The article presents the analysis of the literature on specific metabolism of anti-tuberculosis drugs depending on polymorphism of genes controlling synthesis and action of biotransformation enzymes, in particular cytochrome P-450 isozymes and enzymes of the IInd phase of biotransformation (N-acetyltransferase, glutathione S-transferase) respective adverse reactions development, first of  all hepatotoxic ones. The  possibility of pharmacogenetic studies with the evaluation of genetic predisposition to developing adverse reactions to medications has been discussed in respect of personalized approach to effective and safe treatment of tuberculosis patients.

For the last 15 years the incidence of tuberculosis decreased 1.5 fold in Russia and in 2014 it made 59.5 per 100,000 population. And for the last 5 years the part of the population covered by regular mass screening increased by 1.1 fold and achieved 67.7% in 2014. On the contrary the number of tuberculosis patients detected during the same period decreased 1.3 fold and in 2014 it made 0.044% out of the total number of those screened. This situation provides evidence that given tuberculosis incidence decreasing every year, screening is ineffective from economic point of view since the costs of one TB case detection multiply increase.

The presence of unfavorable epidemiological, medico-biological and social factors promoting development of respiratory tuberculosis has been analyzed among university students in Voronezh. The presence of one or several factors has been detected in 92.59% of students. Detection and recording of the factors promoting tuberculosis development among students is the main task of doctors in students’ polyclinics and general medical services for tuberculosis prevention and early diagnostics.

Goal of the study: to study the efficiency of using MIRU-VNTR molecular genetic technique for molecular epidemiological studies among pulmonary tuberculosis patients.

Materials and methods: 20 patients with pulmonary tuberculosis relapses, 12 pulmonary tuberculosis patients with hetero-resistant results of drug susceptibility testing, 7 patients who developed tuberculosis during staying in a medical social unit, one adult and one child exposed to tuberculosis in their families with doubtful correlation between their diseases. The genetic pattern of M. tuberculosis strains for MIRU-VNTR 9-10 loci have been compared.

Results. 55% of tuberculosis relapses are related to infection with a new M. tuberculosis strain, the remaining cases belong to re-activation of the endogenous strain of M. tuberculosis. In case of hetero-resistant results of DST the mixed infection with two strains of M. tuberculosis was found only in 1 (8.3%) out of 12 patients, in the remaining cases M. tuberculosis belonged to the one genotype but with different resistance patterns. Contact tracing of tuberculosis break-out (7 patients) in the closed medical social unit proved the presence of several sources of the infection. Contract tracing of the family exposure proved the actual infection transmission in the family and the source of the infection was identified. 

Goal of the study: to investigate the effect of low-intense laser radiation of blood on the level myeloperoxidase in those suffering from community-acquired pneumonia.

Materials and methods. 78 patients were enrolled into the study, 52 of them received the intravenous laser radiation of blood (VLOK) as per VLOK-405 technique during 7 days. The level of myeloperoxidase was tested with the help of reagents kit for blood enzyme multiplied immunoassay before and after the treatment.

Results. The analysis of the study results detected the confident improvement of myeloperoxidase rates in the group of patients receiving additional VLOK treatment. Conclusions. Using VLOK as a part of integral therapy of those suffering from community-acquired pneumonia promotes the normalization of myeloperoxidase rates. 

In order to evaluate the efficiency of treatment in day hospital for pulmonary tuberculosis patients the data for 10 years have been analyzed.

Materials and methods: epidemiological rates in Orel Region for the last 10 years have been analyzed. Day hospital has been described as a treatment format substituting the in-patient treatment. Basing of the data of 734 patients registered for treatment in day hospital for 10 years the treatment efficiency has been analyzed.

Results. The tendency towards the increase in the number of TB patients receiving treatment in day hospital (from 9.7 to 14.9%), treatment efficiency in day hospital was high: the average rate made 92.0% (the same rate for Orel Region made – 80.2%, p < 0.001) with the low default rate, on the average it made – 1.2% (for Orel Region it made – 2.4%; p = 0.35).

The analysis of the other hospital substituting treatment forms detected the decrease in the number of patients receiving treatment in TB treatment rooms and feldscher stations (from 13.0% in 2004 to 3.8% in 2013) which is due to the difficulties in the provision of directly observed treatment in these units. The comprehensive use of the hospital substituting forms with the provision of the daily observation of TB drugs in-take assures high treatment efficiency rates, including in socially marginalized patients which provides the positive impact on the epidemic situation in the region. 

In order to investigate the spectrum of drug susceptibility of slowly growing of non-tuberculous mycobacteria and define minimum inhibiting concentrations (MIC) regarding the drug panel including anti-tuberculosis drugs and antimicrobial agents of wide spectrum, 68 strains of slow growing non-tuberculous mycobacteria belonging to such species as M. avium, M. intracellulare, M. gordonae, M. kansasii, M. xenopi, M. malmoense and M. simiae were tested. Minimum inhibiting concentrations were defined with use of the panel consisting of 13 drugs of SLOWMYCO Sensititre (Trek Diagnostic System, Thermo Scientific, USA). It has been proved that the majority of tested strains of non-tuberculous mycobacteria were susceptible to clarithromycin and rifabutin. Amikacin, linezolid and moxifloxacin were also fairly effective. Considering that for mycobacteria of M. avium the borderline drug concentrations were not defined it is important to investigate and to compare the results of defining minimum inhibiting concentrations in vitro with therapy efficiency.

When infecting the lungs with Mycobacterium avium of B6 line mice genetically susceptible to this infection the compact aggregates (follicles) of B-lymphocytes are formed with the peak at the 11-13th week after the infection. Physiological role of these cellular accumulations remained unclear. Having applied segregative genetic analysis to allele conglutination of Slc11a1 gene with two signs – quantity of mycobacteria and accumulation of B-cellular follicles to the F2 mice from crossing (В6 × I/St), one managed to find out that the quantity and size of follicles directly correlate with M. avium replication in the lungs. Thus this type of the lung tissue infiltration does not protect the host from infection and it is a pathogenic factor.

The article presents the brief data from literature and the own observation of the lethal case due to mycobacteriosis caused by M. avium in 33 year old patient at the terminal stage of HIV. The disease developed by lesions in the intestinal tract and various groups of lymph nodes which histologically manifested by formation of fields consisting of spindle-shaped histiocytes and macrophages with foam cytoplasm containing the significant number of acid-fast bacilli. Expressed necrotic changes were minimum and classic epithelioid cell granulomas were absent. Culture of M. avium was isolated and verified by molecular-genetic techniques intravitally out of fecal matters and post mortem out of intestinal and lymph node tissue.