What is the mechanism of development of drug resistance of the tuberculosis pathogen. Multidrug-resistant tuberculosis. What is MDR

a) sensitive to all anti-tuberculosis drugs;
there

b) monoresistant MBT;

c) multidrug-resistant MBT;

d) single-drug resistant MBT;

e) multidrug-resistant MBT, resistant
to a combination of main and reserve anti-tuberculosis
drugs.

56. Primary drug resistance of MBT indicates:

a) about endogenous reactivation;

b) about exogenous superinfection;

c) about hematogenous dissemination;

d) about lymphogenous dissemination;

e) about bronchogenic contamination.

57. Toxic adverse reactions are associated with:

a) with the dose and duration of taking the anti-tuberculosis drug
paratha;

b) with the antigenic effect of an anti-tuberculosis drug;

e) with all of the above.

58. Allergic adverse reactions are associated with:

a) with the individual sensitivity of the patient’s body;

b) with the dose and duration of taking the anti-tuberculosis drug
paratha;

c) with a form of tuberculosis process;

d) with the patient’s place of residence;

e) with all of the above.

59. What standard chemotherapy regimen is prescribed for the first time?
presented to a patient with tuberculosis:

d) III;
D) IV.

60. What standard chemotherapy regimen is prescribed to a patient with tumor?
berculosis with a high risk of developing drug-resistant
stimbt:

61. What standard chemotherapy regimen should you receive for the first time?
identified patient from long-term contact with a patient with fibrosis
no-cavernous tuberculosis:

63. In case of correction of treatment when drug resistance is identified,
resistance to isoniazid or rifampicin in the chemotherapy regimen
pi should be added:

a) one main-line drug;

b) one reserve drug;

c) one drug to which sensitivity is preserved
MBT;

d) one drug to which MBT resistance has been determined;

e) two or more drugs to which sensitivity is preserved;
MBT.

64. The total duration of the main course of drug chemotherapy
nationally resistant tuberculosis is in months:

65. Indications for prescribing corticosteroids in patients with tuberculosis
forest is:

a) caseous pneumonia;

b) bronchial tuberculosis;

c) exudative pleurisy;

d) meningitis;

d) all of the above.

66. The use of immunomodulators for tuberculosis is due to:

a) underweight;

b) accelerated ESR;

c) eosinophilia;

d) immunodeficiency;

d) intoxication.

67. Treatment with artificial pneumothorax is indicated for:

a) focal tuberculosis;

b) cavernous tuberculosis;

c) caseous pneumonia;

d) exudative pleurisy;

e) cirrhotic tuberculosis.

68. Pneumoperitoneum is indicated for:

a) a cavity in the upper lobe of the lung;

b) lesions in the lower lobe of the lung;

c) a cavity in the lower lobe of the lung;

d) exudative pleurisy;

e) cirrhosis of the lung.

69. While maintaining the sensitivity of MBT to 3-4 anti-tuberculosis
drugs as the main type of surgical intervention
is:

a) thoracoplasty;

b) extrapleural pneumolysis;

c) cavernotomy;

d) resection of affected areas;

d) pleural puncture.

70. Duration of post-vaccination anti-tuberculosis immunity

theta caused by the administration of the BCG vaccine:

a) 1-2 years;

b) 3 years;

d) 5-7 years;
d)

71. 1 dose (0.1 ml of solution) of the BCG vaccine contains the amount
drug in mg:

72. Method of administration of the BCG vaccine:

a) oral;

b) intradermal;

c) cutaneous;

d) subcutaneous;

d) intramuscular.

73. The second BCG revaccination is carried out at the age of:

b) 10-11 years;

74. The main anti-tuberculosis drug for chemotherapy
myoprophylaxis is:

a) isoniazid;

b) ethambutol;

c) pyrazinamide;

d) rifampicin;

e) streptomycin.

75. The duration of the course of chemoprophylaxis is:

a) 1-2 weeks;

b) 2-4 weeks;

c) 4-8 weeks;

d) 3-6 months;

e) 9 months.

76. To carry out chemoprophylaxis for contact persons, the most
It is important to know:

a) the results of the source stability study;

b) phase of the tuberculosis process of the source;

c) duration of the source’s illness;

d) sanitary and hygienic condition of the home;

e) compliance with the patient’s treatment regimen;

f) increased sensitivity to tuberculin.

77. The first anti-tuberculosis dispensary was opened in the city:

a) Edinburgh;

d) Moscow;

d) Kazan.

78. The Day against Tuberculosis is called the day:

a) White chamomile;

b) Blue daisy;

c) Blue chamomile;

d) lotus;

d) independence.

79. Healthy persons in contact with a source of tuberculosis
infection, are observed in the dispensary registration group:

80. Newly identified patients with questionable tumor activity
berculosis process are observed in the dispensary registration group:

81. Documentation in the form of form No. is sent to the sanitary and epidemiological control authorities regarding information about a patient with tuberculosis identified for the first time:

82. Patient Yu., 20 years old. A mechanic by profession. No previous tuberculosis
was sick. Last x-ray examination - two years ago
ass Denies contact with tuberculosis patients. History of chronic
nic viral hepatitis B. I fell acutely ill with a rise in temperature
body rye up to 38 °C. Complaints of pain in the right side of the chest
with a deep breath, cough with sputum, weakness, sweating. You-
a survey radiograph of the chest organs was completed,
tuberculosis is suspected. Sent to the PTD at the place of residence. Metho-
home fluorescent microscopy found MBT in sputum. After
After the examination, the patient was diagnosed with infiltration
trative tuberculosis of the upper lobe of the right lung in the decay phase,
MBT+. In biochemical parameters: increased ALT activity
and AST three times, a slight increase in the thymol test.
Which anti-tuberculosis drug should not be used?

a) Streptomycin.

b) Isoniazid.

c) Rifampin.

d) Ethambutol.

e) Phtivazid.

83. Patient V., 45 years old. Suffering from alcoholism. Suffering from tuberculosis

1997 Over the past few years, periodically short courses of chemotherapy in a hospital setting, which are interrupted due to

patient due to violation of hospital regulations. There are no data on the drug sensitivity of MBT. He was hospitalized in the department in a state of moderate severity, exhausted, temperature up to 38 °C, cough, shortness of breath on exertion, pain in the left half of the chest. The liver protrudes from under the costal arch by 4 cm. Using Ziehl-Neelsen microscopy and sputum culture, MBT resistant to isoniazid, rifampicin and streptomycin were detected. Blood test: NH. - 143; Er. - 4.5; Color - 0.95; n. - 11%; With. - 57%; e. - 4%; l. - 20%; m. - 18%; ESR - 34 mm per hour. The patient was diagnosed with fibrous-cavernous tuberculosis of the upper lobe of the left lung in the infiltration phase, M BT+. Drug resistance to isoniazid, rifampicin and streptomycin. What chemotherapy regimen should be prescribed to the patient?

d) III;
D) IV

84. A child aged 7 years before the first revaccination at school was given a Mantoux test with 2 TE PPD-L. The result is a papule of 10 mm. The scar on the left shoulder is 3 mm. What conclusion can be given based on these data:

a) infection with Mycobacterium tuberculosis;

b) the child retains post-vaccination immunity;

c) primary infection with Mycobacterium tuberculosis;

d) hyperergic sensitivity to tuberculin.

ANSWERS AND EXPLANATIONS

1. The correct answer is b.

Only M. tuberculosis bovines, the bovine type that causes 10-15% of all diseases in humans, has initial resistance to pyrazinamide.

2. The correct answer is a.

The causative agents of tuberculosis in humans in 92% of cases are M. tuberculosis humanus, and M. tuberculosis bovis and M. tuberculosis africanum cause the development of tuberculosis in humans, respectively, in approximately 5% and 3% of cases.

3. The correct answer is c.

The resistance of MBT to acids, alkalis and alcohol is due to the high content of mycolic acid in the cell wall.

4. The correct answer is c.

which manifests itself in their ability to retain color, even with intense bleaching with acids, alkalis and alcohol, is due to the high content of mycolic acid, lipids, etc. in the cell walls of mycobacteria.

5. The correct answer is c.

The cycle of simple division of a mother cell into two daughter cells
takes from 13-14 hours to 18-24 hours. Microscopically visible
The visible growth of microcolonies on liquid media can be detected on
day, visible growth of colonies on the surface of a solid medium
yes - for a day.

6. The correct answer is d.

One of the characteristic properties of MBT is their ability to change under the influence of external factors. The polymorphism of the pathogen is manifested in the formation of filamentous actinomycete, coccoid and L-forms. In connection with this restructuring, not only the morphology of the office changes, but also the antigenic composition and pathogenicity for humans and animals.

7. The correct answer is d.

One of the characteristic properties of MBT is their polymorphism and the ability to change under the influence of unfavorable environmental factors.

8. The correct answer is c.

The core factor, or virulence factor, is located in the form of a monolayer and consists of 30% trehalase and 70% mycolic acid; the resistance of MBT to solutions of acids, alkalis and alcohols is associated with it.

9. The correct answer is g.

The MBT genome has a length of 4,411,529 nucleotide pairs, which are almost 70% represented by guanine and cytosine. Nucleotide contains
4000 genes, of which 60 encode components of PH K. For MBT
there are unique genes, in particular the mtp40 and mpb70 genes, which
ry are used to identify in re-
shares (PCR).

10. The correct answer is g.

In dried sputum, MBT can persist for up to 10-12 months (in a residential area).

11. The correct answer is g.

MBT survive in raw milk for 14-18 days; souring of milk does not lead to their death. When heating milk, they can withstand heating at 55-60 °C for 60 minutes, heating at 70 °C for 20 minutes, and boiling kills MBT within a few minutes.

12. The correct answer is b.

In patients with the presence of decay cavities in the lung, MBT can be detected by two methods - microscopy of sputum and its inoculation on nutrient media. It is this category of patients that currently constitutes the main reservoir of tuberculosis infection in society. According to WHO, one such patient can excrete up to 7 billion MBT per day.

14. The correct answer is a.

When a patient with tuberculosis coughs, sneezes, or even talks,
of which there are always particles in the air containing
In this case, the infection disperses over a distance of 80-100 cm.
A sneeze can create more than a million particles the diameter of a
it is 100 microns (on average about 10 microns).

14. The correct answer is d.

There is a critical range of particle sizes that allows for maximum inhalation and retention of infectious particles in the respiratory tract, leading to infection. This critical range is approximately 1 to 5 µm. According to experimental data, for the appearance of tuberculous granuloma in the lungs during aspiration infection, only

15. The correct answer is g.

The development of active tuberculosis is determined by various factors: the massiveness of the infection, the duration of contact with the source of infection, the entry routes of infection and the state of resistance of the human body. Of the four mentioned factors, the greatest importance is attached to the level of resistance of the human body. It has been established that generalized and acutely progressive forms of tuberculosis develop in weakened individuals under conditions of starvation or malnutrition, during natural disasters and armed conflicts; in this regard, tuberculosis is determined by both biological and social factors, which makes tuberculosis considered a medical, biological and social problem .

16. The correct answer is c.

In the absence of treatment, a bacterial pathogen can infect, on average, up to a person in its environment within a year.

17. The correct answer is g.

Macrophages are fixed on the cell membrane, then immerse (invaginate) them into the cytoplasm of the cell, with the formation of phagosomal-lysosomal complexes, in which the generation of hydrogen peroxide during an oxygen explosion is enhanced and nitric oxide is formed via the L-arginine-dependent cytotoxic pathway.

18. The correct answer is c.

MBT, entering macrophages, can persist in phagosomes and even continue to reproduce. In this case, phagocytosis may be incomplete. It has been established that MBT can produce ammonia, which, on the one hand, can inhibit the fusion of the phagosome with the lysosome, and on the other, by alkalizing the contents of the lysosome, reduce its enzymatic activity.

18. The correct answer is c.

The increased virulence of MBT is associated with the activity of catalase/peroxidase, which increases the intracellular survival of the pathogen, protecting it from lysis mechanisms in the macrophage.

20. The correct answer is d.

Delayed-type hypersensitivity (DHT), which is the main mechanism in the formation of cellular anti-tuberculosis immunity, mediates the development of cellular immunity aimed at localizing tuberculosis inflammation in the infected body, and the creation of acquired immunity aimed at destroying

21. The correct answer is b.

CD4+ lymphocytes produce significant quantities of in-which is the main mediator of resistance to tuberculosis, increasing the digestive ability of macrophages to destroy MBT.

22. The correct answer is d.

The morphological equivalent of the body's protective cellular reactions against tuberculosis infection is a specific granuloma. In this case, there are four types of cellular elements in the granuloma. Its center and main mass are epithelioid cells. Lymphocytes and plasma cells, as well as neutrophilic leukocytes, are located along the periphery. The fourth element contains giant multinucleated cells (Pirogov-Langhans type).

23. The correct answer is c.

Secondary immunodeficiency is formed under conditions when phocytes are unable to provide adequate resistance to infection and die in large numbers (apoptosis), which in turn leads to rapid and massive proliferation of the mycobacterial population and progression of the tuberculosis process. Increased apoptosis, leading to a decrease in the number of T lymphocytes, is accompanied by a significant decrease in the synthesis of interleukin-2 and interferon-g.

24. The correct answer is d.

In primary tuberculosis, MBT spread throughout the body through the blood and lymph, so-called primary or obligate (obligate) mycobacteremia occurs. MBT settle and become fixed in the tissues of various organs, where the microcirculatory capillary network is most pronounced. These are the capillaries of the lymph nodes, the glomeruli of the renal cortex, the epimetaphyseal sections of the long bones, the ampullar-fimbryonic section of the fallopian tube, the uveal tract of the eyes, etc., while from the moment of primary infection the tuberculosis infection is generalized and systemic in nature, which subsequently leads to the possibility of developing extrapulmonary forms of tuberculosis.

25. The correct answer is d.

In the development of secondary tuberculosis, a necessary condition is a decrease in immunity, including specific immunity, the breakthrough of which does not provide sufficient control over the multiplying mycobacterial population. In this case, as a rule, 90% of patients develop clinical manifestations of the disease and there is practically no tendency to spontaneous cure, which is characteristic of primary tuberculosis.

26. The correct answer is c.

Cheesy necrosis of lung tissue is characterized by the formation of extensive lobar and lobar lesions of lung tissue, consisting of foci of primary necrosis of lung tissue merging with each other with a very poor specific cellular reaction. With this type of specific inflammation, a cheesy degeneration of the liquid and cellular elements of the inflammatory exudate quickly occurs with the formation of first dry and then liquefied necrotic masses.

27. The correct answer is d.

The most pronounced clinical symptoms are in patients with acutely progressive and widespread destructive forms of tuberculosis. In minor forms, an asymptomatic course of the disease is usually noted.

28. The correct answer is d.

Patients with tuberculosis complain of increased body temperature, sweating or night sweats, chills, increased fatigue, weakness, decreased or lack of appetite, weight loss, and tachycardia. The easiest to quantify is the temperature reaction, with fever noted in 40-80% of patients.

29. The correct answer is d. Bronchopulmonary complaints are not strictly specific to pulmonary tuberculosis and can also occur in other inflammatory diseases, such as pneumonia, chronic obstructive pulmonary disease, etc.

30. The correct answer is b. The number of MBT detected during microscopic examination is a very important information indicator, since it characterizes the degree of epidemic danger of the patient and the severity of the disease.

31. The correct answer is a. When performing a Mantoux test with 2 TE of PPD-lungs, only a local reaction develops, i.e., at the site of tuberculin injection (injection), reaction. This reaction is assessed quantitatively and is recorded by measuring the central area of induration, i.e. the papules, in millimeters.

32. The correct answer is d. The tuberculin test is an immunological test. Detects an immune reaction - delayed-type hypersensitivity, therefore it is registered after 72 hours.

33. The correct answer is c. The Mantoux test with 2 TE PPD-lungs is considered positive when the papule size is 5 mm or more. Accurate response measurement is very important. Careless measurements and taking into account the results “by eye” are unacceptable.

34. The correct answer is a. The Mantoux test with 2 TE is given to children from one year of age and adolescents once a year, preferably at the same time of year.

35. The correct answer is c. In tuberculosis, along with lymphocytosis (25-60%), there is an increase in the number of neutrophils, mainly in secondary forms of an active specific process (fibrous-cavernous and tuberculosis). In primary tuberculosis with

defeat is noted by them

36. The correct answer is b.

The child has positive tuberculin sensitivity, which is due to post-vaccination immunity. There is a tendency for the test result to decrease, which will become questionable and negative 3-4 years after the vaccine is administered, if the child does not become infected with MBT naturally.

37. The correct answer is d.

Ultrasound is a method of non-invasive additional examination used to diagnose pleurisy and identify subpleurally located round formations.

38. The correct answer is c.

Detection of M BT makes it possible to establish an etiological diagnosis without much difficulty.

39. The correct answer is a.

Specific tuberculous inflammation has a variety of radiological manifestations - from single or multiple confluent foci, round infiltrates and recissuritis to lobar tuberculous pneumonia. However, the majority are characterized by localization of the process in the 1st -2nd and 6th segments of the lungs.

40. The correct answer is c.

In case of doubtful activity of tuberculous changes. In this case, chemotherapy is prescribed with 4 drugs - isoniazid, rifampicin pyrazinamide, ethambutol. After 2 months, the X-ray examination is repeated. In cases of tuberculous etiology, partial resolution of inflammatory changes is observed.

41. The correct answer is g.

Chemotherapy is carried out with 4 anti-tuberculosis drugs (isoniazid, rifampicin, pyrazinamide and ethambutol). In such cases, a repeat X-ray examination is necessary after 2 months. In cases of tuberculous etiology, partial or complete resorption of inflammatory changes is observed.

42. The correct answer is c.

An additional research method for diagnosing tuberculosis is bronchoscopy, since the detection of caseous masses and cellular elements of a specific tuberculous granuloma in a biopsy specimen allows morphological verification of pulmonary tuberculosis.

43. The correct answer is c.

Detection of specific elements of tuberculous granuloma (caseosis, epithelioid and multinucleated cells) in a biopsy specimen allows morphological verification of pulmonary tuberculosis and timely initiation of anti-tuberculosis treatment.

44. The correct answer is a.

Identification of patients with tuberculosis is carried out by medical personnel of medical institutions of the general medical network (LU compulsory health insurance) when examining patients who have sought medical help, as well as during routine preventive examinations of certain population groups.

45. The correct answer is a.

Periodic fluorographic examinations of the population once every 1-2 years make it possible to detect respiratory tuberculosis at relatively early stages of development, which significantly increases the likelihood of complete clinical cure.

46. The correct answer is g.

Persons in contact with tuberculosis patients. Family contact or work-related contact with the bacteria-releasing agent is especially dangerous.

47. The correct answer is d.

In patients from risk groups, due to a decrease in the body's resistance, tuberculosis can develop very quickly (possibly within weeks, but certainly within months), so the optimal periodicity of fluorographic examinations should not exceed 6 months.

48. answer - g.

With a gentle regimen, in all cases, morning hygienic exercises are recommended, and, if indicated, physical therapy using a method with a reduced load. Its duration in inpatient treatment should be no more than 1 - 1.5 months.

49. The correct answer is b.

During the training regime - 2700-2900 kcal/day (11.3-12.2 MJ).

50. The correct answer is d.

The most effective drugs in the GINK group are isoniazid and fenozide.

51. The correct answer is g.

A daily dose of rifampicin of 10 mg/kg body weight of the patient is
is uniform for daily and medication use
Karstvo (3 times a week).

52. The correct answer is g.

The daily dose of streptomycin is 8 mg/kg body weight of an elderly patient, which is half the standard daily dose, which is associated with a large number of adverse reactions of neurotoxic, vascular and hepatotoxic effects.

53. The correct answer is c.

It is necessary to increase the dose of rifampicin or replace it with rifabutin.

54. The correct answer is g.

Fluoroquinolones have been used as anti-tuberculosis drugs since the 1980s.

55. Correct answer. - d.

Patients with single-drug-resistant MTB, resistant to a combination of primary and reserve anti-TB drugs, have an unfavorable prognosis and high mortality due to the fact that there are no specific drugs for their treatment.

56. The correct answer is b.

Primary drug resistance is determined in patients who have taken anti-TB drugs for less than 1 month. In this case, it is assumed that the patient was infected with these MBT strains. In Russia, the current frequency of primary multidrug resistance in individual regions is

57. The correct answer is a.

Toxic reactions depend on the dose and duration of use of the drug, on the nature of its inactivation and elimination, as well as on the characteristics of interaction with other drugs in the body, on the functional state of the main parts of the detoxification system of the body (the influence of age, concomitant diseases, previous drug treatment).

58. The correct answer is a.

Allergic reactions are the individual response of the patient’s body to an antigen drug or its catabolism products. An allergic condition may develop following the first administration of drugs, but is usually due to gradual sensitization with repeated doses. The occurrence of the reaction does not depend on the dose of the drug, but the degree increases as it increases. All anti-tuberculosis drugs can cause sensitization of the body, but antibiotics have these properties to the greatest extent.

59. The correct answer is a.

Chemotherapy regimen I is prescribed to newly diagnosed patients with pulmonary tuberculosis with the release of MBT detected by sputum microscopy, and to newly diagnosed patients with widespread (more than 2 segments) forms of pulmonary tuberculosis (disseminated tuberculosis, extensive exudative or bilateral pleurisy), but with negative sputum microscopy data .

60. The correct answer is c.

The PB regimen is prescribed to patients who have epidemiological (regional level of primary multidrug resistance of MBT exceeding 5%), anamnestic (contact with patients known to the dispensary who secrete multidrug-resistant MBT), social (homeless people released from penitentiary institutions) and clinical (patients with ineffective treatment according to chemotherapy regimen I, Na, III, with breaks in treatment, with common forms of tuberculosis, both newly diagnosed and recurrent pulmonary tuberculosis) indications.

The correct answer is b. A patient with fibrocavernous tuberculosis, as a rule, secretes multidrug-resistant MBT, so patients in contact with such a patient should be treated with the Pb chemotherapy regimen for patients at high risk of developing drug resistance.

62. The correct answer is d.

Before starting chemotherapy, it is necessary to clarify the drug sensitivity of MBT according to previous studies, as well as during the examination of the patient before starting treatment. Therefore, it is desirable to use accelerated methods for bacteriological examination of the obtained material and accelerated methods for determining drug sensitivity, including using the system

63. The correct answer is d.

If drug resistance of MBT to isoniazid or rifampicin is detected, one anti-tuberculosis drug should never be added to the chemotherapy regimen due to the risk of developing multidrug resistance.

64. The correct answer is d.

Long-term prescription of reserve anti-tuberculosis drugs is due to their low activity and bacteriostatic effect.

65. The correct answer is d.

Indications for the use of corticosteroids are forms of tuberculosis with a pronounced exudative reaction - acute miliary tuberculosis, infiltrative tuberculosis of the lobita type, caseous pneumonia, tuberculous meningitis, exudative pleurisy, peritonitis, pericarditis, polyserositis, tuberculous lesions of the bronchi. They can also be used for side effects of anti-tuberculosis drugs associated with toxic and allergic reactions with damage to the liver, kidneys, and skin.

66. The correct answer is g.

In connection with the signs of immunodeficiency identified in recent years in patients with tuberculosis, especially with the development of severe forms of the disease, immunomodulators (tactivin, thymalin, levamizol, diucifon, etc.) are increasingly used as pathogenetic agents.

Resistant tuberculosis is caused by Koch bacteria, which have a greater degree of survivability compared to similar pathogens. The resistant form of tuberculosis is difficult to treat, and its course is severe. Drug-resistant tuberculosis has begun to actively progress among the world's population. Only a TB doctor can rid the body of it; self-medication in this case can negatively affect the patient’s condition.

Resistant tuberculosis most often occurs in the following categories of citizens:

Persons diagnosed with AIDS

If a person is affected by AIDS, the immune properties in his body are weak. Penetration of Koch's bacilli into the body of such people in most cases results in tuberculosis. A weakened body is not able to fight tuberculosis pathogens, so the latter become stronger and more resilient.

Citizens with reduced immunity.

Cases of infection of the body with tuberculosis are common if the human body’s immunity is weakened. The inability of the body's leukocytes to quickly respond to pathogenic agents entering the body leads to the development of resistant tuberculosis.

Suffering from drug addiction and alcoholism.

Resistant tuberculosis is more common in drug addicts and alcoholics. People with such an antisocial lifestyle daily expose their body to the harmful effects of bad habits. Against the background of frequent entry of dangerous compounds into the body, the destruction of many body cells, including leukocytes, begins. As a result, the immune system weakens and the body becomes powerless against pathogenic agents that have entered the body.

Homeless people.

If a person does not have a permanent place of residence and spends most of the day in unsanitary cold conditions, he is guaranteed to have a resistant form of tuberculosis.

Bacilli excretors.

With frequent contacts of healthy citizens with bacilli-transmitters, numerous aggressions of the tuberculosis pathogen lead to infection of the body with this disease. If the necessary treatment is not carried out, the disease develops into a resistant form, the treatment of which becomes much more difficult. A large number of bacilli excretors are located on the territory of prisons and pre-trial detention centers.

People with untreated tuberculosis.

When a person has not completely gotten rid of tuberculosis, a stable form of this disease may develop. This picture is often observed during self-medication of this pathology by patients whose education is far from medical.

People at risk should pay more attention to their own health, since their lungs are more susceptible to damage by a resistant form of tuberculosis.

Resistant pulmonary tuberculosis and its treatment have a special approach based on the existing signs of pathology.

The Scientific Council of the World Medical Community classifies the following symptoms as this pathology:

Attacks of coughing with phlegm.

Patients with a resistant form of tuberculosis of the lung often suffer from a strong and prolonged cough, along with which a lot of sputum containing pathogenic agents comes out of the body. Such a symptom should not go unnoticed!

Discharge of blood when coughing.

Drug-resistant tuberculosis is characterized by the release of some blood when coughing. This indicates the destruction of the smallest blood vessels that previously fed the alveoli (pulmonary vesicles).

Feeling weak.

A constant feeling of fatigue and weakness also indicates a disease in the body. If at the same time a person complains of coughing attacks, weakness most likely developed as a result of this.

Mass loss.

According to recent studies, it has been proven that drug-resistant tuberculosis leads to dramatic weight loss. Rapid weight loss accompanied by a severe cough is considered a symptom of the described pathology.

Attacks of sweating.

Often patients with this disease complain of excessive sweating. This symptom should also not be left unnoticed, as it serves as an addition to the diagnosis.

An experienced phthisiatrician can detect tuberculosis in the human body even before conducting the necessary research. Therefore, if you have symptoms, you should not wait for the body to heal on its own, but immediately go to the hospital. A curable version of the disease can be obtained with a timely visit to the doctor.

Among these factors it is worth noting:

undertreatment of tuberculous lung disease;
close and prolonged contact with patients.

Let us consider the noted factors in more detail.

Due to undertreatment of tuberculosis of the lungs, a change in the species composition of microorganisms that have penetrated the human body is possible. Thus, there are many known cases where bacteria, under the influence of certain factors, could mutate directly without leaving the human body. The resistant form of tuberculosis is clear evidence of this.

As a result of emerging mutations, many bacteria become resistant to the effects of previously destructive drugs. Therefore, the medications taken become ineffective against new mutant pathogens. The latter begin to actively feed and reproduce, spreading throughout the respiratory system. After some time, resistant tuberculosis develops in the body.

If a person has been treated for tuberculosis of the lungs in a medical setting under the supervision of an experienced doctor, his immune system will be able to independently destroy the bacterial mutants present in the body. In the absence of the correct treatment regimen, the immune system becomes less strong, which does not prevent the free reproduction of pathogenic particles in the body. This leads to an increase in the number of mutant bacteria compared to the number of conventional tuberculosis pathogens. It is the mutant forms that begin to dominate in this counterbalance, easily destroying their opponents. This is how resistant tuberculosis can be transmitted.

Drug-resistant tuberculosis is transmitted through contact between a sick organism and a healthy one. In this case, Mycobacterium tuberculosis (MBT) freely penetrates through the air from infected lungs to healthy areas. Considering the vitality and aggression of these pathogens, they instantly enter the healthy respiratory tract, from where they penetrate the lungs. Adolescent or mature organisms are equally capable of being exposed to these agents. After a set period of time, the disease begins to manifest itself with corresponding signs.

Resistant tuberculosis is characterized by a certain course during the treatment phase. Medical practice has described a large number of cases in which this chronic pathology had multiple exacerbations.

Based on this, it should be concluded that only a phthisiatrician should treat the described disease, using the necessary equipment and medications.

If, as a result of an x-ray examination, not the smallest spots, but rather large stripes were found on the surface of the lung, then the tuberculosis disease has become resistant to many drugs. This phenomenon is quite normal for this disease.

Drug-resistant tuberculosis can interact with the following agents:

viral particles;
bacteria;
certain categories of diseases;
infections.

As a result of such interaction, multiple types of tuberculosis pathology can form, for which no effective cure has been invented. Therefore, it is so important to try to treat the disease to the end using the correct anti-tuberculosis drug. The latter can be prescribed exclusively by a doctor after the patient has undergone the necessary diagnostic procedures.

The sputum released from a body affected by tuberculosis is rich in numerous microbacteria, many of which are very dangerous. A child or adult should try to get rid of such dangerous mucus without swallowing it back. This action will reduce the number of pathogenic particles in the body, thereby slowing down the spread of the disease. These are the main features of the course of drug-resistant tuberculosis during its treatment.

Treatment of drug-resistant tuberculosis lung disease should be carried out by a specialist with appropriate qualifications. Such a doctor knows well that to combat this pathology, special medications should be used that differ from the standard set of anti-tuberculosis drugs. The reason for this is the very specificity of the disease.

As noted earlier, with drug-resistant tuberculosis, numerous mutant bacteria can form in the human body. Naturally, such particles will be endowed with special properties and increased survivability. Even Rifampin in this case becomes powerless! The effect of conventional anti-tuberculosis medications on such microorganisms will be weak and ineffective, which will in no way prevent the spread of pathology throughout the body.

In most cases, phthisiatricians use a special set of medications in the treatment of this pathology, corresponding to the individual type of sensitivity of microorganisms of an individual person. Before such an appointment, the patient is subjected to special testing to determine the susceptibility of his body to antibiotics and other anti-tuberculosis drugs.

On average, treatment for drug-resistant TB lasts at least a year, but in severe cases it can be much longer. Compliance by the patient with all the doctor’s instructions in most cases leads to ridding the body of this terrible disease. In some cases, even removing the affected lobe of the lung can help.

Medvedka helps well in the treatment of drug-resistant tuberculosis. With the help of Asian mole cricket leukocytes introduced into the blood of a tuberculosis patient, it is possible to significantly reduce the number of Koch bacilli. Insect leukocytes, resistant to the poisons of the tuberculosis bacillus, quickly “swim up” to the pathogenic agents and begin to devour them. Numerous studies by scientists in many countries of the world have proven the positive effect of treating tuberculosis with mole cricket leukocytes. Such a positive result is a negative move for Koch's bacilli.

A positive result in the treatment of the described type of tuberculosis is obtained by doctors and patients following the following principles:

disciplinary behavior of a person affected by tuberculosis;
careful monitoring by doctors;
the use of different drug combinations;
continuous nature of medication administration;
the use of long-term course treatment.

Among other things, the patient is recommended to observe:

healthy daily routine;
balanced diet;
cleanliness of clothing and premises;
room ventilation mode;
positive emotional mood.

Self-medication of drug-resistant tuberculosis leads to the formation of new mutations of microorganisms in the human body, which will be very difficult to cope with. Therefore, you should not experiment with your own health, and if you suspect the described pathology, seek help from a doctor.

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Of particular concern to TB doctors is the widespread prevalence of a serious form of the disease called multidrug resistance in tuberculosis or MDR-TB. What does it mean? The answer can be found in this article.

What is MDR?

This type is characterized by the lack of effectiveness in using the most effective drugs that can resist the harmful effects of Koch's bacillus on the body.

The main factor contributing to the development of resistance of Mycobacterium tuberculosis to the strongest drugs used in the treatment of infection is considered to be patient violation of recommendations for taking medications. This is irregularity or incorrect dosage.

In most cases, this attitude leads to a situation where the most effective medications do not cope with pathogenic bacteria, which puts the patient’s life at risk.

Causes

The ability of tuberculosis bacteria to resist the effects of extremely strong drugs is determined by a variety of factors, the main one of which is the wrong approach to their use.

The formation of resistance in mycobacteria is the result of their chromosomal mutation, caused by the lack of sensitivity of some of them to drugs or a violation of the concentration of the drug used. In this case, not all bacteria die; the survivors inherit resistance to the drugs.

Among other factors that contribute to the acquisition of a resistant form by mycobacteria, it should be noted:

Lack of timely detection of primary drug resistance in a patient.
Premature cessation of treatment, interruption of the course.
Untimely and irregular medication intake.
Reduce the prescribed dosage.
Low quality of drugs.
Lack of checking the compatibility and effectiveness of the medications used.
Making a mistake in choosing a treatment regimen.

The emergence of cross-resistance, when resistance to one of the drugs used can provoke a lack of sensitivity to another.

The persistence of the infectious agent is often a consequence of the patient’s negligence, who stops taking medications when they feel better before completing the full course of therapy. Relapse of tuberculosis contributes to its progression, but in a stable form.

Other reasons include medical errors and lack of necessary medications.

Kinds

The classification of manifestations of resistance of the infectious agent to drug treatment distinguishes three categories. Each of them examines certain chemotherapy drugs to which mycobacteria develop resistance (resistance).

MDR-TB

A distinctive feature of multidrug-resistant tuberculosis is the inability to cure it with the strongest drugs that are effective in treating ordinary tuberculosis, although the causative agent of the infection is the same Koch bacillus.

These are the main and most powerful first-line anti-tuberculosis chemotherapy drugs - Rifampicin and Isoniazid. They are recognized as the most effective in the fight against tuberculosis, however, in the presence of MDR, they cannot destroy the Koch bacillus even without developing resistance to drugs of another series.

Multiple drug resistance is difficult to treat, which is explained by the exceptional aggressiveness and survivability of mycobacteria that have lost sensitivity to anti-tuberculosis drugs.

XDR-TB

In contrast to MDR, in extensively drug-resistant tuberculosis, there is a lack of sensitivity not only to Ioniazid and Rifampicin, but also to all representatives of fluoroquinolones belonging to the second-line anti-tuberculosis drugs. In addition, this form of tuberculosis is resistant to third-line medications (Capreomycin, Amikacin and Kanamycin), which greatly complicates the choice of treatment tactics.

Absolutely resistant tuberculosis

It should be recognized that this term most accurately characterizes tuberculosis, accompanied by the manifestation of resistance of Koch's bacillus to all anti-tuberculosis drugs.

This lack of sensitivity of mycobacteria occurs due to mutation or omissions during the treatment of the pathology. In this case, treatment of the patient is very difficult and often causes death.

Other types

In addition to the listed types of disease, it is necessary to take into account the possibility of manifestation:

Primary resistance of mycobacteria, in which the patient was infected from a patient who is a carrier of a resistant bacterium.
Acquired resistance that arose after a certain period after the start of the therapeutic course.
Monoresistance – to one particular drug.
Polyresistance – to several drugs simultaneously.

Multidrug-resistant tuberculosis, accompanied by increased resistance of mycobacteria to anti-tuberculosis drugs, is characterized not only by poor therapeutic effectiveness against the infectious agent, but also by a high probability of death. Treatment of this form of the disease is complex and lengthy.

Multidrug resistance can be suspected in the following situations:

if there is no improvement from therapeutic treatment;
if the tuberculosis process progresses despite regular use of medications;
if mycobacteria continues to be isolated.

At the initial stage of tuberculosis, it is possible to determine the presence of a drug-resistant form only through special testing.

Determining the type of MDR is an important stage in an integrated approach and a determining factor in choosing a treatment regimen.

Basic principles of treatment

Drug therapeutic effects involve the use of various combinations of 1st and 2nd line chemotherapy drugs. In addition, in severe cases of the disease, the use of a drug group belonging to the 3rd row is allowed.

Among the immutable principles of the effect of drugs on the tuberculosis bacillus, the following should be taken into account:

adequate choice of funds;
an integrated approach to the use of drugs;
continuity of the therapeutic course;
systematic monitoring of medical workers over compliance with the rules for taking medications.

In addition, drug-resistant tuberculosis requires a therapeutic course according to standard regimens, taking into account the selection of effective drugs, dosage, appropriate regimen and duration of treatment.

The fundamentally important requirements when treating patients with multidrug resistance are:

The use of simultaneous use of 5 anti-tuberculosis drugs that have not lost sensitivity to the identified mycobacteria. Depending on the severity, additional medications may be prescribed.
Using the maximum dosage to effectively influence tuberculosis bacteria.
Mandatory continuation of the course of antibiotics for six months after the moment indicating the absence of mycobacteria in the patient’s body.
The total duration of treatment after recovery ranges from one and a half to two years, despite the negative results obtained.
Unlike the usual form of tuberculosis, which requires one dose of medication per day, a patient with MDR tuberculosis receives medications in 2 or 3 doses over 24 hours. The procedure takes place under the mandatory supervision of doctors.

A prerequisite is strict registration of patients and their official consent to the proposed treatment regimen.

Side effects

The use of drugs from the 2nd and 3rd series provokes a large number of side effects. This:

general malaise;
urge to vomit, nausea;
poor appetite;
hearing loss;
presence of joint pain;
nervous tension, anxiety, dizziness.

Such symptoms are typical mainly for the initial stage of the treatment course. But they should not be ignored. You must inform your doctor about this. He will adjust the dosage or select a similar drug.

Treatment should not be interrupted, as this will lead to even greater aggressiveness and resistance of mycobacteria, and it will be even more difficult to treat tuberculosis.

Consequences and complications

A typical mistake that leads to the resistance of the tuberculosis bacillus is a situation in which the patient, when his condition improves, believes that he is finally cured and stops taking the medication.

As a result, the resumption of the treatment course does not produce positive results due to the development of multidrug-resistant mycobacteria.

In this case, it is no longer possible to select effective drugs. This necessitates surgical removal of the affected organ.

The outcome of the operation is difficult to predict. At the same time, after it there remains a need for further therapeutic effects in order to avoid relapse of the tuberculosis process. However, the selection of effective drugs is greatly complicated and even becomes almost impossible, which leads to the inevitable death of the patient.

It is possible to prevent the likelihood of developing MDR in tuberculosis only if the basic principles of treatment are strictly followed. To this end, the patient should prepare for a complex and lengthy course of therapy, as well as strictly follow the doctor’s instructions.

MDR tuberculosis is the resistance of pathogenic microorganisms to the used tuberculosis drugs. This type of pathological process is considered the most dangerous due to the lack of effective treatment options for patients. As a result, the disease actively progresses and can lead to disastrous consequences.

Where does resilience come from?

The resistance of microorganisms is most evident when using powerful medications: Rifampicin and Isoniazid. The drugs are among the primary therapeutic options that can combat the activity of the tuberculosis viral infection.

The formation of stability is carried out in several situations:

Incorrectly selected therapy for the disease. It is necessary to take a comprehensive approach to the treatment of the disease; the use of several antibiotic options is recommended. In this case, options are established depending on the nature of the pathological process and the form of the disease.
Preliminary completion of therapeutic measures. The duration of therapy should be at least six months. The absence of symptomatic signs and improvement in general well-being is not an indicator for stopping medication.
Interruption of prescribed treatment. Such a violation occurs as a result of the lack of necessary control over the implementation of therapy.

Today, drug resistance occurs in all countries of the world. Mycobacteria can be transmitted to healthy people with an insufficiently strong immune system, in places with large numbers of people, especially in medical institutions, prisons and nursing homes.

Varieties of persistent forms of the disease

Drug resistance of the body is divided into primary and acquired forms. The first type represents strains of patients who have not previously undergone therapy, or the treatment was incomplete (interrupted). In this case, patients belong to the group of initial resistance. If deviations are detected during therapeutic measures for one month or longer, the pathology is characterized as acquired.

Depending on the structure of drug resistance, disease stability to one type of medication is distinguished (while sensitivity to other options is preserved) and multidrug resistance in tuberculosis. There is a so-called super resistance that can be fatal.

XDR tuberculosis (extensively drug resistant) is known. It represents the inability to use numerous anti-tuberculosis drugs. The process occurs as a result of ill-selected therapy, most often due to independent selection of medications.

Elimination of pathology

The effectiveness of therapy depends on what stage of development the disease is at. The timing of treatment plays an equally important role. Medical specialists are obliged to approach the choice of medications responsibly, taking into account the individual characteristics of the patient. Preference is given to complex treatment using antibiotics of various types.

adhere to a strictly established treatment regimen; when using traditional medicine recipes, you must inform your doctor about this;
the patient is obliged to take medications within a clearly established period of time;
it is important to protect a person from sources of exposure to harmful microorganisms, this will prevent relapses;
the patient should carefully monitor the state of the immune system.

If the most resistant variant of tuberculosis is diagnosed, the patient is recommended to use several treatment regimens at once.

In the absence of the necessary therapeutic effect from first-line drugs, second-line drugs are prescribed. They are a backup option. Medicines are administered intravenously. The most common drugs include Levofloxacin, Cycloserine, Ethionamide.

Before medication is prescribed, the patient undergoes special testing. It allows you to determine the body's sensitivity to antibiotics. It is acceptable to use a third treatment regimen. It is used in certain clinical situations. The most popular drugs are Clarithromycin, Amoxiclav and Meropenem. This option is considered relevant in the case of diagnosing multidrug resistance in relation to medications of the first two groups.

Properties of MBT

1) Reproduction occurs quite slowly, cell division occurs in 20 - 24 hours. On liquid nutrient media at tº 37 Cº, visible growth appears on days 5-7, on solid nutrient media - on days 14-15.

2) Possess stability:

· to the influence of environmental factors, are not afraid of the cold (survive at temperatures of -269˚ C.),

· to high concentrations of acids, alkalis, alcohols (acid resistance).

3) Different great vitality, i.e. can retain their pathogenic properties in:

- dried sputum in the dark, without access to sunlight, for 10 - 12 months,

- indoors, on the pages of books, clothes, furniture, walls up to 3-4 months,

- street dust up to 2 weeks,

- damp soil from 4 to 12 months.

- water up to 5 months,

- butter - up to 8 months, cheese - up to 7 months.

Direct sunlight has a detrimental effect on ICD, under the influence of which they die within a few hours.

They die quickly:

· when boiling (after 15 minutes),

· from exposure to ultraviolet radiation, bleach, chloramine, iodine, formaldehyde. For disinfection, preparations containing high concentrations of chlorine are used.

In a dry-heat oven - at a temperature of 100 Cº, they die after 45 minutes.

4).Exhibit variability and adaptability to adverse effects.

The variability of the ICD manifests itself in the following forms:

- Morphological variability

- Variability to dyes

- Biological variability - a change in virulence towards increase or decrease for complete loss of virulence.

Morphological variability manifests itself as polymorphism, i.e. the ability to form different forms. They may completely or partially lose the cell membrane (the so-called L forms) and become inaccessible to the action of drugs or natural human defense mechanisms.

This allows mycobacteria to exist unnoticed in a living organism for years and decades, but there is always a danger that they will again transform into ordinary mycobacteria and cause recurrent tuberculosis.

Atypical forms of MTB can cause diseases in humans and animals that are indistinguishable from the clinical, radiological and morphological manifestations of tuberculosis. Such diseases are called mycobacteriosis.

Diagnosis of tuberculosis is based on data from clinical, histological, microbiological studies, assessment of the results of tuberculin tests and test therapy. Of these methods, the most reliable is the detection of Mycobacterium tuberculosis (MBT), while the rest are informative only in combination. Modern microbiological diagnosis of tuberculosis consists of several main groups of tests aimed at:
identification (detection) of the pathogen;
determination of drug resistance;
typing of Mycobacterium tuberculosis.

Bacterioscopic methods. Detection of the pathogen begins with the simplest and fastest bacterioscopic methods: light microscopy with Ziehl-Neelsen staining and fluorescent microscopy with fluorochrome staining. The advantage of bacterioscopy is the speed of obtaining results, but its capabilities are limited due to low sensitivity. This method is the most economical and is recommended by the World Health Organization as the main one for identifying infectious patients.
Cultural studies. Cultural studies are recognized as the “gold standard” for identifying MBT. In Russia, egg media are used for inoculating pathological material: Levenshtein-Jensen, Finn-II, Mordovsky, etc. To increase the percentage of mycobacteria isolation, inoculation of pathological material is carried out on several media, including liquid ones, which makes it possible to satisfy all the cultural needs of the pathogen. Crops are incubated
up to 2.5 months; if there is no growth by this time, the culture is considered negative.
Biological sample method. The most sensitive method for detecting MBT is considered to be the biological test method - infection of guinea pigs highly sensitive to tuberculosis with diagnostic material.
Molecular genetic diagnostics. The development of molecular biology has significantly increased the efficiency of detection of mycobacteria. The basic method of molecular genetic research is polymerase chain reaction(PCR), aimed at identifying mycobacterial DNA in diagnostic material. PCR provides exponential amplification of a specific DNA region of the pathogen: 20 cycles of PCR lead to an increase in the content of the original DNA by 1 million times, which makes it possible to visualize the results using agarose gel electrophoresis. The role of molecular diagnostics in clinical practice is increasing as the number of patients with poor bacterial excretion increases. However, when establishing a diagnosis, PCR results are complementary and must be compared with data from a clinical examination, radiography, smear microscopy, culture, and even response to specific treatment.

Drug resistance of MBT:

· primary (in untreated patients);

· secondary (if therapy is inadequate).

There is monoresistance (to one drug),

multiresistance (2 or more),

· multidrug resistance (drug resistance to HR) - to isoniazid, rifampicin.

It is the multi-resistance or multi-drug resistance (MDR) of the tuberculosis pathogen that has epidemiological and clinical significance in modern conditions.

The clinical significance of identifying patients with MDR tuberculosis is that this category of patients is characterized by:

· high prevalence of the process,

progressive course of the disease,

· immunodeficiency,

· lack of effect from standard chemotherapy.

An important sign of MBT variability. is resistance to one or more anti-tuberculosis drugs. Types of drug resistance:

Primary - MBT resistance to anti-tuberculosis drugs (ATDs) in patients with tuberculosis who have not previously received specific therapy.

Initial - MBT resistance to anti-TB drugs in tuberculosis patients who could previously receive them. Includes

primary and undetected acquired.

Acquired (secondary) resistance in patients who have previously received specific therapy.

Monoresistance - resistance to one drug.

Polyresistance is resistance to two or more anti-TB drugs, but not to a combination of isoniazid and rifampicin.

Multiple - -//- + combination of isoniazid and rifampicin

Cross (full and incomplete)

Basic mechanisms for the development of drug resistance

I.Mutation

2. Selection

Therefore, at least 4 drugs are used for chemotherapy; if the drug = 40 mcg/ml and the MBT is resistant, what should be excluded.

Methods for determining drug resistance

1.Classic: -m-d proportions

Md stability coefficient - md absolute concentrations

2. Accelerated:

Radiometric MD of the VAS GES system

3.Promising: -molecular genetic.