The article presents information on the prevalence of tuberculosis with MDR/RR/XDR in different countries and the WHO regions in comparison with the Russian Federation, given in the WHO Global Reports on Tuberculosis, and the interpretation and systematization of data presented in the WHO publications.

The issues of the WHO estimations of MDR/RR/XDR TB prevalence and incidence rates, the role of drug resistance sample survey and continuous MDR TB surveillance system in obtaining both qualitative data on registered cases of MDR/RR/XDR TB and adequate estimations of relevant indicators are considered.

The article provides basic information on the evaluation and registration of cases of MDR/RR/XDR TB in the countries of the world, the WHO regions and in the world at large.

The data given in the article include information on the coverage and effectiveness of treatment of patients with MDR/RR/XDR TB.

The objective of the study: to investigate the prevalence of extrapulmonary tuberculosis in HIV patients in Moscow and to study the potential of computed tomography to detect extrapulmonary tuberculosis in the HIV infected.

Subjects and Methods. Data of 6,588 new TB patients, detected in Moscow in 2014-2015 were analyzed, as well as CTs of 118 of TB/HIV patients, which were performed in 2014-2016.

Results. In Moscow, the absolute number of extrapulmonary tuberculosis patients went down by 67.5% from 2012 to 2016 (140 persons). In Russia and in Moscow, the number of new extrapulmonary tuberculosis patients tends to decrease and currently makes approxamtely 3% versus 4-5% in 2011-2012. Among HIV negative TB patients the part of those with lesions within pulmonary parenchyma made 94%, and among the HIV positive it made 74.8% (p < 0,05). As expected HIV infected patients prevailed among those suffering from extrapulmonary tuberculosis (4.6% versus 2.1%). According to the data of TB/HIV register, out of 593 new TBpatients, 41.3% had two and more sites of tuberculosis lesions (95% CI 37.4-45.3%). When estimating results of advanced CTprotocol in 118 patients with TB/HIV co-infection and the average CD4+ count of 134.0±19.8 cells/mcl, additional sites with tuberculous lesions were detected in all of them.

Conclusion. According to the official statistics, the number of extrapulmonary tuberculosis patients is going down. According to data from personal registers, extrapulmonary tuberculosis is several times more prevalent in HIV/TB patients due to generalized forms.

Based on real-time allele-specific polymerase chain reaction, the ranges of potential mutations in codons of 306 and 405 of the embBgene in Mycobacterium tuberculosis associated with resistance to ethambutol were investigated. 5 different mutations were detected in codon 306 and 3 mutations were found in codon 406 of the embB gene. The detected mutations were confirmed by sequencing and mass spectrometry. By analyzing the frequency of detected mutations of , the set of reagents was developed for rapid testing of susceptibility tuberculous mycobacteria to ethambutol by multi-competitive allele-specific real-time PCR. Out of 107 tested specimens of clinical isolates, mutations of the embB gene of M. tuberculosis were detected in 49 (45.8%) specimens, and no mutations were found in 58 (52.2%) specimens. 39 (36.4%) specimens had mutations in codon 306 of the embB gene, and 9 (8.4%) specimens had a mutation in codon 406, and 1 (0.9%) specimen had mutations in both codons 306 and 406. The high level of agreement in the results of molecular genetic and bacteriological tests (84%) proved the significance of mutations in codons 306 and 406 of the embB gene in M. tuberculosis and the need for their identification in order to detect ethambutol resistant strains of M. tuberculosis. When using molecular genetic tests, the sensitivity level made 75.8%, while the specificity of standard culture-based methods makes 95.6%.

The objective is to study the efficiency of prevention of a mediastinal hernia and efficiency of its treatment through anterior mediastinal plastics performed during pneumonectomy.

Subjects and Methods. Results of pneumonectomies in 30 patients (22 men and 8 women at the age varying from 20 to 56 years old) with fibrous cavernous pulmonary tuberculosis with multiple or extensive drug resistance.

Group 1 included 17 patients who had pneumonectomy with anterior mediastinal plastics, of them 10 (58.8%) had no mediastinal hernia and 7 (41.2%) patients had a minor one. Group 2 included 13 patients who had pneumonectomy without anterior mediastinal plastics.

Results. When pneumonectomy was performed, no mediastinal hernia developed in 82.4% (95% CI 59.0-93.8%) of patients who had anterior mediastinal plastics and in 7.7% (95% CI 1.4-33.3%) of patients with no plastics, p < 0.01.

Anterior mediastinal plastics performed during pneumonectomy repaired a minor mediastinal hernia in 71.4% (95% CI 35.9-91.8%) of patients.

After pneumonectomy with anterior mediastinal plastics due to fibrous cavernous tuberculosis, the risk of mediastinal hernia made 10.0% (95% CI 1.8-40.4%) in the patients who had no hernia before surgery, while in the patients who had this type of hernia before surgery, the risk of it made 28.6% (95% CI 8.2-64.1%). If no plastics was applied this risk made 90.0% (95% CI 59.6-98.2%).

Due to the efforts of TB services and state support, the threat of tuberculosis has diminished compared to the past, but for its drug resistant forms. InKazakhstan, the stable annual growth of HIV incidence is concerning. Under these circumstances, TB/HIV co-infection becomes a crucial issue as well as its control.

The objective is to evaluate the epidemic situation and tactics of TB/HIV co-infection control in the Kazakhstan Republic (KR).

Subjects and methods. The retrospective epidemiological analysis was performed based on the KR National Register of Tuberculosis Patients for 2010-2015. The KR regulations were studied in order to analyze the organization of anti-tuberculosis care for TB/HIV.

Conclusions. The increase of tuberculosis cases among people living with HIV is due to growing notification of new cases, and every third case is caused by drug resistant strains. Unfortunately, despite the fact that all tuberculosis cases, including resistant ones can be cured and they are not that dangerous as in the past, but for people living with HIV, TB remains to be the major concurrent disease and one of the main causes of death. The strategy of integrated tuberculosis control implemented currently inKazakhstan requires new organizational and financial decisions in the health care organisation of the Republic.

59 destructive pulmonary tuberculosis patients were examined. 27 of them suffered from tuberculosis with concurrent type 1 diabetes, and 21 had type 2 diabetes. The comparison group included 11 tuberculosis patients with no diabetes. It was found out that tuberculomas in case of concurrent diabetes (both type 1 and type 2) differed from the ones in the patients with no diabetes. The patients with concurrent diabetes more often had multiple tuberculomas, unlike the patients without it. And the intensity of the disease was much higher in tuberculosis patients with this concurrent condition. It was confirmed by the destruction in tuberculomas and a positive result of sputum test, as the more intensive intoxication symptoms and abnormalities in the general blood count. Analysis of rates of systemic inflammation response also proved the higher intensity of the disease in case of tuberculomas in the patients with concurrent diabetes which was documented by the confidently higher level of acute phase reactants.

The objective of the study: to evaluate non-specific reactivity of the host based on the adaptive response, its impact on the clinical and morphological manifestations and efficiency of treatment of tuberculous exudative pleurisy.

Materials and methods. The non-specific reactivity of 237 tuberculosis exudative pleurisy patients and its correlation with clinical and morphological manifestations and treatment efficiency were investigated as per methods developed by L.Kh. Garkavi and modified by N.A. Brazhenko (2006).

Results. It was found out that tuberculosis pleurisy patients had significant disorders of non-specific reactivity by the moment when they were admitted to the in-patient unit: 59% of cases demonstrated compromised adaptive response and 80% had abnormal types of reactivity. Caseous necrotic changes were detected in punctual biopsy specimens more often in case of compromised response versus the normal one (43.8 and 23.6%, p < 0.05). When compared to those with the adequate response, the patients with abnormal reactivity had more disseminated and severe clinical forms of pulmonary tuberculosis with concurrent pleurisy, tuberculous mycobacteria were confidently more often detected in sputum (32.79 versus 17.39%, p < 0.05), and tuberculous inflammation was manifested through more frequent caseous necrotic changes (41.05 versus 17.24% , p < 0.05), and treatment efficiency was lower.

The objective of the study is to compare the efficiency of chemotherapy in new pulmonary tuberculosis patients depending on the time when multiple drug resistance was detected.

Materials and subjects: 89 new patients with pulmonary tuberculosis were enrolled into the study, they all had a positive result of sputum test (at least, culture). All patients were divided into 3 groups: Group 1 (55 persons) included those with mycobacteria susceptible to rifampicin (as per the cartridge test and culture), Group 2 (16 persons) - patients resistant to rifampicin (as per the cartridge test and culture), and Group 3 (18 persons) was formed retrospectively and included patients with MDR (confirmed by culture).

Results. The structure of clinical forms of tuberculosis among new cases does not depend on the drug resistance of mycobacteria. High treatment efficiency can be achieved in the new pulmonary tuberculosis cases if the initial treatment regimen was prescribed based on the results of the cartridge test with consequent correction depending on the results of the proportional method on liquid media in the automated system detecting growth of mycobacteria. If the above is provided the time of destruction healing did not depend on the drug resistance of mycobacteria, and sputum conversion was achieved in all patients of Groups 1 and 2, 71 (100 ± 1.6% ) by the 6th month of treatment.

In order to detect tuberculosis risk factors among clinical manifestations of immunopathology, a retrospective study was conducted among 177 children (55 children with tuberculous infection only, 50 children with concurrent HIV, and 72 healthy children). The predictive significance of infectious immunopathology syndrome was identified, this syndrome was registered in the major part of children infected with tuberculous infection (40%, OR=6.3) and in all children with TB/HIV co-infection. The following risk factors of developing active disease in case of tuberculous infection were identified: recurrent pneumonias (20%, OR=17.8) and relapsing bronchitis (38.3%, OR=6.8). And the history of clinical manifestations of infectious, lymphoproliferative and autoimmune immunopathology syndromes in the children ill with tuberculosis can be the indirect evidence of concurrent HIV infection.