В течение последних 20 лет в нашей стране на фоне социальных потрясений резко возросла заболеваемость туберкулезом, претерпел отрицательную динамику его патоморфоз и получила широкое распространение множественная лекарственная устойчивость возбудителя [2, 23, 51]. Сложность современной ситуации усугубляется тем, что значительная часть пациентов имеют сопутствующие заболевания, среди которых доминирующую значимость приобретают ВИЧ-инфекция и сахарный диабет (СД).

The paper compares the results of treatment in patients with multidrug-resistant tuberculosis who were treated within the project based on the World Health Organization (WHO) principles in the software management of drug-resistant tuberculosis and those who are treated only in the framework of national programs and resources for the treatment of tuberculosis. It has been ascertained that the recommended WHO principles in the software management of multidrug-resistant tuberculosis, by preserving the existing structure of patients, allow the efficiency of treatment to be enhanced by 14.8%. At the same time, mortality rates may be expected to be reduced by 45.3% and, if there are no effective social support programs for patients with tuberculosis, the proportion of patients who discontinue a treatment cycle may increase by 40.1%.

The article describes the current epidemiological situation of multidrug resistant tuberculosis (MDR TB) in the Republic of Belarus and offers the new approaches to the diagnostics and treatment of MDR TB based on the experience of the Republican TB program and the recommendations of leading international experts. Implementation of new approaches will allow reducing the time necessary for diagnostics and treatment of MDR-TB and to increase its efficiency.

The 2005 to 2012 case histories of patients with acute nonspecific abdominal diseases from the Primorye Territorial Tuberculosis Dispensary were retrospectively analyzed. Clinical, laboratory, and radiological diagnostic studies were of no informative value and required that a surgeon should make invasive studies. The patients were divided into 4 groups who underwent laparotomy, laparocentesis, laparoscopy, and laparolift for the diagnosis of acute abdominal diseases. Among the invasive diagnostic techniques, gas-free laparoscopy proved to be optimal and informative in patients with unstable hemodynamics and respiratory failure.

The prevalence of respiratory diseases was analyzed in the Republic of Sakha (Yakutia). A cross-sectional clinical and instrumental study of 2856 dwellers from the town of Yakutsk and the village of Churapcha showed that the proportion of chronic obstructive pulmonary diseases (COPD) was 14.1 and 20.5% in the town and in the village, respectively. One of its chief causes is a considerable spread of tobacco smoking among the urban and rural dwellers of Yakutia. The incidence of COPD among the males aged over 60 years was higher than that in the women; that was almost 2-fold in the rural area; and the male-to-female ratio was nearly equal in the urban area. According to our data, the urban and rural rates of catarrhal diseases were 54.5 and 43.9%, respectively; which was also due to severe climatic conditions and one of the risk factors for COPD.

The paper analyzes contamination factors in children and adolescents from the foci of multidrug-resistant tuberculosis. The analysis of a study of these disease sources, the people who discontinued treatment and contacted with the children and adolescents in the foci demonstrated that these were mainly male alcoholics, as well as unemployed, intensive-phase therapy non-compliant inpatients, patients who went home without permission; 16% of them had convictions. The contacted children and adolescents from a group of patients who discontinued treatment were significantly more frequently stated to have a hyperergic response to tuberculin (10.8%) than those who continued treatment (3.4%) (p ≤ 0.05). Two children and 3 adolescents (15%) fell ill in the treatment discontinuation group. One (3.0%) adolescent did in the treatment continuation group (p ≤ 0.05).

Вспышки туберкулезной инфекции в медико-социальных учреждениях являются актуальной проблемой вследствие тесного контакта пациентов в закрытом учреждении. Несмотря на высокую вероятность распространения инфекции от одного больного, не исключается возможность возникновения в медико-социальном учреждении новых случаев заболевания, обусловленных контактами с другими больными туберкулезом.

The study of the main epidemiological TB indicators in children and adolescents in Russia was conducted, the description of work performed in TB risk groups is presented and its efficiency is defined. The first outcomes of introduction of innovative techniques for childhood TB detection (in line with the Executive Order of the Ministry of Health of the Russian Federation # 855) were summarized.

The frequency of complications after TB vaccination and challenges of TB/HIV co-infection in children were identified and the need to continue the scientific research in this field was demonstrated.

Four hundred and sixty-seven male patients with genital tuberculosis (TB) were examined. Scrotal TB was detected in 372 (79.7%) patients. Fifty-five (11.8%) patients with the unilateral process were found to have isolated epididymal TB; primary isolated epididymal TB occurred in 21 (4.5%) patients. Prostatic TB was diagnosed in a total of 398 (85.2%) patients, of them 27 (5.8%) had isolated prostatic TB, 15 (3.2%) had primary isolated prostatic TB. Seminal vesicle TB was diagnosed in 354 (75.8%) men; one (0.2%) had isolated seminal vesicle TB in the presence of cavernous TB of the left lung. No primary isolated seminal vesicle TB cases were identified. Penile TB was observed in 2 (0.4%) patients; one of them had additionally infiltrative TB of the penile urethra and TB of the prostate; the other had scrotal skin TB.

The genetic structure of drug-resistant and drug-susceptible Mycobacterium tuberculosis (MBT) circulating in the civil sector of the Kyrgyz Republic was analyzed. One hundred and three MBT DNA samples isolated from the expectoration of patients with new-onset pulmonary tuberculosis were examined. MBT was genotyped by the spoligotyping method; its resistance to rifampicin and isoniazid was determined using a TB-Biochip kit. The TB population circulating in the Kyrgyz Republic was characterized by a predominance of Beijing family strains (59.2%). The other strains represented the following families: Т (n = 14), LAM (n = 9), Ural-1 (n = 3), Ural-2 (n = 6), and others (n = 9). Multidrug-resistant strains were statistically significantly more frequently found in the genetic Beijing family than in other genotypes (p = 0.03). Thus, the circulation of drug-resistant Beijing MBT strains is a major factor that complicates the current tuberculosis situation in the Kyrgyz Republic.

The peripheral blood count of γδТ cells was investigated in patients with new-onset pulmonary tuberculosis depending on the clinical form of the disease, on Mycobacterium tuberculosis susceptibility to antituberculosis drugs, and on the response to intradermal tuberculin administration (Mantoux test). The count of γδТ cells was shown to decrease in all clinical forms of tuberculosis infection; however, the most significant increase in their count was noted in disseminated and fibrocavernous pulmonary tuberculosis, as well as in the presence of multidrug resistance in Mycobacterium tuberculosis (in infiltrative and fibrocavernous forms of the disease) and a negative response to the Mantoux test in patients with infiltrative pulmonary tuberculosis. The demonstrated decrease in the count of circulating γδТ cells in the blood of patients with pulmonary tuberculosis promotes a reduction in the protective immune response to Mycobacterium tuberculosis.

По оценкам Всемирной организации здравоохранения, 4,4 млн людей на планете коинфицированы микобактерией туберкулеза и вирусом ВИЧ. Начиная с 2000 г. ежегодно туберкулез является причиной смерти 1 млн человек с ВИЧ-инфекцией. По данным статистики США, около 100 тыс. больных ВИЧ-инфекцией ицированных являются носителями микобактерий туберкулеза. Туберкулез – это наиболее частая инфекция, с которой сталкиваются пациенты с ВИЧ-инфекцией [1]. По данным ряда авторов, в России в структуре оппортунистических инфекций у больных с ВИЧ-инфекцией туберкулез занимает 2-3-е место [2].

Therapy in pregnant women with tuberculosis always presents certain difficulties and sets regarding not only the status of the mother, but also that of her baby. Tuberculosis and pregnancy have been mostly recently considered to be incompatible. The presented clinical case provides evidence that therapy can be performed during pregnancy and can yield a good clinical result in the course of a specific process in the mother and in the adequate intrauterine development in the baby. There is a need for adequate combination therapy with regard to the susceptibility of isolated Mycobacterium tuberculosis, the status of the mother and the baby, and the constant patient monitoring by a phthisiatrician and an obstetrician/gynecologist.