Phthisiatrician-patient cooperation, the efficiency of which largely depends is influenced by the outcome of treatment, is one of the aspects of antituberculosis therapy. This review gives a brief general characterization of studies dealing with physician-patient relationships and details the issues of communication having regard to the specific features of phthisiatrician specialty.

The hygienic, social, and clinical factors were studied in the foci of tuberculosis infection. The social status of an infection focus, the clinical form of tuberculosis, the duration of the disease of a source, massive bacterial excretion, small living space per capita, the level of insolation and microclimate were found to affect the incidence of tuberculosis in contact patients.

This publication presents the current methodical approaches and organizational aspects of the diagnosis and differential diagnosis of multidrug-resistant tuberculosis, which should be applied at all stages and levels of medical care. The use of an algorithm for the differential diagnosis of tuberculosis and the commission consideration of each unclear case make it possible to reduce the number of diagnostic errors, to timely make a correct diagnosis, and to use adequate etiotropic therapy.

The social, clinical, radiological, and bacteriological causes of DOTS-PLUS failure were analyzed. According to the findings, diagnosis at the early stage of fibrocavernous tuberculosis, respiratory failure, or hemoptysis in the presence of chronic bronchitis, gastrointestinal and urinary tract diseases, as well as in prison increased the risk of poor therapy outcome. Massive bacterial excretion, high rate of secondary resistance development in Mycobacterium tuberculosis, and its drug resistance to five agents or more are maximally associated with treatment failure in patients with multidrug-resistant tuberculosis.

The purpose of the investigation was to study trends in the prevalence of recurrent pulmonary tuberculosis and the efficiency of treatment in patients of this group from the civil sector of the Arkhangelsk Region in 2003 to 2009. There is evidence supporting that the epidemic situation has been recently improved, with the incidence of recurrent tuberculosis decreasing from 12.4 in 2003 to 7.8 per 100,000 population in 2009. There was a significant rise in the rates of multidrug-resistant tuberculosis among patients with its recurrences (29.2 and 32.5% in 2003 and 2009, respectively; p = 0.009542). Among the recurrent cases of the disease, the rate of bacteriological diagnosis verification increased from 16.3% in 2003 to 78.0% in 2009. Drug resistance in Mycobacterium tuberculosis among the recurrences remains high. Among the bacillary patients with recurrences, the proportion of those with multidrug-resistant tuberculosis was 55% in 2003 and 55.7% in 2009. There was one case of broad-spectrum drug resistance in the pathogen in 2005, 2007, and 2009. During the follow-up, the therapeutic efficiency decreased; this was due to the large number of cases who discontinued treatment for multidrug-resistant tuberculosis.

The Xpert MTB/RIF analysis was used to test 3,829 autopsy specimens. The detection rate of rifampicin-resistant tuberculosis averaged 13%. The fact that the detection rate of patients with multidrug-resistant tuberculosis was 5% among the new cases with negative sputum smears and almost 20% among the pretreated patients who had also negative smear microscopy engages our attention.

In vitro and ex vivo models for culturing different M. tuberculosis genotypic clusters (8 W cluster strains, 3 AI cluster ones, and 1 BJ and laboratory virulent strain H37Rv) in murine peritoneal macrophages yielded results of expression of the two basic genes icl and hspX induced by M. tuberculosis entering the macrophages. The housekeeping rrs16S gene was used as reference. The polymorphism of strains of different clusters and those of one cluster was revealed from the expression of the icl and hspX genes when cultured in the medium and macrophages. It was shown that there were 3-122- and 2-514-fold increases in the expression of the icl and hspX genes when cultured in the macrophage as compared to their in vitro growth. The expression of the icl gene showed a not more than 30- fold difference between the strains. The difference in the expression of the hspX gene that is a marker of transition to dormancy was 140 times greater. A strain with hspX gene overexpression was identified in vitro and ex vitro. This strain was referred to as a W148 subcluster that was 30% of the W strains circulating in the Russian Federation. The increased MBT W cluster constitutive expression of the hspX gene included in the dormancy regulon may provide these strains some advantages for survival in the host.

Drug susceptibility tests were monthly carried out in 41 patients treated in the multidrug-resistant tuberculosis unit. All cultures were examined using the molecular genetic methods IS6110 RFLP and MIRU-VNTR in 10 patients with a changed result of the drug susceptibility test. Molecular genetic examination of nosocomial infection showed that the likelihood of in-hospital infection in the specialized hospital unit for patients with multidrug-resistant tuberculosis was 19.5%.

The paper describes a clinical case of Mycobacterium abscessus infection in the practice of a phthisiatrician. Bacteriological examination of specimens with isolation of a Mycobacterium culture and its identification is of great importance in making a correct diagnosis.

Reply to professor M. A. Vladimirsky’s open letter Immunological tests using Mycobacterium tuberculosis-specific proteins ESAT-6 and CFP-10.

В сентябре 2013 г. исполнилось 90 лет заслуженному деятелю науки, доктору медицинских наук, профессору Вере Аркадьевне Фирсовой.