The tendency of tuberculosis prevalence reduction observed in the Russian Federation is mostly related to the cases without multiple drug resistance (MDR). In general the number of MDR TB cases still tends to be increasing in the Russian Federation. Confident long-term reduction is registered only in the Central and North-Western Districts with relatively low level of MDR TB prevalence. From 2017 MDR TB patients are expected to prevail in the structure of the sputum positive cases which surely provides negative impact on the treatment efficiency and epidemic trends. The system of dispensary follow-up allows evaluating the annual number of MDT TB cases and following the ways of its increase and reduction. Taking MDR TB sources on and off the register is less intensive compared to the same flows of non-MDR infectious cases. The number of MDR TB sources is increasing mostly due new tuberculosis cases however acquired MDR TB makes significant contribution to the growth of MDR TB sources number. The increase in the ratio of respiratory MDR TB patients with sputum conversion to those died reflects the success in the improvement of the treatment strategy of MDR TB patients.

Goal: to investigate the impact of HIV infection on the development of tuberculosis epidemic in Russia.

Materials. The data from federal statistic surveillance forms no. 8 on active tuberculosis cases, no. 33 on tuberculosis cases and no. 61 on HIV positive cases have been investigated. The number of those died is presented as per the data of Rosstat.

Results. Progressing epidemic of HIV infection starts playing the unfavorable critical role in the development of tuberculosis epidemiological process. Tuberculosis prevalence goes down not only due to cure of tuberculosis, but mostly due to lethal outcomes in tuberculosis cases from various causes, first of all HIV infection. In 2015 the mortality rate due to HIV infection surpassed tuberculosis mortality.

By 2020 25% or more of new tuberculosis patients will be HIV positive; tuberculosis will the cause of death in up to 60% of lethal HIV cases; among died tuberculosis patients HIV will be the cause of death by 1.5 times more often compared to tuberculosis.

Taking into account this unfavorable situation it is necessary to change certain aspects related to HIV and TB care, first of all, prevention of tuberculosis is to be improved among the patients of AIDS centers; high quality diagnostics and directly observed treatment of tuberculosis are to be provided among HIV patients at all stages of dispensary follow-up. Additionally it is necessary to improve regulations aimed to prevent tuberculosis transmission in HIV patients in the Russian Federation, to monitor tuberculosis incidence in the HIV infected as well as mortality in case of TB/HIV co-infection. 

Goal of the study: to define efficiency of tuberculous infection detection in children from 8 to 17 years old basing on the results of screening with recombinant tuberculous allergen skin test (RTA).

Materials and methods. During 2015 in medical units of Kaliningrad Regions 24,483 children in the age from 8 to 17 years old (24.4% of all children of this age in KR) were screened for tuberculous infection with recombinant tuberculous allergen. The remaining children (69,366) were screened with Mantoux test.

Screening results are the following: negative RTA result was in 23,565/24,483 (96.3%) persons, questionable – 382/24,483 (1.5%), positive – 536/24,483 (2.2%). The biggest number of questionable and positive results of RTA skin test was observed in children from 12 to 17 years old.

Results of screening with Mantoux are the following: negative 9.5% (6,590/69,366) of those examined, questionable – 16.4% (11,376/69,366), positive – 74.1% (51,400/69,366).

Introduction of screening with RTA in 24.7% of children in the age from 8 to 14 years old did not reduce the frequency of tuberculosis cases detection (0.016 and 0.015% out of those examined in 2015 and 2014) in Kalinigrad Region. In 2015 the detection rate was 3.5 fold higher in the districts where RTA screening had been introduced (0.35 and 0.10 per 1 000 examinations) And frequency of positive results as per Mantoux test and RTA tests differs to significant extend (72.7 and 2.2% respectively in children from 8 to 15 years old, and 78.4 and 2.1% in adolescents from 15 to 17 years old), thus reducing the post-screening examination load (reducing the number of those referred for additional examinations) when using RTA test for screening. 

Extrapulmonary tuberculosis still remains a mysterious problem greatky due to significant degree of divergence in definitions.

Materials and methods. Extrapulmonary tuberculosis incidence and its structure have been analyzed for Siberian and Far Eastern Federal Districts for the last 10 years – from 2006 to 2015.

Results. In 2006 in Siberian and Far Eastern Federal Districts there were 871 patients suffering from isolated extrapulmonary tuberculosis, the structure of the forms was as follows: tuberculosis of central nervous system (CNS) – 5.7%; bone and joint tuberculosis – 28.7%; urogenital tuberculosis – 35.9%; tuberculosis of peripheral lymph nodes – 15.8%; ocular tuberculosis – 5.2%, other forms – 8.7%. Starting from 2008 ocular tuberculosis was excluded from reporting, despite the fact that the number of such patients was almost the same as the number of CNS tuberculosis cases. 10 years later in 2015 isolated forms of tuberculosis were diagnosed in 699 (-172) people, forms were the following: CNS tuberculosis – 10.6%, double increase; bone and joint tuberculosis – 39.8%, 1.5 fold increase; urogenital tuberculosis – 24.5%, 1.5 fold decrease respectively. Number of those suffering from tuberculosis of peripheral lymph nodes remained the same – 14.2%, other forms inclusive tuberculosis of salivary glands, pancreas, gall bladder, intestine, breast, skin etc. increased respectively up to 11%.

Conclusions. The problem of extrapulmonary tuberculosis in Russia as in the whole world still needs to be resolved. Extrapulmonary tuberculosis incidence greatly depends on the number of properly trained specialists and sufficient technical facilities of dispensaries. The following changes are to be made to Form 8: firstly, urological and genital tuberculosis cases are to be recorded separately; secondly, all forms are to be recorded separately according to HIV status. 

This research is based on the investigation in 144 tuberculous foci and examination of 272 persons living in those foci and contacting with tuberculosis cases. It has been found out that outside tuberculous infectious foci a significant number of people is still exposed to tuberculous infection. During 5 years the average annual incidence in those exposed to tuberculous infection made 1176.5 per 100,000 pop., which is 32.2 fold higher than the rate for general population. In order to enhance efficiency of tuberculosis control activities in infectious tuberculous foci it is feasible to increase the territory coverage and duration of follow-up period.

45 pulmonary tuberculosis patients with concurrent type 1 diabetes, 69 pulmonary tuberculosis patients with concurrent type 2 diabetes and 131 pulmonary tuberculosis patients without diabetes (control group) were examined. The intensity of the system inflammatory response syndrome was evaluated by the markers of the acute inflammation phase – blood levels of C-reactive protein (CRP), serum amyloid A (SAA), α1 -antitrypsin (α1 -АТ), haptoglobin, and fibrinogen. Nutritional status was assessed by body mass index (BMI) and concentration of total protein (TP), albumin (A), and transthyretin (TTR). It was found out that in new progressing forms in pulmonary tuberculosis patients with concurrent diabetes the mobilisation of acute phase proteins responsible for early anti-infection protection (CRP, SAA) was less expressed compared to the patients without concurrent diabetes. On the contrary in torpent forms of the disease CRP and SAA were much higher in those with concurrent conditions compared to the patients without concurrent diabetes. The reaction of acute phase proteins in new cases and infiltrate and pneumonic forms of the disease was more severe in those with concurrent type 1 diabetes and more moderate and slow in case of type 2 diabetes. Nutritional status in the patients with concurrent conditions differed greatly from patients in the control group. With no concurrent diabetes all signs of nutritional deficiency (low BMI, A and TTR) promoted the severe course of the disease. TP remained within normal limits. Patients with concurrent diabetes demonstrated reduction TP and TTR, but BMI and A remained normal in case of type 1 diabetes and increased in type 2 diabetes. Ratio of albumins/globulins (A/G) went down in the control group but tended to increase in case of concurrent diabetes. According to correlation analysis the reduction of TP in the patients with concurrent condition was not due to A but globulins. Shifts fundamentally different for patients with concurrent diabetes and those without concurrent diabetes (increase of BMI, A, A/G) were much greater expressed in type 2 diabetes and manifestations of protein-energy deficiency (decrease of TP and TTR) were more intensive in type 1 diabetes.

Specific personal features of 296 children and adolescents exposed to tuberculosis and those with unidentified exposure were comparatively analyzed. Children with unidentified exposure demonstrated psychic tension, poor self-control, poorly developed social communication skills which determined disruptive interpersonal relations and uneasy personal growth. Children exposed to tuberculosis in their families were characterized by judging didactive position towards their neighbors which was formed by dysfunctional patterns of relations in their parental families. Adolescent with unidentified exposure manifested the contrast combination of pre-morbid personal attitudes which had certain etiologic contribution to the development of borderline neurotic states. The higher level of destructive reactions in the interpersonal communication was observed in the adolescents exposed to tuberculosis in their families. Identified personal features are considered to be psychological factors determining the hyperactivation of adaptive systems at the pre-morbid state and consequent development of structural functional disorders in various systems of the host, as well as providing impact on the course of tuberculosis.

Sarcoidosis is a systemic disease characterized by the development of chronic immune inflammation and formation of granulomas. It is important to know clinical, morphological and immunologic variants of the course of this disease in order to investigate the pathomorphologic parameters of the granuloma.

Of late negative trends have been observed in the changes of sarcoidosis pathomorphology. Due to the above it is important to investigate predictors for the course of this disease, including specific parameters of granulematous inflammatory process in various clinical variants not only from the point of view of diagnostics but further management tactics for those suffering from this disease. 

The article presents the clinical case of invasive aspergillosis in a 15-year-old adolescent with lesions in the spine, ribs and both lungs, and primary immune deficiency which was not diagnosed earlier. In order to diagnose this disease it was necessary to differentiate it from the generalized form of tuberculosis and to perform integral X-ray examination and surgery with consequent morphological and bacteriological examination of the surgical samples.

The article describes the clinical case of successful treatment of a 42 year old female patient suffering from bilateral fibrous cavernous pulmonary tuberculosis with fully destroyed left lung, persistent bacillary excretion and extensive drug resistance. The treatment was complicated by poor tolerance of the used anti-tuberculosis drugs.

Multiple surgeries were applied combined with resection and collapse interventions; anti-tuberculosis drugs and their doses were prescribed individually to this patients and supplemented by adjuvant therapy.

The course of the disease stabilized, sputum converted and cavities were healed.