The article presents a literature review dedicated to the 100th anniversary of introduction of the BCG vaccine against tuberculosis; it analyzes of 83 publications by Russian and foreign authors. The results of the BCG vaccination used in various clinical studies and real clinical practice are assessed. The article presents data on development of new candidate vaccines and mechanisms of their effect on various parts of the immune system. Candidate vaccines are of particular interest, these candidate vaccines are used not only for prevention before infants are exposed to the infection for the first time, but also for therapy, the vaccines are aimed at therapeutic action against tuberculosis and latent tuberculosis infection.

The objective: based on a systematic review and meta-analysis of data from published results of clinical studies, to evaluate clinical efficacy and safety of chemotherapy regimens containing clofazimine in MDR-TB patients.

Subjects and Methods. A systematic analysis of publications was performed using key words “clofazimine”, “tuberculosis treatment”, “mycobacteria drug resistance”, and “safety” in electronic libraries: PubMed, Google Scholar, eLIBRARY.RU, and medRvix. 7 clinical studies were selected for further analysis.

Results. The risk of treatment failure in main groups receiving regimens containing clofazimine was 1.7 times lower versus control groups (without clofazimine) (p = 0.02; RR = 0.6 (95% CI: 0.39 – 0.92)). The risk of sputum conversion by week 12 of treatment is 7 times higher in main groups receiving regimens containing clofazimine versus control groups (p = 0.01; RR = 0.14 (95% CI: 0.03 – 0.25)). The risk of adverse events in main groups receiving regimens containing clofazimine was comparable to control groups (p = 0.54; RR = 1.27 (95% CI: 0.59 – 2.71)).

The objective: to determine causes of frequent detection of disseminated tuberculosis in HIV-infected patients taking into account the behavioral characteristics of patients, to propose additional measures to enhance tuberculosis detection.

Subjects and Methods. 108 questionnaires filled out by TB/HIV co-infected patients staying in specialized hospitals in 3 regions of the Russian Federation were studied. We filled out the first 18 questionnaires ourselves while talking to patients, to assess whether the questions were clear to patients. The questionnaire included 28 questions with prompted answers; in addition, patients could give their own answers. Using the questionnaire, we found out whether the patients were seeking medical help in a timely manner, units to which they referred, awareness of tuberculosis before developing it, and exposure to tuberculous infection.

Results. The majority of interviewed patients with previously diagnosed HIV infection did not undergo medical examination at the Center for AIDS Prevention and Control (CAIDSPC). When complaints associated with tuberculosis appeared, 57/108 (52.8%) respondents referred to the clinic at their place of residence. In 56/108 (51.8%) patients, 2 or more months passed from the moment of referral for medical help to diagnosis and initiation of tuberculosis treatment. 7/108 (6.5%) respondents reported history of tuberculosis, and 4/108 (3.7%) respondents reported exposure to a tuberculosis patient. After developing tuberculosis, 20/108 (18.5%) respondents were exposed to other HIV-infected patients. After detection of HIV infection, 93 (86.1%) patients indicated that they had not been made aware of tuberculosis.

The objective: to evaluate results of M. tuberculosis detection and testing drug susceptibility to rifampicin using molecular genetic methods in tuberculosis patients with a negative sputum smear microscopy result.

Subjects and Methods. Pulmonary tuberculosis patients registered in Arkhangelsk Region from 2016 to 2020 were enrolled in the study; those patients were notified as new cases and relapses with a negative sputum smear microscopy result before treatment and had results of molecular genetic testing (MGT) (Xpert MTB/RIF MTB/RIF) and BACTEC MGIT 960 available.

Results. 479 people (40%) were registered as pulmonary tuberculosis cases with a negative sputum smear microscopy result. MGT was performed in 327 (68%) patients. A positive result of MGT was received in 120 (37%) patients, a positive result of BACTEC MGIT 960 was received in 165 (50%) people. Concordance of results was observed in 70% of cases. In 136 (41%) people, both tests did not detect Mycobacterium tuberculosis, in 95 (29%) both tests showed a positive result. Discrepancies between the results of two tests were observed in 30% of cases. In 71 (22%) cases, culture growth was observed in BACTEC MGIT 960 with negative results of MGT. In 8% of cases, DNA of Mycobacterium tuberculosis was detected, but there was no culture growth on the nutrient medium. 43/120 (36%) cases of resistance to rifampicin were detected. The median time from sputum collection to initiation of MDR-TB treatment based on sputum MGT results made 18 (IQR 10–29) days. Molecular genetic testing makes it possible to promptly detect the majority of TB patients with a negative sputum smear result, and reduce the time for drug susceptibility testing, which allows this testing to be used as the first test when examining for pulmonary TB.  

The objective: to specify indications for extrapleural thoracoplasty in patients with destructive pulmonary tuberculosis and comorbid HIV infection.

Subjects and Methods. Results of surgical treatment of 78 destructive pulmonary tuberculosis patients were studied. Those patients underwent extrapleural thoracoplasty in Pulmonary Tuberculosis Surgery Unit of City Tuberculosis Hospital No. 2 in St. Petersburg from 2009 to 2022.

Results. The article clarifies the indications for extrapleural thoracoplasty in patients with destructive pulmonary tuberculosis and comorbid HIV infection, in whom contraindications to pulmonary resections have been identified. Medical records of 78 patients with destructive tuberculosis were retrospectively analyzed, the patients were divided into two groups according to their HIV status. It has been established that with combination of adequate preoperative preparation and postoperative management, rational anti-tuberculosis chemotherapy and ART, extrapleural thoracoplasty for HIV-positive patients can be performed in accordance with general practice.

The objective: to study effectiveness of surgical methods for treatment of various forms of destructive pulmonary tuberculosis (meta-analysis).

Subjects and Methods. A systematic search was performed in electronic bibliographic databases, including PubMed and Google Scholar. Cohort studies published from January 1, 2019 to June 20, 2023 were selected, those studies were aimed to assess effectiveness of surgical treatment in patients with destructive tuberculosis using resections of various volume. For meta-analysis, 9 studies published in 2019 - 2023 were selected.

Results. The effectiveness of comprehensive treatment with resections of various volume in destructive pulmonary tuberculosis patients made 85.3%. The success of surgical treatment in patients with fibrous cavernous pulmonary tuberculosis was somewhat less – 80.3%. At the same time, the incidence of postoperative complications in patients with fibrous cavernous pulmonary tuberculosis was higher and could reach 42.5%, while in the group patients with destructive tuberculosis, it was 27.3%. Some postoperative complications required repeated operations. The ratio of surgeries to patients was the following: 3263 surgical interventions per 1564 patients (average 2.08 surgeries per patient). Hospital lethality among patients with fibrous cavernous pulmonary tuberculosis after surgical treatment was 2.6%, and tuberculosis mortality within 5 years after surgery was 4.8%. The relapse rate among patients with fibrous cavernous pulmonary tuberculosis after surgical treatment was 7.1%.  

The objective: to analyze changes in psycho-emotional status of children ill with respiratory tuberculosis (RTB) in the perioperative period while the children were provided with psychological support.

Subjects and Methods. 15 respiratory tuberculosis patients aged 7−12 years who received psychological support during surgical treatment were enrolled in the study. The data of psychological examination in the preoperative, early postoperative and late postoperative periods are presented.

Results. In the preoperative period, the vast majority of children with respiratory tuberculosis showed a higher level of neuropsychic tension (86.7% of patients) and anxiety (73.3% of patients). When psychological support was provided during surgical treatment, the program of which was based on EMDR approach and mindfulness, in the early postoperative period, there was a significant decrease in the number of children with a high level of neuropsychic tension – from 86.7% to 46.7% (p<0. 01). At the beginning of the late postoperative period, parameters of psychoemotional status in the overwhelming majority of children were within the range of normal values.

The article describes a clinical case of generalized tuberculosis manifested by tuberculous spondylodiscitis and disseminated pulmonary tuberculosis with extensive drug resistance and bilateral multiple destruction. The chemotherapy regimen compiled according to the sensitivity pattern of the pathogen, sequential implantation of two endobronchial valves and their long-term (18 months) synergic effect made it possible to cure pulmonary tuberculosis with healing of all multiple bilateral destruction. The same chemotherapy regimens allowed achieving cure of tuberculous spondylodiscitis. Co-infection of hepatitis C provided no negative impact on the treatment course.

The most severe manifestation of COVID-19 is bilateral pneumonia with development of acute respiratory distress syndrome accompanied by cytokine storm, pulmonary edema and death of the patient. In a number of patients, occurrence of mucormycosis of mucous membranes was one of the stages of the lethal outcome development. The arctile presents a clinical case of mucormycosis of the tracheobronchial tree detected by bronchoscopy several days before death in a patient with COVID-19 who was on mechanical ventilation. The endoscopic signs (endoscopic image) are described.

The review analyzes 69 publications, of which 45 are devoted to studying gut microbiota in tuberculosis patients. The review presents data on the effect of gut microbiota disorders on the development of tuberculosis, severity and relapse rate. It covers the issues of changes in gut microbiota composition during anti-tuberculosis therapy and the effect of their management with probiotics on the tolerability of anti-tuberculosis therapy and effectiveness of treatment, including children.