The review presents data on the frequency of detection of drug resistant (DR) tuberculosis mycobacteria (MTB) as well as on the change in DR patterns in Russia and abroad from the mid-50s of the 20th century till the present. Along with the well-known mechanisms for DR MTB development, it tells about new research describing mutations associated with drug resistance.

The purpose of the study was to assess the efficacy of glutamyl-cysteinyl-glycine disodium (Glu) as adjuvant therapy in patients with isoniazid resistant pulmonary tuberculosis. Methods. This was a randomized placebo-controlled blind study. The study involved 67 patients who was randomly assigned to the treatment with Glu and antituberculosis cchemotherapy (group 1; n = 23), or placebo (group 2; n = 10), or antituberculosis chemotherapy (group 3; n = 34). All patients were positive for M.tuberculosis (MBT). The treatment included a standard intensive chemotherapy in a hospital (DOTS strategy) during 5 months (2S 3–5HRZE/5RSE). Glu was administered intramuscularly in the dose of 60 mg once daily during 10 days followed by 60 mg once daily every other day during 20 days; the total course included 20 doses. Results. Single-drug resistant MBT was detected in 26.1%, 20.0%, and 8.8% of patients in groups 1, 2, and 3, respectively. Multiple drug resistance was detected in 73.9%, 77.8%, and 91.2%, respectively. Sputum conversion was achieved in 26.1%, 52.2%, and 21.7% of group 1 patients in one, two and three months of the treatment, respectively. Sputum conversion in group 2 was achieved over 3 months of the treatment only (n = 3 at 3 months, n = 4 at 4 months, and n = 2 at 5 months); two patients were still MBT-positive to the end of the treatment. In group 3, sputum conversion was achieved in 18 patients (53.0 %) at 3 months, in 6 patients (18%) at 4 months, and in 5 patients (14.7%) at 5 months; 5 patients remained MBT-positive to the end of the treatment. Median time to sputum conversion was 62, 114, and 100 days in groups 1, 2, and 3, respectively. Conclusion. The adjuvant treatment with Glu in patients with isoniazid-resistant pulmonary tuberculosis was associated with earlier sputum conversion. This strategy can shorten the duration of the intensive treatment.

The analysis of the features of diagnostics of peripheral lymph nodes tuberculosis in modern conditions is carried out. For this 28 case histories of patients suffering from tuberculosis of peripheral lymph nodes were studied and 85,7% of them had a combination of tuberculosis and infection caused by the human immunodeficiency virus. All patients were undergoing biopsies or surgery of lymph nodes, and the material was examined using microbiological molecular, genetic and histological methods. 85,7% of patients had relapses with different periods of time, on average, 34 years, and repeated periods of tuberculosis activation. At all patients the lymph nodes were enlarged, mainly cervical (71,4%) and axillary (67,9%), the sizes of nodes varied from 1 to 5 cm, on average, 2,21,6 cm. In 78,6% cases tuberculosis of peripheral lymph nodes was characterized by fluctuation of nodes and the discharge of 30 to 80 ml of odorless creamy pus. It was found that tuberculosis of peripheral lymph nodes is part of a widespread tuberculous lesions especially at patients with tuberculosis associated with an infection caused by the human immunodeficiency virus. Tuberculosis of peripheral lymph nodes develops simultaneously with a specific lesion of other groups of lymph nodes intrathoracic (75%), intra-abdominal (57,1%), which allows to generalized tuberculosis of the lymphatic system. Fibrobronchoscopy showed in 35,7% patients residual bronchial tuberculosis changes, at 14,3% an active fistulous form of bronchial tuberculosis. Microscopy of biopsy material was negative at 78,6% of cases, while cultural examination revealed Mycobacterium tuberculosis in 100% and molecular genetic studies deoxyribonucleic acid of Mycobacterium tuberculosis in 64,3% patients.