The development of new coronavirus infectious disease (COVID-19) is associated with an increase in the pro-inflammatory and pro-thrombotic potential of microvascular endothelium. A specific feature of SARS-CoV-2 infection is the post-COVID syndrome that is characterised by long-term impairment of various organs and systems. The immune pathogenesis of post-COVID syndrome in patients with pulmonary tuberculosis requires special attention due to their baseline pro-inflammatory status. The objective of this study was to evaluate the effect of novel coronavirus infection on the risk of chronic systemic hyper-inflammation and low-grade systemic inflammation in patients with pulmonary tuberculosis. Two main groups consisted of patients with pulmonary tuberculosis who had survived COVID-19 (mild form) 3 months ago, or at earlier terms, including the subjects with post-COVID symptoms and those free of these symptoms. The comparison group included patients with pulmonary tuberculosis without a history of COVID-19. The control group was presented by healthy blood donors. Concentrations of IL-6, IL-10, tumor necrosis factor alpha (TNFá), D-dimers, troponin I, cortisol, and endothelin I (ET-I) were measured in patients’ plasma by immunoassay technique. On the basis of these markers, we calculated integral indices of systemic inflammatory response (SIR) – the levels of reactivity (RL), and chronic systemic hyper-inflammation (ChSI). Low-grade systemic inflammation (LGSI) was diagnosed in absence of ChSI, but in cases of simultaneous increase of D-dimer levels 250 ng/ml and ET-I levels 90 pg/ml in the patient. The most prevalent symptoms of post-COVID in patients with pulmonary tuberculosis were tachycardia, arthralgia, and chronic fatigue syndrome, which correspond to the population-wide data. By all empirical parameters, the groups of tuberculosis patients were comparable to each other (p 0.05) and significantly differed from control group. However, evaluation of integral indexes is more crucial for assessing the ‘systemic’ origin of the process. Thus, 23-50% of patients with pulmonary tuberculosis developed subcritical SIR (RL = 1-2), being a feature of ChSI in 7.1-13.6% of cases (both in COVID-19 reconvalescents and non-COVID-19 patients). Meanwhile, all patient groups did not show significant difference in the frequency of LGSI and endothelial dysfunction (p 0.05). However, there was a trend towards an increase of these scores in the following sequence: tuberculosis without COVID-19 – tuberculosis + COVID-19 – tuberculosis + COVID-19 + post-COVID syndrome. Most patients with pulmonary tuberculosis are not characterized by the development of chronic systemic hyperinflammation. LGSI is the most probable feature of general pathology in tuberculosis infection. Tuberculosis infection sufficiently contributes to the development of LGSI, since the frequency and severity of LGSI and its individual manifestations are independent on the new coronavirus infection and signs of post-COVID syndrome.

Aim: to assess the retina (including peripapillary retinal nerve fiber layer/RNFL and retinal vessel diameter) in patients with tuberculosis (TB) or HIV/TB coinfection in the lack of abnormalities detected by standard eye exam using optical coherence tomography (OCT). Patients and Methods: all patients were divided into three groups. Group 1 (n=19) included patients with HIV/TB coinfection. Group 2 (n=18) included patients with pulmonary and extrapulmonary TB. Group 3 (n=20) included healthy volunteers (controls). All patients underwent standard eye exam and OCT (iVue-100 v3.2, Optovue, USA) to measure peripapillary RNFL thickness, central macular thickness, and the firstorder retinal vessel diameter (eight vessels). Results: OCT demonstrated greater peripapillary RNFL thickness in the nasal sector (by 13.4–18.3%) and central macular thickness (by 4.0– 7.5%), narrowing of retinal arteries, and enlargement of veins (predominantly temporal). These patterns may illustrate retinal microcirculation in the setting of a pathological condition (HIV/TB, including highly active antiretroviral therapy [HAART]) and be a harbinger of further abnormalities of ocular structures and central nervous system. Conclusion: OCT identifies changes in vessel diameter, central macular thickness, and peripapillary RFNL thickness before visual disturbances in preclinical eye changes in patients with HIV/TB coinfection. Keywords: HIV, tuberculosis, optical coherence tomography, calipermetry, retina. For citation: Burylova E.A., Demin A.P., Skornyakov S.N., Sabadash E.V. Optical coherence tomography for examining retina in patients with HIV/TB coinfection. Russian Journal of Clinical Ophthalmology. 2022;22(1):23–29 (in Russ.). DOI: 10.32364/2311-7729-2022-22-1-23-29.

The objective of the study: detection of early preclinical manifestations of vision disorders in patients with TB/HIV co-infection using optical coherence tomography (OCT).Subjects and methods. A prospective open-label study was carried out enrolling patients with TB/HIV co-infection (Group 1, n = 19) and patients with pulmonary and extrapulmonary tuberculosis (Group 2, n = 18). In both groups, standard ophthalmological examination and OCT were performed with measurement of the thickness of the choroid and the diameter of upper and lower temporal and nasal arteries and veins, and assessment of arteriovenous coefficient (AVC).Results. In the patients of both groups, the thickness of the choroid in the fovea area decreased in comparison with healthy volunteers (control group, n = 20), however, the decrease in choroid thickness was statistically significantly more pronounced in the patients of Group 1, and this group was also characterized by change in the caliber of retina arteries and veins, which is expressed in a higher AVC.Conclusion. OCT allows early preclinical diagnosis of eye disorders (in the absence of eye complaints) in patients with tuberculosis, including those with concurrent HIV infection. Detection of choroid disorders and AVC changes in such patients allows timely prescription of therapy and prevention of pathological changes from progression.

INTRODUCTION:The current epidemic situation in Russia is characterized by increasing rate of co-infection (HIV/tuberculosis). Damage to the organ of vision is more common among patients with this pathology, presenting significant difficulties in diagnosis of the ophthalmic manifestations. High-tech imaging method - optical coherence tomography (OCT) allows exploration of the eye tissues with high accuracy and depth, as well as evaluation of the structure of the choroid and microcirculation parameters of the anterior and posterior eye segments.

The current epidemic situation in Russia is characterized by increasing rate of co-infection (HIV/tuberculosis). Damage to the organ of vision is more common among patients with this pathology, presenting significant difficulties in diagnosis of the ophthalmic manifestations. High-tech imaging method - optical coherence tomography (OCT) allows exploration of the eye tissues with high accuracy and depth, as well as evaluation of the structure of the choroid and microcirculation parameters of the anterior and posterior eye segments.Введение. Современная эпидемическая ситуация в России характеризуется ростом коинфекции ВИЧ/туберкулез. У пациентов с этой патологией поражение органа зрения встречается чаще и представляет значительную трудность в диагностике офтальмологических проявлений. Высокотехнологичный метод визуализации - оптическая когерентная томография (ОКТ) позволяет исследовать ткани глаза с высокой точностью и глубиной, оценить структуру хориоидеи, параметры микроциркуляции переднего и заднего отрезков глаз. Цель исследования - изучение возможности ранней диагностики поражений органа зрения у пациентов с туберкулезом и коинфекцией ВИЧ/туберкулез с помощью ОКТ. Материал и методы. Проведено проспективное открытое исследование. Исследованы две клинические и контрольная группы. В 1-ю группу вошли пациенты с коинфекцией ВИЧ (IV-я стадия) и туберкулез, n=19, во 2-ю - пациенты с туберкулезом легочной и внелегочной локализации, n=18. Контрольную группу составили здоровые добровольцы, n=20. Во всех группах проводили стандартное офтальмологическое обследование и ОКТ (ivue-100, версия 3.1, карта Nerve Fiber 3D Disc, режим En Face) с измерением толщины хориоидеи (карта Retina Map) в 7 точках и диаметра 8 сосудов сетчатки: верхних и нижних темпоральных и назальных артерий и вен на расстоянии 0,5-0,75 диаметра диска от края диска зрительного нерва и определение артериовенозного коэффициента (АВК). Результаты. При ОКТ у пациентов с туберкулезом и коинфекцией ВИЧ/туберкулез отмечены уменьшение толщины хориоидеи в области фовеа по сравнению с аналогичным показателем у здоровых добровольцев контрольной группы (на 4,07 и 21,8% соответственно), а также изменение калибра артерий и вен сетчатки с нарастанием артериовенозного коэффициента. Вариабельность показателей назальных и темпоральных сосудов характерна для пациентов с коинфекцией ВИЧ/туберкулез. Заключение. ОКТ определяет изменение калибра сосудов и уменьшение толщины сосудистой оболочки, являющихся предвестниками развития патологии, и позволяет обнаружить у пациента коинфекцию ВИЧ/туберкулез.

On the model of experimental tuberculosis of guinea pigs to study the effect of amino acid arginine on the course of the tuberculosis process. Experiments were carried out on 75 guinea pigs and 25 rats (weighing 200-250 g). To reproduce experimental tuberculosis, a museum strain of mycobacteria was used at the Central Research Institute of Tuberculosis H37Rv, 1993. Groups of animals: 3 groups of guinea pigs of 25 pcs. (Healthy control, infected with ILW and infected with ILT, receiving arginine daily 10 mg / kg body weight of the animal for a month) and 2 groups of rats of 25 pieces (healthy control, infected with ILW and infected with MBT). Determined in the blood nitrites and nitrates, total lipid peroxides by ELISA Biomedica GRUPPE and R & D Systems. Results. In animals lacking resistance to tuberculosis infection, increased plasma levels of nitric oxide derivatives caused by the use of arginine is an unfavorable factor contributing to the progression of tuberculosis.

Different sensitivity of guinea pigs and rats to Mycobacterium tuberculosis and membranotropic mutagenic xenobiotics is associated with differences in the metabolism of amino acid precursors of phospholipids. In turn, specific features of phospholipid metabolism are determined by differences in the level of sulfur-containing regulatory metabolites (methionine, taurine, and glutathione) in tissues. Taurine and methionine increase organism's resistance to Mycobacterium tuberculosis (typical of rats), glutathione and its constituent amino acids improve resistance to the mutagenic effects of xenobiotics (typical of guinea pigs). These metabolites can be used for strengthening of natural resistance to tuberculosis and mutagenic and carcinogenic xenobiotics.

The purpose:The aim of the study was to determine changes in the level of reactive oxygen species (ROS) and high-nitrogen compounds (HNC) of white blood cells of patients with various forms of pulmonary tuberculosis, and attempt to identify the pathogenic importance marked disturbances in protection mechanisms and damaged by the disease.Methods:A prospective study of 92 people, who were divided into 4 groups: I - 25 patients with newly diagnosed infiltrative tuberculosis and localization process within the same lobe of the lung, II - 42 patients with newly diagnosed pulmonary tuberculosis with a limited process (tuberculoma), III - 15 patients with fibrosis - cavernosis pulmonary tuberculosis with disease duration of less than 2 years old and group IV - healthy people - 10.Results:It has been found that chronic TB infection suppresses the phagocytes activity of leukocytes in any form of study of its development. However, in more severe forms of tuberculosis with a predominance of exudative tissue reactions (infiltrative) levels of these metabolites in the white blood cells increases and they become damaging significance. With limited forms of pulmonary tuberculosis - tuberculoma - levels of these metabolites (especially ICA) in white blood cells is reduced, which may have a protective value.Conclusion:The obtained results allow to claim that in the diagnosis and assessment of the nature of the tuberculosis process may be used definition of functional and metabolic characteristics of blood leukocytes and plasma (phagocytosis, peroxide, total lipid, BURST TEST, AFC, ICA and their derivatives), as well as the number of amino acids, taurine and arginine in plasma and leukocytes.

The study included 90 patients with pulmonary tuberculosis who were divided into 3 groups, according to intensity and clinical form of the disease. Group 1 included 32 patients with infiltrative tuberculosis and two-segment pulmonary lesions; group 2, 31 patients with pulmonary tuberculoma, and group 3, 27 patients with fibrous/cavernous tuberculosis for less than two years after the process stabilization. Group 4 represented a control (comparison) group of 30 healthy volunteers. The analysis showed that amino acid balance of monocytes in pulmonary tuberculosis can be, in general, characterized as deficient for antioxidant resources. In case of tuberculous inflammation, the criteria of specific resistance comprise a necessary taurine pool to greater extent than glutathione oxidation in immunocompetent cells. The plasma/monocyte taurine ratios exhibit different values, depending on clinical form of pulmonary tuberculosis. Redistribution of plasma amino acids to the monocytes, or, vice versa, probable “washout” certain amino acids from the cells may be considered a factor that reflects severity of the infectious process.

According to modern representations the phagocyte is a key link in protection of an organism against tuberculosis mikobakteriya. Studying of possibilities of a flowing cytofluorimetry in an assessment of activity of blood phagocytes of cages at tuberculosis of lungs became the purpose of work. Surveyed 39 people: 14-with an infiltrative form of tuberculosis, 15 – from tuberkulomy, 10 almost healthy people. In work used the CoulterEpicsXL device, Phagotest reagents (Orpegen Pharma), BurstTestKit (Glycotope Biotechnology) and monoclonal antibodies for definition of subpopulations of lymphocytes. Statistical processing is carried out with Statisticа program use. It is established that the assessment activity of blood phagocytes is important criterion of determination of activity of tuberculosis of lungs at early stages of supervision and in the course of treatment, the flowing cytofluorimetry allows quickly, precisely and objectively to estimate activity of blood phagocytes, markers of early activation of a cage can reflect activity of pathological process and be used for forecasting of a course of tuberculosis of lungs.

Harmful environmental agents [polycyclic aromatic hydrocarbons (PAH)] have been ascertained to greatly stimulate the biosynthesis of arginine and urea and reduce the amount of sulfur-containing metabolites in the liver of experimental animals by increasing the level of sulfur sulfate. Against this background, contamination with Mycobacteria tuberculosis (MBT) inhibits the activity of arginine and drastically decreases its amount by elevating the concentration of sulfur-containing metabolites. The supplementary administration of sodium glutamate to animals receiving PAH and MBT potentiates a decrease in nitrogen-rich metabolites and increases the level of sulfur-containing metabolites guinea pigs, tuberculosis resistance being on the rise. Under the influence of a combined action of PAH and MBT, the mutagenic effect of the former lowered in rats.