Analysis of risk factors for default and failure treatment among patients with pulmonary tuberculosis under DOTS strategy

Department of Pneumophtysiology, Chiril Draganiuc Institute of Phtysiopneumology, Nicolae Testemitanu State University of Medicine and Pharmacy Chisinau, the Republic of MoldovaBackground: The biggest incidence of tuberculosis (114.3/100.000) in the Republic of Moldova correlates with the lowest success treatment rate (52.3%), the biggest default rate (10.9%) and failure rate (3.5%) in new pulmonary TB cases among European region countries. Material and methods: We studied social, economical, epidemiological risk factors and case-management features of a total amount of 457 pulmonary tuberculosis cases, distribuited in 1-st study group, consisting of 201 cases who failed the anti-tuberculosis treatment, 2-nd study group, consisting of 142 cases, who defaulted the treatment, and a control group of 105 successfully treated patients under Directly Observed Treatment Short Course Chemotherapy. Statistic evaluation was performed using T Student criteria and Odds Ratio, calculated through the two by two table. Results: According to the predictible value, high risc factors for failure were: chronic alcohol consumption, detention releasing and for default were: male sex, economic disadvantage, single civil state, chronic alcohol consumption, detention releasing. Conclusions: Default and failure antituberculosis treatment refers to the patients belonging to economicaly and social disadvantaged groups, with harmful habits (alcoholosm, drug injection using, active smoking), low living conditions, belonging high risk epidemiological groups. Migrations, homelessness and detention releasing imperil the continuing of antituberculosis treatment, predisposisng to failure and default of the antituberculosis treatment. Social, educational support and withdrawl techniques for harmful habits must be implemented to high risk groups to minimise the risk of non-adherence to the disease

The frequency and efficacy of treatment to rezistence tuberculosis at antituberculosis drugs in Chishinau in 2006-2007 years

Catedra Pneumoftiziologie USMF „N. Testemiţanu”, R. Moldova IMSP Spitalul clinic municipal de ftiziopulmonologie, ChişinăuThe resistance of the first line of the antituberculosis drugs, has been analyzed to 109 pacients in 2006 year and 108 (in 2007) in Chishinau. The monoresistence decreased from 43,1% till 15,7% and increase the MDR from 38,5% till 64,8%, the polyresistence rest at the same level (18.3%, 19.4%). Conversion of sputum in the new cases of tuberculosis in the abandon treatment DOTS+ was 87,5%. A fost analizată rezistenţa la preparatele antituberculoase de linia I-a la 109 bolnavi (a. 2006) şi 108 bolnavi (a. 2007) în mun. Chişinău. Se atestă o scădere a monorezistenţei de la 43,1 la 15,7%, o creştere a multirezistenţei (MDR) de la 38,5 la 64,8%, polirezistenţa rămănând la acelaşi nivel (18,3 şi 19,4%). Abacilarea în cazurile noi de tuberculoză în tratamentul standardizat DOTS+ a fost de 87,5%

The efficacy of treatment DOTS pulmonary tuberculosis in district Chishinau

Catedra Pneumoftiziologie USMF “N. Testemiţanu, R. Moldova IMSP Spitalul clinic municipal de ftiziopneumologie, ChişinăuThe efficiency of the treatment has been studied in 547 patients with pulmonary tuberculosis in district Chisinau: 293 (53.6%) with bacilary emission and 254 (46.6%) nonemissed. The success of the treatment (recovered + finished treatment has been obtained in 66.0% cases. The therapeutical failure has been established in 4.8% cases, in 10.8% the treatment has been abandoned and in 8.2% cases died, 7.5% continue the treatment and 2.7% patients hav been transferred in other localites. A fost studiată eficacitatea tratamentului a 547 bolnavi de tuberculoză pulmonară din mun. Chişinău: 293 (53,6%) – bacilari şi 254 (46,4%) – nonbacilari. Succesul tratamentului (vindecat + tratament încheiat) a fost obţinut în 66,0% de cazuri. Eşecul terapeutic sa constatat în 4,8% cazuri, au abandonat tratamentul 10,8% de bolnavi şi au decedat 8,2%, prelungesc tratamentul 7,5% şi s-au transferat în alte localităţi 2,7% de pacienţ

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

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