Based on data on tuberculosis patients, died of tuberculosis in Moscow city in 2012-2018, comparative analysis of their places of death, social and occupational status, characteristics of dispensary observation in TB-control facility, clinical structure and cause of death was carried out. It is shown, that outside the hospital TB patients died of tuberculosis in 24.4%. This indicator significantly depends on dispensary observation in TB-control facility and its period. In patients, which were unknown for TB-control facility at the time of their life, died in hospital 33.9% only. At the same time, patients, which were followed up by TB-control facility, died in hospital in 97.7% (followed up to one year) and in 75.0% (followed more than one year). The clinical structure of the death causes in patients, died in and out of hospital is the same. This indicates that TB patients, died out of hospital, have significant epidemiological risk and need special attention in the niduses TB infection identification and sanation.

In the context of rapid spread of the new coronavirus infection, the introduction COVID-19 in in-patient tuberculosis facilities becomes an urgent problem. Expected greater exposure to new coronavirus infection in tuberculosis patients and и more severe course of COVID-19 in them requested a review of the new approaches to organization of diagnostic and treatment, and compliance with security measures by patients and stuff. The work was carried out in order to prevent the introduction of COVID-19 in tuberculosis inpatient clinicв, it nosocomial distribution and creation of conditions for providing quality and affordable medical care to tuberculosis patients. The stages of improving the organization in the conditions of «pavilion» development of the Moscow Research and Clinical Center for Tuberculosis Control described. Method of the expert evaluation and strategic planning (SWOT-analysis) used. As the result, during 5 months neither one case of COVID-19 was introduced in tuberculosis in-patient clinic.

Objective: improvement of algorithms for early diagnosis of tuberculosis infection by comparing the results of the Mantoux test, DST and a laboratory test for evaluating the production of gammainterferon (QuantiFERON®-TB Gold-IT, QFT) in children with respiratory tuberculosis and in children with chronic nonspecific lung diseases.
Subjects and methods. The study included 62 children with respiratory tuberculosis and chronic non-specific lung diseases. All children were examined using three methods, first QFT, then an intradermal test with DST and a Mantoux test. Children aged 1 to 17 years. Of these, the 1st group was 40 children, the 2nd – of 22 children.
Results. For a test with DST, positive reactions were noted in 38 of 40 examined with respiratory tuberculosis (95.0%), Doubtful in 2 patients (5.0%). In children with chronic non-specific lung diseases, 1 out of 22 children examined had a positive reaction (4.5%), in 21 of
22 (95.5%) – negative. For the QFT test, positive reactions were obtained in 38 patients from 40 examined respiratory tuberculosis (95.0%), negative – in 2 (5.0%) patients. In the chronic non-specific lung diseases group, a positive reaction was obtained in 1 out of 22 children (4.5%), negative in 21 (95.45%). The results of both tests were positive in 36 of 40 patients in the first group (90.0%). In the second group, both tests were positive in one child out of 22, in the remaining 21 the results of both tests were negative.
Conclusion. The sensitivity and specificity of the test with DST and QFT in children with chronic lung disease were 95% and 95.5%, respectively, and are regarded as high. At 100% sensitivity of the Mantoux test, its specificity in children with chronic lung disease is insufficient. In this regard, for the diagnosis of respiratory tuberculosis in children with chronic lung disease and chronic allergic pathology, a test with DST and the QFT test should be used.

The article analyzes the effectiveness of using a skin sample with recombinant tuberculosis antigen (ATR) for differential diagnosis of infiltrative processes in the lungs of the lower lobe localization in comparison with a Mantoux test in 282 patients aged 18 to 87 years who were treated at the Voronezh regional tuberculosis dispensary in 2011-2018. It was found that the sensitivity of the sample with ATP was 70.0%, the specificity was 70.4%, the sensitivity of the Mantoux sample with 2 TE was higher and was 86.0%, but the specificity was lower – 43.7%. In infiltrative pulmonary tuberculosis, the proportion of people with a positive reaction to ATP (70,0%) is significantly higher than in healthy (8.9%) and patients with non-specific lung diseases (NSLD) – 29.7%, and the average size of the infiltrate (10,2 ± 1,2 mm) exceeds that in healthy individuals (1,1 ± 0,4 mm) and in patients with NSLD (3,6 ± 0,5 mm). The expediency of using a sample with ATP in the differential diagnosis of tuberculosis and NSLD in adults with lowerlobe localization of the process has been established.

Clinical analysis of co-infection COVID-19/tuberculosis in children based on 27 patients. Co-infection occurred in a light and moderate form, which does not need hospitalization in department of reanimation and intensive therapy. Cytokine storm, severe or critical symptoms were registered not once. In addition, there were no complications of tuberculosis and concomitant diseases. CT changes by type “ground glass” observed in 6 (22.0%) children. Average hospitalization period of co-infected COVID-19/tuberculosis children in infectious in-patient clinic – 19,4 days. Treatment regimens, include anti-viral, anti-bacterial and adjuvant therapy, are effective and provide cure rate 100%.

The HIV-epidemic spread depends on one or another prevailing risk factors for infection with human immunodeficiency virus among population. In recent years, there has been a tendency in Russia to the predominance of a heterosexual transmission route of HIV, which accelerates the epidemic outbreak from marginalized groups into the general population. With the aim to study trends in the risk factors for infection with HIV among the population of the Northwestern Federal District’s regions, the 2007 - 2018 data obtained from the federal statistical monitoring forms № 4 “Information on subjects tested for HIV” were compared. In the Northwestern Federal District, the frequency of parenteral HIV transmission route during the study period decreased in 1,8 times (p < 0,01), and the share of the heterosexual transmission increased in 2,6 times (p < 0,01). In almost of all regions, by 2018, the heterosexual transmission of HIV became dominant, especially in the Novgorod, Pskov and Murmansk regions, where from six to nine out of ten screened HIV cases occurred through heterosexual contacts, and in the Nenets Autonomous District, all 9 new HIV cases in 2018 had a heterosexual transmission. Consequently, heterosexual contacts that potentiate the HIV spread become its main transmission route in the regions of the Northwestern District of the Russian Federation. The study results should be taken into account when developing regional HIV programs with the primary focus of resources on prophylaxis measures to prevent infection with HIV during heterosexual contacts.

Complete clinical cure with minimal residual changes is one of the basic goal for TB-physicians during treatment and follow-up of children and adolescents with local tuberculosis. The evaluation of the treatment effectiveness is important, because it determine duration of the required course antituberculosis chemotherapy and following-up, and is a prognostic criterion for durable clinical cure and absence of relapses. Results of the immunological tests become one of the criteria of active or clinical cured tuberculosis in children and adolescents. Study show, that moderate or large residual tuberculosis-related changes ребенка promote the persistent of sensitivity to tuberculin on the basic level. Results of the allergen tuberculosis recombinant test (ATR), on the contrary, at the clinical cure stage not depend on residual changes manifestation and let us to evaluate disease activity in any case of lung tissue and intrathoracic lymph nodes damage. Therefore, ATR is criterion of mycobacterial population’s activity.

The analysis of literature data on multi co-morbidity of socially important diseases: tuberculosis, diseases of addiction and HIVinfection carried out. Information on these diseases’ distribution in the world and in Russia in the recent years. Patients with comorbidities are the great epidemiological danger. Patients with triple diagnose are especially difficult for treatment due to the low treatment adherence. Late diagnosis advanced and complicated tuberculosis, massive bacterial release, diseases chronization, high rate of the multidrug resistance and treatment interruption, chronic lung failure, hemoptysis, drugs intolerance, high mortality rate – are typically in this patients. The problem of tuberculosis control must be solved in combination with diseases of addiction and HIV-infection.

In a clinical case, a successful treatment of pulmonary tuberculosis caused by extensively drug-resistant mycobacteria in a patient with oncology presented. The peculiarity of this case can be called extensively drug-resistant tuberculosis of a young patient with advanced breast carcinoma, without pronounced clinical symptoms, socially preserved, fluorographically examined not annually. The presented clinical case demonstrates the relevance of the topic under discussion. Treatment of drug-resistant tuberculosis is an urgent problem for the whole world. The appointment of the V chemotherapy regimen to the patient, with the inclusion of linezolid, perchlozone and bedaquiline in the complex therapy, made it possible to achieve stabilization of the patient’s condition in the shortest possible time, a pronounced positive clinical and radiological dynamics of a specific process in the lungs with extensive drug resistance of mycobacterium tuberculosis.