Despite the introduction of new anti-tuberculosis drugs, the problem of treating tuberculosis patients with a broad drug-resistant pathogen (XDR MBT) remains relevant.Aim of the study. Тo increase the effectiveness of treatment of this category of patients using an autologous composition based on dendritic cells activated by a specific antigen.Research materials and methods. А prospective study conducted in 2016-2019 included 52 patients, 36 (69.2%) men and 16 (30.8%) women, average age 43.2 ± 1.5 years. All patients received antituberculosis therapy in accordance with existing regulatory documents and recommendations. The main group consisted of 25 patients (48.1%) who agreed to immunotherapy with the introduction of an autologous composition with activated specific peptides ESAT-6 and SFP-10 dendritic cells against the background of anti-tuberculosis therapy. Statistical processing of the material carried out using the Statistica 10.0 application software package.Results. In 70.0% of cases (n = 14), there were no adverse reactions to suspension administration in patients of the main group. One patient (7.2%) had a general reaction in the form of tremor, chills after the first injection. In 5 (38.7%) patients on the 8th and 9th administration, a skin reaction was noted at the injection sites in the form of a papule, with a final regression of these changes after 8 weeks. By 18– 24 months of the course, anti-tuberculosis therapy in combination with immunotherapy in the first month of treatment allowed to obtain a positive effect according to clinical, bacteriological and radiological data in 64% of cases. It was not possible to obtain this result during therapy at the previous stages of treatment. In the comparison group, a positive result achieved only in 45.5% of cases.Conclusion. The results of the study suggest a positive effect of complex treatment with the inclusion of immunotherapy with an autologous composition based on dendritic cells in the most severe contingent of patients with pulmonary tuberculosis with broad drug resistance of the pathogen, even with an ineffective course of chemotherapy at the previous stage in 64% of cases.

The diagnostic of tuberculosis infection, including the use of immunological methods, evolved significant changes. The introduction of new diagnostic tests allowed to improve the diagnosis of latent tuberculosis infection (LTI). However, the positive results of immunological tests in both tuberculosis patients and in those with LTI do not allow to divide these conditions, which requires the development and implementation of new diagnostic approaches.Materials and methods. A prospective study with a survey of two groups of patients was conducted: group I (n=50) - patients with verified pulmonary tuberculosis, MBT (+); group II (n =15) – subjects with LTI and control group – healthy subjects (n=14). The examination complex included clinical, radiological, bacteriological, immunological (Mantoux test with 2 TU, T-SPOT.TB, QFT and Diaskintest) methods. Immune complexes were determined in all patients and healthy individuals by the method of dynamic light scattering after the in vitro addition of specific antigens - peptides ESAT-6 and SFP-10.Results. The obtained data demonstrate the low informativeness of the clinical method in the diagnostic of pulmonary tuberculosis. In the presence of characteristic X-ray changes, bacteriological verification of tuberculosis was obtained only in 46% of cases. The use of various immunological tests allows to obtain positive test results in 84-90% of cases simultaneously with the 100% of the positive results in subjects with LTI. Determination of specific immune complexes by the method of dynamic light scattering allows to determine the activity of tuberculosis infection in 100 % of cases and to identify a high-risk group for the development of active tuberculosis in people with latent tuberculosis infection.Conclusions: the obtained data can be applied not only in the diagnosis of active tuberculosis in the absence of diagnosis verification, but also allow to identify a high-risk group for the development of the disease in people with latent tuberculosis infection.

Tobacco smoking not only contributes to infection with tuberculosis, but also worsens the effectiveness of treatment, increasing the risks of relapse of tuberculosis, the formation of multiple and wide drug resistance. Materials and methods. 44 patients with pulmonary tuberculosis (21 to 60 years old) were examined. 17 patients agreed to include varenicline (main group) in the complex therapy of tuberculosis, 27 patients received only individual telephone counseling (control group). Upon admission, patients were interviewed on the status of smoking, the degree of nicotine dependence (Fagerstrom test), and the adaptability questionnaire. Statistical data processing was performed using the SPSS application package. Results. When smoking cessation, the manifestations of nicotine withdrawal syndrome were registered in patients: desire to smoke, irritability, worsening mood, headache. In varenicline group, nausea was more common (in 3 days in 29% of cases versus 7.4% in the control group; in 7 days — 24% and 15%, respectively, p>0.05). Quit day took place on the 7th day of taking the drug in 6 people, 8 patients with pulmonary tuberculosis reduced (2 or more times) the number of cigarettes smoked per day. In 9 days 8 people did not smoke, in 10 days — 11 patients, in 12 days — 14 from 17 people did not smoke (82%). In the control group, all patients prescribed a day for quitting tobacco and did not smoke in 84% of cases on the day of quitting smoking. After 30 days in the main group of patients with tuberculosis 41% were nonsmokers, in the control group of patients — 37% (p>0.05). The remaining patients in both the main and control groups reduced the number of cigarettes smoked per day by at least two times. Despite some manifestations of withdrawal syndrome, only three patients refused to take varenicline because of nausea, although it should be noted that even in the control group, whose patients received only standard tuberculosis treatment and individual counseling, nausea was noted in 7.4–15% of cases It is indicates that nausea in some cases is due to the chemotherapeutic treatment of tuberculosis, and not the treatment of nicotine addiction syndrome. Conclusion. The study showed that most smokers with pulmonary tuberculosis need help in smoking cessation and nicotine dependence treating, because they had average and high degree of nicotine dependence and a pronounced withdrawal syndrome when tobacco quit. Varenicline and individual telephone counseling are effective interventions for smoking cessation in patients with tuberculosis. Varenicline in most cases (85%) was well tolerated by tuberculosis patients receiving treatment for the underlying disease.

абакокурение не только способствует инфицированию туберкулезом, но и ухудшает эффективность лечения, увеличивая риски рецидивов туберкулеза, формирования множественной и широкой лекарственной устойчивости. Материалы и методы. Всего было обследовано 44 больных туберкулезом легких (от 21 до 60 лет). 17 больных согласились на включение в комплексную терапию туберкулеза варениклина (основная группа), 27 больных получили только индивидуальное телефонное консультирование (контрольная группа). При поступлении больных интервьюировали по статусу курения, степени никотиновой зависимости (тест Фагерстрома), опроснику «Адаптивность». Статистическая обработка данных проведена с помощью пакета прикладных программ SPSS. Результаты исследования. При отказе от табакокурения (ТК) у больных были зарегистрированы проявления синдрома отмены никотина: желание курить, раздражительность, ухудшение настроение, головная боль. В группе лечения варениклином тошнота встречалась чаще (на 3-й день приема в 29% случаев против 7,4% в контрольной группе; на 7-й день приема — в 24 и 15% соответственно; р>0,05). Отказ от ТК состоялся на 7-й день приема препарата у 6 человек, 8 больных туберкулезом легких снизили (в 2 и более раз) число выкуриваемых в день сигарет. На 9-й день приема препарата не курили 8 человек, на 10-й день — 11 больных, на 12-й день не курили 14 человек из 17 (82%). В контрольной группе все больные назначили день отказа от табака и не курили в 84% случаев в день отказа от табакокурения. Через 30 дней в основной группе больных туберкулезом оставались некурящими в 41% случаев, в контрольной группе больных — 37 % (р>0,05). Остальные больные и в основной, и в контрольной группах снизили число выкуриваемых в день сигарет не менее чем в два раза. Несмотря на некоторые проявления синдрома отмены, только 3 больных отказались от приема варениклина из-за тошноты, хотя надо отметить, что даже в контрольной группе, пациенты которой получали только стандартное лечение туберкулеза и индивидуальное консультирование при отказе от табака, тошнота отмечалась в 7,4–15% случаев. Это свидетельствует о том, что тошнота в некоторых случаях обусловлена проведением химиотерапевтического лечения туберкулеза, а не лечением синдрома зависимости от никотина. Заключение. Исследование показало, что большинство курящих больных туберкулезом легких нуждаются в помощи в отказе от табака и лечении никотиновой зависимости при отказе от табака, так как имеют среднюю и высокую степени никотиновой зависимости и выраженный синдром отмены при отказе от потребления табака. Лечение варениклином и индивидуальное телефонное консультирование являются эффективными вмешательствами для отказа от табакокурения больных туберкулезом. Варениклин в большинстве случаев (85%) хорошо переносился больными туберкулезом, получающими лечение основного заболевания.

Early diagnosis of tuberculosis remains essential for the prevention of the disease and control of its incidence. The diagnosis of latent tuberculosis infection (LTBI) has significantly improved over the last years due to the use of new immunological tests, including the Diaskintest.The aim of the study was to assess the potential of immunological assays for diagnosis of latent tuberculosis infection and determination of risk groups for tuberculosis among personnel of different institutions.Materials and methods: in 2015–2018, a prospective group-control study was conducted that included employees of various medical centres (n = 154) and healthy individuals (n = 30). There were no significant age differences between the subjects. All the subjects included in the study shared their medical history, underwent general examination, X-ray examination, and were tested with Diaskintest. Multispiral computed tomography (MSCT) of the chest was performed for every subject with a positive Diaskintest result.Results: the comparison of the number of persons with LTBI in general care hospitals, personnel of a manufacturing firm, and among healthy individuals showed that the risk of being infected with Mycobacterium tuberculosis is very similar in all the groups (from 6.8 to 10.0 %). The highest risk of developing LTBI was found in people who worked in an infectious area for more than 5 years (48.4 %). The analysis of the level of immune complexes (ICs) demonstrated that individuals with LTBI did not have isotypes of IgG3 and IgE immune complexes, which are found in patients with tuberculosis. The identification of particular isotypes indicates a borderline state between LTBI and tuberculosis and requires therapeutic intervention.Conclusions: the use of the Diaskintest makes it possible to distinguish groups of employees of various institutions who are at a higher risk of developing tuberculosis. At the same time, determination of the ICs helps to reveal the borderline condition which requires medical intervention.

The article describes the clinical case of successful treatment of a 42 year old female patient suffering from bilateral fibrous cavernous pulmonary tuberculosis with fully destroyed left lung, persistent bacillary excretion and extensive drug resistance. The treatment was complicated by poor tolerance of the used anti-tuberculosis drugs.Multiple surgeries were applied combined with resection and collapse interventions; anti-tuberculosis drugs and their doses were prescribed individually to this patients and supplemented by adjuvant therapy.The course of the disease stabilized, sputum converted and cavities were healed.

Co-infection of tuberculosis and HIV-infection continues to be the current crucial issue not only due to the persistent growth of HIV-infection but also due difficulties in diagnostics of tuberculosis. Often X-ray changes in the lungs are atypical, clinical signs are manifested only in case of the severe and disseminated disease. At present the IGRA-tests are widely used worldwide while in Russia TRA tests are used. The trial provided the data on the use and comparative efficiency of the above immunological tests against Mantoux test with 2 TU when examining 239 persons from 2014 to 2015. The comparativeness of diagnostic sensitivity of all immunological tests had been proved. The specificity of IGRA-tests and TRA tests is twice higher compared to Mantoux test with 2 TU. Also it was proved that when diagnosing tuberculosis in HIV patients the skin tests (Mantoux test with 2 TU and TRA test) had low diagnostic informativeness compared to IGRA tests, among which ELISPOT was the most sensitive.

Co-infection of tuberculosis and HIV-infection continues to be the current crucial issue not only due to the persistent growth of HIV-infection but also due difficulties in diagnostics of tuberculosis. Often X-ray changes in the lungs are atypical, clinical signs are manifested only in case of the severe and disseminated disease. At present the IGRA-tests are widely used worldwide while in Russia TRA tests are used. The trial provided the data on the use and comparative efficiency of the above immunological tests against Mantoux test with 2 TU when examining 239 persons from 2014 to 2015. The comparativeness of diagnostic sensitivity of all immunological tests had been proved. The specificity of IGRA-tests and TRA tests is twice higher compared to Mantoux test with 2 TU. Also it was proved that when diagnosing tuberculosis in HIV patients the skin tests (Mantoux test with 2 TU and TRA test) had low diagnostic informativeness compared to IGRA tests, among which ELISPOT was the most sensitive.