The article presents the results of five-year (2014–2019) monitoring data analysis of indications for hospitalization of adult patients to in-patients’ tuberculosis hospitals in Moscow. The structure of the collected information, created on the basis of the developed guidelines, is presented. From 1 to 15 indications were notified for each hospitalization. It has been shown that the majority of patients were hospitalized on the basis of groups of indications associated with the tuberculosis process and / or the need for a diagnostic examination (91.2%). These groups of indications were registered in 73.7% and 28,0% respectively. Also, 48.2% of hospitalizations were associated with the presence of concomitant diseases and conditions requiring hospital treatment and / or seriously aggravating the course of tuberculosis, and 32.8% – with epidemiological and social factors. These four groups were analyzed for their various indications, such as the presence of bacterial excretion and lung cavern, a widespread tuberculosis process, the need to use special treatment methods or individual selection of chemotherapy regimens, the presence of different concomitant diseases and various social factors, such as living with children under 14 years of age, old age, etc. Separately, a comparative analysis of indications was carried out depending on the presence of HIV coinfection, which showed that these patients more often have indications associated with a widespread tuberculosis process, the need for individual selection of therapy, drug addiction, bad treatment adherence, and belonging to homeless people. Periodic monitoring of indications for hospitalization is a necessary measure that allows you to obtain information necessary to optimize the quantitative and qualitative structure of the bed fund of antituberculosis medical organizations.

Exercise intolerance of chronic diseases associated with increased morbidity and mortality, and reduced quality of life for patients. The present study determined pathophysiological mechanisms of exercise intolerance in pulmonary tuberculosis (PT) patients.

Methods. In a prospective cross-sectional observational study 95 pulmonary cavitary tuberculosis patients performed cardiopulmonary exercise testing with metabolic, ventilation and haemodynamic measurements. Peak exercise O₂ consumption and cardiac performance were measures of exercise tolerance.

Results. The physical performance was reduced in all of the examined PT patients, the decrease was severe (less than 60% predicted) in 62.1%. Exercise intolerance was in the majority (89.5 %) patients. Ability to use oxygen (decrease of anaerobic threshold) was diminished in 80.0%, the ventilation efficiency was decreased in 53.7% (the increase in EqCO₂ – 53.7%, EqO₂ – 35.8%), disorders of ventilationperfusion relationships (increase VD/VT) was in 51.6%, impairment of O₂ delivery (reduced O₂ -pulse) was in 52.6%, myocardial ischemia was detected only in 2.1%.

Conclusions. The leading pathophysiological mechanisms of exercise intolerance in PT patients were of oxygen utilization violation and ventilation inefficiency.

Objective. Тo study the features of humoral immunity to SARS-CoV-2 among the medical stuff of an antitubercular hospital in the context of the spread of a new coronavirus infection.

Materials and methods. The interim results of a single-center prospective observational study involving 350 employees of a pulmonary tuberculosis hospital that was not repurposed to work with COVID-19 are presented. The results of weekly monitoring of IgM and IgG levels for the period from May 15 to November 28, 2020, were analyzed in comparison with the results of diagnosis of COVID-19 cases (identification of the pathogen in a smear from the oropharynx and nasopharynx, changes in lung tissue according to computed tomography).

Results. During the observation period, COVID-19 was detected in 106 people (30.3%). Antibodies to SARS-CoV-2 (IgG and/or IgM) were detected at the start of monitoring in 30 people (8.6%, 95%CI 5.8-12.2%), by the end of the follow – up period-in 95 people (27.1%, 95%CI 22.7- 32.0%). The frequency of detection of antibodies in the patients was 70.8% (95%CI 55.6-88.7%): IgM class in 23 (21.7%), G class in 73 (68.9%). The median time from disease detection to IgM detection was 1.5 weeks. (interquartile range 0-4 weeks), before the discovery of IgG – 4 weeks. (interquartile range 2-5 weeks). At any follow-up period, the chances of IgG production in the protective titer were higher in the case of moderate or severe disease with the development of pneumonia compared to the mild course (OR 2.6, 95%CI 1.1-6.3); the IgG titer was also higher (p < 0.01). «Atypical» variants of the antibody response were identified in individuals with confirmed COVID-19: no antibody formation (31 people), production of class M antibodies only (4 people); long-term persistence of IgG in a titer of less than 30 g/l, long ahead of the disease manifestation (6 people). The sensitivity of serological testing as a method for detecting current and / or transmitted coronavirus infection was 70.8% (95%CI 61.1-79.2%), and the specificity was 91.8% (95%CI 87.6-94.9%).

Conclusion. The frequency of detection of antibodies to SARS-CoV-2 among employees of the TB hospital corresponds to the dynamics of the incidence of COVID-19. Virus-specific antibodies were detected in 70.8% of COVID-19 survivors (IgG in 68.9%); in the absolute majority of patients, the antibodies remained in a significant titer (IgG > 10 g/l) for 6 months or more at the start of testing. When the disease occurs without the development of viral pneumonia, the chances of forming a significant and persistent antibody response are significantly lower. Serological testing is a sensitive and highly specific method for detecting a previous COVID-19 disease.

Background. Little is known about the relationship between the COVID-19, HIV and tuberculosis (TB). The aim of this study is to describe a group of patients with triple infection: TB (active disease or sequelae)/HIV and COVID-19.

Materials and methods. Data from 526 hospitalized patients with TB and COVID-19 were analyzed. HIV(+) were 113 (21.5%) patients (median age 39 y.o.), HIV(-) – 413 (78.5%) (median age 42 y.o.).

Results. The susceptibility of HIV/TB patients to SARS-CoV-2 (COVID-19) is most typical in age from 31 till 50 years old (86.0%), in men mostly (75.2%) and unemployed of working age (97.3%). A proportion of residents was 35.4% and 39.0% in groups 1 and 2 respectively, others were migrants (p > 0,05). Homeless people dominate in group of triple infection: 32.7% vs 16,0% (p < 0,05). Mortality rate was higher in COVID-19/HIV/TB patients: 8,9% vs 6,8% in HIV(-) (p < 0,05). Overall, 38 out of 526 (7.2%) patients died. The most (7 – 70.0%) deceased out of 10 in group 1 died from HIV complications and TB, and only 3 (30,0%) of them died from COVID-19. The main cause of mortality in group 2 was COVID-19 – in 15 (53.6%) cases out of 28, HIV+TB complications – in 8 (28.6%) and TB – in 5 (17.9%). Active tuberculosis diagnosed in 106 (93.8%) in group 1, sequelae – in 5 (17.9%). The health status of triple infection patients is determined mainly by stage of HIV (100% were in IV B and IVC stages), TB and others secondary and concomitant diseases. There are 1.7 localizations of tuberculosis and 3.2 associated diseases per patient. Less than half (44.2%) of HIV/ TB patients with COVID-19 receive HAART, 46.9% have serum CD4⁺ levels below 100 cells/mm³, and 15.0% range from 100 to 350 cells/mm³.

In order to identify unwanted adverse reactions (ADRs) to antituberculosis drugs, using original questionnaires, a voluntary questionnaire was conducted among 40 patients with respiratory tuberculosis and 42 patients with HIV-infection and tuberculosis concomitant pathology. In both groups, most patients were treated according to IV and V chemotherapy regimens, in the group of patients with TOD – 72.5% and in the group of patients with HIV/TB – 71.4%. A total of 965 undesirable side reactions were recorded; the minimum number of undesirable side reactions in one patient is 0, the maximum is 40. In patients in the TOD group, the most frequently observed ADRs were from the central nervous system and sensory organs, the gastrointestinal tract and the musculoskeletal system. In patients in the HIV/TB group, ADRs of the central nervous system and sensory organs, the gastrointestinal tract and the immune system prevailed. In the group of patients with TOD, adverse reactions with a moderate degree of severity were most often noted, in the group of patients with HIV/TB – with a mild degree of severity. According to the severity of ADRs, significant differences were established only when comparing the total number of reactions in both groups of patients.

The purpose of the study. analysis of undesirable side effects when using second-and third-line drugs in the chemotherapy regimens of tuberculosis in children and adolescents.

Materials and methods. The study included 109 children with newly diagnosed tuberculosis at the age of 0 to 18 years, who received backup drugs. Group I consisted of patients receiving fluoroquinolones and second – line oral bacteriostatic drugs along with first – line drugs (71 people, 65.1%), group II-patients who, in addition to second-line drugs, included linezolid in the chemotherapy regimen (28 people, 25.7%), group III-patients whose treatment regimen included bedaquiline, linezolid and PASC (10 people, 9.2%).

The results of the study. The development of undesirable side effects in the three groups of patients was noted in 32.4–42.8%, which did not differ significantly. Most of them were toxic reactions (from 100.0% to 69.2%). Undesirable side effects in the regimens including linezolid were observed only in group III, in 20% (2 people) with severe concomitant pathology. In group II, where linezolid was used without bedaquiline, no adverse reactions to linezolid were observed.

Conclusions. The administration of PTP to children from group A according to WHO (levofloxacin / moxifloxacin linezolid, bedaquiline) in some cases is vital, since only they can provide an adequate chemotherapy regimen. There was no significant increase in the number and severity of adverse events.

The article presents a clinical case of generalized tuberculosis in a woman with multiple pregnancies after in vitro fertilization, which indicates the continuing problem of early detection of tuberculosis and timely implementation of preventive and therapeutic measures. Lack of alertness of doctors of the general medical network in relation to tuberculosis, including extrapulmonary localizations. Moreover, emphasizes the problem of managing patients with infertility in combination with latent tuberculosis, including the use of in vitro fertilization. 

The review presents current information on the prevalence of multidrug-resistant tuberculosis in the world and in Russia, analyzes the literature data on adverse events of its treatment, their frequency and types, methods of prediction and prevention.