jofinЖурнал инфектологииJournal Infectology2072-6732IPO “АIDSSPbR"10.22625/2072-6732-2018-10-2-30-38jofin-724Research ArticleОбзорыReviewОБНАРУЖЕНИЕ MYCOBACTERIUM TUBERCULOSIS В МОКРОТЕ У БОЛЬНЫХ КОИНФЕКЦИЕЙ ВИЧ/ТУБЕРКУЛЕЗ РАЗЛИЧНЫМИ МЕТОДАМИ (ОБЗОР ЛИТЕРАТУРЫ)Detection of Mycobacterium tuberculosis in sputum in patients coinfected with HIV / tuberculosis by various methods (literature review)ВиктороваИ. Б.ViktorovaI. B.

доцент кафедры фтизиопульмонологии Новокузнецкого государственногоинститута усовершенствования врачей – филиала Российской медицинской академии непрерывного профессионального образования, к.м.н.; тел./факс: 8(3843)45-42-19

Novokuznetsk, Russia

irinaviktoroff@mail.ruДегтяреваС. Ю.DegtyarevaS. Yu.

ассистент кафедры инфекционных болезней с курсами эпидемиологии и фтизиатрии медицинского института Российского университета дружбы народов; тел./факс: 8(495)365-25-33

Moscow, Russia

degtyareva_svet@mail.ruКулабуховаЕ. И.KulabukhovaE. I.

заведующая лабораторией кафедры инфекционных болезней с курсами эпидемиологии и фтизиатрии медицинского института Российского университета дружбы народов, аспирант Центрального научно-исследовательского института эпидемиологии; тел./факс: 8(495)788-00-02

Moscow, Russia

ekulabukhova@mail.ruБелобородоваЕ. Н.BeloborodovaE. N.

ассистент кафедры инфекционных болезней с курсами эпидемиологиии фтизиатрии медицинского института Российского университета дружбы народов; тел./факс: 8(495)365-25-33

Moscow, Russia

lenor.schmidt@gmail.comЗиминаВ. Н.ZiminaV. N.

профессор кафедры инфекционных болезней с курсами эпидемиологиии фтизиатрии медицинского института Российского университета дружбы народов, д.м.н.; тел./факс: 8(495)365-25-33

Moscow, Russia

vera-zim@yandex.ruНовокузнецкий государственный институт усовершенствования врачей – филиал Российской академии непрерывного профессионального образованияРоссияNovokuznetsk State Institute for Further Training of Physicians – Branch Campus of Russian Medical Academy of Continuous Professional EducationRussian FederationРоссийский университет дружбы народовРоссияRussian University of Friendship of PeoplesRussian FederationРоссийский университет дружбы народов Центральный научно-исследовательский институт эпидемиологииРоссияRussian University of Friendship of Peoples Сentral Science Research Institute of EpidemiologyRussian Federation2018270620181023038Copyright © Викторова И.Б., Дегтярева С.Ю., Кулабухова Е.И., Белобородова Е.Н., Зимина В.Н., 20182018Викторова И.Б., Дегтярева С.Ю., Кулабухова Е.И., Белобородова Е.Н., Зимина В.Н.Viktorova I.B., Degtyareva S.Y., Kulabukhova E.I., Beloborodova E.N., Zimina V.N.This work is licensed under a Creative Commons Attribution 4.0 License.https://journal.niidi.ru/jofin/article/view/724

В обзоре представлены данные об особенностях бактериовыделения при коинфекции ВИЧ/ туберкулез и частоте обнаружения кислотоустойчивых микроорганизмов при микроскопии  мазка в зависимости от уровня иммунного статуса пациента. Рассмотрены предикторы  положительного роста микобактерии туберкулеза из мокроты при отрицательной  микроскопии у данной категории пациентов. Приведен опыт разных стран мира  относительно эффективности различных диагностических алгоритмов выявления  туберкулеза при коинфекции ВИЧ/ТБ, обсуждается роль молекулярно-генетических методов  в диагностике туберкулеза. Согласно данным, представленным в обзоре, информативность метода микроскопии мазка мокроты значительно варьирует и зависит от  множества факторов, в том числе от иммунного статуса пациента с ВИЧ-инфекцией и уровня лаборатории, в которой проводится исследование. Различная информативность микроскопии мазка в совокупности с особенностями клинической и рентгенологической картины  туберкулеза у пациентов с ВИЧ-инфекцией приводит к задержке диагностики и  отсроченному началу противотуберкулезной терапии. Культуральные и молекулярно- генетические методы исследования мокроты повышают частоту обнаружения возбудителя,  однако диагностика туберкулеза с помощью посевов не может считаться быстрой у  пациентов с иммунодефицитом. Поэтому в условиях продолжающегося увеличения  количества пациентов с коинфекцией быстрые молекулярно-генетические методы  выявления ДНК МБТ должны быть включены в алгоритм обследования на туберкулез при  обращении в первичное звено медицинской помощи, оказываемой пациентам с ВИЧ- инфекцией.

The review presents the special aspects of bacillary excretion in  tuberculosis patients co-infected with HIV and the yield of acid-fast  smear depending on the CD4-cell count. Predictors of positive  growth of Mycobacterium tuberculosis from sputum under negative  microscopy in this category of patients are considered. The  experience of different countries of the world on the effectiveness of  various diagnostic algorithms for detecting tuberculosis in HIV/TB  co-infection and the role of molecular-genetic methods in the  diagnosis of tuberculosis are discussed. According to the data  presented in the review, the yield of acid-fast sputum smear  microscopy varies significantly, and depends on a variety of factors,  including the immune status of the patient with HIV infection, the  level of the laboratory service. The different yield of the smear  microscopy in combination with the subclinical course of tuberculosis  and atypical radiologic presentation in patients with HIV infection leads to a delay in diagnosis and to late initiation of  antituberculosis therapy. The culture and the molecular-genetic  methods of sputum examination increase the frequency of detection  of the pathogen, however, the diagnosis of tuberculosis by culture can not be considered rapid in patients with  immunodeficiency. Therefore, in the context of the continuing  increase in the number of patients with co-infection, rapid,  molecular-genetic methods for the detection of MTB DNA should be  included in the algorithm for screening for tuberculosis of HIV- infected patients during their first encounter with the healthcare system.

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The authors declare that there are no conflicts of interest present.