Objective of the study: to study the effect of specific TB drugs and antimicrobial agents constituting chemotherapy regimens on the efficiency of treatment of tuberculosis patients with various patterns of multiple drug resistance.

Subjects and Methods. 412 pulmonary tuberculosis patients with bacillary excretion and various patterns of multiple drug resistance were enrolled into the study (117 patients with MDR TB (non pre-XDR and non-XDR); 120 patients with pre-XDR TB and 175 with XDR TB). Patients in the subgroups were compatible regarding sex and age. The patients were prescribed regimens including 5-6 drugs in accordance with their drug resistance pattern. The time of sputum conversion (by culture) versus the year of treatment was selected as a surrogate endpoint. The effect of specific TB drugs and antimicrobial agents on treatment efficiency was assessed through calculation of odds ratio (OR) of achieving a surrogate endpoint in the patients receiving and not receiving a certain drug.

Results. In the subgroup of pre-XDR TB, the following drugs demonstrated the valid increase of odds of sputum conversion: ethambutol (OR 11.8), pyrazinamide (OR 10.2), moxifloxacin (OR 7.8), capreomicin (OR 4.41). Sputum conversion was achieved in all 11 patients treated with bedaquiline.

In the subgroup of XDR TB, the following drugs provided a positive effect on the achievement of sputum conversion: bedaquiline (OR 9.62), linezolid (OR 8.15), cycloserine (OR 7.88), pyrazinamide (OR 7.29), moxifloxacin (OR 7.08), and ethambutol (OR 6.69). Ofloxacin demonstrated a confident negative effect on achieving sputum conversion (95% CI 0.06-0.32). 

The article presents the impact of HIV transmission on the incidence of tuberculosis in a big city according to the data of the tuberculosis monitoring register for 2015-2016. The findings demonstrated that among tuberculosis patients with concurrent HIV infection, the following typical characteristics were frequent versus other tuberculosis patients: patients permanently residing in the city, the age of 31-40 years old, men, the unemployed, with no destruction of lung tissue, with disseminated form of pulmonary tuberculosis, and experience of incarceration. The significant part of such patients had lesions in chest lymph nodes. Despite the overall reduction in the part of HIV positive cases among tuberculosis cases in Moscow, the obtained data highlight the significant impact of concurrent HIV infection on tuberculosis incidence and structure of new cases of tuberculosis.

The article analyzes the results of using TB-Test technology (Biochip-IMB, Russia) within the diagnostic procedure for testing clinical specimens with the purpose of tuberculosis diagnostics and drug susceptibility testing in Ural Research Institute of Phthisiopulmonology. The use of this test system is feasible if there are at least 102 cells of tuberculous mycobacteria in 1 ml of the specimen, and there is a high level of multiple drug resistance in the region; and within 2-4 days one test allows detecting mutations associated with resistance to main first and second line TB drugs and performing intraspecific typing of mycobacteria, which is needed for epidemiological monitoring and detection of cases with nosocomial superinfection.

Bactericidal activity of leukocytes was investigated in 63 patients with new infiltrate pulmonary tuberculosis and 28 patients with fibrous cavernous pulmonary tuberculosis. The diverse oxygen-dependent bactericidal activity of phagocytes is typical of the patients suffering from both clinical forms of tuberculosis: reduction of nitrosative stress rates, which is more frequent in those suffering from fibrous cavernous tuberculosis, and increase of oxidative stress rates, which is more intensive in case of fibrous cavernous tuberculosis. The associated functions were detected among immune-competent cells, involved in the bactericidal function: in case of fibrous cavernous tuberculosis – between oxidative stress rates, and in case of infiltrate pulmonary tuberculosis – between nitrosative stress rates; the synergistic effect of respiratory burst was observed. In case of chronic pulmonary tuberculosis, both types of cells were equally responsible for bactericidal functions, while neutrophils were dominating in new infiltrate pulmonary tuberculosis, without prior treatment, being the cells of the first line of defense. The obtained results allowed concluding that in case of new pulmonary tuberculosis without prior treatment, nitrosative stress played the important role in the killing of tuberculous mycobacteria, while in case of chronic tuberculosis – it was oxidative stress.

The article analyzes the differences in clinical and laboratory manifestations of tuberculosis and mycobacteriosis in HIV patients. It was found out that mycobacteriosis developed mostly in the socially well patients at the advanced stages of HIV infection. In case of mycobacteriosis, lesions were mostly located in the abdomen with limited inflammation in the chest, while in case of tuberculosis pulmonary lesions dominated. A negative result of sputum PCR assays for tuberculosis mycobacteria with a positive result of the test for AFB is an important sign for differential diagnostics. The obtained results allow performing differential diagnostics of these diseases in those HIV infected.

The objective of the study is to investigate the specific course of pregnancy, perinatal outcomes and treatment results in HIV negative female patients.

Subjects and Methods. Medical files of 109 pregnant tuberculosis patients were analyzed who were followed up in Krasnoyarsk Regional TB Dispensary no. 1 from 2010 to 2014.

Results. The part of children prematurely born by mothers ill with tuberculosis was practically compatible with the overall national cohort of live-born children (6.8% in the analyzed group versus 5.7% in the national cohort for 2014). The part of children with congenital abnormalities born by mothers suffering from tuberculosis turned out to be twice lower versus the overall national cohort of live-born children (1.4% versus 3.0% in 2010 and 2.9% in 2014).

The efficiency of the main treatment course in pregnant women without multiple drug resistant tuberculosis, of which 3.8 ± 0.3 months of tuberculosis treatment coincided with pregnancy was practically the same as treatment efficiency for the overall cohort of patients in Krasnoyarsky Kray (66.2% in the analyzed cohort versus 60.3-72.7% in the regional cohort for 2010-2014). In the pregnant with multiple drug resistant forms of tuberculosis, treatment efficiency was lower versus the regional cohort (30.4% in the analyzed cohort versus 41.1-60.2% in the regional cohort for 2010-2014). 

During the chemotherapy, frequency and characteristics of adverse reactions to second line anti-tuberculosis drugs in 324 patients ill with multiple drug resistant tuberculosis were investigated. The majority of patients (319 - 98.4%) had various adverse reactions to second line anti-tuberculosis drugs.

Adverse reactions caused by one or two drugs provided no negative impact on treatment efficiency. As the number of poorly tolerated drugs increased, the level of favorable treatment outcomes went down, whereby the significant confident correlation was observed between adverse outcomes and poor tolerance of 3 and more anti-tuberculosis drugs p = 0.000, r = +> 0.9. There was doubtful correlation observed between poor tolerance anti-tuberculosis drugs and cases deaths (p > 0.05, r = +> 0.3). The doubtful correlation was also observed between cases of lost from treatment and poor tolerance of anti-tuberculosis drugs, p > 0.05, r = +> 0.3. 

The main objective of a phthisiologist following up and treating children and adolescents with local forms of tuberculosis is to achieve complete clinical cure with minimal remaining post-tuberculosis changes. Evaluation of treatment progress is important since it defines not only the duration of chemotherapy and follow-up but it also serves a prognostic criterion of stable clinical cure and prevention of relapse in the future. New criteria for evaluation of tuberculosis activity and clinical cure in children and adolescents were assessed. It was proved that Mantoux test could not be the criterion of the disease activity. While results of the test with tuberculous recombinant allergen (TRA) performed at the moment of clinical cure did not depend on the volume and severity of changes and allowed assessing the activity of the disease with any intensity of specific changes in chest lymph nodes and lung tissue, and TRA test served as a criterion of activity of mycobacterial population in the host.

Polymorphism of clinical manifestations and absence of pathognomic symptoms are typical of urogenital tuberculosis. Since anti-microbial agents are widely used (fluoruquinolones, amikacin, rifampicin), it is more difficult to verify the diagnosis by pathomorphologic and bacteriological methods. The index of suspicion and certain required minimum level of knowledge on urogenital tuberculosis are crucial for its early diagnostics.

Materials and methods. In order to assess the level of knowledge in doctors specializing in different fields (urologists, gynecologists, general practitioners, phthisiologists) about specific symptoms and early diagnostics of urogenital tuberculosis and to evaluate the level of their awareness of this disease, 265 specialists had a test in the form of a questionnaire. To define preferences of specialists when choosing specific therapy of infectious inflammatory disorders of the urogenital system, the answers to the questionnaire given by 2 groups of doctors were analyzed, Group 1 (103 persons) included urologists, gynecologists and phthisiologists from medical units of Novosibirsk Region and city of Novosibirsk, Group 2 (298 persons) included interns and residents of Novosibirsk State Medical University by the Russian Ministry of Health.

Results. There was no significant difference between the level of knowledge about urogenital tuberculosis among the specialists: urologists, gynecologists, and general practitioners gave the right answers in 59.2-63.7% of cases; phthisiologists had a better level of knowledge and 77.2% of their answers was right. In every third case, the choice of anti-microbial agents for empiric therapy of acute and chronic cystitis was not the best option regarding the drug resistance and inhibiting action against M. tuberculosis.

Conclusion: The results of the questionnaire survey showed the low level of knowledge about urogenital tuberculosis among the specialists of general medical services (urologists, gynecologists, general practitioners). The high number of antibacterial agents with tuberculostatic action which were mentioned as drugs for the empiric treatment of urogenital disorders reflects the fact that importance of urogenital tuberculosis is underestimated by the specialists. 

Tuberculosis incidence among those, expecting kidney transplantation or after kidney transplantation is 10 times higher than the one in the general population, which is related to the development of drug-induced immune deficiency. So far there is no universal approach to treatment of such patients since numerous factors are to be taken into account: drug resistance of mycobacteria, the interaction of anti-tuberculosis drugs and immunosuppressive agents, development of adverse reactions and toxic effect on the kidney. The article presents a clinical case of diagnostics and successful treatment of pulmonary tuberculosis, tuberculosis of chest lymph nodes and bronchi in the patient with chronic renal failure in the terminal stage after the kidney transportation.