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The formalized procedures to commensurate the results and expenditures were used to make a comprehensive evaluation of the clinical efficiency and economical expediency of purposeful application of rifabutin in new cases of disseminated and destructive pulmonary tuberculosis.

The patients with multiresistant tuberculosis were divided into 2 groups: the sensitivity of Mycobacteria tuberculosis to antituberculous drugs was evaluated in Group 1 by the methods of absolute concentrations and in Group 2 by biological microchips determining mutations in the rpo3 gene responsible for rifampicin resistance. The results of the drug sensitivity test were obtained after 3 months of treatment in Group 1 and several days prior treatment in Group 2. By taking into account the test results, reserve drugs was used in Group 2 patients. Subsequently, the results of the drug sensitivity tests carried out by the bacteriological method in Group 2 patients showed that isoniazid resistance was simultaneously noted if there were mutations in the rpo-B gene. Timely treatment with reserve drugs exhibited higher efficiency of treatment with its shorter duration in Group 2 than in Group 1.

Diabetes mellitus accompanying tuberculosis complicates the course of the latter and remains a topical problem of phthisiology. Surgical treatment of patient with both conditions presents a high risk and is employed unreasonably rarely. The results of medical (173 patients) and surgical (107 patients) treatments were studied in patients with destructive tuberculosis concurrent with diabetes mellitus. Analyzing early and late results of treatment showed a more steady-state effect in the group of surgically treated patients. Thus, surgery should be desirably used in all patients with preserving destructive changes after the basic course of antibacterial therapy.

Clinical and X-ray studies were made in 148 children 2-10 years after hospital treatment to evaluate the stability of clinical recovery by the frequency of relapses in relation to the use of different drug treatment regimens. Children from an experimental group (n = 75) received shorter chemotherapy with 3-4 drugs (isoniazid, rifampicin, pyrazinamide in uncomplicated tuberculosis plus streptomycin in complicated one) in the intensive phase of chemotherapy. Pyrazinamide was not used in the intensive phase in the control group (n = 73). Long-term follow-ups showed a high efficiency of shorter chemotherapy regimens in treating intrathoracic tuberculosis in children since they do not lead to the higher incidence of recurrences--2.7% in both groups. The latter occurred in adolescents who had severe residual changes, who had been irregularly followed up at the tuberculosis control dispensary after hospital discharge, who had not received seasonal preventive chemotherapy courses, and who had experienced complicated, generalized or acute tuberculosis.

Ample clinical material obtained in Yakutia was used to study the efficiency of combined treatment in patients with disseminated pulmonary tuberculosis concurrent with gastrointestinal and respiratory diseases. At the same time it was justifiable to employ alternatives to deliver antituberculous agents to the lesion focus (rectal dropwise administration, phono- and photophoresis of isoniazid, endobronchial colloid diluted rifampicin, and activated silver water diluted antituberculous drugs) with additional biophysical exposure. This made this group of patients have much better antituberculous agent intolerance, which increased nonbacterial isolation rates and closed decay cavities as compared with conventional methods for administering antituberculous agents.

Examination of 23 adolescents with rapidly progressive pulmonary tuberculosis (RPPT) discovered severe bilateral lesions in 47.8%, caverns in 91.3%, M. tuberculosis in 86.9% of the examinees. 75% of the adolescents were resistant to antituberculous treatment. RPPT in adolescents is represented mainly by infiltration pulmonary tuberculosis (78.3%), caseous pneumonia and disseminated pulmonary tuberculosis (21.7%). RPPT develops because of late diagnosis and infection with drug-resistant M. tuberculosis.

The studies have showed the frequency and spectrum of drug resistance, determined by the methods of proportions and absolute concentrations, to be virtually equal. This suggests that both methods are of equal diagnostic value. The method of absolute concentrations is rather accurate and similar to that of proportions in sensitivity, by ensuring comprehensive determination of the spectrum of drug resistance. Furthermore, the advantages of this method are its simplicity, accessibility, and cost-efficiency.

Fifty-two patients with caseous pneumonia (CP) (whose age ranged from 18 to 60 years) admitted to a specialized tuberculosis facility of the general health care system were followed up. On admission, all the patients had marked intoxication and bronchopulmonary manifestations of the disease. X-study revealed lesions to one lobe in 19.2%, to 2 lobes in 32.7%, to 3 lobes or more in 48.1% of the patients. At the same time, all the patients had destructive changes with large and giants caverns in 57.7% of cases. The sputa of all 52 patients exhibited Mycobacteria tuberculosis (MBT), whose primary drug resistance being established. The nonspecific microflora composed of gram-positive cocci, gram-negative bacilli, fungi of the genus Candida in over 60% of patients was found in the sputa in two thirds of cases. A retrospective analysis indicated that CP had been correctly diagnosed only in 11.5% of patients within the first fortnight, in 65.4% by the end of the first month and by the beginning of the second, and in 23.1% following 2 months. The main reason for untimely diagnosis of CP was no sputum test for MBT. An algorithm of early CP diagnosis at general hospitals was developed, which includes a compulsory test of 3 sputum smears by the Ziehl-Nielsen method in all patients with pneumonia on admission and 2 weeks after treatment with wide-spectrum antibiotics. Chemotherapy in CP patients was long-term and combined 4-5 essential drugs within the first 4 months with obligatory correction after there was evidence for drug resistance. A course of nonspecific antibiotic therapy and a developed complex of symptomatic and pathogenetic treatments were compulsory. By the cessation of bacterial isolation, the efficiency of combined treatment was 82.7%, but a question as to a surgical intervention that is a compulsory component of CP therapy always arose at the final stage.

The paper presents a historical review of the literature on the rare form of extrapulmonary tuberculosis--gastric tuberculosis. It is more frequently associated with tuberculosis of other organs and observes as an isolated form. The disease has no specific clinical signs. It is diagnosed as gastric carcinoma or ulcer by X-ray and in most cases endoscopic studies. The diagnosis of gastric tuberculosis can be made only by histological study of the resected stomach or its biopsy specimen. Antibiotic treatment for tuberculosis yields a good effect.

To develop differential chemotherapy regimes for intrathoracic tuberculosis in children aged 3-12 years, 255 children with active tuberculosis underwent clinical and X-ray examination. Of them, 120 children received shorter chemotherapy in an early intensive phase by using three drugs (isoniazid, rifampicin, and pyrazinamide supplemented by streptomycin) in complicated tuberculosis. A control group (n = 135) had therapy without pyrazinamide. Shorter courses of therapy were shown not only to reduce total treatment duration on an average to 6.4 and 9.2 months in uncomplicated and complicated tuberculosis, respectively, but to contribute to more perfect healing processes and resolution of abnormal changes in 85.3 and 60.0% of children with uncomplicated and complicated forms, respectively. At the same time shorter treatment is well tolerated. It shows much fewer side effects than does longer treatment (20 and 36%). There are no increases in the incidence of recurrent tuberculosis late at follow-up (2.7 and 2.7%, respectively).

In 1996-1998, the Central Institute of Tuberculosis, Russian Academy of Medical Sciences performed more than 600 operations. Of them 90 (15%) patients isolated mycobacteria. The drug resistance of M. tuberculosis was found in 69 (76.7%) patients. In 60.9% of cases, the resistance of M. tuberculosis to isoniazid and rifampicin was concurrently accompanied by that to one (21.4%), two (61.0%), and even 3 (14.8%) tuberculostatics. Removal of the lung or its remnants in the extrapleural layer was most common (67.7%); thoracic cavernomyoplastic operations were made in 17.4% of cases, and partial resections accounted for only 13%. Postoperative complications were more frequently encountered in patients with drug-resistant tuberculosis than in controls (6.7%). Among them, tuberculosis progression and empyema were prevalent (13%). The clinical efficiency and duration of surgical treatment were directly related to the rates of progression and to the magnitude of drug-resistance of Mycobacteria.

In 1994-1996 the Santarishkes republican tuberculous hospital (Lithuania) has admitted 98 patients (82 males, 16 females) with polyresistant tuberculosis (M. tuberculosis were resistant to at least isoniazid and rifampicin). Of these, 13 patients were untreated, 17 had recurrences, 68 had chronic tuberculosis. After polyresistance of M. tuberculosis was found, the patients received an individual treatment with sensitive drugs. 20 patients were operated. The absence of bacteria was achieved only in 24 (24.5%) patients. Tuberculous lesions in the lungs disappeared and clinical symptoms relieved in 14 of them. In 74(75.5%) nonresponders the course of the disease was unfavourable. Negative treatment outcomes were observed in 38.5%, 64.7% and 85.3% of new-onset, recurrent and chronic cases, respectively.

Drug-resistant tuberculosis in the Ukraine and in other countries as well is a great important problem. The presence of drug-resistant Mycobacteria worsens clinical and bacteriological responses to therapy, prolongs hospital stay, and increases costs. The novel derivative of rifampicin, rifabutin, produced by Pharmacia & Upjohn under the trade name Mycobutin is more effective and safe than rifampicin. Rifabutin is approved for clinical application for tuberculosis and other mycobacterial infections. It is also recommended for rifampicin-resistant tuberculosis.

The review deals with Mycobacterium infection that is assuming greater topicality as an opportunistic infection, including that in AIDS. Presents the latest data on the property of Mycobacterium avium-intracellulare (MAI), ecology, epidemiology, and possible causes of higher incidence rates. Considers current approaches to preventing, diagnosing, and treating MAI infection-associated diseases.

The paper provides the data on the spread of drug-resistant strains of Mycobacterium tuberculosis (MBT) among contingents of patients with pulmonary tuberculosis who have been registered at a dispensary and new cases. The spread was 42.5 and 20.0%, respectively. In the past 3 decades, the spread of primary (baseline) drug resistance of MBT has increased from 6.5 to 22.0%.

Combined drug therapy ceases bacterial isolation and clinical symptoms of the disease and resolves infiltration in most patients after 1-month therapy. Gordox has a pronounced inhibitory action on Mycobacterium tuberculosis irrespective of their responses to antibiotics. L-transformation of M. tuberculosis was found with 5000-10,000 ATpE (U) of gordox.

133 homeless subjects with pulmonary tuberculosis were examined microbiologically in Moscow Tuberculosis Hospital N 7 in 1993-1994. In most of the examinees the disease was advanced with destruction and intensive bacterial discharge (100-10,000 microbes in the sample). New-onset cases discharged mycobacteria with multiple drug resistance. Acquired drug resistance was registered in 83.8% of previously treated patients, 73% of them had resistance to 2-6 drugs. Isoniazid-, rifampicin- and streptomycin- resistant were 48.6, 33.8 and 63.5% of the examinees, respectively.

108 guinea pigs were infected with M-tuberculosis 2 weeks later 36 of them were put on treatment with rifampicin and isoniazid, the rest served as untreated control. The comparison was made of mixed population of all the cells isolated from bronchoalveolar lavage versus pure fraction of alveolar macrophages (AM) by spontaneous and BCG killed culture-stimulated NBT-test, activity of superoxide dismutase and catalase, levels of malonic dialdehyde. Estimations were conducted 1 day, 1, 2 and 6 weeks after inoculation in untreated animals and after 1 months of treatment in treated animals. AM lost ability for stimulation to the end of 24 h period since inoculation. 1-2 weeks later metabolic depression and complete areactivity occurred. Mixed population within postinoculation week 1 mobilized its defense potential. In extensive generalized tuberculosis all the cells of the respiratory tract worked for self-defense and lost protecting abilities. Specific chemotherapy reestablished functional status of both AM and cell population on the whole.

The experimental studies have provided strong evidence that the efficacy of etiotropic therapy for tuberculosis can be enhanced by applying a number of antimicrobial agents having different mechanism of action, which belong to cephalosporins, macrolides, aminoglycosides, fluoroquinolones. The basis of the mechanism responsible for potentiation of activity of essential tuberculostatic drugs for potentiation of activity of essential tuberculostatic drugs is enhanced inhibition of the viability of a microbacterial population, prevented development of drug resistance in tuberculosis mycobacteria, and increased function of macrophages.

The paper presents the therapeutical results of 82 adolescents suffering from respiratory tuberculosis. During multi-modality therapy by using tuberculin, oliphen plus prednisolone there were clear-cut changes in immunological parameters, an increase in therapeutical efficiency and an average 3-month reduction in hospital stay.

To study the nature of lesions in the lungs developing as a result of using glucocorticoids in combined therapy of tuberculosis, two groups of new cases of infiltrative tuberculosis were observed. 51 patients were treated with the use of prednisolone and 23 patients were treated with antibacterial drugs alone. In addition, studies were performed on two groups of noninbred albino rats infected with mycobacteria Bovinus-8. It was shown that by changing the nature of the tissue reactions prednisolone promoted formation of tuberculoma type foci in the lung tissue and prolonged the periods of cavern closing.