Yaky mechanism of development of lykarskoy stikosti of tuberculosis. Lykarsko-stiyky tuberculosis

Federal State Institution "Novosibirsk Scientific and Preliminary Institute of Tuberculosis of the Ministry of Health and Social Development"

Topic "Likarska stikist MBT"

viconavets:

Clinical resident of the 1st rock navchannya

Abasov Tarlan Mamed Rahim ogli

Novosibirsk2010

Lykarska MBT resistance ........................................... 3

Mechanism and dynamics of the formulation of policy ... 4

Methods for diagnostics of medical stigma ........................ 8

Lіkuvannya ................................................. ............................. ten

Prevention of drug development .................. .. 22

List of Literature ................................................ ............... 24

Lykarska MBT resistance.

The emergence of a multitude of diseases of mycobacterium tuberculosis has become a serious threat to the effectiveness of anti-tuberculosis programs in the countries of the world. The Russian Federation has an expanded mycobacterium, anti-tuberculous drugs that are resistant to the main ones, and one of the main problems of the phthisiatric service. In 2007, in the Russian Federation, 13% of ailments with novel tuberculosis were diagnosed before the disease was diagnosed. There is a great deal of likarsky stiffness in a number of regions of the country reaching 50-60% of the average of repeated infections in tuberculosis. The treatment of tuberculosis ailments is the main component of the national anti-tuberculosis programs. The ailment, which is vilikovuyutsya from tuberculosis, shaved off the lance of transmission of infection. In quiet people, if the patients do not find the necessary treatment and continue to see the microbacteria tuberculosis, they will see an expanded infection in the suspension with a stretch of deciduous rock. In a large number of ailments for tuberculosis, it is possible to reach a disease, unaffected by the manifestation of a disease of mycobacterium tuberculosis (MBT), other diseases and development side effects from the reception of lykarskiy zasob_v. Timely diagnostics of ailments from the MBT, sensitive to the main anti-tuberculosis drugs, can be detected for at least 6 months, and it is practical to start to develop a tuberculosis. The most difficult situation is the diagnosis, if the office has a strength to the main anti-tuberculosis drugs. Ailments with multiple disease (MLS) anti-tuberculosis drug - those, in those diagnosed with the MBT strength to the stage of izoniazide and rifampicin one hour, for the onset of any disease without apparent Organіzatsіya dіagnostiki that lіkuvannya ailments of mnozhinnoyu lіkarskoyu stіykіstyu Office vimagaє digit fіnansovih vitrat in laboratornіy dіagnostitsі, organіzatsії spetsіalіzovanogo vіddіlennya for lіkuvannya danoї category of ailments, Username Lost Password protituberkuloznih preparatіv another number i lіkarskih zasobіv for kupіruvannya pobіchnih efektіv. Ailments for tuberculosis, when they see lykarsko-stiyki by MBT, it takes three hours to get sick of tuberculosis and can infect others with lykarsko-resistant pupils. If there is a greater number of ailments, who are seeing lykarsko-stiyki MBT, tim vische risik widen the infection among healthy individuals and show new types of people who are ill for tuberculosis due to the primary disease. According to the assessment of the WHO experts, lykarsko-stiy tuberculosis is a type of tuberculosis lesions from the type of MBT, persistent up to one or more anti-tuberculosis drugs. In the rest of the rock, in connection with the destruction of the epidemic situation, there have been a lot of ailments that are seen by the MBT, stirs to the main anti-tuberculous drugs. For danimy TsNDI tuberculosis RAMS in 2008r. 50% of those who had previously developed and previously not treated with anti-tuberculosis drugs had ailments in their sputum, and 27.7% of them had up to 2 main anti-tuberculous drugs - izoniazide and rifampici. In chronic fibrous-cavernous tuberculosis, the incidence of lycopene-resistant MBT grows up to 95.5%. The phenomenon of likarskoy stikosti MBT is less important than the clinically significant. There is a strong interconnection between many changes in the microbial population and changes in a number of biological authorities of the Office, one of which is likarska style. In the active multiplying of the bacterial population of children, there are many of these small mutants, which are not practical, but in the world of fast bacteriological populations for the purpose of taking health-care winters Cich minds are seen to be multiplied by the head rank of the strong MBT, while the bacterial population is growing. In clinical practice, it is necessary to achieve a higher sensitivity of the Office and the result of a long history of the dynamism of the tuberculous process in the legends.

Mechanism and dynamics of the formulation of policy.

The development of lycars' stiffness in the office is the result of various genetic mutations. Would you like to reach the great population of the MBT? There is no knock-on factor of stiffness, similar to the plasmid of gram-negative sticks. Mutations are not tied between themselves and occur at a low, albeit transmitted frequency in between 1-2 pods per 106-108 MBT. Table 1 shows the efficiency and the width of mutations, which increase the strength to the most anti-tuberculous drugs in the first row.

Table 1. Features and width of mutations

So, as mutations are not tied, one-hour treatment of several medications (polychemotherapy) will make it possible to get rid of the stiffness. Mutuvav with pins that are resistant to medication A (for example, up to izoniazide), will be degraded by drug B (for example, rifampicin), and pins that are resistant to medication B will appear to be vicious with drug A, and so on. When tuberculosis is important, there is an empty drop, and there can be more revenge from the active MBT. Spontaneity viniknennya mutatsіy scho prizvodyat to poєdnannya stіykostі to іzonіazidu i rifampіtsinu, Buti Got rіdkіsnim yavischem - priblizno 1018. Prote appears on lіkarskoї stіykostі tlі neadekvatnoї hіmіoterapії rіzko zbіlshuєtsya Vero yatnost at Parvin zarazhennі strains of temple vmіstom lіkarsko stіykih-MBT. At the zyazyka z cim, sickness with empty rospad in the legends, de vidbuvayetsya shvidke the proliferation of the great number of MBT, shilny to more high rhiziku podbannya stikosti.

In the clinical practice of development of significant drug stability, there is even more in all cases - a lot of inadequate treatment. Inadequate lіkuvannya, in its own heart, can be overwhelmed by decilcom reasons, including:

Nedotrimannya we are sick to the regime of lіkuvannya

Incorrectly assigned chemotherapy scheme

The availability of the necessary assortment and number of chemicals

Sufferers of tuberculosis (malabsorption syndrome, fibrosis - sclerotic processes in the lungs, obstructive lesions)

Organizational prorachunka anti-tuberculous programs.

Most often, we do not treat ailments to the regime of lіkuvannya roztsіyuyut, since the most widespread is the reason for the bogus likarski-zhavnoi stijkosti. In the real life of the most important changes in the minds of the large number of medical conditions of the MVT, there are organizational shortcomings of the anti-tuberculosis programs. Ailments, in some, the strength of up to one drug has grown, it is more subdued to the point of being too stiff (such a rank, you can lastly appear in the form of drugs in MBT stamps). Ailments, for those who have developed a likarska style, can become a dilemma of the widening of strong strains of MBT, as a result of which in the onset of ailments, in their own heart, if it is already formed, a “first-rate” style is being formed. terms - first, prideful, mono-, poly - and many likarski-nogo style - traditionally vicious life in the recent letter-tours and their values ​​are presented in Table 2. Unimportant at the price, many times know the inadequacy of the practice. For example, as long as the experience of lykarskoy sensibility was not violated on the cob of lykuvannya, then in the bagatokh vipadki it is unwise to see the practicality of the primordial, to make the value of these vignettes. Moreover, it is often confusing terms that are multi-lingual strength and polyresistance.

Table 2: Typi likarskoi stikosti.

The Russian Federation is known for wide social-eco-ci and political changes, scale and scale of wikikh seryoznі inheritance for all versions of the suspension. A significant blow to the health of the population, which called for a sharp destruction of the main indicators of the health of the population. In the course of all-out social and economic transformations, anti-tuberculous robots have been taken seriously, and in this hour, the situation with tuberculosis in the Russian Federation has reached a serious level.

Russian Federation Volodya has an enviable infrastructure against the birch service and the most recent history effective fight s TB. The program for combating TB with a vertical structure with a wide grid set. Uninvolved on the price, organizing changes in the system and protecting health, immediately due to the fast budget, drastically reduced the health of the system and cope with the growing number of ailments on TB. Even in the 1990s, the rockets of the anti-tuberculosis drugs began to fail, and they were repaired from the mid-1990s, with the backs of a few ailments, the country had gone badly.

Conducted in 1998-1999 rockets in two regions of the Russian Federation have shown that the level of MLS-TB in them is average. Thus, in the Ivanivsk region, 9% of the formerly diagnosed ailments and 25.9% of the cases were diagnosed with mali MLS-TB. Similar indicators of the widened MDS-TB in the Tomsk region: 6.5% in the middle of the previously diagnosed ailments and 26.7% in the middle of those who were previously abused.

The breadth of TB in the penitentiary institutions of the Russian Federation will need to reach a high, unimportant value for the last 5 years. In the late 90s, the mortality rate of TB in the period of letting down the will was 30 times higher than the mortality of the middle of the rest of the population, and the sickness rate - 54 times. Rivn MLS-TB has reached the threatening value. Approximately 10% of the cases of TB are active, and up to 20% of them are MLS-TB.

Varto mean that the number of demon-staging demon-staging the oppressive results and the treatment of ailments due to MDR-TB and VIL-infections. It is possible to reduce the diagnosis and ear of a sick person with a combined infection, it is possible to reduce the number of such cases of sickness. You can clean up the growing epidemic of VIL-infection in the Russian Federation and made your contribution to the development of TB and MLS-TB. The non-intrusive nature of the situation of non-guilty actions in effective partnerships with various international organizations, including VOOZ, Svitovy Bank and uncommon organiza- tions. I will look at some of the more active pilots projects in the fight against TB and the learning of new resources, it is possible to help, that the Russian Federation will be in the wake of the virility of the serious problems that stand in front of the protection of health, including the edge.

The new DOTS program in the Tomsk region has been implemented since 1996, the protective program for the MLS-TB treatment in the Tomsk region has been deprived in 2000. Until the tsi moment in the civilian sector there was over 600, and in the penitentiary - about 200 bil-them from MLS-TB. Until the end of 2002, 256 ailments were included in the program, of which there are 100 ailments in the penitentiary set Toms-ka, VK # 1. Previous results have shown that the likelihood indicator can be over 80%. However, according to the forecasts, as well as all the ailments are recognized in every case, there is a certain amount of rock in order to reduce the value of both TB and MLS-TB.

Methods for diagnostics of likarskoy stіykostі.

The emergence of ailments with a lot of lykarskoy style can be grounded on different methods. Testing on lively middles of mycobacterium sensitivity to anti-tuberculous drugs is a key factor in the choice of strategy. The chemotherapy scheme is based on the results of the lykarskoy sensitivity test. As a result of the terms of MDR diagnostics, there is a permanent sign of anti-tuberculous chemotherapy. Otzhe, for the regional anti-tuberculosis programs it is important to correctly and rationally organize the diagnosis of resistance to the main anti-tuberculous drugs. You can spend the last two crops on the solid middle ground and one seed on the middle farming middle ground. In such a way, the result of testing for durability to preparations in the first row will be taken off after 3-4 weeks. In the case of the indirect method of absolute concentration on solid midpoints, in a large number of cases until the end of the day, the quality of the visa starts for 8-12 tendencies. A direct method of transferring a non-permeable sputum for testing lykarskoy sensitivity. If sputum for the direct method is used to treat tuberculosis in ailments, and in those diagnosed by MBT by microscopy, then sensitivity and specificity of the method will increase and the diagnosis of MLS for 4-8 weeks of tuberculosis will be accelerated. quality, which permits the vicariousness of the standard of diagnostics of the stiffness to the preparations in the first row. The accuracy of the test results for drug sensitivity varies widely from drug preparations. Thus, the most reliable results are evident when the sensitivity is tested to rifampicin and izoniazide, less to etambutol and streptomycin. The value of sensitivity to preparations in another row is necessary to carry out all ailments in case of manifestation of stiffness to preparations in the first row. Sensitivity testing to drugs in the other row is foldable, not to those of the first row. In the current hour of the final control of the quality to the degree of sensitivity to the preparation, there is no sense in another row, because of the reason that the test is ordered on the basis of the fact that in the world of the drug the drug will appear for sure. As soon as the efficiency is taken to the preparation in another row, it is repeated two or more times with pre-admission on solid midpoints, the efficiency of the drug's efficiency in the treatment of tuberculosis supravascularly in the temporal area is repeated. The designation of the stiffness to the preparation in another row allows the diagnosis of a wide and total drugstability. A wide range of drugs is used for mycobacterium tuberculosis, which is also suitable for any drug from a group of fluorochinolones and one or a large number of drugs, for example do not allow the standard of quality control of the ILC during the day-to-day quality control and in some methods of high specificity. When the specificity of the methods of molecular diagnostics and in the integrated control of the quality of the method of likarskoy sensitivity is improved, it will become the main standard for the rapid (1-2 days) diagnostics of MDR MBT.

Pіdvischennya efektivnostі lіkuvannya tuberkulozu, viklikanogo lіkarsko-stіykimi ILO mozhlivo for rakhunok vikoristannya priskorenih metodіv viyavlennya lіkarskoї stіykostі Office scho dozvolyaє svoєchasno zmіnyuvati hіmіoterapії mode skasuvavshi a drug to yakih viyavlena stіykіst MBT i priznachiti protituberkuloznі zasobi to yakih chutlivіst zberezhena. Pre-treatment of the MBT policy by the indirect method of getting rid of the MBT culture, visions of the sick, from 30 to 45 dB. The correction of chemotherapy in such a way is of an alternating character and is carried out, as a rule, even at the end stage of the intensive phase of chemotherapy. Likarsku performance of the Office in a given hour is started by the method of absolute concentration, which is the standard concentration of anti-tuberculous drugs added to the hospital center of Levenshtein-Jensen, which are accepted as borderline ones. For isoniazide won, add 1 μg / ml, rifampicin - 40 μg / ml, streptomycin - 10 μg / ml, etambutol - 2 μg / ml, kanamicin - 30 μg / ml, amikacin - 8 μg / ml, Prothonamid (ethionamid) - 30 μg / ml, ofloxacin (tarivid) - 5 μg / ml, cycloserine - 30 μg / ml, and pirazinamide - 100 μg / ml. The definition of the MBT likarskiy stikosti before pirazinamida should be carried out on a specially prepared egg medium with a pH of 5.5-5.6. The culture of the Office is involved in style, as 20 colonies have grown in the test. The stagnation of the direct method of measuring the MBT policy can be done with massive bacteriovision, and it is possible to move towards the seed of the preliminarily material on the living middle ground, to put anti-tuberculous drugs, without the general view of the MBT. The results of this will take place on the 21-28th day, which allows you to carry out a correction of chemotherapy earlier. An hour will remain for the accelerated detection of medical measures. The radioometric method using the automatic system BACTEC is 460 TB (Becton Dickinson Diagnostic Systems, Sparks, MD), which allows the middle to reach the middle 10

Likuvannya.

Vibir chemotherapy schemes work according to the order of the Ministry of Health of Ukraine No. 109 dated 21.03.03. There are three types of strategies for the treatment of ailments with a multitude of drugs for mycobacteria.

The first strategy is the standardization of the policy. The scheme of chemotherapy is broken down on the basis of representative data about the lykarskoy style in children with ailments (new type of disease, relapse, etc.) In this region. The strategy of chemotherapy for tuberculosis with MDR MBT is indivisible based on the results of sensitivity testing to drugs in the first and other series, and on the alternatives about anti-tuberculosis drugs. Empirical strategy of treatment in the preparation of chemotherapy drugs and contact with ailing MDR MBT, to the rejection of vigorous results of political sensitivity. In the present hour, in the tuberculosis programs, the standardization or empirical treatment of the transition to individualized therapy is becoming standardized. The scheme of chemotherapy for ailments from the MLS MBT includes two phases of treatment: intensive therapy and advanced treatment. Chemotherapy is guilty of transferring the sign of not less than chotiroh, but most often five drug preparations, to the extent that the drug sensitivity and efficiency are saved. Lykarsky drugs are guilty of being accepted under the direct control of a medical or specially prepared personnel for 6 days per day. Dozi likarskih zasobіv viznachayutsya in fallowness wіth a sick person. Preparations of a group of aminoglycosides, polypeptides, fluorochinolones, etambutol, pirazinamide should be taken in one additional dose. The drugs of another series - prothionamide, cycloserine and PASK - are recognized on a different basis in the stationary stage of treatment, and one-time in outpatient treatment, as well as ailments at once, you can take all the problems. The phase of intensive therapy is based on the test of an anti-inflammatory drug of aminoglycosides (kanamicin, amicacin or streptomycin) or polypeptide (capreomycin) for at least 6 months until 4-6 negative The triviality of pursuing the recommendations "Key to the programmed treatment of high-grade tuberculosis" (VOOZ, 2008) is responsible for 18 months of diagnosing bacteria by the method of direct bacterioscopy. I will look at the principle of chemotherapy for ailments from the MLS MBT, it is necessary to carry out a review of drugs for chemotherapy by an advanced rank:

1. Preparations of the first row, until sensitiveness is preserved, are included in the chemotherapy scheme. The importance of sensitivity to pirazinamide in the form of special methods, as it is rarely vicious in regional reference laboratories, so pirazinamid is always included in the chemotherapy scheme, but I do not have to spend the middle of 5 medication in the middle of the year. Etambutol is included in the chemotherapy regimen, as long as the MBT sensitivity is preserved.

2. The vibration of an effective preparation is primed for a higher efficiency, in the presence of side effects and variability. Most effective є streptomycin, while the sensitivity of the office is protected to the utmost. A cheap drug is kanamicin, which can change the strength of amikacin. In the case of small-scale drugs, the detection of capreomycin is more significant than in the case of a low percentage of patients with a stigma before the given polypeptide and in the presence of fewer types. The same hour has one of the most expensive drugs.

3. Sered fluoroquinolones in terms of efficacy and efficacy with the best anti-tuberculous drug - levofloxacin. In the Danish hour, when treating tuberculosis from MDR MBT, while saving the sensitivity of mycobacteria to ofloxacin, Danium fluorochinolone is often victorious. It is influenced by the parameters of self-reliance and efficiency.

4. In the fourth group of anti-tuberculous drugs, two or all three bacteriostatic drugs are injected into the drug: prothionamide, cycloserine, PASK.

In such a rank, the chemotherapy scheme for a sick person is often standardized in many ways. During the phase of intensive therapy, there are 6 drugs in stock. At the phase of the continuation of the treatment of ailments MDR MBT, the chemotherapy schemes without the drug should be recognized for at least 12 months, the general term of treatment becoming 24 months.

During the period of testing, sputum is detected on MVT-dvich by the method of direct bacterioscopy and by inoculation. To monitor side effects of anti-tuberculosis drugs, during the phase of intensive therapy, carry out an additional creatine, blood calorie and audiometry. During the whole period of treatment, it is necessary to carry out an additional analysis of blood, blood, bilirubin, transaminases, sech acid and electrocardiography. The first dose of thyroid-stimulating hormone should be carried out after 6 months of treatment and then repeat the skin 3 months until the end of chemotherapy.

The system for the restoration and the rate of ailments from the MLS MVT is necessary for monitoring the advancement of the expansion of microbacteria from the disease and the formation of a wide, total resistance of MBT. For the monitoring of the effectiveness of the treatment, a card of treatment of the MLS MVT is used, in which it is restructured, from which group of people with ailments diagnostics of tuberculosis from MDR, bacteriovision, and the value of medical skin sensitivity to the results Іnformatsіyna system neobhіdna for tochnoї reєstratsії vsіh ailments of lіkarskoyu stіykіstyu mіkobakterіy, to vazhlivo reєstruvati ailments of novih vipadkіv, retsidivіv zahvoryuvannya, of groupies - lіkuvannya pіslya perervanogo rate hіmіoterapії, pіslya neefektivnogo Perche rate hіmіoterapії i pіslya neefektivnogo repeated courses hіmіoterapії. It is important to restore the ailments of the combined HIV infection and the MLS MVT, as well as the efficiency of this category of ailments is extremely low and the need for an uncomplicated middle of the culture is widened. The results of the treatment of ailments from the MLS MVT will begin in 24 months of testing and the results will be determined by the order of the Ministry of Health of Ukraine No. 50 on February 13, 2004: an effective course of chemotherapy, verification by microscopic examination, using microscopy methods; an ineffective course of chemotherapy, microscopic confirmation, phlegm seeding and clinical and radiological methods; interruptions of chemotherapy course; death due to tuberculosis; ailments vibuv; diagnosis of tuberculosis of knowledge.

Vazhlivіst problemi dіagnostiki that lіkuvannya mnozhinnogo lіkarsko-stіykogo tuberkulozu obumovlena not tіlki Poperedjennia Yogo poshirennya, ale i zapobіgannyam viniknennyu vipadkіv іz a spreading gromadskіstyu totalnoї lіkarskoyu stіykіstyu, strategіya lіkuvannya yakoї not bude rozroblena in nayblizhchі Rocky appears to novih protituberkuloznih preparatіv.

It’s not less important that the administration is correct - it’s correct to treat the previously diagnosed ailments for tuberculosis; In the case of cyclists, there is a growing trend of being able to navigate with the manifestation of the primary policy of MBT bacteriostatic action to give 2 or 3 chemotherapy drugs, to which sensitivity is saved. Same nedotrimannya ftizіatrami NAUKOVO obgruntovanih kombіnovanih rezhimіv hіmіoterapії at lіkuvannі Vpershe viyavlenih Khvorov i priznachennya їm in bіlshostі vipadkіv tіlki 3 hіmіopreparatіv Je Roughly lіkarskoyu pomilkoyu scho in kіntsevomu rahunku, Veda to formuvannya vtorinnoї lіkarskoї stіykostі Office. The detection of tuberculosis in a patient with a disease of drug-resistant MBT is often lowering the efficiency of treatment, to the appearance of chronic and non-violent forms, and in a number of diseases and to lethal injuries. It is especially important to fight against lesions, polyresistant MBT, as a minimum to izoniazide and rifampicin, to the main and most active anti-tuberculous drugs. There is a multiplicity of measures of MBT є on the current year, the most important form of bacterial stiffness, and specific lesions, such as microbacteria, are called polyresistant tuberculosis lesions. The efficiency of the MBT is not only classy and epidemiological, but economically significant, since such ailments can cost a lot more expensively, not just ailments from the MBT, sensitive to the basic chemotherapy. The development of a drug-resistant tuberculosis legends in one of the priority directions of the current phthisiology. To carry out effective chemotherapy of ailments in chronic forms of tuberculosis, there is a lot of disease in the MBT, a combination of reserve anti-tuberculosis drugs, which include pirazinamide, to the end of these diseases. All reserve drugs can reach low bacteriostatic activity, which is why the triviality of chemotherapy in ailments with chronic fibrous-cavernous tuberculosis is a legacy and multiple medical style of MBT is not to blame for the 21st century. In case of an out-of-day effect due to chemotherapy performed with reserve anti-tuberculosis drugs, it is possible to use surgical methods of treatment, the application of a single piece pneumothorax or pneumoperitoneum. Operate the next step for the fastest possible speed of microbacterial population, so that you should start for additional microscopy or cultural dosage of sputum. During the operation, it was necessary to continue using the same chemotherapy regimen for a minimum of 18-20 msec. Licuval piece pneumothorax is guilty of trivacy in patients with polyresistant tuberculosis for a period not less than 12 m / s. Increasing the efficiency of treating ailments with acute tuberculosis is a legacy in the world to find a way to fast correction of chemotherapy and preservation of anti-tuberculosis drugs, to the point of being saved. For the elimination of ailments on lycarsko-stiyky and, especially, polyresistant tuberculosis of the disease, it is necessary to use reserve drugs: protionamide (ethionamide), amikacin (kanamicin), ofloxacin. The number of drugs on the basis of the main ones (izoniazide, rifampicin, pirazinamide, etambutol, streptomycin) is more expensive, less effective and may have a lot of side effects. Stinks are guilty but are available only for special anti-tuberculous installations.

On a current day, at the phthisiatric center, there is no reason to be completely grounded in order to broaden the medical efficiency by the integral characteristic of the effectiveness of anti-tuberculous visits. The reasons for the broadening of the policy are carried out to the early stages of the epidemic process and to be managed at the new levels of the organization of the educational and preventive activity. Monitoring of the disease of mycobacterium tuberculosis є the most important part of the control over the widening of the infectious disease. The tse of the understanding is interpreted in to reach the wide boundaries, however, the statistical data about the teacher's policy does not represent the depth of the current problem. Until then, on this day of the day, one of the principles of organizing the monitoring of tuberculosis from the disease in the Russian Federation until the creation of a real picture and inconsistency of regency, Since 1999, in the state statistical significance of introductions, the indicator of the widening of multiple licenses (MLS) in the middle of the ailments that have arisen in the past. However, until the current day, the rules for the restoration of such ailments have not been established, the rules for the development of indicators of the territorial spread of tuberculosis for the disease have not been established, and also they have not been asked in the necessary way to achieve the necessary results of the results Throughout the last 15 years, several times the spread of tuberculosis from lykarskoy style in the Russian regions of the Russian Federation has been increasing. However, the aggregation of donations based on the territorial principle, however, in the dynamism actually turned out to be ill-advised, but some of the same principles in organizing the monitoring of the disease of the tuberculosis specialist. The validity of the indicator of the disease of a tuberculosis originator should be based on the three basic principles: For those who are familiar with the description of the infectious process є the stiffness of the circulating stampede, seen in the first sick person for tuberculosis in the period of diagnosis, to the ear of the addiction. For those who are important to the understanding, it is the style of the wanderer to bathe in the process of drinking. In practice, it is actively to vikoristovua understand the primordial style. However, when the rules are widespread, the indicator is not effective. The understanding of the primordial style has become a savory one: it included both the real primordial efficiency of the MBT in the formerly diagnosed ailments, as well as the likarsk ethicality of the MBT in the later emerging ailments in the course of chemotherapy - according to the way During the period of supreme control, most often ailments were detected on the field, as well as ailments were taken from the previous history of anti-tuberculous chemotherapy. Not surprisingly, there was no evidence of the territorial broadening of political sensitivity, but it was taken into the organizational methodology, and it was acquired in bacteriological laboratories, but it was not possible due to a great development. In some cases, statistical indicators took a paradoxical value in the vicinity of the territory. For example, the effectiveness of the treatment of ailments from the ILC was seen as a viscera, not an indicator for the later emerging ailments; The breadth of MDR in the middle of ailments with relapses is lower, lower in the middle of the earlier emerging ailments. In the process of curatorial visits and discussion with phthisiatricians, the status of the ILC was poorly determined due to the important results (so called “critical” performance), which is unacceptable for demonstration purposes. In such a rank, with the formulated indicators of the widening of the doctor's stigma, tuberculosis must be strictly victorious the witness, described in the regulatory documents. There are three groups of terms, which can be used in the description of the expansion of the policy. Prior to the first group, a testament should be included to characterize ailments, for those who are tested for a test. Before them, the patients are introduced to the bacteria, we will establish by the seeding method:

Earlier, I did not catch ailments - for the first time the manifestations of ailments, registrations for a disease, but before that I did not take anti-tuberculous drugs, but I did not take less than one month.

Earlier, ailments were caught - a patient, who were registered for re-treatment, which earlier took anti-tuberculous preparations for a period of one month.

To assess the indicators of the results of chemotherapy, the group has previously tried to overcome the ailments by:

Earlier, he had ailments with recurrent tuberculosis and those of repeated treatment.

Before the other group, there should be a witness who can characterize tuberculosis with microbacteria, seeing from one sick person, according to the results of tests for lykarsky sensitivity:

Likarska style of MBT (LU MBT) - the manifestation of lykarsko-style MBT strains in the vision of culture.

The primary drug is the strength of the MBT in a newly diagnosed sick person who has not been treated before, if only anti-tuberculosis drugs are less than one month old (we are not sick with anti-tuberculosis before).

Secondary health care - the effectiveness of the MBT in patients undergoing anti-tuberculous therapy, which is carried out during a month and more, at the time of reestablishment of a second course of chemotherapy (taken until early chemotherapy).

Combination of lykarska style - the presence of a patient of MBT culture, a stiffness to more than one anti-tuberculosis drug, behind the blame of many lykarskoy stikosti.

Wide likarska style (SLS) - the presence in the patient of MBT culture, the minimum to isoniazide, rifampicin, ofloxotsin and one of the internal anti-tuberculous drugs (a

The spectrum of drug resistance is a characteristic of MBT in terms of resistance to skin and anti-tuberculous drugs in the first and / or another series.

The third group of terms includes indicators of lykarskoy sensitivity of the population of mycobacterium tuberculosis, which is circulating on the territory. To them are admitted:

The frequency of the primary drug stigma. The indicator of the growth of the number of people who have developed ailments for tuberculosis from the primary disease up to the number of all people who have developed ailments for the first time, as they carried out the preliminaries on the level of sensitivity of the population,

Frequency of drug abuse in the middle of earlier noncautious diseases of tuberculosis. The indicator grows as the rate of change in the number of MBT cultures up to the number of strains, pre-existing for the manifestation of the disease in the ailments registered on the re-treatment of the short course of chemotherapy. According to the point, it is an indicator of the dumb stiffness at the time of the restoration of the ailments on re-treatment.

The frequency of the many and widespread illnesses is insured by an analogous rank for certain groups of illnesses (the first to emerge, the ailments were caught earlier, and the ill with relapses had previously been caught)

It means that the terms are taken and taken into account in the international practice (the All-round organization of health protection, the International Union in the fight against tuberculosis and illnesses of the legacy, the Committee of the green I would like to brutalize respect for those who, in the midst of the laboratory results obtained in terms of medical sensitivity for the development of epidemiological indicators, to assess only the results, taken out of the diagnostic material for the first development Let it be conveyed that the range of all the received tributes in terms of territory means their representativeness, but at the same time it doesn’t mean so.

First, due to the multistage process of rejecting these real epidemic processes, they appear in a twisted view (the efficiency of developing bacteria in small droplets becomes 70%, and often - less than 50%; , the result of the test for lykarsky sensitivity є the inheritance of laboratory robots, which is often not monitored).

In other words, in practice, the presentation of data on bacteriovision and on politic sensitivity, as a rule, is associated with negative results.

Thirdly, the identification of bacteria on the territory of the sub'ct of the Russian Federation, as a rule, isn’t equal, because the representation of such tributes for the wider political sensitivity may not be able to visualize the real epidemiological processes. Failure to adhere to the principle of representativeness of outward tributes to bring to an unnatural breakdown the value of the indicator of advanced tuberculosis from ILC in the Russian sub'ekts of Russia, which can be seen in statistical calls for the last rocks.

So, for example, the spread of MDR increased in 2006 from 3% (Smolenska, Kursk, Amur Oblast, Krasnodar Territory) to 80% (Evenky AT). In the light of the well-spoken, with the development of the territorial indicator, it is necessary to formulate a second vibration from the spontaneously gained vibration of the ailments according to the principle of equal representation of the ailments from the outer districts (representativeness in the districts). In practice, it means offensive. Accordingly, it is necessary to create quotas for the number to be included in the analysis of ailments for the skin area (bacteriological pre-treatment is carried out) on the basis of indicators of incidence in areas and the number of emerging bacteria. Tobto, for the development of the territorial indicator of political style, the second vibration is guilty of formulating the most obvious results in the value of personal style. In the districts with the lowest number of bacteria in the number of indicators, accepted results will be included in all the events. Quotas for the other districts shall be raised according to the principle of equal representation of the ailing from the local districts. In general, there is a large number of illnesses, which will turn on until the indicators are displayed, if there is less than the obvious number of ailments due to the results of lykarskoy sensitiveness. Before the vibration for the development of the territorial indicator, the results are included in the proportional proportions of positive results. For example, in three districts, in the region where the population becomes ill for tuberculosis, 50, 70 and 100 ailments per 100 yew. Population, with a district with the most ailments є the least. Admittedly, 70, 50 and 40 ailments were found in these regions, with a total number of bacteria in the warehouse 40, 40 and 20 individuals (Table 3).

Table 3

The butt of the development of the territorial indicator of lykarskoy stijkosti in the middle of the previously evolved ailments

The smallest number of bacteria was found in the third district, so the allocation of quotas will be based on the proportions that are known for the third district. So, with an incidence of 100, 20 bacteria are infected, while when an incidence of 50, 10 bacteria are guilty, and with an increase of 70 - 14 bacteria. Some of the positive results for the skin region are to blame for some of the positive results for the skin region. Tobto, in the first district, with a positive or negative result in a test of 1: 7 in the quota of 1 positive and 9 negative results. In another area, with positive and negative results in the test at 3:16 in the quota of 3 positive and 11 negative results. That is, the value of the territorial indicator of lykarskoy sensitiveness, taken into account according to the principle of representativeness of the data in the districts, if it is one third more, the lower the estimate based on all the selected test results. Such a decision is used to transfer the role of organizational methods to the federal and territorial anti-tuberculosis settings in organizing the monitoring of indicators of advanced tuberculosis disease. The area of ​​territorial representativeness is to be carried out to assess the indicator in the newly emerging ailments. Adequacy of the regional representativeness in the assessment of the indicators of LU in the past, there were some illnesses who were guilty of being the subject of an approximate long-term experience, some of the reasons for the use of MBT to anti-tuberculous drugs in the majority of cases For bacteriological laboratories, this also means an additional stage of the classification of results. Slide to add a markup for quiet results, as you can turn on the organizational methodology for the second vibration for the development of territorial indicators of personal style. Only those results are presented to them, as they are pleased with the vimogam for the reliability of laboratory dosages... Tse means to take the offensive rules:

There are no results of lykarskoy sensitivity in case of generalization of MBT less than 5 KUO in case of the first seizure, some of them in case of such a number of colonies, if the results of stiffness may be lack of accuracy and a great amount of 10 lykarsku sensitiveness.

Do not take into account the results of lykarsky sensitivity in the case of reestraction of critical sensitivity of the MBT (if the growth rate for a test with an anti-tuberculous drug is close to 20%

The representativeness of the given means not only that it is not controlled, but that it is not taken into account in all regions. Zbir of vicarious donors is guilty of being in the district tuberculosis dispensaries and microbiological laboratories, on the basis of which ailments are treated. The pre-treatment of the MBT's sensitiveness for the ailments by means of the formation of indications is guilty of being important in the central territorial (regional) laboratories. There, the species identification of cultures for all ailments is carried out.

A system for securing the reliability of laboratory data є a comprehensive coordinated system for monitoring organizational, laboratory, statistical methods. Vona polyaga in the control of the quality of documentation, Internal laboratory control of the quality of documentation, internal control of the quality of information, control of the assessment of statistical indicators. Vona includes yak minimum: conducting regular auditions to collect regional information in organizational-methodical reviews and bacteriological laboratories at the territorial level; as a rule, 1 time in 2-4, in the fallowness of the amount of money; maintenance of the territorial register of all ailments from MLS and SHLS; vibrating control of donations transferred to federal and regional levels (vibrating control of lists of ailments from MLS and SHLS, as well as vibrating ailments from sensitive and sustainable MBT cultures). Through the number of hard tests to the quality of laboratory tests, the reliability of their results in some cases is difficult to assess objectively. According to official data, after 380 microbiological laboratories to carry out analyzes on the sensitivity of the tuberculosis cultivator to anti-tuberculous drugs; In many laboratory data about the medical sensitivity of the MBT, it is possible to read it without reading laboratory standards. In the first place, there are oligobacillary ailments that need to be victorious in the development of territorial indicators of lykarskoy style. Due to the data of the laboratory conditions conducted during the curatorial visits and the questionnaire, in the bacteriological laboratories, critical concentration of drugs for the purpose of determining the medical sensitivity of the MBT is recommended as The bulo is well understood that the rules for the preparation of preparations for setting tests in large laboratories cannot be touched, but before the results are created. In order not to get overridden to ask for a pardon, it is necessary:

zabezpechennya tochnostі rezultatіv testіv on lіkarsku chutlivіst not less then 95% vіdpovіdnostі rezultatіv testіv to іzonіazidu i rifampіtsinu i is not less then 85% vіdpovіdnostі rezultatіv testіv to etambutolu i streptomіtsinu for chogo neobhіdno zabezpechiti regular participation laboratorії in cycles zovnіshnoї otsіnki yakostі on osnovі test panelі atestovanih cultures Office;

The minimization of the laboratory definition of the LU MBT (no more than 5% for the MBT strains with the ILC) is directly based on the vicious method, for which it is necessary to maximally centralize the display on the LU MBT. With all the laboratory to blame, the brothers take part in the cycles of the most recent assessment of the quality.

Obviously, in all regions of the laboratory tests on the MBT's sensitivity to the blame are carried out according to a single standardized methodology and, more importantly, in the main territorial laboratories of the vocational schools of the federal subunits. The significance of the problem of the quality of laboratory diagnostics begins with the folding method of measuring the sensitivity of the MBT. From the procedure for eliminating sputum from a sick person to the establishment of bacteriological laboratory about the sensitivity of the vision of the MBT culture, a number of recent procedures are displayed. On the skin of them є has its own pardon. The amount of pardon has been accumulated until the moment the result of the test is taken out in a given hour of the warehouse is close to 30%. In the case of a shorter drop in the case of pardons, which lie like a laboratory robot, 10% has been accumulated in the warehouse;

Table 4

Formation of the accumulated pardon of health care

The situation on the importance of the problem and the maintenance of the high quality of robots and bacteriological laboratories and the setting by them of tests for the sensitivity of microbacteria was revealed. To ensure the quality of laboratory data about the sensitivity of the doctor in all regions of the country, it is necessary to establish a guaranteed system of continuous monitoring of the quality of laboratory tests for bacteriological laboratories of vocational schools. The control of the quality is still guilty of being responsible at all levels. All bacteriological laboratories are responsible for carrying out tests of internal and external assessments of the quality of the dosage. The name of the assessment of the quality of the laboratory is guilty of being carried out on the basis of a single reference panel of MBT strains, as well as in the form of vibrational control of cultures. In case of the appearance of unsatisfactory results in the most recent assessment of the quality, the results of the average Russian indicators are guilty of two: for the results and without the improvement of the results in the sub-regions of the Russian Federation, in some bullets, such are the results. To ensure the quality of laboratory tests at the federal level, a permanently effective system of quality control is required, integrated into the international system of call quality assessments laboratory diagnostics tuberculosis. For the current day, the practice of preparing a test panel of MBT cultures for FSVOK by bacteriologists of a foreign profile, without sufficient information from phtisiobacteriology, to produce singing systemic pardons as a result of not preparing the middle ... Until then, I supervise the laboratory, I am free to give additional help in a wide variety of robots. In such a rank, in order to ensure a reliable assessment of the indicator of the width of the LU MBT, it is necessary to take advantage of the technology of the formulation of the indicator. On the current day, it means the need for a number of additional measures to organize anti-tuberculous service. It is necessary to introduce additional functions for organizational methods and for bacteriological laboratories in the main anti-tuberculosis cases, as well as for federal specialized NDI. The rules for the selection of representative tributes are responsible for the control of the organizational methods for the head anti-tuberculous installations of the RF sub'ects. The development and implementation of the rules is guilty of being in charge of supervising the professional NDI. For the coordination of performance, a special single methodical center is required for a call to the assessment of the quality of the laboratory. Associatively organizing such a methodical center at the Ministry of Health of the Russian Federation. Realіzatsіya Names printsipіv organіzatsії monіtoringu lіkarskoї stіykostі zbudnika tuberkulozu permitted otrimati reprezentativnі danі poshirennya lіkarsko-stіykih forms Office, scho is allowed viznachiti mozhlivіst vprovadzhennya Suchasnyj lіkuvalnih tehnologіy, rozrobiti Reigning strategіyu lіkuvannya ailments on tuberkuloz іz mnozhinnoyu lіkarskoyu stіykіstyu zbudnika, stvoriti peredumovi for vikoristannya in borotbі of tuberkulozom information about the possibilities of international organizations.

Prevention of development of lykarskoy stikosti.

The method of protecting natural mutations, which leads to the formation of the MBT lykarskoy style, is unavoidable. However, thinking and adequately detecting ailments on TB can lead to a minimum of selection of stable MBT strains, both from the first cobbled people, and from the patients who were already rejected. In addition to the choice of the correct chemotherapy scheme, it is absolutely necessary to ensure that the treatment regime is not taken care of. First of all, we are even more important є for the possibility of widening the MLS-TB in the middle, but there are no contacts (or maybe such) with the ailments of the MLS-TB.

Diagnosis of tuberculosis with a variety of drugs. Єdiny sposіb pіdtverditi dіagnoz MLS-TB - tse doslіdzhuvati lіkarsku chutlivіst vidіlenoї od patsієnta culture mіkobakterіy i bring її stіykіst, yak mіnіmum to іzonіazidu i rіfampіtsіnu.U vsіh ailments before cob lіkuvannya rekomenduєtsya doslіdzhuvati chutlivіst ILO to іzonіazidu, rifampіtsinu, etambutolu that streptomіtsinu. Tse make sure that all ailments of MLS-TB are detected. If it’s a possibility, then in the first screening it is possible to include specific sensitivities and up to other drugs, for example kanamicin, ofloxacin and ethionamide. When MLS-TB is detected, it is possible to increase sensitivity to all drugs in a different series. Even if the patient is on the same pathology, there is no evidence of bacteriosis (according to the results of microscopy, or the sputum growth), because it promotes clinical and radiological progression of tuberculous progression, the need to re-educate the patient. As in any region of the resource for the preliminaries of likarskoy sensitiveness of intercourse, then it is more practical є vibrating-vallny pіdhіd to the preliminaries of lіkarskoy sensibility at the presentation of individual displays. In such cases, on the basis of and subsequent improvement of the stiffness, the sputum is sent from the ailments to the MLS-TB in maturity. Groups of children, for some Danish people, you can use them:

Patients, previously used the TB drive

Patients, as mali, we have contact with the disease with the confirmation of the diagnosis of MLS-TB.

Patients who have been in contact with TB ailments, die in the course of the disease without prior visualization (DOT).

Proceedings have established the protection of health.

Patients, information VIL

Patients, in any of the results of microscopic phlegm, they are sparing positive (or even more positive) after 4 months of treatment.

Patients who have been in a few moments of letting go

Adequate results and advances in the MBT's responsiveness are the basis for the optimal treatment of MLS-TB. A lot of regional laboratories may be able to achieve a certain sensitivity only to preparations in the first row (H, R, E, S). It is advisable to carry out an increase in sensitivity to drugs in another row in special centers or international reference laboratories. All laboratories require regular monitoring of the quality of the results.

List of literature.

Balabanova Ya.M., Raddi M., Grem K., Malomanova N.A., Ulizarova E.D., Kuznetsov S.I., Gusarova G.I., Zakharova S.M., Melent'ev A.S., Kryukova O.G., Fedorin I.M., Golishivske V.I., Dorozhkova I.R., Shilova M.V., Arokhin V.V., Drobnevski F. Analysis of factors in the diagnosis of disease in patients with tuberculosis and penitentiary sector in the Samara region of Russia // Problems of tuberculosis and ailments of the lungs. - 2005. - No. 5. - S. 25-31.

Baranov A.A., Maryandishev A.O., Nizovtseva N.I., Oparina E.N., Presnova S.E., Gvozdovskiy L.A., Markelov Yu.M., Trekino I.A., Tungusova Pro .Z., Mannsoker T. Expansion of primary disease in tuberculosis in the administrative territories of the Russian Federation // Problems of tuberculosis and ailments of lung disease. - 2006. - No. 12. - S. 9-12.

Buljakov V.D. epidemic process(Theory and method of vivchennya) .- L.: Medicine, 1964.- 238 p.

Bogorodskaya E.M., Sterlikov S.A., Popov S.A. - 2008. - No. 7. - C. 8-14.

Biglhol R. Fundamentals of Epidemiology. WHO. Geneva, 1994.- pp. 1-16.

Vishnevsky B.I. The main directions of robotic laboratory microbiology of tuberculosis // Tuberculosis: problems of diagnostics, treatment and prevention. - SPb., 2003 .-- S. 34-38.

Vlasov V.V. Epidemiology in modern Russia // International Journal of Medical Practice. - 2001, no. 2:. - S.27-29.

Vlasov V.V. Efficiency of diagnostic diagnostics. M: Medicine 1988 .-- 245 p.

Dorozhkova I.R., Popov S.A., Medvedeva I.M. Monitoring of tuberculosis disease in Russia 1979-1998 // Problems of tuberculosis and ailments of the lungs. - 2000. - No. 5. -S.19-22

Dorozhkova I.R., Popov S.A., Medvedeva I.M. Components of monitoring of tuberculosis disease in order to assess the effectiveness of national programs of anti-tuberculosis assistance to the population // Problems of tuberculosis and lung ailments. - 2001. - No. 2. -S.18-20.

Popov S.A., Puzanov V.A., Sabgaida T.P., Antonova N.V., Kazakov A.S. The main problems of regional bacteriological laboratories of anti-tuberculous diseases // Problems of tuberculosis and ailments. - 2008. - No. 5. - S. 29-35.

Popov S.A., Puzanov V.A., Sabgaida T.P., Bogorodskaya E.M. Monitoring of the disease of mycobacterium tuberculosis in the regions of the Russian Federation // Information sheet (sent to sub'єkti No. 10-11 / 06-6013 dated May 18, 2007 Roszdrav 2008). - 8p.

Popov S.A., Puzanov V.A., Sabgaida T.P. Optimization of laboratory diagnostics of tuberculosis. // Dovidnik of the manager of the CDL, 2008, No. 12, P.17-28.

Order of the Ministry of Health of the Russian Federation dated 21.03.2003 r No. 109 "About thoroughly anti-tuberculous visits to the Russian Federation"

Certification for the epidemiology of infectious diseases. - T. 1. Pid ed. V.I. Pokrovsky. - M .: Medicine, 1993 .-- 373 p.

Sevastyanova E.V., Petrova L.V. Monitoring of the disease of mycobacterium tuberculosis in the Republic of Mary El // Problems of tuberculosis and lung ailments. - 2008. - No. 9. -S.13-26.

tuberculosis, increasing polyresistance, blocking tuberculosis in Nevilikovna ...

1. tuberculosis (9)

   Robot control >> Medicine, health

   Organize the isolation of the ailments lykarsko stiff forms tuberculosis ", - ascertaining the head sanitary doctor ... lykuvannya and reabilitation at tuberculosis, Before transferring the distribution to the site ...

2. tuberculosis intestine i tuberculosis Brijov's lymph universities

   Abstract >> Medicine, health

   Tse is tied with a frankness lykarsko-stiff mutants in mycobacteria. For ... trivial chemotherapy courses. lykuvannya tuberculosis intestines can be carried out in ... the most effective regimes lykuvannya tuberculosis intestines є welcome izoniazide i ...

3. lykarska roslinna sirovina revenge saponin

   Abstract >> History

   ... lykarsky sirovini. problem of sucking lykarsky Roslin u virobnistvі lykarsky ... at in water, as in the presence of triterpene saponin, stiyku... vikorystyuyutsya at lykuvanni heart ... at what forms tuberculosis ...

O.A. Vorobyova (Irkutsk Institute for Advanced Studies)

The Russian Federation is known to the number of countries with a high rate of tuberculosis disease, since 2003 the tendency towards the stabilization of the epidemic situation has become apparent. The most unfavorable for tuberculosis was found in 1999 in the territory of Western Siberia, de indicators of sickness occupied the first place in the middle of all sub'ektiv of Russia. The unhealthy growth of indicators of tuberculosis in sickness is becoming a significant threat to the suspension.

However, even more serious for the current phthisiatrician is the problem of tuberculosis disease (LU) of the tuberculosis pediatrician, which is only one of the factors that combine the effectiveness of antibacterial therapy. Likarska style is natural, for the health of a person who has become ill is taken care of when infused into a new drug.

According to the classification of the WHO (1998), mycobacterium tuberculosis (MBT) can be:

• mono-resistor- stike up to one anti-tuberculosis drug;
• polyresistant- up to two or more anti-tuberculous drugs (PTP);
• many highly resistant- stipulations yak minimum until the end of the period for izoniazide and rifampicin, regardless of whether it is obvious or as a result of the speed up to the lowest PTP.

In the international practice, they see the understanding of the primary and secondary political style (LU). In the first vipadku, the price is enveloped in the infection with a strain of mycobacterium, we see ailments with a lot of stiffness. The other has a stiffness, as a result of non-rational chemotherapy. Seeing so the self of the "true", "gracious", "accustomed" and "new" lykarskoy style. More resistance is more often found in persistent bacteria. In case of true lykarskoy stikosti one MBT stiyka up to a few antibacterial drugs(ABP). Most often, pomilkov resistance is observed, if one MBT is resistant to one drug, and
- to others.

Nutrition of accustomed lykarskoy stikosti vimagaє fake vivchennya. Adequate identification of a particular type of medical style is less likely to occur with microbial pre-diagnosed caverns; Remaining kind of likarskoy stikosti, learn to finish up ridko. In this hour, if there are a lot of new reserve preparations for the treatment, it is necessary to remember about the manifestation of the transcendental policy.

The emergence of the first antibiotic-resistant strains of mycobacterium tuberculosis (MBT) to knit from the screen in 1943 r i wide sucking streptomycin as an effective anti-tuberculous drug. Already the first systematic data about the expansion of the primordial lykarskoy style to izoniazide and streptomycin bully were eliminated in the 50s beyond the cordon during the epidemiological studies. Bully of vision of the country with high up to 9.4% (Japan and India) and low - from 0.6 to 2.8% (USA and Great Britain) equal to two drugs. At the same time, the indicators of stiffness to streptomycin were found to be vyshche stikosti to izoniazid.

In Russia, there is a prescription for the development of the drug treatment to streptomycin, PASK, drugs in the GINK group have been carried out since the mid-50s in the Central NDI tuberculosis. Otrimanі for the sixth period (1956-1963 rr.) The data were given about the change for the whole period of the drug structure in the direction of the change in MBT strains, which are resistant to streptomycin, and the drug itself is increased to some extent of the resistance

Introduction and introduction of new anti-tuberculous drugs into practice (in the 50s - preparations of the group GINK, pirazinamid, cycloserine, ethionamid, kanamicin and capriomycin; in the 60s - rifampicin and etambutol; in 80 vikorstannya chemotherapy schemes, scho turn on one hour to conclude 4-5 anti-TB drugs, it would be possible to temporarily resolve the problem of drug stigma. Possibly, until the end of the 80s of the decade, the indicators of political style in Russia were taken for a relatively low price, and the number of people was insignificant.

The large-scale development of the tendency towards the development of medicine in Russia for the 20-year period (1979-1998). Trochee lower than boules showed resistance to rifampicin (21%), kanamicin (19%), ethionamide and etambutol (16%). The lowest level of lykarskoy stikosti is promoted to PASK (8%). We are glad to use these drugs, such as streptomycin and isoniazide, may be the most important indicators of drug treatment, but they are not the best for the history of chronic disease, and in the standard therapy, PASK is not. Syntheses with one of the remaining ones, etambutol became the most "superior" drug, until the resistance of the plant was trimmed at a relatively low rate.

An analysis of these drugs to streptomycin, izoniazid, rifampicin and etambutol (1991-2001) for some preparations. The level of stiffness to rifampicin is less likely to be reduced to izoniazide, and often the association of drug dysfunction of two drugs is to rob rifampicin as a marker of multiple drug dysfunction.

Being one of the main drugs, it infuses the MBT fraction into actively multiplying, rifampicin enters the warehouse of all chemotherapy schemes, so that it becomes stagnant for the treatment of new ailments to active tuberculosis, and to prevent the especially urgent problem of multiresistance. Negotiate trivial data about patients with multidrug-resistant tuberculosis in tight communities. The increase in mortality rates due to tuberculosis in society will be associated with the increase in MDR mortality. The order of the about those who are ill, such as seeing mycobacteria, stirs to izoniazide and rifampicin, є are less infectious, less patients.

Growth of the extravagant frequency of drug resistance, the prevention of tuberculosis in all localizations, and the development of significant improvements in the structure for the reduction of mono-resistance and the improvement of the reduction of the reduction. The indicators of the MBT's licensing stiffness are unevenly distributed throughout the entire territory of Russia and vary to reach a wide range. Already from the end of the 90s, the indicators of the first class of care from 18 to 61% in the other regions of Russia, the indicators of the second level of care from 50 to 70% in the secondary regions of the country, 70% in the secondary regions, 70% are almost everywhere. Resistance of MBT to the main drugs is more typical for the first ailments with a widening process. Development of MBT resistance until the end of the main and reserve drugs - for relapses and chronic interruption tuberculosis legen.

The frequency of the population of ILC in new-onset ailments is not high (2-10%), so it cannot be seriously infused on the basis of epidemiological indicators of tuberculosis. Greater epidemiological significance of secondary resistance. The inflow of anti-tuberculous bacteria is early enough to grow to the end of the population of high-grade to lykarsky bacteria. I dare to endure the greatness of the one who is lykarskiy inflow not to cause an additional elimination of the pathogen in the organisms of humans, but as an additional factor of this straightforward evolution.

Reasons for the formulation of likarskoy style of development... In the industrialized lands, the price can be tied to lykarskie graves when developing treatment schemes; in those who are poorly guilty - due to marriage, financing and the supply of less effective, more cheap drugs. In groups of patients according to the formulation of resistant to tuberculosis є ailments, which disrupt the treatment regime and re-digest the main course of treatment on its own, or through allergic abnormal toxic delay; I have a sinister mood with alcohol, drug addiction; individuals who are in contact with tuberculosis ailments, see likarsko-stiyki MBT.

Likarsky style is formed as a result of one or several spontaneous mutations in the independent genes of the office, which is very important in case of inadequate chemotherapy regimens. Empirical recognition of the standard combination of chemotherapy drugs in the presence of primary drug treatment, for some reason, as well as redistribution of the course of therapy to produce up to the accumulation of mutations for the main reason.

Some mutations can be developed in the bacterial population before the MBT comes into contact with anti-tuberculous drugs. The frequency of detection of spontaneous mutations of natural MBT strains, to pull the development of drugs to antibacterial drugs, is variable. In the literature, the phenomenon of cross-resistance is described - I will become, at any rate, the drug is genetically summed up to decile drugs in one hour. Cross-resistance is characteristic for izoniazide and ethionamide, rifampicin and other elderly, as well as streptomycin, kanamicin, amikacin. Burkhlivy development of molecular genetics, which helps to promote in the end of the rock, gave the opportunity for the development of MBT genes, controlling the efficiency and mechanisms of development. Naybіlsh generally vivchenі geni and mechanisms of the formulation of drugs up to preparations in the first row.

The resistance to izoniazide is encoded by some genes: Kat G - healthy control of cell catalase-peroxidase activity; inh A - control of the synthesis of microlithic acids; kas A - control of protein interactions. The resistance to rifampicin is linked to a single rpo B gene, which controls the transcription process (RNA synthesis). Rps L і rrs - geni who code the processes of translation and linkage with the synthesis of a cell phone. Mutations in cich genes are key in the formulation of resistance to streptomycin and kanamicin. The resistance to ethambutol is encoded by the emb B gene, which controls the process of normal induction of blood cells during the conversion of glucose into monosaccharide. The pcn A gene is responsible for the robotic enzyme enzimpirazimidazi, which is responsible for the transformation of pyrazinamide into an active complex (pirazinodonic acid).

When consumed in the body, the drug or its metabolism is involved in the cycle of robotic microbacterial cells, destroying the normal life. As a result, the drug becomes inactive in terms of maturity to its targets, so that it can lead to the development of a picture of lykarsko-stiy tuberculosis.

Infused with the nature of drug resistance for interruptions and the result of falling ill є insane... State-of-the-art tuberculosis of lesions in a large number of diseases is developing on the basis of many major diseases and is supervised by a great widening of specific and nonspecific status in diseases of the lung tissue, in the rate of restoration Evidence of resistance up to 1-2 drugs is practically not detected on the results of treatment. Stability up to 3 or more drugs, and especially ILC, accelerating the process of treatment and reducing its efficiency. The process of swirling in the trustworthy rate of sputum negativity, degradation of inflammatory and destructive changes, in conjunction with this, helps to prevent a great demand in surgical treatment.

The problem of improving the effectiveness of preventive visits for the prevention of infection with high-grade tuberculosis is of wide interest. The prevalence of tuberculosis in contact persons in families of ailments, which is seen by the MBT's lactic-style staff, is 2 times more common in cases of ill-contact in families of bacteria.

Try to roam thoroughly for preventive and political visits. Approved from the spectrum of the MBT medical stiffness spectrum. To roam over the box of a model of a sick person with a lykarsko-stiy tuberculosis is a problem. The trend of linearity between different types and resistance is taken into account. Further, the development of the problem of lykarskoy stikosti and promising possibilities for the intercourse of tuberculous infections.

2015-07-14 19:32:43

Antonina will write:

I'm going! I have a lot of food, on which I cannot know the type. My cholovik buv absolutely healthy people Having passed a medical examination, at one point, I learned about those who have ailments for tuberculosis. Diagnosis buv deliveries 2 rocky that only on the basis of X-ray. There were no symptoms of ailment. Analysis of blood, sputum did not show anything. Pislya trivial lіkuvannya vognischa healed. After a dozen hour, there was a relapse, now he has a stiff tuberculosis, so that the drugs in the first row do not go. Diagnosis sounds like "multidrug-resistant tuberculosis".
For the first time, we learned about the ailment, since I had been in 2 months of vaginosity. We were planted for the child, led a healthy way of life, but about contacts with the tubes, we cannot be ill and cannot be moved. Could the stars be taken by the gidota?
Mass vaccination of children is carried out in the canopy booth crushed BCG Why do they have tuberculosis ailments? Does it mean that the chips are not? And just one hour later, the ailment ceased to be social, it is a disease of decent people, as they lead the way of life, does it mean that scraps are not captured from ailments? What is the reason for the incidence of ailments in a grown-up child? Even in the organism of a child, they settle weakened microbacteria, as they can "sit and check" the necessary moment, and become active with a weakened immunity, or a deterioration of the quality of life.
Whenever I fight for my health and the health of a child, even if the form is closed, it can become critical, but at any moment, it’s impossible to say anything.

reply:

Privit, Antonina! Infection with tuberculosis is not caused by splinters, but due to contact with tuberculosis. Moreover, from such a contact, which can happen at any moment in any huge mission, the woman is not insured. The active splash of disease on tuberculosis can be explained by the renewed breakdown of the system of anti-tuberculous therapy, which was even more effective and good in an hour of CPCP, as well as immunodeficiencies, which are types for a happy person. The multi-resistance of an educator is the price of the inheritance of incorrect schemes for the treatment of tuberculosis, the lack of treatment of ailments is a sign of a drug and a foreign situation due to the growing stiffness of microorganisms to the extent. Vaccination against tuberculosis is organized by the organism of people with a weakened tuberculosis bacterium, which allows the organism in friendly minds to formulate anti-tuberculosis immunity, thus preventing the formation of splinters (in case of appearance) Protect your health!

2014-01-29 21:33:44

Oksana:

I'm going!
I have been using MDR tuberculosis for more than 18 months (strength up to all the first row, and up to two drugs of another). Remaining X-ray: fibrosis + abnormalities of the brain (seemingly, it seems to be the best choice). Likuvannya will be held for more than 2 months. For less than 30 years (with a happy family), I led and am leading a healthy way of life, I did not miss a welcome welcome. So as information about the vilikuvani of this type of tuberculosis is much too small, so there is such nutrition. My vipadok - no more love, why should there be no more about the "calming down" of the ailment, how much more severe relapses? Yaka statistics for such ailments. In an hour or so, can I know the practice as an administrator in the sanatorium installations after the end of the trip (or now I have a robot at my place)? Why can I give birth to a child, for the great rizik will know how to become ill? Pidkazhit, which is the same drug in Ukraine, there is a great dose of ill health on MLS-TB (who can you turn to)? Vibachte for a great number of food, but I can’t reject all of my friends.
Skin advice for less important ones, and specifically information on advanced tuberculosis (if you ask me strictly for all recommendations, you may not know).

vidpovidaє Gordev Mikola Pavlovich:

Privit, Oksana. Your vipadok is tse and those, and I will explain: the tse is the option of making money, but not the most beautiful. Tsei option of transferring all the dishes to the firing and interconnection of healthy tissues with coarse tissue. Poganiy vin tim, scho in tsikh dilyankas of the wickedness there are loneless living mikobakterіy. I need to undergo 2-3 courses of anti-recurrent therapy to extinguish the infection. And in someplace you can lay down 80% of your health on TB. Pratsyuvati with people, like і people, you can again come here in 12 mіs. for wash away, there will be no relapses, and you will regularly undergo and overhaul. You don't need any kind of fakhivtsya from MLS at once. Vzhe practical health on TB lyudin. Good health to you.

2012-01-25 10:35:58

I will feed Darina:

Good afternoon! It is possible, if you want to reject the power supply from the senior scientific specialist of the National Institute of Phthisiology and Pulmonology. F.G. Yanovskiy AMS of Ukraine, metro Kiev, Strizh Viri Oleksandrivni. My cholovikov was diagnosed with tuberculosis desemination on 11/17/11 right legends, Without a drop, BK -. The self-feeling was normal, the thought of the radiologists was growing, they respected, as for the sign of the surplus changes, after 5 years of pneumonia and pleurisy were transferred. Protest VKK diagnosed tuberculosis.
Izoniazide (0.3 - 1 tablet)
Rifampicin (0.6 - 4 capsules)
Pirazinamid (2.0 - 3 tablets)
Etambutol (1.2 - 3 tablets)
Pyridoxine (Vitamin B6) - 1 tablet.
Cholovik tablets are brave all and always. After 2 months, a splinter of control marks was broken. The idea of ​​roentgenologists was once again unambiguous, they were summed up є a drop or no. What was the reason for the destruction, in the case of pretrimanded therapy? Does it mean that a person has persistent tuberculosis? All the smears and the negative result in the bully's head, it was not possible to convert them to sensitivity. Cholovik may not cough and do not see phlegm. Infected the drug by identifying streptomycin in іn'єktsії, why is it correct? Do not you need to add antibiotics to another series? You can come for a consultation, visit the Institute of Phthisiology and Pulmonology before you. F.G. Yanovskogo, why is the mother straight? Thank you for your feedback.

vidpovidaє Strizh Vira Oleksandrivna:

Privit, Darina! Chomu Virіshili, scho instructing the destruction. The appearance of a drop could be due to the loss of a part of the infiltrative changes, for which early empty was not backed up. Another option is chemical resistance. Come for a consultation You can, however, it is necessary to bring a vip with a history of ailments by radiographers. Write me about the details by mail.

2011-10-24 13:05:29

I will feed Timur:

I have the third risk of being ill for tuberculosis, the drug over the whole hour has been overwhelmed and repeated several times. lіkuvavya drugs first і other series. How can you learn about any of the preparations? and if someone is infected with persistent tuberculosis, is there any chance of getting sick?

vidpovidaє Medical consultant to the "site" portal:

Privit, Timur! A collection of tuberculosis bacteria is sensitive to all representatives of the group of anti-tuberculosis drugs. Strength to antibiotics - the quality, as it is formed by the flow of mental minds in the process of mutation of microorganism, it can form quite a bit, including the lack of discernibility of the child before the development of drugs. If someone is infected with a persistent strain of tuberculous sticks - the inability of Shkira's stick to buy drugs from the new ruler. Protect your health!

2009-12-01 19:28:27

Keti will feed:

Hello. I work in the tuba of the dispensary of the town of Zugdіdі, Georgia and I declare the organization "Likarі without cordonіv".
How many people are right for the disease of persistent tuberculosis and do I accept the vi-DOT system?
If you may be like that food, I'll be glad to answer them.

vidpovidaє Strizh Vira Oleksandrivna:

Privit, Kety! Dyakuyu for the fate and proposition. I am imparting to Georgia and Georgians - a wonderful beautiful and strong people. And how to sleep and dance ... DOTS-strategy is unacceptable for our countries in that option, in which WOOZ is proponent. The Qiu program was developed for the families of the third world, since the day is not developed, because the infrastructure of the phthisiatric service has not been developed. Moreover, the given strategy is absolutely unacceptable for a child's tuberculosis, more prompted by the bacterioscopic method of diagnostics and not transmitting the ability of early (stage of infection) detection of tuberculosis. In children, sticks in sputum appear, if there is a large part of legends and bronchi, it is unacceptable. For the treatment of persistent tuberculosis in our Institute for the Development of Intensive Combination of Chemotherapy Modes, the arsenal of chemotherapy drugs for antimycotic activity has been expanded. My mailing address is in the Information about Fakhivtsia.

2008-11-10 18:55:16

Will feed Olena:

I'm going! Douzhe turbulent nutrition of lykarsko-stiyky tuberculosis! Likar vidmahutsya, and more turn nikudi. Be a weasel to help!
Meni 26 rock. More than a month later, they gave me a diagnosis: vognischevic tuberculosis of the right legacy f. іnfіltratsії. The drugs were designated: rifampicin, pirazinamide, izoniazide and etambutol. The day before the cob of treatment, 10/7/2008, I made a biochemical analysis of blood, as I have Gilbert's syndrome. However, there were no results in the analysis. Through the author, if I came to the reception before the phthisiatrician, when I got sick, then in the analysis of the ALAT adjustment (3.2 at a norm of up to 0.68 mmol / hl) and ASAT (3.0 at a norm of up to 0.68 mmol / ch). Bilirubin is in the norm. At the end of the period is less turbulent nudota. I repeated the analysis two times according to that (naturally, it was already in reverse), 10/22/2008. Enzymes have become essential: ALAT 10.6 і АСАТ 8.0. Suspicions for hepatitis A, B and C were not confirmed. A new analysis was published through the author of the publication - 11/01/2008. There indicators in the same units: ALAT - 115.5 Odes (norm up to 34), ASAT - 62 (norm 31). They gave me: toxic (lykarsky) hepatitis. Ale the nudota by the rapt has passed, not a turbine. In addition, they wrote to Ursosan (I wish I took Essentiala before).
However, for a complete analysis, since the norms are all one change, phthisiatric therapy for three days was taken 3 from choter drugs (izoniazide, rifampicin, pirazinamid), and I drank only etambutol. Then, for one day, I renewed the intake of these drugs, and when I took the drug, I got rid of rifampicin. For that tridenous interruption, I do not take rifampicin, and only three drugs - isoniazide, pirazinamide and etambutol - are already six days, but at once in these three days, interrupt to become already nine days. I am still using amikacin. Likar do not go to know the signs of rifampicin. I am still worried that from the minimum two months I took rifampicin (at least 60 doses, as I was told) I took only one month. I am even more afraid of the development of lykarsko-stiy tuberculosis through qiu skasuvannya. Inadvertently, I will be drinking rifampicin dal chi ni. Raptom to chew the call? Likar vidmahutsya, as if, through the ovens, I can become an invalidity, and three drugs can be delivered, plus іngalyatsії. And it’s enough, it’s just a buzz of sign of rifampicin with a lot of it ?! First of all, more beautiful: to become an indiscriminate by the principle of death from nevilikovny tuberculosis ???
Nutrition: I’ll take a break of 10-15 days in one of the anti-tuberculous drugs (rifampicin). Naskіlka is not safe on the outside of your skasuvannya (how to skasuyut), how much is it close to a month before you drank it? And why is it that it’s already terribly changed by the norms of ALAT and ASAT in the last analysis, dated 1.11.2008, what was the need to get rid of rifampicin? Be affectionate, let me show you!

vidpovidaє Strizh Vira Oleksandrivna:

In case of hepatotoxic reactions, it is necessary to correct the chemotherapy regimen. So, for the approval of the drug, replace the wine preparation or change the way of its introduction: the tablets can be replaced by internal or internal introductions, so that the lungs are sagging, the stove is minuscule (ale of the normal baking). For the elimination of toxic hepatitis of the year є the straining drug Heptral, generalized vicious sorbents, internal infusion of glucose, salt solutions, essential and rich. Rifampicin is often the cause of hepatitis without laboratory signs. Once again, there are signs of hepatitis and zhovtyanitsi contraindications pirazinamid For an hour, as long as the transaminases do not reach the norms, all drugs are taken for an hour to enjoy only streptomycin and etambutol for hepatitis. ... The therapy scheme can be as follows: 2 ms. SHE + 10 ms. HE. In addition, as the problem of hepatitis will be violated, I know that the necessary anti-tuberculosis chemotherapy is being introduced step by step.

2016-05-01 22:21:19

Anna:

In a person with an onset of tuberculosis, the form of tuberculosis occurs in the hospital. ale to go to the house of skin problems. says he went to the minus after three months of the use of sticks. may infect us

vidpovidaє Medical consultant to the "site" portal:

Privit Anna! For detailed information about the risk of infection in case of contacts with ailing tuberculosis, you can find it in the statistics on our medical portal... Protect your health!

2016-05-01 13:09:08

Galina will feed:

Privit me 67 years old, fell ill with tuberculosis. strong likes but the weakness is not found and the weakness is added to the slunk;

vidpovidaє Medical consultant to the "site" portal:

Privit, Galina! Anti-tuberculous drugs can wiklicati bitter appearances in viglyadi depressions in the robotic slunk-intestinal tract and grass roots. From the side, at your visit to the bagatokh people є chronic shlunkovo-intestinal disease, Yake can give me a picture. If you are going to get into a situation and get adequate education, you should go to full-time reception before your phthisiatrician and gastroenterologist and go through a routine. Protect your health!

2015-11-24 15:22:36

Zapituє Anatoly:

Good day. My dad knew the form of tuberculosis. They drank etombutol, pirazinamide, isoniazide, rifampicin. A selection of wines of beer at home did not give a better result. The infection is sent to the dispensary in the tube, and it seems like you will be pretty in the same form, because it’s not always the regime that is not always taken into account in the out-of-the-way, and it’s not like it’s going to be. At a new edge of that number of air boules. The tomograph has revealed the bones of the pechinka. Nachebto darkening only the upper part of the left light. 1Would you say you have a chance to find yourself in a drug that will not become stagnant in such cases as highly toxic? Secondly, I might be ill, є a cough, but on the signs of nothing, I’m not talking about phthisiatric medicine, but then remembering and writing to me, respecting the likes of the burning legends !? Besides, they didn't take sputum from me! Tse right? 3 How can I help my father lie down?

vidpovidaє Agababov Ernest Danielovich:

Good day, Anatoly, what kind of prognosis you can get sick will only be able to say if you have estimated that you will be "prompted" for therapy in a hospital, you see typical signs on the radiography that you should be recommended to get sick.

Popular statistics on the topic: persistent tuberculosis

Vipadkovy contact with the nose of a tuberculous stick is safe: it is not a disease of infection. And the axis with a trivial and regular spilkuvanny with a bladder in the form of tuberculosis can be infected singingly. Uniknuty ailments can be helped by proph_laktika.

Tuberculosis is not an infectious disease, as a result of being infected with tuberculosis (Mycobacterium tuberculosis), and is characterized by statements of specific granules in the tissues and organs.

Infections and allergies - often intertwine and the potential for one pathological process. Aje neridko route bronchial asthma offensive: flu, bronchitis, pneumonia, obstructive syndrome, attack of asthmatic breath.

Today we can talk about those who have a world of sorts in all countries, including in Ukraine, infectious diseases of the lower dickheads, pneumonia and bacterial aggravations in the first place. chronic bronchitis, I represent important medical and social ...

Coccydioidosis - endemic contagious systemic mycosis, which manifests itself as a primordial infection, or progressive granulomatous lesions of shkiri, cysts, loams, internal organs, Moss tunica.

Unimportant to the high level of development of the current pharmacology and medicine, people do not like to succumb to tuberculosis. The zvichaynu form of getting sick has come up successfully, right up to the rest of the day. Through the building of bacteria mutuwati won often become insensitive to antibiotics. I will call this form of ill-health "tuberculosis MLS".

Tuberculosis є Infectious for bacterial illnesses... In the scheme of yogo lykuvannya, it is necessary to include a sprinkle of antibiotics. It is possible to carry out the treatment until the end of the day, if possible, after the treatment of ailments.

There is a lot of tuberculosis resistance - not even the strength of Koch's bacillus sticks to anti-tuberculosis drugs in the first row. Izoniazide and rifampicin are used as the most effective drugs in the fight against tuberculosis. The triviality of drug addiction is more than 6 months.

Vidi LU tuberculosis

It is necessary to go through the treatment until the end, do not be timid to interrupt and do not bother with taking medications, most often there is an illness, even in some cases, often with the wrong scheme of therapy, the bacteria become insensitive.

In general, the symptoms of becoming ill do not appear as tuberculosis. Win can be closed in the closed, so in the open form, you can prikhovanie perebіg... You can establish caverns and infiltration of the bacterium of the entire organ. In rare cases, an extrapulmonary form of tuberculosis of MLO is possible. Ale the love of this disease will be even more and more important.

Unimportant to the loss of sensitivity up to two antibiotics, TB-MLS is given in the order of the drug in another row. Stink, unaffected by the triviality of a taste and a lot pobichna diya, Zdatnі stifle and destroy the pathogenic flora.

The most important form of illness is XDR tuberculosis. Dane fell ill with a wide likarskoy style of victories great difficulties in likuvanna. In this context, the range of drugs, up to which the stick has grown in style, significantly expands. The most frequent successor to the disease is tuberculosis of the ILC.

Reasons and manifest

One of the main reasons for the deterioration of the drug efficiency is the lack of additional lykarsky recommendations, Zokrem, prypinennya not brought to the end of the course likuvannya. Often the price is seen through the value of polishhennya, and the patient accepts the "period of prosperity" for the outside world.

For the most part, not so. Chi is not underestimated until the end of the bacterium, as she has become aware of the injection of the drug, the attempt is made to recognize the gene mutations, which are directly linked to the injection of the drug. Try not to use bacteria, but instead of changing bacteria, to remove non-standard microorganisms.

After a dozen hour, I’m getting sick of knowing it’s more likely to show myself, in deyaky vipadki yogo will be prikhovanie. Alle the preparations, which were used in the previous therapy scheme, will not be practical anymore.

XDR - the price of the inheritance is not up to the end of the brought disease of multiple tuberculosis. In this regard, the rate of infection is promoted to the drugs that were selected for the therapy of MDS. Such a rank, number effective drugs Significantly change in the skin of the skin.

Likewise, multiple tuberculosis can be the cause of re-infection of the disease. Most often, the price of wine is common in people with a group of rhizik. For new skin infections, the list of persistent drugs can be changed. The infection can be as long as possible until the bacterium occurs. We should not be able to see if we are in contact with an illness on the form of an ILC or XDR. Kokh's stick in such children is passed on to people from the past to the last.

In case of vyshevichennyh reasons for the diagnosis, you can see factors that take the diagnosis of stiffness to antibiotics. Before the development of the ILC the following people are more competent:

Often the strength of the wine is through the intake of the drug low quality(Pidrobok). In this way, hopefulness diyuchy speech to stick to the independent types of the patient's reasons. Selected podії є this day to complete with extensions, unaffected by the retail control of pharmacological pawns.

Once you take the drug, you can get through the visibility of the drug in the region or in the country. It should be taken into account, if the drug is on reestablishment for any reason.

I am majestic, I am not safe to bear people who are ill on a form of persistent tuberculosis. Infection from them is seen as unattractive to infection. Through the price, it is recommended to find children in the isolation wards of infectious diseases.

Tse become ill most often against tuberculosis. Vono supravodzhutsya second vagi, fever, coughing more than 2 months, hemoptysis and other symptoms. Vidmіnnistyu є non-receptiveness to standard treatment and further progresuvannya illnesses. Most often, on the basis of taking medications, patients will see more of themselves more beautifully than after the first month of treatment. With MDR, the symptoms will only become more prevalent, and the camp will start to decline.

Features of diagnostics and treatment

Often, the appearance of TB-MLS is repaired by the reception of a positive effect from the consumption of therapy. For the development of stiffness, you can choose old methods, as you may be able to see the crops for the growing middle of the world with new antibiotics.

It is always antibiotic, in any case, there will be a growing bacterium, it is antibiotic, which is not receptive. dane doslіdzhennya to be held for a few days.

In the given hour for the formulation of a diagnosis of vicarious tests, quickly begin the sensitivity of the bacterium. The smell can be molecular and cultural. A very quick result is given by molecular tests - from 2 years to 1-2 days. Unimportant for high efficiency, the stench does not make a great financial contribution, but it is possible for the vicarists to navigate in the home regions.

At one primary diagnosis, there are several standard diagnostic methods:

• Mantoux test;
• fluorography;
• radiography;
• microscopic dosage of phlegm.

When diagnosed with tuberculosis, the method for monitoring the effectiveness of therapy is described.

As soon as the patient develops stiff tuberculosis of the legends, then the disease becomes twisted in the region. Obov'yazkovoyu є a psychological robot with a patient, so as a trivial therapy is negatively signified on the mental health of a sick person.

Due to the unhappiness of storing a few important preparations of the first choice, it is necessary to take preparations of another line, more important for the whole body:

1. Hinolini.
2. Cycloserine.
3. Linezolide.
4. Prothionamid / Etionamid.

A lot of people have used the therapy with these drugs with chemotherapy, as they become stagnant in the therapy of oncological ailments. The drugs are strong shlunkov_ rozladi, Pain in the abdomen, tediousness, strong muscles and swelling pains.

Through toxicity, the liver, nirki, heart and organisms suffer. It is necessary to fix the preparations in order to seize them. In some cases, there may be damage from the side of the patient's psyche, right up to suicide. Unimportant at the time of the end of the trimming of the designated scheme of treatment, so yak Single option lykuvannya TB-MLS.

Riziki and forecasts

Through the visibility of a safe treatment, it is possible to diagnose multiple organ deficiencies, both for aphids and for toxicity. Ailments can lead to the development of tuberculous menіngіtu, or broadening infections in all organisms.

Principles of tuberculosis therapy

Zakvoryuvannya in the region is not without a doubt for the suspension. Infection, which is characterized by a stiffness, is important to support therapy.

I am not safe to get bacteria, because I have violated the strength to drugs in another row. Give the preparations є the lasting effective medicines. Pharmacology, do not marvel at post-production, have not yet cracked the drugs, as soon as it was quickly and effectively eliminated from getting sick.

Uninvolved in the conduct of the lykuvannya, the winners of the lifeless difficulties with the usunions of the infection center. Bagato patients through the important side effects do not show the liking. Through a trivial crossing of ailments, in the body of a vine, there are no functional and morphological changes, as it is unfortunate in the past.

In the case of people who have been involved in infection, it is most common for people to become an indiscriminate. It is also possible to repeat the information. Often the disease will end with a lethal result.

Zapobіgannya development of pathology

To prevent the transition from acute tuberculosis to stable tuberculosis, it is necessary to clearly and summarily take into account the treatment scheme. Significantly I will become in the first month of therapy, not knowing the knowledge of infection and in the course of continuing to take the drugs.

In order to reduce the number of transmissions of infection from the dzherel, it is recommended to isolate patients with an open form of MLS and SLS. If you do not come in, do not wait to get stuck, a lot of patients, often from the asocial beliefs of the population, are considered from the state hospitalization and therapy.

Slid namagatisya unique repeated information. Yaksho is a factor, so it is necessary to receive an infection. Obov'yazkovy є free diagnostics come in, direct to the early detection of the disease. The important role of vidigraє community propaganda of diagnostics of ill health.

Obov'yazkovoyu for prophylaxis є vidmova vid shkіdlivyh ringtone, Especially kurnnya.

It is necessary to maintain a healthy way of life with good food and physical rights. During the period of acute ailments in the nose (spring, autumn), there are many unicatious people, especially in the closed-mindedness.

Dane fell ill є a heritage of hopelessness, in the first place of children. Scientists made a great breakthrough in the therapy of tuberculous infection. Even before, they died in 100% of the cases - at the same time, they died.

Alle, in a small number of times, the rate of return does not go down - there is a great development of MLS and SLS in suspension, right up to the development of the strength of the bacterium to all the useful preparations. In such a way, the liking of this pathology will be ill-humored.