7 research outputs found
The spectrum of primary drug resistance of Mycobacterium tuberculosis in patients with tuberculosis in relation to human immunodeficiency virus status
Aim. To estimate the detection rate and spectrum of primary drug resistance of Mycobacterium tuberculosis (MBT) in patients with tuberculosis (TB) in relation to their human immunodeficiency virus (HIV) status in a region with high HIV infection rates (the Perm Territory) and to compare of drug-resistant MBT (DR-MBT) in patients with HIV/TB co-infection, by using phenotypic and molecular genetic testing (MGT) methods. Subjects and methods. The results of sputum bacteriological examination were analyzed in 178 HIV-infected patients and 354 non-HIV-infected individuals with a TB diagnosis made in the period July 1, 2014 to August 1, 2015. The diagnostic algorithm for all patients involved a duplicate sputum test for MBT by two techniques: fluorescence microscopy (FM) and inoculation into the Levenstein-Jensen dense culture medium. In patients with HIV/TB, the bacteriological examination was complemented with two more methods: detection of MBT DNA by a real-time polymerase chain reaction assay using the AmpliTube-RV system (Synthol, Russia); and inoculation into the Middlebrook liquid nutrient medium, by applying the automated BACTEC MGIT 960 system. Results. In patients with HIV/TB, the sensitivity of FM proved to be lower than in those with TB (24.2 and 32.8%, respectively; p0.05). The primary drug resistance of MBT in patients with HIV-TB was higher than that in HIV-negative individuals (60.2 and 41.6%, respectively; p<0.05). The phenotypic method (inoculation into the Levenstein-Jensen culture medium) and MGT revealed their agreement for the resistance of MBT to rifampicin (the most clinically significant drug in the choice of treatment policy) in 88.5% of the patients with HIV/TB. Conclusion. In patients with HIV/TB, the sensitivity of FM for detecting acid-resistant mycobacteria was lower than in those with TB and that of inoculations into the dense medium was comparable regardless of HIV status
ΠΡΡΠ²Π»Π΅Π½ΠΈΠ΅ ΠΌΠΈΠΊΠΎΠ±Π°ΠΊΡΠ΅ΡΠΈΠΉ ΡΡΠ±Π΅ΡΠΊΡΠ»Π΅Π·Π° Π² ΠΌΠΎΠΊΡΠΎΡΠ΅ Ρ Π±ΠΎΠ»ΡΠ½ΡΡ ΠΠΠ§-ΠΈΠ½ΡΠ΅ΠΊΡΠΈΠ΅ΠΉ ΠΏΡΠΈ ΠΈΡΠΏΠΎΠ»ΡΠ·ΠΎΠ²Π°Π½ΠΈΠΈ ΡΠΎΠ²ΡΠ΅ΠΌΠ΅Π½Π½ΠΎΠ³ΠΎ Π°Π»Π³ΠΎΡΠΈΡΠΌΠ° ΡΡΠΈΠΎΠ»ΠΎΠ³ΠΈΡΠ΅ΡΠΊΠΎΠΉ Π΄ΠΈΠ°Π³Π½ΠΎΡΡΠΈΠΊΠΈ Π·Π°Π±ΠΎΠ»Π΅Π²Π°Π½ΠΈΡ
The objective. To establish the informativity of using phenotypic and molecular genetic methods of detection of mycobacterium tuberculosis (ΠΠΠ’) from sputum to diagnose tuberculosis in patients with HIV infection. Patients and methods. 360 HIV-infected individuals with suspected tuberculosis were examined. A diagnostic algorithm included two tests of sputum for AFB/ ΠΠΠ’ by fluorescence microscopy, detection of ΠΠΠ’ DNA in real-time PCR and inoculation of liquid and solid media. Results. Tuberculosis was diagnosed in 49.4% of the examined patients. The greatest sensitivity and accuracy of ΠΠΠ’ detection was demonstrated by molecular genetic methods (71.3% and 0.85, respectively), which even exceeded tire results of culture diagnosis (sensitivity - 58.4 and 60.7%, accuracy - 0.79 and 0.81 for inoculation of liquid and dense media, respectively). An extremely low sensitivity was demonstrated by fluorescence microscopy (24.2%). No relation between the frequency of ΠΠΠ’ detection and the number of CD4+-lymphocytes was found in any method but for fluorescence microscopy showed a tendency of a better effectiveness in patients with profound immunodeficiency (in CD4 less than 100 cell/pl). Repeat analysis of inoculation of liquid media and detection of ΠΠΠ’ DNA (MGM) enhanced the diagnostic value of each method by 8.6 and 7.1%, respectively. In 73.5% of patients, tuberculosis was diagnosed within 2-3 days from the moment of turning for medical help. Conclusion. In general, an examination algorithm for detection of ΠΠΠ’ demonstrated its sensitivity in patients with co-infection (HIV/Π’Π) in 87.1%. If molecular genetic methods can be used for rapid detection of a causative agent fluorescence microscopy looses its relevance for diagnosing tuberculosis.Π¦Π΅Π»Ρ. Π£ΡΡΠ°Π½ΠΎΠ²ΠΈΡΡ ΠΈΠ½ΡΠΎΡΠΌΠ°ΡΠΈΠ²Π½ΠΎΡΡΡ ΠΈΡΠΏΠΎΠ»ΡΠ·ΠΎΠ²Π°Π½ΠΈΡ ΡΠ΅Π½ΠΎΡΠΈΠΏΠΈΡΠ΅ΡΠΊΠΈΡ
ΠΈ ΠΌΠΎΠ»Π΅ΠΊΡΠ»ΡΡΠ½ΠΎ-Π³Π΅Π½Π΅ΡΠΈΡΠ΅ΡΠΊΠΈΡ
ΠΌΠ΅ΡΠΎΠ΄ΠΎΠ² Π΄Π΅ΡΠ΅ΠΊΡΠΈΠΈ ΠΌΠΈΠΊΠΎΠ±Π°ΠΊΡΠ΅ΡΠΈΠΈ ΡΡΠ±Π΅ΡΠΊΡΠ»Π΅Π·ΠΈΡ (ΠΠΠ’) ΠΈΠ· ΠΌΠΎΠΊΡΠΎΡΡ Π΄Π»Ρ Π΄ΠΈΠ°Π³Π½ΠΎΡΡΠΈΠΊΠΈ ΡΡΠ±Π΅ΡΠΊΡΠ»Π΅Π·Π° Ρ Π±ΠΎΠ»ΡΠ½ΡΡ
ΠΠΠ§-ΠΈΠ½ΡΠ΅ΠΊΡΠΈΠ΅ΠΉ. ΠΠ°ΡΠΈΠ΅Π½ΡΡ ΠΈ ΠΌΠ΅ΡΠΎΠ΄Ρ. ΠΠ±ΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΠ΅ Π²ΡΠΏΠΎΠ»Π½Π΅Π½ΠΎ 360 ΠΠΠ§-ΠΈΠ½ΡΠΈΡΠΈΡΠΎΠ²Π°Π½Π½ΡΠΌ Ρ ΠΏΠΎΠ΄ΠΎΠ·ΡΠ΅Π½ΠΈΠ΅ΠΌ Π½Π° ΡΡΠ±Π΅ΡΠΊΡΠ»Π΅Π·. ΠΠΈΠ°Π³Π½ΠΎΡΡΠΈΡΠ΅ΡΠΊΠΈΠΉ Π°Π»Π³ΠΎΡΠΈΡΠΌ Π²ΠΊΠ»ΡΡΠ°Π» Π΄Π²ΡΠΊΡΠ°ΡΠ½ΠΎΠ΅ ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΠ΅ ΠΌΠΎΠΊΡΠΎΡΡ Π½Π° ΠΠ£Π/ΠΠΠ’ Π»ΡΠΌΠΈΠ½Π΅ΡΡΠ΅Π½ΡΠ½ΠΎΠΉ ΠΌΠΈΠΊΡΠΎΡΠΊΠΎΠΏΠΈΠ΅ΠΉ, Π²ΡΡΠ²Π»Π΅Π½ΠΈΠ΅ΠΌ ΠΠΠ ΠΠΠ’ Ρ ΠΏΠΎΠΌΠΎΡΡΡ ΠΏΠΎΠ»ΠΈΠΌΠ΅ΡΠ°Π·Π½ΠΎΠΉ ΡΠ΅ΠΏΠ½ΠΎΠΉ ΡΠ΅Π°ΠΊΡΠΈΠΈ ΡΠ΅Π°Π»ΡΠ½ΠΎΠ³ΠΎ Π²ΡΠ΅ΠΌΠ΅Π½ΠΈ ΠΈ ΠΏΠΎΡΠ΅Π²ΠΎΠΌ Π½Π° ΠΆΠΈΠ΄ΠΊΠΈΠ΅ ΠΈ ΠΏΠ»ΠΎΡΠ½ΡΠ΅ ΠΏΠΈΡΠ°ΡΠ΅Π»ΡΠ½ΡΠ΅ ΡΡΠ΅Π΄Ρ. Π Π΅Π·ΡΠ»ΡΡΠ°ΡΡ. Π’ΡΠ±Π΅ΡΠΊΡΠ»Π΅Π· ΡΡΡΠ°Π½ΠΎΠ²Π»Π΅Π½ 49,4% ΠΏΠ°ΡΠΈΠ΅Π½ΡΠ°ΠΌ ΠΎΡ ΡΠΈΡΠ»Π° ΠΎΠ±ΡΠ»Π΅Π΄ΠΎΠ²Π°Π½Π½ΡΡ
. ΠΠ°ΠΈΠ±ΠΎΠ»ΡΡΡΡ ΡΡΠ²ΡΡΠ²ΠΈΡΠ΅Π»ΡΠ½ΠΎΡΡΡ ΠΈ ΡΠΎΡΠ½ΠΎΡΡΡ Π² Π²ΡΡΠ²Π»Π΅Π½ΠΈΠΈ ΠΠΠ’ ΠΏΠΎΠΊΠ°Π·Π°Π»ΠΈ ΠΌΠΎΠ»Π΅ΠΊΡΠ»ΡΡΠ½ΠΎ-Π³Π΅Π½Π΅ΡΠΈΡΠ΅ΡΠΊΠΈΠ΅ ΠΌΠ΅ΡΠΎΠ΄Ρ (71,3% ΠΈ 0,85 ΡΠΎΠΎΡΠ²Π΅ΡΡΡΠ²Π΅Π½Π½ΠΎ), ΠΊΠΎΡΠΎΡΡΠ΅ Π΄Π°ΠΆΠ΅ ΠΏΡΠ΅Π²ΡΡΠΈΠ»ΠΈ ΡΠ΅Π·ΡΠ»ΡΡΠ°ΡΡ ΠΊΡΠ»ΡΡΡΡΠ°Π»ΡΠ½ΠΎΠΉ Π΄ΠΈΠ°Π³Π½ΠΎΡΡΠΈΠΊΠΈ (ΡΡΠ²ΡΡΠ²ΠΈΡΠ΅Π»ΡΠ½ΠΎΡΡΡ - 58,4 ΠΈ 60,7%, ΡΠΎΡΠ½ΠΎΡΡΡ - 0,79 ΠΈ 0,81 Π΄Π»Ρ ΠΏΠΎΡΠ΅Π²Π° Π½Π° ΠΆΠΈΠ΄ΠΊΠΈΠ΅ ΠΈ ΠΏΠ»ΠΎΡΠ½ΡΠ΅ ΡΡΠ΅Π΄Ρ ΡΠΎΠΎΡΠ²Π΅ΡΡΡΠ²Π΅Π½Π½ΠΎ). ΠΡΠ°ΠΉΠ½Π΅ Π½ΠΈΠ·ΠΊΡΡ ΡΡΠ²ΡΡΠ²ΠΈΡΠ΅Π»ΡΠ½ΠΎΡΡΡ ΠΏΠΎΠΊΠ°Π·Π°Π»Π° Π»ΡΠΌΠΈΠ½Π΅ΡΡΠ΅Π½ΡΠ½Π°Ρ ΠΌΠΈΠΊΡΠΎΡΠΊΠΎΠΏΠΈΡ (24,2%). ΠΠ΅ ΠΎΡΠΌΠ΅ΡΠ΅Π½ΠΎ ΡΠ²ΡΠ·ΠΈ ΠΌΠ΅ΠΆΠ΄Ρ ΡΠ°ΡΡΠΎΡΠΎΠΉ Π²ΡΡΠ²Π»Π΅Π½ΠΈΡ ΠΠΠ’ ΠΈ ΠΊΠΎΠ»ΠΈΡΠ΅ΡΡΠ²ΠΎΠΌ Π‘Π4+-Π»ΠΈΠΌΡΠΎΡΠΈΡΠΎΠ² Π½ΠΈ ΠΏΠΎ ΠΎΠ΄Π½ΠΎΠΌΡ ΠΈΠ· ΠΌΠ΅ΡΠΎΠ΄ΠΎΠ², ΠΎΠ΄Π½Π°ΠΊΠΎ Π΄Π»Ρ Π»ΡΠΌΠΈΠ½Π΅ΡΡΠ΅Π½ΡΠ½ΠΎΠΉ ΠΌΠΈΠΊΡΠΎΡΠΊΠΎΠΏΠΈΠΈ ΠΎΡΠΌΠ΅ΡΠ΅Π½Π° ΡΠ΅Π½Π΄Π΅Π½ΡΠΈΡ Π»ΡΡΡΠ΅ΠΉ ΡΠ΅Π·ΡΠ»ΡΡΠ°ΡΠΈΠ²Π½ΠΎΡΡΠΈ Ρ Π±ΠΎΠ»ΡΠ½ΡΡ
Ρ Π³Π»ΡΠ±ΠΎΠΊΠΈΠΌ ΠΈΠΌΠΌΡΠ½ΠΎΠ΄Π΅ΡΠΈΡΠΈΡΠΎΠΌ (ΠΏΡΠΈ CD4 ΠΌΠ΅Π½Π΅Π΅ 100 ΠΊΠ»Π΅ΡΠΎΠΊ/ΠΌΠΊΠ»). ΠΠΎΠ²ΡΠΎΡΠ½ΡΠΉ Π°Π½Π°Π»ΠΈΠ· ΠΏΠΎΡΠ΅Π²Π° Π½Π° ΠΆΠΈΠ΄ΠΊΠΈΠ΅ ΡΡΠ΅Π΄Ρ ΠΈ Π²ΡΡΠ²Π»Π΅Π½ΠΈΡ ΠΠΠ ΠΠΠ’ (ΠΠΠ) ΡΡΠΈΠ»ΠΈΠ»ΠΈ Π΄ΠΈΠ°Π³Π½ΠΎΡΡΠΈΡΠ΅ΡΠΊΡΡ ΡΠ΅Π½Π½ΠΎΡΡΡ ΠΊΠ°ΠΆΠ΄ΠΎΠ³ΠΎ ΠΈΠ· ΠΌΠ΅ΡΠΎΠ΄ΠΎΠ² Π½Π° 8,6 ΠΈ 7,1% ΡΠΎΠΎΡΠ²Π΅ΡΡΡΠ²Π΅Π½Π½ΠΎ. Π£ 73,5% Π±ΠΎΠ»ΡΠ½ΡΡ
Π΄ΠΈΠ°Π³Π½ΠΎΠ· ΡΡΠ±Π΅ΡΠΊΡΠ»Π΅Π·Π° Π±ΡΠ» ΡΡΡΠ°Π½ΠΎΠ²Π»Π΅Π½ Π² ΡΠ΅ΡΠ΅Π½ΠΈΠ΅ 2-3 Π΄Π½Π΅ΠΉ ΠΎΡ ΠΌΠΎΠΌΠ΅Π½ΡΠ° ΠΎΠ±ΡΠ°ΡΠ΅Π½ΠΈΡ Π·Π° ΠΏΠΎΠΌΠΎΡΡΡ. ΠΠ°ΠΊΠ»ΡΡΠ΅Π½ΠΈΠ΅. Π ΡΠ΅Π»ΠΎΠΌ Π°Π»Π³ΠΎΡΠΈΡΠΌ ΠΎΠ±ΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΡ Π΄Π»Ρ Π²ΡΡΠ²Π»Π΅Π½ΠΈΡ ΠΠΠ’ ΠΏΡΠΎΠ΄Π΅ΠΌΠΎΠ½ΡΡΡΠΈΡΠΎΠ²Π°Π» ΡΡΠ²ΡΡΠ²ΠΈΡΠ΅Π»ΡΠ½ΠΎΡΡΡ Ρ Π±ΠΎΠ»ΡΠ½ΡΡ
ΠΊΠΎ-ΠΈΠ½ΡΠ΅ΠΊΡΠΈΠ΅ΠΉ (ΠΠΠ§/Π’Π) 87,1%. ΠΡΠΈ Π²ΠΎΠ·ΠΌΠΎΠΆΠ½ΠΎΡΡΠΈ ΠΈΡΠΏΠΎΠ»ΡΠ·ΠΎΠ²Π°ΡΡ Π±ΡΡΡΡΡΠ΅ ΠΌΠΎΠ»Π΅ΠΊΡΠ»ΡΡΠ½ΠΎ-Π³Π΅Π½Π΅ΡΠΈΡΠ΅ΡΠΊΠΈΠ΅ ΠΌΠ΅ΡΠΎΠ΄Ρ Π΄Π΅ΡΠ΅ΠΊΡΠΈΠΈ Π²ΠΎΠ·Π±ΡΠ΄ΠΈΡΠ΅Π»Ρ Π»ΡΠΌΠΈΠ½Π΅ΡΡΠ΅Π½ΡΠ½Π°Ρ ΠΌΠΈΠΊΡΠΎΡΠΊΠΎΠΏΠΈΡ ΡΠ΅ΡΡΠ΅Ρ ΡΠ²ΠΎΡ Π·Π½Π°ΡΠΈΠΌΠΎΡΡΡ Π² Π΄ΠΈΠ°Π³Π½ΠΎΡΡΠΈΠΊΠ΅ ΡΡΠ±Π΅ΡΠΊΡΠ»Π΅Π·Π°
Detection of Mycobacterium tuberculosis in blood for diagnosis of generalised tuberculosis in HIV-positive patients
Objective: To study the informative value of the detection of mycobacteria in blood with the cultural method in patients with suspected tuberculous sepsis and to determine the most significant clinical and laboratory criteria for testing. Materials and methods: The investigation to detect M.tuberculosis was fulfilled in 159 HIV-positive patients with suspected tuberculosis sepsis. Blood culture was completed with culture medium Myco/F Lytic Culture Vials and analyzer BACTEC 9050. Results: Mycobacteria were detected in blood of 19 patients (11,9% of all patients): in 18 patients the growth of M. tuberculosis complex was detected (25,3% of all patients with diagnosed tuberculosis) and in 1 patient it was Mycobacterium avium complex (0,6% of all patients). It was shown, that the probability of M.tuberculosis detection was especially associated with the severity of the disease, immunosupression (less than 100 cells/mkl), hemoglobin quantity less than 90 g/l (levels were determined through the seeking for the most significant cutoffs). It was not proofed, that meningoencephalitis develops more often in patients with proven bacteremia. There were no evident differences in detection frequency of mycobacteria in sputum between patients with tuberculous sepsis and without it
The spectrum of primary drug resistance of Mycobacterium tuberculosis in patients with tuberculosis in relation to human immunodeficiency virus status
Aim. To estimate the detection rate and spectrum of primary drug resistance of Mycobacterium tuberculosis (MBT) in patients with tuberculosis (TB) in relation to their human immunodeficiency virus (HIV) status in a region with high HIV infection rates (the Perm Territory) and to compare of drug-resistant MBT (DR-MBT) in patients with HIV/TB co-infection, by using phenotypic and molecular genetic testing (MGT) methods. Subjects and methods. The results of sputum bacteriological examination were analyzed in 178 HIV-infected patients and 354 non-HIV-infected individuals with a TB diagnosis made in the period July 1, 2014 to August 1, 2015. The diagnostic algorithm for all patients involved a duplicate sputum test for MBT by two techniques: fluorescence microscopy (FM) and inoculation into the Levenstein-Jensen dense culture medium. In patients with HIV/TB, the bacteriological examination was complemented with two more methods: detection of MBT DNA by a real-time polymerase chain reaction assay using the AmpliTube-RV system (Synthol, Russia); and inoculation into the Middlebrook liquid nutrient medium, by applying the automated BACTEC MGIT 960 system. Results. In patients with HIV/TB, the sensitivity of FM proved to be lower than in those with TB (24.2 and 32.8%, respectively; p0.05). The primary drug resistance of MBT in patients with HIV-TB was higher than that in HIV-negative individuals (60.2 and 41.6%, respectively; p<0.05). The phenotypic method (inoculation into the Levenstein-Jensen culture medium) and MGT revealed their agreement for the resistance of MBT to rifampicin (the most clinically significant drug in the choice of treatment policy) in 88.5% of the patients with HIV/TB. Conclusion. In patients with HIV/TB, the sensitivity of FM for detecting acid-resistant mycobacteria was lower than in those with TB and that of inoculations into the dense medium was comparable regardless of HIV status
ΠΡΡΠ²Π»Π΅Π½ΠΈΠ΅ ΠΌΠΈΠΊΠΎΠ±Π°ΠΊΡΠ΅ΡΠΈΠΉ ΡΡΠ±Π΅ΡΠΊΡΠ»Π΅Π·Π° Π² ΠΌΠΎΠΊΡΠΎΡΠ΅ Ρ Π±ΠΎΠ»ΡΠ½ΡΡ ΠΠΠ§-ΠΈΠ½ΡΠ΅ΠΊΡΠΈΠ΅ΠΉ ΠΏΡΠΈ ΠΈΡΠΏΠΎΠ»ΡΠ·ΠΎΠ²Π°Π½ΠΈΠΈ ΡΠΎΠ²ΡΠ΅ΠΌΠ΅Π½Π½ΠΎΠ³ΠΎ Π°Π»Π³ΠΎΡΠΈΡΠΌΠ° ΡΡΠΈΠΎΠ»ΠΎΠ³ΠΈΡΠ΅ΡΠΊΠΎΠΉ Π΄ΠΈΠ°Π³Π½ΠΎΡΡΠΈΠΊΠΈ Π·Π°Π±ΠΎΠ»Π΅Π²Π°Π½ΠΈΡ
The objective. To establish the informativity of using phenotypic and molecular genetic methods of detection of mycobacterium tuberculosis (ΠΠΠ’) from sputum to diagnose tuberculosis in patients with HIV infection. Patients and methods. 360 HIV-infected individuals with suspected tuberculosis were examined. A diagnostic algorithm included two tests of sputum for AFB/ ΠΠΠ’ by fluorescence microscopy, detection of ΠΠΠ’ DNA in real-time PCR and inoculation of liquid and solid media. Results. Tuberculosis was diagnosed in 49.4% of the examined patients. The greatest sensitivity and accuracy of ΠΠΠ’ detection was demonstrated by molecular genetic methods (71.3% and 0.85, respectively), which even exceeded tire results of culture diagnosis (sensitivity - 58.4 and 60.7%, accuracy - 0.79 and 0.81 for inoculation of liquid and dense media, respectively). An extremely low sensitivity was demonstrated by fluorescence microscopy (24.2%). No relation between the frequency of ΠΠΠ’ detection and the number of CD4+-lymphocytes was found in any method but for fluorescence microscopy showed a tendency of a better effectiveness in patients with profound immunodeficiency (in CD4 less than 100 cell/pl). Repeat analysis of inoculation of liquid media and detection of ΠΠΠ’ DNA (MGM) enhanced the diagnostic value of each method by 8.6 and 7.1%, respectively. In 73.5% of patients, tuberculosis was diagnosed within 2-3 days from the moment of turning for medical help. Conclusion. In general, an examination algorithm for detection of ΠΠΠ’ demonstrated its sensitivity in patients with co-infection (HIV/Π’Π) in 87.1%. If molecular genetic methods can be used for rapid detection of a causative agent fluorescence microscopy looses its relevance for diagnosing tuberculosis.Π¦Π΅Π»Ρ. Π£ΡΡΠ°Π½ΠΎΠ²ΠΈΡΡ ΠΈΠ½ΡΠΎΡΠΌΠ°ΡΠΈΠ²Π½ΠΎΡΡΡ ΠΈΡΠΏΠΎΠ»ΡΠ·ΠΎΠ²Π°Π½ΠΈΡ ΡΠ΅Π½ΠΎΡΠΈΠΏΠΈΡΠ΅ΡΠΊΠΈΡ
ΠΈ ΠΌΠΎΠ»Π΅ΠΊΡΠ»ΡΡΠ½ΠΎ-Π³Π΅Π½Π΅ΡΠΈΡΠ΅ΡΠΊΠΈΡ
ΠΌΠ΅ΡΠΎΠ΄ΠΎΠ² Π΄Π΅ΡΠ΅ΠΊΡΠΈΠΈ ΠΌΠΈΠΊΠΎΠ±Π°ΠΊΡΠ΅ΡΠΈΠΈ ΡΡΠ±Π΅ΡΠΊΡΠ»Π΅Π·ΠΈΡ (ΠΠΠ’) ΠΈΠ· ΠΌΠΎΠΊΡΠΎΡΡ Π΄Π»Ρ Π΄ΠΈΠ°Π³Π½ΠΎΡΡΠΈΠΊΠΈ ΡΡΠ±Π΅ΡΠΊΡΠ»Π΅Π·Π° Ρ Π±ΠΎΠ»ΡΠ½ΡΡ
ΠΠΠ§-ΠΈΠ½ΡΠ΅ΠΊΡΠΈΠ΅ΠΉ. ΠΠ°ΡΠΈΠ΅Π½ΡΡ ΠΈ ΠΌΠ΅ΡΠΎΠ΄Ρ. ΠΠ±ΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΠ΅ Π²ΡΠΏΠΎΠ»Π½Π΅Π½ΠΎ 360 ΠΠΠ§-ΠΈΠ½ΡΠΈΡΠΈΡΠΎΠ²Π°Π½Π½ΡΠΌ Ρ ΠΏΠΎΠ΄ΠΎΠ·ΡΠ΅Π½ΠΈΠ΅ΠΌ Π½Π° ΡΡΠ±Π΅ΡΠΊΡΠ»Π΅Π·. ΠΠΈΠ°Π³Π½ΠΎΡΡΠΈΡΠ΅ΡΠΊΠΈΠΉ Π°Π»Π³ΠΎΡΠΈΡΠΌ Π²ΠΊΠ»ΡΡΠ°Π» Π΄Π²ΡΠΊΡΠ°ΡΠ½ΠΎΠ΅ ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΠ΅ ΠΌΠΎΠΊΡΠΎΡΡ Π½Π° ΠΠ£Π/ΠΠΠ’ Π»ΡΠΌΠΈΠ½Π΅ΡΡΠ΅Π½ΡΠ½ΠΎΠΉ ΠΌΠΈΠΊΡΠΎΡΠΊΠΎΠΏΠΈΠ΅ΠΉ, Π²ΡΡΠ²Π»Π΅Π½ΠΈΠ΅ΠΌ ΠΠΠ ΠΠΠ’ Ρ ΠΏΠΎΠΌΠΎΡΡΡ ΠΏΠΎΠ»ΠΈΠΌΠ΅ΡΠ°Π·Π½ΠΎΠΉ ΡΠ΅ΠΏΠ½ΠΎΠΉ ΡΠ΅Π°ΠΊΡΠΈΠΈ ΡΠ΅Π°Π»ΡΠ½ΠΎΠ³ΠΎ Π²ΡΠ΅ΠΌΠ΅Π½ΠΈ ΠΈ ΠΏΠΎΡΠ΅Π²ΠΎΠΌ Π½Π° ΠΆΠΈΠ΄ΠΊΠΈΠ΅ ΠΈ ΠΏΠ»ΠΎΡΠ½ΡΠ΅ ΠΏΠΈΡΠ°ΡΠ΅Π»ΡΠ½ΡΠ΅ ΡΡΠ΅Π΄Ρ. Π Π΅Π·ΡΠ»ΡΡΠ°ΡΡ. Π’ΡΠ±Π΅ΡΠΊΡΠ»Π΅Π· ΡΡΡΠ°Π½ΠΎΠ²Π»Π΅Π½ 49,4% ΠΏΠ°ΡΠΈΠ΅Π½ΡΠ°ΠΌ ΠΎΡ ΡΠΈΡΠ»Π° ΠΎΠ±ΡΠ»Π΅Π΄ΠΎΠ²Π°Π½Π½ΡΡ
. ΠΠ°ΠΈΠ±ΠΎΠ»ΡΡΡΡ ΡΡΠ²ΡΡΠ²ΠΈΡΠ΅Π»ΡΠ½ΠΎΡΡΡ ΠΈ ΡΠΎΡΠ½ΠΎΡΡΡ Π² Π²ΡΡΠ²Π»Π΅Π½ΠΈΠΈ ΠΠΠ’ ΠΏΠΎΠΊΠ°Π·Π°Π»ΠΈ ΠΌΠΎΠ»Π΅ΠΊΡΠ»ΡΡΠ½ΠΎ-Π³Π΅Π½Π΅ΡΠΈΡΠ΅ΡΠΊΠΈΠ΅ ΠΌΠ΅ΡΠΎΠ΄Ρ (71,3% ΠΈ 0,85 ΡΠΎΠΎΡΠ²Π΅ΡΡΡΠ²Π΅Π½Π½ΠΎ), ΠΊΠΎΡΠΎΡΡΠ΅ Π΄Π°ΠΆΠ΅ ΠΏΡΠ΅Π²ΡΡΠΈΠ»ΠΈ ΡΠ΅Π·ΡΠ»ΡΡΠ°ΡΡ ΠΊΡΠ»ΡΡΡΡΠ°Π»ΡΠ½ΠΎΠΉ Π΄ΠΈΠ°Π³Π½ΠΎΡΡΠΈΠΊΠΈ (ΡΡΠ²ΡΡΠ²ΠΈΡΠ΅Π»ΡΠ½ΠΎΡΡΡ - 58,4 ΠΈ 60,7%, ΡΠΎΡΠ½ΠΎΡΡΡ - 0,79 ΠΈ 0,81 Π΄Π»Ρ ΠΏΠΎΡΠ΅Π²Π° Π½Π° ΠΆΠΈΠ΄ΠΊΠΈΠ΅ ΠΈ ΠΏΠ»ΠΎΡΠ½ΡΠ΅ ΡΡΠ΅Π΄Ρ ΡΠΎΠΎΡΠ²Π΅ΡΡΡΠ²Π΅Π½Π½ΠΎ). ΠΡΠ°ΠΉΠ½Π΅ Π½ΠΈΠ·ΠΊΡΡ ΡΡΠ²ΡΡΠ²ΠΈΡΠ΅Π»ΡΠ½ΠΎΡΡΡ ΠΏΠΎΠΊΠ°Π·Π°Π»Π° Π»ΡΠΌΠΈΠ½Π΅ΡΡΠ΅Π½ΡΠ½Π°Ρ ΠΌΠΈΠΊΡΠΎΡΠΊΠΎΠΏΠΈΡ (24,2%). ΠΠ΅ ΠΎΡΠΌΠ΅ΡΠ΅Π½ΠΎ ΡΠ²ΡΠ·ΠΈ ΠΌΠ΅ΠΆΠ΄Ρ ΡΠ°ΡΡΠΎΡΠΎΠΉ Π²ΡΡΠ²Π»Π΅Π½ΠΈΡ ΠΠΠ’ ΠΈ ΠΊΠΎΠ»ΠΈΡΠ΅ΡΡΠ²ΠΎΠΌ Π‘Π4+-Π»ΠΈΠΌΡΠΎΡΠΈΡΠΎΠ² Π½ΠΈ ΠΏΠΎ ΠΎΠ΄Π½ΠΎΠΌΡ ΠΈΠ· ΠΌΠ΅ΡΠΎΠ΄ΠΎΠ², ΠΎΠ΄Π½Π°ΠΊΠΎ Π΄Π»Ρ Π»ΡΠΌΠΈΠ½Π΅ΡΡΠ΅Π½ΡΠ½ΠΎΠΉ ΠΌΠΈΠΊΡΠΎΡΠΊΠΎΠΏΠΈΠΈ ΠΎΡΠΌΠ΅ΡΠ΅Π½Π° ΡΠ΅Π½Π΄Π΅Π½ΡΠΈΡ Π»ΡΡΡΠ΅ΠΉ ΡΠ΅Π·ΡΠ»ΡΡΠ°ΡΠΈΠ²Π½ΠΎΡΡΠΈ Ρ Π±ΠΎΠ»ΡΠ½ΡΡ
Ρ Π³Π»ΡΠ±ΠΎΠΊΠΈΠΌ ΠΈΠΌΠΌΡΠ½ΠΎΠ΄Π΅ΡΠΈΡΠΈΡΠΎΠΌ (ΠΏΡΠΈ CD4 ΠΌΠ΅Π½Π΅Π΅ 100 ΠΊΠ»Π΅ΡΠΎΠΊ/ΠΌΠΊΠ»). ΠΠΎΠ²ΡΠΎΡΠ½ΡΠΉ Π°Π½Π°Π»ΠΈΠ· ΠΏΠΎΡΠ΅Π²Π° Π½Π° ΠΆΠΈΠ΄ΠΊΠΈΠ΅ ΡΡΠ΅Π΄Ρ ΠΈ Π²ΡΡΠ²Π»Π΅Π½ΠΈΡ ΠΠΠ ΠΠΠ’ (ΠΠΠ) ΡΡΠΈΠ»ΠΈΠ»ΠΈ Π΄ΠΈΠ°Π³Π½ΠΎΡΡΠΈΡΠ΅ΡΠΊΡΡ ΡΠ΅Π½Π½ΠΎΡΡΡ ΠΊΠ°ΠΆΠ΄ΠΎΠ³ΠΎ ΠΈΠ· ΠΌΠ΅ΡΠΎΠ΄ΠΎΠ² Π½Π° 8,6 ΠΈ 7,1% ΡΠΎΠΎΡΠ²Π΅ΡΡΡΠ²Π΅Π½Π½ΠΎ. Π£ 73,5% Π±ΠΎΠ»ΡΠ½ΡΡ
Π΄ΠΈΠ°Π³Π½ΠΎΠ· ΡΡΠ±Π΅ΡΠΊΡΠ»Π΅Π·Π° Π±ΡΠ» ΡΡΡΠ°Π½ΠΎΠ²Π»Π΅Π½ Π² ΡΠ΅ΡΠ΅Π½ΠΈΠ΅ 2-3 Π΄Π½Π΅ΠΉ ΠΎΡ ΠΌΠΎΠΌΠ΅Π½ΡΠ° ΠΎΠ±ΡΠ°ΡΠ΅Π½ΠΈΡ Π·Π° ΠΏΠΎΠΌΠΎΡΡΡ. ΠΠ°ΠΊΠ»ΡΡΠ΅Π½ΠΈΠ΅. Π ΡΠ΅Π»ΠΎΠΌ Π°Π»Π³ΠΎΡΠΈΡΠΌ ΠΎΠ±ΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΡ Π΄Π»Ρ Π²ΡΡΠ²Π»Π΅Π½ΠΈΡ ΠΠΠ’ ΠΏΡΠΎΠ΄Π΅ΠΌΠΎΠ½ΡΡΡΠΈΡΠΎΠ²Π°Π» ΡΡΠ²ΡΡΠ²ΠΈΡΠ΅Π»ΡΠ½ΠΎΡΡΡ Ρ Π±ΠΎΠ»ΡΠ½ΡΡ
ΠΊΠΎ-ΠΈΠ½ΡΠ΅ΠΊΡΠΈΠ΅ΠΉ (ΠΠΠ§/Π’Π) 87,1%. ΠΡΠΈ Π²ΠΎΠ·ΠΌΠΎΠΆΠ½ΠΎΡΡΠΈ ΠΈΡΠΏΠΎΠ»ΡΠ·ΠΎΠ²Π°ΡΡ Π±ΡΡΡΡΡΠ΅ ΠΌΠΎΠ»Π΅ΠΊΡΠ»ΡΡΠ½ΠΎ-Π³Π΅Π½Π΅ΡΠΈΡΠ΅ΡΠΊΠΈΠ΅ ΠΌΠ΅ΡΠΎΠ΄Ρ Π΄Π΅ΡΠ΅ΠΊΡΠΈΠΈ Π²ΠΎΠ·Π±ΡΠ΄ΠΈΡΠ΅Π»Ρ Π»ΡΠΌΠΈΠ½Π΅ΡΡΠ΅Π½ΡΠ½Π°Ρ ΠΌΠΈΠΊΡΠΎΡΠΊΠΎΠΏΠΈΡ ΡΠ΅ΡΡΠ΅Ρ ΡΠ²ΠΎΡ Π·Π½Π°ΡΠΈΠΌΠΎΡΡΡ Π² Π΄ΠΈΠ°Π³Π½ΠΎΡΡΠΈΠΊΠ΅ ΡΡΠ±Π΅ΡΠΊΡΠ»Π΅Π·Π°
Healthcare visits of HIV-infected persons before and after tuberculosis diagnosis and contamination of the environment of health-care facilities with mycobacterium tuberculosis
The objective. To study healthcare visits of HIV-infected persons before and after they were diagnosed with tuberculosis and contamination of healthcare facilities (HF) with mycobacterium tuberculosis. Materials and methods. We studied medical records of 169 HIV-infected patients who fell ill with tuberculosis. The frequency of visits of HIV-infected patients to various HF before and after tuberculosis diagnosis was determined. Molecular-genetic examination of 316 smears was performed for the presence of mycobacterium tuberculosis (MBT) DNA, taken from the working environment of four HF (AIDS Centre clinic, infectious inpatient hospital for HIV-infected persons, tuberculosis inpatient clinic, local general-duty polyclinic). Results. As has been found, before and after tuberculosis diagnosis HIV-infected persons most commonly apply for medical aid to the AIDS Centre polyclinic, more rarely to other HF. Tuberculosis in HIV-infected persons is most commonly diagnosed in the AIDS Centre polyclinic, more rarely in general-duty polyclinic, department of the infectious hospital for HIV-infected patients, somatic and surgical inpatient units. According to molecular-genetic examination of environmental smear sampling in various healthcare facilities, the maximal contamination with MBT DNA was found in the AIDS Centre polyclinic, in a less degree in the tuberculosis inpatient hospital and the infectious inpatient hospital for HIV-infected persons. In the general-duty polyclinic, no mycobacterium tuberculosis DNA was isolated. Conclusion. Predominant visits of HIV-infected persons before and after tuberculosis diagnosis to the AIDS Centre polyclinic and a higher level of contamination of healthcare environment in this facility with MBT DNA show that in the settings of a specialised polyclinic there are conditions for nosocomial infection with tuberculosis bacteria
Healthcare visits of HIV-infected persons before and after tuberculosis diagnosis and contamination of the environment of health-care facilities with mycobacterium tuberculosis
The objective. To study healthcare visits of HIV-infected persons before and after they were diagnosed with tuberculosis and contamination of healthcare facilities (HF) with mycobacterium tuberculosis. Materials and methods. We studied medical records of 169 HIV-infected patients who fell ill with tuberculosis. The frequency of visits of HIV-infected patients to various HF before and after tuberculosis diagnosis was determined. Molecular-genetic examination of 316 smears was performed for the presence of mycobacterium tuberculosis (MBT) DNA, taken from the working environment of four HF (AIDS Centre clinic, infectious inpatient hospital for HIV-infected persons, tuberculosis inpatient clinic, local general-duty polyclinic). Results. As has been found, before and after tuberculosis diagnosis HIV-infected persons most commonly apply for medical aid to the AIDS Centre polyclinic, more rarely to other HF. Tuberculosis in HIV-infected persons is most commonly diagnosed in the AIDS Centre polyclinic, more rarely in general-duty polyclinic, department of the infectious hospital for HIV-infected patients, somatic and surgical inpatient units. According to molecular-genetic examination of environmental smear sampling in various healthcare facilities, the maximal contamination with MBT DNA was found in the AIDS Centre polyclinic, in a less degree in the tuberculosis inpatient hospital and the infectious inpatient hospital for HIV-infected persons. In the general-duty polyclinic, no mycobacterium tuberculosis DNA was isolated. Conclusion. Predominant visits of HIV-infected persons before and after tuberculosis diagnosis to the AIDS Centre polyclinic and a higher level of contamination of healthcare environment in this facility with MBT DNA show that in the settings of a specialised polyclinic there are conditions for nosocomial infection with tuberculosis bacteria