The data available in the literature and the results of the authors’ studies on some issues regarding the ecology of mycobacteria were analyzed. The heterogeneity of their qualitative and species spread in the environment, circulation in the animal and human body and the trophic chain of transmission of pathogenic Mycobacterium species from animals to humans, and conversely, were traced. The degree of their spread in the natural landscapes depends on soil-climatic conditions and vertical zones.

The clinical and radiographic manifestations of maturity-onset tuberculous spondylitis were analyzed in 107 patients. If there is drug resistance in Mycobacterium tuberculosis (MBT), the extent and degree of spinal bone destruction, the extent of abscess formation, the rate of neurological disorders are greater than those in the MBT drug sensitivity group; however, the significant difference concerns only the involvement of vertebral arches in destruction. The pattern and activity of a tuberculous process in the lung and the proportion of bacteria-excreting persons with drug resistance in MBT significantly exceed those with drug sensitivity. All the patients were operated on; the diagnosis was histologically verified in 100% of cases; the postoperative specimens exhibited MBT culture in 72.9%; the polymerase chain reaction was positive n 98.9%. Bacteriological and molecular genetic studies established multiple drug resistance in 73.4%, polyresistance in 17.3%, and monoresistance in 9.3%.

The paper describes the most common reproductive health problems in women with active respiratory organ tuberculosis during their hospital stay. The toxic effect of tuberculosis infection and the long-term use of drugs favor the development of a number of female genital diseases (external and internal genital inflammatory diseases, menstrual irregularities) that should be corrected with specialized treatment and menstrual cycle regulation. The timely, rationally chosen chemotherapy prevents genital tuberculosis.

Thirty-five case histories were analyzed in patients with tuberculous spondylitis (TS) in the presence of HIV infection. The peculiarity of TS in HIV-infected patients is a preponderance of the disseminated and multiple forms of spinal lesion. The patients of this category versus those without HIV infection also tended to have a higher rate of significant neurological disorders (types A-C by the ASIA scale, 1992). With drastically suppressed immunity, the patients with TS and HIV infection (blood CD4+ levels of less than 200 cells/µl of blood) had the disseminated forms significantly more frequently (χ2 = 1.480; p = 0.089) and cases of multiple locations (χ2 = 4.174; p = 0.124) in the vertebral column.

The psychological trauma of pulmonary tuberculosis and long-term treatment may cause the development and progression of different borderline neuropsychic disorders in patients, lower therapeutic effectiveness, and prematurely discontinue therapy. The main practical tasks of psychological rehabilitation during intensive treatment are to render care for a patient during his adaptation to the hospital setting, to correct inadequate attitude towards disease, and to motivate active cooperation with specialists. Competent psychological support of drug therapy promotes a reduction in the intensity of psychic and somatic experiences in the patient and an increase in his psychological resources. A respective microclimate in the tuberculosis control facility and a patient-centered doctorpatient model should be considered as the most important rehabilitation factors.

Two hundred and fifty-three patients with chronic fibrocavernous pulmonary tuberculosis were examined using clinical, radiological, functional, and laboratory studies, a questionnaire developed by R. Lazarus, and specially elaborated questionnaires. The findings made it possible to identify destructive emotions in the patients, their copying behavior strategies and, according to the analysis of copying strategies, to propose the areas of psychosocial correction and the modes of treatment motivation.

The endobronchial pattern of significant bronchial obstructive syndrome of various etiologies was analyzed in 4,000 patients with this condition. At the same time, bronchial malformations were encountered as supplementary bronchi of the left and right basal pyramids, axillary left bronchi, supplementary and displaced tracheal bronchi, and a single case of distal transposition of the right proximal bronchus in 1.58% of cases. According to the bronchoscopic findings, supplementary bronchi and transpositions of the left bronchi are the most common anatomic bronchial abnormalities (1.08%).

To study the effect of M. bovis BCG vaccine strain and virulent laboratory M. tuberculosis H37Rv strain on the expression of macrophageinducible immunoproteasome subunits, a real-time reverse-transcription polymerase chain reaction technique using cDNA obtained with mRNA was employed to investigate gene expression. The results of infection were taken into account on days 1, 2, and 3 of inoculation. There was a difference in the time course of changes in lmp7 expression, which consisted in reducing the number of transcripts on day 3 after infection with the virulent M. tuberculosis strain versus the vaccine one. It was assumed that the inhibited transcription of this subunit, when inoculated with the virulent M. tuberculosis strain, might lead to the blocked assembly of the whole immunoproteasome and to its reduced functional activity. The investigation showed the stimulating effect of the M. bovis BCG vaccine strain against the macrophage that contributed to the presentation of major histocompatibility complex class I antigens (processed by the immunoproteasome) and the inhibitory effect of the virulent M. tuberculosis H37Rv strain.

The efficacy and safety of choludexan used to treat antituberculosis drug-induced liver injury were studied in 80 patients with respiratory organ tuberculosis. The indicators of liver functional test became normal in 20 patients with no history of hepatitis and in the group of patients with tuberculosis concurrent with hepatitis B and C virus infection by days 10 and 15 of choludexan administration, respectively; liver dysfunctions recovered in the group of patients with tuberculosis concurrent with chronic alcoholism at the time exceeding the reference one. In terms of the findings, choludexan may be recommended for the treatment of antituberculosis drug-induced liver injury. Longer choludexan cycles up to 30 days or more should be used in patients with tuberculosis concurrent with chronic alcoholism when the indicators of liver functional tests recover slowly.

The efficiency of mass screenings for tuberculosis in children and adolescents was determined as a proportion of persons who were found to have tuberculosis. The diagnostic effectiveness of the skin test with recombinant tuberculosis allergen (Diaskintest) was 0.1%; that of traditional diagnosis using purified tuberculosis allergen in standard dilution for intradermal use (2 TU PPD-L) was 0.003%. With the use of a combined regimen (firstly, mass diagnosis with Mantoux test with 2 TU, then additional examination of identified risk groups with the Diaskintest), the efficiency was 0.006%.

The authors made a cost-effectiveness analysis of the skin tests with recombinant tuberculosis allergen (Diaskintest) and purified tuberculosis allergen in standard dilution (2 TU PPD-L) used to diagnose tuberculosis infection in children and adolescents. Pharmacoeconomically, the analysis showed the advantages of the Diaskintest. The cost-effectiveness coefficient of a Diaskintest model was 178,400 rubles; that of the combined regimen and traditional tuberculin diagnosis was 2,573,166 and 4,870,666 rubles, respectively. The lowest cost were required to identify a patent with tuberculosis in the primary diagnosis with Diaskintest. 

The paper describes a case of effective treatment in a patient with pulmonary tuberculosis and multidrug resistance in Mycobacterium tuberculosis concurrent with chronic renal failure after kidney transplantation. It shows treatment approaches, optimal chemotherapy regimens, and correction methods for treatment-related adverse reactions in this category of patients.