Current trials are underway to design chemotherapy regimens that include bedaquiline to treat children with rifampicin and isoniazid resistant mycobacterium tuberculosis. This clinical observation is interesting from the viewpoint of experience of the potential effective and safe use of the new anti-tuberculosis drug bedaquiline (Sirturo) in children under 12 years of age, as the publications of clinical trials of the drug use in children is limited. The female patient was diagnosed with primary tuberculosis complex complicated by infusional pleurisy based on the epidemiological anamnesis (family contact with tuberculosis patients), immunodiagnostic tests – a positive ATR-test result (Diaskin-test), pathological changes in the lung tissue and intrathoracic lymph nodes found on the chest CT scans. The diagnosis was confirmed by detection of MBT in pleural effusion by PCR and liquid culture method (BACTEC MGIT-960), which are resistant to isoniazid and rifampicin (multidrug resistance, MDR). The girl was enrolled in a clinical trial and treated according to chemotherapy regimen IV including a new anti-tuberculosis drug, which she received for 6 months. There was a positive clinical and X-ray dynamics of the tuberculosis process with minimal residual changes throughout the entire course of chemotherapy followed by confirmed clinical cure of TB (after 24-month follow-up). Based on the example of this clinical observation, it can be concluded that bedaquiline is safe and showed good clinical efficacy in the chemotherapy regimen to treat MDR MBT in children under 12 years of age.

Introduction. The treatment of children with multidrug-resistant and extensively drug-resistant tuberculosis (MDR / XDR-TB) is a difficult task due to many factors: the duration of treatment, the lack of drugs with children’s dosages, age restrictions (according to the drug instructions).Purpose of the study. To assess the efficacy and safety of regimen with the inclusion of bedaquiline in children and adolescent with respiratory tuberculosis with drug-resistant tuberculosis.Materials and methods. The study is prospective, cohort, non-comparative from the period 2017–2019. We included 24 patients aged 5 to 17 years with MDR-TB (established or suspected) began regimen containing bedaquiline for 24 weeks. The duration of observation of patients included in the study was 24 months.Results. We can state a sufficient level of safety of using the latter for 24 weeks: adverse events presumably associated directly with the intake of bedaquiline were noted in only 1 patient out of 24 (4.2%; 95% CI 0.7-20.3). The efficacy of a regimen containing bedaquiline in combination with other anti-tuberculosis reserve drugs is beyond doubt: positive clinical and radiological dynamics and cessation of bacterial excretion by the end of the 24-week course of treatment were noted in all patients included in the study. In the course of 2-year follow-up, no exacerbation of the tuberculous process was observed in any case. All patients achieved clinical cure of tuberculosis.Conclusion. Regimen containing bedaquiline for children aged 5–17 years with multidrug-resistant tuberculosis is effective and safe.

Scientists around the Globe are making deliberate attempts to develop the new methods for predicting and diagnosing tuberculosis, but these measures are not enough to end its epidemic. The purpose of the study was to evaluate the excisional rings of the T-cell receptor (TREC) and K-deletion element of B-cells (KREC) in infants and preschool children at high risk of tuberculosis as a promising prognostic marker for tuberculosis infection activity. A cross-sectional study was conducted in Jan. - Sept. 2022. The observation group consisted of 87 children aged 1 to 7 [6 (5‒7)] y/o, of which 13 (14.9%) aged 1 to 3 y/o and 74 aged 4 to 7 y/o; 53 (60.9%) boys/34 (39.1%) girls. The three groups were formed: G1 (n=27) with an established diagnosis of tuberculosis (TB), G2 (n=34) with TB infection diagnosis made based on the results of tuberculin diagnosis and without signs of a local specific process, and [control] G3 (n=26) without signs of TB infection according to the results of specific skin tests and without signs of TB, i.e., conditionally healthy. All children, in addition to methods to confirm or exclude TB and methods of specific immunodiagnostics, have undergone a molecular genetic study: DNA extraction from a dry blood spot and quantitative determination of TREC and KREC by real-time PCR in values of TREC and KREC copies per 105 cells. In order to build the reference values of TREC and KREC quantitative indicators in dry blood spots, the results obtained in G3 were analyzed as well. Results: the reference values of TREC and KREC were established for children of early and preschool ages when extracting DNA from a dry blood spot. When assessing tuberculosis infection in children of early and preschool ages, statistically significant criteria were determined, such as: anti-tuberculosis therapy (F=42.001; p<0.001), positive or negative reaction to the recombinant tuberculosis allergen during an intradermal test (F=39.394; p<0.001), high blood TREC level (F=12.707; p<0.001), tuberculin reaction (F=10.625; p<0.001), and KREC level (F=3.182; p=0.039). Conclusion: high level of TREC can be considered as a marker for the activity or a personalized predictor for the risk of progression of TB infection in children of early and preschool ages with high risk of TB.

Introduction Osteoarthritis (OA) is a common polyetiological disease of the musculoskeletal system, leading to disability. The condition can prevent a person from work, affect mental health, increasing mortality and affecting health care resources around the world as a current and future disease burden. OA had been considered an aseptic disease in the past and now the microbiological factor is viewed as one of the significant etiological aspects of the condition.The objective was to summarize the literature data on the role of microorganisms in the etiology and pathogenesis of osteoarthritis, including concomitant HIV infection.Material and methods The original literature search (2010 to 2023) was conducted on key resources including Scientific Electronic Library (www.elibrary.ru) and the National Library of Medicine (www.pubmed.org). Literature searches included both Russian and English studies reporting the effect of microbiological factors on the development of arthropathy.Results and discussion New, more advanced microbiological diagnostic methods have been used. There has been evidence of a variety of microorganisms including pathogenic and opportunistic pathogens in the absence of clinical and radiological signs of arthritis. This changes ideas about the etiology and pathogenesis of degenerative processes in the articular cartilage and necessitates a revision of treatment protocols for some joint diseases. Multicenter comprehensive studies of the microbiome of joint formations, blood and intestines are needed.Conclusions The presence of pathogenic microflora in the joint structures is evident in a significant number of observations. There is evidence of a local infectious process in the local cellular elements of osteochondral tissue in patients with previously diagnosed aseptic osteoarthritis. Intestinal microbiomes and the urogenital tract are most common sources of infection. A local influence of the immunodeficiency virus on the development of osteonecrotic processes in joint formations can be suggested in HIV patients.

The objective: to determine the effectiveness and safety (tolerability) of non-injection chemotherapy regimens containing bedaquiline in pediatric patients with multiple drug resistant respiratory tuberculosis.Subjects and Methods. Effectiveness and safety of treatment regimens containing non-injection drugs and Bdq were studied in 45 children from Main Group (MG) aged from 5 to 17 years old inclusive who were ill with multiple drug resistant tuberculosis. Control Group (CG) included patients of the same age with MDR TB who were treated with chemotherapy regimens containing injectable drugs (a retrospective study).Results. After 24 weeks (the period during which patients took bedaquiline), clinical effectiveness of chemotherapy regimens was achieved in all patients. By the end of week 24 of treatment, significant positive radiographic changes were noted in 84.4% of patients in MG and in 75.7% in CG (OR 1.741; 95% CI 0.658–4.611), healing of cavities was achieved in 42 (93.3%) and 66 (94.3%) patients, respectively (OR 0.848, 95% CI 0.181-3.982). No tuberculous mycobacteria were not detected in 100% of cases in both groups by month 6 of chemotherapy. The number of adverse reactions (AR) per patient averaged 1.25 and 1.26 in MG and CG. ARs occurred in patients receiving aminoglycosides in 41.4%: in MG – in 33.3%; 4/70 (5.7%) children from CG receiving injectable drugs developed adverse reactions requiring replacement of anti-tuberculosis drugs. No irreversible ARs were observed in MG.