Концепция существования множественных (смешанных) туберкулезных инфекций получает все большее признание.

The paper analyzes the results of treatment in 5,396 patients with multidrug-resistant tuberculosis who were treated in the regions of the Russian Federation under the Global Fund Round 4 project based on the recommended World Health Organization principles in the software management of drug-resistant tuberculosis. In the patients with multidrug-resistant tuberculosis, the total efficiency of chemotherapy was 49.6% and the efficiency of treatment in new multidrug-resistant tuberculosis cases was 59.5%. The main poor outcome of chemotherapy was its discontinuation that was 21.8%. The efficiency of chemotherapy in patients with multidrug resistant tuberculosis in the regions of the Russian Federation corresponds to that of treatment in the countries of the world and Europe.

The results of clinical, radiological, and laboratory examinations were analyzed in 126 patients with new-onset pulmonary tuberculosis of small extent were analyzed. The comparative efficiency of treatment in out- and inpatient settings was investigated. Indications for outpatient treatment in a low-incidence region and for in-home treatment were defined.

It was identified, that the proportion of lung tuberculoma is insignificant among TB cases with bacterial excretion and destruction of lung tissue, therefore their epidemical risk is low.

The analysis of relapses after surgical and non-surgical treatment of patients with lung tuberculoma was performed at 4-7 years after the completion of treatment which demonstrated that the frequency of relapses after both modes of treatment has no valid difference. However, the course of relapses in operated patients is more severe than in non-operated patients and the cost of treatment for surgical modes is significantly higher. It is necessary to revise the indications for surgical treatment of this form of tuberculosis. 

The prevalence and spectrum of mutations in the rpoB gene encoding for rifampicin resistance were studied in 257 active pulmonary tuberculosis patients living in the Saratov Region. Investigations were performed using a TB-Biochip MDR kit (Russia). A molecular genetic technique was used to reveal the high prevalence of rifampicin-resistant M. tuberculosis strains (44.3%). Thirteen different types of mutations were recorded in 8 codons of the M. tuberculosis rpoB gene. Among the rifampicin-resistant strains, there was an unfavorable spectrum of gene mutations, namely: a large number of Ser 531->Leu mutations (62.2%), which was associated with the high level of rifampicin resistance. A significant predominance (70.7%) of this mutation type was found in patients with multidrugresistant tuberculosis as compared to those with rifampicin resistance (25%); p = 0.0013. The findings show the need for elaborating additional measures to limit the spread of rifampicin-resistant strains.

Multivariate analysis was made to analyze a contingent of patients with tuberculosis concurrent with HIV infection in the Russian Federation over 7 years, by applying recording form No. 263-y/TB “Tuberculosis/HIV Patient Card”. The tuberculosis/HIV patients were shown to be the most difficult contingent among both the patients with tuberculosis and those with HIV infection.

Based on the characteristics of the contingent of co-infected patients, the authors propose additional recommendations to activate and improve approaches to preventing tuberculosis in HIV-infected patients. Among other activities, work is done in penitentiary and narcological facilities where there are commonly HIV-infected patients who are at high risk for tuberculosis and those who are unregistered in the AID center. 

The correlation between the functional state of the neurocytes of hypothalamic nuclei and pituitary adenocytes was calculated. There was a change in the correlation towards an increase or a decrease, which was accompanied by the change in its direction. These changes were a manifestation of the body’s adaptation to new living conditions, i.e. disease. They reflect the stimulating effect of regulatory centers on the respective organs and systems, the immune system in particular. Morphofunctional discoordination in the relationships within the hypothalamic-pituitary system may be regarded as a component of the pathogenesis of tuberculosis.

Tuberculosis epidemiological parameters were analyzed in children in the unfavorable epidemic area in 2008-2011; followup schedules were analyzed in 142 children with positive tuberculin sensitivity; the results of preventive therapy were studied in 32 children at risk. The use of Diaskintest followed by computed tomography was found to have a considerable impact on the tuberculosis epidemiological parameters of children in the Primorye Territory: as a larger number of new tuberculosis cases were detected in children, there was a better clinical morbidity structure and tuberculosis was identified in its earlier stages. Diaskintest allows unreasonable treatment with antituberculosis drugs to be avoided in 56, 20, and 64.3% of the children in Groups 6A, 6B, and 6C, respectively. The intradermal test using the Diaskintest proved to be a reliable method for monitoring the efficiency of preventive therapy.

Infection control (IC) in tuberculosis facilities is a package of specific measures and technological procedures to reduce the likelihood of tuberculosis transmission. To monitor and assess IC measures is an important component of work of any tuberculosis facility. The health protection in healthcare workers and patients in different healthcare organizations may be compared on the basis of qualitative and quantitative evaluation of the efficiency of tuberculosis IC measures. The major indicators of IC in the healthcare organizations are the incidence of tuberculosis among healthcare workers and that within the first year of their work in the given healthcare organization. An algorithm for IC measures is proposed for tuberculosis facilities.

A comparative investigation was conducted to study the safety and efficacy of rifapentine (Rifapex, Lipin Ltd, India) used to treat 65 patients with drug-susceptible pulmonary tuberculosis. A study group of 41 patients took rifapentine thrice weekly; a comparison group of 24 patients received a standard thrice-weekly regimen of rifampicin according to the manufacturer’s guidelines. The follow-up lasted 12 weeks. The rates of adverse reactions during treatment with rifapentine and rifampicin were 63.4 and 70.8%, respectively (the differences were statistically insignificant). A drug was discontinued because of side effects in 2 (4.9%) and 5 (20.8%) patients in the study and comparison groups, respectively (p = 0.09, Fisher’s exact test). Therapeutic effectiveness was comparable in both groups: all the patients ceased to excrete bacteria, had none complaints or symptoms of intoxication, showed pronounced X-ray changes as reductions in infiltrative changes, consolidation, and foci (the effectiveness was analyzed in 35 patients (20 from the study group and 15 from the comparison one). The findings (comparable efficacy and tolerability, the lower rate of unremovable adverse reactions associated with rifapentine than that with rifampicin) provide a basis for using rifapentine in patients with drug-susceptible tuberculosis.

Two hundred and six patients aged 18-86 years with pleural effusions of varying etiology and a control group of 21 healthy volunteers were examined to evaluate the efficacy of immunological intradermal test with diaskintest to diagnose tuberculous pleurisy. The diagnosis of the latter was verified by microbiological and histological methods in 100% of the patients. Diaskintest was found to be sufficiently high (78.38% in nontuberculous pleural diseases and 80.95% in healthy individuals), which can recommend its use in the comprehensive examination of patients with pleural effusions of unclear etiology.

The hepatic and endothelial protective effects of remaxol and S-adenosyl-L-methionine were studied on 24 male rats with liver damage caused by reserve-series antituberculosis drugs in combination with alcohol. The test agents were found to have a unilateral hepatoprotective effect in decreasing the blood levels of triglycerides, bilirubin, and alkaline phosphatase with a concurrent significant reduction in the manifestations of hyaline-drop and hydropic dystrophy of hepatocytes. Remaxol and ademethionine have the same endothelial protective activity manifested as normalization of an endothelium-dependent vasodilation response and endothelial dysfunction coefficient.

Spontaneous pneumothorax was treated by placing two endobronchial valves during rigid bronchoscopy under anesthesia in a patient with severe end-stage chronic obstructive pulmonary disease (an emphysematous phenotype) and overall paraseptal emphysema in the presence of grade III respiratory failure, with complicated spontaneous pneumothorax recurring manifold even after surgical treatment for spontaneous pneumothorax. This gave rise to the expansion of the lung that had collapsed within 18 months, to healing of bronchopleural fistula, and to return to normal life.

The duration of a follow-up was 1 year with the valves being present in the bronchi and another year after their removal; there was no recurrence of spontaneous pneumothorax. Examination of respiratory function established significant positive changes (forced expiratory volume, vital capacity, and forced vital capacity after one year, then after removal of endobronchial valves). There were more significant positive changes in blood gas composition: normalization of blood oxygen saturation was achieved.