The objective: to evaluate tuberculosis situation in the Russian Federation among children aged 0-17 years based on the analysis of key epidemiological rates from official statistics for 2023.

Subjects and Methods. Information from official statistical surveillance forms was studied, and the rates describing tuberculosis situation were calculated.

Results. In 2023, tuberculosis incidence stabilized in the Russian Federation: among children aged 0-14 years, it made 6.7, and among adolescents aged 15-17 years, it made 12.7 per 100,000 children of the corresponding age. The proportion of foreign citizens among those aged 0-17 years who developed the disease made 2.2%, which was insignificantly different from previous years. In 2023 for the first time, no cases of tuberculosis among children and adolescents were registered in penal institutions. Tuberculosis mortality among persons aged 0-17 from reached a historic low (2023 – 0.01 per 100,000). The proportion of HIV co-infection among new tuberculosis patients aged 0-17 years decreased to 1.0% (2% in 2022). The problem of multiple drug resistant tuberculosis (MDR TB) remains significant – 50% of new patients aged 0-17 years received treatment with MDR TB chemotherapy regimens. The number of children subjects to dispensary follow-up due to exposure to tuberculosis patients increased to 595.1 per 100,000 children, while numbers decreased in the risk groups of Children Newly Detected with Residual Post-Tuberculosis Changes and Children with Abnormal Reactions to Immunodiagnostic Tests. The tasks of etiological confirmation of tuberculosis diagnosis and development of preventive treatment regimens for children exposed to MDR TB remain relevant.

The objective: to evaluate effectiveness of treating respiratory tuberculosis with multiple and pre-extensively drug resistance in adolescents depending on the drug susceptibility testing methods.

Subjects and Methods. In Group 1 consisting of new patients (16 adolescents), the pathogen was identified in the institute’s laboratory (Amplitub-MLU-RV, Amplitub-FQ-RV, BACTEC MGIT 960; DST for the full spectrum of anti-tuberculosis drugs). In Group 2 consisting of 35 adolescents admitted for repeated treatment (comparison group), the pathogen was identified at the place of residence (GeneXpert MTB/RIF), by culture on solid nutrient media.

Results. In all 16 (100%) patients of Group 1, chemotherapy (CT) was prescribed taking into account the full DR spectrum according to individual regimens, the achieved outcome was assessed as “effective treatment”. In 12/35 (34.3%) patients of Group 2 with a positive sputum test, chemotherapy was prescribed with no consideration of the full DR spectrum, the outcome was “treatment failure”. A statistical relationship was established between the risk factor “chemotherapy with no consideration of the full DR spectrum” and the outcome “treatment failure” (χ²=7.174; p=0.008). The presented results prove the importance of information on the full DR spectrum in adolescents for the prescription of chemotherapy according to individual regimens.  

The objective: to evaluate effectiveness and safety of inhaled highly purified tauractant as a pathogenetic agent in the treatment of pulmonary tuberculosis with multiple, pre-extensively and extensively drug resistance.

Subjects and Methods. 104 patients with drug-resistant tuberculosis were included in the study, 29 of them were HIV-positive. Patients received chemotherapy (CT) according to the regimen for drug-resistant tuberculosis (MDR, pre-MDR, and MDR) based on the individual drug susceptibility of Mycobacterium tuberculosis (MTB). Tauractant was administered by inhalation in the form of a lyophilisate for the emulsion preparation. The patients were randomized into 2 groups: In CT+ST Group (n=52), surfactant therapy was prescribed in addition to chemotherapy, using tauractant in the form of Surfactant BL (Russia) at a dose of 25 mg according to the regimen [5], in CT Group (n=52), only chemotherapy was administered.

Results. By the end of 2 months of chemotherapy, respiratory symptoms resolved in 35/39 (89.7%) patients in CT+ST Group, and in 22/33 (66.7%) in CT Group (p<0.05). Positive X-ray changes were observed in 39/52 (75.0%) patients in CT+ST Group and in 28/52 (53.8%) patients in CT Group, (p<0.05), and healing of cavities was observed in 9/30 (30.0%) and 2/33 (6.1%) (p<0.05) patients, respectively. The trend toward faster sputum conversion (by culture) and healing of cavities persisted throughout the study period in CT+ST Group versus CT Group. In the patients from cavernous and fibrous cavernous tuberculosis subgroup of CT+ST Group, cavities healed more frequently (size up to 3 cm) by week 8 of treatment versus the same subgroup of CT Group. No serious adverse reactions were observed during the study, and no connection between adverse reactions and the use of tauractant was established.

The objective: to evaluate safety profile when adding thioureidoiminomethylpyridinium perchlorate (Tpp) to anti-tuberculosis regimens during the intensive phase of treatment of pulmonary tuberculosis patients with MDR, pre-XDR and XDR.

Subjects and Methods. Group Tpp+ consisted of 72 patients who completed a course of anti-tuberculosis therapy containing Tpp at a daily dose of 400 mg during the intensive phase of treatment. Group Tpp-included 50 patients who completed the intensive phase of anti-tuberculosis therapy containing no Tpp.

Results. It has been confirmed that a large number of endocrine adverse reactions (AR) leading to hypothyroidism are due to inclusion of Tpp to the treatment regimen, but to a greater extent, its combination with other thyrotoxic drugs - protionamide and aminosalicylic acid. However, there was not a single case of hypothyroidism in the group where the above drugs were prescribed without Tpp. Among 72 (100%) patients who were prescribed drugs suspected of the thyrotoxic action, hypothyroidism developed in 21% of cases: when Tpp was prescribed – in 3%, when Tpp + aminosalicylic acid were prescribed – in 11%, when Tpp + prothionamide were prescribed – in 7%.

The objective: to evaluate predictors of cardiotoxicity when using modern chemotherapy regimens in comorbid patients with multiple drug-resistant tuberculosis (MDR TB) to identify a group facing a high risk of cardiovascular events.

Subjects and Methods. A single-center, open-label, controlled prospective cohort study was conducted. A total of 87 MDR TB patients were enrolled and divided into 2 groups: Group 1 included 24 patients whose QT interval length exceeded 450 ms at one or more control points; Group 2 included 63 patients whose QT interval duration length was less than 450 ms at all observation periods.

Results. In this study, traditional risk factors for QT prolongation, such as: overweight or underweight, smoking, hypokalemia, bradycardia, taking two QT-prolonging anti-tuberculosis drugs (fluoroquinolone and bedaquiline) and in combination with capreomycin, did not provide a significant effect on the development of cardiotoxic reactions during anti-tuberculosis chemotherapy. The risk of QT prolongation and related cardiovascular complications was significantly associated with comorbid cardiovascular diseases (CVD) (OR=4.29, CI 1.46–12.56; p=0.009), a family history of CVD (OR=4, CI 1.26–12.72; p=0.024), chronic obstructive pulmonary disease (OR=2.9, CI 1.1–7.67; p=0.033), and female gender (OR=3.73, CI 1.38–10.07; p=0.015). The identified predictors, even at the stage of compiling an anti-tuberculosis regimen, make it possible to identify a risk group for developing cardiotoxic reactions among MDR TB patients.

The objective: tto study the structure of kidney disorders in tuberculosis patients.

Subjects and Methods. Data from the unified medical information and analytical system (UMIAS) and medical records of 382 tuberculosis patients with nephrological pathology were retrospcetively analyzed. All those patients underwent in-patient treatment in Extrapulmonary Tuberculosis Department of Clinic no. 2, Moscow Research and Clinical Center for Tuberculosis Control of the Moscow Government Department of Health, from January 1, 2012 to December 31, 2022.

Results. Acute kidney injury induced by anti-tuberculosis drugs was observed in 77/382 (20.2%) patients. Overall, drug-induced toxic nephropathy associated with tuberculosis treatment and comorbid conditions accounted for 111/382 cases (29.1%). Amyloidosis was detected in 42/382 (11.0%) patients, 23/382 (6.0%) underwent deceased-donor kidney transplantation. 61/382 (16.0%) patients had chronic glomerulonephritis. 95 patients received programmed hemodialysis. The main causes of end-stage renal disease in them were chronic glomerulonephritis (30–31.6%), amyloidosis (16–16.8%), and tubulointerstitial nephritis (12–12.6%). Emergency hemodialysis was performed in 43 patients, in 20 (46.5%) patients it was due to tubolointerstitial nephritis caused by anti-tuberculosis drugs, in 7 (16.3%) patients, it was due to some other drugs, and in 14 (32.6%) patients it was due to uric acid nephropathy.  

The objective: to detect causes of thoracotomy wound dehiscence in the patients who underwent surgery for pulmonary tuberculosis.

Subjects and Methods. 960 HIV-negative patients who underwent surgery for pulmonary tuberculosis from 2018 to 2023 were included in the study. Thoracotomy was performed in 851 patients, of whom 285 (33.5±1.6%) had MDR/XDR TB, and thoracoplasty was performed in 109 patients, of whom 58 (53.2±4.8%) had MDR/XDR TB.

Results. Out of operated 960 patients, a complication such as thoracotomy wound dehiscence (TWD) was reported in 69 (7.2±0.8%) cases, among whom men prevailed. The study did not establish a statistically significant relationship between the incidence of TWD and the type of intervention, dissemination of the disease, or the presence of concomitant conditions. The incidence of TWD was the highest (39/61 (63.9±6.2%)) during thoracotomy with insufficient aerostasis; during thoracoplasty, there was no such complication at all. In the absence of other postoperative complications, TWD occurred statistically significantly more often during thoracoplasty than thoracotomy (4/8 (50±17.7%) versus 9/61 (14.8±4.5%), p=0.017). In patients with TWD, a predominance of MDR/XDR TB was established in both types of surgical interventions (in 35/61 (57.4±6.3%) during thoracotomy, 5/8 (62.5±17.1%) during thoracoplasty, p>0.05). Moreover, the OR of developing TWD was higher in patients with MDR/XDR TB (2.68; 95% CI 1.6-4.4; p_χ2<0.001).  

The objective: to analyze clinical, radiological, and endoscopic manifestations of bronchial tuberculosis in elderly patients with respiratory tuberculosis.

Subjects and Methods. Endoscopic examinations conducted in Endoscopy Department of Central Tuberculosis Research Institute from July 1, 2020 to June 30, 2024 were retrospectively analyzed. 4,429 respiratory tuberculosis patients above 18 years old (all HIV-negative) underwent bronchoscopic examinations. Expert-class endoscopes were used: Olympus BF H190 (Olympus CV-190 video system (Olympus Japan)), Pentax EB15 J10 (DEFINA video system (HOYA Corporation Pentax Life Care Division, Japan)), and Fujifilm EB-580S (Fujifilm ELUXEO 7000 video system, Japan) under local or intravenous anesthesia (sedation). Combined rigid bronchoscopy and video bronchoscopy were performed under total intravenous anesthesia with high-frequency mechanical ventilation.

Results. 7 patients with bronchial tuberculosis aged 65 years and older were included in the study, 3/7 (42.9%) of them had a relapse of bronchial tuberculosis. In all cases, diagnosis verification was preceded by a prolonged period of clinical symptoms (median time before diagnosis made 34 (27-59) weeks). Untimely administration of anti-tuberculosis therapy due to late diagnosis led to a prolonged course of bronchial tuberculosis and widespread and deep damage to the walls of the trachea and bronchi. Chronic tuberculosis inflammation led to metaplastic degeneration of the ciliary epithelium, up to grade II dysplasia and the formation of scar stenosis of the trachea, and grades II-III dysplasia of main and lobar bronchi.  

The objective: to compare sarcoidosis patients with complete remission to the patients who developed pulmonary fibrosis, search for causes of a different course of the disease, and assess the impact of adherence to clinical guidelines on the development of pulmonary fibrosis in sarcoidosis.

Subjects and Methods. The data of 459 patients who according to chest CT data had complete remission (373, Remission Group) or developed fibrosis (86, Fibrosis Group) were analyzed.

Results. The comparison revealed that patients in Fibrosis Group were older, the proportion of women was lower, Lefgren's syndrome at onset was less common, patients more often received anti-tuberculosis therapy, as well as inhaled glucocorticosteroids, systemic glucocorticosteroids, and systemic glucocorticosteroids with no observation period, repeated courses of systemic glucocorticosteroids, methotrexate, leflunomide, and treatment tactics were less likely to comply with clinical recommendations. Spontaneous remissions of sarcoidosis were rarely associated with the development of fibrosis. When comparing subgroups with preliminary stratification of copy pairs (20/20) of patients (initially stage II sarcoidosis, FEV1 ≥70% of normal value), there were no significant differences in gender, age, Lefgren's syndrome at the detection, concomitant pathology, smoking, frequency of SGS prescription, but the frequency of adherence to clinical recommendations was 95% in the subgroup from Remission Group and only 35% in the subgroup from Fibrosis Group.  

The objective: to study effects of dextrazide on fibrotic complications in the organs of mice with chronic BCG-induced inflammation.

Subjects and Methods. We used intact mice and animals that were given the BCG vaccine. Six months after the infection, infected mice were administered NaCl and dextrazide intraperitoneally for three months, after which inter-organ remodeling of the extracellular matrix was assessed.

Results. Dextrazide exhibited antifibrotic activity, the mechanisms of which varied between organs. In the liver, fibrosis reduction was achieved mainly through collagen degradation, in the lungs through collagen degradation and suppression of collagen synthesis, and in the spleen through suppression of synthesis. Additionally, the levels of hyaluronan and perlecan decreased in all organs, especially in the lungs, while the levels of galactose in proteoglycans increased. Changes in collagen and proteoglycan metabolism were associated with the local regulation system of the extracellular matrix. Administration of dextrazide caused an elevated activity of degrading enzymes (hyaluronidases and matrix metalloproteinases) in the liver and, especially, in the spleen, while their activity in the lungs remained at the level in the infected mice. At the same time, the level and activity of protease inhibitors (tissue inhibitors of metalloproteinases-1 and -2, α2-macroglobulin) were reduced in the liver and lungs, while in the spleen, on the contrary, their levels were elevated and corresponded to the level in the infected mice.  

The objective: to study changes in the clinical structure of tuberculosis, concomitant pathology, and causes of death in a TB hospital in order to identify main areas of medical activity aimed to reduce tuberculosis lethality and mortality.

Subjects and Methods. 2,724 lethal outcomes in in-patient units of Irkutsk Regional Clinical TB Hospital were analyzed over the period of eight years (2016-2023).

Results. Over the past 8 years in Irkutsk Regional Clinical TB Hospital, a positive trend towards decrease in the incidence of lethal outcomes among tuberculosis patients has been observed. Among the 2,724 lethal outcomes, 1,863 (51.2%) had tuberculosis with concomitant HIV infection of stage 4B or terminal stage, which led to rapid death (within 1 month) against the background of the disease progression and development of acute cardiac, respiratory and multiple organ failure. Among HIV-negative tuberculosis patients, fibrous-cavernous tuberculosis had a predominant influence on the mortality. The following measures that contribute to reducing mortality and lethality in tuberculosis patients have been identified: prevention of tuberculosis in people living with HIV, increasing their coverage with ART, early detection of tuberculosis regardless of HIV status, and analysis of all cases of untimely detection of tuberculosis.  

The objective: to compare results of six tests for immunological diagnosis of tuberculosis infection (TBI): intradermal tests (Mantoux with 2 TU PPD-L; test with tuberculous recombinant allergen (Diaskintest)) and IGRA laboratory tests (T-SPOT^®. TB, QuantiFERON^®-TB Gold Plus, STANDARD Е TB-Feron, and IGRA-TB) in groups of individuals with high and low risk of TBI and pulmonary tuberculosis patients.

Subjects and Methods. The study was conducted in June of 2023. 100 people above 18 years old were enrolled in the study. The low probability group (TBI LPG), n=50, included regularly examined healthcare workers who had not responded positively to Diaskintest skin or any IGRA test for the previous 2 years. The high probability group (TBI HPG), n=25, included individuals who had responded positively to Diaskintest or any IGRA test for the previous 2 years. The PTB Group, n=25, included patients with pulmonary tuberculosis who were admitted to hospital.

Results. The results of Diaskintest correlated well (at a level of 88-92%) with the results of IGRA tests (STANDARD E TB-Feron, QuantiFERON^®-TB Gold Plus, and IGRA-TB), the results of which also coincided with each other in 86-88% of cases. The consistency of Mantoux test with 2 TU PPD-L with other tests was lower (57.9-70.5%). The results of T-SPOT^®.TB coincided with skin tests in only 61.5-64.2% of cases, and with other IGRA tests in 72.3-75.9% of cases. It has been established that the results were best interpreted when using STANDARD E TB-Feron IGRA, QuantiFERON^®-TB Gold Plus, and IGRA-TB (100/100, 100/100, and 99/100, respectively), and worse when using Diaskintest (95/100) and T-SPOT^®. TB (83/100) and Mantoux test (78/100). The T-SPOT^®.TB test and Mantoux test with 2 TU PPD-L showed the best results in the PTB group (88% and 76% positive results, respectively), but in the high probability group (presumably without TBI), only 50% and 32% negative results were observed, respectively. When screening conditionally healthy study participants (TBI LPG), Diaskintest and all IGRA tests (except T-SPOT^®.TB) showed good agreement of negative results (at 88-90%).  

This article describes a clinical case of an extremely rare combination of two nosological types of skin lesions – dermatosis and cutaneous tuberculosis. It presents stages of diagnosis, which took 6 years and difficulties when choosing treatment. During the combination treatment (corticosteroids, anti-tuberculosis drugs, and other medications), PATE developed, leading to a fatal outcome.