Introduction. The priority of anti-tuberculosis work in the Saratov Region is the early detection of the disease and the prevention of new cases of pathology. The presence of medical and social risk factors for developing tuberculosis significantly increases the risk of developing local forms of tuberculosis, especially if patients have latent tuberculosis infection (LTBI).Aim. To assess the prevalence of LTBI in the adult population with an increased risk of developing tuberculosis in the adult population.Materials and methods. The design of the study is a retrospective non-comparative. The data of patients from high-risk groups for the development of the disease for the period of 2015–2019, examined using a skin test with a recombinant tuberculosis allergen (Diaskintest, Generium JSC, Russia) in the Saratov Region, were analyzed.Results. 153,120 people from medical outpatient risk groups and 3,099 people from social risk groups were examined. Among adults with medical risk factors for developing tuberculosis, the largest number of positive and doubtful results of Diaskintest were recorded in patients with chronic bronchopulmonary pathology – 15.88%; among the group of those surveyed with social risk factors for developing tuberculosis – in persons released from penitentiary institutions (25.88%).Conclusions. The decrease in incidence rates in the Saratov Region confirms the correctness of the chosen tactics regarding the use of the Diaskintest test to identify individuals with LTBI among the adult population and the implementation of measures to reduce the reservoir of tuberculosis infection. Given the effectiveness of the measures taken, it is advisable to work with risk groups for Diaskintest and further examination in a general medical network. To do this, it is necessary to make additions to the current Order of the Ministry of Health of the Russian Federation dated March 21, 2017 No. 124n “On approval of the procedure and terms for conducting preventive medical examinations of citizens in order to detect tuberculosis” regarding the use of recombinant tuberculosis allergen samples in the adult population.

Introduction. Extensive drug resistance (XDR) M. Tuberculosis (MBT) is considered the main factor that reduces the effectiveness of the treatment of TB patients around the world, including Russia. A significant role in improving the effectiveness of chemotherapy (CT) in people with resistant TB belongs to the introduction of new anti-TB drugs, the first of which was bedaquiline (LP-002281).Objective. To assess the profile of an XDR-TB patient receiving bedaquiline and the efficacy of chemotherapy regimens including bedaquiline in patients with XDR pulmonary tuberculosis.Materials and methods. The study is retrospective, non-comparative, descriptive. The data of 88 patients who received bedaquiline in the XDR-TB treatment regimen in anti-tuberculosis institutions of the Saratov region in 2017–2018.Results. Patients with chronic TB prevailed – 50/88 [56.8%, 95% CI 46.3–67.4], every fourth patient had a history of surgery. The cessation of bacterial excretion, confirmed by bacterioscopy, was achieved in 51/67 [76.1%, 95% CI 65.7–86.5] patients; by cultural method – in 47/67 [70,1%, 95% CI 59.0–81.3]. Negative sputum smear in a significant proportion of patients 43/51 [84.3%, 95% CI 52.4–75.9] was observed after 12 weeks of therapy, negative cultures in 36/47 [76.6%, 95% CI 41.6–65.9] – after 16 weeks.Discussion. Compared to individual patient analyzes – 43% success rate in the treatment of XDR-TB, in our cohort of XDR-TB patients treated with bedaquiline, the success rate was 53.4%, which is consistent with data from a large study describing the safety in 2017, tolerability and efficacy of bedaquiline and could be higher in the absence of “discontinuations from treatment”.Conclusion. The regimens of treatment of patients with XDR-tuberculosis with the inclusion of bedaquiline are effective in terms of the termination of bacterial excretion, confirmed by bacterioscopy and culture in patients with a complex course of a specific process with previous ineffective therapy.

The review analyzed 56 publications in order to investigate the possibility of using flavonoids as concomitant therapy in the long-term treatment of multidrug-resistant tuberculosis (MDR TB) and to determine the relevance of such studies. Publications were selected from main databases including RSCI, PubMed, and Google Scholar. The use of bioflavonoids in tuberculosis chemotherapy can enhance its effectiveness and prevent toxic effects of anti-tuberculosis drugs. The growing rate of MDR TB among new tuberculosis cases confirms the relevance in this study.

Introduction. TB incidence rate among children is a dynamic indicator used to describe the epidemic situation of tuberculosis. Monitoring and analysis of the epidemic situation helps improve the performance of the primary health care in the early detection of tuberculosis in children and adolescents, the formation of groups at high risk of exposure to tuberculosis and the implementation of preventive measures in these groups.Aim. To provide a detailed analysis of the current epidemiological situation of tuberculosis among children and adolescents in the Saratov region, assess the implementation of early detection of tuberculosis in the pediatric population over a five-year observation period (2019–2023) and in high-risk groups.Materials and methods. The statistical data on TB patients collected using Federal Statistical Observation Form No. 33 and the information presented in the annual reports from different areas of the region and Saratov city for the period from 2019 to 2023 were studied.Results. The incidence rates in population were 3.5 times lower in 2023 compared to 2001, the incidence rates among children and adolescents decreased as follows: 8.5 times in children and 2.6 times in adolescents. The comparative analysis of the effectiveness of skin tests in the early detection of active tuberculosis in children under 14 years showed the prevailing value of Diaskintest. The analysis of TB detection methods in adolescents proves the appropriateness of TB testing done twice over the course of a year, alternating between using Diaskintest and check-up X-ray at the age of 15, 16, 17 years. The results of Diaskintest in children with medical and biological (n = 14.840) factors, as well as social risk factors (n = 3.767) were assessed. The level of latent tuberculosis infection (LTBI) in each group was 1.4% and 3.3%, respectively, which is higher than that (0.6%) in the general population of the region.Conclusions. Monitoring TB incidence rates among children and adolescents in the Saratov region indicates sufficient performance of anti-tuberculosis program in the region. The data obtained confirm the rationale for using immunodiagnostics in adolescents as the key screening test for tuberculosis.

Pulmonary histiocytosis is a rare disease of the group of interstitial lung lesions of unknown etiology, associated with difficulties in diagnosis and treatment and an uncertain prognosis. We present a clinical case of a combination of tuberculosis and histiocytosis in a young woman. This clinical case demonstrates the difficulties in establishing a correct diagnosis due to the lack of pathognomonic clinical signs, the need for pathomorphological verification of the diagnosis, an unfavorable course of the disease, which, despite the abatement of the tuberculosis process, led to a steady progression of pulmonary histiocytosis with the development of severe respiratory failure, which led to a fatal outcome.

Introduction . Test with recombinant tuberculosis allergen (ATP) widely used to detect tuberculosis infection in children. However, the prognostic value of ATP test for assessing the effectiveness of preventive tuberculosis therapy remains controversial. Aim. To study the dynamics of the results of a skin test with a recombinant tuberculosis allergen (ATP) (Diaskintest®) in children from tuberculosis infection foci against the background of preventive chemotherapy. Materials and methods . A retrospective analysis of the medical records of 153 children (aged 1 to 17 years) registered at Saratov Regional Clinical Anti-Tuberculosis Dispensary in Group IVA, who had been in contact with tuberculosis patients excreting bacteria, was conducted. ATP skin test results were assessed at baseline and after a course of preventive therapy at follow-up points: 6 months and 1 year of observation. Results. A significant reduction in the incidence of hyperergic ATP test results after a course of preventive chemotherapy was demonstrated, from 8.5% to 1.9% (4.5-fold) at 6 months and to 2.6% (3.3-fold) at 1 year of observation. Among positive results, papule size decreased in 35% of children at 6 months and in 50% at 1 year. Test negativity was achieved in 10% of children at 6 months and 1 year of observation. Conclusions. The obtained results demonstrate the influence of preventive chemotherapy on changes in the sensitivity of ATP skin test and, therefore, the possibility of using the test to monitor latent tuberculosis infection in children and adolescents in tuberculosis foci. Children who did not convert from positive and hyperergic tests, and whose papule size did not change significantly, require further monitoring to prevent the development of active tuberculosis.