The objective of the study: to assess the prevalence of drug resistance of tuberculous mycobacteria (MTB) to pyrazinamide, linezolid, cross-resistance to fluoroquinolones, and cross-resistance to injectable anti-tuberculosis drugs among tuberculosis patients in Tomsk Region.

Subjects and methods. The data of 814 patients with tuberculosis were analyzed. Of them, drug susceptibility test to pyrazinamide was performed in 812 patients; ofloxacin, levofloxacin, moxifloxacin – in 475 patients; kanamycin, amikacin, capreomycin – in 301 patients, and linezolid – in 423 patients.

Results. The frequency of resistance to pyrazinamide is the highest in patients who were treated with pyrazinamide in the past (relapses and chronic cases). In the patients resistant to ofloxacin, the frequency of susceptibility to levofloxacin is low (16.9%), while susceptibility to moxifloxacin is higher (41.3%). The cross-resistance of MTB to kanamycin and amikacin makes less than 50% in the cases resistant to one of these two drugs. 38.6% of patients with poly-resistance to kanamycin and capreomycin, remain sensitive to amikacin. The level of MTB resistance to linezolid was minimal – 2.8% of those examined.

The objective: to study the specific diagnostics of inflammatory lesions of the osteoarticular system depending on the patient's HIV status.

Subjects and methods. The medical records of 166 patients with signs of inflammatory changes in the osteoarticular system were analyzed. Patients were divided into groups depending on their HIV status. 

Results. Tuberculosis was the major cause of osteoarticular inflammation in HIV positive patients (58.21%), while it was much less frequent in HIV negative patients (13.13%) (OR = 9.214; 95% CI 4.314; 19.680). HIV positive patients were found to have lower leukocyte counts (6.18 ± 0.24 per 10⁹ cells/l versus 9.40 ± 0.43 per 10⁹ cells/l in the group of HIV negative patients, p < 0.05). Tuberculous etiology of osteoarticular inflammation in patients with HIV infection was verified by microbiological methods in 43.3% of cases (95% CI 2.767; 13.472), and molecular genetic tests in 46.3% (95% CI2.722; 12.357). Invasive methods were used to obtain samples from the focus of inflammation.

The objective: to identify specific features of the clinical course of tuberculosis in elderly and senile patients under the current epidemic situation.

The specific clinical course of tuberculosis was analyzed in 54 patients at the age of 61 years and older and compared with the course of 234 patients at the age from 18 to 39 years selected by the continuous sampling of all 472 patients discharged from hospital in 2018. The following features were found to be typical of patients of 61 years and older: more frequent chronic forms of the disease (37.0%) and complications (35.2%), the major complication was chronic cor pulmonale (33.3%); more frequent concurrent chronic nonspecific lung diseases (13.0%) and coronary heart disease/arterial hypertension (14.8%); more frequent deaths (31.5%), mainly due to pulmonary heart disease; less frequent generalization of tuberculosis (5.5%) and concurrent HIV infection (7.4%).

The objective: to analyze the expression of certain genes in the blood cells of children and adolescence to differentiate the active and latent phases of tuberculosis infection.

Subjects and methods. Peripheral blood samples collected in 36 pediatric patients with latent tuberculosis infection and 24 patients aged 1 to 16 years undergoing in-patient treatment for pulmonary tuberculosis were tested. A modified method for isolating messenger RNA and reverse transcriptional polymerase chain reaction was used to identify the transcription of six genes selected for analysis.

Results. In a comparative study of the expression values of six promising genes in blood cells in the study of two groups of children and adolescents with latent and active tuberculosis infection, it was found that the most differentiating feature for determining active tuberculosis infection was a significantly higher level of expression of PDCD1 gene encoding PD1 lymphocyte receptor. At the same time, the sensitivity to detect the active infection was found to be 95.8%, specificity – 94.4%, the accuracy of the positive prognosis of active tuberculosis infection was 93.3%.

The article describes a retrospective study of the results of microbiological and molecular genetic tests of 685 M. tuberculosis cultures isolated from 685 adult tuberculosis patients registered for dispensary follow-up in Moscow in 2014.

The following was identified during the study: phenotypic drug resistance (FDR) of MTB to rifampicin, isoniazid, fluoroquinolones, kanamycin, amikacin, and capreomycin in groups of patients with different treatment history; the frequency of FDR to the above anti-tuberculosis drugs in strains with mutations being drug resistance markers; the frequency of various mutations in case of FDR of mycobacteria in the patients from different groups; the relationship of FDR or the presence of a particular mutation with various characteristics of the patients and their treatment history.

The history of previous treatment was determined as statistical significance to provide the greatest influence on the spread of drug resistant MTB: patients undergoing repeated treatment had FDR more often and also a much more pronounced variety of mutations being markers of FDR to certain anti-tuberculosis drugs.

The results of the study showed that the detection of genetic mutations in MBT associated with FDR was a reliable tool for predicting phenotypic resistance and should be used as the main method for selecting anti-tuberculosis drugs when compiling the etiotropic therapy regimen.

The objective of the study: to analyze the efficacy of endobronchial valve block (EBV) during out-patient treatment of patients with destructive pulmonary tuberculosis who refused in-patient treatment and therapy with anti-tuberculosis drugs.

Subjects and methods. Treatment outcomes of 129 patients were randomly studied, the patients suffered from destructive pulmonary tuberculosis and demonstrated low adherence to therapy with anti-tuberculosis drugs and staying in hospital. EBV was used in one group (66 patients), and it was not used in patients from another group (63 patients). 

Results. The use of EBV in patients with poor adherence to inpatient treatment and chemotherapy allowed achieving sputum conversion in 36 (58.1%) patients and healing of cavities in 43 (65.2%). Among the patients in whom no EBV was used, sputum conversion was achieved in 12 (20.7%) patients (p = 0.001, χ²) and cavities were healed in 14 (22.2%) patients (p = 0.001, χ²). Efficacy and safety of EBV was demonstrated when used on the out-patient basis in the above category of patients.