Health workers are one of the risk groups for tuberculosis (TB) and the employees of TB facilities are particularly at risk of infection with mycobacteria and the development of the disease. The possibility of the new immunological methods for early detection of TB infection will allow to carry out preventive measures and prevent the development of the disease in future.
Materials and methods of the study. We conducted a prospective study with the examination of the staff of TB facilities (n = 118) and medical health care facilities (n = 52) in the age from 18 to 65 years. The comparison group consisted of healthy subjects (n = 68) with no acute and chronic diseases, as well as a contact with TB patients. Diaskintest was used to identifying latent TB infection (LTI).
Results and discussion. The rates of LTI was higher in the staff of TB facilities than in health care workers of medical health care facilities and in healthy subjects. The risk of mycobacteria infection in the group II was similar to healthy subjects (0.06 vs 0.08). In the TB facilities the high-risk group for LTI are the respiratory tuberculosis departments, while in the extrapulmonary TB departments the percentage of LTI detection did not differ from differential diagnostic and administrative departments. The obtained data allows to identify departments with high and low risk of LTI (more than 50% and less than 50%, respectively).
Conclusions. The obtained data obviously demonstrated that in the healthcare and TB departments the risk of infection may be different and is determined by epidemic processes. However, even in the TB facilities, the risk of LTI varies, taking into account the number of treated patients with pulmonary TB, which makes it possible to identify departments with high and low risk of LTI.

Respiratory muscle dysfunction exacerbates respiratory failure.
The aim: to study the influence of functional parameters on the development of respiratory muscle dysfunction in patients with pulmonary tuberculosis.
Materials and methods. 373 patients with pulmonary tuberculosis were examined. All patients underwent spirometry, bodyplethysmography, a study of lung diffusion capacity, respiratory muscle strength measurements (maximal inspiratory pressure (MIP), maximal expiratory pressure (MEP) and the pressure at the overlap of the respiratory tract in the first 100 ms of breath.
Results. Half of the patients (53%) had respiratory muscle dysfunction. A moderate direct dependence of the MIP and MEP on FEV1 VC and TLC was revealed. A moderate direct dependence of the MEP on and RV/TLC was found. A moderate inverse dependence of the P0,1 on FEV1, VC, DLCO.
Conclusion. Respiratory muscle dysfunction was found in patients with severe ventilation disorders. The increased neurorespiratory drive is influenced by airway disorders, lung hyperinflation, impaired pulmonary gas exchange.

We detected MICs for the line of the drugs using for the treatment of mycobacterisises caused by mycobacteria of avium-intracellulare complex (МАС). Our MICs meanings were similar (but not always identical) to those determined by other methods.
Mycobacteria of the МАС were susceptible in most cases to amikacin, clarithromycin, moxifloxacin, rifabutin, and resistant to other drugs located on the SlowMyco Sensititre® panel. At the same time, a number of strains with intermediate sensitivity/resistance were determined for a number of drugs for which most strains were resistant. Certain differences in drug sensitivity of M. avium and M. intracellulare species were also revealed. Both of these facts must be considered when prescribing chemotherapy.

The drug sensitivity of 258 strains of rapidly growing mycobacteria of the fortuitum coMPlex was studied by broth microdilution method to 15 chemotherapeutic agents (Sensititre RAPMyco). It was established that M. fortuitum and M. peregrinum, which are included in the coMPlex, have similar sensitivity / resistance to the studied drugs. At the same time, they remain sensitive to a number of chemotherapy drugs, and in some cases, with a large number of resistant cultures, there are quite a significant number of strains with «intermediate» sensitivity, which creates a «reserve» for chemotherapy.

We investigated comparative activities of fluconazole, itraconazole, voriconazole, posaconazole (a triazole group), anidulafungin, сaspofungin, micafungin (an echinocandin group) and amphotericin B against 330 strains of 14 Candida species isolated in a TB hospital (blood, lung and pleural cavity contents, respiratory samples). We justified recommendations to perform in vitro susceptibility testing to 7 antimycotics, widely used in candidiasis treatment (fluconazole, itraconazole, voriconazole, anidulafungin, сaspofungin, micafungin, amphotericin B), for common and rare Candida species based on their initial susceptibility. The choice of drug against candidiasis should consider variative or reduced susceptibility of some Candida species. The choice of a triazole should consider laboratory data (precise species identification and, if necessary, antimycotic resistance determination); otherwise treatment might be ineffective.

Misuse (inappropriate or imprudent use) of anti-tuberculosis drugs is one of the reasons to the ongoing spread of drug-resistant forms of tuberculosis. And the problem of rational therapy for tuberculosis is still of urgent interest. With the present abundance of drugs for tuberculosis, patients can be cured, on the one hand, but on the other hand, a serious harm to patients’ health can be inflicted. Hence physicians are required to have knowledge of both pharmacological drug properties and personalized approach to patients. This article features basic principles of rational drug choice for tuberculosis, combining drugs, drug formulations, and drug dosages. Factors complicating pharmacotherapy in children and the elderly patients are specified. The issues related to off-label drug use are contemplated. Key factors and methods to improve the effectiveness of pharmacotherapy for tuberculosis are pointed out. Methods of predicting and preventing drug side effects are discussed. Issues related to therapeutic drug monitoring and pharmacogenetic study
(the tools for personalized pharmacotherapy) are touched upon. Types and examples of drug-drug interaction are presented.

The data of medical documentation for 165 children with active respiratory tuberculosis aged 6 to 18 years are analyzed. It has been established that in children, adverse reactions (AR) to anti-TB drugs develop in 40% of cases, more often in the first month of treatment
(the average period is 20.3 ± 6.0 days). Toxic reactions are developed significantly more often than allergic reactions: 86.5% and 13.4%, respectively (95%CI 76.0% –93.7%). Hepatotoxic reactions predominate (68.6%), which are latent in 45.6% cases. More than half of patients (56.7%) with AR have a concomitant pathology before chemotherapy begins. Among patients with normal tolerability of anti-TB drugs, the concomitant pathology was significantly less frequent, p < 0.01. In patients with a slow type of acetylation, adverse reactions to anti-TB drugs at an average daily dose are significantly higher than in children with a rapid type of acetylation: 93% and 25.0% of cases, respectively, p < 0.01. 22% of new respiratory TB cases need correction of standard regimens of chemotherapy because of the AR development.

The real research is devoted to features of identification, a clinical current and outcomes of a meningeal tuberculosis in patients with HIV infection in present time in the Volgograd region. At patients with HIV infection the prevailing clinical forms were disseminated (41.2%, 95%CI 29.5–52.9%) and an infiltrative pulmonary tuberculosis (27.9%, 95%CI 17.3–38.6%). Extrapulmonary localization are diagnosed in 60.3% of cases (95%CI 48.7–71.9%) at patients with HIV infection. MBT resistance in a sputum is revealed in 63.2% of cases (95%CI 47.8– 78.5%) among patients with HIV infection. In liquor MBT are found out in 35.3% of patients (95%CI 23.9–46.7%). The accompanying chronic viral hepatitis C is registered in 88.2% of cases (95%CI 80.6– 95.9%). The lethal outcome was observed in 66.2% of cases (95%CI 54.9–77.4%) among patients with HIV infection.

This study aimed to identify the clinic, laboratory and radiological features of urogenital tuberculosis in HIV-patients (UGTB).
Methods. Retrospective descriptive study over a Jan 2012 – June 2018. All patients hospitalized for UGTB in the Moscow Research and Clinical Center for TB Control were included in the study. The study focused on 199 cases (> 18years of age). HIV-coinfection registered in 102 (51.2%) cases (I group), 97 (48.8%) patients were HIV-negative (II group).
Results. TB of renal parenchyma prevailed in the I group (62.8%) vs 12.4% in the II group. Polycavernous renal TB revealed in 6.9% HIV-coinfected patients vs 25.8% in HIV-negative, cavernous renal TB – in 2.9% and 13.4%, tuberculous papillitis – in 10.8% and 24.7% cases respectively (p < 0.05). Sectional study detected miliary renal TB in 5 (4.9%) patients of the I and in one (1.0%) of the II group. Isolated tuberculous epididymitis took place in 7.8% and 18.6% cases, prostate TB – in 3.9% and 4.1% respectively. Multispiral computed tomography (MSCT) revealed the signs of UGTB significantly less often in HIVpositive persons vs HIV-negative ones: cavities – in 11.7% vs 36.4%, hydronephrosis – in 10.6% vs 38.6%, ureteral strictures – in 5.3% vs 20.4%, pelvic wall thickening – in 8.5% vs 30.7%, ureteral wall thickening – in 12.8% vs 42.0%, bladder wall thickening – in 7.4% vs 21.6%, bladder scarring – in 4.2% vs 14.8% respectively (p < 0.05). MSCT recognized several (more than one) signs of UGTB significantly more often than excretory urography (EU): 123 (61.8%) vs 65 (32.0%) cases (p < 0.05). Pathological examination helped to confirm the diagnosis of UGTB twice rare in HIV-positive vs HIV-negative patients (24,5% vs 54,6%), contrariwise cultural methods identified M. tuberculosis 1,5 times more often (66,7% vs 40,2%, p < 0.05), molecular genetic methods – 2,5 times more often (79,4% vs 31,9%, p < 0.01).
Conclusion. Tissue destruction and scarring are less common for UGTB in HIV-positive patients vs HIV-negative. Bacteriology played the leading role in UGTB verification. Radiologic findings (urothelium thickening, cavities, ureteral strictures and microcyst) are identified better by MSCT vs EU.

The article focuses on socio-psychological characteristics of HIV and HIV/tuberculosis co-infection patients. Awareness of underlying HIV condition and tuberculosis among patients, as well as concept and attitude towards their treatment efficiency of tuberculosis and HIV co-infection were explored. In this study the Medical-Psychological Counseling Questionnaire has been developed, which is a multiplechoice test of 28 items. The methods of questionnaire, diagnostic interview, overt observation, and comparative analysis were used. That study has identified the socio-psychological personality characteristics of HIV and HIV/tuberculosis co-infection patients that decrease resistance to stress and social adaptiveness. The findings can then be used for selecting of existing methodic facilities and
development of new ones during psychological diagnosis, correction and psychotherapeutic counseling of HIV and HIV/tuberculosis coinfection patients. Some respondents’ questionnaire replies contradict their answers during personal diagnostic interview. So the patients tend to give socially upheld (insincere) answers in written survey. These findings highlight the need for further development of the topic, and also for individual psychological counseling of each patient.

The development of methods for lung tuberculosis specific treatment is one of the contemporary phthisiology key priorities. The transformed forms of electric and mechanical energy – electrophoresis, impulse and alternating current etc, formerly considered as contraindicated in active tuberculosis, now are essential in the complex of antituberculosis therapy. The proper and timely usage of different kinds of electric current, electrical and magnetic fields, methods of electrotherapy promotes the minimization of the residual post tuberculosis changes in the damaged lung tissue, prevents the excessive fibrosis, enhances the adhesions and scar tissue resorption.