplification of fluoroquinolone resistance. When introducing standardised shorter regimens, baseline drug susceptibility testing and minimising missed doses are critical. High rates globally of pyrazinamide, ethambutol and ethionamide resistance raise questions of continued inclusion of these drugs in shorter regimens in the absence of drug susceptibility testing-confirmed susceptibility

Modelling the Effect of Short-Course Multidrug-Resistant Tuberculosis Treatment in Karakalpakstan, Uzbekistan

Multidrug-resistant tuberculosis (MDR-TB) is a major threat to global TB control. MDR-TB treatment regimens typically have a high pill burden, last 20 months or more and often lead to unsatisfactory outcomes. A 9-11 month regimen with seven antibiotics has shown high success rates among selected MDR-TB patients in different settings and is conditionally recommended by the World Health Organization