The objective: to assess frequency of detection of M. tuberculosis resistant to anti-tuberculosis drugs in tuberculosis patients with various histories of previous treatment, to determine the coverage with susceptibility testing to first-line and reserve drugs in the Russian Federation in 2023-2024.

Subjects and Methods. The analysis was based on national statistical data and results of microbiological tuberculosis diagnosis collected in regions of the Russian Federation. Susceptibility testing for isoniazid, rifampicin, bedaquiline, linezolid, and fluoroquinolones was used to assess the prevalence of drug resistance. The rates were calculated as a percentage of patients who underwent the relevant testing and had a confirmed history of previous treatment.

Results. In 2024, the Russian Federation recorded a 9.4% decrease in the number of new tuberculosis cases compared to 2023, while the proportion of microbiologically confirmed cases remained stable at 53%. Among new cases, the proportion of tuberculosis with multidrug resistance (MDR) increased from 33.1% to 34.1%, as did the proportion of cases with monoresistance to isoniazid, which increased from 10.7% to 11.8%. Meanwhile, the monoresistance to rifampicin decreased. Among tuberculosis relapses, MDR-TB accounted for 58.6% of cases, while resistance to fluoroquinolones decreased from 35.3% in 2023 to 32.6% in 2024. Coverage with susceptibility testing to reserve drugs increased: up to 80.8% to bedaquiline and up to 81.2% to linezolid, with a low level of resistance to these drugs (<7.5%).

The objective: to investigate influence of the factor of employment in the coal industry with potential exposure to coal dust on the treatment outcomes of patients with rifampicin-susceptible tuberculosis.

Subjects and Methods. A retrospective cohort study was aimed to investigate treatment outcomes of rifampicin-susceptible tuberculosis (TB) in men residing in a coal-mining region of the Russian Federation. Information from the following registration forms was used: Notification of New Cases of Relapse of Tuberculosis (Extended Form 089/u and Medical Treatment Record TB-01/u). Patients were randomized in two groups: male workers of the coal industry (n=287) and a comparison group – other working men aged 21 to 60 years (n=1644) from this region.

Results. The hypothesis about influence of work in hazardous conditions (inhalation of fibrogenic silicon-containing coal dust) in the period preceding the disease on the effectiveness of tuberculosis treatment was found to be untenable after comparison to individuals who had no occupational hazards. The structure of outcomes of chemotherapy for respiratory tuberculosis in workers of the coal industry most likely working in mines, differed from that in Comparison Group by a lower frequency of individuals interrupting treatment (χ²=14.463; p=0.006). The high adherence to tuberculosis treatment among coal industry workers is likely due to the high skill requirements in the industry and their desire to return to work after completing chemotherapy. Thus, it has been proven that work in the coal industry with well-developed labor and social legislation does not relate to risk factors of an unfavorable outcome and poor treatment effectiveness in the patients with rifampicin-susceptible tuberculosis.

The objective: to analyze and compare laboratory parameters in isolated pulmonary and generalized mycobacteriosis in HIV-positive patients.

Subjects and Methods. 115 adult HIV-positive patients with mycobacteriosis were included in a retrospective study, they all underwent in-patient treatment in Infectious Diseases Department of National Medical Research Center of Phthisiopulmonology and Infectious Diseases from 2019 to 2022. All patients included in the study had mycobacteriosis caused by Mycobacterium avium.

Results. Of the 115 patients, 70 (60.9%) were diagnosed with generalized mycobacteriosis (GM), and 45 (39.1%) were diagnosed with isolated pulmonary mycobacteriosis (IPM). In GM, there were no patients with a CD4+ T count greater than 85 cells/μl, and 75% of them had the count below 29.0 cells/μl. In IPM, the maximum CD4+ T count was 684 cells/μl, and 75% of patients had this count above 54.5 cells/μl. In GM versus IPM, the median CD4+ count was 10 times lower (13 cells/μl versus 134 cells/μl), and the mean VL in patients who did not receive ART or received ART for less than 2 months was higher (4.76 versus 3.91 log10 HIV RNA copies/ml; p = 0.006).

In GM Group, the most frequent (77.2%) combination was the following: CD4+ 0-50 cells/μl with VL 100,000 copies/ml (in 48.6% of patients) and CD4+ 0-50 cells/μl with VL 1001-99,999 copies/ml (in 28.6% of patients). In IPM Group, the most frequent (48.9%) combination was the following: CD4+ >200 cells/μl with VL 1000 copies/ml and below (28.9%) and with CD4+ 101-200 cells/μl with VL 1000 copies/ml and below – in 20.0% of patients). With CD4+ >101 cells/μl, even a high VL (100,000 copies/ml and above) did not lead to generalization of mycobacteriosis.

The objective: to study the species diversity of non-tuberculous mycobacteria detected in Samara and incidence of mycobacteriosis taking into account the patients’ immune status.

Subjects and Methods. In 2017-2024, 69 patients aged 21-86 years in whose specimens non-tuberculosis mycobacteria had been detected were examined. In 30 (43.5%) people, non-tuberculous mycobacteria were detected only once in sputum, which was assessed as carriage (Observation Group (OG)). The mycobacteriosis group (MG) included 39 (56.5%) individuals in whom the same non-tuberculous mycobacteria were detected in sputum at least twice, or once in BALF and surgical specimens.

Results. In 2023 in Samara, the incidence of pulmonary mycobacteriosis was 1.6 per 100,000 population, while prevalence made 3.4 per 100,000 population. The most frequently detected causative agents of mycobacteriosis were Mycobacterium avium complex (MAC) and M. kansasii, and of the fast-growing non-tuberculous mycobacteria, it was M. septicum. Among individuals who developed mycobacteriosis, 25.6% (10/39) were HIV positive (of which 9/10 (90%) had a CD4+ lymphocyte count below 300 cells/μl). In 1 patient, mycobacteriosis developed against during continuous administration of glucocorticosteroids for nonspecific ulcerative colitis.

The objective: to evaluate the results of transsternal occlusion of the main bronchus in pulmonary tuberculosis patients, including management of postoperative complications.

Subjects and Methods. 58 patients operated on using transsternal access in 2001-2024 were included in the study. Surgery indications were related to the need to perform a staged pneumonectomy in complicated cases of pulmonary tuberculosis or to eliminate a fistula in the stump of the main bronchus after a previous pneumonectomy.

Results. Occlusion of the main bronchus, as a stage of surgical treatment (staged operation) was performed in 49 patients, and 9 patients were operated on due to fistula of the main bronchus after pneumonectomy. 28 patients had occlusion of the main bronchus (or the stump of this bronchus) on the right, and 30 patients on the left. Postoperative complications developed in 10/58 (17.2%) patients, of which stump failure occurred in 2/58 (3.4%). 12.2% (6/49) of the patients undergoing staged surgery died: 4 patients died from the progression of tuberculosis after transsternal occlusion of the main bronchus until the next stage, and 2 patients died from cardiorespiratory complications after the final pneumonectomy. There were nor complication, neither lethal cases in transsternal occlusion of the main bronchus stump due to fistula (9 patients).

Conclusion. Transsternal occlusion of the main bronchus is a well-known method that is used when performing staged pneumonectomies if there is a high risk of bronchial suture failure. Transsternal access to the stump of the main bronchus in postoperative fistulas ensures safety of the intervention in combination with effective occlusion.

The objective: to assess the incidence of tuberculous enterocolitis (TEC) in Moscow from 2016 to 2023 and determine main factors of hospital lethality of this form of extrapulmonary tuberculosis.

Subjects and Methods. Sources of information on tuberculous enterocolitis patients were as follows: Form 003/u on Hospital Record of new patients with tuberculous enterocolitis from 2016 to 2023 who were treated at Clinic 2 of Moscow Research and Clinical Center for Tuberculosis Control; Form no. 8 on Information on Active Tuberculosis Cases in Moscow for the same period.

Results. As statistically calculated, in Moscow the estimated incidence of tuberculous enterocolitis makes 0.2 cases per 100,000 population, accounting for 1.0% of all new tuberculosis. Hospital lethality for all forms of tuberculosis was recorded at 27.65%, and the main predictors were the following: young age, positive HIV status, surgical complications, caseous pneumonia and tuberculous meningitis, as well as multidrug resistance. The resulting mathematical model for predicting a fatal outcome is a convenient tool for determining therapeutic tactics in tuberculous enterocolitis and routing patients.

The objective: to study the level of mRNA expression of the TSC1 and TSC2 genes in peripheral blood leukocytes of patients with chronic pulmonary sarcoidosis and healthy individuals.

Subjects and Methods. A total of 58 people were examined, of them 28 people were patients with chronic pulmonary sarcoidosis (stage II of the disease) without treatment, their average age made 42.11±2.21 years, and 30 people were included to Comparison Group (healthy individuals) with the average age of 43.03±1.84 years. Real-time PCR was used to assess the level of mRNA expression of the TSC1 and TSC2 genes in peripheral blood leukocytes (PBL) of patients with pulmonary sarcoidosis and healthy individuals.

Results. In the group of patients with sarcoidosis (stage II of the disease), testing peripheral blood leukocytes revealed a significant decrease in expression of mRNA of the TSC1 gene (p=0.007) and a significant increase in the number of transcripts of the TSC1 gene (p=0.0002) compared to healthy individuals matched for age.

The objective: to evaluate monitoring of tuberculosis outbreaks to obtain information on the spread of tuberculosis infection in the region, assess the effectiveness of preventive measures in the infection foci and determine the amount of resources required for this.

Subjects and Methods. Data for 2023-2024 were analyzed. The data were obtained from registers of outbreaks (5,554 outbreaks registered in the city) and the register of dispensary follow-up (5,675 tuberculosis patients registered in the city), developed by Moscow Research and Clinical Center for Tuberculosis Control of the Moscow Government Department of Health, and implemented in Moscow.

Results. Of 5,554 tuberculosis outbreaks registered in Moscow, 3,242 (58.4%) were household ones, with a prevalence of 12 cases per 100,000 population, of which 29.6% were formed by tuberculosis (TB) patients with a positive result of the sputum test, and 39.5% by non-permanent residents of the city. In the outbreaks, 92 cases of active tuberculosis were detected among close contacts. Of these, 3 cases were detected during a repeated examination of contacts from Dispensary Follow-up Group IV. This rate reflects the incidence of tuberculosis in outbreaks after preventive measures were carried out by a district phthisiologist, which equals to 5.1 (95% CI: 1.1-14.9) per 100,000 people registered in Dispensary Follow-up Group IV. 87 patients fell ill with tuberculosis before the outbreak was detected by a phthisiologist; they were detected during the first screening of the exposed people. The indicated number determined the natural course of the tuberculosis epidemic process – the incidence in outbreaks before its detection by phthisiologists made 1561 (95% CI: 1252-1922) per 100,000 examined contacts from the immediate environment of the patient. Tuberculosis patients who were permanent residents had fewer contacts in the immediate environment than those who belonged to the non-permanent population: 1.78±0.04 and 2.25±0.12, respectively (p<0.01). Tuberculosis patients aged 18–40 years, who were permanent residents had significantly more contacts than patients over 40 years old: 2.13±0.08 versus 1.59±0.05, respectively (p<0.01). The number of detected outbreaks formed by one patient varied from 0.4 to 1.3 in the patients of different population groups. The proportion of patients with detected outbreaks is 64.5% (95% CI: 63.3-65.8%) overall, and 91.8% (95% CI: 90.4-93.1%) among permanent residents. Among the outbreaks that phthisiologists worked with, 17.7% turned out to be false.

The objective: to study the species and quantitative composition of vaginal microbiota in the girls aged 2-13 years, ill with respiratory tuberculosis during chemotherapy.

Subject and Methods: 80 girls aged 2-13 years were enrolled in the study: Group 1 (21 patients) included girls ill with respiratory tuberculosis at different stages of anti-tuberculosis therapy Group 2 (59 patients) included girls belonging to Health Groups 1 and 2, not registered in TB services. Vaginal microbiota was tested once using microscopy and real-time PCR (FEMOFLOR®16 reagent kit, DNA-Technology LLC, Russia). Results of the vaginal microbiota testing were assessed taking into account the Tanner stages for girls.

Results. In girls from Group 1, vaginal dysbiosis was recorded in 90.5% of cases (with Tanner I – 100% of cases, Tanner II-III – 88.9%, Tanner IV – 85.7%) and was associated in 66.7% of cases with candidal vulvovaginitis (with Tanner I – 100% of cases, Tanner II-III – 55.6%, Tanner IV – 57.1%). Vaginal dysbiosis occurred with complaints in 19.0% of cases and clinical manifestations in 71.4% of cases. Specific features of the vaginal microbiota composition in girls of Group 1 were identified based on the frequency of detection and quantitative content of symbionts. The molecular genetic testing made it possible to increase the efficiency of diagnosing candidal vulvovaginitis to 66.7%, versus 28.6% in microscopic examination of scrapings from the mucous membrane of vulva and vaginal vestibule with a predominance of the species Candida glabrata (42.8%).

Conclusion. The girls ill with tuberculosis and receiving anti-tuberculosis therapy suffer from significant changes in the species and quantitative composition of the vaginal microbiota.

The objective: to analyze medical and social factors in new cases among children and adolescents from tuberculosis outbreaks with lethal cases.

Subjects and Methods. 107 children and adolescents aged 0 to 17 years were enrolled in the study. They all were examined and treated at Hospital No. 3 of Regional Clinical TB Dispensary in Astrakhan in 2015-2023. They were confirmed as new cases after exposure to 99 tuberculosis outbreaks with lethal cases.

Results. A retrospective analysis of medical records revealed that from 2015 to 2023, the absolute number of children and adolescents ill with tuberculosis after exposure to tuberculosis outbreaks with lethal cases decreased, which was associated with a significant reduction of tuberculosis mortality in the region. The majority of cases were identified by immunodiagnostics – 52/107 (48.6%) and contact screening – 50/107 (46.7%), the rest were detected by fluorography – 2/107 (1.9%) and when seeking medical help – 3/107 (2.8%). In children aged 0 to 14 years, tuberculosis of the intrathoracic lymph nodes (TBITLN) was diagnosed more often – 77/88 (87.5%), of which in 51/77 (66.2%) children and 10/19 (52.6%) adolescents, the calcification phase was observed. Most often one of the parents was the index case at the outbreak with lethal cases – in 50/107 (46.7%) children or adolescents. Multidrug resistance of was confirmed in the index case in 68/99 (68.6%) outbreaks with lethal cases. In 40.2% of children or adolescents, tuberculosis was detected 3 years after the death of the index case. 36/107 (33.6%) children and adolescents belonged to socially marginalized families.

The objective: to study specific features of detection new pulmonary tuberculosis and structure of its clinical forms of in elderly and senile individuals living in the city of Voronezh and Voronezh Oblast in 2018-2023.

Subjects and Methods. 376 individuals with new pulmonary tuberculosis over 60 years old were included in a retrospective study. They all lived in the city of Voronezh and Voronezh Oblast, and they were detected at N.S. Pokhvisneva Regional Clinical TB Dispensary in 2018-2023. The data of Statistic Report 089/u on New Case Notification were analyzed.

Results. In Voronezh Oblast in 2018-2023, in the proportion of elderly and senile people among new pulmonary tuberculosis cases increased from 16.39% to 24.16%. 59.84% of new patients lived in rural districts. Among clinical forms, infiltrative tuberculosis was predominant (74.2%), cavernous and fibrous cavernous tuberculosis accounted for 1.32% among residents of the city of Voronezh and 1.87% among residents of rural areas. 65.69% patient had a positive result of sputum testing. 78.45% cases were detected by active case finding, In non-TB hospitals, tuberculosis was detected in 81/376 (21.54%) patients.

The article describes a clinical case of successful treatment of a patient with recurrent tuberculosis after bilateral lung resections. For the treatment of disseminated destructive tuberculosis, chemotherapy regimen for pre-XDR tuberculosis and short-term valve bronchial block were used.

The review analyzes 69 publications discussing formation mechanisms of neutrophil extracellular traps in various infectious and non-infectious diseases. It depicts patterns of formation of neutrophil extracellular traps in active respiratory tuberculosis and their role in the pathogenesis of disseminated destructive forms of the disease. It provides information on age-related characteristics of the neutrophil net-forming function in tuberculosis infection.