ОБНАРУЖЕНИЕ MYCOBACTERIUM TUBERCULOSIS В МОКРОТЕ У БОЛЬНЫХ КОИНФЕКЦИЕЙ ВИЧ/ТУБЕРКУЛЕЗ РАЗЛИЧНЫМИ МЕТОДАМИ (ОБЗОР ЛИТЕРАТУРЫ)

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.

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