The Hindu written monuments of the Vedas, which, in particular, reported the prohibition of entering into family relations with individuals who showed signs of a disease similar to tuberculosis. However, since the end of the 80s of the last century, an increase in the incidence of pulmonary tuberculosis and extrapulmonary tuberculosis has been recorded in countries of all continents, especially in developing countries. Unfortunately, our state was among these countries. The WHO was forced to declare tuberculosis a global problem and record an epidemic of this disease.
Features of the epidemiological situation addition to the primary resistance of mycobacteria, which is at the level of 30–35 %, there is a tendency to develop secondary resistance, which is observed against the background of antibacterial therapy after 5–6 months of treatment in 45–65 % of patients.
It should be especially noted that the effectiveness of treatment of patients with multidrug-resistant tuberculosis does not reach 60 %. According to the recommendations of the WHO, in order to stop the further intensification of resistance, such patients should be transferred and are transferred to palliative treatment, which should take place in outpatient settings, according to the Protocol of the Ministry of Health.
The Government has proposed the Concept of the National Targeted Program to Combat Tuberculosis for 2018–2021. In view of this, our thesis paper is devoted to the investigation of the peculiarities of the diagnosis and the effectiveness of the treatment of this particular form of tuberculosis, which can affect all the chains of the epidemic process in tuberculosis.
The leading chains in the epidemic process are dominated by the source of tuberculosis, which remains the tuberculosis patient, although some domestic animals may also be considered. The second link of this process remains the ways of transmission of the infection, which play a crucial role in case of a domestic center of tuberculosis, especially in the presence of pathogens of the multiresistant type. Constant moral and psychological stress and economic troubles significantly weaken the immune status of contacts and make them susceptible to common infections in general, and to tuberculosis in particular.
The peculiarities of diagnosis of domestic tuberculosis have been previously covered by us. Therefore, this work fully focuses on the effectiveness of the domestic tuberculosis treatment.
In the course of the research, we studied two groups of patients who belonged to domestic tuberculosis: 1) the comparison group – the patients who were found first at the given address and became the source of tuberculosis, thereby «founding» a tuberculosis center, which we consider appropriate to call a «domestic tuberculosis center»; – the main group consisted of people who lived together with an ill person (the source of tuberculosis infection) – and turned out to be contacts.
Since, globally, tuberculosis, among all infectious diseases combined, remains the main cause of death among the adult population, the relevance of studying the characteristics of domestic tuberculosis is undeniable.
The purpose of the study was to establish the features and effectiveness of the diagnostic process of tuberculosis sources and contacts, comparing their duration, which, in our opinion, can significantly affect the start of treatment, and to investigate the effectiveness of treatment of this group of patients with the recommendations regarding the preventive effect on certain links of the epidemic process, among which are the features of treatment of patients – sources of tuberculosis and features of treatment of contacts, at the same time agree on the relationship to surgical methods of treatment and terms of their use.
It was established that the sources of infection in family tuberculosis in 42,6 % of patients were carriers of multiresistant tuberculosis mycobacteria, and contacts had such pathogens in 39,4 % ((p = 0,074). Therefore, the difference in the frequency of such pathogens is not reliable, which may indicate their identical origin.
We established that the tubercular process was verified among persons – sources of tuberculosis mainly (73,3 %) after 20 days of examination, and among contacts (84,6 %) – up to 10 days. Hence the difference in the effectiveness of treatment.
In order to reduce the burden of tuberculosis in our country, there are 5 laws of Ukraine, 3 orders of the Cabinet of Ministers, 23 Orders of the Ministry of Health of Ukraine, and 44 International recommendations on the prevention, diagnosis and treatment of patients with tuberculosis, but the rates of reduction of morbidity leave much to be desired, which is confirmed by WHO data, according to which about 25 % of new patients. A special role in this chain of the epidemic process, in our opinion, belongs to family tuberculosis. Our study is devoted to the investigation of some reasons for this situation.
