Tuberculosis Relapse Research Articles

Risk factors and socio-demographic determinants of tuberculosis relapse in the pediatric population

Risk factors and socio-demographic determinants of tuberculosis relapse in the pediatric population. The aim of the study was to evaluate the risk factors of tuberculosis (TB) relapse in the pediatric population and to identify sociodemographic determinants for establishing the risk reduction recommendations in tuberculosis relapse development. Material and methodology: a retrospective, case-control study was conducted, which included the study group – 27 relapses of TB and the control group with 109 new cases of TB diagnosed in children (age 0-18 years) hospitalized in the IMSP Municipal Hospital of Phthisiopneumology during 2006-2021. Results: socio-demographic determinants of new cases and TB relapse are the same, and the major risk factor for relapse is the comorbid state. Maintaining the dispensarisation of previously treated patients is one of the key principles of the clinical management.

Factors Associated with Tuberculosis Relapses Development

The objective: to identify socio-demographic, clinical and laboratory factors associated with tuberculosis recurrence.Subjects and Methods. Clinical and laboratory data of 208 TB patients treated at the National Scientific Center for Phthisiopulmonology of the Ministry of Health of the Republic of Kazakhstan were analyzed.IL-2 to the AlaDH was assessed using test platforms Lionex GmbH (Germany) according to the manufacturer's instructions. SPSS 23.0 software was used for statistical processing of obtained data. To assess the significance of differences in groups, the Pearson Chi-Square test was used. To determine the factors associated with of the tuberculosis relapse, а multiple binary logistic regression analysis was carried out.Results. Multivariate logistic regression analysis confirmed that male gender (OR = 2.086, 95% CI 1.001-4.350, p = 0.050), drug resistance (OR = 4.910, 95% CI 1.923-12.534, p = 0.001), fibrosis cavernous tuberculosis (OR = 6.362, 95% CI 2.178-18.585, p = 0.001) and low level of sensitized T cells that synthesize IL-2 in response to exposure to the AlaDH antigen in IGRA in vitro (OR = 2.155, 95% CI 1.060-4.379, p = 0.034) were significantly associated with tuberculosis recurrence.

Lymphatic Malformation Presenting as Recurrent Pleural Effusion and Ascites

Background: Chylothorax is defined as the accumulation of chyle in the pleural space and is characterized by elevated triglyceride content in pleural fluid >110 mg/dl. Chylous ascites is the accumulation of chyle in peritoneal fluid characterized by triglyceride levels >200 mg/dL. Causes can be traumatic or nontraumatic; portal or nonportal; and congenital or acquired (inflammatory, postoperative, malignant, or infectious). Lymph duct abnormalities are a rare cause of concurrent occurrence of chylothorax with chylous ascites. Clinical Description: We report a 4½-year-old girl who initially presented a fever and was diagnosed to have right-sided pleural effusion. Since no other focus was identified, she was treated as a case of tubercular pleural effusion, following which her symptoms settled transiently. She thereafter had a recurrence of her symptoms in association with ascites and was managed as a case of relapse of tuberculosis (TB) with category 2 anti-tubercular therapy. Since her symptoms did not resolve, she was referred to our hospital for further management. Management: Clinical reasoning based on history and examination coupled with investigations ruled out cardiac, renal, hepatic, malabsorption, or nutritional pathologies of recurrent effusions. TB was ruled out. A lymphatic malformation was suspected. Therapeutic cum diagnostic paracentesis was done in a fed state, which indicated a chylous nature by the milky appearance and suggestive cytology and biochemistry. Lymphoscintigraphy confirmed the presence of a lymphatic duct abnormality. The child was managed with diet modifications, following which she improved within a week. Conclusions: The approach to recurrent effusions without any focus should be logical and sequential, as described above, to exclude the aforementioned common conditions. If workup for TB is repeatedly negative other less likely causes should be considered.

Diagnostic and treatment outcomes of patients with pulmonary tuberculosis in the first year of COVID-19 pandemic.

The COVID-19 pandemic has put a significant strain on human life and health care systems, however, little is known about its impact on tuberculosis (TB) patients. To assess the impact of COVID-19 pandemic on pulmonary tuberculosis (PTB) diagnosis, treatment and patient outcomes, using the WHO definitions. A cross-sectional study was conducted in Malatya region, Turkey (population 800 000). Data on regional PTB test numbers, case notification rates and PTB patients' clinical characteristics and treatment outcomes were collected. Data from the first pandemic year (2020) were compared to data from the previous 3 years (2017-2019). The attitudes and experiences of patients were analysed. Despite a non-significant 22% decrease in annual PTB case notifications (P = 0.317), the number of TB tests performed (P = 0.001) and PTB patients evaluated (P = 0.001) decreased significantly during the pandemic year compared with the previous 3 years. The proportion of patients with high (3/4+) sputum acid-fast bacilli grades (P = 0.001), TB relapse (P = 0.022) and treatment failure (P = 0.018) increased significantly. The median 64.5-day treatment delay detected in 2017-2019 increased significantly to 113.5 days in 2020 (P = 0.001), due primarily to patients' reluctance to visit a health care facility. In addition to the problems with case detection, this study shows notable deterioration in several indicators related to the severity, contagiousness and poor outcomes of TB, which had already been suppressed for decades.

Examining nonadherence in the treatment of tuberculosis: The patterns that lead to failure.

Adherence has been shown to be a major predictor of tuberculosis treatment failure and relapse. The current adherence metrics can be improved to provide higher resolution of adherence patterns and identify patients in need of alternative treatment interventions. We investigated how adherence patterns affect treatment outcomes, when adherence is likely to decrease during treatment and which patients are at risk of being nonadherent. Individual-level data were pooled from 3 clinical trials (n =3724) for treatment of drug susceptible tuberculosis where monthly or weekly adherence patterns were collected and adherence patterns were quantified to assess the impact of clustered missed doses vs. randomly missed doses on tuberculosis treatment outcomes. Significance was determined through univariate and multivariate cox regression models. Patients who miss doses in clusters have an increased hazard risk for unfavourable outcomes and missing as little as 4 treatment days in 1 month resulted in 61% higher risk of unfavourable outcomes compared to patients who missed no treatment days (P < .01). Patients older than 50 years, and patients who experienced an adverse event were associated with lower adherence. Our results show that the pattern in which patients miss their drugs is important to their overall outcomes and missing treatment days in clusters rather than randomly increases the risk of poor outcomes. In the future more intensive and longitudinal adherence measurements will be valuable for clinical trials and regimen design and interpretation.

Long-term results of 10 years of observation of cured cases of pulmonary tuberculosis

Aim of the study: Conduct long-term monitoring of recovered patients with pulmonary TB and study the frequency of relapses of pulmonary TB and factors contributing to their development in the Republic of Tajikistan. Material and research methods: Of the total number of patients with pulmonary TB, 820 people in 2010-2011 after successful treatment, were transferred for further dispensary observation to PHC facilities, whose health status we monitored for 10 years (including 2020). Of the 820 patients, we were able to track the health status for 10 years in 622 patients (320 men and 302 women, age groups 19-44 years old - 330 people and 45-69 years old - 292 people). The rest - for various reasons were lost from further dispensary observation. All patients in PHC facilities annually during the period of dispensary observation underwent clinical, instrumental, laboratory, and X-ray examinations to exclude the recurrence of TB. Data for each patient were tracked using the National TB Registry OpenMRS data. Research results: The elimination of preventive anti-relapse measures in people with residual post-tuberculosis changes in the lungs led to an increase in the number of relapses of the disease. The analysis of the conducted studies shows that the incidence of relapses of pulmonary TB does not depend on the regions and the severity of TB burden, they often develop with insufficient follow-up after the end of treatment and inadequate preventive measures in dispensaries patients. The study of the reasons for the development of relapses makes it possible to timely identify a group of patients who need anti-relapse measures and prolongation of dispensary observation. Conclusion: Thus, the results of this observation revealed the occurrence of relapses within 10 years in 19.3% of cases. A retrospective analysis of the initial forms of the disease showed that relapses of pulmonary tuberculosis occurred more often in patients who had had fibrous-cavernous pulmonary tuberculosis, than in patients who had disseminated pulmonary TB, and less often after suffering infiltrative pulmonary TB. Relapses of the disease occurred more often in men aged 19-44 years. The results obtained indicate the development of relapses of pulmonary tuberculosis has a statistically significant dependence on the form of the initial disease, the presence of RPTCL, comorbid diseases such as HIV, diabetes mellitus, COPD, and the regularity of taking anti-TB drugs. At the same time, it turned out that the social status of all patients with relapses corresponds to the level of poverty, which should also be taken into account.

Surgical Treatment of Cavernous and Fibrous-Cavernous TB in Children.

Treatment of cavernous and fibrous cavernous tuberculosis in children, especially in the presence of multiple drug resistance-tuberculosis or extremely drug resistance-tuberculosis, presents a major challenge. We analyzed results of treatment of 65 patients (mean age 14.8 + 2.9 years) with cavernous TB (group I) and 116 patients (mean age 15.6 + 1.9 years) with fibrous-cavernous TB (group II). Evaluation of treatment efficiency was performed directly at discharge and 1 year after treatment according to Lazerson's criteria. In group I, after 80 operations, two (2.5%) cases showed delayed expansion of the lung after combined resections, in group II, postoperative complications after 160 operations occurred in eight (5.0%) cases (the difference is reliable p ≤0,05). There was no hospital fatality. The effectiveness at the time of discharge from surgery (cessation of bacterization and elimination of decay cavities in the lung) was 100% in groups I and II, respectively. A year later, according to Lazerson's criteria, the efficiency in group I was 100%, in group II was 97.4%. Operations in patients with cavernous tuberculosis performed after 10 to 12 months of conservative treatment present a lower risk of postoperative complications and relapses of cavernous tuberculosis than operations in patients with fibrous cavernous tuberculosis performed after 22 months or more of treatment.

Chronic pulmonary aspergillosis is common among patients with presumed tuberculosis relapse in Ghana.

Chronic pulmonary aspergillosis (CPA) may mimic pulmonary tuberculosis (PTB). The two diseases are clinically indistinguishable and may result in CPA misdiagnosed as PTB or vice versa. Although PTB is largely recognised as a differential diagnosis of CPA and often ruled out prior to CPA diagnosis, the reverse is uncommon. The aim of this study was to determine the proportion of CPA cases among patients being assessed for PTB. A cross-sectional survey was conducted among consecutive patients referred for GeneXpert Mycobacterium tuberculosis test for the diagnosis of PTB at the Korle-Bu Teaching Hospital, Accra, Ghana. Patients’ demographics, clinical and socioeconomic details were obtained using a structured questionnaire. Blood was collected for Aspergillus and HIV serology, and sputum samples obtained for Aspergillus culture. Chest radiograph was obtained, and computed tomography scan was also done for patients with positive Aspergillus serology or cavitation. CPA was defined using an algorithm developed by the Global Action for Fungal Infections (GAFFI) international expert panel. A total of 154 patients were included in the analysis, of whom 134 (87%) did not have a prior PTB diagnosis. There were 41 (26.6%) GeneXpert positive cases. CPA prevalence was 9.7% overall, but 50% in patients with a prior history of PTB and 3.7% in those without previous PTB. Although CPA is rarely considered as a differential diagnosis of PTB in Ghana, our findings show that CPA may affect half of patients being assessed for PTB relapse. Efforts to diagnose CPA should be prioritised in this patient group.

Factors responsible for default among patients under the revised national tuberculosis control programme

Tuberculosis (TB) is an infectious disease caused by bacillus Mycobacterium tuberculosis. It infects the lungs and causes pulmonary tuberculosis. But it can affect any organ in the human body. Defaulting from treatment has been one of the major obstacles to treatment management and an important challenge for tuberculosis control programmes. Defaulting from therapy is the main reason for its prevalence in our society, leading to relapse and multi-drug resistance TB cases. This study has been done to determine the causes of default among patients undergoing treatment under the Revised National Tuberculosis Control Programme (RNTCP) and their rectification.

Incidental Tuberculosis Epididymitis/Epididymo-orchitis: A Retrospective Analysis at a Tertiary Center in Taiwan

ObjectivesTo determine the earliest noticeable manifestation and diagnosis in patients diagnosed with tuberculosis (TB) epididymitis/epididymo-orchitis incidentally and to analyze their responses to surgical and medical treatment. MethodsPatients who underwent surgery for the preliminary impression of chronic epididymitis/epididymo-orchitis or epididymal/testicular tumor from 2000 to 2019 were included in the study. The clinical presentations, laboratory data, radiological examinations, and operative findings were analyzed retrospectively. The outcomes were assessed by the responses to anti-TB chemotherapy and post treatment radiographic evaluations. ResultsAll of our 25 patients with a mean age of 60.6 years were diagnosed incidentally with TB epididymitis (48.0%) and TB epididymo-orchitis (52.0%) according to the histopathological findings from their surgeries. The presence of a palpable scrotal mass (76.0%), was the major presentation. Nineteen (76.0%) patients had undergone complete chemotherapy after the surgery and 15 (78.9%) patients showed complete recovery. Four (21.1%) patients had unfavorable outcomes, 3 had TB autonephrectomies and 1 required re-surgery years after complete chemotherapy. Of the 3 (12.0%) patients who did not receive chemotherapy after their surgeries, 1 had a TB relapse in the spine and lung and 1 developed bladder cancer years later. ConclusionTuberculosis epididymitis/epididymo-orchitis is difficult to diagnose. However, some clinical clues can assist including aged patients, extragenital TB histories, poor responses to antibiotic treatment and scrotal skin lesion. Complete anti-TB chemotherapy is mandatory even after the total removal of TB lesion. Supplemental surgical interventions can be considered when the symptoms are not relieved after chemotherapy. Lifespan follow-up is recommended due to high relapse rate.

Penerapan Metode SMOTE CHAID dalam Klasifikasi Tuberkulosis Relapse

DKI Jakarta Province is one of the provinces with the highest tuberculosis cases, and a person's chance of contracting tuberculosis is the greatest among other provinces. Tuberculosis can be cured with regular treatment within a certain period of time, but after recovering, some tuberculosis sufferers may relapse so that it can cause new problems. This study aims to build a classification model and determine which factors influence tuberculosis relapse using the CHAID method. SMOTE with majority undersampling is applied as a solution to deal with the problem of patient categories (relapse and non-relapse) who have an unbalanced number of observations. Based on the CHAID classification tree, the results show that the factors that influence relapse in tuberculosis patients include the type of diagnosis, age, gender, and place of residence. In addition, the application of SMOTE can improve the performance of the CHAID classification tree in classifying patients based on their categories. These results were indicated by an increase in the values of accuracy, sensitivity, and specificity to 76,153; 26,667; and 82,608 compared to the performance of CHAID without SMOTE. Based on these results, the SMOTE CHAID classification model has better performance than CHAID

Tuberculosis Molecular Bacterial Load Assay Reveals Early Delayed Bacterial Killing in Patients With Relapse.

Bacterial killing in patients with tuberculosis (TB) relapse was compared to that in patients achieving cure, measured by TB molecular bacterial load assay (TB-MBLA) or mycobacteria growth indicator tube (MGIT) time to positivity (TTP). TB-MBLA in 4 relapsed patients was significantly different compared to 132 cured patients after 2 weeks of treatment; MGIT TTP showed a significant difference from week 8.

The course of pregnancy and relapse of tuberculosis after COVID-19

The own observation of pregnancy and tuberculosis after COVID-19 in a patient who was treated in the pulmonary tuberculosis department N 2 of the Zaporizhia Regional Phthisiopulmonology Clinical Medical Diagnostic Center is presented. According to the presented clinical case, a woman, who had pulmonary tuberculosis 9 years ago, underwent mild COVID-19 at the 20th week of pregnancy and did not receive any treatment. The patient had of the dispensary observation in the phthisiatrician and regularly underwent preventive check-­up, because of her previous tuberculosis. However, the patient was hospitalized in the intensive care unit of the PNE «Regional Perinatal Center» ZRC with moderate preeclampsia, signs of intrauterine fetal hypoxia, in which the mother needed medical care, at the 32nd week of pregnancy. Three days after hospitalization, in view of the fetal distress and preeclampsia, it was made a decision to perform assisted delivery by cesarean section. The child was born alive, vertical transmission of COVID-19 was not diagnosed. Taking into account the history of tuberculosis in anamnesis, the woman underwent X-­ray examination of the thoracic cavity organs, where the reactivation of a specific process, on the background of metatuberculous changes, were revealed. The woman was diagnosed of multidrug­-resistant tuberculosis (MDR-­TB) with a destructive process in the lungs by further examination, that’s why, she was hospitalized to Zaporizhia Regional Clinical and Diagnostic Center of Phthysiatry and Pulmonology» of Zaporizhia Regional Council for further treatment. A course of antimycobacterial therapy (AMBT), according to the modified short­-term treatment regimen, was prescribed to the patient. Against the background of AMBT, rapid positive dynamics was determined: stable cessation of bacterial excretion was determined after 1 month of AMBT, and healing of destruction with the formation of residual post-­tuberculosis changes — after 2 months. The presented clinical case demonstrates the negative impact of COVID-19 both on the course of pregnancy (moderate preeclampsia, which led to cesarean section at 32nd weeks of pregnancy) and on the reactivation of the tuberculous process, with its course in the form of MDR­-TB.

Tuberculosis reinfection and relapse in eastern China: a prospective study using whole-genome sequencing

ObjectivesTuberculosis recurrence after an initial successful treatment episode can occur from either reinfection or relapse. In a population-based sample and whole genome sequencing in eastern China, we aimed to evaluate risk factors for tuberculosis recurrence and assess the proportion of recurrence because of either reinfection or relapse. MethodsSuccessfully treated pulmonary tuberculosis patients with sputum culture positive results were recruited from five cities in Jiangsu Province from 2013 to 2015 and followed for 2 years for tuberculosis recurrence. Among patients developing a second tuberculosis episode, whole genome sequencing was performed to distinguish relapse or reinfection through a distance threshold of 6-single-nucleotide polymorphisms. We analyzed risk factors for recurrence and epidemiological characteristics of different types of recurrent patients. ResultsOf 1897 successfully treated tuberculosis patients, 7.4% (141/1879) developed recurrent tuberculosis. Compared with nonrecurrent tuberculosis, patients were at higher risk of recurrence in older age (adjusted odds ratio, 1.02 for each additional year; 95% CI, 1.01 to 1.03, p = 0.003), patients previously treated for tuberculosis (adjusted odds ratio = 2.22; 95% CI, 1.52 to 3.26, p < 0.001), or with bilateral cavities (adjusted odds ratio, 1.56; 95% CI, 1.05 to 2.32, p = 0.029). Among 27.0% (38/141) recurrent tuberculosis patients with successfully sequenced pairs, relapse was substantially more common than reinfection (71.1% vs 28.9%, p = 0.014). DiscussionEndogenous relapse was significantly more common than exogenous reinfection in the first 2 years after treatment in eastern China. Prioritization of high-risk groups for recurrence, such as the elderly, with a previous tuberculosis diagnosis, or with bilateral cavities, may provide opportunities to reduce post-tuberculosis morbidity.

Use of DosR and Rpf antigens from Mycobacterium tuberculosis to screen for latent and relapse tuberculosis infection in a tuberculosis endemic community of Huainan City.

The dormancy survival regulator (DosR) antigens upgraded during latency and resuscitation-promoting factors (Rpfs) expressed over the reactivation from dormant Mycobacterium tuberculosis (M. tuberculosis) could be used to diagnose tuberculosis (TB) at different stages. We performed a retrospective cohort study based on four groups, including healthy controls (HCs), active tuberculosis infections (ATBs), latent tuberculosis infections (LTBIs), and relapse tuberculosis infections (RTBs) enrolled between November 2020 and June 2021. Compared to the fusion protein E6-C10, combined with early secreted antigenic target 6kDa (ESAT-6) and culture filtrate of 10kDa (CFP-10), the DosR- or Rpf-encoded antigens could not elicit significant IFN-γ concentration for the diagnosis of ATB. Of note, the DosR antigens produce significantly more antigen-specific IFN-γ in LTBIs than Rpfs, and the levels of antigen-specific IFN-γ elicited in RTBs stimulated by Rpfs were higher than the DosR antigens. Among the DosR antigens, Rv2003c was the most immunogenic in diagnosing LTBIs, followed by Rv2007c and Rv2005c. As far as Rpfs are concerned, Rv0867c was the best antigen to identify RTBs, followed by Rv2389c and Rv1009. Both Rv2450c and Rv1884c showed relatively limited IFN-γ concentration in RTBs. Besides, the selected DosR antigens and Rpfs showed ideal specificity and inadequate sensitivity, which could have been enhanced by the fusion antigens prepared by the DosR antigens or Rpfs, respectively. The results of this study can provide more accurate detection methods for LTBIs and RTBs and could be used for screening the dormant M. tuberculosis throughout reactivation.

Safety and pharmacokinetics-pharmacodynamics of a shorter tuberculosis treatment with high-dose pyrazinamide and rifampicin: a study protocol of a phase II clinical trial (HighShort-RP)

IntroductionIncreased dosing of rifampicin and pyrazinamide seems a viable strategy to shorten treatment and prevent relapse of drug-susceptible tuberculosis (TB), but safety and efficacy remains to be confirmed. This clinical...

Correlation Between CT Features of Active Tuberculosis and Residual Metabolic Activity on End-of-Treatment FDG PET/CT in Patients Treated for Pulmonary Tuberculosis.

Patients who complete a standard course of anti-tuberculous treatment (ATT) for pulmonary tuberculosis and are declared cured according to the current standard of care commonly have residual metabolic activity (RMA) in their lungs on fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography (FDG PER/CT) imaging. RMA seen in this setting has been shown to be associated with relapse of tuberculosis. The routine clinical use of FDG PET/CT imaging for treatment response assessment in tuberculosis is hindered by cost and availability. CT is a more readily available imaging modality. We sought to determine the association between CT features suggestive of active tuberculosis and RMA on FDG PET/CT obtained in patients who completed a standard course of ATT for pulmonary tuberculosis. We prospectively recruited patients who completed a standard course of ATT and declared cured based on negative sputum culture. All patients had FDG PET/CT within 2 weeks of completing ATT. We determined the presence of RMA on FDG PET images. Among the various lung changes seen on CT, we considered the presence of lung nodule, consolidation, micronodules in tree-in-bud pattern, FDG-avid chest nodes, and pleural effusion as suggestive of active tuberculosis. We determine the association between the presence of RMA on FDG PET and the CT features of active tuberculosis. We include 75 patients with a mean age of 36.09 ± 10.49 years. Forty-one patients (54.67%) had RMA on their FDG PET/CT while 34 patients (45.33%) achieved complete metabolic response to ATT. There was a significant association between four of the five CT features of active disease, p < 0.05 in all cases. Pleural effusion (seen in two patients) was the only CT feature of active disease without a significant association with the presence of RMA. This suggests that CT may be used in lieu of FDG PET/CT for treatment response assessment of pulmonary tuberculosis.

A Retrospective Study on Tuberculous Lymphadenitis: A Finding from Multicenter Referral Hospitals.

Extrapulmonary tuberculosis represents about 14% of all cases of tuberculosis (TB) in Malaysia. The aim of the study includes the evaluation of sociodemographic factors, clinical manifestations, comorbidities among patients with tuberculous lymphadenitis and their treatment outcomes. The retrospective study was conducted from 2006 to 2008. Data on sociodemographic along with histopathological results were collected. The signs and symptoms were also recorded from TB registers, treatment cards, and TB medical personal files using the standard data collection tool. Among multiple variables, the significant factors identified by univariate analysis were included in the multivariate logistic regression to estimate the odds ratios with the 95% confidence intervals. The statistically significant P value was considered <0.05. There were 348 (57%) males, and on the other hand, 262 (43%) females which shows almost equal incidence rate of lymphadenitis in both genders. The age group was observed from 2 to 83 years old. Therefore, the age group between 26 and 35 years showed 194 (31.8%) patients diagnosed with lymphadenitis and followed by 16-25 years (21%). The mean age was found as 34.3 ± 14.6 years were majorly reported with positive diagnosis. One hundred and ninety-six (32.1%) Malay population were found with tuberculous lymphadenitis followed by the Chinese population of 148 (24.3%). The other prominent races were Pilipino, Indonesians, and other expatriates. Geographically, patients were from 386 (63.3%) urban population were found positive for lymphadenitis and over 224 (36.7%) population of the rural region. The treatment outcome was observed 444 (72.8%) with successful treatment. The World Health Organization states the types of treatment failures, and accordingly, 85 (13.9%) patients were continued with the therapy that can be due to noncompliance or relapse of TB. Among the unsuccessful outcomes, 194 patients of age group 26-35 years, 65 (33.5%) were reported and 38 (29.7%) patients out of 128 between ages of 16-25 years. Blood test results showed erythrocyte sedimentation rate >10 in 280 (45.9%) patients. Therefore, among 280, there were 115 (41.1%) patients were found to have unsuccessful treatment showing very strong association with P < 0.001. The finding signifies that effect of weight loss on poor treatment outcomes' and active screening measures for patients with comorbidities are therefore recommended in patients with tuberculous lymphadenitis along with improvements in the diagnosis and early management of comorbidities complications. As young age group was found to have poor or unsuccessful treatment outcomes and required aggressive strategy together with educating patients can further increase the treatment success rate.

Efficacy and safety of pneumonectomyin the comprehensive treatment of patientswith destructive pulmonary tuberculosis

Introduction. Despite significant progress in the fight against pulmonary tuberculosis, surgical methods of treatment are still in demand all over the world. The pro-portion of pneumonectomy in various clinics varies from 9.8 to 32%, and the incidence of postoperative compli-cations and mortality remain at a fairly high level. Ob-jective. Substantiation of the effectiveness and safety of pneumonectomy in the complex treatment of patients with destructive pulmonary tuberculosis. Materials and methods. A retrospective study was conducted from 2010 to 2019. In accordance with the inclusion and exclusion criteria, 198 patients were included into the study. The clinical and radiological data and features of the course of tuberculosis, functional parameters, characteristics of surgical interventions, intraoperative and postoperative complications were studied. Postoperative complications were assessed using the TM&amp;M classification. The risk fac-tors were selected using correlation and logistic regres-sion analysis. Survival analysis was carried out using Kap-lan-Meier method. Factors influencing the recurrence of tuberculosis and mortality in the long-term period were chosen using Cox regression analysis. The value of p&lt;0.05 was considered significant. Results. Complications in the early postoperative period developed in 94 (47.5%) pa-tients. In their structure, minor complications occurred in 41 (43.6%) cases, major complications occurred in 53 (56.4%). Surgical complications developed in 29 (14.6%) cases. A satisfactory immediate result of treatment was recorded in 181 (91.4%) patients, unsatisfactory — in 13 (6.6%), 4 (2%) patients died. The long-term outcome was studied in 146 (75.2%) patients. Among them, a suc-cessful result of treatment was achieved in 129 (88.3%) patients, ineffective treatment — in 9 (6.2%). 8 (5.5%) patients died. Among patients who successfully com-pleted the course of treatment, 10 (7.7%) had a relapse of tuberculosis. Among them, 6 (60%) patients managed to achieve a successful result of treatment, the remaining 4 (40%) patients died. Survival at one year was 97.9%, 3- and 5-year survival rates were 97.2 and 89.4%, respectively. Conclusion. The early and long-term outcomes present-ed by the authors demonstrate high efficiency and safety of pneumonectomy in the comprehensive treatment of patients with destructive pulmonary tuberculosis

ЭФФЕКТИВНОСТЬ И БЕЗОПАСНОСТЬ ДЕЛАМАНИД-СОДЕРЖАЩИХ РЕЖИМОВ У ПАЦИЕНТОВ С ЛЕКАРСТВЕННО УСТОЙЧИВЫМ ТУБЕРКУЛЕЗОМ И КОМОРБИДНОЙ СЕРДЕЧНО-СОСУДИСТОЙ ПАТОЛОГИЕЙ

Aim. To study the effectiveness of treatment with delamanid-containing regimens in patients with multidrug-resistant and extensively drug-resistant tuberculosis and comorbid cardiovascular diseases, to assess the frequency, structure, and severity of adverse events in the cardiovascular system in this group of patients. Materials and methods. The study included 125 adult patients with multidrug and extensive drug resistance who started treatment with delamanid-containing regimens from July 2016 to February 2018 at the Republican Research and Practical Center for Pulmonology and Tuberculosis and six regional anti-TB institutions. The main group included patients with multiple and extensive drug resistance and comorbid cardiovascular diseases (N = 46). The control group included patients with multiple and extensive drug resistance without comorbid cardiovascular diseases (N = 79). The formulation and coding of the diagnosis (the underlying disease and comorbid diseases (conditions)) corresponded to the International Classification of Diseases (ICD) of the 10th revision. Adverse events were classified according to the international dictionary MedDRA (Medical Dictionary for Regulatory Activities). The severity of adverse events classification complied with CTCAE (Common Terminology Criteria for Adverse Events). The severity of adverse events was determined in accordance with the definitions of ICH (The International Council for Harmonization of Technical Requirements for Pharmaceuticals for Human Use), and the treatment outcomes were identified in accordance with clinical guidelines and WHO recommendations. The study materials were the data from the medical records of the patients in the E-Register "Tuberculosis". Sputum culture conversion was defined as two consecutive negative test results. Treatment outcomes were classified as successful and unsuccessful. For the analysis of adverse events, each event was considered as a unit of analysis both in the aggregate of all adverse events in the cardiovascular system and in groups of patients. Testing of statistical hypotheses was carried out at a critical level of significance p = 0.05, i.e. the difference was considered statistically significant if p &lt; 0.05. Results. The effectiveness of treatment with delamanid-containing regimens in the group of patients with comorbid cardiovascular diseases was 88.0%, sputum conversion after 6 months of treatment (abacillation by culture) was observed in 93.0% of patients in this group, when compared no statistical difference was present in the effectiveness of treatment (p = 3.841) of the patients of the main group and those of the comparison group. In the analysis of long-term results, only one patient with cardiovascular comorbidity (3.0%) had a relapse of tuberculosis more than one year after successful treatment. 78.0% of patients of the main study group (with comorbid cardiovascular diseases) and 70.0% of the comparison group manifested cardiovascular adverse events during treatment. The most common adverse event in both groups was prolongation of the QTcF interval, which was recorded in 37.0% of patients with comorbid cardiovascular diseases and in 42.0% of patients without cardiovascular diseases (p = 0.597). Timely correction and careful monitoring of adverse events made it possible to avoid the development of life-threatening conditions in both groups of patients. In this regard, no withdrawal of anti-tuberculosis drugs was registered due to cardiovascular adverse events, including those due to the prolongation of the QTcF interval. The highest frequency of cardiovascular adverse events was detected during the first month of treatment of patients, then, in the course of treatment, it decreased, which may indirectly indicate the absence of a cumulative cardiotoxic effect of delamanid-containing treatment regimens. Conclusions. Treatment with delamanid-containing regimens in adult patients with multidrug-resistant tuberculosis and comorbid cardiovascular disease was effective and had an overall favorable cardiovascular safety profile comparable to the comparison group. Despite a large number of cardiovascular adverse events, they were manageable at the program level (prevailing at the initial stages of treatment, having light, mild or moderate severity, having been relieved), which made it possible to complete anti-tuberculosis treatment with delamanid-containing regimens.