Destructive Tuberculosis Research Articles

Effectiveness of Surgical Treatment of Patients with Destructive Pulmonary Tuberculosis (Meta-Analysis)

The objective: to study effectiveness of surgical methods for treatment of various forms of destructive pulmonary tuberculosis (meta-analysis).Subjects and Methods. A systematic search was performed in electronic bibliographic databases, including PubMed and Google Scholar. Cohort studies published from January 1, 2019 to June 20, 2023 were selected, those studies were aimed to assess effectiveness of surgical treatment in patients with destructive tuberculosis using resections of various volume. For meta-analysis, 9 studies published in 2019 - 2023 were selected.Results. The effectiveness of comprehensive treatment with resections of various volume in destructive pulmonary tuberculosis patients made 85.3%. The success of surgical treatment in patients with fibrous cavernous pulmonary tuberculosis was somewhat less – 80.3%. At the same time, the incidence of postoperative complications in patients with fibrous cavernous pulmonary tuberculosis was higher and could reach 42.5%, while in the group patients with destructive tuberculosis, it was 27.3%. Some postoperative complications required repeated operations. The ratio of surgeries to patients was the following: 3263 surgical interventions per 1564 patients (average 2.08 surgeries per patient). Hospital lethality among patients with fibrous cavernous pulmonary tuberculosis after surgical treatment was 2.6%, and tuberculosis mortality within 5 years after surgery was 4.8%. The relapse rate among patients with fibrous cavernous pulmonary tuberculosis after surgical treatment was 7.1%.

Indications for Extrapleural Thoracoplasty in HIV-Positive Patients with Destructive Pulmonary Tuberculosis

The objective: to specify indications for extrapleural thoracoplasty in patients with destructive pulmonary tuberculosis and comorbid HIV infection.Subjects and Methods. Results of surgical treatment of 78 destructive pulmonary tuberculosis patients were studied. Those patients underwent extrapleural thoracoplasty in Pulmonary Tuberculosis Surgery Unit of City Tuberculosis Hospital No. 2 in St. Petersburg from 2009 to 2022.Results. The article clarifies the indications for extrapleural thoracoplasty in patients with destructive pulmonary tuberculosis and comorbid HIV infection, in whom contraindications to pulmonary resections have been identified. Medical records of 78 patients with destructive tuberculosis were retrospectively analyzed, the patients were divided into two groups according to their HIV status. It has been established that with combination of adequate preoperative preparation and postoperative management, rational anti-tuberculosis chemotherapy and ART, extrapleural thoracoplasty for HIV-positive patients can be performed in accordance with general practice.

Dynamics of ventilation parameters in patients with bilateral destructive tuberculosis after staged surgical treatment using extrapleural pneumolysis with silicone plombage.

AimTo study the dynamics of respiratory function indicators in patients with bilateral widespread destructive tuberculosis during staged surgeryt using extrapleural pneumolysis with silicone plombageon the side of the smallest lesion
 Material and methods.The main group consisted of 14 patients with widespread bilateral destructive tuberculosis who underwent extrapleural pneumolysis with silicone plombage (ESP) in combination with lung resection on the opposite side. The control group included 29 patients who underwent lung resection operations on both sides. All patients underwent spirometry before and 3-5 weeks after each stage of surgery: FVC (functional vital capacity of the lungs) and FEV1 (volume of forced exhalation in 1 second) were determined.
 Results.The dynamics of the spirometric study after staged surgery in the ESP group was a decrease in FVC by 1.050.47, FEV1 by 0.950.6 l, and in the comparison group by 1.740.76 l and 1.330.5 l, respectively (p0.05).
 Conclusion.Staged surgery with the use of ESP is accompanied by a significantly smaller decrease in functional parameters and can be used in patients with widespread bilateral destructive tuberculosis with low respiratory function.

Dynamics of respiratory indicators in patients with bilateral destructive tuberculosis after surgical treatment using staged bilateral extrapleural pneumolysis with silicone plombage

Introduce. Patients with a high prevalence of the process and extensive destruction of the pulmonary parenchyma have reduced lung reserves, which limits the use of resection interventions.Objective. To study the dynamics of respiratory function indicators in patients with bilateral widespread destructive tuberculosis during surgical treatment using staged bilateral extrapleural pneumolysis with silicone plombage (ESP).Object and methods. The main group consisted of 11 patients who underwent surgical treatment using staged bilateral ESP. The comparison group included 8 patients with bilateral widespread destructive pulmonary tuberculosis who underwent consecutive bilateral lung resections with a volume of more than 3 segments. The dynamics of respiratory function indicators were studied 3–5 weeks after surgery.Results. In the main group, after stage-by-stage surgical treatment, the FVC index decreased by 0.9 ± 0.6 liters, while in the comparison group by 1.3 ± 0.7 liters (p < 0.01). The index of FEV1 in patients of the main group decreased by 0.5 ± 0.5 liters, and in the comparison group by1 ± 0.3 liters (p < 0.01).Conclusion. Staged surgical treatment with the use of bilateral ESP is accompanied by a significantly smaller decrease in functional parameters and can be used in patients with widespread bilateral destructive tuberculosis with low respiratory function.

Complex treatment of destructive pulmonary tuberculosis using inhaled tauractant therapy

Introduction. Chemotherapy is the main component used in the treatment of tuberculosis. In addition to chemotherapy, pathogenetic treatment holds a special place in the complex treatment. The inhaled tauractant therapy restores phospholipid content on the surface of the alveolar epithelium, stimulates the involvement of additional lung parenchyma areas in breathing, facilitates elimination of toxic substances together with sputum from the alveolar space and protects the alveolar epithelium against injury caused by chemical and physical agents. Thereby it promotes acceleration of the lung parenchyma recovery processes.Aim. To study the experience of using Surfactant-BL in patients with destructive pulmonary tuberculosis receiving a standard chemotherapy regimen, taking into account the drug susceptibility for Mycobacterium tuberculosis.Materials and methods. A study was conducted involving 10 patients with destructive pulmonary tuberculosis who were diagnosed with it for the first time in their lives. They received treatment in Respiratory Tuberculosis Patients Department No. 4 of the Budgetary Healthcare Institution of Omsk Region – Clinical TB Dispensary in 2022–2023.Results. Tauractant showed a pronounced positive effect on the destructive tuberculosis process in patients who already received a standard chemotherapy regimen. Inhaled therapy promoted acceleration of the cavity closure.Conclusion. The addition of inhaled tauractant therapy to the standard chemotherapy regimen in patients with multidrug resistance (MDR) and pre-extensively drug-resistant (pre-XDR) respiratory TB significantly accelerated the TB cavity closure. The severity of intoxication and respiratory syndrome decreased in terms of clinical symptoms (relief of shortness of breath and cough). Spirography showed an increase in major indices of the pulmonary function test monitored at 2and 4-month follow-up.

Effect of extrapleural silicone filling on lung function in patients with bilateral destructive tuberculosis

BACKGROUND: Despite the success of the fight against tuberculosis, the proportion of patients with multidrug- and extensively drug-resistant pathogens continues to grow. According to the World Health Organization, the effectiveness of treating patients with multidrug- and extensively drug-resistant mycobacterium tuberculosis (MBT) worldwide is 48% and 34%, respectively. The lack of efficiency of chemotherapy in this category of patients leads to complex surgical treatment of tuberculosis.
 AIM: To investigate the effect of surgery on respiratory function of staged surgical treatment with extrapleural silicone filling (ESF) in patients with bilateral destructive pulmonary tuberculosis.
 METHODS: From 2012 to 2022, extrapleural pneumolysis with silicone implant filling in combination with lung resection on the opposite side was performed in 14 patients with extensive bilateral destructive tuberculosis. The control group included 29 patients who underwent lung resection on both sides. The groups were comparable in terms of sex, age, form of the underlying disease, and spectrum of MBT drug sensitivity. External respiratory function was studied by forced spirometry on Master Screen Pneumon devices by Viasys Healthcare with determination of forced volume vital capacity (FVVC) and forced expiratory volume per 1 s (FEF1).
 RESULTS: The dynamics of spirometric parameters after surgical treatment were as follows: FVVC was 1.050.47 and 1.740.76 liters (p 0.05), and SPH1 was 0.950.6 and 1.330.5 liters (p 0.05) in the ESF group and in the resection group, respectively. In the main group 10 (70%) patients showed diverse changes of the ventilatory function. Thus, 5/14 (35%) patients had worsening, whereas 5/14 (35%) patients had increased functional indices. In the main group, the decrease in respiratory indices was significantly lower compared with the control group, indicating the effectiveness of the proposed technique. Staged surgical treatment with both bilateral consecutive resections and the use of ESF in combination with resection on the opposite side was accompanied by a decrease in pulmonary ventilatory function. In the group of ESF patients, a moderate decrease in the indices was observed.
 CONCLUSIONS: When choosing surgical treatment using extrapleural pneumolysis with silicone implant filling, ESF should be performed at the first stage to preserve the maximum ventilatory function of the lungs. The use of ESF in staged surgical treatment of patients with extensive destructive tuberculosis allows expanding the functional operability of patients with limited respiratory reserves.

Clinical example of effective treatment of a patient with a combination of fibrous-cavernous tuberculosis and chronic aspergillosis of the right lung

ntroduction. The combination of destructive tuberculosis and chronic pulmonary aspergillosis remains a pressing and understudied problem. Respiratory tuberculosis is a significant risk factor for bronchopulmonary aspergillosis in 40–72% of cases. The current treatment strategy for pulmonary tuberculosis and bronchopulmonary aspergillosis is governed by clinical guidelines. However, the issues of surgical treatment tactics in complicated forms of the combination of active tuberculosis and pulmonary aspergillosis require discussion and remain relevant at present. Material and methods. A clinical case of complex treatment of a patient with a combination of fibrous-cavernous tuberculosis and chronic aspergillosis of the right lung is described. Patient S., 42 years old, became ill with infiltrative tuberculosis of the right lung in August 2008. On the background of a 9-month anti-tuberculosis chemotherapy according to the I regimen she was cured and in 2012 was removed from the dispensary registration. In February 2018, an episode of pulmonary hemorrhage (volume 200 ml) occurred, and was stopped by conservative methods. At the follow-up examination, tuberculosis recurrence was verified in the right lung with the formation of fibrous-cavernous lesion. On the background of the repeated 6-month course of treatment according to the I regimen no dynamics was obtained, pulmonary hemorrhage of the Ia stage recurred regularly. In September 2018, the patient was hospitalized to SPb NIIF. Pre-examination revealed chronic pulmonary aspergillosis. Voriconazole therapy was started, and correction of the ongoing antituberculosis therapy was carried out, taking into account drug interaction. Surgical treatment was indicated. Results. On 09.25.2018, an upper bilobectomy was performed on the right side. There were no intraoperative complications. The operation was completed by draining the pleural cavity with two drains and suturing the thoracotomy wound. Postoperative period without complications. In order to correct the volume of hemithorax, an artificial pneumoperitoneum of 1000 ml was applied. The drains were removed on the 4thand 5th days after surgery, the surgical wound healed by primary tension. At the follow-up examination after five years, there was no evidence of disease recurrence or late surgical complications. Conclusion. Providing medical care to patients with a combination of tuberculosis and pulmonary aspergillosis requires the organization of full-fledged primary diagnosis and routing of patients to a specialized hospital. A complex approach to treatment allows for successful treatment outcomes with minimal risks.

Reduction of the risk of bronchopleural complications after pneumonectomy due to the use of intraoperative laser treatment of the stump of the main bronchus

Purpose of the study: due to the intraoperative technique of treating the stump of the main bronchus with a high-energy laser LSP-30 during pneumonectomy, to increase the effectiveness of the treatment of patients with destructive widespread pulmonary tuberculosis.Materials and methods. The results of treatment of 112 patients were analyzed. All patients underwent lung removal due to widespread destructive tuberculosis. Patients were divided into main and control groups. The first group, the main one, consisted of 58 patients selected prospectively with a high risk of bronchopleural complications, of which 63.8% (n = 37) of patients had signs of hemoptysis and episodes of pulmonary hemorrhage, which required urgent and sometimes emergency surgical intervention. In 36.2% (n = 21) of patients, limited empyema of the pleural cavity without bronchopleural fistulas was determined radiographically. All patients of the main group after the stage of lung removal before the formation of a stump, the mucosa of the main bronchus was irradiated with a high-energy laser LSP-30 with a wavelength of 930 nm. 54 patients of the control group, selected retrospectively, in whom the course of the fibroticcavernous tuberculosis passed without complications and the HA stump after pneumonectomy was formed without the use of laser irradiation. There were no endoscopic signs of active tuberculous inflammation of the tracheobronchial tree in patients of both groups. A number of patients, in the main group in 5.2% (n = 3) and in the control group in 3.7% (n = 2), showed signs of scarring of the bronchus after tuberculosis. These patients, as part of preoperative preparation, underwent endoscopic biopsy of the main bronchus mucosa in the scar areas, and only after histological confirmation of the absence of active tuberculous inflammation, pneumonectomy was performed.Results. Pronounced post-thoracotomy pain syndrome in 5.2% (n = 3) of patients in the main group and in 9.3% (n = 5) of patients in the control group, for the relief of which narcotic analgesics were used for a long time. Progression of respiratory insufficiency, as a result of accession of nonspecific pneumonia of the only lung in 5.2% (n = 3) of patients of the main group and in 7.4% (n = 4) of patients of the control group, which was resolved by additional resuscitation and avoided mortality. Formation of residual pleural cavity on days 7–21 of the postoperative period in 6.9% (n = 4) of patients in the main group and in 1.8% (n = 1) of patients in the control group in the apex of the hemithorax, which required several sessions of thoracocentesis for the complete elimination of residual pleural cavity. The formation of a pulmonary hernia and the displacement of the mediastinal organs towards fibrothorax, in 5.2% (n = 3) of patients in the main group and in 1.8% (n = 1) in patients of the control group, this complication is the main manifestation of postpneumonectomy syndrome. Progression of tuberculosis in the only lung in 5.2% (n = 3) of patients of the main group and 3.7% (n = 2) of patients in the control group. This complication was revealed radiographically, despite the anti-tuberculosis therapy carried out in the postoperative period in accordance with the sensitivity of Mycobacterium tuberculosis, identified from the surgical material. Intrapleural bleeding in the early postoperative period was detected in 3.7% (n = 2) of patients in the control group, and no such cases were detected in the main group. All cases of intrapleural bleeding in the control group were urgently stopped.Conclusions. The effectiveness of surgical treatment of patients with widespread destructive pulmonary tuberculosis in the volume of pneumonectomy using intraoperative laser treatment of the mucosa of the main bronchus was 98.3%, while in the control group, where the intraoperative technique was not used, it was significantly lower – 87.1% (p < 0.01). A high percentage of cases of histological detection of an inflammatory process on the resection line is a scientifically substantiated confirmation of the need for intraoperative laser treatment of the main bronchus mucosa by the proposed method in patients with widespread destructive tuberculosis during pneumonectomy.

Peranan Sel Sistem Imun Alamiah Pada Infeksi Mycobacterium tuberculosis

Mycobacterium tuberculosis infection which causes tuberculosis is still a major health problem worldwide due to high morbidity and mortality, where in 2018 tuberculosis caused 1.5 million deaths. The degree of pulmonary tuberculosis varies from mild infiltration, chronic infection, cavity formation to severe and destructive tuberculosis. The difference in the degree of pulmonary tuberculosis is influenced by the response of the immune system to M. tuberculosis. When M. tuberculosis infects the lungs, the human immune system will carry out a series of processes to limit the spread and replication of bacteria. The immune system against M. tuberculosis consists of an innate immune system involving cellular components such as macrophages, neutrophils, Natural Killer (NK cells), dendritic cells and upper respiratory epithelium and an acquired immune response which is mainly mediated by T lymphocyte cells of host that is responsible for recognizing and controlling invasion by pathogens. This review will describe the role of natural immune system cells in M. tuberculosis infection. In addition, a complete description of M. tuberculosis infection will also be discussed to increase understanding of the role of natural immune system cells in M. tuberculosis infection.

ОПЫТ ПРИМЕНЕНИЯ СУРФАКТАНТА В ЛЕЧЕНИИ БОЛЬНЫХ ТУБЕРКУЛЕЗОМ ЛЕГКИХ

The experience of using the inhaled drug Surfactant-BL in patients with tuberculosis of the respiratory organs on the background of standard chemotherapy is presented, taking into account the drug sensitivity of Mycobacterium tuberculosis. The epidemic situation of tuberculosis in the Republic of Sakha (Yakutia) has positive trends: the incidence rate of tuberculosis has decreased by 1.6 times, amounting to 28.6 per 100,000 population in 2021; the prevalence of tuberculosis in the republic in 2021 reached 56.2 per 100,000 population (-34.8 % compared to 2019). Despite the decrease in tuberculosis bacillarity (by 1.5 times compared to 2019), the multidrug resistance (MDR) of the pathogen continues to remain at a fairly high level, amounting to 29.5 % – 31.7 %. Patients are prescribed chemotherapy with 5 anti-TB drugs, against the background of which inhalation of surfactant significantly facilitates sputum discharge, and therefore contributes to the rehabilitation of decay cavities, accelerates the disappearance of symptoms of tuberculosis intoxication.The article presents two clinical cases, demonstrating the effectiveness of complex therapy in a patient with newly diagnosed destructive tuberculosis of the respiratory system and a patient with diagnosed mycobacteriosis.

Evolution of the destructive tuberculosis in children

The aim of the study was to evaluate the outcome of pulmonary tuberculosis with lung destruction in children. Material and methods: a retrospective, selective, analytical research was performed, which included 43 children with tuberculosis. Results: the most frequently affected were girls 25 (58.1%) and the age group between 15 and 18 years 34 (79.1%) cases.. Every second child was in tuberculous contact, 41.9% were actively detected and passively 22 (52.4%) cases, even if all patients were symptomatic. Infiltrative tuberculosis predominated, in equally proportion was extended and limited, in most patients with unilateral localization, and with dissemination. Microscopic positive were 20 (46.5%) cases, GeneXpert MTB / Rif positive 30 (69.8%) cases, including resistant in 9 (20.9%) cases. Therapeutic success was registered in 30 (69.8%) cases, 2 (4.7%) cases were lost to follow-up, continued treatment with TB RR/MDR 11 (25.6%) children. Conclusions: destructive pulmonary tuberculosis evolves with unsatisfactory therapeutic results, due to the association with epidemiological risk factors, passive detection, extensive localization and bronchogenic dissemination.

Pathogenetic role of tumor necrosis factor (TNF-α) for the development of peritoneal tuberculosis in an experiment

Currently tuberculosis is considered as a group of diseases united by one etiological factor. The pathogenesis of certain localizations of tuberculous inflammation, in particular peritoneum tuberculosis, hasn’t been sufficiently studied. The role of cytokine mechanisms in the development of the disease and the elaboration of non-sterile immunity requires further experimental studies, in particular the creation of a reproducible model on laboratory animals.The aim: to study the effect of TNF-α on the development of tuberculosis of the serous coat of the abdominal cavity, as well as to evaluate the possibility of modeling tuberculous peritonitis in laboratory animals using infliximab.Materials and methods. The studies were conducted on 18 male rabbits, which were simulated peritoneal tuberculosis by intra-abdominal administration of a suspension of Mycobacterium tuberculosis. 10 rabbits of the experimental group were intravenously injected with an infliximab solution and an iron (III) hydroxide sucrose complex intraperitoneally a day before infection.Results. In the control group of animals, tuberculosis either didn’t develop, or in a third of cases it affected only the pulmonary parenchyma, while proliferative processes prevailed. On the contrary, in animals with inactivated TNF-α, in 100 % of observations, tuberculous peritonitis was detected with associated lung damage and the predominance of alterative caseous processes.Conclusion. The created model of tuberculous peritonitis shows the leading role of TNF-α in the activation of macrophages, as well as in attracting cells to the site of infection. This is the primary signal necessary for the formation and stability of granulomas since the neutralization of this cytokine leads to a loss of control over the infection and the destruction of the granuloma with the development of destructive tuberculosis in the serous coat of the abdominal cavity.

Immunity indicators in tuberculosis patients with diabetes mellitus and autoimmune thyroiditis

Objective — to study the parameters of immunity in tuberculosis with diabetes mellitus and with subclinical hypothyroidism against the background of autoimmune thyroiditis. 
 Materials and methods. 60 patients with pulmonary tuberculosis and diabetes mellitus were under observation. In 30 patients with destructive tuberculosis and diabetes mellitus against the background of autoimmune thyroiditis with subclinical hypothyroidism, the parameters of humoral and cellular immunity were studied. The control group consisted of 30 patients with destructive tuberculosis and diabetes mellitus with intact structure and function of the thyroid gland. In patients of both groups, we assessed the state of T- and B-systems of immunity, natural killers. 
 Results and discussion. The phenotyping of lymphocytes was carried out and the relative content of T-cells was determined: CD3+, T-helpers (CD4+), cytotoxic T-cells, B-lymphocytes (CD19+) and natural killer cells (CD16+). Using the enzyme immunoassay, the cytokine profile was determined: the levels of tumor necrosis factor-α, interferon-γ, interleukin-2, -6 and -4. It has been established that in patients with diabetes mellitus, both cellular and humoral immunity are suppressed. But a significantly more significant suppression of immunity was diagnosed in patients with tuberculosis against the background of diabetes mellitus and autoimmune thyroiditis with subclinical hypothyroidism. 
 Conclusions. According to the authors, it is the deficiency of thyroid hormones that is the negative effect of a more significant suppression of immunity in patients autoimmune thyroiditis with subclinical hypothyroidism.

Phlegmon of retroperitoneal tissue as a complication of cavernous renal tuberculosis

Cellulitis of the retroperitoneal tissue is a rare complication of destructive tuberculosis of the kidney. The clinical picture of the disease is characterized by the absence of characteristic symptoms, which causes certain difficulties in determining the tactics and timeliness of surgical treatment. A clinical case of newly diagnosed cavernous renal tuberculosis complicated by phlegmonous tissue of the retroperitoneal space in an elderly patient with severe comorbid pathology is presented.

Surgical collapse in the treatment of single lung tuberculosis

To improve the treatment of destructive tuberculosis of a single lung by using of collapse surgery. The authors analyzed an experience of collapse surgery for destructive tuberculosis of a single lung. Collapse surgery was effective in 77.5% of patients. Endoscopic surgical collapse improves the outcomes in patients with destructive tuberculosis of a single lung and expands the possibilities for surgery in these patients when resection is not applicable.

Clinical cases of management and treatment of women with chemoresistant tuberculosis during pregnancy

Importance of chemoresistant tuberculosis (CRTB) is undoubted both in Ukraine and all over the world. Especially alarming fact is that together with high CRTB sickness rate among young working-age people there is the low efficiency of therapy (55 %). Data of many researchers show, that tuberculosis of pregnant women is the reason of many significant complications which make serious maternal and perinatal danger. The problem of CRTB for pregnant woman is especially dangerous because the patient should take antimycobacterial drugs of II grade for a long period and these drugs have teratogenic effect.Purpose. Familiarization of physician-practitioners with the clinical features of the course and treatment of CRTB in women during pregnancy.Materials and methods. 4 clinical cases of own observations of the course and treatment of CRTB in women during pregnancy were described.Results. Among our investigations the artificial termination of pregnancy was inevitable in 3 of 4 presented clinical cases. The first patient had tubal pregnancy. The second patient: together with medical indications for artificial termination of pregnancy (multiresistant tuberculosis, unstable position of fetus), the absence of the patient’s tendency for treatment of multiresistant tuberculosis and problem social factor were observed. The patient informed that pregnancy was undesirable. The third patient had polyresistant tuberculosis and generalized destructive tuberculosis in lungs and besides the artificial termination of pregnancy was also her decision. The fourth patient had medical indications for artificial termination of pregnancy (multiresistant tuberculosis, negative clinical and radiological dynamics) but she refused. With regard to refusal antimicrobial therapy was corrected and aminoglycosides were excluded. The patient was responsible as to her own health and treatment of multiresistant tuberculosis. Under complex simultaneous control of phthisiatrician, obstetrician-gynecologist and neonatologist she terminated complete course of antimicrobial therapy with successful treatment result and gave birth to healthy baby.Conclusions. Summarizing our own observations of the pregnant patients with CRTB the following conclusion can be made: if patients with CRTB have tendency to antimicrobial therapy and desire to give birth the positive results such as CRTB treatment and delivery of healthy baby will be obtained under complex simultaneous control of phthisiatrician, obstetrician-gynecologist and neonatologist.

Changes of the pro-hormone levels of vitamin D 25(OH)D in patients with newly diagnosed pulmonary tuberculosis treatment failure

In Ukraine the number of patients with newly diagnosed tuberculosis (NDTB) who successfully complete the course of treatment reaches 60–65 % today. This is while the World Health Organization (WHO) criteria for successful treatment of this category of patients is 85 %. Scientists around the world are studying the possible pathogenetic factors of treatment failure of antimycobacterial therapy in patients with tuberculosis. Nowadays, the impact of vitamin D has been widely studied in this area. Studying of the dynamics of this indicator in patients with NDTB with widespread destructive tuberculosis in the lungs and bacterial excretion with the purpose of finding new markers of progression of a specific process and failure of treatment, as well as finding possible ways of additional pathogenetic therapy to accompany patients is actual. This approach will prevent treatment failure and, as a consequence, improve treatment efficiency.Purpose. To determine changes in the pro-hormone levels of vitamin D 25(OH)D in patients with NDTB treatment failure during the intensive phase of antimycobacterial therapy.Materials and methods. A prospective study involving 58 patients with NDTB lungs was performed. The patients were divided into 2 groups: 28 patients with pulmonary NDTB treatment failure were included in the 1st group (the main group), 30 patients, who subsequently successfully completed the course of treatment were included in the 2nd group (comparison group). The control group consisted of 29 healthy volunteer-donors. All the patients had been in inpatient treatment in Communal Institution “Zaporizhzhia Regional TB Clinical dispensary” during 2017–2019 years. Scientific medical-laboratory center of Zaporizhzhia State Medical University researched changes of the level of 25(OH)D in the blood serum by method of enzyme linked immunosorbent assay using immunoassay analyser Sirio S with “DIAsource ImmunoAssays S.A.” kit (Belgium) (ng/ml). Blood sampling was made after an overnight fast. Blood was collected uniformly throughout the year in all patients and volunteers to avoid the effect of seasonal variability in vitamin D in the blood.Results. While healthy volunteers have a reduction in the level of pro-hormone 25(OH)D only in 51.7 % of cases (deficiency in 13.8 % and insufficiency in 37.9 %), patients with NDTB with generalized specific process in the lungs, the presence of destruction of over 3 cm in diameter and bacterial excretion at the beginning of intensive phase of antimycobacterial therapy (0 doses), have its decrease in 96.5 % (81 % deficiency and 15.5 % insufficiency). 1/3 of patients (35.7 % at the 0th dose and 32.1 % at the 90th dose) with tuberculosis treatment failure have pro-hormone levels 25(OH)D less than 7 ng/ml, whereas in patients who successfully completed the course of treatment, this concentration of pro-hormone 25(OH)D was not even diagnosed. In the dynamics, after 3 months of intensive phase of antimycobacterial therapy (90 doses) in patients with NDTB treatment failure the levels of pro-hormone 25(OH)D continue to decrease significantly by 1.3 times relative to the initial values, which is 1.4 times lower than in patients who successfully completed the course of treatment.Conclusions. In the vast majority of patients with NDTB of lungs with a risk of ineffective treatment, a pronounced deficiency of vitamin D (1/3 patients with pro-hormone levels 25(OH)D less than 7 ng/ml) is determined at the beginning of treatment, and after 3 months of the intensive phase of antimycobacterial chemotherapy exacerbates vitamin D deficiency. Therefore, this indicator can be used as a prognostic for the tuberculosis treatment failure and reducing the level of pro-hormone 25(OH)D in the dynamics require consideration of the problem of methods of its correction by the addition of vitamin D.

Impact of surgical sanation of patients with destructive tuberculosis on the prevalence of tuberculosis and mortality of these patients

To analyze the impact of surgical sanation of patients with destructive tuberculosis on the prevalence of tuberculosis and mortality of these patients. Treatment strategy for destructive pulmonary tuberculosis de novo was developed in the Sechenov First Moscow State Medical University. This strategy was applied at the Surgical Department of the Regional Tambov Tuberculosis Dispensary in 2013-2017. We formed a register of patients with pulmonary destruction and bacterial excretion and developed a personal treatment plan. All patients were divided into 3 groups (group A - surgical treatment, group B - no surgery due to refusal or discontinuation of treatment, group C - patients with contraindications or no indications for surgical treatment). Treatment efficacy considering closure of destruction cavities and abacillation was maximal in group A - 97.2%, 41.4% in group B and 39.8% in group C. The number of patients with pulmonary destruction and bacterial excretion has decreased by 3.3 times (from 516 to 158) or 69.8% for 4 years of extensive application of surgical treatment protocol. A significant reduction of 'bacillary core' interrupted infection chain and affected the main epidemiological characteristics. Short-term reduction of the incidence of tuberculosis may be expected. However, even more significant impact of this factor should be expected in the long-term period. Surgical treatment of destructive pulmonary tuberculosis improves efficacy of the management of these patients and reduces mortality rate.

Influence of surgical sanation of patients with destructive tuberculosis on the prevalence of tuberculosis and mortality

To analyze the influence of surgical sanation of patients with destructive tuberculosis on the prevalence of tuberculosis and mortality. The strategy of treatment for new cases of destructive pulmonary tuberculosis was developed in the Perelman Department of Phthisiopulmonology and Thoracic Surgery of the Sechenov First Moscow State Medical University. This strategy was applied in the tuberculosis surgical department of the Tambov Regional Dispensary in 2013-2017. A register of patients with pulmonary destruction and bacterial excretion was developed and personal treatment plans were applied. Patients were divided into 3 groups depending on the treatment mode. The main group A consisted of patients who underwent surgical treatment. Surgery was not performed due to failure or discontinuation of treatment in the comparison group B. Group C included patients without indications or with contraindications for surgical treatment. Treatment efficacy considering destruction cavities closure and abacillation was 97.2% in group A, 41.4% in group B and 39.8% in group C. Surgical approach for patients with destructive tuberculosis reduced the number of patients in the register by 3.3 times (from 516 to 158) within 4 years. A significant reduction of the bacillary core allows breaking the infection chain, that affects the main epidemiological indicators. Reduced incidence of tuberculosis is observed in short-term period, but even greater impact of this factor should be expected in long-term follow-up. Surgical approach in complex treatment of destructive pulmonary tuberculosis is valuable to improve efficacy of management of these patients and reduce mortality rate.

Study of Mechanisms of Pulmonal Tissue Treatment in Destructive Tuberculosis

Introduction. Disruption of the extracellular matrix is one of the most important pathological events in the formation of residual changes in lung tissue in tuberculous inflammation.
 Аim. Investigation of the dynamics of connective tissue reorganization in lung tuberculosis with a different profile of pathogen resistance to antituberculosis drugs.
 Materials and methods. 124 patients with new cases of pulmonary TB: group I (n=84) – patients with multidrugresistant TB; group II (n=40) – patients with pulmonary TB with preserved sensitivity of the pathogen to drugs.
 Results. After 3 months of treatment in group I remained 11.9 % bacterial excretion. After 3 months of treatment in group II there was a decrease in the activity of macrophages against the background of the termination of bacterial excretion and a decrease in the levels of MMP‑9, OSS and AS, which indicates a slowdown of the destruction processes against the background of low fibrotic activity. After 3 months of treatment in group I, fibrosis was active, accompanied by an increase in OSS levels and a decrease in OS levels. Slow sputum conversion in group I was accompanied by a slow (8.2 %) decrease in the ratio of MMP‑9 / TIMP‑1 due to further increase in the level of MMP‑9.
 Conclusions. In group I, there was a significantly higher activity of the destruction processes, while in group II, there was a lower activity of the fibrotic processes.