Studying the targets and indicators of the Public Health Development Program up to 2020 concerning antituberculosis (anti-TB) care to the population may lead to the conclusion that they may be fulfilled in the Russian Federation as a whole. The difficulties in fulfilling the indicators are associated with the low level of tuberculosis detection in a number of subjects of the Russian Federation; the continuing development of the HIV epidemic; the inadequate development of bacteriological diagnosis of the drug sensitivity of the tuberculosis pathogen to anti-TB drugs; the nonuniform funding of anti-TB measures in the subjects of the Russian Federation – the annual financing per tuberculosis patient differs by 40 times, including that of the purchase of anti-TB drugs by 63 times. Having no federal financial assistance in purchasing reserve anti-TB drugs and consumables for microbiological tests, it is impossible to diagnose multidrug resistance and to cure patients with multidrug-resistant tuberculosis at the expense of the budgets of the Russian Federation’s subjects.

The characteristics of patients receiving tuberculosis retreatment cycles, including those with recurrent tuberculosis, treatment after an ineffective chemotherapy cycle or discontinuation of a chemotherapy cycle, and other retreatment cases were studied. Only a portion of the total number of cases to be treated was established to be registered for treatment. A category of patients receiving treatment after a previous ineffective chemotherapy cycle is most difficult to treat. Among them, there are a very large proportion of cases with positive sputum smear microscopy results and that of patients with multidrug-resistant tuberculosis. The most common cause of a poor outcome was the detection of multidrug-resistant pathogen in patients with recurrent pulmonary tuberculosis and poor compliance in other retreatment cases.

A demand arose for estimating the risk factors influencing the results of treatment for their objective assessment in patients with new-onset pulmonary tuberculosis.

Objective: to estimate risk factors influencing the results of treatment in patients with new-onset pulmonary tuberculosis to provide a rationale for new approaches to their registration and treatment assessment.

Subjects and methods. Information about 227 pulmonary tuberculosis patients registered to be treated in the Ryazan Regional Tuberculosis Dispensary in 2011 was obtained from the reporting forms of the Ministry of Health of Russia. For their analysis, an inquiry schedule consisting of 32 characteristics was worked out. The methods of a multifactorial analysis were applied.

Results. The multifactorial analysis showed that there was a deep relationship between two factors: bacterial excretion and pulmonary cavitation. It was determined that the number of cohorts of pulmonary tuberculosis patients to be registered should be increased from 4 to 6. An effective treatment outcome, or clinical resolution, is indicative of the presence of two signs (cessation of bacterial excretion and closure of pulmonary cavities) and it is a uniform criterion for assessing the results of treatment in all patents with pulmonary tuberculosis regardless of the cohort they had been registered in. Changing a treatment regimen requires that the patient should be re-registered in another respective cohort. 

The long-term results of treatment were studied in multidrug-resistant tuberculosis (MDR-TB) patients who had interrupted a chemotherapy cycle in the civil sector of the Arkhangelsk Region. In January 2005 to December 2009, interrupted treatment for MDR-TB was registered in 211 patients. All the patients were divided into 4 groups: 1) 74 patients who had taken less than 100 doses of antituberculosis drugs; 2) 64 patients who had received 100 to 200 doses; 3) 34 patients who had 200 to 300 doses; 4) 39 patients who had more than 300 but less than 720 doses. A comparative analysis of the long-term results of treatment in MDR-TB patients who had interrupted treatment showed that the percentage of clinical resolution increased and tuberculosis death rates decreased in relation to the number of taken drug doses. The clinical resolution rate in the patients who had interrupted treatment for MDR-TB and received more than 300 but less than 720 doses (for more than 10 months) was ascertained to be high and equal to 79.5%. In the patients who had completed a treatment cycle for MDR-TB, the latter recurred in 5.2% of cases on average during a 2-year follow-up. A repeated chemotherapy cycle was recorded in 10.2% of the patients who had been treated for more than 10 months and who had interrupted a chemotherapy course. Further investigations are needed to decide whether MDR-TB chemotherapy cycle should be reduced to 10-12 months.

Objective: to study the impact of long-term occupational exposure to tuberculosis infection on the immune response of tuberculosis hospital workers. In this category of people versus tuberculin-positive persons having no household or occupational contacts, the investigators assessed the results of Diaskintest and determined the spontaneous and H37Rv and ESAT-6 antigen-stimulated production of IFN-γ and anti-M. tuberculosis antibodies in peripheral blood. The functional abilities of immunocompetent cells were not established to be exhausted in the workers of tuberculosis institutions due to their long-term contact with M. tuberculosis-excreting patients; however, among these examinees, there was a group of patients who had latent tuberculosis infection and needed preventive measures against active tuberculosis. 

The paper gives data on the incidence of tuberculosis in students from the higher educational institutions of Voronezh during 2000-2013. In this period there were 261 sick students; the mean morbidity rate was 29.09 ± 2.12 per 100,000 students. The majority (75.86%) of the students fell ill with tuberculosis during the first 3-year study at the institution. Pulmonary and extrapulmonary tuberculosis was identified in 250 and 11 students, respectively. Primary pulmonary tuberculosis was detected in 4% and secondary one in 96%, including 32.80% with lung tissue breakdown and 33.20% with excretion of Mycobacterium tuberculosis and sputum. The incidence rate of tuberculosis was noted to be highest at the Medical Institute and least at the Institute of Physical Education. It has been concluded that it is expedient to make tuberculin diagnosis at the Preparatory Faculty and during first-second year studies in order to early detect tuberculosis and it is necessary to extensively use a variety of sports and fitness measures at the institutions.

The incidence of tuberculosis was estimated in different age groups of people, applying the digital computer information technologies of tracking. For this, the author used the annual forms of the reporting materials stipulated by the Ministry of Health of Ukraine, the results of his observations, and the data of bank information accumulation in the MS Excel system. The initial positions were formed in terms of the epidemiological indicators of Ukraine and the Lvov Region during a 10-year period (2000-2009) that was, in relation with different initial characteristics, divided into Step 1 (2000-2004) in which the tuberculosis epidemic situation progressively deteriorated and Step 2 (2005-2009) in which relative morbidity was relatively stabilized. The results were processed using the MS Excel statistical and mathematical functions that were parametric and nonparametric in establishing a correlation when estimating the changes in epidemic parameters. The findings of studies among the general population could lead to the conclusion that the mean tuberculosis morbidity in Ukraine was much greater than that in the Lvov Region irrespective of the age of a population. At the same time, the morbidity rate in the foci of tuberculosis infection suggested that it rose among both the children, adolescents, and adults, which provided a rationale for that therapeutic and preventive measures should be better implemented.

The paper describes the experience in treating 30 patients with drug- and multidrug-resistant tuberculosis and HIV infection (median CD4+ lymphocyte count was 629 cells/µl; 8 patients received antiretroviral therapy). Only 11 (36.7%) patients effectively completed a basic treatment cycle; failing therapy was stated in 3 (10%) patients and it was associated with the amplification of drug resistance (n = 2) and progressive tuberculosis with generalization in a patient with low baseline CD4+ lymphocyte counts (101 cells/µl) (n = 1); early treatment termination was seen in 16 (53.3%) cases. Fourteen (46.7%) patients were noted to have adverse events of treatment with second-line (reserve) drugs, among which allergic reactions were prevalent (n = 7 (23.3%)).

Based on a real-time PCR technology using an original-design system of allele-specific, fluorophore-labelled primers complementary to the sequence of a fluorescence quencher, the authors developed a method and test system prototypes for the rapid determination of Mycobacterium tuberculosis (MBT) DNA mutations responsible for resistance to reserve anti-TB drugs, such as fluoroquinolones, amikacin, and capreomycin.

To study drug susceptibility, an Amplitube-MDR-RV molecular genetic test system was used to investigate sputum smears from 68 patients with destructive pulmonary tuberculosis who had been long treated with first- and second-line drugs (53 patients). These patients excreted multidrug-resistant MBT in 51 (75%) cases. All obtained MBT DNA samples were also examined for resistance to fluoroquinolones, amikacin, and capreomycin, by employing both the developed method and prototype reagent kits and by conventional culture methods. Molecular genetic analysis established that the study had a sensitivity of 90% and a specificity of 96%. 

This experimental study established DL50 (mg/kg), the degree of toxicity, and a hazard class for 17 antituberculosis drugs (OAO «Farmasintez», Irkutsk). Experiments were performed on experimental biological models: albino outbred rats (n = 3 400) and mice (n = 3 400). The incorporation of pyridoxine hydrochloride into combined antituberculosis drugs was found to considerably decrease their toxicity.

Pulmonary Langerhans cell granulomatosis is a rare disease. Its causes are unknown and accurate data on its prevalence are lacking. This disease is characterized by the formation of lung tissue granulomas consisting of activated Langerhans cells, lymphocytes, eosinophils, and macrophages. It is mainly encountered in young 20-40-year-olds, generally in heavy smokers. To establish its valid diagnosis, lung biopsy, followed thorough morphological examination of its obtained specimens, is needed for a valid diagnosis. Langerhans cell granulomatosis in its very advanced stage is very difficult to diagnose even histologically. Lung lesion may be primary and sporadic or concurrent with extrapulmonary lesions in other organs and tissues. The paper describe case of pulmonary Langerhans cell granulomatosis.