MDR-TB bavSvebSi

tfdec-is bavSvTa ganyofilebis monacemTa analizi

ia urTqmeliZe; “samSabaToba” 11.01.11

2009 wels saqrTveloSi “0-15” asakobriv jgufSi tuberkulozi dafiqsirda 287 SemTxvevaSi, maTgan

• 43 filtvis TB;• 244 filtvgareSe TB iyo; 2009 wels mgb(+) TB SemTxvevebTan

kontaqtis gamo gamokvleva Cautarda sul 3441 adamians, maTgan

• 300 “0-5” asakobrivi jgufis bavSvi iyo;• aqtiuri TB dadasturda 17 SemTxvevaSi;• LTBI dadasturda da Catarda IPT 165

SemTxvevaSi;

saqarTvelos tuberkulozTan brZolis erovnuli programis farglebSi bavSvTa MDR-TB-is marTva 2008 wlis agvistodan mimdinareobs;

konsiliumis gadawyvetilebiT DOTS+ programaSi sul CarTulia 43 MDR-TB bavSvi;

tfdec-is bavSvTa ganyofilebaSi 2008 wlis agvistodan dRemde gatarebulia 466 pacienti, maTgan:

• 406-Tan dadasturda aqtiuri TB;• 41 (10%) –ma MDR-TB pacientma

mkurnaloba daiwyo stacionarSi;

statistikurad damuSavda 2008 wlis agvistodan dRemde DOTS+ programaSi integrirebuli 41 MDR-TB pacientis

monacemi

asaki N %

0-3 8 19.5%

3-6 7 17.1%

6-10 8 19.5%

10-15 5 12.2%

15-18 13 31.7%

sul 41 100.0%

13

sqesi N %

gogona 15 36.6%

biWi 26 63.4%

sul 41 100.0%

26

monacemebi mxolod raodenobrivi analizis saSualebas

gvaZlevs,monacemTa simciris gamo

cvladebs Soris asocirebuli, an pirdapiri kavSiris dadgena ver

moxerxda

TB kontaqti N %

ki 37 90.2%

ara 4 9.8%

sul 41 100.0%

kontaqti N %

ojaxuri 35 94.6%

skolis 2 5.4%

sul 37 100.0%

sxva risk-faqtorebi N %

aradamakmayofilebeli sacxovrebeli pirobebi 11 26.8%

iZulebiT gadaadgilebuli piri 2 4.9%

diabetiT avadoba 1 2.4%

3735

mantus sinji N %

ki 40 yvela dadebiTi 97.6%

ara 1 2.4% sul 41 100.0%

keloidi N %

ki 29 70.7%

ara 12 29.3%

sul 41 100.0%

BCG N %

ki 33 80.5%

ara 8 19.5%

sul 41 100.0%

BCG-rebuli bavSvebidan keloidi ar etyoba 4-s maTgan 2 “0-3”, xolo 2 “15-18” asakobriv jgufs miekuTvneba;rvave ara BCG-rebulTan MDR-TB kontaqtis Sedegad ganviTarda;

lokalizacia N %

filtvgareSe TB 24 58.5%

filtvis TB 17 41.5%

sul 41 100.0%

24

TB kontaqti filtvgareSe TB filtvis TB

ki (37) 22 15

ara (4) 2 2

sul (41) 24 17

filtvgareSe TB

N %

limfadenopaTia 15 62.5%

meningiti 4 16.7%

TB plevriti 5 20.8%

15

paTologiuri masala N %

biofsiuri masala 5 12.2%

Tzs 4 9.8%

plevraluri siTxe 5 12.2%

naxveli 22 53.6%

paT. masala ver Segrovda 5 12.2%

sul 41 100.0%

mgb N %

_ 27 75.0%

+ 9 25.0%

sul 36 100.0%

kultura N %

_ 17 47.2%

+ 19 52.8%

sul 36 100.0%

biofsia Tzs plevr. siTxe naxveli sul

mgb (+) 1 0 0 8 9

kultura (+) 2 2 1 14 19

masalis Cabareba ver moxerxda 41-dan mxolod 5 SemTxvevaSi; mgb(+) iyo 25%; kultura(+) 52.8%.

27

19

DOTS+ -Si CarTva N %

kontaqtis DST -iT 22 53.7%

sakuTari DST -iT 19 46.3%

sul 41 100.0%

sakuTari rezistentoba N %

MDR-TB 16 84.2%

PDR-B 2 10.5%

XDR-TB 1 5.3%

sul sakuTari DST

19 100.0%

kontaqtis rezistentoba N %

DS-TB 1 3.7% MDR-TB 19 70.4% PDR-B 2 7.4% PDR-C 1 3.7%

Poly 1 3.7% XDR-TB 3 11.1%

sul kontaqtis DST

27 100.0%

DOTS

DOTS+ N %

ki 28 68.3%

ara 13 31.7%

sul 41 100.0%

ETR

ITR N %

ki 12 29.3%

ara 29 70.7%

sul 41 100.0%

Tanmxlebi daavadeba N/%

Ddiabeti 1 (16.7%)epilefsia 1 (16.7%)

hidrocefalia 3 (49.9%)

Tromboflebiti 1 (16.7%)sul 6 (100%)

qirurgiuli mkurnaloba N/%

ki 4 (9.8%)

ara 37(90.2%)

sul 41 (100%)

N Resistance

H R E Z S Am Km Cm Ofx PAS Cs Pto Eto Treat Regimen

7ism

Own DST

R R R S R R R S R S S R CM+LFX+PTO+CS+PASETR→ITR

ContDST

R R R R R R S S R S S R

8yam

Own DST

R R R R R CM+LFX+PTO+CS+PAS+Z

ContDST

12gab

Own DST

R S R R R+E+Z+CM+OFX+CS CM+LFX+CS+PTO+PASDeath /Comleated

ContDST

R S S R

19baw

Own DST

R R R R R S R R S S R S S CM+PTO+MFX+CS+PAS+AMX/CL+CLR+CFZCured/Death

ContDST

R R R R R R S R S R

22Wel

Own DST

R R R R R S S S S S R CM+LFX+PTO+CS+PASETR→ITRCured/Cured

ContDST

S S S S S

34sofo

Own DST

R R R R S S S R S R CM+LFX+PTO+CS+AMX/CLV+CFZ+CL CM+LFX+PTO+CSETR→ITRCompleted/ar umkurnaliaCont

DSTR R R S R S S S R S R

N Resistance

H R E Z S Am Km

Cm

Ofx

PAS

Cs

Pto

Eto

Treat Regimen

2xelaZe

Own DST

No CM+LFX+CS+PAS+Z+E+HMeningitis CSF AFB/Cult(-)DOTS→DOTS+Cont

DSTNo

10akaki

Own DST

No CM+LX+PTO+CS+PASPulmonary Sputum AFB/Cult(-)DOTS→DOTS+

Cont DST

R R R R R R R S S R

20saxokia

Own DST

No CM+LFX+PTO+CS+PAS+CFZ+AMX/CLLymhadenophaty AFB/Cult(-)DOTS→DOTS+ Compleated

Cont DST

R R R R R R S S S S

37maiauri

Own DST

No CM+LFX+CS+PTO+PASPulmonary; Age 0-3; Sputum NOar aris/DeathCont

DSTR R R R R R R R R S R

40imn.n

Own DST

No CM+LFX+PTO+CS+H+R+E+Z

Cont DST

R R R R S S S S R

41jag.m.

Own DST

No CM+LFX+CS+PAS+H+R+Z

Cont DST

R R R R S S S S R

gverdiTi movlenebi

araseriozulipreparati ar Sewyvetila

seriozulipreparati Sewyda

N/%

nevralgiuri(cns) 0 2 2 (14.3%)

hepatotoqsiuri 2 1 3 (21.4%)gastro-enteraluri

(Rebineba) 5 4 9 (64.3%)

sul 7 7 14 (100.0%)

9(64.3%)

gverdiTi movlenebi ganviTarda 14 (34%) pacientTan; preparati Sewyda 4 (9.76%) SemTxvevaSi

gverdiTi movlenebis ganviTarebis SemTxvevebidan mkurnalobis gamosavali gvaqvs 5 pacientTan; arcerTTan

mkurnalobis Sewyveta gverdiTi movlenis gamo ar momxdara

gverdiTi movlenebi dasruleba gankurneb

a gardacvaleba sul

araseriozuli 1 2 0 3

seriozuli 0 1 1 2

• 9 mgb(+) SemTxvevidan naxvelis konversia 7 pacientTan stacionarSi mkurnalobis periodSi mkurnalobis dawyebidan 0-2 TveSi dafiqsirda;

• 19 kultura (+) SemTxvevidan 12-Tan kulturis konversia stacionarSi mkurnalobis periodSi dafiqsirda; maTgan 11 pacientTan 0-2 TveSi, 1 pacientTan 2-5 Tvis periodSi;

stacionaruli mkurnalobis periodSi SemTxvevaTa umravlesobaSi (95.1% da 90.2%)

dafiqsirda dadebiTi klinikuri da rentgenologiuri dinamika

klinikuri dinamika N %

ar aris 2 4,9%

dadebiTi 39 95,1%

sul 41 100,0%

rentgenologiuri dinamika N %

ar aris 4 9.8%

dadebiTi 37 90.2%

sul 41 100.0%

mkurnalobis gamosavali dafiqsirebulia 18 MDR-TB bavSvTan

MDR-TB bavSvis mkurnalobis gamosavali

N %

dasrulebuli/gankurneba 11 61,1%

gardacvaleba 2 11,1%

Sewyvetili 5 27,8%

sul 18 100,0%

kontaqtis mkurnalobis gamosavali

N %

dasrulebuli 1 8,3%

gankurneba 1 8,3%

gardacvaleba 7 58,3%

Sewyvetili 1 8,3%

uSedego 2 16,7%

sul 12 100,0%

MDR-TB bavSvebis mkurnalobis gamosavali asakobrivi jgufebis mixedviT

asaki dasrulebuli gankurneba gardacvaleba Sewyvetili

0-3 0 0 1 0

3-6 1 0 0 3

6-10 1 1 1 1

10-15 1 0 0 0

15-18 0 7 0 1

sul 3 8 2 5

7

8

daskvna: bavSvebSi MDR-TB-is ganviTarebis mTavari riski

ojaxuri TB kontaqtia; saqarTveloSi uzrunvelyofilia srulyofili BCG-reba; tep-is farglebSi mantus sinjiT diagnostireba

yvelasTvis xelmisawvdomia; iseve rogorc zogadad msoflioSi Cveni qveynis

magaliTzec bavSvebi upiratesad filtvgareSe TB-iT avaddebian;

sirTuleebis miuxedavad tfdec-is farglebSi maqsimalurad grovdeba paTologiuri masala, Tumca ver xerxdeba kuWis aspiratis gamokvleva rac mniSvnelovnad gaaumjobesebda diagnostikas;

Cvens magaliTze maRalia kultura(+) SemTxvevebis da Sesabamisad DOTS+ programaSi sakuTar DST-ze dayrdnobiT CarTvis maCvenebeli [19 (46.3%)];

Cvens magaliTze maRali ar aris gverdiTi movlenebis ganviTarebis [14 (34%)] da preparatebis Sewyvetis maCvenebeli [4 (9.76%)];

stacionarSi mkurnalobis periodSi maqsimalurad miiRweva:

• naxvelis da kulturis konversia;• klinikuri da rentgenologiuri dadebiTi dinamika;samwuxarod gvaqvs gardacvalebis da

Sewyvetili mkurnalobis SemTxvevebi;Sewyvetili mkurnalobis arcerT SemTxvevaSi

wyvetis mizezad gverdiTi movlena ar dafiqsirebula, rac bavSvTa TB-Si mkurnalobisadmi damyolobis problemaze miuTiTebs;

gmadlobT yuradRebisTvis