"CTRI Bulletin"
#3,(4),2018.

CTRI BULLETIN №3 (4) 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)

TB in adolescents: challenges and solutions. The 40th anniversary of the Adolescent Department of the Central TB Research Institute

Ergeshov A.E., Ovsyankina E.S., Panova L.V., Poluektova F.G.

5

 

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2)

Vaccinoprophilaxis of TB. Challenges of monitoring and epidemiology of BCG/BCG-M immunization induced complications in the Russian Federation

Aksenova V.A., Sevostyanova T.A.

11

 

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3)

TB in adolescents – epidemiological rates, detection methods, clinical forms

Aleksandrova E.N., Morozova T.I., Otpushchennikova O.N.

21

 

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4)

Tuberculosis in children of different age groups: the leading modern directions and innovations in diagnosis, treatment and prophylaxis in the republic of Moldova

Iavorschi C.M., Bolotnicova V.A.

25

 

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5)

The comparative analysis of phenotypic and genotypic drug resistance of Mycobacterium tuberculosis isolated from children and adolescents at the hospital of the Central TB Research Institute in 2011-2018

Andreevskaya S.N., Smirnova T.G., Andrievskaya I.Yu., Kiseleva E.A., Larionova E.E., Sevastyanova E.V., Chernousova L.N.

30

 

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6)

Inflammatory response in TB in adolescents

Tyulkova T.E., Chugaev Yu.P. , Pirogova N.D., Kozlov N.V. , Mezentseva A.V.

42

 

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7)

Personalized approaches to management of pulmonary TB with MDR/XDR in adolescents using short chemotherapy regimens, valve bronchial blockage and surgery

Viechelli E.A., Panova L.V., Ovsyankina E.S., Bagirov M.A., Sivokozov I.V.

50

 

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8)

Side effects of chemotherapy in children and adolescents with pulmonary TB after surgery

Khiteva A.Yu., Panova L.V., Ovsyankina E.S.

60

 

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9)

The social portrait of a family having a child with pulmonary TB

Zolotova N.V., Petrakova I.Yu., Khokhlova Yu.Yu.

65

 

READ MORE

10)​

​​The first-ever experience of endoscopic ultrasound-guided fine-needle puncture in mediastinal LYMPHadenopathy of a four-year-old child

Sivokozov I.V., Shabalina I.Yu., Evgushchenko G.V., Gubkina M.F., Petrakova I.Yu., Karpina N.L.

71

 

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TB in adolescents: challenges and solutions. The 40th anniversary of the Adolescent Department of the Central TB Research Institute

Article 1.Page 5.
ARTICLE TITLE:

TB in adolescents: challenges and solutions. The 40th anniversary of the Adolescent Department of the Central TB Research Institute

AUTORS:

Ergeshov A.E., Ovsyankina E.S., Panova L.V., Poluektova F.G.

 Central TB Research Institute, Moscow, Russia

DESCRIPTION OF ARTICLE:

Submitted as of 17.04.2018

The article highlights the main research areas of the Child and Adolescent Department of the Central TB Research Institute: diagnosis and differential diagnosis, traits of TB treatment, psychological factors of etiopathogenesis of TB. Objectives and new technologies have been determined for each area. All the research areas of the department are relevant and promising for TB management in children and adolescents, and important for both researchers and clinicians.

KEYWORDS:

TB, children, new technologies, MDR/XDR TB, diagnosis, differential diagnosis, psychological factors, chemotherapy.

FOR CORRESPONDENCE:

Central TB Research Institute,

2, Yauzskaya alley, 107564, Moscow, Russia

Atadzhan E. Ergeshov, Doctor of Medical Sciences, Professor, Director of Central TB Research Institute

Tel.: +7 (499) 785-90-19

E-mail: cniit@ctri.ru

Vaccinoprophilaxis of TB. Challenges of monitoring and epidemiology of BCG/BCG-M immunization induced complications in the Russian Federation

Article 2.Page 11.
ARTICLE TITLE:

Vaccinoprophilaxis of TB. Challenges of monitoring and epidemiology of BCG/BCG-M immunization induced complications in the Russian Federation

AUTORS:

Aksenova V.A.1, Sevostyanova T.A.2

1National Medical Research Center of Phthisiopulmonology and Infectious Diseases, Moscow, Russia

2Moscow Municipal Scientific Practical Center for Tuberculosis Control, Moscow, Russia

DESCRIPTION OF ARTICLE:

Submitted as of 27.06.2018

Monitoring of complications after immunization with BCG or BCG-M vaccine should provide epidemiological surveillance, periodic assessment of the justification for mass immunization of children, reacting to the emergence of reactogenic vaccine series and taking them out of use, identifying immunization defects, conducting applied scientific research to clarify indications and contraindications to the conduct of immunization, monitoring the adequacy and effectiveness of providing medical care to children with complications after immunization. The solution of monitoring tasks is complicated by delayed occurrence of the majority of complications after immunization with BCG vaccine, incompleteness of information on detected complications at the state level. The aim of the study was to determine approaches to monitoring complications after immunization with BCG or BCG-M vaccine, which allow calculating the estimated frequency of complications after immunization, and analyze the epidemic situation for complications after immunization. Information was used for forms of federal statistical surveillance No. 5, 33, as well as information from the complications register after immunization with BCG or BCG-M vaccine containing information on 37.1% of complications. A mathematical model was developed that takes into account the likelihood that the actual complications after immunization refer to the year in which the immunization was performed, as well as a model that takes into account this probability for various clinical forms of complications. It is received that starting from 2010, there is a decrease in the estinated frequency of complications after immunization from the level of 35.3 – 31.5 per 100 000 immunized in 2005-2009 to 11.2 in 2013. In the cartographic analysis of the estimated complication rate after the immunization, averaged over 9 years, there was no clear geographical or climatic dependence of the incidence of complications, but it was found that the estimated frequency of complications varies significantly in different subjects of the Russian Federation. 75% quartile of the average estimated frequency of complications is 3.3 times greater than 25% of the quartile. This may be due to unclearly defined criteria for the diagnosis of the complication after immunization with BCG vaccine to be registered and dispensary observation, as well as differences in approaches for identifying complications. Correlations between the frequency of complications after immunization and the incidence of tuberculosis in children aged 0-14 years were not revealed (r = 0). The estimated frequency of various clinical forms of complications was calculated, which for local complications was 8.6 per 100 000 immunized, lymphadenitis – 15.5 per 100 000 immunized, BCG-ostitis – 3.5 per 100 000 immunized.

KEYWORDS:

immunization with BCG, complications after BCG immunization.

FOR CORRESPONDENCE:

National Medical Research Center of Phthisiopulmonology and Infectious Diseases of the Ministry of Health, 4-2, Dostoevskogo St., 127473, Moscow, Russia

Valentina A. Aksenova, Head of Child and Adolescent Department, Chief Specialist in Children’s Tuberculosis of the Ministry of Health of the Russian Federation, Doctor of Medical Sciences, Professor, Academic of the Russian Academy of Natural Sciences,

Tel.: +7 (495) 681-92-36.

Е-mail: v.a.aksenova@mail.ru

TB in adolescents – epidemiological rates, detection methods, clinical forms

Article 3.Page 21.
ARTICLE TITLE:

TB in adolescents – epidemiological rates, detection methods, clinical forms

AUTORS:

Aleksandrova E.N., Morozova T.I., Otpushchennikova O.N.

Saratov State Medical University named after V.I. Razumovsky, Saratov, Russia

DESCRIPTION OF ARTICLE:

Submitted as of 15.05.2018

We studied the epidemiological rates (incidence, prevalence, mortality), detection methods and clinical forms of TB in patients aged 15-17 in Saratov region. During the five-year observation period (2013-2017) the incidence among adolescents decreased 2.3 times (from 24.0 to 10.6 per 100,000 population), the prevalence – 2.3 times (from 38.1 to 16.6 per 100,000 population). The improvement of the epidemiological rates was preconditioned by high level of early TB detection in this age group, demonstrated by “active” case finding in 83.3% of adolescents. Among adolescents, diagnosis of TB by control fluorography examinations appeared to be five times more effective than by immunology tests. For diagnosis verification every second adolescent was included in the diagnostic (0) dispensary group. The clinical structure of TB was as follows: secondary forms prevailed (93.0%); primary processes were observed in 4.2%; extrapulmonary TB was diagnosed in 2.8%.

KEYWORDS:

adolescents, TB, incidence, prevalence, detection methods, clinical forms.

FOR CORRESPONDENCE:

V.I. Razumovsky Saratov State Medical University, Saratov, Russia

112, Bolshaya Kazachya st., 410012, Saratov, Russia

Elena N. Alexandrova, Candidate of Medical Sciences, Assistant of the Department of Phthisiology

Теl.: +7 (917) 306-66-67

Е-mail: allenik238@mail.ru

Tuberculosis in children of different age groups: the leading modern directions and innovations in diagnosis, treatment and prophylaxis in the republic of Moldova

Article 4.Page 25.
ARTICLE TITLE:

Tuberculosis in children of different age groups: the leading modern directions and innovations in diagnosis, treatment and prophylaxis in the republic of Moldova

AUTORS:

 Iavorschi C.M.1,2, Bolotnicova V.A.1

1 Kirill Draganyuk Phthisiopulmonology Institute, Kishinev, Moldova

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

DESCRIPTION OF ARTICLE:

Submitted as of 14.05.2018

According to the data from the evidence-based medicine, focused on general methodological approaches in assessing the burden of tuberculosis (TB) among children and adolescents, the impact indicators of the most significant morbid risk factors and peculiarities in the system of anti-tuberculosis activity is the patients’ age that plays a key role in this field.

This approach predetermined the purpose of the study and its components, was the subject of studying the age specificity of TB in a cohort (of 445 people) among patients aged 0–17 years, according to the data for 2015-2017. This article provides statistical data on TB morbidity, prevalence and mortality. Its socio-epidemiological and clinical-demographic features are indicated. It is shown that children and adolescents are a vulnerable group for the development of TB infection and disease. There are outlined the priority modern directions and current methods of TB prophylaxis, diagnosis and treatment in children and adolescents of the Republic of Moldova.

KEYWORDS:

tuberculosis, children and adolescents, risk factor, incidence, prevalence, diagnosis, prophylaxis.

FOR CORRESPONDENCE:

Kirill Draganyuk Phthisiopulmonology Institute, 13, K. Vyrnav St., 2025, Kishinev, Moldova

Constantin M. Iavorschi, Professor, Deputy Director for Research and Innovation

Tel.: + (3737) 931-07-38

E-mail: constantin.iavorschi@usmf.md

The comparative analysis of phenotypic and genotypic drug resistance of Mycobacterium tuberculosis isolated from children and adolescents at the hospital of the Central TB Research Institute in 2011-2018

Article 5.Page 30.
ARTICLE TITLE:

The comparative analysis of phenotypic and genotypic drug resistance of Mycobacterium tuberculosis isolated from children and adolescents at the hospital of the Central TB Research Institute in 2011-2018

AUTORS:

Andreevskaya S.N., Smirnova T.G., Andrievskaya I.Yu., Kiseleva E.A., Larionova E.E., Sevastyanova E.V., Chernousova L.N.

Central TB Research Institute, Moscow, Russia

ФГБНУ «Центральный научно-исследовательский институт туберкулеза», г. Москва, Россия

DESCRIPTION OF ARTICLE:

Submitted as of 15.06.2018

We described drug resistance patterns of M. tuberculosis isolated from children and adolescents; we also evaluated effectiveness of molecular genetic methods used for drug resistance determination. We studied diagnostic samples from pulmonary TB patients admitted to the Child and Adolescent Departments of the Central TB Research Institute from 2011 to May 2018, involving cultural studies (BACTEC MGIT 960) and molecular genetic methods (real-time PCR, multiplex PCR, microarrays). The cultural studies were done for 445 children and 778 adolescents. Molecular genetic studies – for 778 children and 705 adolescents. Molecular genetic methods for M. tuberculosis detection in samples demonstrated higher effectiveness versus cultural methods; multiplex PCR for drug resistance determination demonstrated higher analytical sensitivity versus microarray technology. Drug susceptibility testing of M. tuberculosis from children and adolescents demonstrated a large share of MDR (49.39%); most was caused by mutations, which did not produce negative influence on viability or transmissibility of mycobacteria (rpoB531_Ser->Leu + katG315_Ser->Thr). Based on the results, we concluded about a large reservoir of MDR M. tuberculosis, capable of active transmission within a population. For better control of drug resistant TB among children and adolescents we recommend compulsory inclusion of molecular genetic methods for M. tuberculosis detection and drug resistance determination into the diagnostic algorithm. In the future, it is necessary to develop molecular genetic test systems for a wider spectrum of TB drugs.

KEYWORDS:

Mycobacterium tuberculosis, drug resistance, children, adolescents, BACTEC MGIT 960, PCR, microarrays.

FOR CORRESPONDENCE:

Central TB Research Institute

2, Yauzskaya alley, 107564, Moscow, Russia

Sophia N. Andreevskaya, Candidate of Medical Sciences, Senior Researcher, Microbiology Department

Tel.: +7 (499) 785-90-91

Е-mail: andsofia@mail.ru

Inflammatory response in TB in adolescents

Article 6.Page 42.
ARTICLE TITLE:

Inflammatory response in TB in adolescents

AUTORS:

Tyulkova T.E.1,2, Chugaev Yu.P. 1,2, Pirogova N.D.3, Kozlov N.V. 3, Mezentseva A.V. 2

1Ural Research Institute for Phthisiopulmonology (Branch of National Medical Research Center of Phthisiopulmonology and Infectious Diseases), Ekaterinburg, Russia

 2 Ural State Medical University, Ekaterinburg, Russia  

3 Oblast TB Dispensary, Tyumen, Russia

DESCRIPTION OF ARTICLE:

Submitted as of 11.05.2018

In some TB patients we observed elevated levels of acute-phase proteins (α1-α2 fractions of globulins). The aim of the study was to establish the traits of TB process in adolescents based on expressiveness of inflammatory response. The groups were composed as α2-globulins were detected within the reference values (group 1, n=47), or higher (group 2, n=42). During the study we noted that in the adolescents of group 2 TB was detected in the early stage of primary infection oftener than in group 1 (р<0.05) and/or at patients’ referrals (p<0.05). As for clinical forms, tuberculomas, TB pleurisy and intrathoracic lymph nodes TB complicated by bronchopulmonary lesions prevailed. In group 1 TB was oftener detected in the late stage of infection, as calcifications were forming (р<0.05). The adolescents of this group were predominantly infected with drug sensitive strains of M. tuberculosis (р<0.05). Detection of general inflammatory response manifested by increase in α2-globulins required careful epidemiologic, microbiologic, molecular-genetic and radiologic studies to exclude unfavourable or complicated course of TB caused by drug resistant M. tuberculosis.

KEYWORDS:

TB, adolescents, inflammatory response, acute-phase proteins, TB activity.

FOR CORRESPONDENCE:

Ural Research Institute for Phthisiopulmonology (Branch of National Medical Research Center of Phthisiopulmonology and Infectious Diseases)

50, 22 Partsyezda St., 620039, Ekaterinburg, Russia

Ural State Medical University

3, Repina St., 620014, Ekaterinburg, Russia  

Tatyana E. Tyulkova, Doctor of Medical Sciences, Leading Researcher

Tel.: + 7 (343) 333-44-61

Е-mail: tulkova2006@rambler.ru

Personalized approaches to management of pulmonary TB with MDR/XDR in adolescents using short chemotherapy regimens, valve bronchial blockage and surgery

Article 7.Page 50.
ARTICLE TITLE:

Personalized approaches to management of pulmonary TB with MDR/XDR in adolescents using short chemotherapy regimens, valve bronchial blockage and surgery

AUTORS:

Viechelli E.A., Panova L.V., Ovsyankina E.S., Bagirov M.A., Sivokozov I.V.

Central TB Research Institute, Moscow, Russia

DESCRIPTION OF ARTICLE:

Submitted as of 17.04.2018

We carried out a cohort prospective study (from 2015 to 2017), which enrolled 14 pulmonary TB patients with MDR/XDR (aged 13-17), to develop personalized approaches to TB management using short chemotherapy regimens, valve bronchial blockage and surgery. The criteria for short chemotherapy administration were as follows: sputum conversion after 1-3 months, cavity closure within 6 months of treatment. Short chemotherapy (12 months: the intensive phase – 6 months – 5 TB drugs, the continuation phase – 6 months – 3 TB drugs) was administered to 28.6% of patients. The chemotherapy regimens of more than 12 months were administered to 71.4% of patients: due to surgery – to 60.0%, and endobronchial valve installation – to 20.0%. Effectiveness of short chemotherapy regimens was confirmed by absence of relapses one year after the main treatment course. Use of valve bronchial blockage and surgery let achieve favourable outcomes in the cases, when lung cavities remained.

KEYWORDS

adolescents, TB, MDR/XDR, shortened chemotherapy regimens, valve bronchial blockage, surgery.

FOR CORRESPONDENCE:

Central TB Research Institute,

2, Yauzskaya alley, 107564, Moscow, Russia

Evgenia A. Viechelli, Junior Researcher, Child and Adolescent Department

Tel.: +7 (499) 785-90-05

Е-mail: detstvocniit@mail.ru

Side effects of chemotherapy in children and adolescents with pulmonary TB after surgery

Article 8.Page 60.
ARTICLE TITLE:

Side effects of chemotherapy in children and adolescents with pulmonary TB after surgery

AUTORS:

Khiteva A.Yu., Panova L.V., Ovsyankina E.S.

Central TB Research Institute, Moscow, Russia

DESCRIPTION OF ARTICLE:

Submitted as of 17.04.2018

We carried out a cohort prospective study (from 2013 to 2017), which enrolled 52 patients aged 13-17 after surgery for pulmonary TB, in order to evaluate the significance of monitoring of side effects of TB drugs. The prevailing side effects was hepatobiliary toxicity (40%). The monitoring of side effects enabled to detect and timely correct drug intolerance in 70% of patients, which did not affect the duration of their stay in hospital. Based on the minimal clinical and laboratory signs of side effects, 10% of patients received symptomatic treatment along with chemotherapy. Hospital stay increased from 15 days to 3 months for 20% of patients with frequent withdrawals of TB treatment.

KEYWORDS:

adolescents, chemotherapy, chemotherapy after surgery, side effects.

FOR CORRESPONDENCE:

Central TB Research Institute,

2, Yauzskaya alley, 107564, Moscow, Russia

Antonina Yu. Khiteva, Junior Researcher, Child and Adolescent Department

Tel.: +7 (499) 785-90-05

E-mail: detstvocniit@mail.ru

The social portrait of a family having a child with pulmonary TB

Article 9.Page 65.
ARTICLE TITLE:

The social portrait of a family having a child with pulmonary TB

AUTORS:

Zolotova N.V., Petrakova I.Yu., Khokhlova Yu.Yu.

Central TB Research Institute, Moscow, Russia

DESCRIPTION OF ARTICLE:

Submitted as of 19.03.2018

The article discusses theoretical and practical aspects of social factors responsible for the development of pulmonary TB in children, which are traditionally referred to the unfavourable social status of the family. Based on the analysis of the relevant publications, we established neither common typology of socially unfavourable families nor distinct criteria for differentiation of a family social status. Our work disclosed the notion of a “family social status” and drew attention to one of the typology of families with different levels of social adaptation described in the psychological and pedagogical literature. We justified the necessity and expediency of introduction of the notion of a “family at social risk”, which was wider than an “asocial family” and reflected less evident forms of family unsafety. Setting the problems of family risk drew attention of specialists to a wider range of negative social factors, which could be associated as risk factors for TB development in children. We also highlighted main socioeconomic and demographic characteristics, which allowed differentiating a safe family and a family at social risk. According to the aim of the study, we evaluated the social status of 103 families, which were divided in two groups based on the differential approach: a safe family and a family at social risk. The comparative analysis of all other characteristics enabled to create social portraits of these groups. A safe family was a family with two parents (predominantly the birth parents), a middle month income, favourable housing, Moscow residency. Most parents had higher or secondary professional education. All fathers had a permanent job, and mothers either worked or were housewives. A family at social risk was either incomplete, or with two parents; in one third of them birth fathers were replaced by stepfathers. In the latter group, families had a satisfactory income and satisfactory housing. Most families lived in Moscow, every fourth – in different regions of Russia. Most parents had secondary or secondary professional education. Most mothers had a permanent job, one third of fathers were either unemployed or had a temporary job. We established that patients from the risk families reliably prevailed over patients from safe families (67% and 33% respectively). The obtained data demonstrate that TB is a challenge for both social risk families and some so-called safe families and show the necessity of developing differential approaches to study social factors of the disease.

KEYWORDS:

childhood TB, social status, social risk family.

FOR CORRESPONDENCE:

Central TB Research Institute

2, Yauzskaya alley, 107564, Moscow, Russia

Natalia V. Zolotova, Candidate of Psychological Sciences, Senior Researcher, Psychology Team, Child and Adolescent Department

Tel.: +7 (499) 785-90-27

E-mail: Zolotova_n@mail.ru

The first-ever experience of endoscopic ultrasound-guided fine-needle puncture in mediastinal LYMPHadenopathy of a four-year-old child

Article 10.Page 71.
ARTICLE TITLE:

The first-ever experience of endoscopic ultrasound-guided fine-needle puncture in mediastinal LYMPHadenopathy of a four-year-old child

AUTORS:

Sivokozov I.V., Shabalina I.Yu., Evgushchenko G.V., Gubkina M.F., Petrakova I.Yu., Karpina N.L.

 Central TB Research Institute, Moscow, Russia

DESCRIPTION OF ARTICLE:

Submitted as of 04.07.2018

We have described the first-ever experience of endosonography in Russia and Eastern Europe of a child aged under five with mediastinal lymphadenopathy. We demonstrated the peculiarities of transesophageal endosonography with an echobronchoscope (EUS-B), presented the advantages of the new method versus the traditional radiological and immunological diagnosis of lymphadenopathy in individuals with presumptive TB of intrathoracic lymph nodes.

KEYWORDS:

bronchoscopy, diagnosis, endosonography, TB.

FOR CORRESPONDENCE:

Central TB Research Institute

2, Yauzskaya alley, 107564, Moscow, Russia

Ilya V. Sivokozov, Candidate of Medical Sciences, Head of Endoscopy Department

Tel.: +7 (499) 785 9176

Е-mail: sivokozov@bronchology.ru