The objective of the study: to analyze the impact of response activities to the COVID-19 pandemic on the system of tuberculosis care provided to the population of the Russian Federation based on the data of the Federal Register of TB Cases (FRTBC).
Subjects and methods. Using regression analysis of data obtained from the forms of federal and sectoral statistical observation, regression equations were drawn up, and estimated indicators were determined for each month of 2020. The estimated indicators were compared with the data obtained from monthly reports downloaded from FRTBC from January to June 2020.
Results. The shortfall in the registration of all cases of tuberculosis treatment relative to estimated indicators in May-June 2020 amounted to 24.4-24.7%, including 24.8% for new cases and relapses. That is very close to the value estimated by the World Health Organisation (25%). The number of tuberculosis cases detected post mortem increased by 37.1%. The number of detected pediatric tuberculosis cases at the age of 0-14 and 15-17 years old decreased by 31.4 and 28.2%, respectively. In June 2020, there was an increase in almost all recorded indicators that was due to the intensified tuberculosis detection activities.
Conclusions. FRTBC allows performing prompt monitoring of the impact of response activities to the COVID-19 pandemic on the system of tuberculosis care provided to the population. After a period of a significant decrease in the number of registered tuberculosis patients in April and May 2020, in June, as anti-epidemic activities related to COVID-19 were slowed down, the number of registered patients tended to reach the previous level and approach their estimated values.

The objective: analysis of tuberculosis situation among the pediatric population of Russia.

Subjects: the data from Federal Statistics Forms no. 8, 30, 33, 47, and 61 were studied. The number of those died is presented as per the data of Rosstat.

Research methods: epidemiological and statistical analysis, expert assessment, and content analysis of publications and regulations.

Results. In 2005-2019, tuberculosis rates among children and adolescents of 0-17 years old decreased: incidence – from 21.5 to 9.0 per 100,000 children (2.4 times), prevalence – from 28.3 to 10.6 per 100,000 children (2.7 times), mortality – from 0.22 to 0.03 per 100,000 children (7.3 times). The incidence of tuberculosis in children of 0-14 years old decreased from 16.4 to 7.7 per 100,000 children (2.1 times), children of 15-17 years old – from 37.6 to 16.5 per 100,000 children (2.3 times). Boys suffer from tuberculosis less often than girls. The decrease in tuberculosis incidence in children is directly related to the overall improvement of tuberculosis situation in the country including the reduction of exposure to tuberculosis by 2.2 times.

In the structure of tuberculosis incidence, the proportion of lung damage increases, while the proportion of other localizations in respiratory organs and extrapulmonary lesions decreases. From 2005 to 2019 among children of 0-14 years old, the proportion of lung damage increased from 18.0 to 32.1%, and among children 15-17 years old – from 80.8 to 89.1%.

From 2005 to 2019, among children and adolescents aged 0-17 years notified with tuberculosis at the end of the year, the proportion of those HIV infected increased up to 3.4%, while the absolute number of children decreased down to 108.

The proportion of children with MDR TB among those with a positive result of sputum test increases (2005 – 10.0%; 2019 – 45.8%).

From 2005 to 2019, the rate of those died of tuberculosis decreased among children of 0-14 years old from 0.17 to 0.02 per 100,000 children (8.5 times), at the age of 15-17 years – from 0.22 to 0.07 per 100,000 children (3.1 times).

The number of children aged 0-14 years, registered with post-vaccination complications decreased by 6.2 times (2005 – 947 children, 2019 – 153 children).

The objective of the study: to identify risk factors for relapses in patients after the effective course of chemotherapy for multiple drug resistant tuberculosis (MDR TB).
Subjects and methods. Medical files of 346 adult MDR TB patients were analyzed, they all had the effective treatment as per regimen IV in Tomsk Phthisiopulmonology Medical Center in 2009-2011. They were divided into 2 groups: Group 1 included 35 patients who developed a relapse of tuberculosis over the next 5 years; Group 2 consisted of 311 patients who had no relapse of the disease over the next 5 years.
Results. The relapse rate in effectively treated MDR TB patients made 10.1% (35/346 patients). The following social factors contributed to higher chances of the relapse: retirement age (p = 0.045; OR = 2.86 [1.14-7.20]) and disability due to somatic diseases (p < 0.001; OR = 4.82 [2.13-10.90]); while biomedical factors were the following: HIV infection (OR = 19.19 [5.29-69.56]), mental illness (OR = 5.85 [2.27-15.03]), tobacco smoking (OR = 3.16 [1.08-9.20]). People with history of tuberculosis relapses (OR = 12.17 [4.19-35.34]) have higher chances of relapse, as well as those having the following characteristics of the tuberculosis disease during the effective chemotherapy course: destruction of lung tissue (OR = 7.48 [1.76-31.80]), positive results of sputum smear microscopy (OR = 2.91 [1.28-6.61]), persisting bacterial excretion (by culture) after 2 months of chemotherapy (OR = 4.98 [2.41-10.29]).

The objective: to study the phenotypic sensitivity of Mycobacterium tuberculosis (MTB) to fluoroquinolones, ofloxacin and moxifloxacin and correlate it with MTB genome mutations associated with resistance to fluoroquinolones to determine the possibility to use these data when compiling chemotherapy regimens IV and V.

Subjects and methods. The study included 108 multiple drug resistant Mycobacterium tuberculosis cultures obtained in 2018-2019 from specimens of tuberculosis patients from three regions of Russia.

To test drug susceptibility of the isolated cultures, standard methods of the modified method of proportions on a liquid medium by Bactec MGIT 960 were used. Genetic determinants of multiple and extensive drug resistance of tuberculosis mycobacteria were detected using the test system of TB-TEST, OOO Biochip-IMB.

Results. Of 66 cultures resistant to ofloxacin, 26 (39.4%) were found to be sensitive to moxifloxacin, while 40 (60.6%) were resistant. Thus, the interpolation of data of ofloxacin drug susceptibility testing to moxifloxacin is unjustified, and using the absolute concentration method as the only phenotypic drug susceptibility testing method in modern laboratories is unacceptable. It was demonstrated that the high level of resistance to moxifloxacin (0.5 μg/ml) was mainly due to the presence of the gyrAD94G, gyrAD94N, and gyrAD94H substitutions in the genome. It was suggested to revise the existing concentrations for moxifloxacin during phenotypic drug susceptibility testing.

The objective of the study: to assess the efficacy of short course chemotherapy in children suffering from respiratory tuberculosis and exposed to multiple and extensive drug resistant tuberculosis.

Subjects and methods. 17 children (the median age was 7 years) with active respiratory tuberculosis and exposed to multiple and extensive drug resistant Mycobacterium tuberculosis (MTB) received treatment. None of the children had a positive result of a sputum test. During the intensive phase, chemotherapy consisted of 5 drugs and 4 drugs in the continuation phase. The regimen consisted of the drugs, to which the index case was susceptible. The duration of the intensive phase and the whole course of treatment was determined by the time when symptoms of intoxication were relieved, blood rates returned to normal, and positive X-ray changes were observed. The chemotherapy efficacy was confirmed by the absence of relapse during the long-term follow-up (1-3 years after treatment completion).

Results. In 57.1% of cases, symptoms of intoxication stopped after 3 months of treatment, in 42.9% it happened later; blood rates returned to normal in 53.8% of cases after 2 months, in 46.2% – at a later date. In the majority of cases (82.4%), starting from 3 months of treatment, gradual positive X-ray changes were observed; in 17.6% of cases, the X-ray signs remained stable. On average after 8.0 ± 0.4 months of treatment, 35.3% of cases underwent planned surgery. The median duration of the intensive phase made 4.2 ± 0.4 months, the whole course of chemotherapy was 16.0 ± 0.7 months. No relapses were observed in 1-3 years after treatment completion.

The objective of the study: to assess the diagnostic informative value of ADA isoenzymes – ADA-1 and ADA-2 – in the pleural fluid in case of tuberculous pleurisy with the relevance to the age of patients.

Subjects and methods. In 200 patients with pleural effusion of tuberculous etiology and 152 patients with pleural effusion of non-tuberculous etiology, the activity of ADA (and its isoenzymes of ADA-1 and ADA-2) was tested.

Results. In patients with tuberculous pleurisy, the activity of ADA, ADA-1 and ADA-2 was significantly higher than in patients with pleurisy of a different etiology. Tests of ADA activity (above the threshold value of 30 u/L) had sensitivity and specificity of 95 and 94%, respectively. The sensitivity of testing the activity of ADA-1 and ADA-2 (above the threshold value of 20 u/L) was 30 and 93% with the specificity of 96% and 88%, respectively. The frequency of detecting the activity of ADA and ADA-2 above the threshold did not depend on the cellular nature of tuberculous pleurisy. The activity of ADA-2 was associated with the percentage of pleural fluid lymphocytes in the case of tuberculosis.

No influence of age on the diagnostic informative value of ADA and ADA-2 was found out. ADA-1 activity was weakly positively correlated with the age of the patients.

The objective of the study: to assess the efficacy of standard chemotherapy regimens in the treatment of children and adolescents suffering from respiratory tuberculosis.

Subjects and methods. 272 children aged 0 to 17 years old with newly diagnosed respiratory tuberculosis were on treatment.

Results. Treatment of children suffering from respiratory tuberculosis with standard chemotherapy regimens made it possible to achieve cure of tuberculosis in 264/272 (97.1%) children and adolescents aged 0-17 years old, 8/272 (2.9%) underwent surgery additionally to chemotherapy.

The article describes a clinical case demonstrating the results of the lungs ultrasound examination in the COVID-19 patient during the acute period of the disease and early recovery period.

The review presents data from 56 publications about functions of vitamin D in the human body, the mechanisms of its action and the relationship between lung diseases and the level of vitamin D in the blood. Low serum vitamin D levels are associated with impaired lung function and an increase in inflammatory, infectious, or neoplastic diseases. The results of numerous studies allow considering vitamin D not only a marker of different courses of bronchopulmonary diseases but also as a therapeutic target in the treatment of patients with chronic obstructive pulmonary disease while maintaining the immune system and anti-infectious protection.