The aim of the study. To evaluate the effectiveness of monitoring the preventive examination of risk groups to be screened for tuberculosis using medical information systems.

Materials and methods. A retrospective study was conducted on the effectiveness of occupational examinations from 2021 to 2024 among risk groups to be screened for tuberculosis. The forms of state statistical observation No. 30 and No. 33, as well as the functional features of the Moscow Region MIS (in particular, Medinfo and Barclay) have been studied.

Results. Over four years of observation, despite uneven population dynamics among risk groups, their structure remained unchanged. A trend toward an increase in the number of routine medical examinations overall and among medical risk groups, as well as the proportion of tuberculosis patients newly identified during routine medical examinations, was observed. Tuberculosis detection rates in risk groups ranged from 0.1–0.2 per 1,000 examinations for oncopathology and diabetes to 3.1 per 1,000 examinations for patients with HIV infection. The proportion of patients with destructive forms of pulmonary tuberculosis among individuals who had not been examined for two or more years reached 44%.

Conclusion. Medical information systems designed for the rapid collection and analysis of data have proven themselves to be a convenient and objective tool for preventive medical examinations of the population in real time.

The presence of HIV infection does not exclude the possibility of addition and/or development of other co-infections in this category of patients.

Objective. Analyze the frequency and structure of co-infections in HIV-infected patients living in the city and village.

Materials and methods. Retrospective analysis of 1386 outpatient cards showed the presence of tuberculosis, hepatitis B and C, syphilis and candidal stomatitis in HIV-infected patients.

Results. In the structure of infectious pathology in the study group, hepatitis B and C, tuberculosis, syphilis, candidal stomatitis were observed. In terms of frequency, the leading place, both in the urban and rural cohort, was occupied by hepatitis C in 53.3% of patients, then tuberculosis – 10.9%, syphilis – 2.5%, hepatitis B 3.1%, candidal stomatitis – 2.0%. Hepatitis C and tuberculosis were more often diagnosed in the city, syphilis – in the village (p < 0.05).

Conclusion. The frequency and structure of co-infections in patients with HIV infection varies depending on the place of residence, which determines the need for variability of screening programs for the timely detection of infectious diseases depending on the area of residence.

The spread of multidrug- and extensively drug-resistant tuberculosis (MDR- and XDR-TB) is stimulating the search for new drugs and chemotherapy regimens. Delamanid (Dlm) has been used in Russia since 2021; its efficacy and safety as part of chemotherapy regimens, advantages and limitations in Russian clinical practice have not been fully studied.

The aim was a comparative analysis of the efficacy and safety of DR-TB chemotherapy regimens with and without Dlm in real clinical practice.

Method. The observational study included 200 HIV-uninfected adult patients with pulmonary drug-resistant TB; 100 рatients of prospective cohort received Dlm-containing chemotherapy regimens (since 2021), and 100 patients of retrospective cohort – similar regimens without Dlm (in 2016–2020). The effectiveness of treatment was analyzed in those who completed the course («per protocol»), and among all who started treatment («intention-to-treat»).

Results. The effectiveness of treatment per protocol in patients completed the 24-week course was 94.1% vs. 87% (p > 0.05), in those who completed the main course of treatment – 91.0% vs. 80.5% in prospective and retrospective cohorts, respectively (p = 0.06). In the ITT analysis, a bacteriological response was noted in 93.2% vs. 87.7%; mortality was 3% and 5% in the group with and without Dlm, respectively (p > 0.05). In patients with a disease duration of up to 12 months, the time to sputum conversion was shorter for Dlm-containing regimens (median 4 wks vs 8 wks, p = 0.002). There were no differences in the frequency of significant adverse reactions (grades 3–4, 26% vs. 25%, respectively, p > 0.05); neurotoxic reaction (36% vs. 21%, p < 0.05), QT prolongation and gastrointestinal reactions were more frequent in the prospective cohort.

Conclusion. The inclusion of delamanid in modern chemotherapy regimens for MDR-TB helps to increase the effectiveness of treatment, especially in patients with disease duration up to a year; prevention and monitoring of neurotoxic reactions are necessary.

The aim. The study was to evaluate the effectiveness and safety of co-administration of antituberculosis and antiviral therapy (AVT) in patients with coinfection of chronic viral hepatitis C and pulmonary tuberculosis.

Materials and methods. The observational study included 52 patients with active tuberculosis (63.5% drug-resistant cases) and chronic viral hepatitis C; 11 of them received a course of antiviral therapy (pan-genotypic regimens), 8 patients – simultaneously with anti-tuberculosis treatment (ATT, regimens without rifampicin), another 3 – before the start of tuberculosis treatment.

Results. All 8 patients (100%) who received simultaneous AVT and ATT demonstrated a virological response; 7 days after the start of AVT, a complete normalization of transaminase levels was observed, which made it possible to prescribe an adequate ATT regimen and achieve successful treatment of tuberculosis. Two patients experienced mild adverse reactions, including transient eosinophilia, associated with the use of anti-tuberculosis drugs. After AVT, liver enzyme levels remained normal until completion of anti-tuberculosis treatment; in group without AVT (n = 41), the incidence of drug-induced liver injury was 61.0% (p < 0.001).

Conclusion. Co-administration of anti-tuberculosis and antiviral therapy in tuberculosis patients with chronic hepatitis C is safe and effective. Pangenotypic AVT regimens are optimal. It is better to start including anti-tuberculosis drugs from the second week of antiviral treatment.

The aim was to study the features of tuberculosis treatment in patients over 60 years of age.

Materials and methods. The results of a prospective study of 76 tuberculosis patients over the age of 60 newly diagnosed in 2018-2023 in the Yaroslavl and Kostroma regions were analyzed. The study covered the period from the diagnosis of tuberculosis to the completion of the main course of treatment.

Results. All patients required inpatient anti-tuberculosis chemotherapy. Standard doses of anti-tuberculosis drugs were used in only 40% of patients. In most cases, dose reductions and individualized regimens were required. Adverse reactions occurred in 60.5% of cases, requiring discontinuation of anti-tuberculosis medications or treatment interruption. Clinical cure was observed in 80.9% of cases attributed to the development of individualized antituberculosis chemotherapy regimens, the application of pathogenetic treatment, including therapeutic nutrition.

Undernutrition is one of the key risk factors for tuberculosis, complicating the course and treatment of the disease in almost every second patient, and significantly affecting the prognosis. The review examines current concepts of the classification, causes, and pathogenesis of undernutrition in tuberculosis patients, including the role of drug-induced nutritional deficiency. The main methods for identifying nutritional deficiencies and validated scales for assessing nutritional risk in tuberculosis patients are described. The article examines the basic principles and practical issues of implementing nutritional support as the main method for correcting undernutrition in patients with tuberculosis.

The analysis of regulations and literature sources on the procedure for the use of respiratory protection equipment for patients and staff of an antituberculous institution is presented, problematic issues and ways to solve them are identified in order to increase the effectiveness of respiratory protection and reduce the risks of nosocomial spread of tuberculosis. All patients of tuberculosis institutions, both inpatient and outpatient, regardless of the fact of bacterial release of Mycobacterium tuberculosis, are required to observe a mask regime during their stay in the institution. Employees of the above-mentioned institutions, including service personnel, should use respirator masks to protect their respiratory organs.

Granulomatous inflammation in tuberculosis is a risk factor for hypercalcemia. In hypercalcemia caused by tuberculosis, calcium levels return to normal after anti-tuberculosis therapy; however, high calcium levels are a risk factor for renal damage.

A clinical case of renal damage caused by hypercalciemia in a patient with generalized tuberculosis is presented. The examination revealed a diagnosis of tuberculous meningoencephalitis, miliary pulmonary tuberculosis, tuberculosis of the intrathoracic lymph nodes in the abscessing phase, tuberculosis of the peripheral (supraclavicular, subclavian, anterior cervical) lymph nodes in the infiltration and abscessing phase, and tuberculosis of the bone marrow. The blood calcium level upon admission was 3.86 mmol/l, serum creatinine was 255 μmol/l. During the course of anti-tuberculosis, infusion and symptomatic therapy, normalization of the calcium level and restoration of renal function, positive dynamics of the tuberculosis process were achieved.

Conclusion. Timely administration of infusion, symptomatic, anti-tuberculosis therapy allows normalizing calcium levels and restoring renal function in a patient with renal damage caused by capercalcemia in a patient with tuberculosis.

The article presents a complex clinical case of late diagnosis of multiple organ tuberculosis in a 59-year-old female patient with autoimmune hemolytic anemia (AIHA). It delineates a ten-month diagnostic investigation during which the initial symptoms were interpreted by the medical professionals as manifestations of underlying hematological disease, its associated complications, or inefficacy of the antibiotic therapy. The authors highlight low informative value of the immunological tests (ATP test) when utilized in the context of immunosuppression caused by both AIHA and systemic glucocorticoid therapy. An analysis was conducted to identify diagnostic errors and factors contributing to delayed diagnosis. The conclusion drawn from this analysis indicates the need for high phthisiatric vigilance in patients with immunosuppressive conditions and importance of active use of invasive methods of diagnosis verification.