The clinic and computer tomographic imaging of lung pathology in COVID-19 comorbidity, tuberculosis and opportunistic diseases in patients with stage IV of HIV infection, in the phase of progression, in the absence of ART in 29 patients compared with similar 29 patients, but without COVID-19 were studied. It was found that the comorbidity of COVID-19 and tuberculosis, stage IV of HIV infection, in the phase of progression, in the absence of ART is characterized by the generalization of tuberculosis and the development of opportunistic lung diseases, severe clinical picture and visualization with computed tomography of dissemination syndrome, pulmonary pattern pathology and adenopathy, which practically does not differ from patients without COVID-19. It is not possible to diagnose this comorbidity by clinical and radiation methods of research. Special microbiological and molecular genetic methods are needed to study diagnostic material from the respiratory system and other organs in order to prescribe timely etiological treatment.

The study materials of 23 patients with COVID-19 with newly diagnosed tuberculosis at the late stages of HIV infection with an average CD4 + cells count not exceeding 30 cells/pl of blood and in the absence of antiretroviral therapy (the main group) and 23 patients with no COVID-19 (the comparison group) and the similar parameters are presented. The presence or absence of COVID-19 is characterized by social maladjustment, drug addiction, concomitant viral hepatitis B or C and COPD, generalized tuberculosis with extrapulmonary damage of various organs and the development of other opportunistic pulmonary infections, similar clinical and radiological manifestations, which can only be differentiated by microbiological and molecular genetic research methods. To prevent exogenous infection of the healthy population with COVID-19, it is imperative to organize an active regular examination of all patients with tuberculosis and HIV infection for COVID-19, especially at the later stages, in the TB care office for HIV-infected people at TB dispensaries.

Цель исследования: изучить особенности социального статуса, клиники и диагностики у пациентов с туберкулезом (ТБ) на поздних стадиях ВИЧ-инфекции с иммунодефицитом и заболеванием, вызываемым новой коронавирусной инфекцией (SARS-Cov-2) – COVID-19 в сравнении с больными ТБ на поздних стадиях ВИЧ-инфекции с иммунодефицитом, но без COVID-19. Материалы и методы. Обследовано 20 пациентов с коморбидностью COVID-19, ТБ и ВИЧ-инфекции на поздних стадиях с иммунодефицитом (основная группа), 20 аналогичных больных без COVID-19 составили группу сравнения. Результаты. Коморбидность COVID-19 и ТБ на поздних стадиях ВИЧ-инфекции с иммунодефицитом характеризуется социальной дезадаптацией, наркозависимостью с сопутствующим вирусным гепатитом В или С и ХОБЛ, что не отличается от пациентов без COVID-19. Дифференцировать сочетания данных болезней по клиническим и лучевым методам исследования не представляется возможным. Необходимы специальные микробиологические и молекулярно-генетические исследования диагностического материала из респираторной системы и других органов. Заключение. Для предотвращения заражения населения SARS-Cov-2 необходимо активное обследование всех больных ТБ и ВИЧ-инфекцией, состоящих на учете в кабинете противотуберкулезной помощи ВИЧ-инфицированным и противотуберкулезном диспансере (ПТД).

Цель исследования: изучить особенности диагностики и клиники коморбидности туберкулеза (ТБ) органов дыхания и бактериальной пневмонии (БП) у больных ВИЧ-инфекцией с иммунодефицитом. Материалы и методы. Обследовано 93 впервые выявленных больных ТБ органов дыхания и 4В стадией ВИЧ-инфекции в фазе прогрессирования в отсутствие антиретровирусной терапии (АРВТ). Больные были разделены на 3 группы. В 1-ю группу вошел 31 пациент с ТБ органов дыхания и пневмонией, вызванной Streptococcus pneumoniae (S. pneumoniae), во 2-ю группу – 31 пациент с ТБ органов дыхания и пневмонией, вызванной Staphylococcus aureus (S. aureus). В 3-ю группу включен 31 больной без БП, отобранный по принципу «копия-пара». Результаты. Коморбидность ТБ органов дыхания и пневмонии, вызванной S. pneumoniae или S. aureus у больных на 4В стадии ВИЧ-инфекции с иммунодефицитом (ИД), в фазе прогрессирования при отсутствии АРВТ характеризуется генерализацией ТБ и развитием оппортунистических инфекций легких (ОИЛ) с тяжелой клинической картиной, высоким уровнем лекарственной устойчивости M. tuberculosis и возбудителей БП. При компьютерной томографии (КТ) органов грудной клетки (ОГК) выявляются очаговая диссеминация в легких, внутригрудная лимфаденопатия и изменения легочного рисунка, что практически не отличается от пациентов без БП. Заключение. Клинические проявления и рентгенологические изменения при сочетании ТБ органов дыхания и БП, вызванной S. pneumoniae или S. aureus, и ТБ органов дыхания без БП на поздних стадиях ВИЧ-инфекции носят однотипный характер, диагностировать их возможно только при специальных микробиологических, вирусологических и молекулярно-генетических исследованиях патологического материала из респираторной системы и других органов с обязательным определением лекарственной устойчивости к противотуберкулезным препаратам (ПТП) и антибиотикам широкого спектра действия (АШСД).

We studied social status, clinical and radiological manifestations, microbiological and immunological peculiarities in 26 latestage HIV infection patients with pulmonary TB and concomitant mycobacteriosis. They all had CD4+ lymphocyte counts less than 30 cells/μL of blood, did not receive antiretroviral therapy, and excreted both M. tuberculosis and nontuberculous mycobacteria (NTM). Identification of NTM species was based on molecular genetic methods. We found M. avium complex in 84,6%, M. kansasii — in 7,7%, M. fortuitum — in 3,8% and M. xenopi — in 3,8% of the patients. The disease manifested 6–9 years after diagnosing HIV infection; it had pronounced intoxication syndrome, bronchopulmonary and extrapulmonary presentations and was accompanied by other opportunistic infections. Radiological studies revealed intrathoracic adenopathy, dissemination with predominant localization in the middle and lower lung departments, foci and small infiltrates with cavities; injury of interlobar and visceral pleura.

We have presented the data from a two-year dispensary follow-up carried out by a TB dispensary. We observed a cohort of 178 new TB patients co-infected with HIV. Out of them 79,8% were injecting drug users and suffered from viral hepatitis B and C; 86,5% did not receive antiretroviral therapy (ART); and 34,3% had CD4+ cell count less than 50 cells/μL of blood. Most common forms of TB were disseminated (28,8%) and infiltrative (30,5%) pulmonary TB; in 41,6% it was accompanied by extrapulmonary TB and in 29,2% — by other secondary diseases. Complex therapy resulted in clinical cure in 9% of patients in significant improvement in 53,9% of patients in 6,7% the disease was progressing and 30,3% of patients died during the follow-up. Disease progressing and lethal outcome were associated with low antiretroviral therapy adherence, drug addiction, severe and advanced pulmonary tuberculosis with extra pulmonary tuberculosis and other HIV-associated diseases.

We observed a group of 103 patients aged 18-30 years with pulmonary tuberculosis; each patient was observed for 12 months. 103 patients with pulmonary tuberculosis underwent a comprehensive clinical, radiological and microbiological examination. The carried out treatment was individualized basing on the presence and prevalence of cavities in the lungs, detection of Mycobacterium tuberculosis in sputum and determination of their drug sensitivity to anti-TB drugs. In 18.4 % of tuberculosis cases diagnosed with chest X-rays, intradermal Mantoux test with 2 TE PPD-L and Diaskintestom® was diagnostically irrelevant. 18.4 % of respiratory tuberculosis cases were detected during preventive chest X-ray and 81.6 % of patients were diagnosed in primary care facilities having referred with symptoms of inflammatory bronchopulmonary disease or concomitant diseases, combined with pulmonary involvement. We can conclude that without fluorography studies of the chest, intradermal Mantoux test with 2 TE PPD-L and Diaskintestom® is not a method for pulmonary tuberculosis timely diagnostics in people aged 18-30 years. The patients with pulmonary tuberculosis aged 18-30 years, diagnosed during preventive fluorography examination of the chest, after 12 months of treatment in 100 % managed to achieve clinical recovery. Same age patients with pulmonary tuberculosis, diagnosed when applying to primary care facilities with symptoms of inflammatory bronchopulmonary disease, after 12 months of treatment achieved clinical recovery only in 79.2 % and 20.8 % of them still had the lung cavities requiring further treatment and applying surgery to remove affected sections of the lungs.

The article presents the data of the randomized clinical trial of 80 young patients with destructive pulmonary tuber-culosis for various methods of TB drugs injection. Particular attention is paid to the role of parenteral drug delivery. The work demonstrated that newly diagnosed patients with destructive pulmonary tuberculosis of younger age the most optimal and effective is parenteral injection of injectable forms of TB drugs, allowing to halt bacterioexcretion for 3 months in 92.5 % of cases and to close cavities in the lungs in 80 %. In newly diagnosed patients with destructive pulmonary tuberculosis of young age oral use of tablets and of TB drugs is not effective enough, allowing to achieve 3 months cessation of bacterial isolation in 85.2 % of cases and to close cavities in the lungs in 42.5 %. Undesirable side reactions to parenteral administration of injectable forms of TB drugs were detected in 17.5 % of patients and to sep-arate oral tablet forms – in 20 %, fatal reactions were observed in 5 % of cases of drug delivery regardless of method.

The article presents the results of clinical studies of the effectiveness of artificial pneumothorax in the treatment of 124patients with cavernous pulmonary tuberculosis patients and extensively drug resistance. Clinical trials of the use of artificial pneumothorax in young patients with cavernous pulmonary tuberculosis MDR and XDR MBT have proved its high efficiency and that it can be recommended for widespread clinical use. The indications for the use of artificial pneumothorax is a cavernous pulmonary tuberculosis with the release of MDR and XDR MBT with unformed or formed thin-walled cavity not larger than 4 cm in diameter. Pleuropulmonary adhesions revealed at primary application of artificial pneumothorax are the direct indications fpr surgical burn of adhesions. With the diameter of cavities up to 2cm the artificial pneumothorax treatment is applied for 6months and with cavities of 2–4cm in diameter – for 12months. Contraindications to the use of artificial pneumothorax are cavities in the lungs more than 4cm in diam-eter, massive pleural commissures, with the impossibility of their surgical burnout; specific lesion bronchial tubes and severe comorbidities (mental illness, organic lesions of the central nervous system, chronic obstructive lung disease, chronic cardiovascular diseases in the stage of decompensation, congenital malformations of the heart and lungs, chest wall deformity). Treatment of patients with artificial pneumothorax cavernous pulmonary tuberculosis MDR and XDR pathogen can be recommended for use in stationary phase in TB facilities with thoracic surgery, where the implementation of operational burnout pleural commissures is possible.

The data of clinical, X-ray, and radioisotopic pulmonary scintigraphic studies were analyzed in 119 patients with tuberculosis. In patients with pulmonary tuberculosis concurrent with nonspecific infection, impaired pulmonary capillary blood flow may occur in the area of lesion in 60.8% of cases. Concomitant chronic bronchitis observed in half of the patients of this group is an important pathogenetic point of this unfavorable tendency resulting in increased fibrosis in the lung. Less effective treatment of the underlying diseases is another factor contributing to a reduction in pulmonary capillaries during therapy.