Antituberculosis antibodies in patients with tuberculosis during chemotherapy

Enzyme immunoassay of the titer of antituberculosis antibodies (ATAb) from patients with pulmonary tuberculosis has indicated that their levels depend on the different characteristics of a specific process: the form of active tuberculosis, the extent of changes in the lung tissue, the presence of destruction and bacterial isolation, the type of specific inflammatory reaction, and the duration of the treatment performed. Whether there was a correlation of ATAb titers with skin tuberculin sensitivity the level was studied by the Mantoux test using 2 TE PPD-L. The time course of changes in ATAb titers in patients with pulmonary tuberculosis during the routine chemotherapy was analyzed.     

Current chemotherapy for tuberculosis in children.

Antituberculosis medications are extremely well tolerated by children and have proved to be very successful. The newer regimens of intensive short-course chemotherapy for tuberculosis have several advantages over traditional two-drug regimens, including faster sterilization and bactericidal action, shorter duration over which patient noncompliance can occur, less expenditure of resources for monitoring treatment, lower failure and relapse rates, and broader coverage for possible drug-resistant M. tuberculosis. The currently recommended regimen for pulmonary and most extrapulmonary forms of tuberculosis in children is 6 months of isoniazid and rifampin supplemented during the first 2 months by pyrazinamide. Treatment during the first 1 to 2 months should, if possible, be daily but the last 4 to 5 months of therapy can be either daily or twice weekly under direct observation of a health-care professional. For patients in whom social or other constraints prevent reliable self-administration of daily treatment in the initial phase, medications may be given twice weekly from the beginning under close observation. For these situations, a total duration of treatment of 6 to 9 months is reasonable. Non-life-threatening forms of extrapulmonary tuberculosis can be treated in the same manner as pulmonary tuberculosis. Although tuberculous meningitis probably will respond to these regimens, the relative lack of data at present leads most experts to recommend total durations of between 6 and 12 months for this form of tuberculosis. The major limitation to controlling tuberculosis in the United States is noncompliance or nonadherence to medications by patients. The physician and other health-care providers must devote a great deal of their time and energy to ensuring adherence with medications and take whatever steps are necessary to make sure that the child with tuberculosis is adequately treated.     

Ultrasonic monitoring of the status of the liver in children with intrathoracic tuberculosis during chemotherapy

Findings of parallel clinical, laboratory and echographic investigations relating to 44 children with various forms of intrathoracic tuberculosis are presented. Echography permitted dividing the patients into two groups. The first group consisted of 14 patients with normal echograms of the liver parenchyma, insignificant extents of intrathoracic tuberculosis at the phase of incomplete consolidation and calcination and normal function of the liver. Aggravation of the process by the echograms (microfocal consolidations) observed in 5 patients accounted for the adverse reactions. The second group included 30 patients with pathological shifts on the echograms of the liver parenchyma at the moment of the registration in the hospital, significant extent of intrathoracic tuberculosis at the phase of infiltration, shifted biochemical indices of the liver function, microfocal parenchymal changes appeared as high amplitude pulses. The ultrasonic procedure allowed to estimate the functional state of the liver, to modulate the chemotherapy scheme and to predict the adverse reactions.     

Anti-tuberculosis antibodies in the immunoenzyme test in relation to the effectiveness of chemotherapy of tuberculosis]

A method of indirect solid-phase EIA was used to detect serum antibodies in 110 patients with destructive tuberculosis. The preparation with a molecular mass of 38-42 kD isolated from the mycobacteria H37Rv was used as an antigen. Changes in the level of antituberculous antibodies were found during treatment, which are most manifested in 4-6 months of antituberculous therapy and depend on treatment efficiency. The effective therapy is accompanied by a decrease in the level of antituberculous antibodies by that time, while in ineffective therapy it remains high. Hence, changes in the level of antituberculous antibodies may serve as an additional criterion of chemotherapy efficiency.     

Extrapulmonary tuberculosis in children]

Extrapulmonary tuberculosis morbidity in children of the Novosibirsk region for the period of 10 years was analysed on the basis of the materials presented by the regional antituberculosis center. It was found that 44 children has extrapulmonary tuberculosis which accounted for 17.9% of the total number of sick children and 5.7% of all extrapulmonary tuberculosis patients. Tuberculous lymphadenitis was diagnosed in 50% and bone-and-joint tuberculosis in 27.3% of cases; nephrotuberculosis occupied the third and ocular tuberculosis the fourth place; 20% of sick children were detected after their examination and 80% after surgery for other general diseases. Complications of the main process at the moment of application for help had 18.2% of children. The basic causes of later extrapulmonary tuberculosis diagnosis in children is the absence of awareness for tuberculosis in the general practitioners and inadequate work carried out in tuberculosis infection foci.     

Combined chemotherapy of toxic hepatitis in patients with pulmonary tuberculosis]

The follow-up involved patients with infiltrative pulmonary tuberculosis who developed toxic medicamentous hepatitis associated with antituberculosis drugs. They were treated by the method of combined pharmacotherapy which comprised sodium nucleinate (0.5 g 4 times daily), splenin (2 ml twice a day) and quercetin. The given combination of drugs rapidly improved clinical parameters and normalized immunologic tests.     

A radiographic progression during and after initial chemotherapy for pulmonary tuberculosis]

Transient radiographic progressions during or after antituberculous chemotherapy were observed in 60 (4.5%) out of 1,321 cases with active pulmonary tuberculosis who received an initial combination chemotherapy including INH and RFP. The radiographic patterns of these progressions were classified into a singular and a gregarious pattern. A correlation between the two radiographic patterns and a positive or negative culture in sputum at the time of the radiographic progressions was studied, revealing significantly more frequent singular patterns in culture negative cases while more frequent gregarious patterns in culture positive cases. In a majority of the cases, radiographic progressions developed within 3 months after an initiation of chemotherapy. Either of the increased shadows during chemotherapy or after completion of chemotherapy showed an improvement in a moderate degree or over and a good prognosis thereafter by continuous administration of the same drugs or under observation without retreatment respectively. It is concluded that radiographic progressions appeared during an intensive chemotherapy or after its completion do not always require changing the antituberculous drugs or resumption of chemotherapy.