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      Tuberculosis in adolescents and young patients in high prevalence region

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          The study aims to determine what forms of tuberculosis (TB) are the most common in high prevalence region, establishes the drug sensitivity of Mycobacterium tuberculosis in the region, and reveals the key risk factors of the disease as well as assesses the health status of adolescents with tuberculosis. For 10 years, regional anti-tuberculosis hospital in Smolensk has been collecting data from all TB patients aged 14–34 years. Diagnosis of tuberculosis was based on specific radiological data and detection of M. tuberculosis in sputum or bronchial lavage fluid. In total, the study involved 129 TB cases in adolescents aged 14–17 and 420 TB cases in young people. Sixty-five adolescents had close family or periodic contact with TB patients (50.6%), but only eight out of 65 (12%) had received complete course of chemistry prevention. Sixty-two adolescents had social risk factors (48%). Those patients significantly more often had extended pulmonary TB (28.3% versus 16.7%), complicated (36.7% versus 16.9%), and destructive (41.7% versus 26.2%) cases. Eighty out of the 129 (62%) had one or more concomitant diseases; they had significantly higher rate of extended and complicated TB cases. Two hundred and fourteen out of the 420 young patients had drug resistance of M. tuberculosis. Resistant TB cases significantly more often developed in unemployed (83.2% versus 71.8%), heavy drinkers and smokers (59.3% versus 43.7%), and in ex-prisoners (26.6% versus 15%). In conclusion, a comprehensive approach to examination and treatment of adolescents with TB should be performed. History and clinical data can be beneficially used to predict of drug resistance before results of cultural investigation.

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          Most cited references 12

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          Worldwide incidence of multidrug-resistant tuberculosis.

          Planning for tuberculosis (TB) control requires an assessment of the number and distribution of drug-resistant cases. This study used results of resistance surveys from 64 countries, together with data predictive of resistance rates from 72 others, to estimate the number of new multidrug-resistant (MDR) TB cases that occurred in 2000. By these methods, an estimated 273,000 (95% confidence limits, 185,000 and 414,000) new cases of MDR TB occurred worldwide in 2000, 3.2% of all new TB cases. The analysis provides the first comprehensive set of estimates of the MDR TB burden by country and globally.
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            Community-based therapy for children with multidrug-resistant tuberculosis.

            The goals were to describe the management of multidrug-resistant tuberculosis among children, to examine the tolerability of second-line antituberculosis agents among children, and to report the outcomes of children treated for multidrug-resistant tuberculosis in poor urban communities in Lima, Peru, a city with high tuberculosis prevalence. A retrospective analysis of data for 38 children or =5 first- or second-line drugs to which their Mycobacterium tuberculosis strain was presumed to be sensitive. Forty-five percent of the children had malnutrition or anemia at the time of diagnosis, 29% had severe radiographic findings (defined as bilateral or cavitary disease), and 13% had extrapulmonary disease. Forty-five percent of the children were hospitalized initially because of the severity of illness. Adverse events were observed for 42% of the children, but no events required suspension of therapy for >5 days. Ninety-five percent of the children (36 of 38 children) achieved cures or probable cures, 1 child (2.5%) died, and 1 child (2.5%) defaulted from therapy. Multidrug-resistant tuberculosis disease among children can be treated successfully in resource-poor settings. Treatment is well tolerated by children, and severe adverse events with second-line agents are rare.
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              The global situation of MDR-TB


                Author and article information

                European Journal of Microbiology and Immunology
                Akadémiai Kiadó, co-published with Springer Science+Business Media B.V., Formerly Kluwer Academic Publishers B.V.
                1 December 2012
                : 2
                : 4
                : 297-301
                [ 1 ] Smolensk State Medical Academy, Smolensk, Russia
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