Article is devoted to the tuberculosis detection in various sociodemographic and professional strata of the population and their contribution to the overall TB notification rate in the Moscow City over the past fourteen years. Analysis based on data from the City TB case-based register. Moscow shows marked reduction in the key epidemiological indicators for TB, including 26,5% decrease of TB notification rate for residents from 1998-1999 to 2011-2012. At the same time, the study demonstrated an increase of proportion of unemployment patients in economically active ages, from 32,4% to 41,7% and a reduction of working and disabled patients from 31,9% to 27,9% and from 16,0% to 5,2%, respectively. In recent years, the share of active detected new TB cases almost doubled, reaching 63,3% in 2011-2012.
By reducing the overall incidence of tuberculosis in recent years there was a significant increase in the proportion of men younger than 35 years among new TB cases, both in the group of unemployment (up 48,3% compared to 37,8% in 1998-99) and group of all TB cases on the whole (to 43,8% versus 30,8%). This is accompanied by a change of the maximum age of TB notification rates from 45-60 years in 1998-1999 to 31-35 years in 2011-2012. For women in the study period there has been a formation of a more pronounced maximum for proportion of TB patients detected among 31-35-year-old unemployment groups.
Results of multivariate analysis showed that the greatest changes during the study period were recorded as the increasing the share of the unemployed, the increasing the share of patients younger than 35 years, reducing of the proportion of patients with cavitary pulmonary TB and improving of TB case-finding characteristics – reduction in the proportion of cases which have more than three years held fluorography and passive detected TB cases.

The in consecutive order of the structural reorganization of the Sverdlovskaya oblast TB-control facilities is described. The consistent consolidation (in 2006-2012) of the different level TB-units (municipal and regional) ensure the integrated system of TB-facilities, which is capable in effective regional TB-control programme realization and can provide all kind of medical services (including high-technology) for various categories of patients. The main problem has continued to this day is the poor resource base of TB-facilities, which can not comply with the current sanitary regulations. This problem will be solved, as well as shortage of in-patients’ beds (365 roughly), by bringing into service the first and the second stage of the leading regional TB center. According the plan, in 2014-2016 all the regional TB-facilities and TB-departments will be integrated with the single juridical person creation.

The article presents dynamics of level CD4 and virus load in the blood of 31 patients with pulmonary tuberculosis and HIV, held elective surgery in the thoracic surgery ward of City Tuberculosis Hospital N2 in St. Petersburg. Was found that in the postoperative period is not observed reduction of CD4 cell count and enhance of VL, which may indicate the safety of thoracic surgery in patients with pulmonary TB and HIV infection.

Etiological role of M. avium-intracellulare was studied on the material of 13 cases of deaths from HIV infection at AIDS stage, basing on the life-time bacteriological examination results. Grave caseous necrotic changes were found in the lymph nodes, lungs and other organs with large number of mycobacteria M. aviumintracellulare, detected in bacteriological and bacterioscopic, including immunohistochemical examinations. Singularity of anatomicopathological presentation allowed to consider mycobacteriosis, developing in HIV infection at AIDS stage, in the same pathogenetic aspect, as primary tuberculosis. General similarity of morphological manifestations of mycobacteriosis in our study with primary tuberculosis took place due to, obviously, not only the genetic relatedness of these diseases pathogens, their similar pathogenic properties, but also the state of the patients immunity, playing a cardinal role in morphogenesis and determining the form of the disease.

On the basis of the high medical school goals, the main practical problems of the TB-control system and necessity of the Federal State educational standard (generation III) implementation the features of the education in Phthisiology on the different level were analyzed. The up-to-date techniques in graduate and postgraduate education in Phthisiology were considered. The paths of development of the Phthisiology instruction in high medical school as the basic medical specialty on the assumption of high school and health care systems reformation were described.

Drug-induced liver injury (DILI) is one of the most serious complications of anti-tuberculosis chemotherapy. Its reported incidence in TB patients varies between 5,4 and 67,7%. The review contains the recent data about classification and pathogenesis of antituberculosis
DILI, diagnostic approaches, including threshold criteria, definition of the pattern and severity of DILI, its causality assessment, alternative causes of acute liver injury. The main strategies for DILI management are reviewed, including correction of anti-tuberculosis
treatment, drug prescriptions, indications for steroid therapy and extracorporeal procedures, management of drug-induced acute liver failure. Recommendations for screening and prevention of DILI, management of patients with hepatic adaptation are proposed.

The main farmacologic data of bedaquiline, a novel oral diarylquinoline antimycobacterial agent are reviewed. Bedaquiline’s efficacy and safety, expected adverse events and proposal preventive measures are considered according to results of phase II clinical trials. The conditions for inclusion of the drug in the combination therapy of pulmonary tuberculosis are listed in accordance with the existing WHO Guidelines; these conditions are planned to release in Moscow.

Two cases (female 76 and 58 years old) of acute massive hepatic necrosis, due to standard treatment of non-extended sputum smear-negative pulmonary TB, are considered. These adverse events were unpredictable and dose-independent, therefore definite as
idiosyncrasy. The course of the hepatic impairment was fulminate, with massive diffuse centrilobular necrosis, limpho-eosinophilic infiltration of portal tract and acute hepatic failure. The pathologist’s report structure in cases of medicament liver injury is desribed.

In review, the test-systems GenoType® practical importance in diagnosis of multi- and extended-drug resistant TB and nontuberculosis mycobacterial diseases is considered. Plenty of studies confirmed the high diagnostic specificity and sensitivity of GenoType® MTBDRplus in isoniazid and rifampin drug resistance detection. From 2009 г. this test is recommended for TB detection by WHO. The high rates of diagnostic specificity and sensitivity of GenoType® MTBDRsl in ofloxacin drug resistance were also obtained, but, due to the insufficient specificity and sensitivity in detection of resistance to injectable TB drugs and ethambutol, this test isn’t recommended for XDR-TB detection by WHO. The GenoType® Mycobacterium CM/ AS implementation provide for non-tuberculosis mycobacteria
detection with high-level diagnostic specificity and sensitivity. The GenoType® test-systems can be used in routine practice of TB facilities for diagnosis of multi- and extended-drug resistant TB and nontuberculosis mycobacterial diseases.