1. problemebi da miRwevebi bavSvTa tuberkulozis diagnostikaSi “samSabaToba”, nestan JorJoliani, 13.07.10

2. 2000 wels bavSvTa TB -is arasrulyofili aRricxvianobis pirobebSi msoflioSi dafiqsirebuli 8.3 milioni axali SemTxvevidan 884 019 (11%) bavSvTa TB iyo; bolo wlebSi aRricxvianobis gaumjobesebasTan erTad monacemebi gaizarda – samxreT afrikaSi 13 welze umcros asakobriv jgufSi 100 000 mosaxleze dafiqsirda bavSvTa TB -is 407 SemTxveva.

3. bolo wlebSi Catarebuli kvlevebiT miRebuli mtkicebulebebi:  informacia imis Sesaxeb, rom bavSvebi upiratesad tuberkulozis ioli formiT avaddebian ar dasturdeba: indoeTSi bavSvTa sxvadasxva daavadebiT sikvdilianobis 15% TB -ze modis; malaiziaSi TB daavadebul bavSvebSi sikvdilianobis maCvenebli 17%-ia; TB endemur qveynebSi aiv-statusis miuxedavad TB -iT gamowveuli bavSvTa sikvdilianoba utoldeba pnevmoniiT gamowveuli sikvdilianobis maCvenebels;

4.  aiv tvirTis mqone qveynebSi TB -iT avaddebian rogorc aiv-pozitiuri, ise aiv-negatiuri bavSvebi, maSin roca am qveynebis mozrdil mosaxleobaSi aiv-ko-inficirebuli TB SemTxvevebi dominirebs;  bavSvTa TB -is yvela formiT avadobis SemTxvevebidan 48% bronqoadenitze modis;  bavSvTa tuberkuloziT avadobis 52.6% 3 wlamde bavSvebze modis.

5. bavSvTa TB -is diagnostikis problemebi bavSvebSi baqterioskopiuli kvlevisaTvis paTologiuri masalis miReba problematuria; naxvelis mikroskopia TB savaraudo SemTxvevaTa mxolod 10-15%-Si iZleva dadebiT pasuxs; maTgan kulturis zrda mxolod 30-40%-Si fiqsirdeba.

6. TB marTvis saerTaSoriso standartebis rekomendaciiT bavSvTa mgb(-) SemTxvevebis diagnostireba Semdegi triadis gaTvaliswinebiT unda moxdes:  kontaqti registrirebul TB pacientTan;  dadebiTi kanis tuberkulinuri sinji ( TST ); 3. TB specifiuri cvlilebebi gulmkerdis rentgenogramaze ( CXR ).

7. endemur qveynebSi triadaze dayrdnobiT diagnostirebis sizuste klebulobs: problematuria ojaxuri kontaqtis gziT daavadebis transmisiis gamoricxva; mosaxleobis umravlesobas bavSvobis asakSive aqvs Sexeba M. tuberculosis infeqciasTan – maTTan TST dadebiTia; endemur qveynebSi diagnostikuri triadidan pirveli oris sarwmunoeba limitirebulia - diagnostika eyrdnoba klinikur niSnebsa da CXR -is subieqtur Sefasebas.

8. bavSvTa TB -is diagnostikaSi rentgenologiuri kvlevis sarwmunoebis xarisxi dabalia TandarTuli klinikuri niSnebis gareSe gamovlenili mkerdSida limfuri kvanZebis adenopaTia pirveladi inficirebis da ara daavadebis niSania da SemTxvevaTa 50-60%-Si gardamavali (TavisTavad alagebadi) fenomenia; rentgenologiurad gamovlenili mkerdSida limfuri kvanZebis adenopaTiis safuZvelze mxolod gamocdili klinicistis mier klinikuri niSnebis dafiqsireba iZleva saSualebas daisvas pirveladi tuberkulozis diagnozi.

9. 3 wlis zeviT asakis imunokompetenturi bavSvebisaTvis TB simptomatikad iTvleba Semdegi 3 niSani: 2 kviraze metad gaxangrZlivebuli xvela; bolo 3 Tvis ganmavlobaSi Catarebuli antibiotikoTerapiis uSedegoba; saerTo sisuste. am siptomebze dayrdnobiT kvalificiuri fTiziatris mier Catarebuli diagnostikis mgrZnobeloba 82.3%, specifiuroba 90.2%. usimptomo mimdinareobis gamo aiv-inficirebul bavSvebTan gansakuTrebuli yuradReba aris saWiro

10. endemur qveynebSi bavSvTa periferiuli limfadenopaTiis diagnostikis algoriTmi: TB limfadenopaTia savaraudoa Tu pacients aReniSneba mudmivad persistirebadi gadidebuli kisris limfuri kvanZebi, zomiT >2X2-ze; Catarebuli farTo speqtris antibiotikoTerapiis muxedavad hiperplazia kvlav fiqsirdeba; ar fiqsirdeba raime sxva paTologia, romlisTvisac es niSani aseve damaxasiaTebelia. diagnozis dasadastureblad unda Catardes biofsiuri masalis gamokvleva (araendemur qveynebSi, biofsia aucilebelia).

11. serologiuri tastebi bavSvTa TB diagnostikaSi: antisxeulebis aRmoCenaze dayrdnobiT ( TST ) TB diagnostika arasrulyofilia (gansakuTrebiT TB endemur qveynebSi), vinaidan: antisxeulebis aRmomCeni testi ver axdens LTBI -is da aqtiuri tuberkulozis verificirebas, antisxeulebis titrze dayrdnobiT Catarebulma testma BCG -rebis fonze SeiZleba mcdari pasuxi mogvces; serologiuri testebi arasarwmunoa aratuberkulozuri mikobaqteriiT gamowveuli avadobis, an aiv-koinficirebis SemTxvevaSi.

12. TB diagnostika antigenis aRmoCenaze dayrdnobiT ELISA - gulisxmobs lipoarabinoaminis aRmoCenas naxvelSi, an SardSi; transdermalur aplikaciaSi MPB64 antigenis aRmoCenis meTodi (am meTodiT aqtiuri tuberkulozis da LTBI -is erTmaneTisgan gansxvavebis sensitivoba 88-98%, specifiuroba ki 100%-ia).

13. T limfocitebis reaqcia mizani: M. tuberculosis antigenis SeyvaniT gaaqtiurebuli T limfocitebis mier inducirebuli interferon gamas titris gansazRvra; specifiur antigenebad gamoiyeneba: sekretirebuli cila ESAT-6; kulturis filtraciis Sedegad miRebuli cila CFP-10. reaqciebis dasaxeleba: T-SPOT.TB testi ( Oxford Immunotec, Oxford, UK ); QuantiFERON-TB Gold ( QFT-G; Cellestis, Carnegie, Australia )–is reaqcia; QFT-G sinjaraSi- moicavs antigens TB7.7 (Rv2654) (misi gamocda jerjerobiT mxolod mozrdilebze moxda).

14. bavSvebSi QFT-G- is gamoyenebaze Catarebuli kvlevis Sedegebi: italiaSi QFT-G gamoiyenes 5 wlis asakis bavSvebze, diagnozis sworad gansazRvra ver moxerxda SemTxvevaTa 32%-Si; avstraliaSi Catarebuli kvlevis mixedviT diagnozis sworad gansazRvra ver moxerxda bavSvebis 17%-Si; dabali iyo QFT-G da TST- s Soris Tanxvedris maCvenebelic ( k =0.3); indoeTis regionSi hospitalizirebul bavSvebze Catarebulma kvlevam aCvena Tanxvedris kargi maCvenebeli ( k =0.73), magram iq maRali iyo diagnostikuri Secdomebis maCvenebeli.

15. naxvelis evakuaciis problemis SemTxvevaSi: or momdevno dRes aRebul unda iqnas gastraluri aspirati, an moxdes xvelis provocireba; es procedura SeiZleba Catardes mxolod stacionarul pirobebSi; maTi Catareba moiTxovs infeqciis kontroliT gaTvaliswinebuli yvela normis mkacrad dacvas; xvelis provocirebiT naxvelis miReba da misi diagnostireba mgb(_), aiv-koinficirebul, 4 wlamde asakis bavSvebSi gamoiyeneba. baqteriologiuri kvlevisa da rezistentobis swrafi gansazRvrisaTvis mozardebis msgavsad MGIT, BACTEC sistemebi da PCR meTodi gamoiyeneba.

16. uaxlesi midgomebis gaTvaliswinebiT bavSvTa TB -is diagnostikis algoriTmi dabali da saSualo Semosavlis mqone qveynebisaTvis (berlini, 2007) eWvi TB -ze klinikuri niSnebi da simptomebi ar aris klinikuri niSnebi da simptomebi aris TST, QFT-G orive uaryofiTi orive dadebiTi TST - dadebiTi QFT-G - uaryofiTi orive dadebiTi mikroskopia da kultura da PCR yvela uaryofiTi janmrTeli LTBI ara TB baqteria? aqtiuri TB mikroskopia dadebiTi, an uaryofiTi kultura da/an PCR dadebiTi

17. daskvna  TB maRali tvirTis areebisaTvis mikroskopia da kulturaluri kvleva oqros standartad rCeba;  endemur qveynebSi paTologiuri masalis ararsebobis SemTxvevvaSi bavSvTa tuberkulozis diagnostika klinikur simptomebze da rentgenologiur monacemebze dayrdnobiT xdeba;  mniSvnelovania, rom endemuri qveynebi uzrunvelyofili iyvnen kvalificirebuli fTiziatrebiT, rentgenologiuri samsaxuriT, adeqvaturi mkurnalobiT (prevenciuli TerapiiT da/an anti TB mkurnalobiT).

18. bavSvTa TB -is maCveneblis Semcirebis TvalsazrisiT mniSvnelovania: programuli midgomiT mgb(+) pacientebis ricxvis Semcireba; zogadad qveyanaSi epidemiologiuri mdgomareobis gaumjobeseba; infeqciis kontroliT gaTvaliswinebuli yvela normis dacviT daavadebis transmisiis Semcireba; am miznis misaRwevad SemuSavebuli: aTwleulis amocana - UN Millennium Developmental Goals ; globaluri gegma - the Global Plan to Stop TB 2006–15; TB marTvis saerTaSoriso standartebi - the International Standards for Tuberculosis Care; strategia “ SevaCeroT TB” - Stop TB strategy.

19. gmadlobT yuradRebisaTvis