We reviewed the available literature on the spectrum of bone and joint infection (BJI) pathogens and their drug resistance. A systematic search of publications was performed in the international PubMed database and the Russian scientific electronic library eLIBRARY.RU for the period of 2006-2026. The review included 79 studies containing data on the microbiological structure of BJI pathogens and antibacterial drug resistance rates in osteomyelitis, prosthetic joint infection, septic arthritis, and spondylodiscitis. The selection was performed in line with the PRISMA 2020 guidelines.Results. Staphylococcus aureus and coagulase-negative staphylococci, primarily Staphylococcus epidermidis, remain the leading BJIs pathogens, particularly in implant-associated infections. Gram-negative microorganisms, including Pseudomonas aeruginosa, members of the order Enterobacterales, and polymicrobial associations, also play a significant role. An increasing prevalence of methicillin-resistant staphylococci, ESBL-producing, and carbapenem-resistant gram-negative bacteria has been noted which substantially limits the options for empirical antibacterial therapy. The structure of BJI pathogens and their resistance profiles vary depending on the clinical forms of infection, geographical region, and diagnostic approach used. In some regions, a high prevalence of bone and joint tuberculosis caused by Mycobacterium tuberculosis persists. This pathology is characterized by delayed diagnosis and high rates of drug resistance.
The objective: to evaluate the effect of combined use of a fluoroquinolone and bedaquiline on the QT interval length when added to chemotherapy regimens in children with multidrug-resistant respiratory tuberculosis.Subjects and Methods. A retrospective, selective comparative study (2018-2022) was conducted among two groups of children aged 6-12 years with multidrug-resistant respiratory tuberculosis: Main Group (MG) consisted of 13 children who received two drugs with a cardiotoxic effect (bedaquiline and a fluoroquinolone) in their chemotherapy regimen; while 13 children who received a chemotherapy regimen containing a fluoroquinolone only were included in Comparison Group (CG). During the study, a standard ECG was performed assessing the length of the QTс interval.Results. Prolongation of the QTс interval was a frequent (84.6%) adverse reaction (AR) in children from MG and it was observed statistically significantly less frequently (15.4%) in CG, p<0.001. The number of episodes of the QTс interval prolongation was also reported significantly more frequently in MD versus GS: 36 (23.8%) cases out of 151 examinations and 6 (4.2%) out of 144 examinations, respectively, χ2=23.367, p≤0.001. The range of deviations of the QTс interval from the reference value (440 ms) did not exceed 460 ms in MG in 28/36 (77.8%) episodes, in CG – in 6/6 (100%) episodes. Prolongation of the QTс interval from 461 ms and more was recorded only in MG – 8/36 (22.2%). And only 1/13 (7.7%) patient from MG had a prolongation of the QTс interval to 512 ms. In no case the prolongation of the QTс interval was accompanied by clinical symptoms; no electrolyte disturbances, changes in liver or kidney function, or paroxysmal rhythm disturbances were observed.
The objective: to study detection and clinical and radiological characteristics of tuberculosis in children and adolescents with malignant diseases.Subjects and Methods. Medical records of 105 children with respiratory tuberculosis (RTB) aged from 6 months to 17 years inclusive, examined in 2018–2025, were analyzed. Children were divided into two groups: Main Group (MG) – children with respiratory tuberculosis (RTB) and malignant neoplasms (MN) (52 patients) and Control Group (CG) – children with RTB and no MN (53 patients). Demographic characteristics, features of clinical manifestations and forms of respiratory tuberculosis of the patients were retrospectively analyzed.Results. In 73.1% (38/52) of cases, respiratory tuberculosis in children from MG was detected during the onset of malignant neoplasms or their treatment, in 17.3% (9/52) – at the stage of malignant neoplasm remission, in 9.6% – at the stage of post-tuberculosis changes in the form of calcifications in the intrathoracic lymph nodes prior to development of malignant neoplasms. In MG, tuberculosis was detected in 59.6% (31/52) of patients with hemoblastoses and 40.4% (21/52) of patients with malignant neoplasms of solid organs. In children from MG, tuberculosis was detected in 21.2% (11/52) of cases based on the results of immunodiagnostics and in 78.8% (41/52) when they referred for help with complaints. In children from MG, the course of respiratory tuberculosis was characterized by a widespread disease (78.8%, 41/52) and development of bronchopulmonary complications (80.8%, 42/52). Among children with hemoblastoses, generalized or disseminated forms of tuberculosis were in 32.3% (10/31) of cases, in children with malignant neoplasms of solid organs – in 9.5% (2/21). The incidence of lesions of central nervous system in children from MG made 7.7% (4/52).
The objective: to compare the presence and severity of respiratory disorders in students smoking conventional cigarettes and using electronic nicotine delivery systems (ENDS).Subjects and Methods. Spirometry was performed using a portable spirotester USPTS-01 (assessment of forced expiratory vital capacity (FVC), forced expiratory volume for the first second (FEV1)) in students smoking cigarettes or using ENDS.Results. There were no statistically significant differences in such parameters as FVC and FEV1/FVC (p >0.05). The median and quartile values of FEV1 in the group of conventional cigarette smokers were statistically significantly lower than in the group of ENDS users and made 3.5 (3.1-4.1) and 4.2 (3.7-4.5) liters, respectively, p=0.011. The frequency of disorders of pulmonary ventilation (restrictive type, moderate to severe) was 73.7% in the group of regular cigarette smokers and 61.9% in the group of ENDS users (χ2 = 0.208, p = 0.649).
This review analyzes 80 publications on female genital tuberculosis (FGTB) and peritoneal tuberculosis (PTB), conditions of significant clinical and social relevance due to their direct impact on reproductive health. Both forms are associated with severe long-term outcomes, including infertility, chronic pelvic pain, recurrent early pregnancy loss, and the risk of disease dissemination during pregnancy, up to miliary tuberculosis. Early diagnosis is hindered by the deep anatomical location of lesions, the limited specificity of imaging methods, and the frequent latent course of the disease. The review summarizes current laboratory and instrumental approaches to diagnosing extrapulmonary tuberculosis (EPTB), with a focus on FGTB and PTB, and provides a critical assessment of the evidence related to clinical verification and treatment monitoring.
The objective: to conduct a comparative analysis of changes in tuberculosis epidemic situation in Russia before, during, and after the COVID-19 pandemic.Subjects and Methods. The data from official statistical surveillance for 2015-2024 were studied.Results. The changes in tuberculosis incidence in Russia during the COVID-19 pandemic and its aftermath are generally consistent with those worldwide. However, in contrast to the global epidemic situation, the pandemic did not impact tuberculosis mortality in Russia. During the pandemic and after it, tuberculosis incidence reduction slowed down or stopped among people aged 45 years and older, which lead to a shift in the incidence structure to older age groups. The following was also noted: an increase in the proportion of patients with fibrous cavernous pulmonary tuberculosis, and a tendency towards a decrease in the proportion of new patients with TB/HIV co-infection. The COVID-19 pandemic and related processes have contributed to stabilization of the frequency of detection of primary multidrug resistance. In the structure of deaths of tuberculosis during the COVID-19 pandemic and after it, the proportion of tuberculosis cases identified post mortem and one-year lethality are increasing. This requires enhancement of tuberculosis detection in social risk groups.
The objective: to evaluate treatment outcomes in tuberculosis patients when using video-controlled treatment.Subjects and Methods. The study was designed as a retrospective one. Subjects were the following: 854 tuberculosis patients, who received anti-tuberculosis treatment in medical units of Bishkek and Chui Region in the out-patient settings using different treatment observation models, in 2020-2022. Patients were divided in 2 groups: Main Group and Control Group. Main Group (MG) included 422 patients who were on video-controlled treatment (VCT) of tuberculosis drugs, and Control Group (CG) – 432 patients who were on directly observed treatment (DOT).Results. The majority of included patients (85.3%) lived within 3 kilometers from the healthcare organization, therefore, the use of video-controlled therapy is convenient for daily intake of TB drugs for both patients and healthcare workers. It has been found that VCT is not inferior to traditional DOT in terms of treatment outcomes: treatment success made 98.1% versus 79.6%, %, while lost to follow-up made 1.2% versus 9.9%, p> 0.05. It has been revealed that the proportion of missed doses of TB drugs in VCT Group is higher for DS-TB and DR-TB than in DOT Group (3.3% versus 2.5%, 10% versus 4.4%, respectively). While in VCT, the facts of absent on treatment were better documented, and the reasons for missed doses were identified and eliminated in a timely manner.Conclusion. The success of TB treatment using video-controlled intake of TB drugs is not inferior to traditional directly observed TB treatment and can be recommended for further use. The higher treatment effectiveness when using VCT is due to the fact that the study group included patients with good adherence, organizational problems were solved during the treatment: donors paid the Internet costs, TB drugs were delivered to the patient, and patients received some incentives. An important aspect of VCT is the reduction of risk of infecting others while traveling, i.e. prevention of tuberculosis spread.
The objective: to study results of using surgical methods for diagnosis and treatment of pulmonary mycobacteriosis.Subjects and Methods. The study was conducted in Thoracic Surgery Department of National Medical Research Center of Phthisiopulmonology and Infectious Diseases, Russian Ministry of Health, from 2022 to 2024. The data of 29 patients with pulmonary mycobacteriosis were analyzed. All those patient underwent surgical treatment, 22 patients had it for therapeutic and diagnostic purposes, and 7 for therapeutic purposes only. Non-tuberculous mycobacteria (NTMB) from specimens were detected by fluorescence microscopy, molecular genetic methods, and culture on liquid nutrient media. When isolating NTMB culture, mass spectrometry was used for species identification.Results. In 22 patients with suspected pulmonary mycobacteriosis without bacteriological confirmation before surgery, 16 segmentectomies, 4 lobectomies, and 2 combined resections were performed. By culture of surgical specimens on liquid nutrient media, growth of NTMB was obtained in 9/22 (40.9%) patients. The species spectrum of NTMB included M. chimaera intracellulare group, M. xenopi, and M. kansasii (3 cases each, 33.3%). Using the molecular genetic method, NTMBs were obtained in 20/22 (91%) patients.
The objective: to study the actual duration of chemotherapy in patients registered for treatment with drug-resistant tuberculosis regimens and the factors providing impact on it.Subjects and Methods. Using the Kaplan-Meier and Cox regression methods, the duration of treatment of 23,798 cases of tuberculosis in Russia was analyzed.Results. All studied factors, including the registration group, chemotherapy regimen, HIV status, and gender, independently influenced the duration of period from treatment registration to successful treatment. However, the registration group and chemotherapy regimen had the greatest impact. Only the chemotherapy regimen had a statistically significant effect on the duration of treatment until failure. All factors except the gender had an independent effect on the duration of treatment until death. However, the greatest impact on tuberculosis-related deaths was exerted by the patient group and treatment regimen, while the most significant impact on other causes was exerted by the registration group and HIV status. Independent influence on the duration of treatment before loss to follow-up included the initiation of treatment after chemotherapy failure and initiation of an empirical treatment regimen. The duration of treatment until transferred out outcome was not affected by any of these factors.Conclusion. The obtained results will enable the development of a model for calculating the need for anti-tuberculosis drugs, taking into account the actual duration of treatment.
The objective: to study the rates of mono-resistance and poly-resistance to anti-tuberculosis drugs among the population of the Kyrgyz Republic.Subjects and Methods. A cross-sectional study was conducted, which included data of 3,678 tuberculosis patients with mono- or poly-resistance to anti-tuberculosis drugs. 3,221 patients had pulmonary tuberculosis, while 457 had extrapulmonary tuberculosis, the observation period lasted from 2017 to 2022. The data from the National Tuberculosis Control Program in the Kyrgyz Republic (KR) were used.Results. Among the patients with mono- or poly-resistant tuberculosis, new cases accounted for 80.8%, and 87.6% of them were patients with pulmonary tuberculosis. The incidence of mono- and poly-resistant tuberculosis decreased (from 10.1 in 2017 to 6.5 in 2023 per 100,000 population) associated with decrease in the overall incidence of tuberculosis. The incidence of rifampicin-resistant tuberculosis demonstrated a downward trend, while the incidence of mono- and multidrug resistant tuberculosis fluctuated: it increased (in 2019 - by 16.7%, in 2022 - by 53.7%) and decreased (in 2020 - by 37.1%, in 2023 - by 0.22%). According to the drug resistance profile of MTB, the most prevalent (81.8%) was resistance to isoniazid with confirmed sensitivity to rifampicin, regardless of drug resistance to other anti-tuberculosis drugs.
The objective: to analyze results of preventive chemotherapy of tuberculosis in HIV-infected women of the reproductive age.Subjects and Methods. The results of tuberculosis preventive chemotherapy were retrospectively analyzed in 675 HIV-positive women aged 18-44 years for 2015-2019 (continuous sampling). The comparison group consisted of 6018 HIV-infected female patients of the same age who received no preventive chemotherapy of tuberculosis during the analyzed period.Results. The average age of women receiving preventive chemotherapy of tuberculosis (PC TB+ Group) made 32.9±0.2 years. Isoniazid was well tolerated with the drug discontinued due to adverse events only in 11/675 (1.6±2.9%) women. Only 316/675 (46.8±3.6%) women completed the full 6-month course of preventive chemotherapy; the rest defaulted within the first 3 months. From PC TB+ Group, 19/675 (0.7±2.7%) patients developed tuberculosis within the next 5 years. Among 348 women who defaulted within the first 3 months, 17 (4.9±1.5%) developed tuberculosis.Conclusion. The obtained results prove the feasibility of preventive chemotherapy of tuberculosis in HIV-positive women of the reproductive age, as it reduces the incidence of tuberculosis in the following 5 years (19/675 (0.7±2.7% versus 447/6018 (7.4±2.7%) women who developed TB, OR = 2.77, CI (1.73-4.42)). Even though 46.8±3.6% of women defaulted from preventive chemotherapy within the first 3 months.
The objective: to study tuberculosis relapses in Kaluga Region.Subjects and Methods. A retrospective study of all reported tuberculosis cases in Kaluga Region in 2019-2023 (n=996) was conducted. It included 817 new tuberculosis cases (New TB Cases Group) and 179 tuberculosis relapses (TB Relapses Group).Results. Tuberculosis relapses were significantly more often detected among patients with disabilities due to other diseases (p<0.05), 52.3% of tuberculosis relapses were the cases reported 10 years or more after the cure of tuberculosis. Relapses versus new cases of tuberculosis more often had a positive result of sputum tests, (68.4% versus 58.6%, p=0.017), multiple and extensive drug resistance (46.9% and 3.4% versus 16.4% and 0.9%, p<0.05), and lung tissue decay (61.6% versus 46.95%, p<0.001). In the group of tuberculosis relapses, lethal outcomes from tuberculosis were more frequently reported (6.7% versus 2.8%; p=0.010), while in the group of new cases, postmortem diagnosis of tuberculosis was more frequent (6.0% versus 1.1%, p=0.007), which indicated untimely diagnosis of the disease.
The objective: to assess the impact of detection routes (active screening and self-referral) on clinical characteristics and outcomes of respiratory tuberculosis (RTB) in HIV-positive patients.Subjects and Methods. A continuous cohort retrospective study was conducted. Continuous sampling was used to include 446 tuberculosis patients aged 18 years and older, detected in the general medical services (GMS) from 2017 to 2024. Patients were divided into 2 groups: TB+HIV Group included 150 patients with TB/HIV co-infection, while TB Group consisted of 296 HIV-negative tuberculosis patients.Results. It was found out that in HIV-positive patients, the probability of detecting respiratory tuberculosis by self-presentation to a medical unit exceeded that with active screening (OR=2.8). During preventive screening of HIV-positive patients, limited, uncomplicated and anatomically reversible forms of respiratory tuberculosis were predominantly (78%) detected; clinical cure was achieved in 78.4% of cases. In the patients diagnosed with respiratory tuberculosis by self-referral to outpatient units, disseminated and/or complicated forms in combination with extrathoracic localizations were detected in 73.2% of cases. When respiratory tuberculosis was detected upon admission to hospital, in 62.5% of cases, generalized, anatomically irreversible acutely progressive or chronic forms with a high vital threat were foun. The ratio of cured patients to deceased ones was 1:1 when detecting tuberculosis by visits to outpatient units and it was 1:2 when the patient was taken to hospital. In HIV-positive patients, the chances of a fatal outcome within three or more years when respiratory tuberculosis was detected by active screening is 3.3 times lower versus self-referral to outpatient units and 6.4 times lower versus inpatient treatment.
The objective: to identify factors contributing to dysglycemia in patients with pulmonary tuberculosis and comorbid diabetes mellitus, and to assess the effectiveness of dysglycemia management based on the 24-hour glycemic variability.Materials and methods. The study included 51 HIV-negative patients with advanced tuberculosis (TB) and decompensated type 1 or type 2 diabetes.Results. Infection-induced dysglycemia driven by active TB was found to be the leading cause of glycemic decompensation in 98.0% of patients; this condition was frequently compounded by dietary non-compliance, poor self-monitoring, and drug-drug interactions. The introduction of the 24-hour glycemic variability as an additional clinical parameter enabled careful monitoring of glucose-lowering therapy resulting in glycemic profile stabilization within 3–8 weeks. Against this background, combined with the optimization of TB therapy, this approach yielded favorable TB treatment outcomes demonstrated by the radiographic improvements in 66.7% of patients, with the median time to sputum conversion of 2.2 months. Joint management by phthisiologists and endocrinologists combined with management of dysglycemia represents a strategic approach to enhancing TB treatment efficacy in this patient population.
The review analyzes 67 publications from international and Russian databases (PubMed, Scopus, elibrary), publications were selected by the following keywords: «abdominal tuberculosis», «pathogenesis», and «classification». This article presents contemporary data on the pathogenesis, classification and diagnosis of abdominal tuberculosis (ATB). It defines pathogenetic signs of peritonitis, enterocolitis, mesadenitis, splenitis, and hepatitis of tuberculous etiology. It presents classifications of ATB used worldwide. Based on them, a convenient clinical classification of ATB is offered including complications requiring surgical interventions.
The objective: to assess the efficacy of tuberculosis preventive treatment (TPT) in children with latent tuberculosis infection (LTBI) and without risk of multidrug-resistant tuberculosis (MDR-TB), and to identify the advantages of video-observed therapy.Materials and Methods. A cohort of 572 children aged 0 to 17 years (inclusive) with LTBI and positive recombinant tuberculosis allergen (RTA) tests was analyzed. Children with exposure to multi-drug resistant tuberculosis (MDR-TB) were excluded from the study. TPT was administered to 480 (83.9%) children: Group I (no known TB exposure) – n=295, Group II (known TB exposure) – n=163, Group III (video-observed TPT) – n=22 children (no known TB exposure). Parents of 92 (16.1%) children (Group IV) refused TPT. Video-observed therapy was conducted via the Yandex Telemost platform. Statistical analysis was performed using the SPSS 17.0 software package.Results. Within two years after TPT, 13.04% of children in Group IV developed TB compared with 0.34% in Group I and 1.8% in Group II, no cases were observed in Group III. No adverse reactions (ARs) were reported in children receiving video-observed therapy (Group III), whereas in Groups I and II ARs were reported in 20.0% and 39.9% of children, respectively (p<0.05). Reported ARs were mild. A reduction in local response to the recombinant tuberculosis allergen test (Diaskintest) was observed among children who received TB preventive treatment: 87.5% in Group I, 79.1% in group II, and 86.4% in group III, compared with only 26.1% in those who did not receive TB preventive treatment (Group IV) (p < 0.05). Conclusions were drawn regarding the efficacy and safety of video-observed TPT.
The objective: to identify specific clinical, radiological, and laboratory changes in the patients with pulmonary mycobacteriosis caused by M. avium or M. kansasii.Subjects and Methods. An open retrospective cohort study was conducted. Examinations of 102 patients with confirmed pulmonary mycobacteriosis caused by M. avium or M. kansasii were analyzed. Among those examined, 79 (77.5%) were women and 23 (22.5%) were men. The age of patients ranged from 21 to 86 years old, the average age was 54.2 ±14.64 years old. All patients included in the study had newly detected changes in the lungs (foci, dissemination, and cavities); during the examination patients’ history was collected, and a physical examination was performed.Results. In pulmonary MB caused by M. kansasii, a cavitary radiological form was typical – 66.6% versus 16.6% for MB caused by M. avium (p<0.05); in MB caused by M. avium, the bronchiectatic form developed in 53% versus 22.7% for MB caused by M. kansasii (p<0.05). In 63.4% of cases, the intoxication syndrome prevailed among clinical signs of MB. Concomitant pathology was reported in MB cases caused by M. avium in 68.1% versus 31.8% cases caused by M. kansasii (p<0.05). The absence of concomitant diseases in pulmonary MB was reported in 63.8% of cases caused by M. kansasii versus 38.8% caused by M. avium (p<0.05). In MB, the ventilation capacity of the lungs was often impaired according to the obstructive type.
The objective: to analyze risk factors of the unfavorable course of tuberculosis detected in the patients hospitalized with suspected COVID-19.Subjects and Methods. Of 1079 patients hospitalized with suspected COVID-19 and pneumonia, 120 case histories of patients with tuberculosis were retrospectively selected using a continuous sampling method; the fatal outcome was reported in 17.5% of cases (21/120).Results. Chronic kidney disease, diabetes mellitus, and underweight were more common among patients with a fatal outcome. Of the laboratory data, the most significant risk factors for an unfavorable outcome were as follows: levels of hemoglobin below 110 g/l, total protein below 60.4 g/l, D-dimer above 2.21 μg/ml, and C-reactive protein above 91.9 mg/l.
The objective: to compare results of species identification of non-tuberculous mycobacteria by PCR (Amplitub-NTM Differentsiatsia) and MALDI-TOF mass spectrometry in clinical samples and mycobacterial cultures.Subjects and Methods. 40 clinical samples and 110 cultures of non-tuberculous mycobacteria were tested. Two methods were used for testing: Amplitub-NTM Differentsiatsia and MALDI-TOF mass spectrometry.Results. A high level of agreement between results of MALDI-TOF mass spectrometry and Amplitub-NTMB Differentsiatsia PCR kit was demonstrated. PCR confirmed its high efficiency, detecting non-tuberculous mycobacteria in 89.3% of samples; the final match of species identification with MALDI-TOF in both clinical samples and cultures made 85.1%. Both methods demonstrate a high level of agreement and they complement each other. The PCR kit can be used as the main screening method, especially in TB laboratories. If negative or indeterminate results are obtained, combination with MALDI-TOF or sequencing is recommended The optimal diagnostic strategy involves the use of PCR as a part of comprehensive approach to non-tuberculous mycobacteria identification.
The objective: to evaluate cytokine status and types of immune response in patients with chronic obstructive pulmonary disease.Subjects and Methods. A total of 172 COPD patients with varying degrees of bronchial obstruction (II–IV according to GOLD) in the exacerbation phase were examined. The levels of proinflammatory (IL-1, IL-6, IL-17, IL-21, TNF-α, IFN-γ) and anti-inflammatory (IL-4, IL-10, TGF-β1) cytokines were tested. Correlation and cluster analyses were performed to identify types of immune response (Th1, Th1/Th17, Th17).Results. It was found out that as bronchial obstruction increased in COPD patients, the production of IL-6, TGF-β1 and IL-10 increased. At different stages, there were different types of immune response; among 172 patients, Th1 was found in 22.1%, Th1/Th17 in 33.7%, and Th17 in 44.2%. Th17 was more common in extremely severe bronchial obstruction (GOLD IV) and was associated with pronounced hyperproduction of IL-17, IL-21, IL-6, and TGF-β1.Conclusion. The cytokine profile in COPD reflects the formation of Th1, Th1/Th17 and Th17 types of immune response, which determines characteristics of the course of the disease and may possibly serve as a prognostic marker.
