Aim. To determine the composition and properties of the gut microbiota in HIV-infected patients with pulmonary tuberculosis.Materials and Methods. We studied 92 faecal samples from patients with pulmonary tuberculosis (n = 46) and patients with combined pulmonary tuberculosis and HIV infection (n = 46), with the following examination of the appearance, cultural properties, and biochemical profile of the bacteria. The constancy of microbial taxa was determined using Dazho-Odum indicator. Microorganisms were classified as constant at C > 50%, as complementary at 25% < C < 50% and as occasional at C < 25%.Results. Gut microbiota of patients with multidrug-resistant tuberculosis was consistently represented by Bifidobacterium spp., Lactobacillus spp., Enterococcus spp., Escherichia spp., Staphylococcus spp., and Candida regardless of theirHIV status. Species composition and prevalence of virulence factors in Staphylococcus spp. and fungi isolated from patients with multidrug-resistant tuberculosis also did not depend on HIV status. Complementary microorganisms were represented exclusively by Clostridium spp., while random microbiota was represented by 6 genera (Enterobacter spp., Citrobacter spp., Salmonella spp., Klebsiella spp., Proteus spp., and Pseudomonas spp.) belonging to the Proteobacteria phylum.Conclusion. Similar composition of gut microbiota in HIV-positive and HIV-negative patients with multidrug-resistant tuberculosis indicates common mechanisms of intestinal dysbiosis and a uniform approach for its correction.

Fungi are opportunistic microorganisms that colonize all biotopes of the human body, including intestinal. In case of emerging adverse environmental factors (HIV infection, other immunodeficiencies, antibiotic therapy), these microbial representatives begin active reproduction, which might require prescribing antimycotics. Frequent use of the latter in clinical practice induces the development of drug resistance to antifungal drugs, which may impact on effectiveness of both the treatment of fungal infections and other diseases. The purpose of the study was to assess the pattern and spectrum of drug resistance of Candida genus in the intestinal biotope of patients with respiratory tuberculosis and identify risk factors for developing total fungal drug resistance to antimycotic drugs. Material and methods. There were enrolled 21 patients with respiratory tuberculosis. Pattern of the fungal species diversity for the Candida genus isolated from faeces was evaluated, and the spectrum of relevant drug resistance to antimycotic drugs was determined. Patients (n=21) were divided into 2 groups: with (n=10) and without (n=11) total resistance to antimycotics, after which the main risk factors for its development were identified. Results. Members of the Candida genus were isolated from all patients examined, wherein pure cell cultures were characterized by high level of antimycotics resistance. Resistance to three drugs was noted in 1 culture (4.8%), to four in 10 cultures (47.6%), also found in 10 cultures to the entire drug panel (47.6%). During statistical processing, the data were obtained on affecting formation of total resistance to antimycotics of concomitant pathology of the gastrointestinal tract, the presence of a clinically significant dyspeptic syndrome, a history of antimycotic therapy, HIV infection with severe immunodeficiency, and some decrease in the peripheral blood CD4+ lymphocyte count. Conclusions. Fungi of the Candida genus isolated from tuberculosis patients were characterized by high level of resistance to antimycotics. Total resistance was observed in 47.6% of patients. In addition, the major fungi colonizing the intestines of tuberculosis patients were found to be Candida albicans species. The risk factors for the development of total antifungal resistance included: chronic enterocolitis, dyspeptic syndrome, peripheral blood CD4+ lymphocyte count lower than 350 cells/l, and history of antimycotic therapy.

Psychological problems associated with interpersonal relationships are relevant for medical workers and determined by many factors. One of the powerful risk factors for increased anxiety in health workers is the COVID-19 pandemic. The purpose of the study was to evaluate anxiety among TB specialists in the Kuzbass region during the COVID-19 pandemic. Material and methods. The study included 203 TB specialists. The study used the Spielberg-Khanin techniques – a questionnaire to identify the scale of situational and personal anxiety to evaluate anxiety depending on gender, work experience, nature of relationships in the team, place of work and position. Statistical processing included calculation of the median and interquarter range for numerical variables. For categorical variables we used Pearson's Chi-square with odds ratio calculation and 95% confidence intervals. Results. High personal and situational anxiety was registered among 34.9% of TB specialists. A low level of personal anxiety was found in 23.1%, while reactive anxiety - in 14.2% of people. The level of anxiety did not differ between physicians and medical nurses. A high level of personal anxiety was recorded among female medical workers. A low level of reactive anxiety was observed in hospital workers. A steady trend towards decreased levels of situational anxiety among medical workers with less than 25 years of work experience was also identified. Conclusion. Almost half of the employees of the TB service show high anxiety. High anxiety is more typical for females with less than 25 years of work experience, predominantly working in outpatient healthcare settings

В статье определено влияние противотуберкулезной терапии, а также некоторых отдельных противотуберкулезных препаратов на формирование диспептического синдрома. Проведен анализ состояния микробиоценоза кишечника у 30 пациентов в процессе противотуберкулезной химиотерапии по IV режиму. Установлено, что в процессе противотуберкулезной химиотерапии у пациентов формировались нарушения со стороны микробиоценоза кишечника, характеризовавшиеся снижением титров его облигатных представителей и увеличением качественно-количественного состава транзиторных и условно-патогенных микроорганизмов. Значимое влияние на формирование диспептического синдрома оказывал прием парааминосалициловой кислоты, протионамида, пиразинамида.