Факторы, влияющие на эффективность лечения больных туберкулезом с множественной и широкой лекарственной устойчивостью

The objective: to determine factors influencing treatment efficacy in patients with multiple (MDR) and extensive (XDR) drug resistant tuberculosis. Subjects and methods. The medical files of 107 tuberculosis patients (men – 75, women – 32) were analyzed, 17 of them were HIV positive. Those 107 patients were registered for treatment as per chemotherapy (CT) regimens IV-V in 2017 in Kaluga Region. 99 (92.5%) patients suffered from tuberculosis with lung tissue destruction. 60.7% (65 patients) had MDR, while 20.8% (22 patients) had XDR. Only 58.2% of patients had MDR TB confirmed by polymerase chain reaction before treatment start.Results. In 24 months, the effective course of treatment was registered in 64/107 (59.8%). The highest level of effective treatment was expectedly registered among new cases – 21/30 (70%); and the lowest level was among patients starting chemotherapy again after treatment interruption – 4/10 (40%), p > 0.05. Among 64 patients with effective treatment course, 25 (39.1%) had surgery and 39 (60.9%) had chemotherapy only. Surgical activity among the cohort of 2017 made 26/107 (24.3%). The effective treatment outcome was achieved in 8 (47%) out of 17 patients with TB/HIV co-infection, and among HIV negative patients it was reached in 56/90 (62.2%), p > 0,05.Цель: определить факторы, влияющие на эффективность лечения больных туберкулезом с множественной (МЛУ) и широкой лекарственной устойчивостью (ШЛУ) возбудителя. Материалы и методы. Проанализирована медицинская документация 107 больных туберкулезом (мужчин ‒ 75, женщин – 32), 17 из них с ВИЧ-инфекцией, зарегистрированных на лечение по IV-V режимам химиотерапии (ХТ) в 2017 г. в Калужской области. Туберкулез с деструкцией легочной ткани был у 99 (92,5%) больных. У 60,7% (65 пациентов) была МЛУ микобактерий туберкулеза (МБТ), у 20,8% (22 пациента) ‒ ШЛУ МБТ. Только 58,2% пациентов имели подтверждение МЛУ МБТ с помощью полимеразной цепной реакции перед началом данного курса лечения. Результаты. Через 24 мес. эффективно завершили курс ХТ 64/107 (59,8%) пациента. Самая высокая ‒ 21/30 (70%) ‒ частота ожидаемо зарегистрирована среди впервые выявленных больных, самая низкая ‒ 4/10 (40%) – среди больных, зарегистрированных на повторный курс ХТ после прерывания лечения, p > 0,05. Среди 64 пациентов, завершивших эффективно курс лечения, у 25 (39,1%) была сделана операция, а у 39 (60,9%) применялась только ХТ. Хирургическая активность среди когорты 2017 г. составила 26/107 (24,3%). Эффективный исход лечения среди 17 больных с ТБ + ВИЧ-и был у 8 (47%), среди ВИЧ-негативных пациентов с ТБ ‒ у 56/90 (62,2%), p > 0,05

Factors influencing treatment efficacy in patients with multiple and extensive drug resistant tuberculosis

The objective: to determine factors influencing treatment efficacy in patients with multiple (MDR) and extensive (XDR) drug resistant tuberculosis. Subjects and methods. The medical files of 107 tuberculosis patients (men – 75, women – 32) were analyzed, 17 of them were HIV positive. Those 107 patients were registered for treatment as per chemotherapy (CT) regimens IV-V in 2017 in Kaluga Region. 99 (92.5%) patients suffered from tuberculosis with lung tissue destruction. 60.7% (65 patients) had MDR, while 20.8% (22 patients) had XDR. Only 58.2% of patients had MDR TB confirmed by polymerase chain reaction before treatment start.Results. In 24 months, the effective course of treatment was registered in 64/107 (59.8%). The highest level of effective treatment was expectedly registered among new cases – 21/30 (70%); and the lowest level was among patients starting chemotherapy again after treatment interruption – 4/10 (40%), p > 0.05. Among 64 patients with effective treatment course, 25 (39.1%) had surgery and 39 (60.9%) had chemotherapy only. Surgical activity among the cohort of 2017 made 26/107 (24.3%). The effective treatment outcome was achieved in 8 (47%) out of 17 patients with TB/HIV co-infection, and among HIV negative patients it was reached in 56/90 (62.2%), p > 0,05

Impact of labor migration on tuberculosis situation in the Kaluga Region

The objective of the study: to investigate the impact of migration on tuberculosis situation in the Kaluga Region.Subjects and methods. The article analyzes the general population of migrants examined for tuberculosis in 2009-2017 in the Kaluga Region, as well as the total number of migrants in whom tuberculosis was detected.Results. Data on examination of migrants for tuberculosis in the Kaluga Region were analyzed. It was found out that the impact provided by foreign citizens ill with tuberculosis on the local tuberculosis situation was growing. Ethnicity, gender and age structure of migrants ill with tuberculosis were studied as well as a specific clinical course of tuberculosis in foreign citizens