The objective: to analyze the course of the new coronavirus infection (COVID-19) in children with active respiratory tuberculosis.

Subjects and methods. The article describes results of retrospective analysis of the course of the new coronavirus infection in 25 children (3-12 years old) with active respiratory tuberculosis during the outbreak of COVID-19 in an in-patient TB unit.

Results. 24 (96%) persons got infected after the close exposure to the coronavirus infection, and 1 (4%) child didn't get infected. The diagnosis was verified by polymerase chain reaction (detection of RNK of SARS-CoV-2) in 33.3%, by enzyme immunoassay (detection of IgG antibodies to SARS-CoV-2 in 1 month after quarantine removal) in 100%. 58.3% of children with respiratory tuberculosis (14 people) infected with coronavirus infection had minimal respiratory symptoms, that did not differ from signs of other respiratory viral infections; clinical manifestations of the disease were completely absent in 41.7% (10) patients. Coronavirus pneumonia was diagnosed in 4 (16.7%) children who suffered from COVID-19, they had no clinical signs of lower respiratory tract disorders and no body temperature increase; 3 patients had no signs of respiratory viral infection; in all cases, the lung damage detected by computed tomography didn't exceed 10%. In 2 months after the removal of quarantine, no IgG antibodies to SARS-CoV-2 were detected in 2 out of 10 examined children (20.0%), thus there was a chance for re-infection. No mutual aggravating effect of coronavirus infection and tuberculosis was revealed in their combination over the entire observation period (4 months).

The objective: to analyze treatment efficacy and causes of tuberculosis relapses in HIV-infected patients with severe immunosuppression who have started antiretroviral therapy (ART).

Subjects and methods. 139 case histories were studied, those case history belonged to the patients with TB/HIV co-infection and CD4 count below 100 cells/μl, a median of 33.2 cells/μl – 4.2%, who started ART in the in-patient unit. The efficacy of inpatient treatment was assessed; 89 patients were followed up after discharge from hospital. The follow-up period lasted from January 2011 to May 2019.

Results. ART did not increase the efficacy of the in-patient stage of TB/HIV treatment due to the development of immune reconstitution inflammatory syndrome, which occurred in 34.5% of patients and accounted for 70.0% of hospital lethality cases. After discharge from hospital, 69.7% of patients successfully completed anti-tuberculosis chemotherapy, 25.8% died before completing treatment, the main cause of death was tuberculosis (56.5%), including multiple drug resistance in 30.8% of cases. At the outpatient stage, 29.1% of patients interrupted ART, their death rate was higher (p = 0.007), and tuberculosis and HIV-associated diseases became the cause of death more often (p = 0.042) versus the compliant patients. Tuberculosis relapses developed in 17.7% after 16.7 ± 1.7 months after completion of treatment; 63.6% had multiple drug resistance, patients with tuberculosis relapses interrupted ART more often (p = 0.002), had a lower CD4 count (p = 0.030) versus patients without relapses. As of May 2019, 46.1% of patients survived and had no signs of active tuberculosis; 42.7% died, tuberculosis dominated among the causes of death – 50.0% (in 52.6% – multiple drug resistance) as well as HIV-associated diseases (21.1%).

The objective of the study: to characterize the cases of tuberculosis relapses with lesion in urogenital organs.

Subjects and methods. Out of 140 case histories of patients with urogenital tuberculosis (UGTB; tuberculosis of the urinary and male reproductive system), registered for follow-up by the phthisiourologist, all files of patients with tuberculosis relapses were picked up, totally, there were 13 of them.

Results. Men prevailed among cases of relapses (61.5%). Patients at the age of 30-50 years old made 46.1%, and 53.9% were 51 years old and above. In the first episode of tuberculosis, lesions of the genitourinary system were observed in 53.9% of patients, bacterial excretion was found in 38.5%. On the average, the relapse developed in 9.1 years after successful cure of the first episode of tuberculosis: after respiratory tuberculosis – in 5.6 years and after UGTB – in 12.3 years. In 3 (23.1%) patients with relapse, mycobacteriuria was documented, in 1 of them, drug resistance (to streptomycin and isoniazid) was detected. In general, in the relapse of tuberculosis with urogenital lesions, the kidneys were most often (69.2%) affected. The treatment of relapse was effective in 12 out of 13 patients. During chemotherapy of tuberculosis, 3 (23.1%) patients developed toxic and allergic reactions that required treatment interruption or cancellation of the drug.

The objective of the study: to analyze treatment outcomes in patients with pulmonary destructive MDR tuberculosis who completed the intensive phase of treatment and had healed or persisting cavities.

Subjects and methods. Treatment outcomes were retrospectively analyzed in 191 patients suffering from destructive pulmonary MDR tuberculosis who underwent the intensive phase of chemotherapy in in-patient settings in 2009-2012 and 2013-2015 (treated by different regime ns);  in each of those cohorts, groups were formed depending on persistence/healing of destruction (cavities) during the intensive phase of chemotherapy:  (CV-) ‒ the destruction healed, (CV+) – the destruction persisted.

Results. In 24 months, treatment was found to be effective only in 19/68 (27.9%) in the (CV+) group versus 31/40 (77.5%) in the (CV-) group, p < 0.05 (cohort 2009-2012); 17/42 (40.5%) versus 29/41 (70.7%), respectively, p < 0.05 (2013-2015 cohort). Within 48 months, treatment outcomes were as follows: clinical cure in the (CV+) group was 38.2% (26/68 people), and in the (CV-) group – 72.7% (29/40 people), p < 0.05 (2009- 2012) and 23/42 (54.7%) and 33/41 (80.5%), respectively, p < 0.05 (2013-2015 cohort).

Conclusion. Considering the above, when assessing treatment in the intensive phase of chemotherapy in destructive pulmonary tuberculosis patients, it is necessary to take into account the rate of cavity healing but not being limited to sputum conversion. Patients with persisting cavities should not be transferred to the continuation phase, the surgery or collapse treatment should be considered for such patients.

The objective: to determine factors influencing treatment efficacy in patients with multiple (MDR) and extensive (XDR) drug resistant tuberculosis.

Subjects and methods. The medical files of 107 tuberculosis patients (men – 75, women – 32) were analyzed, 17 of them were HIV positive. Those 107 patients were registered for treatment as per chemotherapy (CT) regimens IV-V in 2017 in Kaluga Region. 99 (92.5%) patients suffered from tuberculosis with lung tissue destruction. 60.7% (65 patients) had MDR, while 20.8% (22 patients) had XDR. Only 58.2% of patients had MDR TB confirmed by polymerase chain reaction before treatment start.

Results. In 24 months, the effective course of treatment was registered in 64/107 (59.8%). The highest level of effective treatment was expectedly registered among new cases – 21/30 (70%); and the lowest level was among patients starting chemotherapy again after treatment interruption – 4/10 (40%), p > 0.05. Among 64 patients with effective treatment course, 25 (39.1%) had surgery and 39 (60.9%) had chemotherapy only. Surgical activity among the cohort of 2017 made 26/107 (24.3%). The effective treatment outcome was achieved in 8 (47%) out of 17 patients with TB/HIV co-infection, and among HIV negative patients it was reached in 56/90 (62.2%), p > 0,05.

The objective: to compare the results of follow-up over patients with a mild form of pulmonary sarcoidosis who received alpha-tocopherol and those receiving no treatment.

Subjects and methods. The results of follow-up over 80 sarcoidosis patients were retrospectively analyzed – two groups of 40 patients enrolled according to the copy – pair principle (gender, age, initial X-ray stage, Löfgren syndrome, and follow-up duration). The only sign that statistically distinguished the groups was a high frequency of complaints about weakness in those who received vitamin E – 55% versus 30% (p < 0.05). The follow-up period for patients in both groups was a year or more (a control point). The database was maintained and processed using SPSS-18, Windows 10. A clear advantage of vitamin E administration was revealed when comparing the data of computed tomography, which resulted in improvement in 87.5%, and the disease progressed in 2.5%, while in the group receiving no treatment – 60 and 12.5%, respectively. The OR of improvement in computed tomography with alpha-tocopherol versus the group receiving no treatment made 4.67 (95% CI, 1.51-14.46).

Conclusion. The use of vitamin E in mild forms of thoracic sarcoidosis gives a better result compared to the group receiving no treatment.

The objective of the study: to determine the potential improvement of tuberculosis detection in primary health care institutions (PHC) through identification of risk groups and screening them for tuberculosis.

Subjects and methods. Tuberculosis incidence in Azerbaijan over 10 years (2006-2015) was retrospectively analyzed. In two districts of Baku (with TB incidence rate of ≤ 30 per 100,000 population), certain activities were performed to confirm that such level of tuberculosis incidence among the local population was true-to-life. The groups of the population with the highest tuberculosis detection rate were identified. In 2016, those groups included: pensioners, housewives, in-country migrants, ex-prisoners, as well as people at the age group 19-24 years old. In 2016, a central register for these groups was created that helped to screen them for tuberculosis in 2017-2018.

Results. The problems interfering with tuberculosis detection in PHC were identified. In this regard, in two districts of Baku with TB incidence ≤ 30, health education among medical personnel and population was intensified, social groups facing the high risk to develop tuberculosis were identified, and laboratory diagnostics of tuberculous mycobacteria tuberculosis (MTB) was improved. For the first time in PHC, the rapid molecular genetic method (GeneXpert MBT/Rif) was used to detect MTB DNA and the predictor of multiple drug resistance. As a result of the events of 2017-2018 aimed to screen risk groups for tuberculosis, the incidence in those two districts among the local population increased by 1.5 times, and in the overall population of both districts – by 1.7 times. After that, the clinical structure of new tuberculosis cases improved. Thus, the rate of focal tuberculosis increased by 3 times. Among extrapulmonary tuberculosis cases, there were no cases of meningitis.

The article describes a clinical case of a rare combination of hereditary pathology – Gaucher disease and latent tuberculosis infection in an 8-year-old child. The child was examined for tuberculosis due to disseminated small foci and calcination in the lung tissue detected by chest computed tomography. The particular parameter of latent tuberculosis infection of this case was the positive results of IGRA tests (T-SPOT TB and QuantiFERON) with a negative response to the intradermal test with recombinant tuberculosis allergen. According to the examination results, the disseminated tuberculosis was not confirmed, diffuse lung damage was regarded as a manifestation of Gaucher disease, which was a rare sign of this pathology according to the published data.

The article presents data from 48 publications about clinical signs and diagnostics of cutaneous tuberculosis.

The article presents the analysis of 36 publications about neurotoxic properties of anti-tuberculosis drugs, their clinical manifestations and mechanisms of the neurotoxic action. It specifies predisposing factors for the development of neurotoxicity and risk groups. It highlights the necessity of early detection of neurotoxicity caused by chemotherapy regimens for timely management and adequate treatment of patients.