The objective: to assess the prevalence of latent tuberculosis infection among people living in social housing.

Subjects and Methods. Prevalence of latent tuberculosis infection (LTBI) was analyzed among residents of two social homes in Moscow; totally 936 people were examined. These individuals were given a skin test with the tuberculous recombinant allergen (TRA). To exclude tuberculosis, those with a positive response underwent examination and tests including chest computed tomography and 3 consecutive sputum smears for acid-fast mycobacteria. If tuberculosis was ruled out according to the results, the condition of these individuals was classified as latent tuberculosis infection (LTBI).

Results. Among those living in social housing, LTBI was more common in men than in women, OR=1.72 (95% CI 1.16–2.57). In persons with mental retardation, LTBI was detected more often than in those with schizophrenia: 20.68% versus 12.44%, p<0.05. The presence of concomitant diseases (diabetes mellitus, COPD, viral hepatitis, gastrointestinal pathology, oncology, and autoimmune diseases) is no risk factor for LTBI in people with mental pathology.

The objective: to assess detection rates of non-tuberculous mycobacteria (NTM), incidence of mycobacteriosis, and results of mycobacteriosis treatment in Arkhangelsk Oblast from 2010 to 2020.

Subjects and Methods. All patients in whom mycobacteria were detected by microscopy and/or culture with a negative result for M. tuberculosis were examined for NTM. Patients with NTM who had two positive cultures and/or clinical findings suggestive of the disease received treatment of mycobacteriosis.

Results. In Arkhangelsk Oblast from 2010 to 2020, NTM were detected in 138 people, with an average rate of 1.09 cases per 100,000 population. Mycobacteria belonging to the M. avium complex (M. avium and M. intralcelulare) (MAC) were reported in the majority of cases (56/138; 40%). In 19/138 (14%) patients, the type of NTM could not be determined. The diagnosis of mycobacteriosis was registered in 67/138 (49%) people, with an average rate of 0.53 cases per 100,000 population. In 45/67 (67%) cases, the disease was caused by MAC. In 71/138 (51%) patients with NTM, no mycobacteriosis was diagnosed. Treatment was started in 60/67 (90%) patients with mycobacteriosis, and in 58/60 (97%) the regimen contained clarithromycin. Results were as follows: treatment was completed in 37 (62%) patients, 10 (16%) patients were defaulters, treatment was canceled for medical reasons in 5 (8%) cases, 1 (2%) patient died of mycobacteriosis, 4 (7%) patients died of other causes, 2 (3%) patients were transferred out, and treatment failed in 1 (2%) patient.

The objective: to analyze specific management of the patients with rheumatological diseases and limited respiratory tuberculosis.

Subjects and Methods. Management and treatment of 46 patients with limited respiratory tuberculosis was compared and analyzed. Of those, 22 patients (Case Group) had rheumatological diseases and 24 patients (Control Group) had no such disorders. There were no significant differences in age, gender, and dissemination of tuberculosis between the groups.

Results. Other diseases were found to be more common in Case Group – 81.8% versus 37.5% in Control Group (p<0.05). In the same group, persons with three or more concomitant diseases predominated – 36.4% versus 4.2% in Control Group (p <0.05). In Case Group, the majority of patients were managed by a rheumatologist due to rheumatoid arthritis – 14/22 people (63.6%). At the time of tuberculosis detection, all patients with rheumatological pathology were receiving immunosuppressive therapy; they continued taking it while tuberculosis was diagnosed and treated. In both observation groups, a high proportion of invasive techniques used to verify respiratory tuberculosis was noted: 45.4% and 62.5%, respectively (p>0.05). There was no statistically significant difference in incidence of drug-resistant tuberculosis between the groups (p>0.05). It was established that successful anti-tuberculosis chemotherapy was possible during treatment of rheumatoid diseases (Case Group); there were no statistically significant differences in effectiveness versus Control Group (p>0.05).

The objective: to build up models for the areas of infectious risk of tuberculosis spread in a big urban center, to evaluate the presence of objects and parameters influencing the probability of development of tuberculosis infection nudi.

Subjects and Methods. A retrospective and prospective study was conducted from January 2021 to June 2022 in St. Petersburg TB Dispensary no. 5. The study was performed taking into account the results of field surveys, with subsequent processing of materials for the territory of Kalininskiy and Krasnogvardeyskiy Administrative Districts of St. Petersburg.

Results. According to the multivariate analysis of certain parameters, it was found that adult population density was a statistically significant factor influencing the type of tuberculosis infection risk areas (aOR=1.0002; p=0.0002). The role of educational facilities density (aOR=0.9932; p=0.9), and detected cases of latent tuberculous infection (aOR=1.0837; p=0.6), was statistically insignificant.

The objective: to analyze effectiveness and safety of bedaquiline administered concurrently with antiretroviral therapy in treatment regimens for patients with such comorbidities as HIV infection and multiple drug resistant and extensively drug resistant tuberculosis.

Subjects and Methods. Effectiveness and safety of chemotherapy regimens containing bedaquiline in the treatment of patients in 2017-2019 was analyzed. The study included 40 patients with multiple drug resistant and extensively drug resistant tuberculosis (MDR/XDR-TB) and HIV infection receiving antiretroviral (ART) therapy.

Results. Treatment of tuberculosis in this category of patients who completed the main course of chemotherapy was found to be effective in 70.6%. The effectiveness was significantly higher in the following patients: those with intact immune status (88.9% and 51.6%, p=0.04) due to a significant reduction in the proportion of fatal outcomes from 19.4% to 0; those with preserved susceptibility to fluoroquinolones (81.8% and 51.7%, p=0.08) due to a 3.4-fold reduction in the proportion of unfavourable treatment outcomes (from 31.0% to 9.1%) and a 1.9-fold reduction in the proportion of treatment outcomes that could not be evaluated (from 17.2% to 9.1%). The analysis showed good tolerability of bedaquiline included in MDR/XDR-TB treatment regimens in combination with antiretroviral therapy. The frequency of AEs associated with the bedaquiline-containing regimen made 7.5%. When prescribing bedaquiline, preference should be given to ART regimens that do not contain NNRTIs and PIs (the incidence of adverse treatment outcomes when bedaquiline is prescribed in combination with NNRTIs is 1.7 times higher; the incidence of adverse events (AEs) associated with the use of a bedaquiline-containing regimen in combination with PIs is 2.7 times higher than when prescribing ART regimens without PIs (including those associated with bedaquiline – 5.2 times). In 1-3 years after the effective course of chemotherapy with bedaquiline during antiretroviral therapy, tuberculosis relapse rate made 9.1%.

The objective: to evaluate clinical, laboratory and instrumental signs of generalized mycobacteriosis (MB) in HIV patients.

Subjects and Methods. Generalized MB was diagnosed in 83 patients with HIV, patients. 57.8% (48 people) were men, while 42.2% (35 people) were women. The average age of patients was 39.2 years (from 19 to 63 years).

Results. The M. avium complex was the main etiological agent of generalized MB in HIV patients (97.6%). The most frequent clinical manifestations included fever (80/83 (96.1%)); abdominal discomfort and pain, diarrhea (53/83 (63.8%)), and decreased body weight (56/83 (67%)). The median CD4+ count in the group was 50 cells/μL. In 52% (43/83) of cases, generalized MB developed concurrently with other opportunistic or secondary infections (CMVI, pneumocystis pneumonia, and candidiasis). In 70% of cases (55/78), NTMs were isolated from two or more biological specimens. The positive result of blood culture for NTM had the greatest clinical significance (in 32/60 (53%) of the examined patients).

The objective: to increase effectiveness of surgical treatment of infectious spondylitis with impaired support function of the spinal column through the combined use of a titanium cylindrical block mesh, a resorbable double-sided collagen membrane and an osteoconductor to achieve successful spinal fusion.

Subjects and Methods. A prospective monocenter cohort study included 17 patients with infectious spondylitis who were operated with anterior spinal fusion with a titanium mesh graft filled with an osteoconductor and delimited by a barrier double-sided collagen membrane. In the postoperative period, antibacterial treatment was administered based according to the results of bacteriological tests of biological specimensl. Formation of the bone block (spondylodesis) was evaluated by the scale for assessing the fusion of the graft with the bed of the cranial and caudal vertebrae.

Results. 6 months after surgery, the fusion of the graft with the bed of the supporting vertebra according to the Baulin scale was 4.5 ± 0.4 scores on the average. In 5 (29%) patients, a clear, homogeneous bone block with a transition of bone beams was achieved after surgery which amounted to 5 scores by the Baulin scale.

The objective: to determine the role of the rpoB Leu430Pro mutation in the degree of phenotypic resistance of Mycobacterium tuberculosis to rifampicin.

Subjects and Methods. The WHO classifies the rpoB Leu430Pro mutation of Mycobacterium tuberculosis as a borderline resistance mutation but of clinical significance. From an array of cultures, we selected and analyzed 14 isolates of M. tuberculosis with discrepancies in the results of molecular genetic and phenotypic testing, carrying only this mutation in rpoB. For all samples, the phenotypic resistance level (MIC) of these isolates to rifampicin was determined using BACTEC MGIT 960 and Middlebrook 7H11 medium.

Results. It was found out that 12 of 14 isolates had the rifampicin MIC below the current critical concentration when tested by both methods, thus they were phenotypically sensitive. One isolate was resistant when tested with Middlebrook 7H11 but susceptible when tested with BACTEC MGIT 960. Only one isolate which had the additional rpoB F425L mutation demonstrated high-level phenotypic resistance when tested by the same tests. Our data indicate that the clinical significance of this mutation requires clarification since even a decrease in the critical concentration of rifampicin does not lead to unambiguous results of molecular genetic and phenotypic tests. It is necessary to standardize the use of various molecular genetic tests and principles of their clinical interpretation to optimize strategies for managing patients with tuberculosis caused by M. tuberculosis with the rpoB Leu430Pro mutation.

The objective: to provide molecular genetic characteristics of Mycobacterium tuberculosis isolates from patients with HIV-associated tuberculosis.

Subjects and Methods. Two groups of M. tuberculosis isolates were included in the study: 103 isolates from patients undergoing treatment for generalized tuberculosis with concurrent HIV infection, and 61 isolates from autopsy specimens of patients who had suffered from generalized tuberculosis and HIV infection. The Beijing genotype of M. tuberculosis isolates, its subtypes and major Russian subtypes were identified by PCR and real-time PCR methods based on the analysis of specific markers and genome loci (dnaA-dnaN::IS6110, Rv2664-Rv2665::IS6110, sigE, NTF, RD181). Genotyping of non-Beijing isolates was performed by spoligotyping followed by comparison with SITVIT2. The results were compared to the published data on the genetic diversity of M. tuberculosis in the North-West of the Russian Federation.

Results. In both groups, a predominance of isolates of the Beijing genotype was detected (89.3% and 70%, respectively), among which the majority belonged to subtypes 94-32 (51% and 44.1%) and B0/W148 (41.3% and 30%) related to the modern subline of the Beijing genotype. Some of the isolates belonged to the ancient subline of the Beijing genotype (8.7% and 4.6%). When compared to previously obtained data for the North-West of the Russian Federation, the proportion of MTB isolates of ancient subline from HIV-infected patients was significantly higher than among isolates isolated from HIV-negative patients (6.7% vs. 1.6%, P = 0.0028).

The article describes two clinical cases of mycobacteriosis with intrathoracic lymph node involvement in infants. In both cases, the disease occurred in infancy and tuberculosis was initially diagnosed. The protracted disease required surgical treatment. The histological signs were consistent with granulomatous inflammation with caseous necrosis. The diagnosis was established by the detection of M. avium DNA in the surgical specimens. No underlying diseases accompanied by immunosuppression were found in the infants. Only anti-tuberculosis drugs were used for treatment. The disease was successfully cured; during follow-up examinations (one year after the treatment completion), there was no evidence of the disease relapse.

The article describes a clinical case of a female patients with the continuous course of tuberculosis (more than 14 years). Despite the ongoing anti-tuberculosis therapy, the use of all possible surgical methods including valvular bronchial blocking, bacterial excretion persisted, fibrous cavernous tuberculosis with pre-XDR and severe cicatricial bronchial stenosis developed. Due to comprehensive personalized approach based on implantation of an endobronchial valve in a bronchus restenotic by cryorecanalization supported by adequate chemotherapy regimen V, the patient managed to achieve sputum conversion, cavity healing and cure of tuberculosis.

The review summarizes the current understanding of population genetics and genetic classification of Mycobacterium tuberculosis. Articles accumulated in Elibrary and PubMed were used as a source of information. Using keywords, more than 100 publications were found and analyzed for the period from 2009 to 2023, 35 of which were included in the review. According to the current concept, M. tuberculosis is represented by nine lineages (superfamilies L1-L9), each of which has different characteristics of evolutionary status, genetic diversity, transmissibility, drug resistance, latency, and vaccine effectiveness.