During the period of rising COVID-19 morbidity in Moscow, a specialized department for the treatment of patients with tuberculosis combined with COVID-19 was established in the Moscow Research and Clinical Center for Tuberculosis Control. Employees of this department are a higher risk group for COVID-19 morbidity due to close contact with patients.

The aim was to assess the incidence of new coronavirus infection among the staff of the department for the treatment of tuberculosis patients combined with COVID-19 in comparison with the staff of other departments of the TB organization in the period 2020–2023.

Methods. The incidence rates of new coronavirus infection were analyzed among the staff of the department for treatment of tuberculosis combined with COVID-19 (group 1, 143 people) and staff of other departments not involved in the provision of medical care to COVID-19 patients (group 2, 2815 people) in the period from April 1, 2020 to December 31, 2023.

Results. During the study period, 94.4% of group 1 and 54.2% of group 2 staff, respectively, became ill. The morbidity rates of covid unit staff were higher than those of staff in other units: 2-fold in 2021, 4.1-fold in 2022, and 15.5-fold in 2023 (p<0.05). Among those who became ill, the proportions of nursing and paramedical staff were predominant (56.9% and 59.0%), compared to physicians (17.9%) and other staff (14.3%), p < 0,05.

Conclusion. The risk of infection of staff of COVID-19 treatment units during their work exceeds the risk of infection of medical workers of other departments who do not work with patients infected with SARS-CoV-2, despite high vaccination coverage and use of personal protective equipment, which requires the development of additional preventive measures.

Prevention of tuberculosis among the population is difficult without coordinated and organized interaction between the TB service and primary outpatient care.

The aim was to improve the system of interaction between local TB doctors and general practitioners using the NextGIS QGis geographic information system to improve the quality of preventive measures.

Materials and methods. Information on the attachment of residential buildings of the district to the city polyclinics was used, as well as distribution of addresses between phthisiatric sections of anti-tuberculosis dispensary No. 14. NextGIS QGis version 24.2.1 with vector analysis tools was used to process spatial data. To assess the epidemiological situation, cartographic visualization using the method of thematic point layers and heat maps was used, built on the basis of data on tuberculosis patients from dispensary observation groups 1–3, registered in 2019– 2024.

Results. Offline maps of polyclinic sites in comparison with the boundaries of phthisiatric sites allowed visualization of epidemically compromised sites with the reflection of data on TB cases, contact information of the therapist and TB specialist responsible for providing medical care to the assigned population; a tool was obtained for generating analytical information, necessary for a phthisiatrician and a general practitioner to work together.

Conclusion. The use of a geographic information system makes it possible to increase the efficiency of interaction between medical organizations, optimize collegial decisions on preventive examinations of the population of the region, organize examination, treatment and dispensary observation of tuberculosis patients.

The objective. To analyze the incidence of linezolid- and bedaquiline-resistant strains of M. tuberculosis from smear-positive TB patients in 2011–2022.

Subjects and Methods. A total of 3637 clinical strains were obtained from patients undergoing treatment in the CTRI in 2011-2022. Drug susceptibility for linezolid and bedaquiline were determined using Bactec MGIT 960 (Becton Dickinson, USA) with a critical concentration of 1 mg/L.

Results. 101 patients with linezolid- and bedaquiline-resistant strains were detected. The incidence of linezolid-resistance increases from 0,2% in 2011 to 5,5% in 2022 (p<0,05). The incidence of bedaquiline-resistance also increases from 1,4% in 2018 to 12,2% in 2022 (p<0,05).

Conclusion. Resistance to linezolid and bedaquiline is increasing for the period 2011-2022. Molecular methods for linezolid and bedaquiline resistance detection are urgently needed.

Purpose. To study the clinical features of respiratory tuberculosis in long-livers with newly diagnosed tuberculosis in 2013–2023.

Materials and methods. A continuous cohort study of newly diagnosed patients with respiratory tuberculosis in the Yaroslavl and Kostroma regions for the period 2013–2023 was conducted, with an assessment of cases of the disease in patients over 90 years of age.

Results. Three cases of the disease were identified and analyzed in long-livers aged 91–97 years, two men and one woman. Clinical forms of tuberculosis included disseminated pulmonary tuberculosis, tuberculoma and bronchial tuberculosis with large residual changes. All patients had a blurred clinical picture, long-term intoxication syndrome with background of decompensation of comorbid pathology; senile asthenia masked tuberculosis intoxication. All 3 cases occurred under the guise of chronic obstructive pulmonary disease. The test with recombinant tuberculosis allergen was negative in 100%. The delay in diagnosing tuberculosis in the presence of massive bacterial excretion was unreasonably long.

Conclusion. The clinical features of tuberculosis in long-livers are low severity of symptoms simulating the course of chronic obstructive pulmonary disease, long-term intoxication syndrome under the guise of senile asthenia, and negative result of an immunological skin test.

The main problem in the treatment of tuberculosis (TB) patients is the increase in drug resistance of M.tuberculosis, which is not always detected at the start of chemotherapy, which leads to inadequate and lengthy treatment.

Research objective. Analysis of the treatment of newly diagnosed patients according to the regimen of drug-sensitive TB.

Materials and methods. We analyzed the facts of correction of the regimen and the timing of the intensive phase of chemotherapy in 55 newly diagnosed patients with pulmonary TB who were taken for treatment according to regimen of drug-sensitive TB in 2019–2021.

Results. At the start of treatment, bacterial excretion and drug sensitivity of M. tuberculosis were confirmed by microscopy and molecular genetic tests only in 9 (16.4%) patients. Results of cultural tests confirm the bacterial excretion in 23 (41.8%) patients. Of these, 10 patients (43.6%; 18.2% of those who started treatment, 21.7% with no data on bacterial excretion at the start of chemotherapy) received data on drug resistance during treatment (7 – MDR, 2 – pre-XDR, one had resistance to isoniazid), which required a change in regimen with an extension of the intensive phase to 8 months. Of the remaining 45 patients, in 29 the duration of the intensive phase was 2 months, in 15 with HIV infection – 3 months; in one patient the intensive phase was prolonged to 5 months due to poor tolerability.

Conclusion. A change of treatment regimen due to drug resistance was required in 18.2% of newly diagnosed TB patients with suspected drug sensitivity of the pathogen. It is necessary to improve management strategies for newly diagnosed patients with oligobacillary pulmonary tuberculosis.

The aim of the study. To evaluate the results of surgical treatment of lung cancer with active tuberculosis performed in a tuberculosis institution.

Materials and methods. We analyzed the immediate and long-term results of surgical interventions for lung cancer in patients with concomitant active tuberculosis (15 people, 0.7% of all patients discharged from the tuberculosis surgical department in 2016-2020), 12 men and 3 women aged 49- 64 years old.The log-rank test was used to analyze possible factors influencing patient survival.

Results. Surgical interventions were more often performed in cases of combination of active tuberculosis and stage IA lung cancer (60%). Anatomical resections including lobectomies, combined resections and pneumonectomies were performed in 66.6% of cases.The incidence of postoperative complications was 6.6%; mortality during 5 years of observation was 46.7% (95% CI 24.8-69.9%) of cases. The overall 5-year survival rate (53.3%, 95% CI 30.1-75.2%) after surgical treatment did not depend on the activity of  TB process. Unfavorable factors influencing the risk of death were stage III lung cancer, squamous cell carcinoma, ipsilateral localization of cancer and tuberculous process (in the same lung).

Conclusion. Surgical treatment of lung cancer in patients with active tuberculosis in a tuberculosis institution is characterized by an overall 5-year survival rate of 53.3%, a low level of postoperative complications, and the absence of hospital mortality and tuberculosis reactivation.

Objective. The aim of this study was to identify significant risk factors associated with postoperative complications, relapses, and exacerbations of pulmonary tuberculosis, with the intention of elucidating their cumulative effect on the likelihood of adverse outcomes

Materials and methods. An observational retrospective cohort single-center study included patients operated on for destructive pulmonary tuberculosis in the period 2004-2010. Inclusion criteria were the presence of a known long-term outcome of treatment or death in hospital. The exclusion criterion was unknown long-term outcome.. Out of 1338 patients operated in this period, 439 (32.8%) met the inclusion criteria.

Results. 111 complications have developed in 87 (19.8%) patients in the postoperative period. In-hospital mortality (within 30 days after surgery) was observed in 4 cases (0.9%) and was associated with tuberculosis progression in all cases. Relapses have occurred in 114 (26.0%) of 439 patients within 15 years after surgical treatment. 16 main risk factors for postoperative complications and relapses of tuberculosis have been identified; the most significant were the presence of XDR MBT, the palliative nature of surgical treatment, duration of the disease, the presence of cachexia and bacterial excretion at the time of surgery. For each patient, the sum of factors in points was calculated (one factor = 1 point). A significant increase in the likelihood of tuberculosis reactivation (>50%) corresponded to a score >5 points. All cases of hospital mortality were observed in patients with a risk level of 9-10 points, late mortality from tuberculosis  –  7–11 points.

Conclusion: Patients with a risk score for tuberculosis reactivation exceeding 5 points demonstrate unsatisfactory treatment outcomes. This underscores the necessity for a more judicious approach to surgical indications, discouraging palliative interventions, while emphasizing the imperative development of preventative strategies tailored to individual risk level.

Introduction. The implementation of enhanced recovery after surgery (ERAS) protocols, preservation of physiologic homeostasis, and reduction of perioperative stress have reduced the number of surgical complications and the length of hospital stay. These protocols have not yet found application in augmentation cystoplasty in patients with genitourinary tuberculosis.

Aim. To evaluate the effect of ERAS protocol on the results of augmentation cystoplasty and quality of life of adult patients.

Materials and Methods. The study included 99 patients with urogenital TB who underwent augmentation ileocystoplasty: 29 patients constituted the main group (using ERAS protocol) and 70 patients constituted the control group.

Results. The most severe complications (category 4 according to Clavien-Dindo scale) were absent in the main group and were observed in 4 (5.7%) patients of the control group. In the ERAS group the volume of residual urine did not exceed 100 ml, in the control group the volume more than 100 ml was observed in every fifth case. Residual urine volume between 50 ml and 100 ml was 48.5% more frequent in the control group, and ≤ 50 ml was 62.8% more frequent in the main group. The postoperative increase of the glomerular filtration rate (GFR) was noted to a greater extent in the ERAS group, by 38.4%. The physical component of health in the ERAS group increased by 6.9% on the SF-36 scale, while in the standard method group it decreased by 23%. The increase in the mental component of health was 68.8% greater in the ERAS group compared to the control group.

Conclusion. Application of the modified ERAS protocol at augmentation ileocystoplasty significantly reduces the incidence of serious postoperative complications, promotes the recovery of renal function, achievement of the best functional results, improvement of the physical component of the quality of life. The optimal capacity of the formed reservoir with a small volume of residual urine and the increase in GFR have a significant positive impact on the overall health indicator.

Resistance of M. tuberculosis to anti-tuberculosis drugs (ATDs) and then to antibacterial drugs initially developed for other purposes, but effective against M. tuberculosis is an extremely serious problem. Treatment of drug-resistant tuberculosis is difficult, it is significantly more expensive, and its effectiveness is lower than in the treatment of drug-sensitive tuberculosis. With the advent of new anti-TB drugs such as bedaquiline and delamanid, the efficacy of etiotropic chemotherapy for MDR- and XDR-TB has increased significantly.

The review shows that bedaquiline has high activity in vitro against both M. tuberculosis and non-tuberculous mycobacteria. However, strains with natural resistance to this drug have been found in some cases. There are also data on the development of acquired resistance to bedaquiline. This indicates the need for rational (according to indications and in accordance with the developed optimal dosages and regimens) use of bedaquiline in the treatment of tuberculosis and mycobacterioses.

In childhood the function of the lymphatic system is active and multifaceted: all immune reactions are carried out with the help of the lymphatic system; it takes an active part in various pathological processes and is often itself affected by inflammatory, granulomatous and tumor diseases. Usually diagnostic problems are associated with search for causes of intrathoracic lymphadenopathy detected during radiologic examination of children with positive immunologic tuberculosis tests. An accurate diagnosis in case of lymphadenopathia requires careful assessment of history, clinical and laboratory signs and is only possible with the co-operation of phthisiologists and other specialists.

A case series is presented demonstrating the diversity of causes of hilar lymphadenopathy in children and the process of the necessary diagnostic search.

Genitourinary tuberculosis is one of the most common extrapulmonary forms of tuberculosis, the diagnosis of which is difficult due to the lack of specific symptoms. One of the rare forms of renal tuberculosis is tuberculous interstitial nephritis. Isolated cases of this pathology have been described.

A clinical case of tuberculous interstitial nephritis in a 56-year-old patient is presented. During the diagnostic search, a puncture biopsy of the kidneys was performed, which revealed signs of active granulomatous interstitial nephritis and focal necrotizing glomerulonephritis. Acid-fast mycobacteria were detected in the urine. The patient received anti-tuberculosis chemotherapy (levofloxacin, ethambutol, phenazide, rifampicin, ertapenem), given the decrease in the glomerular filtration rate (GFR) to 3.4 ml/min/1,73м², renal replacement therapy was carried out renal replacement therapy (hemodialysis 4 hours 2 times a week). After 4 months of treatment, an improvement in renal function was noted (GFR 12 ml\min\1,73м²), which required switching to hemodialysis and transferring the patient to the continuation phase of chemotherapy. A repeat kidney biopsy was performed, which revealed chronic granulomatous interstitial nephritis, interstitial fibrosis and grade 3 tubular atrophy.

Conclusion. Timely diagnosis using puncture biopsy of the kidneys and adequate etiotropic therapy can restore kidney function in tuberculous interstitial nephritis.

The article is devoted to the initial stages of the development of a tuberculosis sanatorium as the main medical institution for the treatment of tuberculosis patients at the beginning of the 20th century both abroad and in Russia. The starting points are Thomas Mann’s novel «The Magic Mountain» (1924) and a review of this novel by B.P. Levenshtein (1929). It is important to note that neither before nor after «The Magic Mountain» was such a detailed literary «study» of various aspects of the lives of tuberculosis patients published. Undoubtedly, reading T. Mann’s novel «The Magic Mountain» will be useful for both a novice phthisiatrician and an experienced specialist.