ДИНАМИКА ТУБЕРКУЛЕЗНОГО ПРОЦЕССА У ПАЦИЕНТОВ С РАЗЛИЧНЫМ ПСИХОЛОГИЧЕСКИМ СТАТУСОМ

The objective of the study: to investigate the changes in the course of tuberculosis in the patients with different psychological status.Subjects and methods. The changes in the course of tuberculosis were studied in 249 new pulmonary tuberculosis patients who had in-patient treatment in CTRI. The groups within the study were formed basing on the results of psychological status assessment: Group 1 included patients with favorable psychological status (171; 68.7% of patients) and Group 2 included patients with different psychological disorders (78; 31.3% of patients) (p < 0.001). Among patients from Group 2 women (66; 84.6%) significantly prevailed over men (12; 15.4%) (< 0.001).Results. It has been found out that groups with different psychological status did not confidently differ in their clinical and X-ray signs before the treatment start. Whereby, in patients from Group 2 versus patients from Group 1, the abnormalities in the results of laboratory tests were registered confidently more often (87.2 versus 75.4% cases) (p < 0.05), as well as multiple drug resistance (58 versus 41.4% of cases) (p < 0.05). The frequency of adverse events caused by anti-tuberculosis drugs was higher in Group 2 versus Group 1 (25; 32.1% and 28; 16.4% of cases) (p < 0.05). After management of adverse events, the number of patients with poor tolerance was still confidently higher in Group 2 (14; 17.9% of cases), compared to Group 1 (11; 6.4%) (p < 0.05). It was found out that the efficiency of in-patient treatment did not confidently differ in the patients with different psychological status.Цель исследования: изучение динамики туберкулезного процесса у пациентов с различным психологическим статусом.Материалы и методы. Изучена динамика туберкулезного процесса у 249 впервые выявленных пациентов, находившихся на стационарном лечении в ФГБНУ «ЦНИИТ». Группы исследования сформированы по результатам диагностики психологического статуса: 1-я группа с благоприятным психологическим статусом (171; 68,7% пациентов) и 2-я группа с различными нарушениями психологического статуса (78; 31,3% пациентов) (p < 0,001). Среди пациентов 2-й группы доля женщин (66; 84,6%) значительно преобладала по сравнению с мужчинами (12; 15,4%) (p < 0,001).Результаты. Установлено, что группы с различным психологическим статусом до начала терапии достоверно не различались по клинико-рентгенологическим проявлениям заболевания. При этом у пациентов 2-й группы по сравнению с пациентами 1-й группы достоверно чаще регистрировались отклонения лабораторных показателей от нормы (87,2 и 75,4% случаев) (p < 0,05), а также выявлялась множественная лекарственная устойчивость МБТ (58 и 41,4% случаев) (p < 0,05). Частота выявления нежелательных реакций на прием противотуберкулезных препаратов оказалась более высокой во 2-й группе по сравнению с 1-й группой (25; 32,1% и 28; 16,4% случаев) (p < 0,05). После терапевтической коррекции нежелательных реакций доля пациентов с неудовлетворительной переносимостью оставалась во 2-й группе достоверно более высокой (14; 17,9% случаев), чем в 1-й группе (11; 6,4%) (p < 0,05). Установлено, что результативность стационарного лечения достоверно не различалась среди пациентов с различным психологическим статусом

CHANGES IN THE COURSE OF TUBERCULOSIS IN THE PATIENTS WITH DIFFERENT PSYCHOLOGICAL STATUS

The objective of the study: to investigate the changes in the course of tuberculosis in the patients with different psychological status.Subjects and methods. The changes in the course of tuberculosis were studied in 249 new pulmonary tuberculosis patients who had in-patient treatment in CTRI. The groups within the study were formed basing on the results of psychological status assessment: Group 1 included patients with favorable psychological status (171; 68.7% of patients) and Group 2 included patients with different psychological disorders (78; 31.3% of patients) (p < 0.001). Among patients from Group 2 women (66; 84.6%) significantly prevailed over men (12; 15.4%) (< 0.001).Results. It has been found out that groups with different psychological status did not confidently differ in their clinical and X-ray signs before the treatment start. Whereby, in patients from Group 2 versus patients from Group 1, the abnormalities in the results of laboratory tests were registered confidently more often (87.2 versus 75.4% cases) (p < 0.05), as well as multiple drug resistance (58 versus 41.4% of cases) (p < 0.05). The frequency of adverse events caused by anti-tuberculosis drugs was higher in Group 2 versus Group 1 (25; 32.1% and 28; 16.4% of cases) (p < 0.05). After management of adverse events, the number of patients with poor tolerance was still confidently higher in Group 2 (14; 17.9% of cases), compared to Group 1 (11; 6.4%) (p < 0.05). It was found out that the efficiency of in-patient treatment did not confidently differ in the patients with different psychological status

A CLINICAL CASE OF DISSEMINATED PULMONARY LESIONS WITH A CONCURRENT CONDITION

The article presents a clinical case of a complex differential diagnostics of disseminated pulmonary lesions with a concurrent condition

Bedaquiline–Pretomanid–Linezolid Regimens for Drug-Resistant Tuberculosis

BACKGROUND: The bedaquiline-pretomanid-linezolid regimen has been reported to have 90% efficacy against highly drug-resistant tuberculosis, but the incidence of adverse events with 1200 mg of linezolid daily has been high. The appropriate dose of linezolid and duration of treatment with this agent to minimize toxic effects while maintaining efficacy against highly drug-resistant tuberculosis are unclear. METHODS: We enrolled participants with extensively drug-resistant (XDR) tuberculosis (i.e., resistant to rifampin, a fluoroquinolone, and an aminoglycoside), pre-XDR tuberculosis (i.e., resistant to rifampin and to either a fluoroquinolone or an aminoglycoside), or rifampin-resistant tuberculosis that was not responsive to treatment or for which a second-line regimen had been discontinued because of side effects. We randomly assigned the participants to receive bedaquiline for 26 weeks (200 mg daily for 8 weeks, then 100 mg daily for 18 weeks), pretomanid (200 mg daily for 26 weeks), and daily linezolid at a dose of 1200 mg for 26 weeks or 9 weeks or 600 mg for 26 weeks or 9 weeks. The primary end point in the modified intention-to-treat population was the incidence of an unfavorable outcome, defined as treatment failure or disease relapse (clinical or bacteriologic) at 26 weeks after completion of treatment. Safety was also evaluated. RESULTS: A total of 181 participants were enrolled, 88% of whom had XDR or pre-XDR tuberculosis. Among participants who received bedaquiline-pretomanid-linezolid with linezolid at a dose of 1200 mg for 26 weeks or 9 weeks or 600 mg for 26 weeks or 9 weeks, 93%, 89%, 91%, and 84%, respectively, had a favorable outcome; peripheral neuropathy occurred in 38%, 24%, 24%, and 13%, respectively; myelosuppression occurred in 22%, 15%, 2%, and 7%, respectively; and the linezolid dose was modified (i.e., interrupted, reduced, or discontinued) in 51%, 30%, 13%, and 13%, respectively. Optic neuropathy developed in 4 participants (9%) who had received linezolid at a dose of 1200 mg for 26 weeks; all the cases resolved. Six of the seven unfavorable microbiologic outcomes through 78 weeks of follow-up occurred in participants assigned to the 9-week linezolid groups. CONCLUSIONS: A total of 84 to 93% of the participants across all four bedaquiline-pretomanid-linezolid treatment groups had a favorable outcome. The overall risk-benefit ratio favored the group that received the three-drug regimen with linezolid at a dose of 600 mg for 26 weeks, with a lower incidence of adverse events reported and fewer linezolid dose modifications. (Funded by the TB Alliance and others; ZeNix ClinicalTrials.gov number, NCT03086486.)