Diagnosis of mycobacteriosis and differential diagnosis of tuberculosis is an urgent problem, which solution will allow starting treatment correctly in time, especially among people with immunodeficiency, incl. HIV/AIDS. From 2007 to 2016, the incidence of HIV infection, tuberculosis and HIV-associated tuberculosis in the Republic of Mari El (RME) was analyzed. The increase in the incidence of HIV infection was revealed (2007: 8.9 per 100,000 population, in 2016: 19.6); there was a decrease in the incidence of tuberculosis in the RME from 76.6 per 100,000 people in 2007 to 48.4 per 100,000 people in 2016. The average annual incidence of tuberculosis is 5.1 times higher than the same indicator for HIV infection in the country. The study uses data from bacteriological studies, statistical and graphoanalytical methods. During the whole period of registration of HIV infection on the territory of the RME, 3 cases of mycobacteriosis, confirmed by laboratory methods, associated with HIV infection were detected, among them 1 case of mixed infection (HIV-associated tuberculosis process and mycobacteriosis). In the period of 2007-2016, there was an increase in reported cases of HIV-associated tuberculosis by 5.7 times (in 2007, tuberculosis was diagnosed in 3.2% of HIV-infected patients, in 2016 – in 18.1%).
Among opportunistic diseases in the Russian Federation (RF) registered among HIV-infected patients, more than 90% are infectious pathologies. More than 60% of cases in the structure of the latter, in turn, are tuberculosis, which causes the death of about 50% of patients with HIV infection. At the same time, among the HIV-infected, there is an increase in the number of diagnosed mycobacteriosis on the background of stage III and IV HIV infection. However, mycobacterial infection can accelerate the progression of AIDS by reducing the number of CD4+ lymphocytes [Corbett E. et al., 2003]. HIV-infected patients often suffer from mycobacteriosis caused by Mycobacterium avium and Mycobacterium intracellulare, which tend to form a complex called Mycobacterium avium complex (MAC). Non-tuberculosis mycobacteria (NTMB) are ubiquitous in the environment and are now considered as saprophytes and conditionally pathogenic bacteria capable of causing a disease clinically very similar to tuberculosis. Two ways of human infection of MAC-related NTMB have been proven: airborne (through the respiratory system) and through food and water (through the gastrointestinal tract). One of the objectives of this study is to determine the level of CD4+ lymphocytes among HIV-infected patients in the Republic of Mari El (RME), which promoted mycobacteriosis development, since the literature data determine the levels of this clinical and laboratory indicator, in which the incidence of mycobacteriosis among patients with HIV infection increases, as less than 100 cells/μL (N.V. Fomenkova, 2011) or less than 200 cells/μl (N.R. Mikhailova, 2015) [1, 2, 3, 4, 5, 6].
In Western countries, the problem of NTMB has been well studied, since mycobacteriosis is quite often diagnosed in HIV-infected patients at the stage of AIDS. The real picture of the prevalence of mycobacteriosis in the Russian Federation remains unknown. The problem of diagnosing the disease caused by NTMB remains unresolved due to incomplete bacteriological examination of HIV-infected patients for this pathogen because of the lack of standards for diagnosis and treatment of mycobacteriosis. Mycobacteriosis-causing NTMBs cannot be treated with anti-tuberculosis drugs despite their similar clinical and radiologic patterns with tuberculosis, which affects the results of treatment of this, often misdiagnosed, opportunistic disease [7, 8, 9,10, 11].
At the same time, there is a problem of correct interpretation of bacteriological studies on mycobacteriosis. Bacteriological laboratory tests of NTMB culture bear a probability that the received positive result can indicate both its relation to pathological process, and possible contamination of a sample from an environment or an asymptomatic colonization of organs and systems of the patient. This issue requires a comprehensive solution on the part of providing an anti-epidemic regime in bacteriological laboratories, including during microbiological monitoring of laboratory facilities . The only bacteriological laboratory in the RME involved in the laboratory diagnosis of mycobacteriosis is located on the basis of the Republican tuberculosis dispensary of the RME. The doctors in this bacteriological laboratory have been working in this direction since 1994, which allows correctly prescribing therapy to patients.
Over the past 10 years, the RME has established an increase in the incidence of HIV infection by 2.2 times (2007 – 8.9 per 100,000 of people, 2016 – 19.6), and a decrease in the incidence of tuberculosis (2007 – 76.6 per 100,000 of people, 2016 – 48.4). The average annual incidence of tuberculosis is 5.1 times higher than the same indicator for HIV infection in the republic. During the whole period of registration of HIV infection on the territory of the RME (since 1990), 3 cases of HIV-associated mycobacteriosis were detected, among them 1 case of mixed infection (HIV-associated tuberculosis process and mycobacteriosis). All patients were found to have M.avium. In 2007-2016, there was an increase in reported cases of HIV-associated tuberculosis by 5.7 times (in 2007, tuberculosis was diagnosed in 3.2% of HIV-infected patients, in 2016 – in 18.1%). The epidemiological situation with HIV-associated tuberculosis is characterized as tense and requires adjustment by chemoprophylaxis and work on involvement of HIV-infected patients in antiretroviral and anti-tuberculosis treatment. All 3 cases of atypical mycobacteriosis among HIV-infected people were characterized by different levels of CD4+ lymphocytes (1 cell/μl, 30 cells/μl, 399 cells/μl), at which mycobacteriosis was registered, which generally corresponds to literature data (N.V. Fomenkova, 2011; N.R. Mikhailova, 2015), except for the third value of this clinical and laboratory indicator (at CD4+ lymphocyte cell count of 399 cells/μl, a case of mixed infection of HIV-associated tuberculosis and atypical mycobacteriosis was established in one HIV-infected patient). In the RME, tuberculosis among HIV-infected patients was recorded at the level of CD4+ lymphocytes less than 350 cells/μl.
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