22. Lusiak M., Podwińska J. Interleukin 10 and its role in the regulation of the cell-mediated immune response in syphilis. Abstract. Clinical features of pregnancy in multidrug-resistant tuberculosis and type I diabetes mellitus comorbidities (a case report). Raznatovska O.M., Fedorec A.V., Shalmina M.O., Grekova T.A.Objective -to update the literature data with the clinical features of pregnancy in multidrug-resistant tuberculosis (MRD-TB) and type 1 diabetes mellitus (T1DM) comorbidities based on an example from own clinical experience. A clinical case of pregnancy course in MRD-TB and T1DM comorbidities was described based on our own clinical experience. We report the clinical case of newly diagnosed MRD-TB in a 38-year-old woman suffering from T1DM. Her general condition was unstable from satisfactory to moderately severe despite an adequate treatment of MRD-TB and T1DM with manifestations of intoxication syndrome and nephropathy. Adenomyosis with periodic bloody vaginal discharge was diagnosed. There was no clinical-radiological dynamics and sputum culture conversion. After an intensive phase of antimycobacterial therapy within 3 months, the patient got pregnant. Based on the medical indications (MRD-TB, absence of sputum culture conversion and clinical-radiological dynamics, moderate severity of T1DM, nephropathy) and adenomyosis with bloody vaginal discharge, the patient was requested to induce the pregnancy termination, and she consented. On month 7 of antimycobacterial therapy, an extensive drug-resistance of Mycobacterium tuberculosis

Aim. To analyze the effectiveness and safety of a modified short-term regimen (mSTR) of antimycobacterial therapy (AMBT) for rifampicin-resistant tuberculosis (RR-TB) in a 71-year-old patient with type 2 diabetes mellitus (T2DM) on the clinical case example of own observation. Materials and methods. A clinical case from own observation of the patient who was treated at the clinical base of the Department of Phthisiology and Pulmonology of Zaporizhzhia State Medical University – Pulmonary Tuberculosis Department No. 2 of the Communal Non-profit Organization “Zaporizhzhia Regional Phthisio-Pulmonology Clinical Treatment and Diagnostic Center” is presented. Results. The presented case demonstrates the high safety and efficacy of all oral mSTR, including Lfx-Bdq-Lzd-Cfz-Cs, in the elderly person with RR-TB and concomitant decompensated T2DM who was smear-negative after 4 months as a result of treatment with 9-month mSTR AMBT (Lfx, Bdq, Lzd, Cfz, Сs). Positive radiological dynamics were observed all the time and residual changes in the lungs after tuberculosis were diagnosed at the end of the treatment course. These results complement indications for the use of mSTR, including Lfx-Bdq-Lzd-Cfz-Cs, in RR-TB patients. Conclusions. mSTR AMBT (Lfx, Bdq, Lzd, Cfz, Сs) is effective and safe in elderly patients with RR-TB and concomitant decompensated type 2 diabetes mellitus when adequate treatment of diabetes and timely correction of antimycobacterial drug side effects are undertaken.

BACKGROUND. Tuberculosis (especially chemoresistant), coronavirus disease (COVID-19) and Churg-Strauss syndrome (CSS), both separately are serious illnesses, and in combination with each other (tuberculosis + COVID-19, COVID-19 + CSS). The analysis of the literature also indicates the difficulty of differential diagnosis between these diseases, as they have common clinical and radiological features. The outcome of treatment depends on timely and early diagnosis of each of these diseases with the prescription of corresponding therapy. We haven’t found in the available literature described cases of concomitant tuberculosis, COVID-19 and CSS, which may be interesting in terms of diagnostic vigilance of physicians of different specialties. OBJECTIVE. To demonstrate the features of the simultaneous course of tuberculosis and COVID-19 in a patient with CSS on the example of a clinical case of self-observation. RESULTS AND DISCUSSION. During the last 19 years of her life, the patient suffered from CSS. From the treatment she received only polcortolon, which was insufficient for such a serious disease. Whereas, according to the literature, for the treatment of eosinophilic granulomatous vasculitis not only glucocorticoids should be prescribed, but also immunosuppressants (cyclophosphamide for induction and azathioprine for maintenance therapy), mepolizumab and others. During these years, the patient developed lesions of the cardiovascular system (metabolic cardiomyopathy of ethanol and eosinophilic-granulomatous-vascular origin, myocardial fibrosis with arrhythmia, heart failure of 1st degree), gastrointestinal tract (chronic gastroduodenitis, peptic ulcer of the duodenum, gallstone disease, chronic calculous cholecystitis, chronic pancreatitis), urogenital system (chronic pyelonephritis), skin (autoimmune dermatitis, hemosiderosis), respiratory system (respiratory insufficiency of the 2nd degree, chronic allergic rhinosinusitis). COVID-19 and multidrug-resistant tuberculosis joined on the background of the depleted organism. COVID-19 treatment was effective. However, the treatment of multidrugresistant tuberculosis, which the patient received for 3 months, did not have a positive effect (negative radiological dynamics on the background of continued bacterial excretion). Renal dysfunction (creatinine >140 μmol/l) and peripheral eosinophilia also persisted during this period. According to the FFS lethal risk scale, the patient had two factors, which indicated a very severe flow of the disease and a high risk of death. Acute heart failure was the reason of death. CONCLUSIONS. CSS (eosinophilic granulomatous vasculitis) is a rare disease that requires timely, quality and proper treatment that will prevent the development of damage of various organs and body systems (especially cardiovascular and respiratory). The presented case demonstrates a very severe course of CSS with damage of many organs and body systems in the absence of proper treatment, which could lead to timely regression of vasculitis symptoms and improve the patient’s prognosis. On the background of this syndrome, COVID-19 and multidrug-resistant tuberculosis joined. However, death has occurred as a result of acute heart failure after 3 months, that was inevitable.

Aim. To analyze the course of multidrug-resistant tuberculosis (MDR-TB) in HIV-infected people, depending on the time to COVID-19 diagnosis, using the example of clinical cases from our own observation. Materials and methods. The article presents 3 clinical cases of our own observation of MDR-TB in HIV-infected persons depending on the time to COVID-19 diagnosis in patients, who were treated in the Pulmonary Tuberculosis Department No. 2, clinical base of the Department of Tuberculosis and Pulmonology ZSMU – Municipal non-profit enterprise “Zaporizhzhia Regional Phthisiopulmonology Clinical Medical and Diagnostic Center” of Zaporizhzhia Regional Council. Results. In clinical case 1, in an HIV-infected patient, MDR TB was detected after COVID-19. This clinical case has shown that after mild and treated COVID-19, even on the background of severe immunosuppression, but with AMBT and ART timely prescribed, MDR-TB in the patient had a favorable course with positive dynamics. In clinical case 2, in an HIV-infected patient, MDR-TB was detected concomitantly with COVID-19. The clinical case indicated that the patient received all 3 therapies for MDR-TB, HIV and COVID-19 in full and on time. In contrast to clinical case 1, the patient was diagnosed with a more severe process that required a longer period of treatment, although it was effective. In clinical case 3, an HIV-infected patient with COVID-19 was diagnosed after 5 months of MDR-TB treatment. Against this background, there was culture positivity. But after prescription of appropriate COVID-19 treatment against the background of AMBT and ART, positive dynamics and culture negativity were determined. All 3 patients completed antimycobacterial therapy of MDR-TB with results – recovery. Conclusions. Regardless of the HIV infection duration with underlying severe immunosuppression (<200 CD4 lymphocyte cells) and the time to COVID-19 diagnosis (before, during or after the diagnosis of MDR-TB) on the background of timely therapy of MDR-TB, HIV and COVID-19, positive results can be achieved while saving the lives of patients.

Background. According to World Health Organization (WHO), experimental studies performed in rats and rabbits have revealed no evidence of harmful side effects of bedaquiline to the fetus. WHO points out that, given the lack of adequate and controlled studies on the effects of bedaquiline on the fetus in pregnant women, and the fact that drug data regarding teratogenicity are limited to nonclinical animal data, this drug may be used when an effective treatment regimen cannot otherwise be provided. However, WHO recommends thorough registering treatment, pregnancy, and postpartum bedaquiline-related outcomes to provide data on appropriate dosing for multidrug-resistant tuberculosis (MDR-TB) treatment during pregnancy and postpartum. However, in the modern literature, there are no data about attributable to bedaquiline adverse events in MDR-TB/HIV co-infected pregnant women and their fetus as well as during the postpartum period. oBjective. To update the literature data with the clinical features of pregnancy and postpartum period in a MDR-TB/ HIV co-infected patient receiving a bedaquiline-containing regimen as antimycobacterial therapy in the third trimester based on an example from own clinical experience. Methods. We report the clinical case of pregnancy course in the MDR-TB/HIV co-infected woman treated with the bedaquiline-containing regimen as antimycobacterial therapy in the third trimester. results. In the clinical case presented, the patient demonstrated an initial poor adherence to treatment for both MDR-TB and HIV infection resulting in tuberculous process and HIV rapid progression. Since the patient refused the option of undergoing the therapeutic abortion prior to 22 gestational weeks as the pregnancy was intended, the antimycobacterial therapy regimen was modified by bedaquiline inclusion at 30 weeks' gestation (the third trimester) for the maternal and neonatal mortality prevention. However, there was no sputum smear conversion on the antimycobacterial therapy regimen including bedaquiline, the patient presented with the signs of endogenous intoxication and nephropathy. Relatedly, neonatal transabdominal ultrasound revealed intrauterine growth retardation, worsening fetoplacental insufficiency (reverse flow) and intrauterine dystrophy. There was abundant placental calcification. Taking into account breech presentation, II degree intrauterine growth retardation, III degree fetoplacental insufficiency (reverse flow), oligohydramnios, fetal distress syndrome and bilateral pyelectasis, the patient was transferred to the Perinatal Centre for planned caesarean section at the 32nd week of gestation. The premature female infant was declared dead some hours later. In the postpartum period, the patient continued the initiated bedaquilinebased antimycobacterial therapy and antiretroviral therapy. However, positive clinical-radiological dynamics and sputum smear conversion have not been achieved. conclusions. The clinical case presented confirms the literature data that the features of pregnancy and postpartum pe...