Tsybikova E.B.
Federal Public Health Institute, Moscow

The resume. Background: The Millennium has passed, yet pulmonary tuberculosis is still at a rise in Russia, the main reason being low efficiency in management of secondary destructive pulmonary tuberculosis.

The aim of this study was to analyze in a cohort survey the outcomes of management of primary pulmonary tuberculosis and secondary destructive pulmonary tuberculosis in Russian Federation in 2007-8.

Methods: A comparative analysis of outcomes was implemented in two groups: patients with primary pulmonary tuberculosis and patients with secondary destructive pulmonary tuberculosis. The study was carried out through analysis of the data from the cohort survey of RF in 2008. The latter was carried out on the basis of medical registry and accounts produced according to the Order No.50 of 13.02.2204 of the Ministry of Public Health and Social Development. For comparative analysis of the results, an accurate method of Fisher was used when comparing Tables 2X2 through the program EPIINFO, Version 3 (EPOCDC,1988).

The investigation into a structure of the cohort of successfully cured incidental patients with pulmonary tuberculosis was carried out. The patients of this cohort were classified along presence/absence of bacterial excretions assessed with microscopy of sputa.

The Districts of RF were ranged along the total number in 2008 of surgical interventions performed in them for tuberculosis in patients of this cohort. Three categories has been established: Districts with 200-320 operations, Districts with 100-200 operations, and Districts with 50-100 operations.

Results: Comparative analysis proved that efficiency of treatment for incidental destructive tuberculosis was evidently lower than for the primary tuberculosis. The structure of the group of effectively cured patients was dominated by patients in whom the disease was not accompanied by bacterial excretion, while the patients with associated bacterial excretion most frequently failed to be uncured and occasionally died. Lack of surgery in combined treatment for incidental destructive pulmonary tuberculosis is found in half a Districts of RF, and this is a factor negatively affecting the successful outcome.

Conclusions: High mortality rates in patients with primary destructive tuberculosis is determined by two factors: bacterial excretion and low efficiency of their treatment. Patients with associated bacterial excretion most frequently remained uncured and occasionally died. Lack of surgery in combined treatment for incidental destructive pulmonary tuberculosis was a factor negatively affecting the effective treatment and successful outcome.

Key words: incidental pulmonary tuberculosis, destructive tuberculosis, cohort study, efficiency of treatment, surgical intervention, outcomes.

References

1. Bogush LK. Khirurgicheskoye lecheniye tuberkuleza legkikh [Surgical treatment of lung TB]. Moscow: Meditsina; 1979. 296 p.
2. Gavrilenko VS, Khruleva TS. Klinicheskaya struktura tuberkuleza u vpervye vyyavlennykh vzroslykh bolnykh [Clinical structure of TB in primary registered adult patients]. Problemy tuberkuleza 1997;(5):9-11.
3. Giller DB, Ustinov AV, Tokaev KV, et al. Povysheniye effektivnosti lecheniya vpervye vyyavlennykh bolnykh destruktivnym tuberkulezom legkikh [Elevating efficiency of management of destructive lung TB]. In: Aktualnye problemy khirurgicheskogo lecheniya tuberkuleza i soputstvuyushchikh zabolevaniy legkikh. Moscow: TsNIIT RAMN; 2010. p. 53-56.
4. Perelman MI, Koryakin VA, Protopopova NM. Tuberkulez: Uchebnik [Tuberculosis. Textbook]. Moscow: Meditsina; 1990. p. 135-154.
5. Perelman MI, Naumov VN, Dobkin VG, Streltsov VP, Dubrovskiy AV. Pokazaniya k khirurgicheskomu lecheniyu bolnykh tuberkulezom legkikh [Indications for surgical treatment of lung TB] Problemy tuberkuleza i bolezney legkikh 2002;(2):51-55.
6. Repin YuM. Khirurgiya otyagoshchennykh form tuberkuleza legkikh [Surgery of aggravated patterns of lung TB]. Leningrad: Meditsina; 1984. p. 153-196.
7. Levashev YuN, Repin YuM, editors. Rukovodstvo po legochnomu i vnelegochnomu tuberkulezu [Guidelines on lung and extralung TB]. St. Petersburg: ELBI-SPb; 2006. p. 407-436.
8. Friden T, editor. Tuberkulez: vyyavleniye, lecheniye i monitoring po K. Tomenu. Voprosy i otvety [Tuberculosis: identification and treatment. Monitoring along K.Tomen]. (Translation from English). 2^nd ed. Geneva: WHO 2006; p. 26-31.
9. Cherkasov VA, Stepanov SA, Miroshnikova IP. Seytmuratova SI. Klinicheskiye aspekty patomorfoza infiltrativnogo tuberkuleza legkikh [Clinical aspects of pathomorphology features of infiltrative lung TB]. Problemy tuberkuleza 2002;(4):16-19.
10. Tsybikova EB, Ots ON. Khirurgicheskoe lecheniye destruktivnogo tuberkuleza legkikh u vpervye vyyavlennykh bolnykh [Surgical treatment of lung TB in primary registered patients]. Tuberkulez i bolezni legkikh 2010;(6):57-63.
11. Global tuberculosis control. WHO Report 2001. Geneva, World Health Organization, 2001 (document WHO/CDS/TB/2001.287).

Write Comment

Please keep the topic of messages relevant to the subject of the article. Personal verbal attacks will be deleted. Please don't use comments to plug your web site. Such material will be removed. Just ensure to *Refresh* your browser for a new security code to be displayed prior to clicking on the 'Send' button. Keep in mind that the above process only applies if you simply entered the wrong security code.
Name:
E-mail
Comment:
Code:*