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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
0-3
3-6
N
8
7
%
sqesi
N
%
19.5%
gogona
15
36.6%
biWi
26
26
63.4%
sul
41
100.0%
17.1%
6-10
8
19.5%
10-15
5
12.2%
15-18
13
31.7%
sul
41
100.0%
monacemebi mxolod raodenobrivi analizis saSualebas
gvaZlevs,
monacemTa simciris gamo cvladebs Soris asocirebuli, an
pirdapiri kavSiris dadgena ver moxerxda
TB kontaqti
N
%
ki
37
37
90.2%
ara
4
9.8%
sul
41
100.0%
kontaqti
N
%
ojaxuri
35
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%
mantus sinji
%
N
40
ki
97.6%
yvela dadebiTi
ara
sul
1
41
2.4%
100.0%
BCG
N
%
keloidi
N
%
ki
33
80.5%
ki
29
70.7%
ara
8
19.5%
ara
12
29.3%
sul
41
100.0%
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
24
58.5%
filtvis TB
17
41.5%
sul
41
100.0%
TB kontaqti
filtvgareSe TB
filtvis TB
ki (37)
22
15
ara (4)
2
2
sul (41)
24
17
filtvgareSe TB
N
%
paTologiuri masala
N
%
limfadeno
paTia
15
15
62.5%
biofsiuri masala
5
12.2%
meningiti
4
16.7%
Tzs
4
9.8%
TB plevriti
5
20.8%
plevraluri siTxe
5
12.2%
naxveli
22
53.6%
paT. masala ver Segrovda
5
12.2%
sul
41
100.0%
masalis Cabareba ver moxerxda 41-dan mxolod 5 SemTxvevaSi; mgb(+) iyo 25%; kultura(+) 52.8%.
mgb
N
%
kultura
N
%
_
27
27
75.0%
_
17
47.2%
+
9
25.0%
+
19
19
52.8%
sul
36
100.0%
sul
36
100.0%
biofsia
Tzs
plevr. siTxe
naxveli
sul
mgb (+)
1
0
0
8
9
kultura (+)
2
2
1
14
19
DOTS+ -Si CarTva
N
%
kontaqtis DST -iT
22
53.7%
sakuTari DST -iT
19
46.3%
sul
41
100.0%
sakuTari rezistentoba
MDR-TB
N
16
%
84.2%
PDR-B
2
10.5%
XDR-TB
1
5.3%
sul
19
100.0%
sakuTari DST
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
ETR
N
%
DOTS+
N
%
ITR
ki
28
68.3%
ki
12
29.3%
ara
13
31.7%
ara
29
70.7%
sul
41
100.0%
sul
41
100.0%
Tanmxlebi daavadeba
N/%
Ddiabeti
1 (16.7%)
epilefsia
hidrocefalia
qirurgiuli mkurnaloba
N/%
1 (16.7%)
ki
4 (9.8%)
3 (49.9%)
ara
37(90.2%)
sul
41 (100%)
Tromboflebiti
1 (16.7%)
sul
6 (100%)
N
Resi
stan
ce
Z
S
7
ism
Own R R R S
DST
8
yam
H R E
Am
Km
Cm
Ofx
PAS Cs
Pto
Eto
Treat Regimen
R
R
R
S
R
S
S
R
CM+LFX+PTO+CS+PAS
ETR→ITR
Cont R R R R R
DST
R
S
S
R
S
S
R
Own R R R R R
DST
CM+LFX+PTO+CS+PAS+Z
Cont
DST
12
gab
19
baw
Own R S
DST
R
R
Cont R S
DST
S
R
Own R R R R R S
DST
R+E+Z+CM+OFX+CS CM+LFX+CS+PTO+PAS
Death /Comleated
R
R
S
S
R
S
R
S
R
S
S
S
S
Cont R R R R R R
DST
22
Wel
Own R R R R R
DST
Cont S S
DST
34
sofo
S
S
S
S
CM+PTO+MFX+CS+PAS+AMX/CL+CLR+CFZ
Cured/Death
S
R
CM+LFX+PTO+CS+PAS
ETR→ITR
Cured/Cured
CM+LFX+PTO+CS+AMX/CLV+CFZ+CL CM+LFX+PTO+CS
ETR→ITR
Completed/ar umkurnalia
S
Own R R R
DST
R
S
S
S
R
S
R
Cont R R R S
DST
R
S
S
S
R
S
R
N
Resista H
nce
2
xelaZ
e
Own
DST
Cont
DST
Own
DST
No
Cont
DST
Own
DST
R
Cont
DST
R
10
akaki
20
saxok
ia
R E
Z
S
Am
K
m
C
m
Of
x
PA C Pt
S
s o
Et
o
CM+LFX+CS+PAS+Z+E+H
Meningitis CSF AFB/Cult(-)
DOTS→DOTS+
No
No
R R
R
R
R
R
S
S
R
No
37
Own
maiau DST
ri
Cont
DST
40
Own
imn.n DST
No
Cont
DST
41
Own
jag.m. DST
Cont
DST
R
R
R R
R R
R
R
R
R
R
R
R
S
R
S
R
S
S
S
R
No
CM+LX+PTO+CS+PAS
Pulmonary Sputum AFB/Cult(-)
DOTS→DOTS+
CM+LFX+PTO+CS+PAS+CFZ+AMX/CL
Lymhadenophaty AFB/Cult(-)
DOTS→DOTS+ Compleated
CM+LFX+CS+PTO+PAS
Pulmonary; Age 0-3; Sputum NO
ar aris/Death
CM+LFX+PTO+CS+H+R+E+Z
R R
R
S
S
S
S
R
No
R
Treat Regimen
CM+LFX+CS+PAS+H+R+Z
R R
R
S
S
S
S
R
gverdiTi movlenebi ganviTarda 14 (34%) pacientTan; preparati Sewyda 4 (9.76%) SemTxvevaSi
gverdiTi movlenebi
araseriozuli
preparati ar Sewyvetila
seriozuli
preparati Sewyda
N/%
0
2
2 (14.3%)
2
1
3 (21.4%)
5
4
99(64.3%)
(64.3%)
7
7
14 (100.0%)
nevralgiuri
(cns)
hepatotoqsiuri
gastro-enteraluri
(Rebineba)
sul
gverdiTi movlenebis ganviTarebis SemTxvevebidan mkurnalobis gamosavali gvaqvs 5 pacientTan; arcerTTan
mkurnalobis Sewyveta gverdiTi movlenis gamo ar momxdara
gverdiTi movlenebi
araseriozuli
seriozuli
dasruleba
gankurneba
gardacvaleba
sul
1
2
0
3
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
%
kontaqtis mkurnalobis
gamosavali
N
%
11
61,1%
dasrulebuli
1
8,3%
gardacvaleba
2
11,1%
gankurneba
1
8,3%
Sewyvetili
5
27,8%
gardacvaleba
7
58,3%
sul
18
100,0%
Sewyvetili
1
8,3%
uSedego
2
16,7%
sul
12
100,0%
MDR-TB bavSvis
mkurnalobis gamosavali
N
dasrulebuli/
gankurneba
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
7
0
1
sul
3
8
8
2
5
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