The objective: to identify the role, clinical and epidemiological significance of rare genotypes of M. tuberculosis (MTB) in the epidemiology of tuberculosis in Saratov Region.

Materials. The spoligotyping and hybridization method by the Spoligo-biochip kit (BIOCHIP-IMB OOO, Moscow) was used to examine sputum samples of 353 patients with newly diagnosed pulmonary TB, who were permanent residents of 20 cities and districts of Saratov Region.

Results. MTB population circulating in the examined TB patients was heterogeneous and represented by 13 genotypes (Beijing, Beijing-like, Haarlem, Ural, LAM, T, Manu, Microti, Rus 1, Cas, EAI, Canetti, AFRI). Rare genotypes (EAI, Manu, Microti, Rus 1, Cas, AFRI, Canetti) were found in 42/353 (11.9%) patients, of which EAI genotype was found in 8 patients (2.3%), Manu in 14 ( 3.9%), Microti - 13 (3.7%), Cas - 2 (0.57%), Rus 1 - 1 (0.28%), Canetti - 3 (0.85%) , and AFRI - in 1 (0.28%). Tuberculosis cases caused by the Microti genotype were endemic and characterized by homogeneity of the revealed spoligotypes (SIT 539). Isolates of the Manu genotype were registered only in men (100%), mainly living in rural areas (71.4%) and were characterized by a high heterogeneity of SIT (1195, 1485, 1460, 1482, 1088). Tuberculosis caused by the EAI genotype was characterized by a smaller number of destructive forms and forms with bacterial excretion, and high SIT heterogeneity (300, 1431, 1428, 924, 622, 192). There were single cases of the Cas, Canetti, and R genotypes. 

The objective: to study the frequency and nature of adverse events caused by anti-tuberculosis drugs in pulmonary tuberculosis patients with and without concurrent diabetes mellitus.

Subjects and methods. 396 patients with pulmonary tuberculosis were examined: 203 patients who had diabetes were included in the TB + diabetes group; the TB group consisted of 193 patients with pulmonary tuberculosis without diabetes.

Results. The incidence of adverse events caused by anti-tuberculosis drugs was analyzed and compared in both groups. Thus, in the TB+diabetes group adverse events developed in 146/203 (71.9%) patients and in 62/193 (32.1%) patients in the TB group ( p < 0.01). Hepatotoxic reactions prevailed in both groups, but in the TB + diabetes group, they were statistically significantly more frequent versus the TB group (55.2 and 27.4%, respectively; p < 0.01). Also, allergic reactions (20.7 and 6.2%, respectively; p < 0.01) and neurotoxic events (13.3 and 5.1%, respectively; p < 0.01) were statistically significantly more frequent in the TB + diabetes group compared to the TB group.  

The objective of the study: to analyze the medical and social characteristics of tuberculosis cases died in hospitals of Kemerovo Region in 2017-2018 including those with HIV infection

Subjects and methods. Clinical, radiological and morphological data of 372 patients who died in in-patient units of Kemerovo Regional Clinical Phthisiopulmonary Medical Center in 2017-2018 were studied.

Results. HIV infection was the major cause of death in tuberculosis patients in Kemerovo Region - in 74.7% (278 patients). Only 21.7% died of tuberculosis, and 3.6% - died of other diseases. The main clinical form of tuberculosis in patients with TB/HIV co-infection was a generalized form with lesions in multiple organs, of them, lesions of intrathoracic lymph nodes, spleen, liver, kidneys, pleura, and central nervous system were the most frequent. In patients who died of tuberculosis, the leading clinical form was fibrous cavernous tuberculosis, mainly complicated by caseous pneumonia.

The objective of the study: to assess the awareness of tuberculosis detection and diagnosis among physicians from primary health services under the current situation.

Subjects and methods. A one-time anonymous survey of 140 physicians was carried out, they filled in a special questionnaire, consisting of two parts (general and qualification ones), including 13 questions.

Results. The questionnaire showed that the knowledge of physicians on the modern principles of detection and diagnosis of tuberculosis was heterogenous, especially related to patients with HIV infection. Training in the standards of examination for respiratory tuberculosis should be included in traditional professional development programs and programs of the continuing medical education for physicians of all specialties.

The objective of the study: to analyze lethal cases of tuberculosis in children and adolescents in Siberian and Far Eastern Federal Districts, to determine the causes that contributed to lethal outcomes.

Subjects and methods. Reports on 9 lethal outcomes of tuberculosis in children (n = 8) and adolescents (n = 1) in 2018 were retrospectively analyzed in 8 regions of Siberian and Far Eastern Federal Districts.

Results. All the deceased lived in socially disadvantaged families. It was found out that parents failed to fulfill their obligations in providing care for the child. All children, except one, were vaccinated with BCG. No one had been diagnosed with HIV infection. Children under 7 years old prevailed. In 63% of cases, exposure to tuberculosis was detected. Immunodiagnosis of tuberculosis was not carried out or was irregular in the majority of cases (75% of lethal cases). All children died within 1 year of follow-up by a TB unit. Tuberculosis with lesions of the central nervous system was registered in 87.5% of lethal cases.

Conclusion. The main causes contributing to the death of children due to tuberculosis were the socially disadvantaged families and the lack of attention from social service specialists, defects in the work of physicians from primary health services on the early detection of tuberculosis among children, and defects in the work of phthisiologists in the nidi of tuberculosis infections.

The objective: to study specific characteristics of epidemiology and clinical manifestations of tuberculosis spondylitis in Ulyanovsk Region.

Subjects and methods: Annual reports of the regional TB dispensary and medical records of all 160 tuberculosis spondylitis patients detected 2009 to 2018 were reviewed. Radiation, laboratory, bacteriological, immunological, molecular genetic, and morphological diagnostic methods were used. Reliability was assessed using the software of Statistica 8.0: in the frequency of events according to χ2, and in the median values according to the discrepancy test.

Results. It was found out that the incidence of tuberculosis spondylitis and its share in the structure of newly detected extrapulmonary forms had increased; tuberculosis spondylitis had specific symptoms such as the severe course with destruction of the vertebral bodies, leaky abscesses, neurological disorders with moderate intoxication; the main pathogenetic mechanism was the activation of foci of the primary period of tuberculosis infection in vertebral bodies, which was facilitated by HIV infection, chronic viral hepatitis, alcohol, and drug addiction.

The objective of the study is to determine characteristics of the clinical course and treatment results of tuberculosis exudative pleurisy in patients with cancer of various localizations.

Subjects and methods. Case histories of 26 patients aged 42-83 years (18 men, 8 women) with tuberculosis exudative pleurisy and concurrent cancer of various localization treated in 1985-2016 were analyzed. Those patients were compared to the group of 120 patients with tuberculosis exudative pleurisy but no concurrent cancer.

Results: From 1985 to 2016, 26 (0.95%) of the 2,723 tuberculosis exudative pleurisy patients suffered from concurrent cancer of various localizations. 10/26 (38.46%) cancer patients were diagnosed 1-13 years before tuberculosis exudative pleurisy developed, all of them received combination anticancer therapy. Other risk factors of developing tuberculosis in patients with tuberculosis exudative pleurisy and cancer of various localizations were the following: exposure to a tuberculosis case (15%), residual changes after previous tuberculosis (38.5%), elderly and senile age (61.5%), and comorbidities (77%). The treatment effectiveness of tuberculosis exudative pleurisy in them was lower compared to the patients without cancer: cure with minimal pleural overlays was less frequent (p1-2 < 0.05; χ2); pleural exudation persisted for a longer period of time (p1-2 < 0.01; χ2); the serous exudate transferred into purulent one more often(p1-2 < 0.05; χ2).

The article describes a clinical case of successful treatment of generalized tuberculosis in a young immunocompetent woman with multifetal pregnancy (triplets) and multiple localizations of tuberculosis: tuberculosis meningitis, disseminated pulmonary tuberculosis, and uterine tuberculosis. Specific parameters of tuberculosis diagnostics in the pregnant are presented.

Scrofuloderm is a rare manifestation of cutaneous tuberculosis.
The article describes a clinical case of secondary scrofuloderm in a 35-year-old man. The case demonstrates significant and irreversible cosmetic defects of scrofuloderm as well as importance of timely use of effective methods for diagnosis of tuberculosis (molecular genetic and histological tests, multi-slice computed tomography of the chest) and modern approaches to tuberculosis therapy based on the drug sensitivity pattern.

For experimental modeling of tuberculosis, animals of various species are used, each of which has its own advantages and disadvantages. Specific characteristics of animal genetics and immunology during the development of tuberculosis in the experiment were studied in sufficient detail. In addition, mice, guinea pigs, and primates are widely used to test new vaccines and candidate drugs. Modeling of tuberculosis of reproductive organs of females has been developed much worse, since artificial approaches to reproducing genital tuberculosis which do not correspond to the real development of pathology in humans, are more often used. The review describes aspects of modeling tuberculosis as systemic and local infectious process including the study of disorders in the reproductive system of female animals during the development of pulmonary tuberculosis.

Self-management is recognized as an essential tool for providing high-quality care for chronic obstructive pulmonary disease (COPD) and it is usually presented in the action plan as a key component that helps patients to recognize exacerbations and to start treatment early. The patient's ability to independently control and manage changes in symptoms of the disease can provide impact on the quality of life, frequency of exacerbations, admissions to hospital, and lethal outcome. Self-control of the disease is recommended worldwide for patients with COPD, self-management programs are described in numerous studies but they are heterogeneous and the evidence for their effectiveness is contradictory. The review studies various self-management programs for COPD and their effectiveness.