The objective: to study the species and quantitative composition of fecal microbiota in children undergoing chemotherapy for drug-resistant respiratory tuberculosis.

Subjects and Methods. The study included 17 children from 2 to 12 years old with respiratory tuberculosis who received treatment for drug-resistant respiratory tuberculosis from 2022 to 2024 at Central Tuberculosis Research Institute. Fecal microbiota was tested by real-time PCR using the ENTEROFLOR® Children reagent kit at the following time points: before the start of chemotherapy, after 2 and 4 months of chemotherapy.

Results. The most pronounced disturbances in the intestinal microbiocenosis among representatives of normobiota were noted after 2 months of chemotherapy; by 4 months, those parameters did not deteriorate either in quantitative terms or frequency of deviations from reference values: for representatives of the phylum Actinomycetota (Actinobacteria) – in Bifidobacterium spp. and Coriobacteriia, for representatives of the phylum Bacteroidota (Bacteroidetes) – in Butyricimonas spp., Parabacteroides spp., Prevotella spp. Changes in the composition of normobiota were associated with the elevated proportion of opportunistic microbiota by 2 months and persistence of these values by 4 months of chemotherapy. Representatives of pathogenic microbiota, which were not present before chemotherapy, appeared by 2 months of chemotherapy with the following frequency: Streptococcus agalactiae – in 35.3% of cases, Clostridioides difficile, with the toxigenic genes cdtA and cdtB – in 58.9%, and increasing to 71.5% by 4 months of chemotherapy.

Conclusion. Treatment with chemotherapy regimens for drug-resistant tuberculosis has a statistically significant negative impact on intestinal microbiota in children: the proportion of normobiota decreases, the proportion of opportunistic microbiota increases, and pathogenic microbiota develops.

The objective: to analyze results of preventive chemotherapy of tuberculosis in HIV-infected women of the reproductive age.

Subjects and Methods. The results of tuberculosis preventive chemotherapy were retrospectively analyzed in 675 HIV-positive women aged 18-44 years for 2015-2019 (continuous sampling). The comparison group consisted of 6018 HIV-infected female patients of the same age who received no preventive chemotherapy of tuberculosis during the analyzed period.

Results. The average age of women receiving preventive chemotherapy of tuberculosis (PC TB+ Group) made 32.9±0.2 years. Isoniazid was well tolerated with the drug discontinued due to adverse events only in 11/675 (1.6±2.9%) women. Only 316/675 (46.8±3.6%) women completed the full 6-month course of preventive chemotherapy; the rest defaulted within the first 3 months. From PC TB+ Group, 19/675 (0.7±2.7%) patients developed tuberculosis within the next 5 years. Among 348 women who defaulted within the first 3 months, 17 (4.9±1.5%) developed tuberculosis.

Conclusion. The obtained results prove the feasibility of preventive chemotherapy of tuberculosis in HIV-positive women of the reproductive age, as it reduces the incidence of tuberculosis in the following 5 years (19/675 (0.7±2.7% versus 447/6018 (7.4±2.7%) women who developed TB, OR = 2.77, CI (1.73-4.42)). Even though 46.8±3.6% of women defaulted from preventive chemotherapy within the first 3 months.

The objective: to assess the impact of detection routes (active screening and self-referral) on clinical characteristics and outcomes of respiratory tuberculosis (RTB) in HIV-positive patients.

Subjects and Methods. A continuous cohort retrospective study was conducted. Continuous sampling was used to include 446 tuberculosis patients aged 18 years and older, detected in the general medical services (GMS) from 2017 to 2024. Patients were divided into 2 groups: TB+HIV Group included 150 patients with TB/HIV co-infection, while TB Group consisted of 296 HIV-negative tuberculosis patients.

Results. It was found out that in HIV-positive patients, the probability of detecting respiratory tuberculosis by self-presentation to a medical unit exceeded that with active screening (OR=2.8). During preventive screening of HIV-positive patients, limited, uncomplicated and anatomically reversible forms of respiratory tuberculosis were predominantly (78%) detected; clinical cure was achieved in 78.4% of cases. In the patients diagnosed with respiratory tuberculosis by self-referral to outpatient units, disseminated and/or complicated forms in combination with extrathoracic localizations were detected in 73.2% of cases. When respiratory tuberculosis was detected upon admission to hospital, in 62.5% of cases, generalized, anatomically irreversible acutely progressive or chronic forms with a high vital threat were foun. The ratio of cured patients to deceased ones was 1:1 when detecting tuberculosis by visits to outpatient units and it was 1:2 when the patient was taken to hospital. In HIV-positive patients, the chances of a fatal outcome within three or more years when respiratory tuberculosis was detected by active screening is 3.3 times lower versus self-referral to outpatient units and 6.4 times lower versus inpatient treatment.

The objective: to identify the most significant social factors contributing to occurrence of early relapses of tuberculosis, to characterize the first episode of respiratory tuberculosis in patients with early relapses.

Subjects and Methods. Records of 76 patients with early relapses of respiratory tuberculosis and 92 patients who completed observation as Group 3 of dispensary follow-up without relapse were analyzed. The analysis covered the period from 2017 to 2024.

Results. Among patients who had completed treatment of tuberculosis and were transferred to Group 3 of dispensary follow-up, categories with a higher risk of early tuberculosis relapse were identified. They include those with a secondary general education or lower, unmarried individuals, homeless people, as well as those living in poorly maintained housing or dormitories, ex-prisoners, the unemployed at the moment of developing tuberculosis, and those addicted to alcohol, smoking in combination with other psychoactive substances. Early relapses occur significantly more often in patients with the following manifestations of the first episode: disseminated tuberculosis, severe bronchopulmonary syndrome, lung tissue decay, and positive results of sputum tests.

The objective: to compare results of species identification of non-tuberculous mycobacteria by PCR (Amplitub-NTM Differentsiatsia) and MALDI-TOF mass spectrometry in clinical samples and mycobacterial cultures.

Subjects and Methods. 40 clinical samples and 110 cultures of non-tuberculous mycobacteria were tested. Two methods were used for testing: Amplitub-NTM Differentsiatsia and MALDI-TOF mass spectrometry.

Results. A high level of agreement between results of MALDI-TOF mass spectrometry and Amplitub-NTMB Differentsiatsia PCR kit was demonstrated. PCR confirmed its high efficiency, detecting non-tuberculous mycobacteria in 89.3% of samples; the final match of species identification with MALDI-TOF in both clinical samples and cultures made 85.1%. Both methods demonstrate a high level of agreement and they complement each other. The PCR kit can be used as the main screening method, especially in TB laboratories. If negative or indeterminate results are obtained, combination with MALDI-TOF or sequencing is recommended The optimal diagnostic strategy involves the use of PCR as a part of comprehensive approach to non-tuberculous mycobacteria identification.

The objective: to study the potential effect of sarcopenic obesity (SO) on the course of chronic obstructive pulmonary disease (COPD) in elderly men.

Subjects and Methods. Seventy-four men aged 60-74 years were examined. All of them had COPD GOLD II, Group A or B, and a post-bronchodilator FEV1/FVC ratio <0.7, COPD Assessment Test < 20 points. 36 patients had sarcopenic obesity.

Results. Patients with COPD+SO versus COPD Group were older (p=0.047), had more pronounced inflammaging according to the neutrophil/lymphocyte ratio (NLR), monocyte/lymphocyte ratio (MLR), and systemic inflammatory index. When assessing relationship between MLR and percentage of body fat (PBF), a direct relationship was established (p=0.842, p<0.001). In COPD+SO Group, FEV1 values were lower (p=0.010), and the chance of moderate dyspnea (mMRS=2) was 9.7 times higher. The impact of COPD on the quality of life of patients (according to SAT test) was 8.4 times higher when combined with SO. Patients with mild dyspnea (0-1 as per) had significantly higher muscle mass values than those with moderate or severe dyspnea, regardless of their SO status (p=0.04). Patients with COPD+SO had more pronounced impairments of their physical activity according to the 6MW and 5.squat-stand tests (p<0.001).

The objective: to study tuberculosis relapses in Kaluga Region.

Subjects and Methods. A retrospective study of all reported tuberculosis cases in Kaluga Region in 2019-2023 (n=996) was conducted. It included 817 new tuberculosis cases (New TB Cases Group) and 179 tuberculosis relapses (TB Relapses Group).

Results. Tuberculosis relapses were significantly more often detected among patients with disabilities due to other diseases (p<0.05), 52.3% of tuberculosis relapses were the cases reported 10 years or more after the cure of tuberculosis. Relapses versus new cases of tuberculosis more often had a positive result of sputum tests, (68.4% versus 58.6%, p=0.017), multiple and extensive drug resistance (46.9% and 3.4% versus 16.4% and 0.9%, p<0.05), and lung tissue decay (61.6% versus 46.95%, p<0.001). In the group of tuberculosis relapses, lethal outcomes from tuberculosis were more frequently reported (6.7% versus 2.8%; p=0.010), while in the group of new cases, postmortem diagnosis of tuberculosis was more frequent (6.0% versus 1.1%, p=0.007), which indicated untimely diagnosis of the disease.

The objective: to identify specific clinical, radiological, and laboratory changes in the patients with pulmonary mycobacteriosis caused by M. avium or M. kansasii.

Subjects and Methods. An open retrospective cohort study was conducted. Examinations of 102 patients with confirmed pulmonary mycobacteriosis caused by M. avium or M. kansasii were analyzed. Among those examined, 79 (77.5%) were women and 23 (22.5%) were men. The age of patients ranged from 21 to 86 years old, the average age was 54.2 ±14.64 years old. All patients included in the study had newly detected changes in the lungs (foci, dissemination, and cavities); during the examination patients’ history was collected, and a physical examination was performed.

Results. In pulmonary MB caused by M. kansasii, a cavitary radiological form was typical – 66.6% versus 16.6% for MB caused by M. avium (p<0.05); in MB caused by M. avium, the bronchiectatic form developed in 53% versus 22.7% for MB caused by M. kansasii (p<0.05). In 63.4% of cases, the intoxication syndrome prevailed among clinical signs of MB. Concomitant pathology was reported in MB cases caused by M. avium in 68.1% versus 31.8% cases caused by M. kansasii (p<0.05). The absence of concomitant diseases in pulmonary MB was reported in 63.8% of cases caused by M. kansasii versus 38.8% caused by M. avium (p<0.05). In MB, the ventilation capacity of the lungs was often impaired according to the obstructive type.

The objective: to study results of using surgical methods for diagnosis and treatment of pulmonary mycobacteriosis.

Subjects and Methods. The study was conducted in Thoracic Surgery Department of National Medical Research Center of Phthisiopulmonology and Infectious Diseases, Russian Ministry of Health, from 2022 to 2024. The data of 29 patients with pulmonary mycobacteriosis were analyzed. All those patient underwent surgical treatment, 22 patients had it for therapeutic and diagnostic purposes, and 7 for therapeutic purposes only. Non-tuberculous mycobacteria (NTMB) from specimens were detected by fluorescence microscopy, molecular genetic methods, and culture on liquid nutrient media. When isolating NTMB culture, mass spectrometry was used for species identification.

Results. In 22 patients with suspected pulmonary mycobacteriosis without bacteriological confirmation before surgery, 16 segmentectomies, 4 lobectomies, and 2 combined resections were performed. By culture of surgical specimens on liquid nutrient media, growth of NTMB was obtained in 9/22 (40.9%) patients. The species spectrum of NTMB included M. chimaera intracellulare group, M. xenopi, and M. kansasii (3 cases each, 33.3%). Using the molecular genetic method, NTMBs were obtained in 20/22 (91%) patients.

The article describes a rare autoimmune disease – eosinophilic granulomatosis with polyangiitis (Churg-Strauss syndrome) and presents a clinical case . The diagnosis was determined according to the established diagnostic criteria (bronchial asthma, blood eosinophilia - 61.2%, sciatic nerve neuropathy, pulmonary infiltrates, catarrhal polysinusitis, extravascular eosinophilia – eosinophils in sputum and bronchoalveolar lavaged) only 5 months after the onset of the disease. Prior to this, the patient had been hospitalized several times with suspected COVID-19.

The article presents a clinical case of cure of pulmonary mycobacteriosis (MB) with healing of a pathological cavity that developed as a result of Mycobacterium kansasii invasion. The combination of individually selected anti-mycobacteriosis chemotherapy and implantation of an endobronchial valve in the upper lobe bronchus of the right lung, draining the cavity, made it possible to achieve this result in a patient with a history of pulmonary embolism and other localizations of thrombosis, which was a contraindication for the lung resections.

The review analyzes 67 publications from international and Russian databases (PubMed, Scopus, elibrary), publications were selected by the following keywords: «abdominal tuberculosis», «pathogenesis», and «classification». This article presents contemporary data on the pathogenesis, classification and diagnosis of abdominal tuberculosis (ATB). It defines pathogenetic signs of peritonitis, enterocolitis, mesadenitis, splenitis, and hepatitis of tuberculous etiology. It presents classifications of ATB used worldwide. Based on them, a convenient clinical classification of ATB is offered including complications requiring surgical interventions.

The detection of latent tuberculosis infection (LTBI) is essential for improving the epidemiological situation in the region. As tuberculosis prevalence declines, identifying LTBI in risk groups becomes increasingly significant. At present, no method exists that can reliably confirm or exclude the presence of latent tuberculosis infection. In this study, we analyzed 71 publications on methods for LTBI detection, including modern immunological tests based on Mycobacterium tuberculosis antigens ESAT-6 and CFP-10, as well as interferon-γ release assays (IGRAs). Developing diagnostic strategies for LTBI is particularly relevant for individuals with diabetes mellitus, congenital or acquired immunodeficiency, those receiving immunosuppressive therapy, patients undergoing hemodialysis, as well as for children and the elderly. The search for novel LTBI biomarkers using artificial intelligence, aimed at improving detection and predicting the progression to active tuberculosis seems to be promising advancement in phthisiology.

Oxazolidinones represent a promising class of drugs for treatment of multidrug-resistant tuberculosis (MDR-TB). Linezolid, the first representative of this class, is highly effective; however, its use is limited due to its toxicity (myelosuppression, neuropathy). 63 publications were analyzed in order to search for new oxazolidinones for treatment of tuberculosis. New drugs and compounds (tedizolid, sutezolid, contezolid, delpazolid, and TBI-223) have a more favorable safety profile with antimycobacterial activity similar to or even greater than that of linezolid. In the coming years, these compounds may become an important component of short, safe, and effective chemotherapy regimens for tuberculosis.