A method for predicting the tuberculous process in the lungs

 

(57) Abstract:

The method is carried out by microbiological release of L-forms of Mycobacterium tuberculosis from sputum of patients and determine the selected L-forms of the pathogen antilysocyme activity. When the level of expression of this trait is equal to or greater 4 g/ml predict exacerbation of tuberculosis. The method improves the accuracy of the forecast in 2-3 times, and also to expand the circle of persons under prediction in the treatment, at the expense of patients with different forms, prevalence and stage of tuberculous lesions in the lungs. 3 table.

The invention relates to medicine, namely to medical Microbiology, and can be used in the treatment of tuberculosis for prediction of tuberculous process.

There is a method of predicting the course of tuberculous process to determine the massiveness of bucillamine [1]. The method consists in monthly quantitative assessment of Mycobacterium tuberculosis, which is carried out by microscopic examination of a smear digested sputum of patients and counting colonies grown on nutrient Lowenstein-Jensen medium. The disadvantages of this method Bodymist of calculating the massiveness of bucillamine and mapping them.

In addition, the predictive capability of the method does not apply to a group of patients, providing patient L-forms of mycobacteria.

Closest to the claimed method according to purpose and essential features is a method of predicting the course of tuberculosis in the lungs by microbiological release of L-forms of Mycobacterium tuberculosis from sputum of patients [2].

However, the known method is insufficiently informative: confirmation of the prediction of exacerbations in the detection of L-forms occurred only in 46,6%. In addition, this method can be used to predict relapse of tuberculosis only a limited group of patients with large residual tuberculosis in the lungs.

The inventive method solves the problem of increasing the accuracy of the prognosis of tuberculous process in the lungs.

To solve this problem in the present method for predicting the course of tuberculosis in the lungs by microbiological release of L-forms of Mycobacterium tuberculosis from sputum of patients, optionally selected from L-forms of the pathogen determine the antilysocyme activity and the level of expression of this recognition is aetsa, what have selected L-forms of the pathogen determine the antilysocyme activity and the level of expression of this trait is equal to or greater than 4 g/ml predict exacerbation of tuberculosis.

Achieved by carrying out the invention the technical result consists in the fact that the new method can improve the accuracy of the forecast in 2-3 times. Also allows to expand the circle of persons under prediction in the treatment, at the expense of patients with different forms, prevalence and stage of tuberculous lesions in the lungs.

There is a method of determining the antilysocyme activity of microorganisms (ALA) [3] and application of methods for the determination of the ALA in the way of forecasting reconvalescence bacteria carrier [4].

However, in the sources of patent and scientific and technical information no data about the use of known methods for determining ALA with respect to the L-forms of microorganisms.

However, assessment of factors persistence from L-forms of bacteria with the aim of predicting the course of disease is paramount, as besstrashnye forms of microorganisms long-parasites inside the host cells and cause severe, chronic form infectiion other types of bacteria: the L-forms of Mycobacterium tuberculosis remains the inner layer of the cell wall, representing peptidoglycan (6, 7). Therefore, to protect the "naked" peptidoglycan from tissue lysozyme appropriate manifestation of L-forms of Mycobacterium tuberculosis the antilysocyme activity.

Features of cultivation of L-forms of bacteria in a special semi-solid nutrient media exclude the possibility of application of the known methods for determining ALA bacteria based on cultivation in nutrient dense environments. It was necessary to find a new technical solution to determine the ALA from L-forms of TB bacteria.

Distinctive features of the proposed method and the known methods for the determination of antilysocyme activity of microorganisms are given in table. 1.

The authors experimentally established that the determination of ALA have isolated from the sputum of patients with L-forms of Mycobacterium tuberculosis allows us to predict the further course of the process in the direction of exacerbation or remission.

The research allowed to determine the level of expression of ALA have isolated from the sputum of patients with L-forms of the pathogen to predict the course of tuberculosis in the lungs.

The results of the study are presented in table 2.

As views of the tuberculous process.

To evaluate the effectiveness of the prediction of the proposed method in comparison with the prototype was examined in 15 patients with infiltrative tuberculosis of the lungs, 6 patients with disseminated TB, 9 patients with focal fibrous-cavernous tuberculosis.

The results of the study are presented in table 3.

As can be seen from table 3, the use of the prototype method has enabled us to effectively predict an unfavorable course of the process, only 37.9% of cases. Application of the proposed method, based on the determination of ALA in the selection of L-forms of the pathogen, has improved the efficiency of the forecast to 81.8%: 9 patients from which they were selected L-shape with ALA 4 mcg/ml or greater at follow-up during the year there were relapses.

The method is as follows:

1. Produce microbiological selection of L-forms of Mycobacterium tuberculosis from sputum of patients.

2. Define ALA dedicated L-forms of Mycobacterium tuberculosis based on the Methodology developed by the authors.

According to the developed Methodology in the wells of polyvinyl tablet contribute through the following components: (a) with 0.2 ml. of a solution of the drug egg lysozyme in to the and from the examined patients after 4-week incubation at t = 37oC; C) 0.15 ml 0.5 billion mist daily agar test-cultures of M. lysodeikticus 0.06% mesopatamia agar. The tablet is incubated for 24 hours at 37oC, then consider the result.

In the wells with antilizotsimnoi L-forms of the pathogen observed zone of growth of the test cultures of M. lysodeikticus. Quantitative assessment of ALA spend the maximum concentration of lysozyme in the hole of the tablet that inaktivirovanie this L-form.

3. Predict the clinical course of tuberculosis in the lungs.

When the level of expression of ALA is greater than or equal to 4 g/ml predict exacerbation of tuberculosis.

Example 1.

Patient N. , 44 years old, with diagnosis of Cirrhotic tuberculosis of the upper lobe of the right lung in the period of stabilization, BC-. Pulmonary-cardiac insufficiency of II degree" was held sputum into a semi-solid medium Shkolnikova. After 1 month of culturing the growth of L-forms /confirmed microscopically and visually/.

The selected L-forms of the pathogen ALA was determined according to the method described above. ALA was 5 g/ml, which allowed to predict progressive disease. Monitor patients for 1 year confirmed the prediction: "Cirrhotic ten Infiltrative tuberculosis of the upper lobe of the right lung, Bq+". After 2 months of TB treatment has stopped a typical smear-positive but were identified L-forms of mycobacteria with the level of expression of ALA 2 g/ml, which allowed to predict a favorable clinical outcome with minimal residual changes. Dynamic monitoring during treatment for patients within 1 year confirmed the prediction: there is resorption of infiltration with minimal residual changes. Repeated clinical and laboratory examination at 3 and 5 years showed no activity of tuberculosis in the lungs.

Example 3.

Patient B., 48 years old. The diagnosis of Disseminated tuberculosis, the phase of infiltration and decay, Bq+". 3 months after the termination of allocation sticks mycobacteria detected L-shape with ALA = 4 g/ml, which allowed to predict adverse outcome. Monitor patients during the year confirmed the prediction: there was undulating course of the process with the prevalence of relapses and the release rod-shaped bacilli.

The use of the proposed method of predicting the course of tuberculosis in the lungs will enable 2-3 times to increase the accuracy of the prediction. In addition, this method allows glatzel reduction of treatment time. Forecasting is an important epidemiological role is to reduce the spread of tuberculosis among the people.

Sources of information

1. The Sagalovich C. Y. Kanev, S. S. Fedorova, With the Clinical significance of the massiveness of bucillamine with chronic destructive pulmonary tuberculosis //Probl. the tubes. - 1976. - N 10. - S. 26-30.

2. I. R. Dorokhova, M. A. Karachunskii, E. T. Abdullayev and other Identification of L-forms of Mycobacterium tuberculosis as a prognostic criterion of recurrence and relapse of tuberculosis in patients with large residual tuberculosis in the lungs //Probl. the tubes. - 1989. - N 3. S. 14-17 /prototype/.

3. O. C. Bukharin, B. J. Usvyatsov, A. P. Malyshkin, N. In. Nemtseva Method of determining the antilysocyme activity of microorganisms //IMEI. - 1984. - N 2. - S. 27-28.

4. O. C. Bukharin, B. J. Usvyatsov, E. I. Leggings, A. P. Malyshkin, S. P. Mikhailov and Y. D. Kagan forecasting reconvalescence Salmonella bacteria carrier // A. S. N 1303163, MKI 4 A 61 K 37/48, 1987

5. Prozorovskiy S. C., Katz, L. N., Kagan, J. L-form bacteria /mechanisms of formation, structure, and role in pathology. - M., 1981.

6. L. N. Katz, A. C. Wolf and N. D. Konstantinov. Ultrastructure of L-forms. Message I. Mycobacterium is acteri TB //TB Issues. - 1988. - N 8. - S. 72-76.

A method for predicting the tuberculous process in the lungs by microbiological release of L-forms of Mycobacterium tuberculosis from sputum of patients, wherein the selected L-forms of the pathogen determine the antilysocyme activity and the level of expression of this trait is equal to or greater 4 g/ml predict exacerbation of tuberculosis.

 

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