Aim. To study the features of clinical manifestations and diagnosis of comorbidity of disseminated pulmonary tuberculosis, coronavirus, pneumocystis and pneumococcal pneumonia in patients with late stages of HIV infection with immunodeficiency. Materials and methods. The prospective study included 120 newly identified patients with disseminated pulmonary tuberculosis with Mycobacterium tuberculosis, stage IVB of HIV infection, in the phase of progression and in the absence of antiretroviral therapy, aged 2953 years, who were randomized into 1A and 2A main groups and 1B and 2B comparison groups. Group 1A included 29 patients with comorbidity and pneumocystis pneumonia and group 2A 31 patients with comorbidity of disseminated pulmonary tuberculosis, coronovirus pneumococcal pneumonia, and group 1B and 2B comprised 29 and 31 similar patients, but without coronovirus pneumonia. To diagnose coronavirus pneumonia, PCR of SARS-CoV-2 RNA was used in smears from the nasopharynx and oropharynx, in sputum or in endotracheal aspirate. To detect Pneumocystis jirovecii, the causative agent of pneumocystis pneumonia, a microscopic examination of diagnostic material from the respiratory tract with RomanovskyGiemse and GrokottGmri coloration was carried out, and to detect Streptococcus pneumoniae, the causative agent of pneumococcal pneumonia, the diagnostic material was seeded on special nutrient media with determination of the drug resistance of the resulting culture to broad-spectrum antibiotics. Statistical data processing was carried out using the Microsoft Office Excel 2019 program with the calculation of the average in the group and the standard error of the average, confidence interval. Results. The comorbidity of disseminated pulmonary tuberculosis, coronavirus, pneumocystis and pneumococcal pneumonia in patients in the late stages of HIV infection, in the phase of progression and in the absence of antiretroviral therapy was characterized by severe immunodeficiency, generalization of tuberculosis with multiple extrapulmonary lesions and severe pneumonia. This determines the similarity of clinical manifestations and respiratory symptoms, and also makes it difficult to visualize computed tomographic changes consisting of a complex simultaneous combination of four pathological syndromes: dissemination, pleural pathology, increased pulmonary pattern and adenopathy. Simultaneous layering of several pathologies with the same type of clinical manifestations and computed tomographic changes requires a comprehensive etiological diagnosis of specific diseases to prescribe timely comprehensive treatment and reduce the lethality of this heavy contingent of patients. Conclusion. Patients with disseminated pulmonary tuberculosis and HIV infection who are registered in the office of tuberculosis care for HIV-infected in the tuberculosis dispensary represent a high risk group of COVID-19 infection and the development of coronavirus pneumonia, and with severe immunodeficiency, pneumocystis and pneumococcal pneumonia, should be regularly subjected to preventive studies for timely detection of COVID-19, coronavirus, pneumocystis and pneumococcal pneumonia for the purpose of their emergency isolation and timely treatment.

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.

Aim. To study the features of the social status, clinic and diagnosis of respiratory tuberculosis comorbidity and viral pneumonia caused by Herpes simplex virus type 1, Cytomegalovirus Human and SARS-CoV-2 in patients with late-stage HIV infection with immunodeficiency. Materials and methods. The prospective study included 25 patients with respiratory tuberculosis comorbidity with Mycobacterium tuberculosis, herpesvirus and coronavirus pneumonia, and 21 patients with respiratory tuberculosis with cytomegalovirus and coronavirus pneumonia (1a and 2a main groups) and, respectively, 25 and 21 similar patients, but without coronavirus pneumonia (1b and 2b comparison group), in the late stages of HIV infection with immunodeficiency. For the etiological diagnosis of herpesvirus- and cytomegalovirus pneumonia, PCR was used to detect the DNA of Herpes simplex virus type 1 and Cytomegalovirus Human in the diagnostic material of the respiratory tract, and for the etiological diagnosis of coronavirus pneumonia, PCR was used to detect SARS-CoV-2 RNA. Statistical data processing was carried out using the Microsoft Office Excel 2019 program with the calculation of the average in the group and the standard error of the average, confidence interval. Results. The comorbidity of respiratory tuberculosis, herpes-, cytomegalo- and coronavirus pneumonia in patients with late-stage HIV infection, in the phase of progression and in the absence of ART was characterized by severe immunodeficiency and generalization of tuberculosis with multiple extrapulmonary lesions. This determines the similarity of clinical manifestations and visualization of CT changes in this comorbidity, which makes it difficult to distinguish them due to the simultaneous layering of several pathologies with the same type of clinical manifestations at once and requires a comprehensive etiological diagnosis of specific diseases to prescribe timely comprehensive treatment and reduce the lethality of this heavy contingent of patients. Conclusion. Patients with tuberculosis of the respiratory system and HIV infection registered in the office of tuberculosis care for HIV-infected in the tuberculosis dispensary represent a high risk group of infection with COVID-19 and CVP disease, and with severe immunodeficiency and GWP and CMVP, should be regularly subjected to preventive studies for timely detection of COVID-19 for the purpose of their emergency isolation and treatment.

Objective The purpose of the study was to investigate the specific features of clinical manifestations and diagnosis of co-infection of COVID-19, tuberculosis and opportunistic pulmonary infections in late-stage HIV patients.Design 27 patients with co-infection of COVID-19, tuberculosis, opportunistic pulmonary infections and late-stage HIV infection with immunodeficiency without antiretroviral therapy (group 1) and 27 patients with equivalent parameters but without COVID-19 (group 2) were examined.Results The patients of the group 1 and group 2 are the persons with social maladjustment and substance addiction. All of them have concomitant viral hepatitis B/C, COPD, opportunistic pulmonary infections and similar clinical and radiological manifestations, which can only be differentiated with microbiological and molecular genetic studies. The patients with co-infection of COVID-19, tuberculosis and HIV pose a high risk of transmission of infection to healthy persons in view of non-adherence to examination and treatment.Conclusion To prevent the spread of infection among the healthy population, it is necessary to arrange in a mandatory manner an active and regular COVID-19 testing of all patients with tuberculosis/HIV co-infection, especially of late-stage HIV patients without antiretroviral therapy, in the tuberculosis care unit for HIV-infected persons at the tuberculosis dispensary.Setting There are few data on the specific features of clinical manifestations of co-infection of COVID-19, tuberculosis (TB) and opportunistic pulmonary infections (OPI) in late-stage HIV patients with immunodeficiency.Objective Study purpose is to investigate the specific features of clinical manifestations and diagnosis of co-infection of COVID-19, TB and OPI in late-stage HIV patients with immunodeficiency.Design Fifty-four (54) patients admitted for inpatient treatment at the TB Clinical Hospital N 3 named after Zakharyin were enrolled in this prospective study. The participants were assigned to two groups: group 1 (main) and group 2 (comparison group). Group 1 consisted of twenty-seven (27) aged 28-52 patients (18 men (66.7 ± 9.1%) and 9 women (33.3 ± 9.1%)) with known co-infection of COVID-19, sputum smear-positive for M. tuberculosis (MBT) pulmonary tuberculosis (PTB) and with late-stage HIV infection in progression phase without antiretroviral therapy (ART). Group 2 included 27 patients who were selected using the “copy-pair” method and were completely identical to the patients of the main group (with virtually the same age, sex, social parameters and clinical and laboratory indicators), but without diagnosis of COVID-19.### Competing Interest StatementThe authors have declared no competing interest.### Funding StatementThis study did not receive any funding### Author DeclarationsI confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.YesThe details of the IRB/oversight body that provided approval or exemption for the research described are given below:Ethics committee of the A.I. Yevdokimov Moscow State University of Medicine and Dentistry gave ethical approval for this work.I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals.YesI understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance).YesI have followed all appropriate research reporting guidelines and uploaded the relevant EQUATOR Network research reporting checklist(s) and other pertinent material as supplementary files, if applicable.YesAll data produced in the present work are contained in the manuscript

The global scientific community has recognized the high importance of lung CT as a diagnostic method. The objective of this study is to prove the significance of lung CT as a means of predicting fatal outcomes of COVID–19 viral pneumonia in patients with a severe and extremely severe course of the disease. The volume of lung damage was retrospectively estimated in postmortem studies of 26 patients with the burden of cancer and in 78 patients without any cancer history (the control group). Lung CT was performed on the day of death and maximum 3 days before it. We concluded that the patients with cancer died with a lesion volume two times smaller than those without cancer, 32.38 ± 17.41% and 69.21 ± 11.63%, respectively. Thus, lung CT is not only a diagnostic tool, but it can also predict the fatal outcome of SARS-CoV-2 pneumonia (COVID-19) in patients with a severe and extremely severe course of the disease.

Aim. To study the features of clinical and radiological manifestations and diagnosis of COVID-19, respiratory tuberculosis and opportunistic lung infections (OIL) coinfection in patients with late stages of HIV-infection with immunodeficiency. Materials and methods. The study included 29 patients with COVID-19 coinfection, respiratory tuberculosis and opportunistic lung infections in the late stages of HIV-infection with immunodeficiency (group 1) and 29 patients similar in all parameters without COVID-19 (group 2). All patients were underwent clinical and laboratory, radiation and bronchological examination, and microbiological, immunological, molecular genetic, cytological and histological examination of diagnostic material of the respiratory tract, cerebrospinal and pleural fluid, blood, urine and feces to identify pathogens of coinfection. Statistical data processing was carried out using the Microsoft Office Excel 2010 program with the calculation of the average in the group and the standard error of the average, confidence interval. Results. It has been established that co-infection with COVID-19, respiratory tuberculosis and opportunistic lung infections in patients with late stages of HIV-infection with immunodeficiency is manifested by a pronounced intoxication syndrome, bronchopulmonary manifestations and symptoms of damage to other organs and systems, which is due to the generalization of tuberculosis with extrapulmonary lesions and the development of opportunistic lung infections, as in patients without COVID-19. A computed tomogram of the chest organs with this coinfection visualizes the syndrome of dissemination, the syndrome of adenopathy and the syndrome of pathology of the pulmonary pattern, represented by the compaction of interstitial tissue in the frosted glass type, which is associated with the simultaneous layering of various pathologies, which complicates their differential diagnosis. This determines the similarity of clinical and radiological manifestations of COVID-19 coinfection, respiratory tuberculosis and opportunistic lung infections in patients with late-stage HIV-infection with immunodeficiency, as in patients without COVID-19. This requires complex microbiological and molecular genetic research methods to identify specific pathogens for the appointment of timely treatment. Conclusion. Patients with COVID-19 coinfection, respiratory tuberculosis and opportunistic lung infections in the late stages of HIV-infection with immunodeficiency pose a high risk of infection in a healthy population, taking into account their social maladaptation and non-adherence to examination and treatment. This requires an active diagnosis of COVID-19 in all patients with respiratory tuberculosis and HIV-infection who are registered in the office of anti-tuberculosis care for HIV-infected in an anti-tuberculosis dispensary, for emergency isolation and treatment.

Цель исследования: изучить особенности клинико-рентгенологической диагностики при коморбидности у больных COVID-19, туберкулезом органов дыхания (ТОД), бактериальной пневмонии (БП), вызванной Streptococcus pneumoniae (S. pneumoniae), Haemophilus influenzae (H. influenzae) или Staphylococcus aureus (S. aureus) и ВИЧ-инфекцией на поздних стадиях с иммунодефицитом (ИД).

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.