Почему при прочих равных условиях (возраст, пол, национальность, социальный статус, заражение одним и тем же штаммом микобактерий и т. п.) у одного человека может развиться ограниченный туберкулез с преимущественно пролиферативными реакциями, а у другого – распространенный с выраженным казеозным компонентом? В обоих случаях тяжесть течения заболевания будет обусловлена особенностями макроорганизма, то есть состоянием иммунной системы больного и наличием у него сопутствующих заболеваний. В связи с тем, что адекватность иммунного ответа обусловлена в том числе и генотипом конкретного пациента, для выявления взаимосвязи полиморфизмов генов с частотой развития определенных заболеваний и тяжестью их течения все шире проводят исследования генома человека. В отечественной фтизиатрии фундаментальные исследования в области экспериментальной иммуногенетики в основном направлены на определение генов, контролирующих восприимчивость к туберкулезной инфекции [1, 4-6, 8, 10]. Так как образование казеозного некроза и фиброзирование – неизбежные спутники туберкулеза, и чем более выражено первое, тем массивнее будет впоследствии второе, то неизбежен интерес к выяснению иммуногенетических особенностей коллагенового обмена при данной инфекции. В таблице представлены данные разных авторов по преобладанию определенных аллель/гаплотипов у больных туберкулезом и здоровых лиц среди коренного населения разных стран.

The article presents the comparative description of multiple resistant tuberculosis patients (MDR TB) abusing alcohol (group 1 – 169 people), and not abusing alcohol (group 2 – 122 persons); the frequency and specificity of adverse reaction to anti-tuberculosis drugs, immediate and postponed treatment outcomes have been studied. The negative effect of the alcohol abuse on the majority of the studied rates has been found out. Disseminated forms, fibrous cavernous tuberculosis, intoxication syndrome, chronic respiratory, intestinal and liver diseases, as well as incarceration experience are observed more often among alcohol dependent MDR TB patients. It is confidently true that adverse reactions occur more often (84.6% versus 57.6%), including toxic reactions, they are more severe and intractable, especially hepato- and neuro-toxic ones.

Efficiency of in-patient treatment is confidently lower in the 1st group – 61.7% versus 82.8%. The cessation of bacillary excretion was lower (69.7% versus 85.6%). The hospital mortality was also higher in the 1st group (8.6% versus 0.9%).

The postponed results of 2 – 6 year follow up are worse in the patients abusing alcohol. The successful treatment outcomes with criteria of cured, treatment completed were observed in the 60.4% in the 1st group of patient, while in the 2nd group this rate made 80.8% (p < 0.05), the mortality and disability rates were also higher as well as the number of patients in whom bacillary excretion persisted (38.3% versus 19.2%, p < 0.05).

70% of patients demonstrated favorable treatment outcomes. 

The sensitivity of skin test with tuberculous allergen in TB/HIV patients has need studied (n = 36) depending on the immune deficiency and the character of tuberculous inflammation. The comparison group included patients with HIV infection and no tuberculosis (n = 54). The test results in HIV patients but without tuberculosis and in the patients with the concurrent condition are directly connected to the degree of immune deficiency. In the patients with HIV infection and progressing tuberculosis the negative results of the test are due to secondary anergy. The patients with severe and expressed immune deficiency the negative results do not exclude the activeness of the infection, thus patients with CD4 level up to 350 + cl/mcl and negative results can be referred as a group of high risk of developing tuberculosis.

106 elderly and aged patients suffering from new respiratory tuberculosis were examined. In 43% of patients tuberculosis was detected during examination for some other disorders. Manifestations of tuberculosis were subclinical. X ray signs of new tuberculosis were found against the background of the treated primary tuberculosis, non-specific pulmonary diseases, engorgement in pulmonary blood circulation, age-related changes in the lung tissue. The tuberculous lesions were not extensive and as a rule unilateral.

The resected material obtained during treatment of destructive pulmonary tuberculosis patients was analyzed, the treatment included bronchial valve block. The majority of patients from comparison group – 23(92.0%) and 6 (40.0%) from the main group (p = 0.0007, Fisher’s exact test – FET) manifested the signs of specific and non-specific pulmonary inflammation at the moment of surgery. Symptoms of chronic bronchitis were detected in 32 (80.8%) patients, of them in 12 (80.0%) in the main group and in 20 (80.0%) patients in the comparison group (p = 0.6, FET). It has been found out that the use of bronchial valve block in the observed patients did not cause the development or exacerbation of chronic bronchitis.

The specific features of respiratory tuberculosis with concurrent conjunctive tissue dysplasia have been studied in 308 patients. Conjunctive tissue dysplasia was found in 69.1% of patients basing on availability of phenotypic manifestations and X-ray signs of chest organs dysplasia. It has been found out that the course of pulmonary tuberculosis is more severe in those with conjunctive tissue dysplasia: only they have such clinical forms as caseous pneumonia, disseminated and miliary tuberculosis. Destruction was 2 fold higher and bacillary excretion was 2.5 fold higher in those suffering from conjunctive tissue dysplasia.

Conjunctive tissue dysplasia is a risk factor of tuberculosis complications. 

The study included 287 cultures of tuberculous mycobacteria received from specimens of patients from Khanty-Mansiysky TB Dispensary in 2011-2012. Patients from Khanty-Mansiysky TB Dispensary have a fairly high rate (24.0%) of co-infection of TB and HIV, especially among urban population (26.8%) compared to rural (13.6%) citizens. When analyzing the drug susceptibility of tuberculous mycobacteria isolated from pulmonary tuberculosis patients it has been found out that multiple drug resistant strains prevailed in the regions (56.8% of all drug resistant strains), and among them in more than a half of cases the strains were resistant not only to HR but to 3-4 additional TB drugs (29.3% of the total number of tested strains), which significantly increases the risk of treatment failure.

52 pulmonary tuberculosis patients with concurrent diabetes and 76 pulmonary tuberculosis patients without concurrent diabetes (control group) have been examined. Systemic inflammation response syndrome (SIRS) has been evaluated by the concentration in the blood serum (plasma) of C-reactive protein, A serum amyloid protein, α1 -antitrypsin, haptoglobin and fibrinogen; nutritive status has been assessed by body mass index and concentrations in the blood serum of general protein, albumin and transthyretin. It has been found out that SIRS in those with concurrent conditions was less expressed compared to the control group. In particular in 56.9% of them the rates of C-reactive protein were within normal limits (in control group in 19.7%, p < 0.01). When evaluating the nutritive status in pulmonary tuberculosis patients with concurrent diabetes as per transthyretin and general protein, the protein deprivation (nitrogenous) has been found out along with paradox tendency in albumin and body mass index increase. The control group demonstrated less expressed signs of protein deprivation, but they were followed by the adequate reduction of albumin and body mass index. The detected changes allow presuming that the negative effect of diabetes on the course of pulmonary tuberculosis is determined by defective formation of SIRS, destroying its initial protective character and nitrogenous deprivation, restraining the reparation.

The article presents the clinical case of extrapulmonary multi-organ tuberculous lesion with involvement of the spine, urogenital and abdominal systems with no clinical manifestations.

Абдоминальный туберкулез, в том числе мезаденит, является наиболее сложной для диагностики локализацией специфического процесса [2, 3, 7]. Положение еще больше усложняется при сочетании туберкулеза с ВИЧ-инфекцией или другими заболеваниями [6].