The article describes the anti-tuberculosis system in Moscow, formed because of the reorganization of tuberculosis institutions of the Moscow Government’s Health Department. The Moscow Research and Clinical Center for Tuberculosis (TB) Control provides activity as the largest anti-tuberculosis institution of the Russian Federation and in November 2012 became the core element for all Moscow city TB facilities integration. The results of the modernization and restructuring of the Center are:
– the straight control and planning of the hospitalization in TB inpatients clinics and shortening of the waiting time from three weeks (2012) up to three days (2016);
– the optimization of the TB-bedspace by number and purpose in accordance with the city requirements. From 01.11.2012 until 01.05.2016 44.6% of the beds (2455 in in-patients clinics and 905 in sanatoria) were reduced and its total number decrease from 5505 to 305. The bedspace of the Moscow Research and Clinical Center for Tuberculosis was reduced by 31% (2012 г. – 1920 beds, 2016 – 1325 ones);
– the bed occupancy per year in in-patients clinics of Moscow Research and Clinical Center for Tuberculosis increase by 10.1% (317 days in 2015 г. and 288 days in 2013 г.);
– the total number of the treated patients per year increase by 8,3%: from 5887,5 in 2013 up to 6374 in 2015;
– the bed turnover per year increase by 17 % from 4,13 in 2013 to 4,85 in 2015 and the overage length of stay decrease by 6% (65,43 days in 2015 г, 69,7 days in 2013);
– the in-patients mortality rate in 3 years decrease by 41,6% (2013 – 3,22%; 2015 – 1,88%).
The modernization and restructuring of the bedspace provide the more effective management of the TB-control in Moscow city, increase the interactions between departments and facilities, and ensure continuity of the treatment and rehabilitation. The rational distribution of the patients inside integrated service provide the accessibility to the newest diagnostic and TB treatment for all stratus of the Moscow population and optimize amount of work for the expensive equipment.

An algorhythm of mycobacteriological and moleculargenetic examinations of patients applicable for tuberculosis and mycobacteriosis diagnostics was worked out and implemented into the routine practice of Moscow Research and Clinical Center for TB Control of Moscow Government Health Department. Investigation of the one whole inoculate by molecular-genetic methods permits to foresee the MDR or XDR drug resistance of M. tuberculosis within 48 hours and if there is MTB growth from the sample on a liquid medium (BACTEC™ MGIT™ 960) we can perform accelerate drug susceptibility testing (DST) for the first- and/or secondline antituberculosis drugs. Such practice permits to carry out a comprehensive laboratory examination of patients and get the results of inoculation and DST for the first- and/or second-line drugs during a month.

The retrospective study include 296 patients, 20–55 years old, 71,6% male and 28,4% female, which in 2002–2014 were surgically treated in occasion of the tuberculosis with fibrous lung cavities (pneumonectomy or pleuropneumonectomy were performed). The I groups patients had unilateral lung lesions (76 pts, 25,7%), the II (220 pts, 74,3%) – bilateral. In 86 patients (29,1%) the postoperative bronchopleural complications were obtained – the delayed fibrothorax formation and/or – empyema with or without bronchonodular fistula. There were no significant difference between groups the number of complications in the early and remote postoperative period (27,6% and 29,5%), mortality rate (1,3% and 1,4%), the tuberculosis expanding in the postoperative period (2,6% и 4,1%). The obtained data indicate a possibility of broader application of surgical treatment by the patient at bilateral fibrous-cavernous tuberculosis of lungs. In time and according to indications the applied thoracoplasty after a pneumonektomiya twice reduces the number of reconstructive operations.

We worked out a protocol of a complex investigation of diagnostic material obtained from HIV-infected patients for the purpose of accelerate and effective diagnostics of latent infection of tuberculosis, active tuberculosis, mycobacteriosis moreover, drug susceptibility
testing of causative agent by bacteriological and molecular-genetic methods.
We tested and instilled an algorithm of investigation of HIV-infected patients with TB and TB suspected individuals in MSCAC clinics and filial agencies.

The data of 257 patients with various forms of pulmonary tuberculosis and the cardiovascular comorbidities (coronary heart disease and/or arterial hypertension) have shown that the reduction of total cholesterol does not reflect a true process of lipoidosis. It is necessary to use the indicator of lipoidosis activity for an objective assessment of atherogenesis. Thus, in the acute tuberculosis stage on the background of C-reactive protein and free radicals increasing, as well as antioxidant activity reduction, the progression of atherosclerosis is characterized by morphology of lipoidosis wave that is superimposed on the previous changes and leads to the development of secondary atherosclerosis. Moreover, in patients with tuberculosis on the background of intoxication syndrome there is a natural process of latent intravascular blood coagulation with impaired microcirculation. As a result, in patients with pulmonary tuberculosis and the cardiovascular comorbidities clinical signs of unstable angina and development of acute myocardial infarction were detected in 3.8–4.0%. According to our data, tuberculosis does not decreasing the development of atherosclerosis which conversely develops and appears to be another predictor of coronarogenic risk factor along with the well-known factors (tuberculosis intoxication,
hypoxia, tachycardia, arterial hyper- and hypotension, smoking), which determines the necessity of pathogenic therapy and, primarily, statins.

The study based on the 5-year experience (2009–2013) of the Moscow multidisciplinary TB-hospital’s urology department. The indications to urological interventions include male genital diseases (20.2%), urological malignancy (19.8%), urinary stone disease (17.2%), urogenital TB (16.0%), nonspecific inflammatory lesions (13.7%) and benign prostatic enlargement (13.0%). The most common operations were scrotum lesions repair (21.4%) and nephrectomies (17.2%), more rarely – endoscopic (11.1%) and transurethral procedures (10.7%), open surgery due to urinary stone disease (9.2%), adenomectomy (8.4%), percutaneus nephrostomy (6.9%) and reconstruction of the urinary tract (5.7%). The complications in the postsurgical period (11.4%) reoperation rate (4.9%) and the postoperative lethality (0.7%) not exceed the overage population rate. The chemotherapy based on the combination of four or five drugs for two or more months until the TB stabilization allows avoid the TB exacerbation or relapse in the postsurgical period. In TB patients with concomitant urologic malignancies, the operative treatment is feasible in the short time, after two-three weeks intensive chemotherapy.

The basic data on non-specific inflammatory intestinal diseases presented. This group of the chronic diseases characterize by destructive immune inflammation of the intestine wall and include ulcerative colitis and Crohn’s disease. The drugs used for its treatment – corticosteroids, cytostatics and antimetabolites, and since the end of XX century biologics – increase the risk of tuberculosis. So, the screening of tuberculosis infection before such treatment and its monitoring over a period of immunosuppressive treatment. The clinical demonstration of female, 34 years old, with Crohn’s disease, treated with corticosteroids and infliximab, and multifocal tuberculosis with involvement of the intrathoracic lymph nodules, lung tissue, liver spleen and kidney. The holistic treatment with tuberculosis drugs achieved the recovery in two years.

The review gives a characteristic of the current state in the field of investigations of drug susceptibility of M. tuberculosis: methods, results of analysis of drug resistance/susceptibility of causative agent to the main anti-tuberculosis drugs, the meaning of evaluation of level of resistance/susceptibility of M. tuberculosis strains, obtained from the patients for the selection of optimal chemotherapy scheme.

The risk of tuberculosis outbreak in health care facilities due to the undisclosed or determined source of the infection cover both the health care workers and patients. It require the highly reliable infection control, and its core component is disinfection. The disinfection must provide the professional security and patients’ safety от воздействия биологических факторов by:
– the chance of the infection admission from the outside minimization;
– the nosocomial infection prevention;
– the infection spreading outwards the health care facilities prevention.
In the article presented the basic information on the regulatory framework, organizational and resource support and the timing of the current and the final disinfection in health care facilities in case of the tuberculosis patient detection. The essential for transmission
of the tuberculosis causative agent interruption activities and quality assessment criteria are detalized.