The growing changes in migration and mobility of the population in Russia require additional study of the epidemic situation related to infectious diseases and evaluation of preparedness of specialized medical services and existing resources of the health care system. Assessment of the incidence rates shows the higher figures among foreign citizens compared to native population as regards tuberculosis (2013: 163.2 versus 61.6 per 100,000 population) and lower figures for HIV-infection (107.5 versus 315.1 respectively).

The study of behavioral risks of acquiring infectious diseases (HIV-infection, sexually transmitted diseases, tuberculosis) and socio-economic living conditions and factors influencing on the self-referral to the Russian medical units conducted among labor migrants in St. Petersburg, showed fairly low level of awareness of socially important diseases and protection from infections in migrants. Due to the fear of deportation in case of detection of infectious diseases, high price of medical services and lack of motivation of the employer to pay for medical insurance, migrants often practice self-treatment. Very few migrants (10%) present themselves for mandatory annual fluorography screening.

A significant flow of refugees from Ukraine especially from the regions with high risk of infectious diseases require special attention from the Russian Ministry of Health and the relevant financial support.

There is also a lack of cooperation between bodies of Rospotrebnadzor and medical units submitting data on notifications of HIV-infection and tuberculosis in foreign citizens. Coordination mechanisms have to be improved to overcome the found deficiencies. 

The character of tuberculous disease and treatment e¦ciency of tuberculosis detected in 140 women after the delivery have been studied. 96 women were included into the main group with tuberculosis diagnosed in the maternity hospital and 44 women were included into the control group with tuberculosis diagnosed in various time periods after the discharge from the maternity hospital (before introduction of mandatory fluorography screening in the maternity hospitals). The mandatory fluorography screening in the maternity hospitals allows timely detection of tuberculosis in the vast majority of cases and achieving favorable outcomes with clinical cure in 95.8% of cases. Wider introduction of this approach is recommended given the epidemics of tuberculosis.

Clinical and X-ray manifestations of spondylites caused by strains of M. bovis BCG and non-vaccination strains of M. tuberculosis complex have been compared in children. Significant di}erences between groups have been found only in the number of a}ected spondyles, value of ESR and leukocytes quantity. No di}erence has been found in the level of the lesion, frequency of specific abscesses, neurologic disorders and hyperergic reaction to 2TU Mantoux tests.

Publication type: comparison of clinical cohorts. Level of evidence – 3. 

Formation of bronchopleural fistulas after surgical reduction of pulmonary volume is one of the most frequent complications of surgical treatment of pulmonary emphysema. In order to control bronchopleural fistulas in the patients after surgical reduction of pulmonary volume the technique of valve bronchial block has been o}ered. This technique has been applied in 7 patients, and the favorable outcomes have been achieved in 6 (85.7%) patients. The use of endobronchial valve for occlusion of fistulous bronchi allowed stopping air leaking through drainages, reducing time for pleural cavity drain and decreasing duration of patients' hospital stay.

The retrospective study of surgical treatment of 463 tuberculosis spondylitis patients having 745 surgical operations has been conducted. Post-surgery complications have been found in 96 (12.9%) patients. Nosocomial infection was observed as early post-surgery complication in 23 (3.1%) patients. Some postponed complications in 16 (2.3%) patients were due to the progress of the specific lesions. The application of combined implants as well as early surgical treatment of patients with non-complicated course of tuberculosis spondylitis without any significant dysfunction of main organs and systems and potential mortality threat, were followed by less number of post-surgery complications.

Changes in the bronchial patency, its correlation with initial manifestations of bronchial obstruction and with the rate of clinical and X-ray changes of tuberculosis disease have been assessed in 215 patients su}ering from active pulmonary tuberculosis. The administered therapy improved the bronchial patency only in 40.5% of pulmonary tuberculosis patients with bronchial obstruction. Functional changes were more often observed in the patients with initially minor or moderate obstructive disorders. Correlation between functional changes has been found including changes in viscous respiratory resistance and changes in tuberculosis disease. Changes in viscous respiratory resistance during the treatment of pulmonary tuberculosis changes with bronchial obstruction can be considered as an indicator of tuberculosis disease. The obtained results provide the evidence of the stable and clear influence of bronchial obstruction on clinical and x-ray changes of pulmonary tuberculosis, which points out at the need of monitoring the respiratory function and timely prescription of comprehensive broncholytic therapy to pulmonary tuberculosis patients.

New untreated infiltrate pulmonary tuberculosis patients commonly demonstrated the same referent level of MMP-8, MMP-3 and multiple increase of MMP-9 level on the background of diverse changes of inhibiting potential (retaining the reference level of TIMP-1 and reduced α2 -МG). Destructive process is related to unbalanced increase of рro-ММР-1 and ММР-9. At the same time the level of рro-ММР-1 correlates to changes in ROF, activity of proteinases of other classes (serine proteinases) and depends on the dissemination of the disease, while the changes in MMP-9 level are influenced by the massiveness of bacillary excretion. 

The goal of the study is to assess the changes in spontaneous and antigen-induced production of macrophages and interleukin-8 in destructive tuberculosis patients during the intensive phase of treatment. The cultures of whole blood of 38 destructive tuberculosis patients were used as a source of macrophages and interleukin-8 production, and the patients were divided depending on procalcitonin semiquantitative test (BRAHMS PCT-Q) results into the group of PCT+ (15 patients) and the group of PCT- (23 patients). Production of macrophages and interleukin-8 were assessed in the cultured blood for 20-22 hours. Antigen-induced synthesis of macrophages was assessed after adding 20 mkg/ml of PPD or 1 mkg/ml of ESAT 6/CFP 10. Production of cytokines was tested by enzyme immunoassay. It has been found that the rates of spontaneous production of macrophages or interleukin-8 in the cultured blood reflect the changes in the production of these factors and can be used without consideration of antigen-induced synthesis; spontaneous production of macrophages in patients with positive test for PCT confidently decreases and production of IL-8 confidently goes up by the 2nd month of anti-tuberculosis chemotherapy; changes in spontaneous production of macrophages di}er in patients with the various course of destructive tuberculosis (favorable, torpid, progressing). In the favorable course of the disease production of macrophages increases, in torpid or progressing ones – goes down or stays unchanged.

Несмотря на снижение заболеваемости и смертности от туберкулеза, эффективность лечения заболевания остается низкой и составляет в России среди впервые выявленных пациентов менее 69,6% по  показателю прекращения бактериовыделения и 61,4% – по показателю закрытия деструкций. Среди рецидивов данные показатели еще ниже – 47,4 и 41,0% соответственно [6]. Это обусловлено, в первую очередь, ежегодным увеличением числа больных туберкулезом с множественной и широкой лекарственной устойчивостью возбудителя (МЛУ/ШЛУ МБТ), что создает серьезные медицинские и финансовые проблемы в здравоохранении.

2 cases of BCG ostitis, developing in 2-4 years after vaccination with BCG-M were followed up. Potential risk factors of their developing could be subinfections and traumas.

The clinical case of mycobacteriosis caused by drug resistant strains of M. avium (subspecies of hominissuis), was observed in the patient su}ering from HIV at the stage of AIDS. The severity of immune deficiency and the absence of opportunity for antibacterial and antiviral therapy promoted the rapid progression of mycobacteriosis, early lymphogeneous generalization and the lethal outcome in 16 months from the start of the disease. Mycobacteriosis in this clinical case was specifically characterized by the massive bacterial semination, the absence of specific granulomatous changes in parenchymal organs, massive lesion of lymph nodes with extensive necrosis and the presence of para-specific changes. It highlights the similarity of mycobacteriosis pathogenesis with pathogenesis of primary tuberculosis.