The increase in HIV patients manifesting clinical signs of sepsis requires up-to-date, rapid and reliable techniques for etiologic diagnostics.

The analysis has included 53 publications related to various aspects of tuberculous bacteriemia, resources for its detection and their efficiency. According to the publications tuberculous mycobacteria in blood can be detected in HIV-positive patients with severe immune suppression (CD4: 17-18 cells/mcl) and presence of the following clinical and laboratory and X-ray signs: fever, severe anemia, paratracheal lymphoadenopathy, miliary dissemination. It is feasible to test the blood in order to detect tuberculous mycobacteria only in the very ill HIV positive patients in whom tuberculosis is suspected and it is impossible to collect sputum and there are no obvious signs of pulmonary lesions.

The presence oftuberculous mycobacteria in blood isrelated to the high mortality level (up to 60%) and the immediate prescription of anti-tuberculosis therapy can reduce it. Antiretroviral therapy can reduce the chances of tuberculous sepsis development. Development and optimization of test systems for rapid detection of DNA of tuberculous mycobacteria in blood can be fairly promising for the diagnostics of the urgent tuberculosis.

Co-infection of tuberculosis and HIV-infection continues to be the current crucial issue not only due to the persistent growth of HIV-infection but also due difficulties in diagnostics of tuberculosis. Often X-ray changes in the lungs are atypical, clinical signs are manifested only in case of the severe and disseminated disease. At present the IGRA-tests are widely used worldwide while in Russia TRA tests are used. The trial provided the data on the use and comparative efficiency of the above immunological tests against Mantoux test with 2 TU when examining 239 persons from 2014 to 2015. The comparativeness of diagnostic sensitivity of all immunological tests had been proved. The specificity of IGRA-tests and TRA tests is twice higher compared to Mantoux test with 2 TU. Also it was proved that when diagnosing tuberculosis in HIV patients the skin tests (Mantoux test with 2 TU and TRA test) had low diagnostic informativeness compared to IGRA tests, among which ELISPOT was the most sensitive.

The article describes the study of comparative efficiency of fenazid (isonicotinoilhydrazine-О,N’) ferrous dihydrate sulphate (II) and isoniazid in drug susceptible pulmonary tuberculosis patients.

The high treatment efficiency namely significant improvement and improvement was observed in the patients of Group 1 – 84.1% which could be compared to the standard treatment regimen (85-7%) in Group 2. The total number of adverse reactions in the main group was confidently lower – 18.6% against 33.9%, p < 0.05. Hepatotoxic reactions with 2-3 fold increase of alaninetransferase level was registered significantly less (9.3%) in Group 1 compared to the Group treated with isoniazid.

Goal of the study: to define efficiency ofthe screening with the tuberculous recombinant allergen (TRA) in children and adolescents with the purpose of tuberculosis detection and defining the groups of the advanced risk of developing tuberculosis.

Materials and methods. Efficiency ofscreening fortuberculosis was compared upon the results ofskin tests withTRA in 72,601 children and Mantoux test with 2 TU PPD-L in 99,448 children in the age from 1 to 14 years old.

Results. The frequency of tuberculosis detection in the mass screening with TRA among children made 0.4 per 1000 of those examined, among adolescents it made 0.7 per 1000 of those examined which was significantly and confidently higher compared to the screening with Mantoux test. The use of TRA test allowed reducing more than 5 times the number of candidates for preventive chemotherapy under direct observation ofthe drug intake.

Goal of the study: to improve treatment results of nosocomial pneumonia being the complication of severe acute exogenous poisoning through endoscopic peribronchial administration of anti-bacterial agents.

Materials and methods. The analysis included data and treatment results in two groups of patients (71 patients) staying in the emergency care department and suffering from hospital pneumonia as a complication of severe acute exogenous poisoning. Treatment of patients in the compared groups was performed as per the same regimen, anti-bacterial medications were prescribed with the consideration of the drug susceptibility of the causative agents. The difference was the use of the endoscopic peribronchial administration of antibiotics in the main group (41 patients), this technique was not used in the comparison group.

Results. Endoscopic peribronchial administration of amikacin to which the isolated causative agent was susceptible, allowed reducing the mortality down to 12/41, 29.0% compared to the group where this method was not used – 13/30, 43.3% (p < 0,05).

Goal of the study: to study the bacterial population in the respiratory tract at various levels in those suffering from pulmonary malicious tumors including patients with concurrent chronic obstructive pulmonary disease (COPD).

Materials and methods. Bacterial population of the respiratory tract was studied in two groups: Group 1 included 52 lung cancer patients without COPD, Group 2 included 23 lung cancer patients with concurrent COPD.

Results. In the lung cancer patients none of the technique of the sample collection from respiratory tract used by itself did not allow identification of the whole spectrum of bacterial population in the respiratory tract. The most comprehensive picture of bacterial population in the respiratory tract could be obtained through integral bacteriological testing of the smear out of pharynx, sputum, bronchial aspirate/washout and samples obtained through «protected» brush biopsy. The study of the bacterial population profile showed that Candida fungi prevail in the upper respiratory tract and the following gram-negative bacteria prevail in the lower respiratory tract: Citrobacter, Serratia, Acinetobacter, Pseudomonas, Escherichia, klebsiella, Enterobacter, Burkholderia. It was found out that the bacterial load in the respiratory tract in the lung cancer patients associated with COPD (115 strains in 23 patients) was significantly higher compared to one of those suffering from lung cancer only (108 strains in 52 patients).

Goal of the study: genotyping of Mycobacterium tuberculosis strains isolated from pulmonary tuberculosis patients in Kareliya Republic from June 2013 to January 2014.

Results. Spoligotyping of 78 M. tuberculosis strains showed that they belonged to families of Beijing (n = 43), T (n = 11), URAL (n = 10), LAM (n = 8), Haarlem and Х. Eight out of 24 spoligotypes: SIT1 (Beijing); SIT40, SIT52, SIT53 (T); SIT35 и SIT262 (H3/URAL); SIT42 (LAM); SIT50 (Haarlem) were represented by two and more strains. The association between primary multiple resistance and Beijing genotype ofthe mycobacterium was defined, and 43.8% of M. tuberculosis strains of this genotype belonged to В0/W148 cluster which was of the epidemiological and clinical significance. T group was represented by drug susceptible strains only.

51 patients suffering from pulmonary tuberculosis with concurrent HIV infection (Group 1) had PCR testing in real time (ZAO Sintol, Moscow) of sputum samples in order to study the spectrum and prevalence of mutations in katG, inhA, rpoB genes coding drug resistance (DR) to isoniazid (H) and rifampicin (R). The control group included 70 HIV negative tuberculosis patients (Group 2). No significant differences in the number and spectrum of mutations in genes coding DR to H and R were found between two groups. However in Group 1 among clinical isolates with multiple drug resistance the confident prevalence of combination of mutations (rpoB Ser531- > Leu + katG Ser315- > Thr1) was found compared to Group 2 where the combined mutations of rpoB Ser531 > Leu + katG Ser315- > Thr1 + inhA 15 were registered more often where mutations in rpoB gene were combined with mutations simultaneously in two genes coding DR to H (katG + inhA).

The article presents molecular genetic description of isolates of Mycobacterium tuberculosis of 178 new patients and 78 patients who had been previously treated obtained in 2009-2011 on the territory of Urals. PCR in real time and MIRU-VNTR typing of 15 loci detected prevalence of M. tuberculosis of Beijing genotype in the both groups of patients, however the part of Beijing isolates was significantly higher in the group of patients who had been previously treated compared to new patients: 80.8% versus 55.1% (p = 0.0002). IS6110-RFLP-typing showed that the majority of Beijing isolates belonged to B0 clone, clinically and epidemiologically significant in Russia. It was found out that M. tuberculosis Beijing carrying mutations rpoB Ser531→Leu and katG Ser315→Thr played the major role in MDR tuberculosis transmission in Urals. Non-Beijing group was represented by isolates of various spoligotypes and MIRU-VNTR types among which the representatives of the following globally common genetic groups prevailed: LAM (LAM9, T5_RUS), URAL (Н3), Haarlem (H1, X), Т (Т1).

The article describes the case of abdominal tuberculosis – isolated tuberculous lesion of liver. The diagnosis was based on computer tomography of the abdomen and retroperitoneal space with bolus amplification, histological testing of surgery specimens and positive results of diaskintest. This case proves the difficulties of abdominal tuberculosis diagnostics and it justifies the need to perform magnetic resonance tomography of the abdomen, and computer tomography of the abdomen with bolus amplification, special attention is to be paid to the patients with low-grade fever belonging to tuberculosis risk groups.

Авторским коллективом из 14 компетентных специалистов ведущих учреждений системы противотуберкулезной службы здравоохранения и АН РФ опубликована объемная и  своевременная статья с рекомендациями по дальнейшему усовершенствованию этиологической диагностики туберкулеза, в  основном по  разработке новых учетных форм для бактериологических лабораторий [2].

The articles provides justification of principles and main provisions governing specialists who developed standard unified reporting forms for bacteriological laboratories of medical TB units in the Russian Federation.