In 2016, World Health Organization published new guidelines for the treatment of multiple drug resistant tuberculosis (MDR TB), which stated that minimum duration of treatment was 9 months. In the Russian Federation, it is impossible to use short course 9-month treatment for MDR-TB since clofazimine is not registered in this country.

The objective of the study: to compare efficacy of short course 9-month treatment of MDR-TB and the standard treatment regimen lasting 18-24 months recommended by the Russian Society of Phthisiologists (ROF).

Subjects and methods. 180 MDR TB cases notified in 2015, and 179 MDR TB cases notified in 2016 were enrolled into the trial and treated for 18-24 and 12 months. respectively. Chemotherapy regimens included anti-tuberculosis drugs recommended by the ROF. With a 12-month course of treatment, an injectable drug was used for 4 months and discontinued after culture conversion.

Results. The efficacy of the short course chemotherapy reached 81% and was not statistically significantly different from the results of the 18-24-month course of treatment. In the patients treated with short course chemotherapy, treatment interruption made 9.5% versus 13.3% in those treated with standard treatment. There were no statistically significant changes in treatment outcomes of both cohorts of MDR-TB patients. Relapses were registered in 6 MDR TB patients from the cohort treated by the standard regimen.

The objective of the study: to investigate the spectrum of drug resistance and genotypes of Mycobacterium tuberculosis isolated from lung surgical specimens of tuberculosis patients.

Subjects and methods. Bacteriological testing of surgical specimens of 287 patients operated due to tuberculosis was performed. Molecular genetic tests detected Mycobacterium tuberculosis with multiple drug resistance in 66.7% of patients. Test results of 42 samples were compared with culture results and a high level of coincidence was observed for isoniazid (90.9%), rifampicin (89.3%) and fluoroquinolones (81.2%). It was found out that the majority of samples (80.8%) belonged to Beijing family. 

The objective of the study: to determine the efficacy of surgery for diagnosis of pulmonary nodules in patients of a TB hospital.

Subjects and methods. 220 surgeries performed due to pulmonary nodules in 2015-2017 were analyzed, all surgeries were carried out in Primorsky Regional Clinical TB Dispensary of the city of Vladivostok.

Results. To determine the etiology of pulmonary nodules, resection was performed in 89 (40.5%) patients, video-assisted thoracoscopic resection in 68 (30.9%), atypical resection in 43 (19.5%), and 20 (9.1 %) patients underwent extended resection of the lung.

A histological test of surgical specimens confirmed pulmonary tuberculosis in 179/220 (81.4%; 95% CI 75.7-86.0%) patients. Microbiological tests detected multiple drug resistance in 39/179 (21.8%) cases; this fact was taken into account when prescribing subsequent anti-tuberculosis chemotherapy. Peripheral lung cancer was detected in 19/220 (8.6%; 95% CI 5.6-13.1%) patients, metastatic lesions – in 2/220 (0.9%), benign tumor (chondroma) – in 17/220 (7.7%), and lung cyst in 3/220 (1.4%). Thus, non-tuberculous etiology of pulmonary nodules was present in 41/220 (18.6%; 95% CI (14.1-24.3%) patients referred to TB hospital for diagnostic purposes.

216 new pulmonary tuberculosis patients suffering from multiple drug resistance (MDR) were examined. The patients were divided into 2 groups. The first group consisted of 164 patients in whom when admitted to hospital, GeneXpert MTB/RIF was used to test the resistance of Mycobacterium tuberculosis (MTB) to rifampicin. Initially, patients in this group were treated with chemotherapy regimen 4 (pyrazinamide, kanamycin/amikacin/capreomycin, fluoroquinolones, cycloserine/terizidone, prothionamide, PAS). Group 2 included 97 patients. They all were treated with chemotherapy regimen 1 (isoniazid, rifampicin, pyrazinamide, ethambutol/streptomycin) before MDR was confirmed in them by sputum culture on solid media (in 2-3 months of treatment) after that treatment regimen was amended with re-registration for chemotherapy regimen 4. It was found out that hepatotoxic reactions in patients without initial abnormal liver function when prescribing chemotherapy regimen 4 occurred in 31.3% of cases and when initially using regimen 1 followed by switching to regimen 4 – in 87.8% of cases ( p < 0.001). In the course of treatment, the signs of liver damage in patients who initially received regimen 4 were more frequent in the first 2 months of treatment, whereas in patients treated initially with regimen 1 with subsequent switching to regimen 4 – during the first 4 months. In the overwhelming majority of cases, hepatotoxic reactions were mild in patients who initially received regimen 4 as well as in patients initially treated with regimen 1 followed by switching to regimen 4. However, severe hepatotoxic reactions were more often observed in patients from Group 2.

The objective: to investigate the anti-tuberculosis effect of laser photodynamic inactivation (PDI) of M. tuberculosis H37Rv in vitro by methylene blue (MB) in the minimum concentration (1 μg/ml) with laser radiation of 662 nm.

Subjects and methods. A comparative analysis of the intensity of growth of Mycobacterium tuberculosis H37Rv after laser irradiation and laser FDI by MB with different doses of light energy was carried out.

Results. Laser radiation with a wavelength of 662 nm was found to have an inhibitory effect on the growth of M. tuberculosis H37Rv. FDI of Mycobacterium tuberculosis was first registered in the presence of a minimum concentration of MB (1 µg/ml) which suppressed colony growth by 97 and 93% when they were processed by radiation with a wavelength of 662 nm with the lowest density of doses of light energy (46.9 and 93.75 J/cm²).

The problem of tuberculosis with concurrent HIV infection is now becoming increasingly important. It is necessary to determine predictors of a lethal outcome from TB/HIV co-infection for timely selection of the optimal tactics for managing patients and reducing the number of unfavorable outcomes.

Objective: to identify significant risk factors of hospital mortality from TB/HIV co-infection among patients in penitentiary institutions.

Subjects and methods. For statistical data processing, machine learning methods were used based on the optimal splitting of feature space. To determine the significance coefficients of the identified risk factors, the artificial neural network method was used.

Results. The predictive factors of mortality of a tuberculosis patient with concurrent HIV infection undergoing inpatient treatment were identified. The major ones were the following: presence of active HIV associated diseases, CD4 count below 88 cell/mcl, viral load exceeding 595,892.5 copies/mcl, such clinical forms of tuberculosis as bilateral infiltrative tuberculosis with lesion in more than two lobes, disseminated, miliary, fibrous-cavernous tuberculosis, caseous pneumonia, extrapulmonary tuberculosis, and arrhythmia.

The objective of the study: To assess the efficacy of comprehensive examination using the skin test with tuberculous recombinant allergen in standard dilution (TRA) and fluorography with the mobile X-ray unit in the patients living in social service institutions for a long period of time.

Subjects and methods: 624 persons living in social service institutions were examined, of them 438 walking patients had fluorography tests by the mobile X-ray unit and a skin test with TRA. 186 immobile and partially mobile patients had sputum microscopy and the skin test with TRA.

Results. It was found out that sputum microscopy for acid-fast mycobacteria was uninformative for early detection of tuberculosis in immobile and partially mobile patients of social service institutions and it should be used simultaneously with TRA test. Immunodiagnostics in the patients of these institutions allowed identifying risk groups facing high risk to develop active tuberculosis in 6.6% of cases and prescribing them with preventive treatment in a timely manner.

Objective: to identify specific features of the immune response making BCG vaccine ineffective in mice carrying H2^f allele of the main complex of tissue compatibility.

Subjects and methods. Inbred lines of B10.M (H2^f) and B10 (H2^b) mice vaccinated and not vaccinated with BCG and infected with M. tuberculosis H₃₇Rv, were compared in terms of survival after the infection, the number of mycobacteria in the lungs, the ability of T-lymphocytes to recognize mycobacterial antigens and produce interferon-γ (IFN-γ ) in response to mycobacterial antigens and non-specific stimulation of T-receptors.

Results. It was found out that B10.M mice were unable to produce T-cells by the lymphoid organs (spleen) and lungs to produce IFN-γ in response to long-term stimulation of mycobacterial antigens in chronic infection, although the recognition of these antigens, as well as the ability to produce IFN-γ in response to non-specific binding of T-receptors with anti-CD3 antibodies, were completely preserved. It was demonstrated that the defect in IFN-γ production manifested at a late stage of infection regardless of prior BCG vaccination, and hypothesized that it was rather associated with the phenomenon of specific "immunological depletion" of T-cells in mice carrying some allelic variants of H2 complex.

The article describes a clinical case demonstrating the possibility of effective and safe administration of two courses of bedaquiline within chemotherapy regimens for multiple/extensive drug resistant respiratory tuberculosis in children and adolescents. In our opinion, the treatment of patients of this age should be carried out in federal centers employing highly qualified specialists in pediatric tuberculosis.

1936-2019

1937-2019