Цель исследования: оценить безопасность и медико-экономическую эффективность различных схем терапии ЛТИ у детей и подростков. Материалы и методы. В исследование включено 205 детей с латентной туберкулезной инфекцией в возрасте от 6 до 17 лет включительно. В основной группе (проспективной) был 31 ребенок со схемой лечения изониазид, рифапентин (HRpt). В группу сравнения (ретроспективной) включено 174 ребенка: 128 ‒ получали схему изониазид, пиразинамид (HZ), 14 ‒ схему изониазид, рифампицин (HR), 32 ‒ схему изониазид, этамбутол (HE). Результаты. При использовании схемы HRpt отмечена удовлетворительная переносимость лечения, нежелательные явления (эозинофилия) зарегистрированы у 6,5% детей. Режим приема препаратов 1 раз в неделю способствует снижению частоты прерывания лечения не по медицинским причинам. Общие экономические затраты на одного пациента при использовании схемы HRpt были ниже, чем при использовании трех иных схем лечения ЛТИ.

Отдаленные результаты применения кожной пробы с аллергеном туберкулезным рекомбинантным для выявления туберкулеза в Ставропольском крае

Introduction. In the context of a decrease in the tension of the epidemic situation on tuberculosis in Russia, it remains relevant to search for new ways to increase the effectiveness of preventive anti-tuberculosis measures among children and teenagers, taking into account an integrated approach to assessing all risk factors for tuberculosis in various age groups of the child population.Objective. Tо study the complex characteristics of groups at increased risk of tuberculosis among children of different ages who have positive results of a skin test with a recombinant tuberculous allergen (АТR).Materials and methods. The study retrospectively included 392 patients aged 2–17 years with a positive ATR test result. The рatients were randomized by age into 3 groups: in the 1st group there were 87 children 2–7 years old, in the 2nd group 182 children aged 8–14 years were included, in the 3rd group included 121 patients 15–17 years. The children did not have clinical and radiological signs of active tuberculosis and were HIV-negativ.Result. Among children and adolescents with a positive result of the test with ATR, social risk factors for developing tuberculosis (unfavorable living conditions, lack of permanent employment in 86.3% of parents) were determined. It was found that children living in families with low social status were dominated by contact with patients with multidrug resistance of the pathogen (MDR-TB), more than half of children (53.1%) had comorbidities. In 13.3% of children, small calcifications were detected in the lungs, in the intrathoracic lymph nodes.Conclusion. Among children 2–7 years old with positive results of the test with ATR, a complex of risk factors for the development of tuberculosis prevails: low material security in every second family, alcohol and drug dependence of parents in every third family, contact with MDR-TB patients in 56.5% of children, high incidence of concomitant pathology (in 67.4% of children).

Цель исследования: изучить распространение латентной туберкулезной инфекции (ЛТИ) среди студентов вузов, оценить эффективность превентивного лечения у студентов с ЛТИ. Материалы и методы. В трехэтапное исследование, проведенное в 2016-2019 гг., были включены все студенты, проходящие обучение в высших учебных заведениях г. Ставрополя. На первом этапе в 2016-2017 гг. с использованием внутрикожной пробы с аллергеном туберкулезным рекомбинантным (АТР) обследовано 4 139 студентов. На втором этапе исследования проведен ретроспективный анализ 141 амбулаторной карты студентов с положительными результатами пробы с АТР, взятых под диспансерное наблюдение, из них у 133 проведено превентивное противотуберкулезное лечение. На третьем этапе исследования в 2018-2019 гг. оценены отдаленные результаты превентивного противотуберкулезного лечения. Результаты. Использование пробы с АТР позволило выявить ЛТИ и определить показания для курса превентивного лечения противотуберкулезными препаратами. Среди 133 студентов с ЛТИ, получивших превентивное лечение, случаев заболевания туберкулезом не было; снизилась чувствительность к АТР, что проявилось уменьшением размеров папулы при контроле. Так, через 36 мес. наблюдения из 83 пациентов с гиперергической пробой она сохранилась только у 4.

The objective: to compare efficacy of preventive treatment of children with latent tuberculosis infection using various regimens of anti-tuberculosis drugs and assess the risk of adverse events to these drugs.Subjects and Methods. 117 children of 2-17 years old with latent tuberculosis infection [a positive result of the test with tuberculous recombinant allergen (TRA)] were enrolled in the prospective study. They received preventive treatment with the regimen containing isoniazid and rifapentine. The comparison group included 84 children who received isoniazid and rifampicin.Results. In terms of safety and efficacy of chemotherapy regimens in the study, the best results were obtained when using the regimen containing isoniazid and rifapentine: the therapy was well tolerated, hepatotoxic reactions were registered in 1.7% of children. After a full course of preventive treatment in 24 months of follow-up, there was a statistically significant decrease in the proportion of hyperergic results of the skit test with TRA from 44 (41.9%) to 0 (0%) χ² McNemar 43.00; p < 0.01; and conversion of the TRA test result from positive to negative was observed in 18.1% of children.

Introduction. In the context of a decrease in the intensity of the epidemic situation of tuberculosis In Russia, the search for new ways to increase the effectiveness of preventive measures to combat tuberculosis among the adult population remains relevant. Aim. To study the prevalence of latent tuberculosis infection in adult tuberculosis risk groups, and to conduct a comparative assessment of the effectiveness of detecting active tuberculosis by immunodiagnostics and fluorography among adults at risk of tuberculosis. Mat erials and methods. In a retrospective study, the results of a survey of people at risk of developing tuberculosis over the age of 18 with a positive test result from ATR-test were analyzed. At the first stage, the prevalence of latent tuberculosis infection was studied. At the second stage, a comparative analysis of the detectability of active tuberculosis during immunodiagnostics and during preventive fluorographic studies was carried out. Results. It was found that among adults at risk of tuberculosis, the prevalence of latent tuberculosis infection in the medical risk group was 2.7 times higher, and in the social risk group it was 8.7 times higher than the average in the population. The detection rate of active tuberculosis according to the results of immunodiagnostics was the highest in the social risk group – 3.8 cases per 1,000 examined. In terms of the effectiveness of tuberculosis detection in adults at risk of tuberculosis, immunodiagnostics is comparable to fluorographic studies (0.19 and 0.17 per 1,000 at-risk subjects, respectively). Conclusions. Conducting annual immunodiagnostics among adults at risk of tuberculosis allows timely detection of latent tuberculosis infection, and also increases the effectiveness of early detection of active tuberculosis, which helps reduce the reservoir of tuberculosis infection.