Molecular genetic tests GeneXpert MTB/RIF and Xpert MTB/RIF (Ultra) in the diagnosis of tuberculosis (review of literature).

In recent tuberculosis years is the main cause of morbidity and death among patients with HIV infection. Modern diagnostics of tuberculosis includes mass screening of the population: digital fluorography from the age of 15 and immunodiagnostics in children and adolescents. Detection of mycobacterium tuberculosis by microscopy occurs in forms of tuberculosis with the decay of lung tissue. Such patients represent a high epidemic risk. To improve the verification of diagnosis in the practice of a phthisiologist, molecular genetic methods for the search for mycobacteria are increasingly used, based on the identification of specific fragments of the DNA chain in the diagnostic material. The most widely used method is the polymerase chain reaction (PCR), which is based on directed DNA amplification. The latest innovation is fully automated systems using cartridge technology GeneXpert. The advantages of GeneXpert are high sensitivity, speed (result in 2 hours), real-time PCR detection, exclusion of sample contamination. The technique of cartridge technology is constantly being improved, various cartridges are used on its platform, which not only detect M. tuberculosis, but also determine the sensitivity to anti-tuberculosis drugs - rifampicin (MTB / RIF cartridge) or several anti-TB drugs (MTB / XDR). Cartridges have been developed that are able to detect Mycobacterium tuberculosis (MBT) at an even lower concentration in the test material - MTB / RIF (Ultra). GeneXpert technology can be used to diagnose extrapulmonary tuberculosis by examining various biological materials, which are more effective in detecting tuberculosis in children and adolescents, in HIV-positive individuals.

Comparative study of the serum hepcidin level of patients with pneumonia in COVID-19 and Pneumocystis pneumonia.

In the context of a pandemic caused by the SARS-CoV-2 virus, for a patient with respiratory symptoms and bilateral lung damage, COVID-19 becomes the first disease in the differential diagnostic search. Pneumonia in COVID-19 shares many characteristics with Pneumocystis pneumonia. One of the possible markers of the severe course of COVID-19 is hepcidin, a peptide hormone that negatively regulates iron metabolism. There are no data on the value of hepcidin in Pneumocystis pneumonia in the published scientific literature. The purpose of this study is to conduct a comparative analysis of hepcidin in the blood serum of patients with pneumonia in COVID-19 and Pneumocystis pneumonia to clarify their pathogenetic features. A case-control observational study was conducted, including 68 patients with pneumonia in COVID-19 and 44 patients with HIV infection and Pneumocystis pneumonia (PCP/HIV). Determination of hepcidin was carried out by ELISA using the ELISA Kit for Hepcidin. Statistical data processing was carried out using the MedCalc 19.2.6 software. Results. Comparative analysis of serum hepcidin levels in the study groups showed that hepcidin is statistically significantly higher in PCP/HIV than in COVID-19 - the median value is 22 times higher (p <0.0001). When examining the ROC curve for hepcidin, it was found that this biomarker has a high diagnostic potential and indicates a higher probability of COVID-19 than PCP/HIV at values ≤768.044 pg / ml. In the context of the COVID-19 pandemic, it is necessary to remember about other diseases that manifest themselves with a similar clinical and radiological picture. COVID-19 and PCP/HIV share many similarities; the peptide hormone hepcidin has shown itself as a potential differential diagnostic marker between them, and therefore the need for further studies of hepcidin is justified, taking into account the severity of the course of COVID-19, the presence of comorbidities and in a comparative aspect with pathologies that «mimic¼ under COVID-19.

Hematological indicators for lung damage caused by COVID-19 infection.

During the pandemic of a new coronavirus infection one of the most serious complications is pneumonia. When entering a specialized pulmonology Department, the presence of pneumonia is confirmed by computed tomography (CT), the etiology is confirmed by the detection of SARS-CoV-2 RNA by PCR, the article analyzes the indicators of blood analysis when patients are admitted to the hospital. All admitted patients were divided into 2 groups. Group 1 of the study - with a new coronavirus infection Covid-19, confirmed by the detection of PCR-RNA SARS-CoV-2 (n=27). Group 2 consisted of 65 patients (70.7%) with lung tissue damage characteristic of Covid-19 according to CT, who had a negative analysis of PCR-RNA SARS-CoV-2. Statistically significant deviations were shown in a decrease in the percentage and absolute content of lymphocytes, monocytes and platelets, and an increase in neutrophils. The comparative analysis in the groups with positive and negative PCR analysis for the detection of SARS-CoV-2 RNA showed no statistically significant differences. It can be assumed that with the similarity of clinical manifestations and CT-data, a negative result of PCR-RNA SARS-CoV-2 can be diagnosed as «lung damage caused by COVID-19 infection¼.

[Surgical treatment of pulmonary tuberculosis]. / Khirurgicheskoe lechenie bol'nykh tuberkulezom legkikh v XXI veke.

The main surgical approaches to the treatment of pulmonary tuberculosis were developed and introduced into surgical practice in the 60s of the last century. However, epidemiological changes and new medical technologies justify advisability of further improvement of surgical management of pulmonary tuberculosis. Computed tomography with 3D-nodeling and preoperative planning are valuable to analyze spread of pathological process and visualize pulmonary structures for improvement of surgical treatment.

[Iron metabolism and indicators reflecting its changes in pulmonary tuberculosis (literature review).]

Iron is an essential element for human and bacteria, including mycobacterium tuberculosis. Over review includesthe literature on the problem of iron metabolism in patients with tuberculosis and with comorbid pathology HIV infection and tuberculosis. The literature was searched for when writing this review using the RSCI, CyberLeninka, Scopus, Web of Science, MedLine, PubMed databases using the following keywords: iron, ferritin, hepsidin, lactoferrin, tuberculosis, pneumonia, HIV infection. Iron compounds are involved in many redox reactions: oxygen transport, cellular respiration, the trichloroacetic acid cycle, DNA biosynthesis, and others. The ratio of intracellular and extracellular iron in the body is regulated by the low molecular weight hormone hepcidin, the mechanism of action of which is to block the function of ferroportin, an exporter of iron from cells, which leads to the accumulation of the intracellular iron pool and the prevention of the toxic effect of free iron. The role of iron in the interaction of the human body with ferro-dependent bacteria has been established. Iron is necessary for the growth and development of bacterial cells, and the methods for its production from the host are different. Information on the effect of iron metabolism on pulmonary tuberculosis is scarce and contradictory: some authors have identified a decrease in hemoglobin and transferrin in combination with elevated levels of ferritin in patients with tuberculosis; according to other sources, hyperferritinemia in tuberculosis cannot be predictive, but is a marker inflammation. At the same time, there are studies that indicate a significant increase in ferritin in patients with disseminated tuberculosis relative to other clinical forms. Currently, the incidence of tuberculosis in patients with HIV infection is increasing, while diagnostic tests are not very informative. The search for diagnostic markers in terms of iron metabolism may open up new possibilities for the diagnosis of pulmonary tuberculosis.

[The clinical and epidemic characteristics of new-onset tuberculosis in relation to the procedure of detection].

The outpatient cards and case histories of 456 patients with tuberculosis detected in Samara in the period from January 1, 1999 to December 31, 2003 were examined. Tuberculosis was identified in 58.3% of the patients when they were asking for medical aid; among them 54.2% were treated at general hospital where caseous pneumonia, disseminated tuberculosis, and tuberculous pleurisy were more frequently diagnosed. The unemployed able-bodied persons amounted to 43% of the detected patients with tuberculosis, of whom 81% being identified on recourse to a doctor. Primary drug resistance does not depend on the procedure of tuberculosis detection. Early detection and the initiation of treatment will improve a clinical prognosis in patients with new-onset tuberculosis.

[The early period of primary "conversion" tuberculous infection in atopic diseases].

The early period of tuberculous infection was comparatively analyzed in 100 children with atopic diseases. The risk factors of tuberculosis, tuberculin sensitivity in mass and individual tuberculin diagnosis, and total IgE levels were studied. Less tuberculin sensitivity was revealed. In-effective vaccination was more frequently seen. Tuberculosis contamination leads to a reduction in serum total IgE levels.

Risk factors for mortality among adult patients with newly diagnosed tuberculosis in Samara, Russia.

SETTING: Five out-patient tuberculosis (TB) clinics and one in-patient TB hospital in Samara, Russia. OBJECTIVE: To identify predictors of all-cause mortality among patients with newly diagnosed TB. DESIGN: A retrospective case-control study of adult TB cases registered over a 5-year period from 1999 to 2003 using multivariate logistic regression modeling. Cases were defined as patients with TB who died within 12 months of diagnosis. Controls were patients with TB who survived at least 12 months. RESULTS: The case fatality rate was 3.6%. A total of 92 cases and 368 controls were identified. Mean age was 43 years; 71% were male; 4% were human immunodeficiency virus (HIV) seropositive. The median survival time for cases was 39.5 days. In multivariate analysis, independent predictors of mortality included bilateral lung involvement (OR 3.65), cavitary lesions on chest radiograph (CXR) (OR 2.45), symptoms >4 weeks at the time of diagnosis (OR 2.62), anemia (OR 5.24), and injection drug use (IDU) (OR 4.45), controlling for age. CONCLUSION: Advanced TB disease at the time of diagnosis (as demonstrated by having bilateral lung involvement, cavitary disease, symptoms >1 month, and anemia) and IDU were associated with increased TB mortality in Samara. Interventions targeted at improving earlier TB case diagnosis and treatment may help to reduce mortality among patients with tuberculosis in this region.

[Individual tuberculin diagnosis by the prick test].

The graded dermal tuberculin test, as described by N. N. Grinchar-Karpilovsky, which is carried out using 100%, 25%, 5%, and 1% tuberculin solution, is most commonly used for individual tuberculin diagnosis. The use of a prick lancet in a test (the prick test) makes the latter easier and standardized, ensures the equal depth of skin lesion, and requires the less surface of the skin. Assessment of the test (measurement of the diameter of a papule) becomes simpler and it is objective. The Grinchar-Karpilovsky prick test using a prick lancet significantly upgrades the quality of individual tuberculin diagnosis.

[Differential diagnosis of postvaccinal and infectious tuberculin allergy in children with atopic diseases].

The study was undertaken to improve the quality of detection of Mycobacterium tuberculosis in children with atopic diseases. A hundred and fifty-five children with atopic diseases were examined. The standard Mantoux test with 2TE and the graded skin tuberculin test were performed. Humoral and cellular immunological parameters were investigated. Children with monotonous and age-related increasing tests presented a problem in the diagnosis of infection. The factorial analysis revealed significant immunological parameters of infectious tuberculin allergy. The increase in the detected significant immunological parameters (total IgE, IgG, IL-2, CD4+, CD8+, and CB16+ cells) was ascertained to supplement the traditional methods for tuberculin diagnosis.

[Specific features of detection of caseous pneumonia and its course in Samara].

A hundred and sixty-three cases of caseous pneumonia were analyzed in Samara. Males aged 35 to 60 years were most frequently ill with the pneumonia; the unemployed and those who had not undergone CC-fluorography for more than 2 years were more frequently ill. The lesion was more commonly bilateral, involving 3 lobes or more with multiple lung tissue destruction. Primary drug resistance was identified in 30.8% of cases. The classical onset of caseous pneumonia with well-defined clinical picture was observed in 75.5% of cases. The average time of diagnosis establishment was I month. One-year death was 34.6%. Progression into chronic forms creates a reservoir of tuberculous infection.

[Immunological parameters in the diagnosis of silicotuberculosis]. / Pokazateli immuniteta v diagnostike silikotuberkuleza.

The study has defined criteria for the concomitant development of tuberculosis as secondary to silicosis. Factorial and discriminant analyses identified the most significant factors of immune homeostasis in silicotuberculosis. The major signs of possible development of tuberculosis in the presence of silicosis are the elevated levels of total IgE and IgG, fibronectin; the cells expressing CD4+ and CD20+ markers; and the decreased concentration of the mucinic antigen 3EG5. The findings were used to construct models of immunity in tuberculosis, silicosis, and silicotuberculosis. The use of a complex of immunological studies promoted the better early diagnosis of silicotuberculosis.

[Eye lesions in patients with pulmonary sarcoidosis]. / Porazhenie glaz u bol'nykh sarkoidozom legkikh.

Experience gained by ophthalmologists at Center for Sarcoidosis control is summarized. Sarcoidosis involvement of the eyes was revealed in 36% of patients with sarcoidosis of the respiratory organs. Uveitis and dry keratoconjunctivitis typical of sarcoidosis involvement of the eyes are described. A protocol of ophthalmologic examination of sarcoidosis patients to detect ocular diseases and monitor the treatment efficacy is offered. The knowledge of ocular symptoms in sarcoidosis patients by public health ophthalmologists will help diagnose the disease at the period when there are no apparent changes, the clinical signs are hardly discernible, and only the ophthalmological picture permits the physician suspect sarcoidosis and direct the patient to a tuberculosis center.