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Issue. Articles

1(28) // 2017



1. Editorial


TB resource center, the first in Ukraine comprehensive platform for simulation in pre- and in-service medical education of health care and non-medical service providers involved into TB control (UKR)

V.I. Petrenko1, M.G. Dolynska1, 2, V.V. Gultai2, N.E. Roman2, V.V. Petrenko1

1 O.O. Bogomolets National Medical University, Kyiv,  Ukraine
2 USAID Strengthning TB control in Ukraine project, Kyiv,  Ukraine

USAID Strengthening TB control in Ukraine project together with National medical Bogomolets University and National Shupick Academy of postgraduate medical education developed the national resource center on tuberculosis http://tb.ucdc.gov.ua/. This is the first comprehensive electronic medical resource in Ukraine, which allows users to read profile publications, undergo online trainings, and make decisions in simulated clinical situations. To date the resource center contains: 30 reports on programmatic activities and operational researches; 20 reviews of international guidelines; 42 manuals; 11 video-training; 7 sets of training materials; 11 case studies for clinical decisions, which require from five to ten steps with detailed feedback on each decision advantages and disadvantages; 2 sets for online testing. Those users, who have undergone the training activities, receive a certificate from the USAID project and a partnering institution, which was involved into development of a particular training.
The resource is an effective tool of simulation for medical students, physicians, and non-medical service providers. It provides objective evaluation of their professional competence, and facilitates managerial decisions aimed at improvement of each link of the medical, psychological, social, and legal services continuum for TB patients. It is popular among users. Video-trainings collected more than 10 000 views in a total, and up to 700 users visits the resource daily.

Keywords: simulation in medical education, tuberculosis.

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Original language: Ukrainian

2. Original researches


Comparative results of treatment of patients with TB (unspecified localization, Rifampicinresistant of lungs, multiresiatant of lungs, milliar and multiresistant of nervous system) combined with HIV infection (UKR)

V.I. Petrenko1, O.V. Panasyuk1—4, G.V. Radysh1, O.B. Holub4, Ya.V. Lopatina4, L.S. Nychyporenko4

1 O.O. Bogomolets National Medical University, Kyiv, Ukraine
2 Kyiv Medical University UAFM, Kyiv, Ukraine
3 Gromashevsky Research Institute of Epidemiology and Infectious Diseases of NAMS of Ukraine, Kyiv, Ukraine
4 Kyiv Area City Center for Prevention and Control of AIDSth, Kyiv, Ukraine

Objective — ​to compare efficacy of antimycobacterial therapy (AMBT) on the background of antiretroviral therapy (ART) of HIV-positive patients with TB of unspecified localization (TBUL), rifampicinresistant TB of lungs (RRTBL), multiresistant TB of lungs (MRTBL), milliar TB (MTB) and multiresistant TB meningoencephalitis (MRTBME) with possible justifications of necessity of medical care for patients with TBUL (with rubric A18. Or A18.10), including ones with concomitant HIV infection.
Materials and methods. 150 randomly selected patients with coinfection of TB/HIV which were examined and treated in accordance with national standards, divided on 5 groups (for 30 patients in each one) depending on clinical form of TB and resistance of Mycobacteria of Tuberculosis. I group — ​patients with TBUL; II group — ​patients with RRTBL; III group — ​patients with MRTBL; IV group — ​patients with MTB, and V group — ​patients with MRTBME.
Results and discussion. Results of cohort analysis shown that for TBUL «effective treatment» achives in 90.0 % of cases, for RRTBL — ​in 76.7 %, for MRTBL — ​in 63.4 %, for MTB — ​in 60.0 %, and for MRTBE — ​in 53.3 %. The same pattern occurs also within died patients.
Conclusions. It was proved significant efficacy of treament of HIV-positive patients with TBUL and slightly better efficacy of HIV-positive patients with RRTBL in comparison with HIV-positive patients with MRTBL, MTB and MRTBME. The syndrome of immune reconstruction increase risk of death and quantity of died HIV-positive patients with low (< 100) level of CD4 celles/mm3 of patients with TBUL and TB of specified localization in case of effective ART on background inadequate AMBT. It is recommended to restore medical treatment of HIV-positive adults with TBUL (under rubrics A18. or A18.10) on national level, because it allows to highly and effectively treat those patients on the stage of detection, diagnostics and treatment of this clinical form of TB.

Keywords: tuberculosis, specified, uspecified localization, chemoresistance, treatment results, combinations with HIV.

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Original language: Ukrainian

3. Original researches


Efficiency of different types parietal pleurectomy with decortication of the lung with specific and nonspecific pleural diseases (UKR)

M.S. Opanasenko, S.M. Shalahai, O.V. Tereshkovych, O.E. Kshanovsky, L.I. Levanda

SI «National Institute of Phthisiology and Pulmonology named after F.G. Yanovsky of NAMS of Ukraine», Kyiv, Ukraine

Objective — ​to compare the efficiency of «classic», video-assisted, videothoracoscopic parietal pleurec­tomy with decortication of the lung for specific and nonspecific pathology of pleura.
Materials and methods. Analyzed the outcomes of 160 operations in patients with pleural effusion with specific and nonspecific pleural pathology, who were treated with the «classic» (I group — ​55 (34.4 %)), video-assisted (II group — ​40 (25.0 %)) and videothoracoscopic (III group — ​65 (40.6 %)) pleurectomy with decortication of the lung.
Results and discussion. Most of the patients were with tuberculous process of pleural cavity — ​123 (76.9 %) cases. Among them, 44 (27.5 %) had chronic tuberculous empyema without bronchial fistula, in 8 (5.0 %) cases — ​with fistula. Also, in 60 (37.5 %) cases were diagnosed chronic tuberculous pleurisy. Non-specific inflammation in the pleura was in 28 (17.5 %) cases. In 9 (5.6 %) patients, surgery was performed on the intrapleural hematoma. «Classical» pleurectomy with decortication of the lung using a thoracotomy was peformed in 55 (34.4 %) patients, chronic pleural empyema was in 23 (14.4 %) cases. Videothoracos­copic — ​in 65 (40.6 %) patients. In most cases of chronic or subacute with a tendency to chronic tuberculous pleurisy — ​in 36 (22.5 %) cases. Video-assisted pleurectomy with decortication of lung with minithora­cotomy was performed in 40 (25.0 %) cases. In this group, the majority of patients were operated for chronic tuberculous pleurisy — ​17 (9.8 %).
The highest intraoperative blood loss was observed in group I (321.1 ± 15.8 ml), the lowest — ​in group III (143.8 ± 10.6 ml). Postoperative complications were observed in 14 (8.8 %) cases. The most common complication in the early postoperative period in patients of all groups was prolonged air leak — ​in 10 (6.3 %) patients. The overall effectiveness of treatment in our clinic of this group of patients was 97.5 %, postoperative mortality rate was 0.6 %, postoperative complications — ​in 8.8 %.
Conclusions. In the early stages of the disease less invasive intervention should be preferred. In case of challenge to perform standard parietal pleurectomy with decortication of the lung, operation should start with videothoracoscopic revision. In certain number of cases, conversion to minithoracotomy using video-assisted decortication of the lung or wide lateral thoracotomy with the performance of «classic» pleurec­tomy decortication of the lung could be performed. When disease lasts less then 4 weeks, videothoracos­copic parietal pleurectomy with decortication of the lung achieves better results, and later wide thoraco­tomy with pleurectomy and decortication of the lung or video-assisted pleurectomy and decortication of the lung can be applied.

Keywords: pleurectomy with decortication, chronic pleurisy, empyema.

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4. Original researches


Frequency and structure multidrug-resistant tuberculosis and extensively drug-resistant tuberculosis pulmonary in adults Lviv region (UKR)

M. I. Sakhelashvili1, I. L. Platonova2, G. D. Shtybel1, O. A. Tkach2, L. M. Rak3, S. R. Nakonechny3, Yu. I. Furgala3, O.B. Omelian3, A. I. Shensny3, R.M. T

1 Danylo Halytskiy Lviv National Medical Universitet, Lviv, Ukraine
2 SI «Lviv RI Epidemiology and Hygiene, Ministry of Healthcare of Ukraine», Lviv, Ukraine
3 PU «Lviv Regional Ftyziopulmonology and Treatment Center», Lviv, Ukraine

Objective — to study the prevalence of resistance range, gender and clinical structure, effectiveness of treatment of multidrug-resistant (MDR) tuberculosis in adults of Lviv region.
Materials and methods. A retrospective analysis of the epidemiological situation of MDR tuberculosis in the Lviv region (2010—2015 years): monitoring the prevalence, patterns and profile MDR, clinical patterns, the effectiveness of treatment of MDR tuberculosis conducted according to the annual reports of TB health facilities in Lviv and 990 medical records of patients: 660 with MDR tuberculosis pulmonary TB and 330 — ​with extensively drug-resistant tuberculosis (XDR).
Results and discussion. Over the past six years (2010—2015 years) an increase in the frequency of detection of patients with MDR with an increase of 1.5 and 1.8 times the share of disseminated and fibro-cavernous tuberculosis, a decrease of 2.0 times infiltrative form. Mostly showed resistance to pathogen combinations HRSE with multi-resistant tuberculosis, which was 32.7 % and tuberculosis with enhanced resistance — ​52.4 %. In the expanded share of drug resistance to drugs and combinations HRSE number grew 1.6 times to HRZS — ​10.5 times, to HREZS — ​1.4 times compared with patients with pulmonary MDR In patients with newly diagnosed MDR cure occurred in 25.6 % of patients completed treatment — ​29.5 %, deaths — ​11.5 %, 14.1 % interrupted treatment.
Conclusions. In recent years, in the Lviv region observed a significant increase in the frequency of detection of patients with MDR tuberculosis and tuberculosis with enhanced resistance. In clinical structure dominated by destructive and distributing forms of pulmonary tuberculosis. In patients with MDR tuberculosis pulmonary often reveal strains of Mycobacterium tuberculosis resistant to HRSE. In XDR proportion of strains of Mycobacterium tuberculosis resistant to first-line combinations HRES increased 1.6 times compared with patients with MDR. The majority of patients (55.1 %) at the end of primary chemotherapy pronounced positive dynamics of the consequent of the «cured» or «treatment completed».

Keywords: multidrug-resistant tuberculosis, adults, Lviv region.

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5. Original researches


Peculiarities of cytokine spectrum IL‑1β, IL‑2, IL‑10 and TNF-α in children with tuberculosis (UKR)

Z.I. Piskur1, L.I. Mykolyshyn1, I.L. Platonova2, L.Ye. Lapovets1

1 Danylo Halytskiy Lviv National Medical University, Lviv, Ukraine
2 SI «Lviv Research Institute of Epidemiology and Hygiene» MOH of Ukraine, Lviv, Ukraine

Objective — to study the cytokine spectrum IL‑1β, IL‑2, IL‑10, TNF-α in young and older children with TB depending on the severity of pathological process and dynamic changes in cytokine system after three months of treatment.
Materials and methods. The study involved 38 children (22 children aged 3 months to 3 years and 16 children — ​4 to 14 years old) treated for tuberculosis.
Results and discussion. In infants and older children with tuberculosis the studied levels of proinflammatory cytokines IL‑1β, IL‑2, TNF-α were significantly (p < 0.001) higher compared to control group. At the same time the level of anti-inflammatory cytokine IL‑10 didn’t significantly differ from the control values.
In young children before treatment the level of cytokine indices IL‑1β/ IL‑10, IL‑2/IL‑10 and TNF-α/IL‑10 were significantly higher (p < 0.01) than those in the control group. After three months of treatment a decrease of immunoregulatory cytokine indices was observed compared with those before treatment. Statistically significant (p < 0.05) were differences between cytokine indices IL‑2/IL‑10, TNF-α/IL‑10.
Conclusions. At the stage of inflammation in young and older children the spectrum of cytokine response was almost identical and was characterized by increased level of proinflammatory cytokines compared to control group indicating the activation of Th1 type of cell response in response to mycobacterial antigen. After three-month chemotherapy there was a tendency to restoration of dynamic balance in the system of pro- and anti-inflammatory cytokines with reduction of immunoregulatory cytokine indices in its settings.

Keywords: tuberculosis, children, cytokines.

List of references:
1.    Dem’yanov AV, Kotov AYu, Simbirtsev AS. Diagnosticheskaya tsennost’ issledovaniya tsitokinov v klinicheskoi praktike (Rus). Tsitokiny i vospalenie. 2003;2(3):20-35.
2.    l’nits’ka L. Osoblivost nterleiknovogo proflyu sirovatki krov pri tuberkul’oz u pdltkv (Ukr). Pedatrya, akusherstvo ta gnekologya. 2008;5:40-41.
3.    Kolosova AB, Urazova OI, Novitskii VV i dr. Osobennosti produktsii tsitokinov i α2-makroglobulina u bol’nykh s razlichnymi klinicheskimi formami tuberkuleza legkikh (Rus). Tuberkulez i bolezni legkikh. 2011;1:48-52.
4.    Kolsnik NS. Suchasn aspekti patogenezu tuberkul’ozno nfekts u dtei (Ukr). Patologya. 2012;1:20-25.
5.    Panasyukova OR, Kadan LP. Tsitokni tuberkul’oz (oglyad lteraturi) (Ukr). [Elektronnii resurs] 2008; 18 s: Rezhim dostupu do zhurnalu: http://www.ifp.kiev.ua/ftp1/original/2008/panasiukova2008.pdf.
6.    Pozdnyakova AS. Sostoyanie immunologicheskoi reaktivnosti detei s latentnoi tuberkuleznoi infektsiei (Rus). Tuberkulez i bolezni legkikh. 2010;10:41-44.
7.    Posplov AL, Averbakh MM, Gubkina MF. Uroven’ sinteza IFN-γ, TNF-α, IL‑1β i IL‑10 na raznykh etapakh lecheniya tuberkuleza detei i podrostkov (Rus). Tuberkulez i bolezni legkikh. 2011;8:36-40.
8.    Tyul’kova TE, Chugaev YuP, Kashuba EA i dr. Izmeneniya immunnoi sistemy detei starshei vozrastnoi gruppy pri pervichnykh i vtorichnykh formakh tuberkuleznoi (Rus). Tuberkulez i bolezni legkikh. 2009;1:51-55.
9.    Chernushenko EF, Kadan LP, Panasyukova OR i dr. Tsitokiny v otsenke immunnoi sistemy u bol’nykh tuberkulezom legkikh (Ukr). Ukrans’kii pul’monologchnii zhurnal. 2010;2:39-43.
10.    Ibrahim L, Salah M, El Rahman AA et al. Crucial role of CD4+ CD25+ FOXP3+ T requlatory cell, interferon-γ and interleukin‑16 in maliqnant and tuberculous pleural effusions. Immunological Investigations. 2013;42:122-136.
11.    Valdes L, San Jose E Alvarez Dobano JM et al. Diagnostic value of interleukin‑12 p40 in tuberculous pleural effusions. European Respiratory J. 2009;33:816-820.

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6. Original researches


Some issues of bone tuberculosis in terms of epidemic (UKR)

I.D. Duzhiy1, G.P. Oleshchenko1, V.O. Oleshchenko2, V.Yu. Kovchun1, L.A. Bondarenko2

1 Sumy State University, Sumy, Ukraine
2 Sumy Regional Clinical TB Dispansary, Sumy, Ukraine

Objective — ​to investigate the trend of tuberculosis osteo-articular localization of residents of Sumy region in dynamics for 2007—2016 years and attract the attention of general practitioners to the urgent problems of today.
Materials and methods. We analyzed the incidence of spinal tuberculosis residents of Sumy region during this period.
Results and discussion. During the years 2007—2016 in Sumy region 129 patients with osteo-articular tuberculosis were registered. In 41 (31.8 %) patients retrospectively transferred suspected tuberculous pleurisy, which was not diagnosed in time and over time the development of complicated spinal tubercu­losis. Tuberculous spondylitis met in 77 (59.7 %) patients, tuberculosis of the hip in 32 (24.8 %) patients, knee — ​in 7 (5.4 %), ankle — ​3 (2.3 %). In 10 (7.8 %) patients founded tuberculosis of other bones and joints. In tuberculous spondylitis 1—2 vertebra defeat occurred in 50 (64.9 %) patients, lesions 3—4 vertebrae recorded in 15 (19.5 %) patients, 5 or more vertebrae — ​in 12 (15.6 %) patients. Patients with tuberculous spondylitis in 55.8 % of the disabled consistently been recognized disabilities: I group — ​15 (34.9 %) patients, II — ​18 (41.8 %), III — ​10 (23.3 %).
Conclusions. In recent years, in Sumy region an increase in the proportion of patients with bone tuberculosis among all patients can testify to improve diagnosis of extrapulmonary disease.

Keywords: tuberculosis, bones and joints, spondylitis, disability.

List of references:
1.    Dyzhiy ID, Piddubna GP. Tuberkul’oznyj plevryt yak provisnyk dyseminovanogo progresuyuchogo tuberkul’ozu [Tuberculous pleurisy as a precursor of disseminated Progressive tuberculosis] (in Ukr). Ukr Pulmonol J. 2016;1:68-70.
2.    Burlakov SV, Oleynik VV, Vishnevskiy . Vliyanie dlitel’nosti zabolevaniya tuberkuleznym spondilitom na razvitie oslozhnenij [Influence of duration of tuberculosis spondilitis on the development of postoperative complications] (in Rus). Travmatology’ya y’ ortopedy’ya Rossy’y’. 2013;1:61-66.
3.    Golka GG, Fadeev OG, Istomin DA, Vesnin VV. Kistkovo-suglobovyj tuberkul’oz yak skladova chastyna problemy hvoroby [Osteoarticular tuberculosis as part of the tuberculosis problem] (in Ukr). Tuberkul’oz, legenevi hvoroby, VIL-infekciya. 2015;2:111-115.
4.    Golka GG, Kalmykova IM, Fadeev OG, Oliinyk AO, Tantsura OV. Rol’ i znachennya polimeraznoyi lancyugovoyi reakciyi v diagnostyci kistkovo-suglobovogo tuberkul’ozu [The role and importance of polymerase chain reaction in the diagnostics of the bone and joint tuberculosis] (in Ukr). Tuberkul’oz, legenevi hvoroby, VIL-infekciya.2016;3:28-34.
5.    Golka GG. Rol’ i znachennya suchasnyh promenevyh metodiv doslidzhennya v diagnostyci tuberkul’oznogo spondylitu [The role and significance of radiation methods of investigation in diagnosis of tuberculosis spondylitis] (in Ukr). Ukrayins’ky’j radiologichny’j zhurnal. 2006;14:12-18.
6.    Klishina LS, Baranova VV, Polyakova VG, Stoyanova HA, Mironova LA. Analiz pervynnogo vyhodu na invalidnist’ hvoryh na pozalegenevyj tuberkul’oz u Lugans’kij oblasti za period 2007-2009 roky [Analysis of primory disability of patients suffered of extrapulmonary tuberculousis in Lugansk region in 2007-2009 y. y.] (in Ukr). Ukrayins’kyj medychnyj al’manah. 2011;14(5):78-80.
7.    Petrenko VI, Dolyns’ka MG, Roznatovs’ka OM. Pozalegenevyj i miliarnyj tuberkul’oz u hvoryh na koinfekciyu tuberkul’oz/VIL [Extrapulmonary and miliary tuberculosis in patients with co-infection TB / HIV] (in Ukr). — «DKS centr», ​2015:112.
8.    Tuberkul’oz v Ukrayini: Analitychno-statystychnyj dovidnyk za 2001-2012 roky. K, 2013 (in Ukr).
9.    Tuberkul’oz v Ukrayini: Analitychno-statystychnyj dovidnyk. K, 2016 (in Ukr).
10.    Feshhenko YuI Mel’nyk VM, Opanasenko MS. Reorganizaciya, restrukturyzaciya ta reformuvannya protytuberkul’oznoyi sluzhby v Ukrayini [Reorganization, restructuring and reforming the TB service in Ukraine] (in Ukr). Ky’yiv: «Vydavnyctvo Lira-K», 2015:172.
11.    World Health Organization (WHO). Global tuberculosis report 2015 (WHO/HTM/TB/2015.22). Geneva: WHO; 2015. Available from: http://www.who.int/tb/publications/global_report/en/.

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Original language: Ukrainian

7. Original researches


Influence of structural and functional changes of thyroid on clinical running of tuberculosis and chemotherapy outcomes in concomitant diabetes (RUS)

S.L. Matveyeva

Kharkiv National Medical University, Kharkiv, Ukraine

Objective — to study of structure and function in patients with cavitary pulmonary tuberculosis and diabetes and outcomes of chemotherapy depending on thyroid state.
Materials and methods. Ultrasound investigation of echostructure of thyroid and definition of levels of free thyroxine, thyroid stimulating hormone and antibodies to thyroglobulin and peroxides in blood by immunoassay method were made in 60 patients with pulmonary cavitary tuberculosis and diabetes. The severance of clinical running of tuberculosis was evaluated by the method of the criterion of ball estimation suggested previously.
Results and discussion. Thyroid pathology of autoimmune type with signs of subclinical hypothyroidism were diagnosed in 66.67 per cent of observed persons. Clinical signs of tuberculosis estimated in ball system were more severe in patients with thyroid pathology. The rates of the disappearance of intoxication, stopping of bacilli excretion and healing of cavitation at the end of intensive phase of the chemotherapy are significantly higher in patients with unchanged echostructure and function of the thyroid. The algorithm of screening of thyroid homeostasis in patients with pulmonary tuberculosis and diabetes is worked out.
Conclusion. In 66.67 % of patients with pulmonary tuberculosis and diabetes structural changes of thyroid of autoimmune type with signs of subclinical hypothyroidism were noticed. Pathology of thyroid makes negative influence on both clinical running and outcomes of chemotherapy. It is of value to test thyroid homeostasis in patients with pulmonary tuberculosis and concomitant diabetes by suggested method.

Keywords: pulmonary tuberculosis, thyroid, antituberculosis chemotherapy outcomes, algorithm of screening of thyroid homeostasis.

List of references:
1.    Kaminskaya GO, Abdullayev RYu. Path physiological presuppositions of unfavorable influence of diabetes mellitus on the running of tuberculosis. Tuberculosis and Lung Diseases. 2014;3:5-10.
2.    Matveyeva SL. Role of previous thyroid state in T-cell immunity formation and outcomes of chemotherapy in patients with cavitary pulmonary tuberculosis. Problems of Endocrine Pathology. 2011;3:35-43.
3.    Matveyeva SL. Influence of thyroid function activity on the indexes of immunity in tuberculosis patients. Tuberculosis, lung diseases, HIV-infection. 2016;2(25):40-43.
4.    Matveyeva SL. Clinical characteristics and chemotherapy response in pulmonary tuberculosis patients with thyroid pathology. Tuberculosis, lung diseases, HIV-infection. 2011;2(5):39-44.
5.    Cherenco SO, Matveyeva SL. Correlation between clinical running of pulmonary tuberculosis, thyroid gland function and some cytokines. Ukr J Pulmonol. 2011;2:35-38.
6.    Yusvenko TYu. The rate of structural changes in thyroid gland in patients with diabetes mellitus of 2-nd type. Int Endocr J. 2015;1(65):19-22.
7.    Baker MA, Harries AD, Jeon CY et al. The impact of diabetes on tuberculosis treatment outcomes: a systematic review. Tuberculosis, lung diseases, HIV-infection. 2016;4(27):66-79.
8.    Dora JM, Machado WE, Rheinheimer J et al. Association of the type 2 deiodinase Thr92Ala polymorphism with type 2 diabetes: case–control study and meta-analysis. Eur JEndocrin. 2010;163:427-434.
9.    Faurholt-Jepsen D, Range N, Praygod G et al. The role of diabetes co-morbidity for tuberculosis treatment outcomes: A prospective cohort study from Mwanza, Tanzania. BMC Infect Dis. 2012;12:165. (PMC free article).
10.    Faurholt-Jepsen D, Range N, PrayGod G et al. The role of diabetes on the clinical manifestations of pulmonary tuberculosis. Trop Med Int Health. 2012;17:877-883.
11.    Hage M, Zantout MS, Azar ST. Thyroid Disorders and Diabetes Mellitus. J Thyroid Res. 2011;2011, Article ID 439463,7. http://dx.doi.org/10.4061/2011/439463.
12.    Kadiyala R, Peter R, Okosieme OE. Thyroid dysfunction in patients with diabetes: clinical implications and screening strategies. Int J Clin Pract. 2010;64:1130-1139.
13.    Ramasamy V, Kadiyala R, Fayyaz F et al. Value of a baseline serum thyrotropin as a predictor of hypothyroidism in patients with diabetes. Endocrine Practice. 2010;14:1-25.
14.    Tomer Y, Menconi F. Type 1 diabetes and autoimmune thyroiditis: the genetic connection. Thyroid. 2009;19:99-102.

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Original language: Russian

8. Original researches


Comparative effectiveness of the methods of detection of tuberculous pathogen and its resistance against chemotherapy in lung tuberculosis patients (UKR)

M.M. Savula1, N.M. Lopushanska2, L.P. Prots2, N.V. Medetska2

1 I.Ya. Horbachevsky Ternopil State Medical University, Ternopil, Ukraine
2 Ternopil Regional TB Dispensary, Ternopil, Ukraine

Objective — to study is to compare the effectiveness of different methods of etiological onfirmation of lung tuberculosis diagnosis and to analyze the sensitivity of mycobacteria to the first line drugs.
Materials and methods. The following results of sputum samples for mycobacterium detection were analyzed: 2764 inoculations on solid media, 595 — ​on liquid media (Bactec system) and 606 molecular-genetic tests (MGT) (GeneXpertMTB/RIF). We also evaluated the informativity of these methods and sensitivity of pathogen to the first line drugs in 230 of in-hospital patients with positive sputum MBT results.
Results and discussion. We detected high rate of coincidence between the results of culture studies on solid and liquid media. In in-hospital patients confirmation of MBT+ was obtained by growing on solid media (93.5 %), less frequently by Bactec system (89.6 %) and MGT (84 %) and only 50 % for 2-times microscopy of the sputum. The most positive results were obtained in the patients of the 4th category. The drug resistance of MBT was detected for isoniazid (38.3 %) and streptomycin (35.3 %). In 45.2 % of patients with negative sputum smear microscopy the culture studies revealed different types of chemoresistance.
Conclusions. Our study confirmed a high efficacy of accelerated methods (Bactec, GeneXpert MTB/RIF) for etiological diagnostics of tuberculosis and rapid detection of chemoresistance of MBT. The lowest efficacy was when light microscopy was applied. We also concluded that the patients’ examination should include price/efficacy estimation based on specific economical and epidemiological circumstances.

Keywords: etiological confirmation of tuberculosis, methods, effectiveness, chemoresistance.

List of references:
1.    Barbova AI. Current approaches to diagnosis of multidrug-resistant tuberculosis. Ukr Pulmonol J. 2016;2:28-29 (Rus.).
2.    Petrenko VI, Proziuk RG. The problem of tuberculosis in Ukraine. Tuberculosis, lung diseases, HIV infection. 2015;2(21):16-29 (Ukr).
3.    Feshchenko YuI, Lytvynenko NA, Pogrebna MV at al. Rationale for shortening the leught for MDR-TB chemotherapy course according to domestic experience. Ukr Pulmonol J. 2016;2:35-37 (Ukr.).
4.    Boehme CC, Nabeta P, Hillemann D et al. Rapid molecular detection of tuberculosis and rifampicin resistance. N Engl J Med. 2010;363:1005-1015.
5.    Leigh Phillips. Infection disease: TB’s revenge. Nature. 2013;493:14-16.
6.    World Health Organisation (WHO). Global tuberculosis control surveillance, planning, financing - WHO report 2014. Chapter 1, Epidemiology. Document WHO /HTM/TB/ 2014:411.

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9. Reviews


Analysis of the optimal duration and ATDs dosages between different short chemotherapy regimens for MDR-TB patients: comprehensive systematic review (UKR)

N.A. Lytvynenko, H.O. Varytska, O.P. Chobotar, N.V. Grankina

SI «National Institute of Phthisiology and Pulmonology named by F.G. Yanovsky of NAMS of Ukraine», Kyiv, Ukraine

Objective — better understanding of the composition of optimal treatment regimens for multidrug-resistant tuberculosis is essential for expanding universal access to effective treatment and for developing new therapies for MDR-TB.
We conducted this systematic review to determine and justify the optimal duration and the dosages of antituberculosis drugs for short multidrug-resistant tuberculosis regimen.
Materials and methods. Three electronic databases (MEDLINE, EMBASE and PubMed) were searched to identify observational study, including «cohort studies» and «follow-up studies», that included results of using short — ​regimen for multidrug resistant tuberculosis treatment. We found only 3 relevant studies for this review: 1st — ​«High effectiveness of a 12-month regimen for MDR-TB patients in Cameroon» («Cameroon» regimen); 2nd — ​«High cure rate with standardized short-course multidrug-resistant tuberculosis treatment in Niger: no relapses» («Niger» regimen); 3rd — ​«Successful “9-month Bangladesh regimen” for multidrug-resistant tuberculosis among over 500 consecutive patients» («Bangladesh» regimen). The studies have low clinical & methodological heterogeneity, that allows make veracious conclusions for the results of comparison.
Results and discussion. All three short — ​regimens had identical composition and quantity of ATDs, but different duration and ATDs dosages. There was no found statistically significant difference between high ATDs dosages of the 9 — ​months and convenient ATDs dosages of the 12-months short MDR-TB regimen. Combined OR for unfavorable outcomes is 0.77(95 % CI 0.48—1.25). Sampling error, I2 = 0 % (of 0 to 40 % is not important)
Conclusions. The 9 month «Bangladesh» regimen could be recommended (in addition — ​ATDs might be used in medium therapeutic doses for short-regimen) and this regimen reduce the health care burden.

Keywords: Multidrug resistant tuberculosis, short chemotherapy regimen, optimal ATDs dosages.

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10. Reviews


Immunological methods of diagnosis of tuberculosis (UKR)

.M. Rekalova, O.I. Belohortseva, N.G. Koval

SI «National Institute of Phthisiology and Pulmonology named after F.G. Yanovsky of NAMS of Ukraine», Kyiv, Ukraine

The review presents modern immunological methods for diagnosis of tuberculosis in patients. Listed short characteristics in vivo (skin test) and in vitro (cellular, serological tests) methods, the indications, contraindications, advantages, disadvantages. Emphasis is placed on the most recent diagnostic techniques. The new directions in researches are identified to develop new tests. The registered diagnostic serological tests determined for use in Ukraine.

Keywords: diagnostic methods, tuberculosis, immunological methods.

List of references:
1.    Aksenova VA, Baryshnikova LA, Klevno NI. Modern approaches to screening for tuberculosis infection in children and adolescents in Russia (Rus). Meditsinskiy sovet [Medical Council] (Rus). 2015;4:30-36.
2.    Gladkova SYe, Reshetnikov SS, Pryakhina VN. Opyt primeneniya test-sistemy «At-tub Best» dlya diagnostiki tuberkuleza [Experience of test systems, "Al-tubes Best" for the diagnosis of tuberculosis] (Rus). Meditsina i zdorov'ye [Medicine and health] (Rus). 2011;5(61):22-24.
3.    Kozhnaya proba s preparatom "Diaskintest» - ​novyye vozmozhnosti identifikatsii tuberkuleznoy infektsii: Monografiya dlya vrachey [Skin testing with the drug "Diaskintest" - ​new opportunities for identifying TB infection: This monograph for physicians] (Rus). Ed. Pal'tseva MA, Moscow: "Shiko"; 2011:44.
4.    Nakaz MOZ Ukrani vd 04.09.2014 620 "Pro zatverdzhennya ta vprovadzhennya mediko-tekhnologchnikh dokumentv z standartizats̈ medichnö dopomogi pri tuberkul'oz ": Tuberkul'oz. Adaptovana klnchna nastanova, zasnovana na dokazakh [Mandate of the Ministry of Health of Ukraine od 9.4.2014 N 620 “On approval and introduction of medical and technological documents for standardization of care in tuberculosis ": Tuberculosis. Adapted clinical guidelines based on evidence] (Ukr).:363. http://www.dec.gov.ua/mtd/_tyberk.html
5.    Ratsional'naya diagnostika i farmakoterapiya zabolevaniy organov dykhaniya [Rational Diagnosis and pharmacotherapy of respiratory diseases] (Rus). ds. YU Feshchenko, Kiev, «Bbloteka «Zdorov’ya Ukrani» [Library "Health Ukraine”](Ukr); 2013:572.
6.    Tuberkulez [Tuberculosis] [Electron resource] (Rus). WHO Fact Sheet, October 2016. Access mode: http://www.who.int/mediacentre/factsheets/fs104/ru/.
7.    Tuberkuloz v Ukrayini (Analitychno-statystychnyy dovidnyk) [Tuberculosis in Ukraine (Analytical and statistical handbook)] (Ukr): Ukr. tsentr kontrolyu za sotsialno nebezpechnymy khvorobamy MOZ Ukrayiny, Tsentr medychnoyi statystyky MOZ Ukrayiny [Eng. control center for the socially dangerous diseases Ministry of Health of Ukraine, Ministry of Health Center for Health Statistics of Ukraine] (Ukr). Kyiv: 2016:235.
8.    Feshchenko YU ta in. Zastosuvannya alerhenu tuberkuloznoho rekombinantnoho dlya diahnostyky tuberkuloznoyi infektsiyi u ditey [The use of recombinant allergen tuberculosis for diagnosis of tuberculosis infection in children] (Ukr). Sovremennaya pedyatryya [Modern Pediatrics] (Ukr). 2014;1:149-159.
9.    Feshchenko YU ta in. Zastosuvannya spetsyfichnykh vnutrishnoshkirnykh testiv dlya diahnostyky tuberkuloznoyi infektsiyi [Application specific intradermal test for diagnosis of tuberculosis infection] (Ukr). Ukr pulmonol Zhurn [Ukrainian pulmonological magazine]. (Ukr). 2013;4:61-67.
10.    Feshchenko YU ta in. Kontseptsiya reformuvannya protytuberkuloznoyi sluzhby ta optymizatsiyi protytuberkuloznykh zakhodiv v Ukrayini (proekt) [The concept of reforming the TB service and optimize TB management in Ukraine (draft)] (Ukr). Ukr pulmonol Zhurn [Ukrainian pulmonological magazine]. (Ukr). 2015; 1: 5-19.
11.    Feshchenko YU ta in. Osoblyvosti suchasnoyi sytuatsiyi z tuberkulozu v Ukrayini [Features of the current situation of tuberculosis in Ukraine] (Ukr). Ukr pulmonol Zhurn [Ukrainian pulmonological magazine]. (Ukr). 2016; 1: 5-9.
12.    Feshchenko YU ta in. Suchasni tendentsiyi vyvchennya problem tuberkulozu [Current trends study the problems of tuberculosis] (Ukr). [electronic resource]. Kyiv, NIFP; 2013: 54. Access mode: http://www.ifp.kiev.ua/doc/staff/naukday2013.pdf
13.    Anderson ST et al. Diagnosis of childhood tuberculosis and host RNA expression in Africa. N Engl J Med. 2014;370:1712-1723.
14.    Ben-Selma W, Boukadida J. Immunochromatographic IgG/IgM Test for Rapid Diagnosis of Active Tuberculosis [Text]. Clin Vaccine Immunol. 2011;18(12):2090-2094.
15.    Commercial serodiagnostic tests For diagnosis Of tuberculosis [Text]: Expert World Health Organization Group Meeting Report 22 July 2010, World Health Organization, 2011. 72 p. http://apps.who.int/iris/bitstream/10665/70684/1/WHO_HTM_TB_2011.14_eng.pdf.
16.    Feng TT et al. Novel monoclonal antibodies to ESAT‑6 and CFP‑10 antigens for ELISA-based diagnosis of pleural tuberculosis. Int J Tuberc Lung Dis. 2011;15(6):804-810.
17.    Guidelines on the management of latent tuberculosis infection. [ ]: 2015, WHO Library Cataloguing-in-Publication Data. 40 .: http://www.who.int/tb/challenges/ltbi/en.
18.    Jafari C et al. Bronchoalveolar lavage enzyme-linked immunospot for a rapid diagnosis of tuberculosis: a Tuberculosis Network European Trialsgroup study. Am J Respir Crit Care Med. 2009;180:666-673.
19.    Jafari C, Ernst M, Kalsdorf B, Lange C. Comparison of molecular and immunological methods for the rapid diagnosis of smear-negative tuberculosis. Int J Tuberc Lung Dis. 2013;17:1459-1465.
20.    John SH, Kenneth J, Gandhe AS. Host biomarkers of clinical relevance in tuberculosis: review of gene and protein expression studies. Biomarkers. 2012;17:1-8.
21.    Kaforou M et al. Detection of tuberculosis in HIV-infected and uninfected African adults using whole blood RNA expression signatures: a case–control study. PLoS Med. 2013;10:e1001538.
22.    Lawn SD et al. Urine lipoarabidomannan assay for tuberculosis screening before antiretroviral therapy diagnostic yield and association with immune reconstitution disease. AIDS. 2009;23(14):1875-1880.
23.    Lewinsohn DM et al. Diagnosis of Tuberculosis in Adults and Children. Clin Infect Dis. 2016:1-33. http://www.cdc.gov/tb/publications/guidelines/pdf/cid_ciw694_full.pdf.
24.    McHugh TD. Tuberculosis: Laboratory Diagnosis and Treatment Strategies (ed. TD McHugh): CAB International. 2013:283.
25.    McNerney R et al. New tuberculosis diagnostics and rollout. Int J Infect Dis. 2015;32:81-86.
26.    Pratomo IP, Setyanto DB. Diagnosing Tuberculosis using ESAT‑6 and CFP‑10 Antigen Complex. J Respir Indo. 2013;33(1):65-71.
27.    QuantiFERON®-TB Gold Plus (QFT®-Plus) ELISA Package Insert (02/2015): http://www.quantiferon.com/irm/content/PI/QFT/PLUS/2PK-Elisa/UK.pdf.
28.    Shah M et al. Diagnostic Accuracy of a Urine Lipoarabinomannan Test for Tuberculosis in ospitalized Patients in a High HIV Prevalence Setting. J Acquir Immune Defic Syndr. 2009;1(52) (2):145-151.
29.    Special Programme for Research Training in Tropical Diseases. Laboratorybased evaluation of 19 commercially available rapid diagnostic tests for tuberculosis [Text]: Geneva, Switzerland: World Health Organization; 2008.
30.    Steingart KR et al. Commercial serological tests for the diagnosis of active pulmonary and extrapulmonary tuberculosis: an updated systematic review and meta-analysis. PLoS Med. 2011;8:e1001062. http://dx.doi.org/10.1371/journal.pmed.
31.    Wallis RS et al. Biomarkers for tuberculosis disease activity, cure, and relapse. Lancet Infect Dis. 2010;10:68-69.
32.    Walzl G et al. Immunological biomarkers of tuberculosis. Nat Rev Immunol. 2011;11:343-354.
33.    WHO Guidelines for intensified tuberculosis case-finding and isoniazid preventive therapy for people living with HIV in resource-constrained settings, 2011: http://www.who.int/tb/publications/ICF_IPTguidelines/en.
34.    Woolfson A, Hales CN, Milstein C. SCD fingerprints. Medical Research Council, Addenbrookes NHS Trust, Cambridge University Technical Services Limited assignee; 2014. US 20140087481 A1.

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11. Lectures


Human immunodeficiency virus/human hepatitis C virus. Shift of paradigm? (RUS)

A.G. Dyachenko1, R.S. Efremin1, S.L. Grabovy2, V.N. Butenko2

1 Sumy State University, Sumy, Ukraine
2 Sumy Regional HIV/AIDS Prevention and Control Center, Sumy, Ukraine

Co-infection with the blood-borne hepatitis C Virus (HCV) and human immunodeficiency virus (HIV) is common due to their shared routes of transmission and the fact that individuals with HIV are at higher risk of contracting HCV. HCV prevalence in the general ukrainian population was estimated 4,2 %. However, in the HIV population, the prevalence of HCV/HIV co-infection has been reported 36.3 %. This population has long been considered a special risk population both in terms of disease progression and subsequent mortality, and in terms of their inferior responses to traditional HCV therapies. Although parenteral (injectable) route of transmission HCV prevails, we can emphasize about a paradigm shift in the spreadung of HCV-infection in HIV-infected. The review considered reasons for this shift and recent epidemiological data concerning HIV / HCV-co-infection in Ukraine and the world.

Keywords: HIV/HCV co-infection, epidemiology, transmission, high risk groups.

List of references:
1.    Form 2. Report on persons with HIV-related diseases. Ukrainian Center for control of socially dangerous diseases. Ministry of Health of Ukraine, 2016.
2.    Form 40. Report on the work of sanitary-epidemiological service. Ministry of Health of Ukraine, 2016.
3.    Bavinton BR, Jin F, Zablotska I t al. The Opposites Attract Study Team. Undetectable viral load is associated with increased unprotected anal intercourse in gay serodiscordant couples. Abstract MOLBPE 30. 7th IAS Conference on HIV Pathogenesis, Treatment and Prevention. Kuala Lumpur, Malaysia, 2013.
4.    Beyrer C, Baral SD, vanGriensven F et al. Global epidemiology of HIV infectionin men whohavesex withmen. Lancet. 2012;380 (9839):367-377.
5.    Branch AD, Van Natta ML, Vachon ML et al. Mortality in hepatitis C virus-infected patients with a diagnosis of AIDS in the era of combination antiretroviral therapy. Clin Infect Dis. 2012;55:137-144.
6.    Bruggmann P, Berg T, vrehus AL, Moreno C. Historical epidemiology of hepatitis Cvirus (HCV) inselectedcountries. J Viral Hepat. 2014;21(1):5-33.
7.    Danta M, Brown D, Bhagani S et al. Recent epidemic of acute hepatitis C virus in HIV-positive men who have sex with men linked to high-risk sexual behaviours. AIDS. 2007;21(8):983-991.
8.    Eyster ME et al. Heterosexual co-transmission of hepatitis C virus (HCV) and human immunodeficiency virus (HIV). Ann Intern Med. 1991;115:764-768.
9.    Fox J, Nastouli E, Thomson E et al. Increasing incidence of acute hepatitis C in individuals diagnosed with primary HIV in the United Kingdom. AIDS. 2008;22:666-668.
10.    Gambotti L, Batisse D, Colin-de-Verdiere N et al. Acute hepatitis C infection in HIV positive men who have sex with men in Paris, France, 2001-2004. Euro Surveill. 2005;10:115-117.
11.    Garten RJ et al. Rapid transmission of hepatitis C virus among young injecting heroin users in Southern China. Int J Epidemiol. 2004;33:182-188.
12.    Gerberding JL. Incidence and prevalence of human immunodeficiency virus, hepatitis B virus, hepatitis C virus, and cytomegalovirus among health care personnel at risk for blood exposure: finalreport from a longitudinal study. J Infect Dis. 1994;170:1410-1417.
13.    Giraudon I, Ruf M, Maguire H et al. Increasein diagnosednewlyacquiredhepatitis CinHIV-positive men whohave sex withmena cross Londonand Brighton, 2002-2006: isthisanout break? Sex Transm Infect. 2008;84:111-115.
14.    Hernando V, Alejos B, Monge S et al. All-cause mortality in the cohorts of the Spanish AIDS Research Network (RIS) compared with the general population: 1997-2010. BMC Infect Dis. 2013;13:382.
15.    Hershow RC et al. Increased vertical transmission of human immunodeficiency virus from hepatitis C virus-coinfected mothers. Women and Infants Transmission Study. J Infect Dis. 1997;176:414-420.
16.    Hua L, Andersen JW, Daar ES et al. Hepatitis Cvirus/HIV coinfection and response stoinitial antiretro viral treatment. AIDS. 2013;27:2725-2734.
17.    Kim AY, Chung RT. Coinfection with HIV‑1 and HCV-a one-two punch. Gastroenterology. 2009;137:795-814.
18.    Koziel MJ, Peters MG. Viral hepatitis in HIV infection. New Engl J Med. 2007;356:1445-1454.
19.    Lavanchy D. The global burden of hepatitis C. Liver Int. 2009;29(1):74-81. UNAIDS Global Report, 2013.
20.    Lieb S, Thompson DR, Misra S et al. Estimating population sofmenwhohave sex withmenint hesout hern United States. J Urban Health. 2009;86(6):887-901.
21.    Marine-Barjoan E et al. HCV/HIV co-infection, HCV viral load and mode of delivery: risk factors for mother-to-child transmission of hepatitis C virus? AIDS. 2007;21:1811-1815.
22.    Matthews GV, Pham ST, Hellard M et al. Patternsand characteristics of hepatitis Ctrans mission clusters among HIV-positive and HIV-negative individuals in the Australian trial in acute hepatitis C. Clin Infect Dis. 2011;52:803-811.
23.    Matthews PC, Geretti AM, Goulder PJ, Klenerman P. Epidemiologyan dimpactof HIV coinfection with hepatitis Bandhepatitis Cvirusesin Sub-Saharan Africa. J Clin Virol. 2014;61:20-33.
24.    Mc Faul K, Maghlaoui A, Nzuruba M et al. Acute hepatitis C infectionin HIV-negative men whohave sex withmen. J Viral Hepat. 2015;22:535-538.
25.    Nelson PK, Mathers BM, Cowie B et al. Global epidemiology of hepatitis Bandhepatitis Cinpeoplewhoin jectdrugs: results of systematic reviews. Lancet. 2011;378:571-583.
26.    Pasquier C, Bujan L, Daudin M et al. Intermittent detection of hepatitis Cvirus (HCV) in semen from men with human immunodeficiency virus type 1 (HIV‑1) and HCV. J Med Virol. 2003;69(3):344-349.
27.    Puoti M, Manno D, Nasta P, Carosi G. The burden of HIV and hepatitis C virus coinfection. Curr Opin HIV AIDS. 2007;6:460-465.
28.    Quan VM et al. Risks for HIV, HBV, and HCV infections among male injection drug users innorthern Vietnam: a case-control study. AIDS Care. 2009;21:7-16.
29.    Rauch A, Rickenbach M, Weber R et al. Unsafe sex and increased incidence of hepatitis C virus infection among HIV-infected men who have sex with men: the Swiss HIV Cohort Study. Clin Infect Dis. 2005;41:395-402.
30.    Rotman Y, Liang TJ. Coinfection with hepatitis C virus and human immunodeficiency virus: virological, immunological, and clinical outcomes. J Virol. 2009;83:7366-7374.
31.    Schmidt AJ, Rockstroh JK, Vogel M et al. Trouble with bleeding: risk factors for acute hepatitis C amongHIV-positive gay men from Germany - ​a case-control study. PLoS One. 2011;6(3):e17781.
32.    Serpaggi J, Chaix ML, Batisse D et al. Sexually transmitted acute infection with a clustered genotype 4 hepatitis C virus in HIV‑1-infected men and inefficacy of early antiviral therapy. AIDS. 2006;20:233-240.
33.    Sherman KE, Shire NJ, Rouster SD et al. Viral kinetics in hepatitis C or hepatitis C/human immunodeficiency virus-infected patients. Gastroenterol. 2005;128:313-327.
34.    Smith C et al. Factors associated with specific causes of death amongst HIV-positive individuals in the D: A: D Study. AIDS. 2010;24:1537-1548.
35.    Sulkowski MS, Thomas DL. Hepatitis C in the HIV-infected person. Ann Intern Med. 2003;138:197-207.
36.    Thomas D et al. Perinatal transmission of hepatitis C virus from human immunodeficiency virustype 1-infected mothers. Women and Infants Transmission Study. J Infect Dis. 1998;177:1480-1488.
37.    Urbanus AT, van de Laar TJ, Stolte IG et al. Hepatitis C virus infections among HIVinfected men who have sex with men: an expanding epidemic. AIDS. 2009;23:F1-7.
38.    Van de Laar TJ, van der Bij AK, Prins M et al. Increase in HCV incidence among men who have sex with men in Amsterdam most likely caused by sexual transmission. J Infect Dis. 2007;196(2):238.
39.    Van de Laar T, Pybus O, Bruisten S et al. Evidence of a large, international network of HCV transmission in HIV-positive men who have sex with men. Gastroenterol. 2009;136(5):1609-1617.
40.    Van de Laar TJ, Matthews GV, Prins M, Danta M. Acutehepatitis Cin HIV-infected men whohave sex withmen: anemerging sexually trans mitted infection. AIDS. 2010;24 (12):1799-1812.
41.    Van der Helm JJ, Prins M, del Amo J et al. The hepatitis C epidemic among HIV-positive MSM: incidence estimates from 1990 to 2007. AIDS. 2011;25:1083-1091.
42.    Vanhommerig JW, Stolte IG, Lambers FAE et al. Hepatitis C virus incidencein the Amsterdam cohort study among men who have sex with men: 1984-2011. 21st Conference on Retroviruses and Opportunistic Infections (CROI). Boston, MA, 2014. Abstract 673.
43.    Wandeler G, Rohrbach J, Metzner K et al. Incident HCV infections in the Swiss HIV Cohort study: natural history and treatment outcomes. 21st Conference on Retroviruses and Opportunistic Infections (CROI). Boston, MA, 2014. Abstract 643.
44.    Wandeler G, Gsponer T, Bregenzer A et al. Hepatitis C virusinfectionsin the Swiss HIV Cohort study: arapidlyevolving epidemic. Clin Infect Dis. 2012;55:1408-1416.
45.    Wiessing L, Likatavicius G, Hedrich D et al. Trendsin HIV and hepatitis C virusinfections amonginjectingdrugusersin Europe, 2005 to 2010. Euro Surveill. 2011:16.
46.    Witt MD, Seaberg EC, Darilay A et al. Incident hepatitis C virus infection in men who have sex with men: a prospective cohort analysis, 1984-2011. Clin Infect Dis. 2013;57:77-84.
47.    Yaphe S, Bozinoff N, Kyle R et al. Incidence of acute hepatitis C virus infection among men who have sex with men with and without HIV infection: asystematic review. Sex Transm Infect. 2012;88:558-564.

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12. Lectures


Mycobacteriosis (UKR)

O. D. Nikolaeva

P.L. Shupyk National Medical Academy of Postgraduate Education, Ministry of Healthare of Ukraine, Kyiv, Ukraine

The objective of publication — a wide range of general practitioners, pulmonologists and phthisiatricians insight into clinical aspects of mycobacteriosis, mainly affecting the lungs in the course of the different origin immunodeficiency. Diagnostics approach and treatment of mycobacteriosis is introduced as well as diagnostics and treatment capabilities today.

Keywords: mycobacteriosis, diagnostic procedure, differential diagnostics, treatment.

List of references:
1.    Litvinov VI, Makarova NV, Krasnova MA.Netuberkuleznye mikobakterii. M. MNPTsBT; 2008:256.
2.    Litvinov VI, Dorozhkova IR, Makarova MV, Krasnova MA, Freiman GE. Vydelenie i identi­fikatsiya netuberkuleznykh mikobakterii. Vestnik RAMN. 2010;3:7-11.
3.    Makarova MV. Vydelenie i identifikatsiya netuberkuleznykh mikobakterii u patsientov ftiziatricheskikh uchrezhdenii. Avtoref. diss. … dokt. med. nauk. M; 2010:48.
4.    Nakaz MOZ Ukrani vd 13.04.2010 Klnchnii protokol «Dagnostika ta lkuvannya opor­tunstichnikh nfektsi  zagal’nikh simptomv u VL-nfkovanikh doroslikh ta pdltkv»:42.
5.    Opredelitel’ bakterii Berdzhi.-9-e izd;2. — ​Per. s angl. Pod redak. Dzh Khoulta, N Kriga, P Snita, Dzh Steili, S Uill’yamsa. — ​M.: Mir; 1997:800.
6. Otten TF, Vasil’ev AV. Mikobakterioz. ​SPb: Meditsinskaya pressa; 2005:224.
7. Otten TF. Mikobakterioz legkikh: kliniko-bakteriologicheskie kriterii diagnostiki. BTsZh o tub. 1999;3:17-19.
8. Otten TF, Solov’eva NS, Vishnevskii BI. Chuv­stvitel’nost’ k levofloksatsinu razlichnykh vidov netuberkuleznykh mikobakterii. Antibiot. i khimioter. 2002;47(6):34-37.
9. Ballarino GJ, Olivier KN, Claypool RJ et al. Pulmonary nontuberculous mycobacterial infections: antibiotic treatment and associated cost. Respir. Med. 2009;103. ​N 10:1448-1455. — Doi: 10.1183/09031936.00055010. Epub 2010 Sep 3.PMID:20817704
10. Billinger ME, Olivier KN, Viboud C et al. Nontuberculous mycobacteria-associated lung disease in hospitalized persons, United States, 1998-2005. Emerg Infect Dis. 2009;15:1562-1569. ​Doi: 10.3201/eid1510.090196.
11.    Brown BA, Wallace RJ, Onyi GO, De Rosa V, Wallace RJ. III. Activities of four macrolides, including clarithromycin, against Mycobacterium fortuitum, Mycobacterium chelonae, and Mycobacterium cfce/onae-like organisms. Antimicrob Agents Chemother 1992;36:180-184.
12.    Daley CL, Griffith DE. Pulmonary non-tuberculous mycobacterial infections. Int J Tuberc Lung Dis. 2010;14(6):665-671.
13.    David L, Heyman . Diseases due to other mycobacteria. — ​Washington: American Public Health Association.2004:572-573.
14.    Griffith DE, Aksamit T., Brown-Elliott BA et al. An official ATS/IDSA statement: diagnosis, treatment, and prevention of nontuberculous mycobacterial diseases. Am J Respir Crit Care Med. 2007;175:367-416.
15.    Good RC. From the Center for Disease Control. Isolation of nontuberculous mycobacteria in the United States, 1979. J Infect Dis. 1980;142:779-783.
16. Griffith DE, Brown-Elliott BA, Langsjoen B, et al. Clinical and molecular analysis of macrolide resistance in Mycobacterium avium complex lung disease. Am J Respir Crit Care Med. 2006;174:928-934.
17. Hoefsloot W, van Ingen J, de Eange WC, Dekhuijzen PN, Boerce MJ, van Soolingen D. Cli­nical relevance of Mycobacterium malmoense isolation in The Netherlands. Eur Respir J.2009;34:926-931. ​Doi:10.1183/09031936.00039009.
18. Jenkins PA, Campbell IA, Banks J, Gelder CM, Prescott RJ, Smith AP. Clarithromycin vs cipro­floxacin as adjuncts to rifampicin and ethambutol in treating opportunist mycobacterial lung diseases and an assessment of Mycobacterium vaccae immunotherapy. Thorax. 2008;63:627-634. ​Doi: 10.1136/thx.2007.087999.
19. Jun HJ, Lee NY, Kim J, Koh WJ. Successful treatment of Mycobacterium celatum pulmonary disease in an immunocompetent patient using antimicobacterial chemotherapy and combined pulmonary resection. Yonsei Med J. 2010;51(6):980-983. Doi: 10.3349/ymj.2010.51.6.980.
20. Kawahara S, Taba A, Nagara H. Comparison of in vitro antimicrobial activities of ofloxacin, levofloxacin, ciprofloxacin and sparfloxacin agents varios mycobacteria. Kekakku. 2000;76(4):357-362.
21. Koh WJ, Kwon OJ, Jeon K et al. Clinical significance of non-tuberculous mycobacteria isolated from respiratory specimens in Korea. Chest. 2006;129:341-348.
22. Koh WJ, Kim YH, Kwon OJ et al. Surgical treatment of pulmonary diseases due to nontu­berculous mycobacteria. J Korean Med Sci. 2008;23(3):397-401.
23. Marras TK, Daley CL. Epidemiology of human pulmonary infection with nontuberculous mycobacteria. Clin Chest Med.2002;23:553-567.
24. McGrath EE, Anderson PB. The therapeutic approach to non-tuberculous mycobacterial infec­tion of the lung. Department of Respiratory Medicine, Northern General Hospital, Sheffield, UK. 2010;23(5):389-396.
25. Mitchell JD, Bishop A, Cffaro A et al. Anatomic lung resection for nontuberculous mycobacterial disease. Ann Thorac Surg. 2008;85(6):1887-1892. ​Doi: 10.1016/j.athoracsur.2008.02.041.PMID:18498789.
26. Nash KA, Brown-Elliott BA, Wallace RJ. A novel gene, erm(41), confers inducible macrolide resistance to clinical isolates of Mycobacterium abscessus but is absent from Mycobacterium chelonae. Antimicrob Agents Chemother. 2009;53:1367-1376. Doi: 10.1128/AAC.01275-08. Epub 2009 Jan 26.
27. Ntziora F, Falagas ME. Linezolid for the treatment of patients with mycobacterial infections: a systematic review. Int J Tuberc Lung Dis 2007;11:606-611.
28. Park S, Suh GY, Chung MP et al. Clinical significance of Mycobacterium fortuitum isolated from respiratory specimens. Respir Med. 2008;102:437-442.
29. van Ingen J, Boeree MJ, de Lange WC, de Haas PE, Dekhuijzen PN, van Soolingen D. Clinical relevance of Mycobacterium szulgai in The Netherlands. Clin Infect Dis. 2008;46:1200-1205. Doi: 10.1183/09031936.00039009.
30. van Ingen J, de Zwaan R, Dekhuijzen RP, Boeree MJ, van Soolingen D. Clinical relevance of Mycobacterium chelonae-abscessus group isolation in 95 patients. J Infect. 2009;59:324-331. Doi: 10.1016/j.jinf.2009.08.016.

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13. epidemic situation


Pulmonary tuberculosis mortality, ts dynamics, structure and regional specifics before and during epidemic (UKR)

L.V. Veselovskiy

SI «National Institute of Phthisiology and Pulmonology named after F.G. Yanovsky of NAMS of Ukraine», Kyiv, Ukraine

Objective — ​to study the dynamics, structure and regional characteristics of mortality from pulmonary tuberculosis in Ukraine before and during the epidemic.
Materials and methods. In this work official statistical reports of medioprophilactic institutions in the tuberculosis control for the years 1985—2013 are analyzed, the materials of analytical and statistical reference books about tuberculosis in Ukraine for the years 1985—2014 that were published by the Health Ministry of Ukraine and Center for Health Statistics of Health Ministry and official publications of State Statistics Committee of Ukraine are used (http://www.ukrstat.gov.ua/).
Results and discussion. To implement the research an observation of  the 29-year duration was taken (1985—2013) that was divided into three periods and two phases: period (1985—1989) — ​preepidemic period; I period (1990—1994) — ​the period of epidemic precursors; period (1995—2013) — ​epidemic period. It was divided into two phases: phase (1995—2005) — ​the phase of TB epidemic progression; B phase (2006—2013) — ​the phase of TB epidemic stabilization. During the period of TB epidemic the mortality of patients with pulmonary tuberculosis increased, both urban and rural areas, the number of deaths in younger age groups, men increased too. Increased the number of dead at home, before 1 year of observation, the bacteria dischargers, from fibro-cavernous, disseminated, miliary, generalized, HIV/AIDS-associated, resistant tuberculosis, caseous pneumonia, and more in the south-eastern region, and before 1 year of observation — ​in the south-central region.
Conclusions. In this work the theoretical generalization of statistical mortality on pulmonary tuberculosis in Ukraine, its dynamics, structure in different regions of Ukraine during the epidemic period in comparison with preepidemic period are shown. All of this information need to be studied and organizational arrangements must be developed for solving the main scientific-practical problem of phthisiology — ​to reduce mortality in patients with pulmonary tuberculosis.

Keywords: tuberculosis, epidemiology, morbidity, mortality, Ukraine.

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