Objective: to summarize the experience in screening and monitoring of tuberculosis infection in individuals receiving genetically engineering biological drugs in Chelyabinsk Region for the period from 2014 to 2018.

Subjects and methods. 372 patients were enrolled in the trial, women made 206 (55.4%), men – 166 (44.6%). The average age of patients was 43.85 ± 1.4 years with no differences by gender. Records of 372 patient's histories were analyzed, they contained information on 1,192 visits of patients referred for screening and monitoring of tuberculosis infection while being treated by genetically engineering biologic drugs.

Results. The stages of implementation and the results of screening and monitoring for tuberculosis infection in those receiving therapy with genetically engineering biologic drugs were analyzed at the regional level for 2014-2018. A procedure was developed and introduced to be implemented by a physician for phthisiologic follow-up of patients receiving genetically engineering biologic drugs; indications for computed tomography, IGRA tests were determined, indications for preventive treatment were summarized.

Conclusions. The experience presented in the organization of tuberculosis control those treated with genetic engineering immunobiological therapy allows disseminating a similar model to any region. To work with this “new risk group”, i.e. individuals receiving genetically engineering biologic drugs, it is advisable to concentrate such patients in a head tuberculosis control institution to generate statistical data, as well as to ensure the best results for the detection, diagnosis and treatment of tuberculosis in this category of patients.

The high incidence of socially important infections among convicts and the specific nature of the penitentiary system require a special approach to the organization of epidemiological surveillance over such infections as HIV infection, tuberculosis and chronic parenteral viral hepatitis.

The objective: to assess the significance of social infections in the incidence of convicts staying in correctional facilities of the Lipetsk regional penal system, and to determine areas for epidemiological surveillance improvement.

Subjects and methods. The article presents statistical processing and analysis of data from official statistics from Medical Sanitary Unit no. 48 of the Russian Penitentiary System, collected from 2012 to 2018 reflecting the incidence in the inmates staying the Lipetsk regional penal system.

Results. The analysis of data on primary incidence of socially important infections among convicts revealed the following: tuberculosis incidence among convicts who are serving sentences in the penal colonies is significantly higher compared with newly convicted inmates and those staying in prisons; the lowest incidence of chronic viral hepatitis is recorded among newly convicted inmates, and the highest among convicts serving prison sentences; the registration of cases of HIV infection among convicts revealed statistically significant differences in the incidence in convicts serving sentences in the colonies, compared with persons serving sentences in prisons.

The identification of these trends allows highlighting the need to optimize epidemiological surveillance and expand the information system by adding information about the specific behavior of convicts.

The objective: to study the frequency of post-operative complications and outcomes of lung resections and pneumonectomies in patients with fibrous cavernous tuberculosis depending on the activity of tuberculous inflammation.

Subjects and methods. 722 patients were enrolled into the study, they all underwent radical surgery for fibrous cavernous pulmonary tuberculosis in the Krasnoyarsk Regional TB Dispensary No. 1. In all cases, the diagnosis of fibrous cavernous tuberculosis was confirmed by pathomorphological tests after surgery. The severity of tuberculous inflammation was evaluated based on the following generally available indicators: massivity of bacterial excretion, erythrocyte sedimentation rate, x-ray changes over 2 months before the surgery. Depending on the activity of the disease, patients were divided into three groups: those with low activity (479 patients), medium activity (171 patients) and high activity (72 patients).

Results. The outcome of resection surgery due to fibrous cavernous pulmonary tuberculosis performed in patients with low tuberculosis activity was more favorable compared to moderate and high exacerbation activity and especially pronounced exacerbation, as indicated by the achievement of a complete clinical effect in 92.7, 74.3, and 37.5%, respectively, and a more favorable course of the postoperative period. Thus, the frequency of severe postoperative complications made in 12.1, 26.3, and 55.6% of patients, respectively. This situation was also confirmed in operations of the same type (among patients with pneumonectomy and among patients with lung resection). The high activity of tuberculosis should be considered a relative contraindication to surgical resections.

The objective: to study the time frames and efficacy of treatment for tuberculosis with confirmed and suspected multiple drug resistance (MDR) in children with different HIV status.

Subjects and methods. The method of continuous sampling was used in the study which included 21 children with MDR tuberculosis, they all had been exposed to MDR TB and were treated in hospital. 3 children had concurrent HIV.

Results. The duration of the intensive care phase in HIV negative children (19 people) made: 60 doses – 1 (5.3%) child, 90 doses – 11 (57.9%) children, 120 doses – 2 (10.5%) children, 180 doses – 3 (15.8%) children, 240 doses – 1 (4.3%) child. The duration of the continuation phase was the following: 120 doses – 1 (4.3%) child, 150 doses – 1 (5.3%) children, 180 doses – 12 (63.1%) children, 270 doses – 1 (5.3%) children, 320 doses – 3 (15.8%) children.

The duration of the intensive phase of treatment in 3 children with concurrent MDR TB and HIV infection made 180 doses in 2 (66.6%) children and 240 doses in 1 (33.4%) child. The continuation phase included 180 doses in 2 (66.6%) children and 320 in 1 (33.4%) child respectively.

Outcomes of the main course of chemotherapy were favorable in the majority of the cases - inflammatory changes resolved, focuses consolidated and fibrosis formed in the lung tissue.

Conclusion. Should children have negative results of sputum tests, the treatment is prescribed based on the results of drug susceptibility tests of the index case. If limited tuberculous lesions are diagnosed, the duration of treatment of children with MDR can be shorter. The outcomes of short-course treatment in children with tuberculosis are favorable, changes in the lungs have resolved and thickened more frequently. In children with HIV infection, low adherence to HIV treatment in socially disadvantaged families requires long-term directly observed tuberculosis chemotherapy combined with antiretroviral therapy.

The objective: to study manifestations of tuberculous infection in children with a positive result of the test with TRA and determine the tactics for their follow-up.

Subjects and methods. In 217 children with a positive result of the test with tuberculosis recombinant allergen (TRA) followed up in a TB dispensary, the results of clinical and radiological (multispiral computed tomography MSCT) examinations were studied and the response to the test with TRA during monitoring (within 3 years) was evaluated to justify terms of dispensary follow-up.

Results. It was found that the test with TRA and MSCT allows diagnosing both latent tuberculous infection and detecting minimal post-tuberculous changes (calcifications). Monitoring was performed in 2 groups: Group 1 (n = 112) included patients with newly detected calcifications in the lungs and chest lymph nodes, Group 2 (n = 105) consisted of patients without detected changes in the lungs and chest lymph nodes. The frequency of hyperergic reactions to the test with TRA recorded in patients of both groups was the same (46.7 ± 4.4 and 48.2 ± 4.7%). Results of the test with TRA in children without radiological changes stabilized two years, and in case of calcifications - in three years of follow-up, which allowed predicting the terms of follow-up for such children as belonging to tuberculosis risk group.

The objective of the study: to evaluate the efficacy and safety of treatment of tuberculosis patients with pre-extensive drug resistance and extensive drug resistance (XDR-TB) with regimen V using new anti-tuberculosis drugs including continuous treatment with bedaquiline.

Subjects and methods. The treatment efficacy and safety were assessed in 39 patients treated with regimen V. Of them, 17 (43.6%) suffered from fibrous cavernous tuberculosis, 31 (79.5%), and 9 (23.1%) were HIV positive.

Results. Treatment efficacy: 32 (82.0%) were cured, 1 (2.6%) was treatment failure, 4 (10.2%) did of non-tuberculosis, 2 (5.1%) defaulted from treatment. 23 (69.7%) patients took bedaquiline for the entire course of chemotherapy (the average duration made 19.3 months). Of them, 22 (95.6%) were cured, 1 (4.4%) had treatment failed. It was observed that the drug was well tolerated.

Adverse events resulted in the cancellation of drugs were documented in 9 (23.1%) patients. After sputum conversion, 30 (76.9%) patients were treated using hospital-substituting technologies, including 10 of them who were treated under direct observation by video. Post-treatment follow-up is carried out in 28 out of 32 (2 changed their place of residence, 2 died of non-tuberculosis) of the treated patients, the average duration of follow-up have made 11.7 ± 6.3 months, the patients are relapse free.

The article presents a clinical case of a patient with respiratory tuberculosis, who experienced the amplification of drug resistance against the background of inadequate chemotherapy for tuberculosis. It demonstrates the need for express drug susceptibility tests which allows timely prescription of the adequate regimen and thereby minimizing the chances of drug resistance amplification.

Sarcoidosis is systemic granulomatosis of an unknown nature, the course of which varies from spontaneous remission to progression resulting in failure of organs and systems. The article presents a review of current approaches to treatment of sarcoidosis putting special emphasis on the use of the anti-rheumatic drug of leflunomide (LEF). LEF is a prodrug derived from isoxazole, which is rapidly converted by liver and intestinal wall into an active metabolite, A77-1726, which inhibits the biosynthesis of pyrimidine nucleotides. LEF slows down the cell cycle, inhibits the activity of the mitochondrial enzyme dihydroorotate dehydrogenase, a key enzyme in the primary (de novo) synthesis of pyrimidines used by lymphocytes for clonal expansion. There are English reports on 2 retrospective studies of LEF used to manage sarcoidosis refractory to traditional therapy and a number of descriptions of clinical cases that provided encouraging results. LEF was found to be safer than methotrexate with comparable efficacy in both rheumatoid arthritis and sarcoidosis. Literature data indicate the feasibility of studying leflunomide in clinical practice of sarcoidosis.