Background. The incidence of tuberculosis (TB) among military personnel is constantly increasing due to the antiterrorist operation (ATO) (deterioration of living conditions, irregular food, disturbed sleep and rest, staying under constant stress), which adversely affects the immune system and increases susceptibility to mycobacteria. The purpose was to study the clinical course, diagnosis and duration of treatment of pulmonary tuberculosis in military personnel participating in the ATO, who were hospitalized at the tuberculosis clinic of the National Military Medical Clinical Center “Main Military Clinical Hospital” (NMMCC “MMCH”) from August 2014 to December 2017. Materials and methods. The data were processed of 229 journals for registration of inpatients and case histories of servicemen participating in the ATO who were treated for pulmonary TB during the period from 2014 to 2017 at the tuberculosis clinic of the NMMCC “MMCH”. The main categories of ATO participants who were treated at a tuberculosis clinic are military volunteers and officers. The following age groups of patients with TB are identified: I — 21–29 years old; II — 30–39; III — 40–49 years old; IV — over 50 years. We have selected and analyzed 129 case histories of servicemen — ATO participants, who were completely examined. Among the 129 patients, men prevailed (120 vs 9 women). The diagnosis was made on the basis of patients’ complaints, anamnesis of the disease, clinical picture, laboratory and radiological data, confirmed culturally and on the basis of sputum staining according to Ziehl-Neelsen. Medical and statistical methods were used, statistical data processing was carried out using Microsoft Excel. Results. 229 servicemen participated in the ATO were hospitalized to the tuberculosis clinic: in 2014 — 29 (12.7 %), in 2015 — 66 (28.8 %), in 2016 — 81 (35.4 %), in 2017 — 53 (23.1 %). The patients with pulmonary TB was represented by military volunteers: soldiers (sailors), sergeants, petty officers, warrant officers (midshipmans) — 88.4 % and officers — 11.6 %. The incidence of pulmonary TB among military volunteers increased from 2014 to 2016: in 2014 — 13 cases, in 2015 — 30, in 2016 — 48, and in 2017, the number of patients decreased by half (23 cases). There were significantly fewer officers: in 2014 — 1 patient, in 2015 — 6, in 2016 — 6, in 2017 — 2 patients. The average age of the patients was: Me = 37 years, min — 20 years, max — 57 years. Most cases were detected at the age of 30–39 years, which is 58 cases, the next group suffering from pulmonary TB is people aged 40 to 49 years (n = 36), a smaller proportion are patients aged 20–29 years and over 50 years (23 and 12, respectively). The causes of hospitalization were: in 2014 — 12 referrals to treatment and 2 to the medical evaluation board (MEВ); in 2015 — 24 referrals to treatment, 11 to the MEВ and 1 to examination; in 2016 — 36 referrals to treatment and 18 to the MEВ; in 2017 — 13 referrals to treatment, 11 to the MEВ and 1 to examination. In total, from 2014 to 2017, the study group (129 people) stayed in the tuberculosis clinic for 5748 beddays. Patients with infiltrative and focal pulmonary TB, 2763 and 1222, respectively, had the longest stay in four years, compared with those with disseminated and fibrous-cavernous forms of pulmonary TB (811 and 372). Conclusions. From August 2014 to December 2017, 229 ATO participants with pulmonary tuberculosis were admitted to the tuberculosis clinic. When analyzing the cohorts, it was established that officers made up 5.4 military volunteers — 94.6 %. Given the military rank, it was found that the largest share belonged to soldiers (sailors), sergeants (petty officers) — 72.1 %, and the smallest — lieutenants, captains, and majors — each 0.8 %. The most common nosological forms of pulmonary tuberculosis were: infiltrative tuberculosis (55 %), the average duration of treatment is 39 bed-days, focal (24.8 %), the average duration of treatment is 38 bed-days, disseminated (10.1 %), the average duration of treatment is 62 bed-days. There is a tendency to reduced detection of destruction in patients from 2014 to 2017 — from 71.4 to 36 %. The number of of patients with active TB decreased from 33.3 to 24 %, the frequency of resistant forms of pulmonary tuberculosis in 2016 was 25.9 %, and in 2017 — 12 %. The cause of hospitalization was mainly treatment (65.9 %). Patients were mainly admitted to the tuberculosis clinic by the referral from the doctor of the military unit (55.8 %), the military hospital (30.2 %), and the least — military registration offices (0.8 %). The servicemen admitted to the hospital generally had a satisfactory state of health (90.7 %).
pulmonary tuberculosis; military personnel; diagnosis; treatment
Ministry of Нealth of Ukraine. Order on September 4, 2014 № 620. On Adopting and Implementing the Medical and Technological Documents on the Standardization of Medical Care for Tuberculosis. Available from: http://old.moz.gov.ua/ua/portal/dn_20140904_0620.html. Accessed: September 4, 2014. (in Ukrainian).
Verkhovna Rada of Ukraine. Law of Ukraine on October 16, 2012 № 5451-VI. On Adopting the National Targeted Social Program for Combating Tuberculosis in 2012-2016. Available from: http://zakon.rada.gov.ua/laws/show/5451-vi?lang=en. Accessed: October 16, 2012. (in Ukrainian).
Cabinet of Ministers of Ukraine. Ordre on December 27, 2017 № 1011-P. On Approving the Concept of the National Targeted Social Program for Tuberculosis Control for 2018-2021. Available from: http://zakon.rada.gov.ua/laws/show/1011-2017-%D1%80?lang=en. Accessed: December 27, 2017. (in Ukrainian).
World Health Organization. Global tuberculosis report 2014. Annex 1. Access to the WHO global TB database. Geneva: WHO Press; 2014. 119-122 pp.
Smetanina OR, Antonenko LF, Bushura IV, authors; Feshchenko YuI, editor. Porivnjal'ni dani pro rozpovsjudzhenist' tuberkul'ozu ta efektyvnist' dijal'nosti protytuberkul'oznyh zakladiv Ukrai'ny za 1998-2008 rr [Comparative data on the prevalence of tuberculosis and the effectiveness of the activity of the tuberculosis institutions of Ukraine for 1998-2008]. Kyiv; 2009. 72 p. (in Ukrainian).
Aleksandrina TA. A current look at the problem of tuberculosis in Ukraine and a forecast for the future. Nova medycyna. 2004;(1):12-13. (in Ukrainian).
Feshchenko YuI, Melnyk VM, Matusevych VG, et al. Assessment of tuberculosis control in Ukraine for period 2006-2010. Ukrainian Pulmonology Journal. 2011;(4):5-10. (in Ukrainian).
Levchuk NM. Asocial'ni javyshha v Ukrai'ni u demografichnomu vymiri : monografija [Asocial phenomena in Ukraine in the demographic dimension: a monograph]. Kyiv: IDSS; 2011. 491 p. (in Ukrainian).
Ministry of Нealth of Ukraine. Order on January 31, 2014 № 1039. On Adopting and Implementing the Medical and Technological Documents on the Standardization of Medical Care for Co-Infection (Tuberculosis / HIV infection / AIDS). Available from:
http://old.moz.gov.ua/ua/portal/dn_20141231_1039.html. Accessed: January 31, 2014. (in Ukrainian).
Melnyk VM, Novozhylova YO, Matusevych VG, et al. Rol'' zakladiv pervynnoi' medychnoi' dopomogy u vyjavlenni, likuvanni ta profilaktyci tuberkul''ozu pry reformuvanni ohorony zdorov’ja i vdoskonalenni protytuberkul''oznyh zahodiv: metodychnyj posibnyk [The role of establishments of primary medical aid in identifying, treatment and prevention of tuberculosis during reformation public health and improvement of tuberculosis control: a manual]. Kyiv; 2016. 44 p. (in Ukrainian).
Feshсhenko YuI, Melnyk VM. Organizacija kontrolju za himiorezystentnym tuberkul'ozom [Organization of control for chemoresistant tuberculosis]. Kyiv: Zdorov'ja; 2013. 703 p. (in Ukrainian).
Migliori GB. A new framework for TB control in Europa. ERS; 2016. 17-29 pp.