"CTRI Bulletin"
#1,(2),2018.

CTRI BULLETIN №1 (2) 2018

Journal Information: Read
Chief Editor: Ergeshov A.E.
Year of foundation: 2017
ISSN (Print): Browse
Publisher site: http://critub.ru
http://tb-bulletin.ru

CONTENT

     

1)

Pulmonary surfactant from the point of view of a morphologist: from science to practice

Lepekha L.N.

7

 

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2)

Differential diagnosis of granulomatosis with polyangiitis and TB

Zaitseva A.S., Shmelev E.I., Lepekha L.N., Stepanyan I.E.

19

 

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3)

The peculiarities of differential diagnosis of pulmonary diseases characterized by infiltration

Karpina N.L.

26

 

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4)

The determining role and the impact of biomedical, medical and organizational factors on the risk of pulmonary TB incidence among the population in the Republic of Moldova (epidemiology aspects and conceptual challenges)

Yavorsky K.M., Bolotnikova V.A., Brumaru A.G.

 33

 

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5)

The prevalence of multidrug-resistant tb in some regions of the russian federation

Rusakova L.I., Punga V.V.

41

 

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6)

The clinical manifestations and the course of newly-diagnosed tb associated with hiv-infection according to the dynamic five-year prospective cohort dispensary follow-up

Mishin V.Yu., Mishina A.V., Levchenko M.V., Ergeshov A.E.

52

 

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7)

The efficacy of silver nanoparticles on the model of clinical isolates of mycobacterium tuberculosis with a variety of drug resistant

Zakharov A.V., Khokhlov A. L.

64

 

READ MORE

8)

The role of the gene xpert mtb/rif assay in improving treatment effectiveness in newly-diagnosed pulmonary tb patients with mdr in stavropol krai, russia

Chumakova E.S., Komissarova O.G., Abdullaev R.Yu., Odinets V.S.

76 

READ MORE

9)

A case of a “wavy” course of intrathoracic lymph nodes tb in a child with a compromised history

Khokhlova Yu. Yu., Gubkina M.F., Petrakova I. Yu., Yukhimenko N.V.

84

 

READ MORE

Pulmonary surfactant from the point of view of a morphologist: from science to practice

Article 1.Page 7.
ARTICLE TITLE:

Pulmonary surfactant from the point of view of a morphologist: from science to practice

AUTORS:

Lepekha L.N.

Central TB Research Institute, Moscow, Russia

DESCRIPTION OF ARTICLE:

Submitted on 12.10.2017

Dedicated to my mentor, V.V. Erokhin

The article presents a review of research studies performed by Professor Yerokhin, a corresponding member of the Academy of Medical Sciences of Russian Federation, Doctor of Medical Sciences, Honored Scientist of the Russian Federation, and his students who developed a fundamental framework for assessing the state of the surfactant system in experimental conditions and clinical cases of pulmonary tuberculosis, as well as the possibility of using exogenous surfactant, particularly Surfactant-BL (“Biosurf” LLC, St. Petersburg), as a means of pathogenetic therapy in TB practice.

FOR CORRESPONDENCE:

Central TB Research Institute

Yauzskaya alley 2, 107564, Moscow

Larisa N. Lepekha, Doctor of Biological Sciences, Professor, Head, Department of Pathomorphology, Electron Microscopy and Biochemistry

Phone: +7 (499)785-91-79,

Е-mail: lep3@yandex.ru

Differential diagnosis of granulomatosis with polyangiitis and TB

Article 2.Page 19.
ARTICLE TITLE:

Differential diagnosis of granulomatosis with polyangiitis and TB

AUTORS:

Zaitseva A.S., Shmelev E.I., Lepekha L.N., Stepanyan I.E.

Central TB Research Institute, Moscow, Russia

DESCRIPTION OF ARTICLE:

Submitted as of 06.10.2017

Similar X-ray and morphological changes, lack of specific symptoms often result in misdiagnosing pulmonary granulomatoses as TB. The article highlights differential diagnosis of TB and granulomatosis with polyangiitis. The main causes of diagnostic errors have been formulated, and the layout for diagnosis of systemic vasculitis is provided.

KEYWORDS:

differential diagnosis, granulomatosis with polyangiitis, TB, antineutrophil antibodies, upgrade, granulomatous inflammation.

FOR CORRESPONDENCE:

Central TB Research Institute

2, Yauzskaya alley, 107564, Moscow

Anna S. Zaitseva, Candidate of Medical Sciences, Department of Differential Diagnosis of TB and Extracorporal Treatments

Phone: +7 (499)785-90-31,

Еmail: anyasyls@yandex.ru

The peculiarities of differential diagnosis of pulmonary diseases characterized by infiltration

Article 3.Page 26.
ARTICLE TITLE:

The peculiarities of differential diagnosis of pulmonary diseases characterized by infiltration

AUTORS:

Karpina N.L.

Central TB Research Institute, Moscow, Russia

DESCRIPTION OF ARTICLE:

Submitted as of 07.10.2017

Detection of infiltrative changes in the lung tissue remains a diagnostic challenge, since, first, such changes are found in a large share of X-ray studies (43-66.3%), and, second, misdiagnoses of infiltrative changes in the lungs are common (35-45%).

Aim: To establish the causes of differential diagnostic errors related to infiltrative changes in the lung tissue.

Materials and methods. The study was conducted at the clinical and diagnostic department of the Central TB Research Institute. We analyzed the results of studies of 181 patients with infiltrative changes in the lungs, who had been referred to the consultation by primary health facilities and TB services in 2011-2013. Among them there were 92 men (50.8%) and 89 women (49.2%). They were aged from 17 to 100, the average age was 45.6 + 0.5 years.

Study design. 1. Detection of the lung process specificity based on clinical and laboratory studies. 2. Analysis of chest multispectral computed tomography results involving qualitative and quantitative characteristics of infiltrates and other pathological changes in the chest organs. 3. Morphological verification of the diagnosis using fibrobronchoscopy results, biopsy complex and videothoracoscopic lung biopsy. 4. Analysis of frequency and character of diagnostic errors related to infiltrative pulmonary TB.

Results. The most common differential diagnoses related to infiltrative changes in the lungs were infiltrative pulmonary TB along with community acquired pneumonia, lung cancer, hypersensitivity pneumonitis and pulmonary sarcoidosis. The frequency of discrepancies between primary and final diagnoses of infiltrative pulmonary TB was 41.7%, community acquired pneumonia – 63.4%, lung cancer, hypersensitivity pneumonitis and pulmonary sarcoidosis – 97.1, 96.0, and 71.4% respectively (р<0.05). The main cause of misdiagnoses of infiltrative pulmonary TB was deficient use of modern techniques: molecular genetic sputum studies (8.8% of cases), chest CT (37.6%); or traditional methods: cultural studies (44.2%), bronchoscopy (5.5%). The analysis of diagnostic errors related to infiltrative pulmonary TB revealed that a high percentage of diagnostic errors was due to hyperdiagnosis of pulmonary TB, hypodiagnosis of other pulmonary diseases, and lack of etiological and morphological verification of diagnoses.

KEYWORDS:

TB, differential diagnosis, diagnostic errors.

FOR CORRESPONDENCE:

Central TB Research Institute

2, Yauzskaya alley, 107564, Moscow

Natalia L. Karpina, Doctor of Medical Sciences, Head, Clinical Diagnostic Department

Phone: +7 (916) 097-36-96

E-mail: natalya-karpina@rambler.ru

The determining role and the impact of biomedical, medical and organizational factors on the risk of pulmonary TB incidence among the population in the Republic of Moldova (epidemiology aspects and conceptual challenges)

Article 4.Page 33.
ARTICLE TITLE:

The determining role and the impact of biomedical, medical and organizational factors on the risk of pulmonary TB incidence among the population in the Republic of Moldova (epidemiology aspects and conceptual challenges)

AUTORS:

Yavorsky K.M.1,2, Bolotnikova V.A.1, Brumaru A.G.1

1Kirill Draganyuk Phthisiopulmonology Institute, Kishinev, Moldova

2Nicolae Testemitanu State University of Medicine and Pharmacy, Kishinev, Moldova

DESCRIPTION OF ARTICLE:

Submitted as of 11.10.2017

Despite the advances in modern medicine pulmonary TB remains a dangerous infectious disease killer around the world, and poses a serious threat to the population of Moldova.

Aim: To study the frequency and the structure of biomedical, medical and organizational factors, which increase the risk of developing TB.

Materials and methods. We carried out a retrospective study of four districts of the Central and Southern zones on the right bank of the river Dniester in 2014-2016. We used recording and reporting forms of the official state statistics, as well as medical documents of TB patients.

Results. Based on the epidemiological, clinical and pathogenic significance, stratification of the factors was performed, and the most important groups of morbid risks were identified. Their role in development and spread of pulmonary TB was established.

Conclusion. The obtained results demonstrate the need for ongoing epidemiological monitoring based on knowledge about the role and the impact of risk factors on TB burden.

KEYWORDS:

туберкулез легких, бремя туберкулеза, фактор риска, эпидемиологический потенциал туберкулеза.

FOR CORRESPONDENCE:

Kirill Draganyuk Phthisiopulmonology Institute,

13 Vyrnav Street, Chişinău, Republic of Moldova,  MD – 2025

Konstantin M. Yavorski, Dr. habil. of Medical Sciences, Professor, Deputy Director for Science and Innovation, Head of the Pneumophthisiology Department, Nicolae Testemițanu State University of Medicine and Pharmacy

Phone.: +373 22-572-200

E-mail: ciavorschi@gmail.com

The prevalence of multidrug-resistant tb in some regions of the russian federation

Article 5.Page 41.
ARTICLE TITLE:

The prevalence of multidrug-resistant tb in some regions of the russian federation

AUTORS:

Rusakova L.I., Punga V.V.

Central TB Research Institute, Moscow, Russia

DESCRIPTION OF ARTICLE:

Submitted as of 03.10.2017

The authors have stated the statistical data on the incidence and prevalence of multidrug-resistant (MDR) TB in 15 regions of the Russian Federation for the 11-year observation period (2006-2016). MDR TB incidence twice increased in 7 regions and in the country in general (from 2.8 to 5.6 per 100 000 population) with a notable divide across the regions. In the same period, MDR TB prevalence increased in 9 regions with the rates above the country average in four regions; the country average increased from 16.9 to 25.8 per 100 000, or by 34.5%. Treatment using regimen IV was not quite effective, as confirmed by sputum conversion rates, due to inadequate notification of MDR TB cases, poor supply of second-line drugs, and increased share of deaths due to reasons other than TB (18.6%). Thus, there is an urgent need for better diagnostics and treatment of concomitant diseases.

KEYWORDS:

incidence, prevalence, multidrug-resistant TB.

FOR CORRESPONDENCE:

Central TB Research Institute

107564, Moscow, 2 Yauzskaya alley

Larisa I. Rusakova, Doctor of Medical Science, Head of the Scientific-Organizational Department

Phone:  +7 (499) 785-91-87

E-mail: larisa.rusakova@mail.ru

The clinical manifestations and the course of newly-diagnosed tb associated with hiv-infection according to the dynamic five-year prospective cohort dispensary follow-up

Article 6.Page 52.
ARTICLE TITLE:

The clinical manifestations and the course of newly-diagnosed tb associated with hiv-infection according to the dynamic five-year prospective cohort dispensary follow-up

AUTORS:

Mishin V.Yu.1,3, Mishina A.V.1,2, Levchenko M.V.2, Ergeshov A.E.3

 1A.I. Evdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia

2Moscow Scientific and Practical Centre for TB Control, Moscow, Russia

3Central TB Research Institute, Moscow, Russia

DESCRIPTION OF ARTICLE:

Submitted as of 05.10.2017

The article presents the data of the four-year prospective dispensary follow-up of 178 newly-diagnosed TB patients co-infected with HIV. The infection lasted for 1-5 years. Out of the patients 79.8% were injectable drug users and suffered from viral hepatitis B or C; and 86.5% were never administered antiretroviral therapy. The most common forms of pulmonary TB were disseminated (28.8%) and infiltrative (30.5%); in 41.6% TB was associated with extrapulmonary lesions, in 39.3% – other secondary diseases typical for HIV-infection. Complex treatment and dynamic four-year follow-up demonstrated as follows: out of 176 TB/HIV patients 124 (69.7%) stayed alive; 78.2% of them were cured mainly due to adherence to treatment, compulsory anti-relapse TB treatment and ART during the whole period, i.e. 113 out of 178 patients (63.5%). 4.8% (6 patients) developed relapse, and 16.9% (21 patients) died – three due to advanced TB, and 18 due to drug overdose.

KEYWORDS:

TB, HIV-infection, TB dispensary, chemotherapy, antiretroviral therapy.

FOR CORRESPONDENCE:

A.I. Evdokimov Moscow State University of Medicine and Dentistry

20/1, Delegatskaya ul., 127473, Moscow, Russia

Vladimir Yu. Mishin, Doctor of Medical Sciences, Professor, Head, Phthisiology and Pulmonology Department

Phone: +7 (910) 436-56-88

E-mail: mishin.vy@mail.ru

The efficacy of silver nanoparticles on the model of clinical isolates of mycobacterium tuberculosis with a variety of drug resistant

Article 7.Page 64.
ARTICLE TITLE:

The efficacy of silver nanoparticles on the model of clinical isolates of mycobacterium tuberculosis with a variety of drug resistant

AUTORS:

Zakharov A.V.1, Khokhlov A. L.2

 1Regional Clinical Tuberculosis Hospital, Yaroslavl, Russia

2Institute of postgraduate education department at Yaroslavl State Medical University, Yaroslavl, Russia

DESCRIPTION OF ARTICLE:

Submitted as of 17.10.2017

The paper presents the results of in vitro suppressive activity of silver nanoparticles on clinical MBT isolates with different drug resistant pathogen. In the group 1 were studied in 117 the office of isolates with resistance to isoniazid and other drugs, but sensitivity to rifampicin, in the 2nd – 108 isolates of MDR bacteria. In the 1st group the most frequent spectra HSE (17,9%), HSKE (12,8%), HS (10.3 per cent), in the 2nd – HRSE (8,3%), HRSK and HRSKE (7.4% each). The most frequently drug resistance of isolates of group 1 was observed to streptomycin (80,3%), ethambutol (59.8%), and kanamycin/amikacin (39,3%), protionamide (21,4%), fluoroquinolones (20,5%). Among the isolates of group 2 maximum resistance was observed to streptomycin (94.4 per cent), kanamycin/amikacin (56,5%), ethambutol (52,8%), fluoroquinolones (37,0%), protionamide (34.3 percent). There were 1350 bacteriological studies. Drug resistance of the pathogen was determined by the method of absolute concentrations in dense environments and by the method of proportions on the automatic analyzer “Bactec MGIT 960” and also included PCR-based diagnostic analyzer GeneXpert. Studied suppressive activity of silver nanoparticles in isolated form in concentration of -5 mg/ml; 25 µg/ml; 50 µg/ml was also investigated in vitro antitubercular activity of nanocomposite consisting of silver nanoparticles in concentrations 5 mcg/ml, 25 µg/ml 50 µg/ml and anti-TB drug isoniazid at a concentration of 1 µg/ml. Nanoparticles with a size of 3-60 nm was obtained by electrochemical dissolution of the metal. Studies have shown that nanoparticles in a solution maintained stability during storage for 300 days. When mixing solutions of silver nanoparticles and isoniazid, as studies have shown that silver nanoparticles had no effect on the chemical stability and concentration of isoniazid in the solution exposure for 24 hours. Complete and significant growth suppression by the ILO (bactericidal effect) of nanoparticles on isolates of the group 1 was observed in 48.1%±0,53 cases, with the greatest suppressive activity was observed when the nanoparticles concentration 5 µg/ml to 58.1%±0,93. The combination of nanoparticles with isoniazid increase the bactericidal action was 17.2% (p<0.05). Bactericidal activity of isolated nanoparticles on clinical isolates of group 2 MDR was 41.7%. The combined use of nanoparticles with isoniazid provided the increase of bactericidal action of 18.8% (p<0.05). Obtained in the experiment in vitro results indicate a potentiating effect of silver nanoparticles on isoniazid.

KEYWORDS:

tuberculosis, isoniazid, nanoparticles, silver, bactericidal action, MBT.

FOR CORRESPONDENCE:

Regional clinical tuberculosis hospital,

150000, Sobinova str. 43, Yaroslavl

Andrey V. Zakharov, PhD. med. of Sciences

Phone: +7 (4852) 43-91-76

E-mail: Yrzahan@mail.ru

The role of the gene xpert mtb/rif assay in improving treatment effectiveness in newly-diagnosed pulmonary tb patients with mdr in Stavropol krai, Russia

Article 8.Page 76.
ARTICLE TITLE:

The role of the gene xpert mtb/rif assay in improving treatment effectiveness in newly-diagnosed pulmonary tb patients with mdr in Stavropol krai, Russia

AUTORS:

Chumakova E.S.1, Komissarova O.G.2,3, Abdullaev R.Yu.2, Odinets V.S.1

1Krai Clinical TB Dispensary, Stavropol, Russia

2Central TB Research Institute, Moscow, Russia

3N.I. Pirogov Russian National Research Medical University, Moscow, Russia

DESCRIPTION OF ARTICLE:

Submitted as of 13.10.2017

We studied 261 patients with different clinical forms of newly-diagnosed pulmonary TB with MDR; they were divided in two groups. Group 1 included 164 patients with rifampicin resistance determined by GeneXpert MTB/RIF at admission to hospital. Initially these patients received treatment regimen IV (pyrazinamide, kanamycin/amikacin/capreomycin, levofloxacin, cycloserine/terizidone, protionamide, PAS). Group 2 (comparison) included 97 patients with MDR established by sputum inoculation on solid media. Prior to DST results, these patients were administered standard chemotherapy regimen I (isoniazid, rifampicin, pyrazinamide, ethambutol). After determination of drug resistance (2-3 months after treatment commencement) we made treatment correction and reregistration as regimen IV. We established that in Stavropol Krai new pulmonary TB with MDR was more common among men; it was predominantly infiltrative TB with bacterioexcretion and lung cavities up to 2 cm in diameter. Effectiveness of treatment of newly-diagnosed pulmonary TB with MDR by sputum conversion confirmed by cultures 3 and 6 months after treatment commencement and by cavity closure 6 months after treatment commencement was reliably higher in the group of patients, who initially received treatment regimen IV, versus those, who initially received treatment regimen I, and later treatment regimen IV.

KEYWORDS:

впервые выявленный туберкулез, GeneXpert MTB/RIF, множественная лекарственная устойчивость, лечение.

FOR CORRESPONDENCE:

Regional TB Dispensary

355020, Dostoevsky Str., 56, Stavropol

Elena S. Chumakova, Phthisiatrician, Head, Department for patients with pulmonary TB #2

Phone: 8 (8652) 28-79-30

E-mail: info@kkptd.ru

A case of a “wavy” course of intrathoracic lymph nodes tb in a child with a compromised history

Article 9.Page 84.
ARTICLE TITLE:

A case of a “wavy” course of intrathoracic lymph nodes tb in a child with a compromised history

AUTORS:

Khokhlova Yu. Yu.1, Gubkina M.F.1,2, Petrakova I. Yu.1, Yukhimenko N.V.1

1Central TB Research Institute, Moscow, Russia

2N.I. Pirogov Russian National Research Medical University, Moscow, Russia

DESCRIPTION OF ARTICLE:

Submitted as of 07.10.2017

Aim of the publication: оn the example of a specific case history we show a wavy course of TB process in a child under late detection, presence of several risk factors and lack of preventive screening for TB. The clinical observation demonstrates late detection and a wavy course of TB process in a child caused by a combination of risk factors.

A six-month-old child, unvaccinated against TB, was under the care of a nurse, an ex-prisoner with TB. The child was not duly examined for TB (routine tuberculin tests were not performed twice a year), which led to late diagnosis of TB. In the age of 2 years 3 months the child was diagnosed with TB of intrathoracic lymph nodes in the infiltration and early calcification phase complicated by bronchopulmonary affection; SS-. The contact with a TB patient with multidrug resistance was established late. Thus, the adequate treatment was commenced untimely, which was the main cause of a wavy course of TB process. Treatment correction based on drug resistance patterns in the infections source led to a significant positive effect after 18 months of chemotherapy.

KEYWORDS:

TB, young child, risk factors, multidrug resistance, chemotherapy.

FOR CORRESPONDENCE:

Central TB Research Institute

2, Yauzskaya alley, 107564, Moscow

Julia Yu. Khokhlova, Physician, Young Children Unit, Children and Adolescent’s Department

Phone: +7 (499)785-90-27

E-mail:  detstvocniit@mail.ru