Противотуберкулезная работа в России имеет большую историю. Ее организационные формы и содержание менялись в зависимости от динамики эпидемического процесса, связанного с распространением возбудителя туберкулеза, изменения социально-экономических условий и прогресса науки. Эти важные перемены определяли необходимость новых решений и требовали соответствующей коррекции в организации противотуберкулезной помощи.

The tuberculosis epidemic situation in the Russian Federation is gradually improving, but remaining very tense. The decline rates of tuberculosis epidemiological parameters have increased in recent years. The incidence of tuberculosis has dropped by 19.9% in the past 4 years, its mortality rates have fallen by 44.8% in the past 7 years. In 2012, the prevalence of tuberculosis shows the lowest level throughout the period of its statistical surveillance. For better management of follow-up monitoring of patients with active tuberculosis and patients from the groups of high risk of tuberculosis, it is necessary to upgrade the recording system for the vocational schools' population in order to perform the individual monitoring of these population groups using the computer databases.

In order to improve the reliability of estimates of tuberculosis morbidity and mortality rates, it is necessary to establish and maintain databases (DB) at three levels: the DB of TB service (level 1), the DB of all regional TB services (level 2), and the DB of services at federal level (level 3). 

The paper gives the characteristics and outcomes of a chemotherapy cycle in new-onset tuberculosis patients registered for treatment in 2011. It shows a further reduction in the efficiency of treatment in both all first detected patients taken together and sputum smearpositive patients at registration. The main reason for lowering the efficiency of treatment in patients with tuberculosis is its higher drug resistant pathogen. Inadequate chemotherapy control and poor treatment adherence remain relevant. More than half of the first detected patients with positive sputum smear microscopy results discontinue a treatment cycle in the periods for up to 3 months. Bacterial excretion or lung tissue decay is a poor predictor requiring a multiprofessional approach to treating the patient.

In 2012, the tuberculosis epidemic situation continued to be stable in the penitentiaries. Tuberculosis morbidity and mortality rates were 1085.5 and 86.8 per 100,000 average listed patients, respectively. The rate of a reduction in the above indicators was 7.9 and 23.9%, respectively. Among the patients, the proportion of young people declined. The higher incidence of tuberculosis and human immunodeficiency virus co-infection and the spread of antituberculosis drug-resistance in the pathogen are a threat to the stabilization of the tuberculosis epidemic situation in the penitentiaries of Russia. In 2012, the proportion of tuberculosis and human immunodeficiency virus-coinfected patients was 16.3% and that of patients with multidrug-resistant patients was 22.1%. Some released prisoners with active tuberculosis are not registered in the civil health facilities; in this connection, it is relevant to establish a total registry of patients with tuberculosis.

The multifaceted clinical presentation of tuberculous meningitis and central nervous system tuberculosis makes their timely diagnosis hard. It is shown that there is a need for a comprehensive approach to diagnosing a specific brain lesion. The results of examinations using computed tomography and magnetic resonance imaging in tuberculous meningitis and central nervous system tuberculosis are assessed.

The presidential order lays down that tuberculosis mortality is a main criterion for evaluating the efficiency of antibuberculosis care to the population.

Objective: to determine whether this criterion may be used to assess the activity of a phthisiatric service in its work with HIV-infected patients.

Materials and methods. Why there was a discord in statistical data on death in patients with tuberculosis concurrent with HIV infection in the subjects of the Russian Federation was analyzed applying recording form No. 263-y/TB (a total of 49,559 cases during 7 years) and discussed with a number of investigators.

Results. Analysis of death rates in patients with tuberculosis concurrent with HIV infection has shown that it may be of informative value only when the determinations of accounted cases are clearly understood. The use of statistical data without clearly understanding the pathogenesis of both diseases leads to incorrect conclusions and may considerably discredit the activity of a phthisiatric service.

The latter should have individual criteria based on the clear understanding of the pathogenesis of tuberculosis at different stages of HIV infection to assess antituberculosis care to HIV-infected patients. Of them, the basic criteria must be those reflecting the extent to which the antiepidemic measures are observed when rendering health care to HIV-infected patients. 

The paper presents the results of tuberculin and recombinant tuberculosis allergen (diaskintest) skin tests in HIV-infected children with tuberculosis. In general, the conducted investigations have shown that the tuberculin tests are of definite value in diagnosing tuberculosis in HIV-infected children. However, the lower the blood CD4 lymphocyte count, the less frequently the positive skin tests were recorded: the rate of recorded positive tuberculin tests was nearly 20% in patients with CD4 counts less than 200 cells/µl and it approximated those (within 85%) in non-HIV-infected patients with CD4 counts more than 500 cells/µl. The susceptibility to the diaskintest also decreased as immunodeficiency increased and it was comparable to that of the tuberculin test.

The normal function of reproductive organs should be regarded as one of the most important indicators of women’s health. During combination therapy, female patients with tuberculosis, regardless of the location of the process, have significant ovarian functional impairments contributing to different menstrual dysfunctions, as well as anatomic and functional changes in the reproductive organs. This all is certain to negatively impact the quality of life in women suffering from tuberculosis.

In assessing the quality of life, it has become obvious that its low indicators are noted in virtually every three patients with tuberculosis.

Hormone modulation therapy with due regard for hormonal changes, the presence of hormone-dependent diseases, the pattern and location of tuberculous lesion, and the specific features of performed specific therapy results in reproductive system rehabilitation and improves the responsiveness of the body as a whole, which is accompanied by a clear increase in the quality of life in this contingent of patients. 

A model of isoniazid-induced liver damage in fast (females) and slow (males) acetylators was used to study the preventive hepatoprotective effect of the novel drug roprene in doses of 10, 15, and 30 mg/kg as an oil solution. It was found that in terms of a set of biochemical and morphological criteria, the most marked hepatoprotective effect of roprene given in a dose of 10 mg/kg and particularly 30 mg/kg was seen in the fast acetylators. In terms of morphological criteria for assessment, the most pronounced hepatoprotective effect of roprene used in a dose of 10 mg/kg and especially 30 mg/kg was observed in the slow acetylators. According to biochemical parameters, there was no advantage of any of the used doses (10, 15, and 30 mg/kg) of roprene in their effect on altered parameters. There is experimental evidence that it is advisable to use roprene to prevent isoniazid-induced hepatotoxicity in the patients with tuberculosis, primarily in the fast acetylators.

The comparative analysis of results of Diaskintest (DT) and PPD-test with 2 TE PPD-L in three groups was executed: the 1st included 56 children with newly diagnosed tuberculosis; the 2nd included 34 299 children in the risk groups observed by phthisiatricians, vaccinated and tested by PPD and DT; in the 3rd group there were 8 666 children evaluated in the general health care facilities with the simultaneous use of PPD and DT (screening). It was identified that at all stages of TB diagnostics and treatment among children DT indicates the activity of tubercular infection significantly better than PPD and is one of main clinical indicators which allows to evaluate correctly the chemotherapy regimen and effectiveness of treatment. The use of DT allowed to simplify selection of children in the risk groups for performance of more detailed evaluation and to increase the TB detection rate, especially of minor forms. The introduction of DT reduced the indications for preventive chemotherapy in the follow-up groups: up to 21% in group VI-A, 56,4% in group VI-B and 32,9% in group VI.

Впервые хирургический метод лечения патологического процесса в единственном легком был применен в 1948 г. Waterman D. [44]. У больного 52 лет через 6 лет после левосторонней пневмонэктомии, выполненной по поводу плоскоклеточного рака, была произведена резекция 10-го сегмента правого легкого по поводу метастаза злокачественной опухоли. Пациент умер через 2 года от метастазов в печень.

Первая публикация о хирургическом лечении туберкулеза единственного легкого принадлежала Woods F., Wilson N., Overholt R. [46]. В 1956 г. они описали опыт хирургического лечения 6 больных. У 2 пациентов была выполнена верхняя лобэк- томия справа и у 4 – сегментарная резекция. Погибла одна пациентка на 4-е сут после операции, а полный клинический эффект был достигнут у 4 больных.

The presented case illustrates the possibilities of complex radiodiagnosis in a patient with tuberculous spondylitis. The specific features of displaying a spinal tuberculous lesion during X-ray study, tomosynthesis, computed tomography, and magnetic resonance imaging are described. A rational algorithm for the examination and treatment of patients with this disease is proposed, by comparing the clinical manifestations of spinal tuberculous lesion and the results of its radiological studies.

The paper describes a clinical case in a female patient with the atypical onset and course of sarcoidosis with predominant central nervous system lesion who has achieved pronounced positive changes due to individualized combination therapy.