The analysis of the results of immunological tests (skin test with tuberculosis recombinant allergen in standard dilution, hereinafter referred to as the test with ATP) and laboratory immunological test IGRA, delivered in 2019-2022 to employees of medical organizations of the Moscow Department of Health, working in four administrative districts of Moscow (Central, Western, South-Western, Troitsk and Novomoskovsk, next – CAD, WAD, SWAD/T&NAD). Among the average annual number of employees over 5 years – 43,452 people, with medical examination and exclusion of tuberculosis, the prevalence of persons with latent tuberculosis infection (LTI) was 2.6, 6.1 and 1.8%, in the CAD, WAD and SWAD/T&NAD, respectively, or 3.4% in general to these districts. At the same time, the average annual frequency of detection of cases of LTI («first detected LTI») was 0.6, 1.3 and 0.6% in these districts, respectively, and 0.75% in all districts as a whole. 95.4% of the employees were assigned a course of preventive therapy (PT), 45.8% of which the course was started. Among the latter, 85.0% successfully completed the course, 14.1% – the course was interrupted by the patient, and 0.9% – canceled by the doctor due to adverse events. The main PT regimen used (78.4%) included 3 months of taking a combination of isoniazid and pyrazinamide (INN: isoniazid 150 mg + pyrazinamide 500 mg), which showed a low proportion of adverse events – 3.1%. The identification of workers of medical organizations of LTI allows to determine a group high risk for tuberculosis and to allocate a group of persons for preventive therapy.

Introduction. In connection with the emergence of a new coronavirus infection COVID-19, since 2020, a set of measures has been carried out in Moscow to ensure the identification, isolation and organization of the treatment process of patients with tuberculosis combined with COVID-19. Based on the data of the TB/COVID-19 co-infection monitoring system created in Moscow, the study analyzed all 430 confirmed cases of COVID-19 among TB patients registered or followed up in Moscow in 2021 in groups I and II of dispensary observation. Aim. To study the incidence of COVID-19 in tuberculosis patients in 2021 and to identify epidemiological features among tuberculosis patients in the second year of the pandemic. Results. The analysis showed that with an increase in the territorial incidence and an increase in the total number of newly diagnosed TB patients in the capital in 2020–2021, the number of confirmed cases of TB/COVID-19 co-infection decreased by 212 cases. Among all 430 patients, 52.3% are permanent residents of the city, 22.3% are residents of other subjects of the Russian Federation, 12.3% are homeless persons and 13.1% are foreign citizens. In 80.5% of cases, the diagnosis of coronavirus infection caused by the COVID-19 virus was established based on the results of etiological laboratory diagnostics (detection of SARS-CoV-2 RNA by PCR in smears with mucosa from the nasopharynx and oropharynx), and in other cases - only according to radiation diagnostics (computed tomography of the chest). More than half of those with combined tuberculosis/COVID-19 infection – 59.8% were unemployed and 14.4% were old-age pensioners. In 2021 in among tuberculosis/ COVID-19 patients, 63.3% (272 people) were newly diagnosed tuberculosis patients, of which:

– 53.3% were permanent residents of Moscow,

– 19.1% residents of other subjects of the Russian Federation,

– 14.7% are homeless,

– 9.9% are foreign citizens.

For new tuberculosis cases, the maximum number of patients, co-infected with a new coronavirus infection was at the age of 31–45 years, which was somewhat different from the age characteristics of the incidence for other patients.

Because of treatment of coronavirus infection, 84% of patients cured of COVID-19 already in 2021, 12.1% (52 people) died. The created tuberculosis/COVID-19 co-infection monitoring system in Moscow allows for a full assessment of the course of a new coronavirus infection in tuberculosis patients, patient routing, analysis of the incidence of COVID-19 among tuberculosis patients, the effectiveness of their treatment and the causes of mortality

The experience of the centralized control of the appointment and implementation of chemotherapy regimens for MDR/XDR TB by subcommittee of the head TB-physicians board of the Moscow Scientific and Practical Center for Tuberculosis Control in 2014-2021 presented. Totally, 6023 cases considered, 30% – primary diagnosis and treatment, 70% – monitoring of treatment.

As a result of measures carried out under centralized control, the number of patients with respiratory MDR/XDR TB decreased by 4 times: from 752 in 2011 to 189 in 2021, mainly due to the cure of patients. There was a significant increase in the effectiveness of treatment of patients with MDR/XDR TB: in the 2013 cohort, the effective treatment courses was 45.9%, in the 2018 cohort. – 69.6%, while there was a decrease in the proportion of ineffective courses by almost 2 times – from 14.0 to 7.9%, a decrease of interrupted treatment by more than 2 times – from 12.2% to 4.8%, a decrease in the proportion of deaths from tuberculosis by 3 times – from 8.7% to 2.8%.

The main difficulties of implementing new regimens of MDR/XDR TB chemotherapy have also been identified. The presence of comorbidity prevents the appointment of at least one of the most effective anti-tuberculosis drugs (bedaquiline, linezolid, moxifloxacin, cycloserine) in at least 25% of patients. The frequency of adverse events (AE) in MDR/XDR TB patients was 2nd stage severity was 33.2%, 3-4 stage – 5.3%. Correction of chemotherapy regimens with the exclusion and/or replacement of anti-tuberculosis drugs was necessary due to AE in general in 52.5% (95% CI 41.7-63.1%) of patients, and in 2.5% of cases chemotherapy was canceled completely, for a period of a week to 1.5 months. In at least 20% of patients, an important task is to ensure proper adherence of the patient to treatment, which requires counseling by a psychologist.

Introduction. The study of the diffusion lung capacity (DLCO) shows the conditions of oxygen transport from the alveolar air into the blood of the pulmonary capillaries. The features of changes in the parameters of pulmonary gas exchange in patients with pulmonary tuberculosis (PT) have not been sufficiently studied.

Materials and methods. 374 patients with verified PT underwent a study of the pulmonary function including DLCO and the transfer coefficient of carbon monoxide DLCO/VA, computed tomography and perfusion scintigraphy of the lungs.

Results. The pulmonary gas exchange depends on the duration of PT, the volume of a specific lesion, the severity of disorders of pulmonary perfusion, including in the lung without foci of tuberculous lesions. In 23% of patients, a decrease in the transfer coefficient was observed at normal DLCO values, which indicates significant alveolar-capillary damage.

Conclusion. When assessing pulmonary gas exchange in patients with pulmonary tuberculosis, it is necessary to estimate not only DLCO, but also on the transfer coefficient of carbon monoxide - DLCO/VA.

When evaluating the role of lactoferrin to improve the effectiveness of preventive treatment of latent tuberculosis infection in adolescents, it was found that the prescriptions of Lactoferrin imun + Colostrum contributed to a significantly more pronounced decrease in the frequency of hyperergic reactions in test with tuberculosis recombinant allergen (from 51.3% to 12.5% in the main group, from 50.7 % to 33.3% in the comparison group, p < 0.05), a decrease in the average size of the papule (from 17.6 mm to 8.2 mm in the main group and from 17.1 to 14.5 mm in the comparison group, p < 0.05). In patients of the main group, the restoration of free radical oxidation and antioxidant protection indicators to the level of healthy donors was established, while in the comparison group, the intensity of blood plasma chemiluminescence and the activity of myeloperoxidase in neutrophils remained elevated, while the activity of catalase and superoxidedismutase remained reduced. The level of lactoferrin during treatment in the main group increased to normal values (740 ng/ml, 95%CI 702.2-777.8), and in the control group remained reduced (440 ng/ml, 95%CI 411.5-478.5), p < 0.05. At the same time, the continuing level of positive reactions to tuberculosis recombinant allergen (Diaskintest®) against the background of normalization of the lactoferrin level indicates the high diagnostic capabilities of Diaskintest® to detect LTBI in adolescents.

Clinical, radiological, and laboratory data of 62 patients with respiratory tuberculosis were studied with the purpose of comparative analysis of clinical efficacy of Glutoxime and Tubosan and evaluation of efficiency of the empirical approach in drug selection. Three groups of patients were formed: the 1st group - 20 patients who received Glutoxim along with anti-tuberculosis drugs. Group 2 - 23 patients (Tubosan), Group 3 – control, 19 patients (only anti-tuberculosis drugs). Empirical approach to the choice of pathogenetic drugs has a limited positive effect on the efficacy and tolerability of etiotropic therapy. In the conditions of forced polypragmasy, the prescription of drugs should be justified by modern highly informative criteria, not being limited only by clinical indications.

According to the results of analytical review of national and foreign scientific publications, it was found that currently mostly and deeply clinical aspects in dental care to TB patients have been studied: various clinical forms of oral and maxillofacial TB are well represented, clinical structure of main non-specific odontogenic diseases in TB patients is described widely. Less frequently medico-social risk factors for dental pathology in TB are presented. Meanwhile the dental management in TB patients has studied the least, which requires providing research studies on this area during the period of increasing MDR-TB prevalence and TB associated with HIV.