Goal: to evaluate efficiency of various immunological tests (tuberculin tests, IGRA tests, skin tests containing proteins specific for M. tuberculosis – ESAT-6, CFP10) in the detection of tuberculous infection, their sensitivity, specificity and opportunities to be used for mass screening in children and adolescents.

Materials. 122 Russian and foreign publications have been analyzed including reviews and meta-analyses.

Results. The specificity of tuberculin testing is fairly low due mass BCG vaccination among children and adolescents, IGRA tests possess high specificity but can not be used for mass screening due to high costs, intravenous manipulations and need for the well-equipped laboratory. Skin tests with agents containing the same proteins as IGRA tests are highly specific, sensible and effective for mass screening. Detection rate of tuberculosis and post-tuberculous changes in children with positive reaction to these tests is significantly higher compared to those with positive reactions to Mantoux testing with 2 TU PPD-L. 

Goal: to investigate efficiency of surgical diagnostics and treatment of pulmonary mycobacteriosis.

Materials and methods: 31 patients diagnosed with pulmonary mycobacteriosis underwent surgery. Should mycobacteriosis be not diagnosed before the surgical intervention, the surgery was performed as per standard indications for fibrous cavernous pulmonary tuberculosis or tuberculoma.

Results. There were 20 segmental resections, 4 lobectomies (with  МАС-, M. kansasii-infection), 5 pneumonectomies (with  M. xenopi and M. fortuitum-infection), 2 combined resections. The causative agent was isolated out of surgical specimens in 11 (35.4%) patients; in 10 patients (32.3%) mycobacteriosis was confirmed by detection of non-tuberculous mycobacteria in sputum or bronchial lavage along with the detection of the causative agent in the resected tissue. In the remaining 10 (32.3%) patients non-tuberculous mycobacteria were detected only in sputum and/or bronchial lavage before surgical interventions. Post-surgery complications were observed in 6 (19.4%) of patients, lethal outcome due to myocardial infarction. Clinical cure was achieved in 29 (93.6%) patients. 

The retrospective cohort study was aimed to evaluate treatment outcomes of 476 patients suffering from multiple and extensive drug resistance, to detect risk factors of unfavorable outcomes and to assess the impact of surgical resections on treatment outcomes. 71.8% of patients were cured, in 22.7% treatment failed, and 5.5% died during treatment. Main predictors of the unfavorable outcome were destructive changes in the lungs (Odds ratio (OR) 10.0; 95% CI 2.4-41.9), more than 2 segments of the lungs affected by tuberculosis (OR 6.8; 95%- CI 3.9-11.9), positive results of sputum smear microscopy (OR 3.1; 95% CI 2.0-4.9), pre-XDR of M. tuberculosis (OR 1.9; 95% CI 1.3-2.9), concurrent HIV infection (OR 3.3; 95% CI 1.3-8.2), addiction to alcohol and/or substances (OR 4.8; 95% CI 3.1-7.5), treatment interruption (OR 7.3; 95% CI 4.6-11.8), prescription of non-standard chemotherapy regimens (OR 2.2; 95% CI 1.4-3.4), low income (OR 3.4; 95% CI 2.1-5.5), incarceration (OR 2.2; 95% CI 1.3-3.6). Regarding statistical significance the use of surgical resections was related to the reduction of the risk of unfavorable outcomes also among the patients with treatment failure predictors.

Goal of the study: to study the changes in parameters of the group of patients with concurrent HIV infection and tuberculosis during 3 year follow-up.

Materials and methods. During first 6 months of 2011 80 patients were enrolled for follow-up provided that they had HIV infection and tuberculosis detected after 01.01.2011. This group was monitored every 6 months during 3 years.

Results. Changes occurring every six months have been described. By the completion of 3 year period tuberculosis was cured in 43.5%, 47.5% died, 3.75% lost for follow-up (n = 3), and 4 patients (5%) continued treatment of tuberculosis. The majority of those with lethal outcome died during the 2nd year of follow-up, which made 50% of all died. The cause of death was the HIV-associated disease in 29 patients, which made 76.3% of all died. Progression of tuberculosis was observed in 16 (55.2%) patients out of 29 those died. 9 (23.7%) patients died due to non-infectious causes of death (overdose of substances, traumas and other). 

The article presents the study of frequency of unfavorable side effects to anti-tuberculosis drugs in new pulmonary tuberculosis patients in Regional Clinical TB Dispensary in Astrakhan in 2012-2013. The study reflects the type and nature of unfavorable side effects to specific drugs. It has been found out that side effect occur more often in case of combination of TB drugs compared to one TB drugs. The efficiency of specific therapy in case of side effects has been demonstrated.

Goal of the study: to study specific manifestations of tuberculous pleurisy in HIV patients, to evaluate the efficiency of video-assisted thoracoscopy when diagnosing tuberculous pleurisy in case of different HIV status of the patients.

Materials and methods: 241 tuberculous pleurisy patients were examined. 88 – HIV positive (group 1), 153 – HIV negative (group 2). Average CD4 count in group 1 made 189 cells/mcl. The following parameters were compared in those groups: clinical and X-ray manifestations, microbiological, cytologic and biochemical rates in blood and effluent. 77 patients with isolated pleurisy (of them 33 HIV positive) had video-assisted thoracoscopy with biopsy for diagnostic purposes. The data of histological examination of pleura, obtained through video-assisted thoracoscopy and autopsy have been presented.

Results: tuberculous pleurisy with concurrent HIV infection is characterized by frequent occurrence of hemorrhagic effusion, scarce cellular sediment of effluent, expressed reduction of glucose level and increase of thymol test rates in effluent. Regardless of HIV status the frequency of tuberculous mycobacteria detection through microscopy and culture is low and does not exceed 10%. Histological testing of specimens obtained through video-assisted thoracoscopy allowed proving tuberculosis in all patients thus differentiating tuberculous changes from metastases. Thus video-assisted thoracoscopy can be recommended for diagnostics of difficult cases of tuberculous pleurisy regardless of HIV status.

From morphological point of view tuberculous pleurisy was characterized by specific granulomas which were presented by lymphoid and epithelioid cells with Pirogov-Langhans cells with minor caseous necrosis in the center (9.1%) or its complete absence (90.9%). 

In recent years the significant deterioration of health has been observed in schoolchildren. As per official data only 20% of children graduating from school are considered to be completely healthy, and 60% suffer from chronic diseases, i.e. belong to health groups III, IV and V, among which there are many children belonging to tuberculosis risk groups and suffering from undetected latent tuberculous infection. The efficiency of the new technique aimed to detect active tuberculous infection in children and adolescents of health groups III, IV and V has been evaluated. Screening proved the reduction in the number of patients in need of TB doctor advising by 8.4 fold compared to traditional mass diagnostics with tuberculin. Hyperergic reactions to diaskintest are 6 fold less common compared to Mantoux test. And 99.2% of children referred to TB doctor were registered to the dispensary follow-up versus 23.4% of children referred to TB doctor as per mass tuberculin testing results. (p < 0.001). Thus the validity of referral to TB doctor increased 4.2 fold. The detection rate of active forms of tuberculosis made 0.4 per 1000 examinations versus 0.1 in case of mass screening with tuberculin testing.

Goal of the study: to study the specific distribution of microbial population in the lungs in the patients being on artificial pulmonary ventilation for a continuous period of time basing on the results of bacteriological culture of the specimens collected from various parts of the lungs and tracheobronchial system through intravital broncoscopy or post mortem.

Materials and methods. Pilot study including intravital and post mortem identification of microbial population in various parts of the lungs and tracheobronchial system in 18 patients with signs of ventilator-associated pneumonia developed after cardiac-vascular and neurosurgical interventions. Intravital microbiological tests of the aspirate collected from all lobar bronchi of both lungs obtained through fiber-optic bronchoscopy were performed in 9 patients. Post mortem collection of pulmonary tissue for culture from all lobes of both lungs, lingulars of the left lung and relevant bronchi (totally 12 specimens from the lungs and bronchi) during 24 hours after death was performed in 9 patients.

Results of the study. As per the data of microbiological tests the pulmonary infection was found in all patients from both groups. Intravital tests detected inter-lobar differences of microbial profile in 5 cases, and in 4 cases the differences were detected between the lungs. Post mortem microbiological tests detected differences between lobes and within lobes in 6 cases, of them in 5 cases there were also differences between the lungs. In all cases of nonuniform distribution detected post mortem, differences between lobes were accompanied by the differences within lobes (between tissue of the lungs and draining bronchus). Data analysis of intravital and post mortem microbiological diagnostics detected the similarity in the microbial population distribution in the tracheobronchial system in case of ventilator-associated pneumonia despite the different techniques of specimen collection. The diagnostic test capable to reflect regional distribution of the microbial population has been offered: aspirate culture from 5 lobar bronchi which could be used when managing patients with ventilator-associated pneumonia. 

Materials and methods: presentation of the clinical case (1 patient) cured from disseminated tuberculosis with multiple cavities in the upper lobes of both lungs. Along with anti-tuberculosis chemotherapy two endobronchial valves were consecutively applied (proximal bronchus of the left and right bronchi), which were kept for the continuous period of time (more than 1 year) simultaneously in both bronchi.

Result: The following was achieved: cessation of bacillary excretion, healing of all cavities, including big ones, resolution and concretion of dissemination foci, restoration of working ability.