Currently, tuberculosis is one of the most significant problems of epidemiology and health care in Russia and the world. Preventive work with children at risk of tuberculosis is a very relevant activity of the health care system. This article presents an analysis of the main tuberculosis indicators in children and adolescents, as well as dispensary work for 2014–2018 in the Tyumen region. The necessity of developing new approaches and practical recommendations for the clinical follow-up of children with latent tuberculosis infection (LTBI) has been substantiated. One of the approaches may be the use of vitamin D for the treatment of LTBI and the prevention of active tuberculosis development in children.

We determined clinical and radiological presentations of disseminated pulmonary TB variants differing by genesis and course considering the current pathomorphism of TB and using hightechnology diagnostic methods. We studied 78 cases with etiologically established and morphologically verified new disseminated pulmonary TB with acute, subacute or chronic course. We demonstrated clinical and diagnostic manifestations, CT and morphological signs typical for each variant of disseminated pulmonary TB. The obtained data would enable to optimize diagnosis and differential diagnosis of different variants of disseminated pulmonary TB, distinguish TB from other disseminated pulmonary diseases.

The article is devoted to the analysis of the structure of morbidity, disability, diagnostic features and clinical course of sarcoidosis. From 1977 to 2012 the incidence of sarcoidosis in the Republic of Belarus increased 6.2 times and reached a level of 8.0 per 100,000 population (since 2013, information on the incidence of sarcoidosis has not been included in the list of mandatory reporting of TB services). In 2019 the incidence rate will reach the level of 10.2 ± 0.34 per 100,000 populations according to the forecast. The primary disability rate is reduced by 2.4% per year. The patients with a minor and asymptomatic course of sarcoidosis prevail in Belarusian population (80.2% in 2005–2015). Stage II of sarcoidosis dominates (76%, p = 0.002). Extrapulmonary manifestations of sarcoidosis are diagnosed seldom (15.7% of cases). An algorithm for sarcoidosis diagnosing has been developed with the inclusion of new prediction criteria in the survey program (total lipid phosphorus level in induced sputum < 90.5 μmol P / L) in combination with a 6-minute walk distance < 425 m) and disease activity (level of tumor necrosis factor-α in induced sputum > 70 ng/ml).

The article presents the results of assessing the territorial features of the spread of drug-resistant tuberculosis in 2011–2018 in the Yaroslavl region, obtained with the help of the author’s computer program. Information about the 1878 new TB cases in adults with established bacterial excretion was included in the database. The presence of drug resistance of Mycobacterium tuberculosis (MBT) to four or more drugs prevailed in 25.7% of patients. Primary drug-resistant MBT detected in 53.2% of cases, the increase was 6.7% for 2011-2018. The deterioration of the spectrum structure of drug-resistant MBT was due to the growth of primary drug resistance of MBT by 35% (23.4–31.6%) and broad drug resistance of MBT on 2% (10.3–10.5%), and also due to the growth of 18.7% (36.4–43.2%) of the number of strains resistant to other combinations of drugs. A high level of drug resistance of MBT was noted to streptomycin (80%), isoniazid (80.8%), rifampicin (68.3%), fluoroquinolones (18%). Territorial regularities of the appearance of primary drug resistance of MBT have not been established. The coincidence of drug resistance of MBT were detected in 72% of cases only in family, family contact, or contact areas in the range of 1-2 houses.

The article presents the results of a retrospective study of multidrugresistant M. tuberculosis (MTB) strains obtained from patients with pulmonary tuberculosis who were under regular medical check-up in 2014 in Moscow. We determined of belonging of 274 MDR MTB strains to Beijing and non-Beijing lineages as well as determinants of drug resistance by spoligotyping and molecular DST for isoniazid, rifampicin, fluoroquinolones, aminoglycosides/polypeptides, and performed the comparative analysis of the genetic structure of the strains. 81% of the studied MTB were detected as highly transmissible, epidemiologically dangerous and difficult to treat Beijing strains with mutations, which, according to the literature, are associated with a high level of pathogen resistance to antitubercular drugs.

In 113 patients with pulmonary tuberculosis, the surgical material examined using microscopic, bacteriological, and molecular genetic methods. Microscopic examination revealed acid-resistant mycobacteria in 70.8% of cases; the growth of M. tuberculosis detected in 17.7% of cases. A molecular genetic method revealed the DNA of M. tuberculosis in 82.3% (95% CI 74.2-88.3%). According to the results of molecular genetic studies of the surgical material, the drug resistance of M. tuberculosis was newly diagnosed in 21.2% (95% CI 14.6-29.7%) of cases, which helpes to optimize the treatment regimen in the early stages after surgery.

In patients with multidrug-resistant pulmonary tuberculosis, the incidence of toxic and allergic adverse reactions reaches 92%. This is one of the reasons for the low effectiveness of treatment due to the interruption of the course of chemotherapy in order to eliminate the disorders that arise. A study of the correction of undesirable side reactions with the help of functional nutrition of the line «Rekitsen-RD» was conducted. The study involved 33 people with intoxication syndrome and changes in clinical and biochemical blood tests in the form of eosinophilia, bilirubinemia, increased ALT levels. The results of the study: a decrease in complaints of intoxication syndrome in 72.7% of cases, a decrease in the level of bilirubin in 72.7% of cases, ALT in 78.5% of cases, and eosinophils in 91.6% of cases.

According to Russian researches, the rate of C. difficile infection (CDI) is 28,7–51,5% among patients with the antibiotic-associated diarrhea, but the CDI caused by hyper-virulent strain 027/NAP1/ BI is less researched. The main factors of CDI are following: using antibacterial drugs and staying at a hospital. In spite of this, there are not many researches about emerging of CDI among patients which take antitubercular chemotherapy. We investigated 57 stool samples obtained from 57 TB patients admitted at Moscow Research and Clinical Center for Tuberculosis control of the Moscow Government Health Department. The samples were tested by Xpert С. difficile assay (Cepheid, USA). The rate of CDI among TB patients was 40,4%. In our investigation we detected CDI caused by strains of С. difficile presumptive type 027/NAP1/BI in 90% TB patients.

The review presents the role of free radical oxydation (FRO) in patients with pulmonary tuberculosis, which are of great importance for the development of clinical symptoms, pathological changes, and the outcome of the disease. The value of FRO is shown for the development of destructive changes in the lungs at different courses of the tissue inflammatory reaction, for the antioxidant protection of mycobacterium tuberculosis for incomplete phagocytosis, as well as the role of free radical processes in the development of resistance of mycobacteria tuberculosis.