Pulmonary scintigraphy in evaluating the efficiency of surfactant therapy in the complex treatment of patients with destructive pulmonary tuberculosis

Functional impairments of the mucociliary system (MCS) are known to develop in destructive tuberculous inflammation in the lung tissue. The effect of surfactant agents and their production stimulants is to recover the ventilation and gas exchange functions of the lung. The radioaerosol technique that adequately characterizes the deposition of an inhaled agent in the bronchial tree and records the state of mucociliary clearance (MCC) and MCS in different portions of the lung by the rate of tracer washout is of the greatest information value for the evaluation of MCC in vivo. Its normal values are in rather wide ranges so the absolute values are of low informative value. By taking into account the variability in the tracer washout range in health, the authors used only the time course of relative changes in this parameter--before and after surfactant therapy. The capacities of pulmonary scintigraphy were employed to monitor the efficiency of treatment for tuberculosis. The percentage of the activities in the areas of the right and left lung individually and in combination was estimated, by constructing the tracer washout curve. The percentage of 60-minute tracer washout was borne in mind to determine the rate of MCC.     

Aerosolized interferon-alpha treatment in patients with multi-drug-resistant pulmonary tuberculosis

Multi-drug-resistant tuberculosis (MDR-TB) has emerged as an obstacle to the control of tuberculosis. Recent data however, suggest that interferon-(IFN)-gamma and IFN-alpha may improve disease evolution in subjects affected with pulmonary tuberculosis caused by multi-resistant (IFN-gamma) and sensitive (IFN-alpha) strains. The mechanisms involved are not known, even though it has been reported that IFN-gamma-secreting CD4+ Th cells may possess antitubercular effects. In addition, IFN-alpha can induce IFN-gamma secretion by CD4+ Th cells, and both types of IFN may stimulate macrophage activities. The aim of this study was to explore the possibility that aerosolized IFN-alpha, administered concomitantly with conventional antitubercular chemotherapy, may improve the course of pulmonary tuberculosis. After six months of directly observed therapy (DOT), seven patients who were non-responders to a second line antitubercular therapy were given an IFN-alpha aerosol (3 MU, three times a week) for two months as adjunctive therapy. All strains were resistant to at least two first-line drugs. After IFN-alpha administration, the patients were followed up for a further six months with the same DOT. Sputum samples were collected monthly during the study period, with the exception of the IFN-alpha administration period, when the observations were performed weekly. High resolution computed tomography (HRCT) chest scans were performed before and after IFN-alpha inhalations. The analysis of the results showed that the mean number of Mycobacterium tuberculosis (Mt) had remained statistically unchanged (p = 0.80) during the first 6 months of DOT. During the following 2 months of IFN-alpha administration, 5 patients became negative (p = 0.02). After the end of treatment a progressive increase in Mt number was observed (p = 0. 02). Sputum cultures remained positive for all patients throughout the study period, although a significant decrease (p = 0.02) in the colony number per culture was observed after adjunctive treatment with IFN-alpha. After stopping administration of IFN-alpha, a significant increase (p = 0.03) in the colony number per culture was noted as well as in Mt numbers. HRCT scans were slightly improved in all patients. These preliminary data suggest that aerosolized IFN-alpha may be a promising adjunctive therapy for patients with MDR-TB. Optimal doses and schedules however, require further studies.     

Epidemiological danger of patients with pulmonary tuberculosis and alcoholism refusing treatment

The comparative evaluation of the epidemiological danger of alcohol-addicted persons with pulmonary tuberculosis who evaded treatment (the test group of 133 persons) and that of tuberculosis patients receiving adequate treatment under hospital conditions (the control group of 162 patients) was made. The morbidity level among relations having contacts with the patients evading treatment exceeded the morbidity level in the families of tuberculosis patients undergoing adequate treatment 4.5-fold for adults and 3.4-fold for children and adolescents, the contamination level in the latter group being twice as high. Although no cases of the disease were registered in the foci of infection where sick persons evading treatment had low bacterial discharge, still the elevated level of infection among children and adolescents in these foci as compared with the foci where tuberculosis patients did not evade treatment (35.0% and 21.7% respectively) indicated that the foci of infection where such aggravating factors as alcohol addiction in the source of infection was present were rightly considered to be epidemiologically most dangerous. Persons suffering with both tuberculosis and alcoholism should be subjected to compulsory hospitalization as early as possible.     

Use of prodigiozan and tactivin for treatment of patients with chronic Klebsiella infections

Two-stage immunocorrection in patients with chronic Klebsiella infections by consecutive administration of prodigiozan and tactivin, has been shown to facilitate the restoration of the balance of immunoregulating cells, to enhance proliferative response to T- and B-mitogens, thus producing favorable clinical dynamics. The possibility of chronic Klebsiella infections therapy, based on the use of immunocorrecting preparations (prodigiozan and tactivin) and antibiotics capable of intracellular penetration (sumamed and cyprofloxacin) is discussed.