The article presents a clinical case of cure of pulmonary mycobacteriosis (MB) with healing of a pathological cavity that developed as a result of Mycobacterium kansasii invasion. The combination of individually selected anti-mycobacteriosis chemotherapy and implantation of an endobronchial valve in the upper lobe bronchus of the right lung, draining the cavity, made it possible to achieve this result in a patient with a history of pulmonary embolism and other localizations of thrombosis, which was a contraindication for the lung resections.

The objective : comparative assessment of hepatotoxicity of combinations of anti-tuberculosis drugs (ATBDs) including those recommended for short-course chemotherapy and analysis of protective properties of Semax and ascorbigen. Subjects and Methods . The study consisted of 2 experiments with different combinations of anti-tuberculosis drugs and the accompanying drug. In Experiment 1, rats in the experimental groups received Mxf Lzd Pto Cs Z and Mxf Lzd Pto Cs Z + Semax; in Experiment 2, they received Mxf Lzd Pto Bdq Cfz and Mxf Lzd Pto Bdq Cfz + ascorbigen. Rats in control groups were administered 1% starch gel orally. The duration of administration made 14 days in all groups. Hepatotoxicity was assessed by biochemical parameters and pathomorphological criteria. Results . In rats, receiving Mxf Lzd Pto Cs Z, a statistically significant increase in transaminase and total bilirubin levels as well as profound changes in liver tissue were detected versus Control Group. In rats receiving Mxf Lzd Pto Bdq Cfz, despite the elevated transaminase activity, pathomorphological changes in the liver were less severe. The use of Semax and ascorbigen contributed to the improvement of enzymatic activity and lower liver tissue damage. It has been shown that the toxicity modifying properties of ascorbigen are more pronounced, however, the hepatoprotective potential of Semax was manifested when the structural liver disorders were more severe.

The objective : evaluation of potential of modern methods of rifampicin susceptibility testing in detection of heteroresistance of Mycobacterium tuberculosis cultures. Subjects and Methods . Mixtures of susceptible (H37Rv) and resistant (strain 5521 with XDR, with the rpoB Ser531Leu mutation) Mycobacterium tuberculosis strains were artificially created in proportions from 0% to 100%. Phenotypic methods (BACTEC MGIT 960, proportion method on Middlebrook 7H10 medium) and molecular genetic tests (TB-TEST, Amplitub-MLU-RV, AmpliTest MBT-Resist I) were used to test resistance to rifampicin. Results . Phenotypic methods revealed resistance to rifampicin with 1% resistant cells in the mixture. Molecular genetic methods showed variable detection thresholds: 5% (AmpliTest MBT-Resist I), 20% (TB-TEST), and 30% (Amplitub-MDR-RV). The authors demonstrate possibility of enhancing the sensitivity of domestic molecular genetic test systems by improving PCR data interpretation software, as well as the need to develop algorithms for tuberculosis diagnosing, taking into account limitations of the methods used.

The objective : to evaluate monitoring of tuberculosis outbreaks to obtain information on the spread of tuberculosis infection in the region, assess the effectiveness of preventive measures in the infection foci and determine the amount of resources required for this. Subjects and Methods . Data for 2023-2024 were analyzed. The data were obtained from registers of outbreaks (5,554 outbreaks registered in the city) and the register of dispensary follow-up (5,675 tuberculosis patients registered in the city), developed by Moscow Research and Clinical Center for Tuberculosis Control of the Moscow Government Department of Health, and implemented in Moscow. Results . Of 5,554 tuberculosis outbreaks registered in Moscow, 3,242 (58.4%) were household ones, with a prevalence of 12 cases per 100,000 population, of which 29.6% were formed by tuberculosis (TB) patients with a positive result of the sputum test, and 39.5% by non-permanent residents of the city. In the outbreaks, 92 cases of active tuberculosis were detected among close contacts. Of these, 3 cases were detected during a repeated examination of contacts from Dispensary Follow-up Group IV. This rate reflects the incidence of tuberculosis in outbreaks after preventive measures were carried out by a district phthisiologist, which equals to 5.1 (95% CI: 1.1-14.9) per 100,000 people registered in Dispensary Follow-up Group IV. 87 patients fell ill with tuberculosis before the outbreak was detected by a phthisiologist; they were detected during the first screening of the exposed people. The indicated number determined the natural course of the tuberculosis epidemic process – the incidence in outbreaks before its detection by phthisiologists made 1561 (95% CI: 1252-1922) per 100,000 examined contacts from the immediate environment of the patient. Tuberculosis patients who were permanent residents had fewer contacts in the immediate environment than those who belonged to the non-permanent population: 1.78±0.04 and 2.25±0.12, respectively ( p <0.01). Tuberculosis patients aged 18–40 years, who were permanent residents had significantly more contacts than patients over 40 years old: 2.13±0.08 versus 1.59±0.05, respectively ( p <0.01). The number of detected outbreaks formed by one patient varied from 0.4 to 1.3 in the patients of different population groups. The proportion of patients with detected outbreaks is 64.5% (95% CI: 63.3-65.8%) overall, and 91.8% (95% CI: 90.4-93.1%) among permanent residents. Among the outbreaks that phthisiologists worked with, 17.7% turned out to be false.

The objective : to analyze medical and social factors in new cases among children and adolescents from tuberculosis outbreaks with lethal cases. Subjects and Methods . 107 children and adolescents aged 0 to 17 years were enrolled in the study. They all were examined and treated at Hospital No. 3 of Regional Clinical TB Dispensary in Astrakhan in 2015-2023. They were confirmed as new cases after exposure to 99 tuberculosis outbreaks with lethal cases. Results . A retrospective analysis of medical records revealed that from 2015 to 2023, the absolute number of children and adolescents ill with tuberculosis after exposure to tuberculosis outbreaks with lethal cases decreased, which was associated with a significant reduction of tuberculosis mortality in the region. The majority of cases were identified by immunodiagnostics – 52/107 (48.6%) and contact screening – 50/107 (46.7%), the rest were detected by fluorography – 2/107 (1.9%) and when seeking medical help – 3/107 (2.8%). In children aged 0 to 14 years, tuberculosis of the intrathoracic lymph nodes (TBITLN) was diagnosed more often – 77/88 (87.5%), of which in 51/77 (66.2%) children and 10/19 (52.6%) adolescents, the calcification phase was observed. Most often one of the parents was the index case at the outbreak with lethal cases – in 50/107 (46.7%) children or adolescents. Multidrug resistance of was confirmed in the index case in 68/99 (68.6%) outbreaks with lethal cases. In 40.2% of children or adolescents, tuberculosis was detected 3 years after the death of the index case. 36/107 (33.6%) children and adolescents belonged to socially marginalized families.

The objective: to establish effectiveness and safety of preventive treatment of tuberculosis with fluoroquinolones in children exposed to multidrug-resistant tuberculosis (MDR TB) in their families.Subjects and Methods. A cohort prospective study was conducted in Arkhangelsk Region from January 01, 2011 to December 31, 2021. Children exposed to MDR TB who received or did not receive preventive treatment were enrolled in the study.Results. 286 children aged 0 to 18 years exposed to 939 adult MDR TB patients were included in the study. Of the 286 children, 37 were exposed to more than one adult with MDR TB, 3 children were exposed to 5 cases, 2 children were exposed to 4 cases, 8 children were exposed to 3 cases, and 24 children were exposed to 1 case. Of the 225 children who received preventive treatment with fluoroquinolones, there were no cases of tuberculosis as of March 1, 2024. Among 61 children who received no preventive treatment, there was 1 (1.64%) case of tuberculosis, which corresponded to the rate of 1639.3 per 100,000 contingent. Adverse reactions to fluoroquinolone were reported in 48/225 (21.33%) children, of which 8/225 (3.6%) were serious ones. All adverse reactions resolved.

The objective: to identify socio-demographic and behavioral risk factors associated with occurrence of tuberculosis relapse among tuberculosis patients during the COVID-19 pandemic in Fergana Region, Uzbekistan. Subjects and Methods. The article describes a cross-sectional study among tuberculosis patients admitted to hospital in 2020-2022. 1499 patients were enrolled in the study. Univariate and bivariate analysis of socio-demographic and behavioral parameters was conducted. Results. Bivariate odds ratio analysis of demographic factors revealed that individuals aged 18-29 years were 3.1 times more likely to develop tuberculosis relapse, while those aged 30-49 years were 2.2 times more likely to develop tuberculosis relapse versus those aged 70 years and older. Also, unmarried people were 4 times more likely to develop tuberculosis relapse than divorced people. While individuals who frequently consumed fatty foods were 2.6 times more likely to develop tuberculosis relapse.

The objective: to evaluate effectiveness of treating respiratory tuberculosis with multiple and pre-extensively drug resistance in adolescents depending on the drug susceptibility testing methods.Subjects and Methods. In Group 1 consisting of new patients (16 adolescents), the pathogen was identified in the institute’s laboratory (Amplitub-MLU-RV, Amplitub-FQ-RV, BACTEC MGIT 960; DST for the full spectrum of anti-tuberculosis drugs). In Group 2 consisting of 35 adolescents admitted for repeated treatment (comparison group), the pathogen was identified at the place of residence (GeneXpert MTB/RIF), by culture on solid nutrient media.Results. In all 16 (100%) patients of Group 1, chemotherapy (CT) was prescribed taking into account the full DR spectrum according to individual regimens, the achieved outcome was assessed as “effective treatment”. In 12/35 (34.3%) patients of Group 2 with a positive sputum test, chemotherapy was prescribed with no consideration of the full DR spectrum, the outcome was “treatment failure”. A statistical relationship was established between the risk factor “chemotherapy with no consideration of the full DR spectrum” and the outcome “treatment failure” (χ²=7.174; p=0.008). The presented results prove the importance of information on the full DR spectrum in adolescents for the prescription of chemotherapy according to individual regimens.

The objective: prevention and relief of hepatotoxic reactions to antituberculosis drugs in patients with infiltrative destructive pulmonary tuberculosis with multiple, pre-extensive and extensive drug resistance.Subjects and Methods. Clinical and laboratory data of 160 patients receiving antituberculosis drugs and additionally morpholinium-methyl-triazolyl-thioacetate (Thiotriazolin) (TTZ Group) or Phosphogliv (Comparison Group (CG)) were comparatively analyzed.Results. After 4 months, TTZ Group showed a decrease in frequency of toxic reactions to antituberculosis therapy, suppression of cytolysis and cholestasis syndrome as evidenced by decreased levels of ALT and AST enzymes, alkaline phosphatase, normalization of bilirubin levels and its fractions, and improved liver protein-synthetic function. In TTZ Group, normalization of the antioxidant defense system and free radical oxidation (FRO) was achieved, while in the comparison group, FRO rates did not show positive changes. Patients in TTZ Group showed more pronounced resorption of infiltration, healing of destruction sites, decrease in the frequency of bacterial excretion 4 months after the start of treatment versus Comparison Group.

The objective: to determine the types and prevalence of Mycobacterium tuberculosis DNA mutations associated with resistance to rifampicin, isoniazid, ethambutol, fluoroquinolones and injectable drugs in MDR TB patients in Arkhangelsk Oblast.Subjects and Methods. In Arkhangelsk Oblast, all patients underwent examination by molecular genetic testing and phenotypic methods for drug susceptibility. In 2010-2017 in Arkhangelsk Oblast, 1064 new MDR TB cases were registered. A total of 1340 cases of MDR TB were registered during this period, including 276 cases with recurrent MDR. Mutations associated with resistance to rifampicin (rpoB gene) and isoniazid (inhA, katG genes) were identified by Genоtype MTBDRplus (Hain Lifescince); mutations associated with resistance to fluoroquinolones (gyrA gene), injectable drugs (rrs gene) and ethambutol (emB gene) were identified using GenoType MTBDRsl (Hain Lifescince) in accordance with the manufacturer's recommendations.Results. In 2010–2017 among 1064 new MDR TB cases, Mycobacterium tuberculosis mutations associated with simultaneous resistance to rifampicin and isoniazid were detected in 922/1064 (87%) cases; mutations associated with monoresistance to isoniazid were found in 2/1064 people. 1196/1340 (89%) MDR TB cases underwent examination with GenoTуре MTBDRsl. The predominant mutation in the rpoB gene was the S531L mutation (86.6%), the second and third most frequent mutations were D516V (5.3%) and L511P (2.6%), respectively. Mutations in codon 526 were less frequent than the others. In all MDR TB cases, mutations in the katG gene were detected, which were combined with mutations in the inhA gene in 85 (9.2%) cases. Only two cases had isolated mutations in the inhA gene. The predominant mutation among M. tuberculosis isolates associated with resistance to isoniazid was S315T1 (98.8%) in the katG gene, and C15T in the inhA gene. According to the results of our study, mutations in the gyrA gene were present in 13.6% (163/1196; 95% CI 11.7–15.7%) of cases, in the embB gene – in 49.7% (594/1196; 95% CI 46.8–52.5%), in the rrs gene – in 7.1% (85/1196; CI 95% 5.7–8.7%). Among all studied isolates with resistance to fluoroquinolones, the most common mutation in the gyrA gene was D94G (79/163; 48.5%), including cases without wild-type dropout. The A90V mutation was present in 19% of cases. The S91P mutation was detected in 11.7% of isolates. The D94N and D94A mutations occurred in 9.2% and 7.4% of cases, respectively. In 3 cases, two mutations were present simultaneously. All isolates in our study had mutations in the rrs gene associated with high levels of resistance to injectable drugs (A1401G and G1484T). In the rrs gene, the rrs A1401G mutation was most common (81/85; 95.3%), including cases of simultaneous detection of “mutant samples” and “wild type” samples. In 4.7% of cases, the G1484T mutation was detected. In Arkhangelsk Oblast, 81.5% (95% CI 78.1% to 84.5%) of mutations in the embB gene were M306V mutations and 18.5% (95% CI 15.5% to 21.9%) were M306I mutations.