The objective: to study the course of tuberculous meningitis (TM) in patients with HIV infection after the initiation of antiretroviral therapy (ART) and evaluate their effect on the outcome prognosis.

Subjects and methods. 58 patients with concurrent tuberculosis and HIV infection were examined, in whom, after initiation of ART, TM exacerbated or developed. The mean age made 36.0 ± 1.4 years; there were 45 men (77.6%). The following groups were identified: 25 patients who were admitted with diagnosis of TM and started treatment; and after ART initiation, they experienced a worsening of meningitis course of (Group I); 17 patients who received anti-tuberculosis drugs for tuberculosis in other sites and in whom, after ART initiation, the course of tuberculosis worsened and TM developed (Group II); 16 patients who started ART at the pre-hospital stage without a previously diagnosed tuberculosis, in whom TM was one of the first manifestations of active tuberculosis (Group III).

Results. Exacerbation of previously treated TM occurred in the period from 3 to 62 days (median 13.0), which was considered as a manifestation of the immune system restoration syndrome. In 20 (80.0%) patients, stabilization was achieved in the period from 30 to 278 days (median 120.0), 4 (16.0%) people died due to progression of meningitis. TM, which began for the first time after ART in patients who had taken 12 to 150 (median 40.5) doses of anti-TB drugs, developed within 5 to 90 days (median 24) and was associated with high mortality (76.5%), which could be due to drug resistance. Of the 16 patients in whom TM developed after the start of ART on an outpatient basis, active tuberculosis could not be excluded in 12 (75.0%) of them before starting treatment. Symptoms of meningitis appeared in 4-63 days (median 28.5), mortality reached 87.5%, one of the reasons could be drug resistance.

The objective: to study the patterns of nonspecific bacterial population isolated in patients with multiple drug resistant tuberculosis in the city of Karaganda and assess its sensitivity to antimicrobial agents.

Subjects and methods. 343 sputum specimens were tested. Microorganisms were identified using mass spectrometry using the MALDI-TOF method (Microflex, BD, Germany). Drug susceptibility was determined by the diffusion method in accordance with CLSI recommendations (2012).

Results. Bacterial growth was observed in 20.99%. More than ⅔ of isolated microorganisms were resistant to three groups of drugs and more, thus it could be classified as MDR. S. aureus prevailed in the structure of secondary bacterial population and made 22.22%, of which 12.5% were MRSA. Among gram-negative bacteria, K. pneumoniae – 12.5% and A. baumannii – 11.11% dominated among isolated species. 10% of K. pneumonia strains and from 40 to 70% of A. baumannii were resistant to carbapenems. The secondary bacterial population isolated in pulmonary tuberculosis is represented by nosocomial strains of ESKAPE group, which are typically resistant to modern drugs.

Chronic obstructive pulmonary disease (COPD) and overweight/obesity are among the leading health problems worldwide.

The objective: to conduct a comparative analysis of exercise tolerance in patients with COPD with normal body mass and overweight during a six-minute walk test using an original device for cardiorespiratory analysis and a method for assessing cardiorespiratory status.

Subjects and methods. 192 COPD patients were enrolled in the study. Patients were divided into two groups - with normal body mass and overweight. To assess exercise tolerance, six-minute walk test was used simultaneously with the device we developed specifically for cardiorespiratory analysis. The distance covered within 6 min (6MWD) was compared with the proper indicator of 6MWD (i).

Results. In patients with normal body weight compared with patients with overweight, the following indicators were significantly lower: the average ratio of 6MWD/6MWD (i) (p = 0.0121), the level of oxygen saturation after 6-minute walking test, % of fat, and % of muscle. A direct correlation was observed between 6MWD and BMI (r = 0.54, p = 0.002), and between 6MWD and % of muscles (r = 0.58, p = 0.012).

Conclusion. Overweight patients with COPD have a higher exercise tolerance compared with patients with normal body weight, which can be partly explained by differences in the body composition with a significantly lower percentage of muscle mass in patients with normal body weight.

The objective: to characterize tuberculosis in children exposed todrug-resistant tuberculosis in St. Petersburg.

Subjects and methods. 51 children exposed to tuberculosis in their families were enrolled into the study; of them, 23 children were exposed to MDR TB; 7 children were exposed to other drug resistant patterns of the disease; 21 children were exposed to drug susceptible tuberculosis.

Results. In St. Petersburg in 2015-2017, MDR TB cases prevailed among adult index cases to whom children were exposed. The course of tuberculosis was the most severe in children exposed to MDR TB. Such children were treated with regimen IV with high efficacy achieved, taking into account the severity of the disease, age, concurrent disorders, and tolerability of the drugs, as well as drug resistance of the index case.

The objective: to analyze the results of preventive treatment (PT) of tuberculosis in HIV infected patients in Nizhny Novgorod Region.

Subjects and methods: in 2015-2017, preventive treatment of tuberculosis was prescribed to 1,374 people living with HIV (PLHIV), registered in TB dispensaries. Before the prescription of preventive treatment, patients underwent a comprehensive examination to exclude active tuberculosis, including digital chest X-ray. For immunodiagnostics of latent tuberculosis infection, an intradermal Mantoux test with 2 TU of purified tuberculin in standard dilution was used. The immune status was assessed based on CD4⁺ count. The effectiveness of antiretroviral therapy (ARVT) was assessed by the concentration of HIV RNA in the blood; when achieving complete viral suppression (less than 58 copies of HIV RNA in μl), ARVT was found to be effective. Preventive treatment included isoniazid at a dose of 5 mg per kg of patient body weight in combination with vitamin B6 (pyridoxine hydrochloride) at the dose of 15-25 mg/day (tablet) for 6 months.

Results. The efficacy of preventive treatment was assessed by 2-year survival free of active tuberculosis in those who started preventive treatment (including those who did not complete it). There were organizational problems while administering preventive treatment of tuberculosis people living with HIV: low adherence to treatment, difficulties in monitoring drug in-take and adverse events monitoring. Only 601/1,374 – 43.7% of people completed the entire 6-month course. Tuberculosis developed in 10 (0.7 ± 2.7%) of 1,374 PLHIV who started preventive treatment, of which 9/10 at that time had CD4⁺ count below 350 cells/μl, and 8/10 patients refused or interrupted ART. Among PLHIV who completed the 6-month course of preventive treatment, 1 of 601 (0.17%) developed tuberculosis, while among those who interrupted – 9/773 (1.16%) (χ2 = 4.66; p < 0.05), which made 170 and 1,160 per 100,000 decreed population, respectively. The presented results allow concluding that preventive treatment of tuberculosis is advisable for PLHIV. 

The objective of the study: to develop a number of organizational measures aimed to improve the effectiveness of early detection and prevention of respiratory tuberculosis among the population including people living with HIV (PLHIV) exposed to tuberculosis infection.

Subjects and methods. The authors used data of 34 patients suffering from chronic respiratory tuberculosis residing in Saransk; they all had bacterial excretion and were monitored in the TB dispensary in 2015; also, data of 198 respiratory tuberculosis patients residing in Saransk in 2014-2015 were used, these data were obtained from Rosstat Form No. 33 and reporting forms of Edict no. 50 of the Ministry of Health of Russia. For all patients, gender, age, year of birth, address of actual residence (street, house number) are indicated. For the analysis, statistical and cartographic analysis based on geographic information systems (GIS) was used as well as data on the number and density of the population in Saransk, and the type of development in each district of the city. The cartographic web service of OpenStreetMap (OSM) was used as a cartographic basis.

Results. The use of a cartographic method based on GIS allowed expanding the concept of a tuberculous nidus setting up buffer zones, within which tuberculosis infection also spread as a result of accidental exposure of population to the source of infection. Use of the cartographic method demonstrated that within the buffer zones for 1 patient with chronic respiratory tuberculosis with MTB+ there were 4 new tuberculosis patients. To reduce this ratio, multi-level comprehensive organizational measures were developed aimed at the early detection and diagnosis of tuberculosis among population, including PLHIV residing near infection nidi.

The objective of the study: to investigate the effect of the molecular genetic test of PCR-RT within the procedure of microbiological diagnosis of tuberculosis on the efficacy of chemotherapy in patients with multiple drug resistant tuberculosis in the Mary-El Republic.

Subjects and methods. 344 patients with multiple drug resistant tuberculosis were enrolled in the study. The efficacy of chemotherapy was assessed based on sputum conversion confirmed by culture.

Results. It was demonstrated that PCR-RT for determining mutations in the diagnostic material samples associated with drug resistance to rifampicin, isoniazid, and fluoroquinolones, and the early prescription of an adequate chemotherapy regimen based on this study, followed by amendment of the treatment regimen according to the results of phenotypic drug susceptibility tests, significantly (on average from 3.6 to 2.5 months, p <0.05) reduced the time required for sputum conversion confirmed by culture, which reduced the time of in-patient treatment.

The objective: to determine the effect of prolonged oxygen therapy (POT) on changes in the clinical and functional status of patients with chronic obstructive pulmonary disease (COPD) and severe hypoxemic chronic respiratory failure.

Subjects and methods. 30 patients with COPD were examined during the period of remission of the disease, the average age was 64.8 ± 6.9 years. After the initial examination, patients were prescribed POT at home for 16 hours/day. As a basic therapy, all patients received a combined bronchodilator of long-acting indacaterol/glycopyrronium at a dose of 110/50 μg once a day in combination with beclomethasone dipropionate (BDP) at the dose of 200-400 μg/day. The patients were examined repeatedly 3 times with a 1-year interval. Clinical indicators, gas composition of arterial blood, results of spirometry and ultrasound examination of the diaphragm were evaluated.

Results. Initially, disorders of the functional state of the diaphragm were detected in COPD patients with hypoxemia (decrease in the thickening fraction and relaxation rate). After the first year of using POT, an increase in the rates of contraction and relaxation of the diaphragm muscle under tidal respiration was observed. On the 2nd and 3rd year of using POT, it was noted that indicators of the functional state of the diaphragm stabilized. As a result of POT, the number of exacerbations went down and mortality in COPD patients with hypoxemia decreased. Against the background of basic therapy with indacaterol/glycopyrronium in combination with low doses of BDP, no adverse events were observed for the entire period of follow-up.

Conclusions. POT in combination with a double long-acting bronchodilator and low-dose inhaled glucocorticosteroids in COPD patients with hypoxemic chronic respiratory failure helps to reduce dyspnea, the number of severe exacerbations, as well as improve pulmonary ventilation functions, blood gas content, and the diaphragm function during the first year of its use. Further, the indicators continued to stabilize.

The article presents a clinical case that confirms the importance of careful collection and analysis of medical history and active identification of pathology of the upper respiratory tract, middle ear and eyes typical of the debut of Wegener's granulomatosis. It demonstrates the need for early testing of level of antibodies to the neutrophil cytoplasm in the blood serum (ANCA) and biopsy in the target organs giving the preference to less invasive transnasal biopsy. The positive results of early comprehensive immunosuppressive ex juvantibus therapy confirm the diagnosis of Wegener's granulomatosis.

The article presents a brief overview of the establishment and development of screening system in the pediatric population for tuberculosis and latent tuberculosis infection - from Koch alt-tuberculin to modern recombinant tuberculosis allergens for intradermal administration and in vitro laboratory tests. It gives extensive data on clinical research and the introduction into practical public health of the Russian Federation of the test with recombinant tuberculosis allergen as a screening method for tuberculosis in children from 8 to 14 years old inclusively.