The purpose of the article is to inform national specialists involved in tuberculosis control about methods for compilation of WHO global tuberculosis statistics, which are used when developing strategies and programmes for tuberculosis control and evaluation of their efficiency.  The article explains in detail the notions of main WHO epidemiological rates, used in the international publications on tuberculosis along with the data on their registered values, new approaches to making the list of country with the highest burden of tuberculosis, drug resistant tuberculosis and tuberculosis with concurrent HIV infection. The article compares the rates in the Russian Federation with global data as well as data from countries within WHO European Regions and countries with highest TB burden. It presents materials on the achievement of Global goals in tuberculosis control and main provisions of WHO End TB Strategy for 2015-2035 adopted as a part of UNO Sustainable Development Goals.

The current situation related to biosafety in bacteriological laboratories in the Russian TB units was comprehensively analyzed. Main problems promoting the increased risk of infection of laboratory personnel with tuberculous mycobacteria were detected. It was found out that during the investigated period cases of occupational tuberculosis had been registered in 5 out of 21 (23.8%) laboratories, thus biosafety requirements were not complied with in those laboratories. Causes of active disease development among laboratory personnel were analyzed and the evidence was provided on the need to improve infectious control in bacteriological laboratories of the Russian TB units and to enhance the level of knowledge in laboratory personnel related to provision of biological safety.

Goal of the study: to investigate ultrasonographic manifestations of tuberculous pleurisy.

Materials and methods. 147 new patients suffering from exudative tuberculous pleurisy were examined as well as 90 patients both male and female suffering from non-specific pleural lesions at age from 18 to 65 years old in the out-patient diagnostic department of National Phthisiology Center, Kyrgyzstan Republic. Ultrasonographic manifestations and their intensity were compared in the patients with pleural lesions.

Results. The following was confidently more often registered in those suffering from tuberculous pleurisy: fibrin deposits on pulmonary pleurae (66.7 ± 3.4%); echogenic suspension, fibrin flakes in pleural fluid (86.3 ± 2.85%); thickness of pleura more than 4 mm (76.3 ± 3.2%); thickness of fibrin deposits more than 4 mm (75.5 ± 3.3%); thick fibrin fibers (80.5 ± 2.2%).

Goal of the study: to study specific features of detection, diagnostics, clinical, morphological manifestations and treatment efficiency of tuberculous exudative pleurisy in those with alcohol addiction.

Materials and methods. 62 medical cases of those suffering from exudative tuberculous pleurisy were retrospectively studied, in whom alcohol addiction was diagnosed basing on the patient's history and examination by the substance abuse doctor. Tuberculous pleurisy was verified in 80.65% of cases.  

Results: Alcohol addiction was diagnosed in 15% of those suffering from tuberculous pleurisy. Among patients with alcohol addiction 47% were 30 years old and older, and they were single, 11% lived alone, 76% were the unemployed but within employable age, 27% had previous convictions, and 10% were homeless. More than 27% of patients had not have fluorography screening for 2 years and more. In 53% of cases pleurisy was combined with concurrent pulmonary lesions and in 27% of cases respiratory lesions were bilateral. Destruction of lung tissue was observed in 42% of cases, and in 35.5% tuberculosis mycobacteria were found in sputum. Caseous necrosis was found in 7.5% of cases, epithelioid giant-cell granulomas were found in 64% of cases, and caseous necrosis in granulemas was found in 44% of cases when examining the needle biopsy specimens. Poor treatment adherence and low treatment efficiency had been observed among those patients.

The study was conducted in order to evaluate the efficiency of adding immobilized probiotic biologically active food supplement of LB-Complex L to integral treatment of pulmonary tuberculosis. Changes of colon microorganism community in pulmonary tuberculosis patients including those with multiple drug resistance were studied in two groups of patients: receiving only basic treatment and basic treatment with the immobolized probiotic of LB-Complex L as a food supplement. The algorithm of probiotic intake has been offered with the consideration of pharmacodynamics of anti-tuberculosis drugs. The offered algorithm proved to be effective for prevention of disorders in microorganism community, enhancement of adherence to treatment, reduction of frequency, severity and duration of side effects to anti-tuberculosis drugs.

The article offers criteria defining the duration of post-operative chemotherapy for 3 or 6 months: volume of surgical intervention; degree of inflammation intensity as per data of histopathological examination; detection of growth of mycobacteria of tuberculosis complex in surgical specimens; course of the disease after surgery; chemotherapy tolerance and degree of intensity of remaining changes in the lungs and chest lymph nodes. Basing on the offered criteria, chemotherapy was prescribed to 19 (63.3%) out of 30 patients. Chemotherapy was longer in 9 (30.0%) patients – from 9 to 18 months due to emergency or staging surgery (surgery on two lungs, postponed thoracoplasty) and undulant course of tuberculosis. 2 (6.7%) patients had no chemotherapy due to development of toxic pancreatitis and drug-induced anemia.

Development of new methods of immune diagnostics of tuberculous infection and their introduction into tuberculosis control practice have changed approaches to diagnostics of tuberculosis in Russia. Along with world recognized IGRA-tests the test with tuberculous recombinant allergen (TRA) developed by Russian researchers is also widely used. High diagnostic value of each of the methods is proved by multiple national and international trials however there is no research comparing results of these methods in the diagnostics of tuberculous infection in children, including those with concurrent conditions. During the study data of testing in 654 children in the age from 0 to 14 years old with positive sensitivity to tuberculin as per Mantoux test with 2 TU were analyzed. All patients had modern immunological tests done: TRA and IGRA-tests (QuantifeRON® Gold ELISA (QFT) and T-SPOT.TB). The study confirmed the low value of Mantoux test with 2 TU as a method of early tuberculosis detection in children; it detected underdiagnosis (10-50%) and overdiagnosis (78%) of latent tuberculous infection in the children with different sensitivity level as per data of Mantoux test with 2 TU. Comparing the results of TRA and IGRA tests it is possible to state that they are compatible for 76-81% of cases. The group of children was detected who had allergic and endocrine disorders (obesity), for whom IGRA tests were recommended to exclude chances of false-positive results of TRA tests.

Goal of study: to define species of non-tuberculosis mycobacteria, isolated from the respiratory tract of the patients from various Russian regions using DNA strips for identification of non-tuberculous mycobacteria.

Materials and methods. 1204 cultures of non-tuberculosis mycobacteria isolated on solid and liquid media from 727 patients in whom tuberculosis/mycobacteriosis was suspected were examined from 2011 to February, 2017. Species of non-tuberculosis mycobacteria were identified using DNA-strips of Hain Lifescience (Germany) GenoType® Mycobacterium CM/AS in compliance with manufacturer's instructions.

Results. 17 species of non-tuberculosis mycobacteria were identified (11 species belonged to the group of those slow-growing and 6 species belonged to fast growing non-tuberculosis mycobacteria). Slow-growing mycobacteria prevailed (564/727, 77.58%) and M. avium was the most prevalent (210/727; 28.89%). The following mycobacteria were found (in descending order): M. gordonae (99/727; 13.62%), M. intracellulare (68/727; 9.35%), M. lentiflavum and M. fortuitum (по 66/727; 9.08%), M. abscessus (49/727; 6.74%), M. kansasii (48/727; 6.60%), M. xenopi (29/727; 3.99%). Prevalence of non-tuberculosis mycobacteria is described in respect of the regions.

Goal: to study prevalence and specific regional features of genetic structure and drug resistance of M. tuberculosis of Haarlem family, circulating on the territory of Saratov Region.

Materials and methods. Genotyping of 152 clinical isolates from sputum of active mostly new pulmonary tuberculosis patients was performed using hybridization on the biological mircochip with reagents of Spoligo-Biochip (OOO BIOCHIP-IMB, Moscow).

Results. It was found out that among genetically heterogeneous strains of M. tuberculosis circulating on the territory of Saratov Region, mycobacteria of Haarlem family were registered in 23.7% of cases, i.e. practically in each fourth patient. Mycobacteria belonging to this genotype were characterized by genetically diverse structure of strains, which could be the evidence of their circulation on this territory for a continuous period of time. Mycobacteria of Haarlem family prevailed in the patients with destruction of lung tissue and positive results of sputum tests (86.1%), and multiple drug resistance was especially high in these mycobacteria (25%), which was typical of Saratov Region since according to data of other studies mycobacteria of Haarlem family were of low virulence and more associated with drug susceptible forms of tuberculosis.

The article describes clinical (respective time of obtaining data on drug resistance) and economic (respective costs of reagents and consumables) efficiency of various procedures for etiological diagnostics of tuberculosis and prescription of chemotherapy regimens. The procedure developed and accepted by Ural Phthisiopulmonology Research Institute has been offered. According to this procedure costs of reagents and consumables when testing drug susceptibility to first and second line drugs for the patients with positive sputum tests makes about 5,000 RUR, time required for obtaining the results is 48 hours since delivery of the specimen to laboratory, time for confirmation of drug susceptibility pattern by culture is 30-40 days. For the patients with scanty bacillary excretion costs of reagents and consumables when testing drug susceptibility to first and second line drugs makes about 6,000 RUR, time required for obtaining the results is 8-14 days since delivery of the specimen to laboratory, time for confirmation of drug susceptibility profile by culture is 30-40 days. Additionally to development of rational testing procedures, the main ways to enhance efficiency of etiological diagnostics are to stop double testing, exclude excessive and non-diagnostics tests, thoroughly reject low quality specimens delivered to laboratory.