The objective of the study: to assess the provision of the Russian medical units with resources that provide medical care for infectious socially important diseases and compare this provision with the current epidemic situation.

Subjects and methods. Data from FGSN Forms no. 8, 14, 14 DS, 33, 61, 30, 47 for the Russian Federation were analyzed. The number of those died is presented as per the data of Rosstat.

Results. At the working age, the mortality rate of the population is significantly affected by HIV infection, tuberculosis, viral hepatitis B and C, and the combination of these socially significant diseases (9.3%). It is difficult to determine the cause of death of the patient with multiple co-morbidities. The incidence of tuberculosis is declining more rapidly than the number of tuberculosis beds. As a result, the number of patients with tuberculosis per 1 adult tuberculosis bed decreased from 4.0 in 2005 to 2.9 in 2017; and per 1 tuberculosis bed for children aged 0-17 years – from 1.2 to 0.7 respectively. As of December 31, 2017, the average number of patients per 1 position occupied by a district phthisiologist in the Russian Federation made 306 people, including 35 people with active tuberculosis, and 8 people with multiple drug resistant tuberculosis. The existing facilities and personnel of medical tuberculosis units allow expanding their functions. Given the reduction in tuberculosis incidence, growing incidence of HIV infection, a high proportion of concurrent tuberculosis, HIV infection and viral hepatitis B and C, the best option could be the establishment of Centers for socially important infectious diseases using the facilities of medical tuberculosis units.

The objective of the study: to analyze the structure and trends in non-tuberculous mycobacteria (NTBM) population causing diseases in the North-Western Federal District of the Russian Federation.

Subjects and methods. 745 clinical NTBM strains were identified. All clinical strains of NTBM were isolated by culture from clinical samples (sputum, bronchial washings, bronchoalveolar lavage fluid, pus, stool, urine, surgical and biopsy specimens, and venous blood in case of sepsis). In 23 cases, NTBM were detected post mortem. Mycobacteria were cultured on solid media or by the automated system of Bactec MGIT 960 BD USA. Species of re-cultured mycobacteria were identified using the test system of GenoType® Mycobacterium CM/AS (Hain Lifescience, Germany).

Results. Analysis of the structure of the NTBM population isolated from patients with mycobacteriosis in the North-West of Russia, for the period of 2012-2018 showed overall dominance of M. avium (56.4%). However, certain NTBM species were found to be prevailing in some regions: M. lentiflavum and M. gordonae dominated in the Komi Republic and Arkhangelsk respectively. Unlike other regions of Russia, in the North-Western region, there was a consistently low level of detection of M. кansasii and M. xenopi. For the last 12 years in Saint Petersburg and Leningrad region, the variety NTBM in patients with different immune status has been growing but the portion of M. avium remains to be stably high exceeding 50%.

The objective of the study: to use of laser Doppler flowmetry for the diagnosis of microcirculatory blood flow disorders in patients with community-acquired pneumonia and determine the possibility of nitric oxide in its regulation.

Subjects and methods. 146 patients with community-acquired pneumonia aged from 21 to 72 years were examined and comprehensively treated. Group 1 included 49 patients who along with standard chemotherapy had therapeutic bronchoscopy and intrabronchial regional lymphatic administration of antibiotics; Group 2 included 82 patients who received complex treatment - standard antimicrobial therapy, therapeutic bronchoscopy, intrabronchial lympharegional administration of antibiotics, and additional NO-therapy; Group 3 consisted of 15 patients in whom only standard antimicrobial therapy and therapeutic bronchoscopy were used. 15 patients from each group had endobronchial laser Doppler flowmetry; LAKK-0, the laser analyzer of capillary blood flow was used for this purpose. The microhemocirculation index (MI) was recorded, then its mean-square deviation (MSD) and variation coefficient were calculated. Blood flow fluctuations were determined and the microcirculation efficiency index (MEI) was calculated.

Results. All tested microcirculation parameters in patients with pneumonia were lower compared with healthy individuals. It was found out that on the 7th day from treatment start only in patients from Group 2, who received NO-therapy within comprehensive treatment, there was a significant increase in PM to 57.4 ± 1.6 pf. units, MSD - up to 8.4 ± 1.2 pf. units, MEI was 0.9 ± 0.02 s.u. By the 14th day of treatment in Group 2, microhemocirculation indices returned to normal, while in other groups there was only a positive trend. This was reflected in the time required of treatment of pneumonia, the best results (14 days on average) were in the group using NO-therapy as a part of comprehensive treatment.

The objective of the study: to estimate efficacy and safety of the drug of rifapentine in continuation phase of chemotherapy in adults suffering from pulmonary tuberculosis.

Subjects and methods. 66 HIV negative pulmonary tuberculosis patients transferred to continuation phase of treatment with regimens I and III were enrolled in a prospective randomized trial. The patients were randomly divided into 2 groups. Group I included 36 of patients who were prescribed with rifapentine at the dose of 10 mg per 1 kg of body mass, 3 of times per week, and isoniazid at the dose 10 mg per 1 kg of body mass daily. Group II included 30 of patients who were prescribed with rifampicin 450-600 mg/day (taking into account the body mass) and isoniazid, 10 mg per 1 kg of body mass daily. In continuation phase of treatment, patients from both groups received 120 doses of drugs.

Results. 1. In continuation phase of chemotherapy in new pulmonary tuberculosis adult cases, the regimen consisting of rifapentine + isoniazid demonstrated the efficacy compatible with the one of the regimen consisting of rifampicin + isoniazide.

2. Use of rifapentine at the dose of 10 mg/kg, 3 times a week in continuation phase of treatment did not cause an increase in adverse events compared to daily in-take of rifampicin.

3. The anti-tuberculosis drug of rifapentine can successfully be used in continuation phase of chemotherapy in drug susceptible tuberculosis patients.

4. The prescription of rifapentine reduces the drug burden since it can be taken 3 times a week.

The objective of the study: to assess the safety and efficacy of preventive anti-tuberculosis treatment of children exposed to multiple drug resistant tuberculosis (MDR TB) using different combinations of anti-tuberculosis drugs.

Subjects and methods. 150 children at the age from 1 to 17 years old inclusive were enrolled in the study, they all had a high risk of being infected with MDR M. tuberculosis. All children had been exposed to MDR TB and had no clinical or X-ray signs of active disease. The average age of children made 9.5 ± 4.1 (median 10) years old, girls and boys made 46.6% and 53.4% respectively. Children were divided into two groups of observation: the main one included 100 children who were prescribed with preventive anti-tuberculosis treatment, while the control group consisted of 50 children who did not receive any preventive treatment for various reasons. In the main group, children received various regimens of preventive chemotherapy: pyrazinamide and ethambutol (ZE) – 30 people; pyrazinamide and prothionamide (ZPt) – 40 patients; three drugs – pyrazinamide, ethambutol, and prothionamide (ZEPt) – 30 children. The combination of drugs was based on the drug resistance of the intended source of infection. Treatment was prescribed for 3-4 months.

Results: the use of a combination of first line (pyrazinamide and ethambutol) and second line (prothionamide) drugs demonstrated lower toxicity of the regimen consisting of pyrazinamide and ethambutol compared to pyrazinamide and prothionamide regimen: OR = 0.3; 95% CI – 0.2-0.6.

In Z + Pt and Z + E + Pt regimens, adverse events occurred in 22.5 and 20% of cases, respectively, and in Z + E regimen – only in 6.6% of cases (p < 0.05).

The review presents literature data on the formation of the immune response to tuberculosis, features of the cellular and humoral link depending on detection of drug susceptible and drug resistant strains of M. tuberculosis. It describes the role of cytokines and genetic factors in disorders of immune reactions affecting pathomorphosis and clinical manifestations of tuberculosis.