The studies have concluded that flureniside therapy has a positive impact on immunological responsiveness in new cases of pulmonary tuberculosis. Positive immunological changes are followed by cessation of bacterial isolation. The findings suggest that it is expedient to use flureniside in the complex therapy of pulmonary tuberculosis.
Infections with multiresistant tubercle bacilli have also become a problem in the rich part of the world. The reasons are lack of compliance in patients with life style problems and ineffectiveness of the health system due to lack of fundings. During a four year period, 1993-1996 ten patients were seen in Denmark with tuberculosis due to multiresistant Mycobacterium tuberculosis. Nine were infected abroad, one developed MDR-TB during treatment in Denmark. It is possible to cure these patients, but it is expensive and takes a long time. In the future more cases created within Denmark are likely to be seen due to lack of funding for the tuberculosis programme and, depending on immigration, further cases created abroad are expected.
Tuberculosis is increasing, partly because of concomitant HIV-infection, but with poverty and lack of social welfare and public health services contributing substantially. Current treatment for tuberculosis has proved efficacious also in HIV-infected patients, and so far seems to have prevented increased transmission of the disease in Tanzania. Strictly controlled chemotherapy provides the only hope of preventing the emergence of multi-resistant tubercle bacilli. The World Bank has evaluated tuberculosis control as the most cost-effective form of health intervention among adults. Norway has made a substantial contribution to the development of a model for tuberculosis control in developing countries and to international mycobacterial research; and therefore has a special responsibility to meet the new challenge.
The incidence of tuberculosis (TB) has more than doubled in the Baltic States during the last decade and is now 10-15 times higher than in Sweden. It is also a serious problem in Russia. Strains resistant to one or several of the anti-tuberculous drugs are common as is multi-drug resistance (MDR), i.e. strains resistant to the two most effective drugs rifampicin and isoniazid. MDR-TB is very difficult to treat; the mortality rate is high. Initiatives have been taken in the Nordic countries in order to help to control and improve the situation by way of supportive measures.
Eradication is here defined as a tuberculosis (tbc.) incidence below one case of contagious tbc. per million per year and a Mycobacterium tuberculosis (Mt) infection prevalence of 1% or lower and declining. The situation is evaluated separately for Danes and foreigners. Late cases of tbc due to Mt infection more than five years earlier will decline with declining Mt infection prevalence over 50 years. Early tbc. due to Mt infection within five years can with good case finding, effective treatment, and contact examination be kept at a level of 33% of late cases. Relapses are now 15% of all cases and will also decline relatively. HIV/tbc. will only be a limited problem for a few years due to a low Mt infection prevalence. Continued limited immigration will only have minor influence on tbc. among Danes. Tbc. in immigrants already living in Denmark will decline over 10-20 years to around 20/100,000 but can not be eradicated in first generation immigrants. MT resistance will not be of importance for eradication. It is estimated that only major social disasters will be able to prevent eradication of tbc. among Danes by 2040.
The problem of tuberculosis prophylaxis remains actual for many countries of the world including Russia. The search of candidates for substitution of the only authorized BCG vaccine has been ongoing for some time, because it does not prevent reactivation of the causative agent in the latent stage and causes generalized BCG-infection in individuals with pronounced immune deficiency. In October 2013 in Lille at the European Congress "World Vaccine 2013" results of multi-year projects and trials of around 40 novel tuberculosis vaccine candidates were presented. The article contains a critical analysis of the materials presented at the congress. 12 vaccines have been developed or are being developed for priming. Among those a live VPM 1002 vaccine based on a genetically modified BCG Mycobacterium bovis (HLY+rBCG) strain and an attenuated vaccine based on Mycobacterium tuberculosis (att. MTB-MTBVAC) have passed phase II clinical trials. 17 candidates are being examined as booster vaccines, among those 6 vaccines have passed phase II clinical trials, and are presented by both modified M. bovis strains and partial proteins of M. tuberculosis. Characteristics of the 3 most perspective vaccines have been presented at the congress: VPM 1002, H &H56 and MVA85A. VPM 1002 is the vaccine closest to introduction. This is a live recombinant anti-tuberculosis vaccine based on the BCG strain, its DNA had genes partially deleted, that code synthesis of listeriolysin. The trials have shown that protective effectiveness of the vaccine is significantly higher than the parent BCG due to better induction of CD4+ and CD8+ cells, as well as IFN-?, IL-18, 12 and other cytokines responsible for cell immunity function against M. tuberculosis.