Background: Tuberculosis (TB), caused by Mycobacterium tuberculosis, remains a major global health challenge, with latent tuberculosis infection (LTBI) serving as a critical reservoir for future active disease. Approximately one-third of the world’s population is infected, yet most remain asymptomatic, creating diagnostic and preventive complexities. Aim: To review integrated laboratory diagnostics and public health strategies for LTBI detection, surveillance, and prevention, emphasizing risk stratification and safe treatment practices. Methods: This narrative review synthesizes current evidence on LTBI epidemiology, pathophysiology, diagnostic modalities—including tuberculin skin test (TST) and interferon-gamma release assays (IGRAs)—and management approaches. It draws on global guidelines and recent studies addressing diagnostic limitations, treatment efficacy, and toxicity mitigation. Results: LTBI diagnosis relies on immune-based tests interpreted within clinical and epidemiologic context, as neither TST nor IGRA distinguishes active disease. Chest radiography and sputum analysis remain essential to exclude active TB. Preventive regimens—isoniazid monotherapy (6–9 months), rifampicin monotherapy (3–4 months), or rifamycin–isoniazid combinations—reduce progression risk by 60–90%. However, hepatotoxicity and adherence challenges necessitate individualized risk–benefit assessment, baseline liver monitoring, and patient education. Emerging biomarkers and shorter regimens promise improved precision and completion rates. Conclusion: Effective LTBI control requires integrated diagnostics, targeted treatment, and interprofessional collaboration. Advances in biomarker research and patient-centered strategies are pivotal for optimizing prevention and minimizing harm.

BACKGROUND. In patients over 60 years of age, senile asthenia (SA), the main geriatric syndrome, may be the background for tuberculosis. The development of SA is accompanied by a decrease in physical and functional activity, adaptive and restorative reserves of the body, which makes the elderly vulnerable to infectious diseases, including tuberculosis. OBJECTIVE. To study the features of detection and diagnosis of respiratory tuberculosis in patients with senile asthenia over the age of 60 in 2018–2024. MATERIALS AND METHODS. A retrospective prospective cohort study wasconducted, which included 301 patients over 60 years of age with newly diagnosed respiratory tuberculosis in 2018–2024 in the Yaroslavl and Kostroma regions. The diagnosis of tuberculosis in all patients was carried out using clinical, laboratory, and instrumental examination methods generally accepted in phthisiology. All patients were screened for SA using the «Age is not a hindrance» questionnaire; asthenia was recorded with a score of 5 or more (Senile asthenia. Clinical guidelines, 2018, 2024). The patients were divided into two groups: 51 patients with SA in the first group, 250 patients without SA in the second group. RESULTS. The time frame for detecting tuberculosis from the moment of contacting the general medical network to the diagnosis was more than one month in 59.1 % of patients over 60 years of age. In most cases (44.8 %), tuberculosis was detected by internists in the general treatment network (GTN) when patients complained of intoxication and bronchopulmonary disorders that had been bothering them for more than 3 weeks. In the group of patients with SA, disseminated (52.3 %) and infiltrative (31.3 %) forms prevailed, and tuberculosis of the bronchi (8.3 %) and tuberculosis of the bronchi (8.3 %) also occurred. Classical radiological signs of pulmonary tuberculosis in patients over 60 years of age werefound in 90.8 % of cases. Patients with SA were more likely to have a negative Mantoux test result with 2 TE than among patients without SA (39.2 % and 64.0 %; p <0.01). The ELISPOT test (T-SPOT.TV) was positive in 100% of cases. CONCLUSIONS. In patients over 60 years of age with SA, there is a late diagnosis of tuberculosis. Tuberculosis is detected mainly by complaints of the development of widespread, disseminated processes against the background of reduced immune reactivity. It is advisable to include computed tomography of the chest organs, sputum analysis for Mycobacterium tuberculosis by molecular genetic methods, microscopy and culture, as well as immunological tests for tuberculosis using the ELISPOT method in the algorithms for diagnosing tuberculosis in patients over 60 years of age.

BackgroundBronchobiliary fistula (BBF) is a rare but fatal disease. Due to its rarity, only a limited number of cases have been reported, leading to a lack of consensus on appropriate treatment strategies.MethodsWe conducted a retrospective analysis of clinical data of 17 patients diagnosed with BBF between January 1, 2012, and May 30, 2025, focusing on the the presenting symptoms, diagnostic approaches, treatment modalities, and outcomes.ResultsAll 17 patients had cough and pathognomonic biliptysis. Sputum analysis confirmed bile components in all samples from 3 patients, and fiber bronchoscopy revealed yellow-green bilious sputum in 6 patients. Computed tomography (CT) or magnetic resonance imaging (MRI) demonstrated communication between the bile duct and the bronchial tree in 9 patients. Cholangiography showed contrast medium passing through a fistulous tract into the bronchi in 10 patients. Surgical intervention was performed in 6 patients, 3 of whom achieved long-term survival (> 24 months). Minimally invasive interventions provided effective symptomatic palliation in 10 of 11 patients. Among these 10 patients, 3 achieved long-term survival (> 24 months), with an additional 3 remaining alive and under ongoing follow-up (though not yet reaching the 24-month threshold). Of the 8 fatalities, 2 were directly attributed to uncontrolled BBF and its complications (sepsis or hepatic failure). The remaining deaths resulted from progressive malignancy (n = 3), postoperative complications (pneumothorax/respiratory failure, n = 1; hemorrhagic shock/disseminated intravascular coagulation, n = 1), and post-transplant septic shock (n = 1).ConclusionsBBF is associated with poor prognosis. Minimally invasive therapies offer effective palliation in malignant cases, whereas surgical intervention may provide curative potential in selected benign cases. Individualized, multidisciplinary management is essential for optimizing outcomes.

Assessing the reliability of upper airway sampling for microbiological surveillance in cystic fibrosis.

BackgroundPulmonary tuberculosis (PTB) diagnosis primarily relies on sputum examination, which can be challenging for patients unable to produce sputum. Minimally invasive oral sampling methods, such as tongue swabs (TS), have been proposed as alternatives. We assessed the effectiveness of TS for PTB diagnosis using molecular tests.MethodsIn a prospective study at two TB clinics, 99 confirmed smear-positive PTB patients provided 11 TS and one additional sputum sample (SS) for GeneXpert-Ultra (Ultra) testing at the National Reference Laboratory for Mycobacteriology. Testing was performed on a single TS (1TS), three pooled TS (3TS), and the additional SS. Additionally, we retrospectively analyzed TS from 120 participants with TB symptoms using an in-house IS6110-qPCR at the Institute of Tropical Medicine, alongside two SSs tested by fluorescence microscopy, GeneXpert-MTB/RIF (Xpert) and Ultra in Guinea.ResultsIn the prospective study, among 99 smear-positive patients, Ultra detected Mycobacterium tuberculosis (MTB) in 86.9% (1TS) and 91.9% (3TS), compared to 96.9% in SS. The highest positivity grade for sputum was “MTB detected high” (n = 31) with no “Trace” results, while for any TS the maximum grading was “Medium”. TS positivity grades were mostly “MTB Low”, and was not impacted by the sample swab number tested. In the retrospective study, positivity rates for sputum were 35% on microscopy, 44% on Xpert, 38.6% on Ultra, and 38.3% on in-house swab-IS6110-qPCR, with strong agreement between sputum-Xpert/Ultra and swab-IS6110-qPCR (k = 0.91 Xpert, k = 0.86 Ultra).ResultsTS demonstrated its ability to detect MTB on molecular tests, providing a minimally invasive complement for PTB diagnosis. Further studies in sputum scarce patients are needed.

Abstract Background Pneumocystis jirovecii pneumonia (PCP) is an opportunistic infection commonly affecting immunocompromised individuals. Invasive procedures are usually required to obtain lower respiratory specimens such as bronchial wash and bronchoalveolar lavage to diagnose PCP. However, this invasive procedure is sometimes not possible in severely ill patients especially patients who are thrombocytopenic. Hence, there is a need for a less invasive sample to diagnose PCP. The majority of previous studies on PCP diagnosis have been conducted mostly among HIV-infected patient population. This study compared the use of induced sputum and bronchial wash in diagnosing PCP in oncology patients. Methods Induced sputum and bronchial wash specimens were collected from patients presenting to a cancer hospital in New York between October 2019 and November 2021. DNA extraction from induced sputum and bronchial wash was done using the BioMerieux eMag Nucleic Acid Extraction System. The Roche Light-cycler 2.0 Real-Time PCR Thermal Cycler system was used to detect P. jirovecii DNA. Results In total, 324 PCP from 289 unique patients were tested in sputum (n = 324; 289 unique patients) and bronchial wash (n = 69; 66 unique patients). Of these, 30 (30/324, 9.3%; 29/289, 10% unique patients) and 9 (9/69, 13%; 8/66, 12% unique patients) PCP positives were detected in sputum and bronchial wash respectively. Further analyses of patient-matched sputum and bronchial wash specimens showed that the induced sputum sensitivity was 72.2%, specificity was 92.9%, positive predictive value was 66.7%, negative predictive value was 94.5% and the accuracy was 89.6%, for the diagnosis of PCP, compared with bronchial wash. Conclusion Detection of P. jirovecii in lower respiratory tract samples especially using minimally invasive collected samples like induced sputum is crucial to the timely diagnosis of PCP and monitoring of patients with chronic infections. Our results suggest that induced sputum is a useful minimally invasive sample for diagnosing PCP infection in our patient population and this has potential application in routine diagnostic laboratory. Comparing PCP diagnosis in lower respiratory samples using a larger patient population (>3500 tests from >2000 unique patients tested in 6 years) to further our understanding of the utility of induced sputum in PCP diagnosis is the current focus of our laboratory.

Abstract Introduction Anti-MDA-5 antibodies are associated with a distinct phenotype of amyopathic dermatomyositis (DM), often presenting with rapidly progressive interstitial lung disease, ulcerations, palmar papules, arthritis, and systemic features. It carries a poor prognosis and high mortality rate, even with aggressive therapy. Early recognition and a multidisciplinary approach are critical to improving outcomes. We present a complex case of MDA-5 positive amyopathic DM overlapping with rheumatoid arthritis and complicated by rapidly progressive interstitial lung disease (RP-ILD). Despite initial clinical deterioration, a prompt diagnosis, escalation of immunosuppression, and MDT management enabled discharge with preserved respiratory function and satisfactory quality of life—underscoring the role of early, aggressive intervention. Case description A 55-year-old woman with established rheumatoid arthritis (RA), treated with tocilizumab and sulfasalazine, presented with progressive breathlessness and diarrhoea. Her medical history included a high BMI, obstructive sleep apnoea and a persistent cough linked to smoking. Previous chest CT imaging had revealed bilateral ground-glass opacities. On admission, pneumonitis due to Pneumocystis jirovecii (PCP) was suspected; however, induced sputum analysis and extended microbiological testing were negative for infection. Despite broad-spectrum antimicrobials, her condition deteriorated with worsening type 2 respiratory failure and fluid overload, necessitating transfer to the intensive care unit (ICU) for ventilatory support. With no clear infectious cause identified, the focus shifted to autoimmune or inflammatory aetiologies. An extended myositis panel revealed positivity for anti-MDA5, anti-Mi2α, anti-Ku, anti-PL7, anti-PMSCL100, and anti-Ro52 antibodies. Her creatine kinase (CK) was normal, and she had no overt muscular weakness or rash, consistent with amyopathic MDA-5 positive DM. Meanwhile, her RA remained quiescent with no active synovitis. Given the high risk of RP-ILD associated with anti-MDA5 positivity, a multidisciplinary team including respiratory, rheumatology, and critical care specialists convened to consider immunosuppression. The complexity of the case and the risks of high-dose immunosuppression were discussed with the patient and her family, and treatment was initiated with three days of intravenous methylprednisolone. This was followed by a single cycle of rituximab (two infusions two weeks apart), three doses of cyclophosphamide administered at three-week intervals, and two rounds of intravenous immunoglobulin (IVIG), approved under exceptional circumstances. The patient gradually improved, weaning to 28% FiO2, and was successfully discharged home with a short-term oxygen requirement. She was planned for further outpatient cyclophosphamide therapy and close respiratory follow-up. Discussion This case points to diagnostic and therapeutic complexities in a patient with established RA who developed RP-ILD secondary to anti-MDA5 positive amyopathic DM. ILD is a recognised extra-articular manifestation of RA; however, when the progression is unusually rapid, alternative or overlapping autoimmune conditions must be considered. In this case, the patient’s background of RA, initially pointed clinical thinking towards infectious causes such as Pneumocystis jirovecii pneumonia, especially given immunosuppressive therapy with tocilizumab. The lack of classic dermatomyositis signs (e.g., rash, muscle weakness) further obscured the diagnosis. It was only when the patient deteriorated despite antimicrobial therapy and a broader autoimmune screen was pursued that the diagnosis of MDA-5 positive ADM was revealed. This overlap had several challenges. The quiescent nature of her RA led to an initial underestimation of the severity of her autoimmune lung involvement. Immunosuppressive decisions were complex, as she was already on disease-modifying treatment. The identification of multiple myositis-specific antibodies (including anti-MDA5, anti-PL7, and anti-Ro52) pointed toward a high-risk phenotype with poor prognosis if not treated aggressively and early. Management required rapid escalation to combination immunosuppression with high-dose corticosteroids, rituximab, cyclophosphamide, and IVIG, which would not be standard first-line approaches in RA-related ILD. The decision-making process emphasised the value of early multidisciplinary collaboration across rheumatology, respiratory, and critical care teams. This case highlights the importance of avoiding diagnostic anchoring in patients with known autoimmune diseases and maintaining a broad differential when clinical trajectories deviate from expected patterns. It also illustrates how overlapping connective tissue diseases can significantly alter disease course and therapeutic strategy. Key learning points • Patients with RA can develop overlapping connective tissue diseases, such as amyopathic dermatomyositis, which may be masked by existing symptoms or attributed to their primary diagnosis. • ILD in RA patients should not be assumed to be RA-related alone; the presence of atypical features or rapid progression should prompt investigation for other autoimmune causes, including myositis-specific antibodies like anti-MDA5. • Anti-MDA5 positivity is associated with rapidly progressive ILD, and coexisting RA may delay recognition, especially in the absence of classic dermatomyositis features (e.g. rash, muscle weakness). • Extended autoantibody panels are essential in RA patients with unexplained or worsening respiratory symptoms, particularly when CK is normal and infection has been excluded. • Multidisciplinary collaboration is critical when managing complex autoimmune overlap syndromes with severe organ involvement.

Pseudomonas aeruginosa is a hallmark pathogen of cystic fibrosis (CF) airway infections, capable of reaching high cell densities despite its limited ability to directly utilize mucin glycoproteins as a nutrient source. In the CF lung, however, P. aeruginosa may access preferred carbon sources (e.g., amino acids and short-chain fatty acids) through metabolic cross-feeding with co-colonizing mucin-degrading microbes. Although host-derived enzymes such as neutrophil elastase can also degrade mucins, the extent to which host-mediated mucin breakdown supports P. aeruginosa growth remains unclear. Thus, here we compared the nutritional impact of microbial versus host mucolytic activity on P. aeruginosa physiology. Analyses of CF sputum revealed patient-specific variability in mucin integrity that is shaped by both host and microbial factors. We demonstrate that mucin degradation by anaerobic bacteria through proteolysis, glycolysis, and fermentation, promotes robust P. aeruginosa growth, unlike mucin processed by neutrophil elastase alone. Targeted metabolomics identified acetate and propionate as key metabolites driving this cross-feeding, while transcriptomic and phenotypic analyses revealed that P. aeruginosa engages in diauxic growth on a broader set of mucin-derived substrates. Unexpectedly, cross-feeding with anaerobes triggered the induction of P. aeruginosa denitrification and fermentation pathways, suggesting redox remodeling despite being cultured under oxygen-replete conditions. Finally, the transcriptional profile of P. aeruginosa grown on anaerobe-conditioned mucins more closely resembled its in vivo gene expression, more so than when grown on intact or neutrophil-degraded mucins. Together, these findings provide new insight into the potential role of interspecies metabolic interactions in shaping pathogen physiology in the inflammatory, polymicrobial, and mucus-rich environment of the CF airways.

Background: Patients with pulmonary tuberculosis (TB) typically produce sputa, which are used to identify the pathogen. Sputum also contains host proteins that may aid in diagnosis. We hypothesized that sputa from TB patients will have unique proteomes when compared to other lung diseases. Methods: Sputa were collected from 219 patients with suspected TB. Neutrophil-derived protein calprotectin (CP), which was used as a marker for lung damage, was quantified and compared between TB and non-TB groups. Three sputa with high or low CP from each group were selected and analyzed using label-free proteomics. Results: There was no difference in CP amounts between TB and non-TB groups. However, TB samples had other differentially abundant neutrophil-associated proteins. Compared to low CP, samples with high CP had much smaller number of proteins that could differentiate between TB and non-TB groups. Only two proteins, MUC5AC and MMP8, were more abundant in TB samples, regardless of CP levels. Conclusions: Our findings suggest that TB sputa may have unique proteomes that depend on CP levels, which should be further validated due to the small sample size. Therefore, controlled and more advanced TB may need a different set of biomarkers to reliably distinguish TB from other lung diseases.

Background: Chronic Obstructive Pulmonary Disease (COPD) is a progressive, life-limiting respiratory condition and a leading cause of global morbidity and mortality. Despite advances in treatment, underdiagnosis and misdiagnosis remain prevalent, especially in primary care. As clinical symptoms often overlap with other respiratory and cardiac conditions, modern evidence-based diagnostic tools—including laboratory and instrumental methods—are essential for early detection, proper staging, and management of COPD. Methods and Materials: This study applied a comprehensive literature review method, analyzing data from global health guidelines (GOLD 2024, WHO), peer-reviewed journals, and clinical databases. Diagnostic tools investigated include sputum analysis, alpha-1 antitrypsin deficiency (AATD) testing, pulmonary function tests (PFTs) including spirometry and pulse oximetry, and radiographic imaging such as chest X-rays and computed tomography (CT). Emphasis was placed on evaluating diagnostic sensitivity, specificity, and real-world application in general practice. Results: Sputum analysis was shown to be highly sensitive and specific for identifying bacterial and viral pathogens during COPD exacerbations. AATD testing identified a genetic component of COPD critical for tailoring patient management. Spirometry emerged as the gold standard for airflow obstruction diagnosis, with FEV1/FVC ratios below 0.7 being confirmatory. Imaging via CT and X-ray provided valuable information for disease staging and differentiating COPD from comorbidities. Collectively, these modern diagnostic tools significantly enhanced the accuracy of COPD diagnosis and informed more precise treatment decisions. Conclusion: The integration of laboratory and instrumental diagnostics, guided by evidence-based medicine, is essential for timely and accurate diagnosis of COPD in general practice. Modern approaches such as sputum analysis, AATD screening, spirometry, and imaging significantly improve disease identification, reduce diagnostic errors, and support early intervention. These methods ultimately contribute to improved patient outcomes, reduced hospitalization, and better quality of life for COPD patients.

This article analyzes 63 scientific works dedicated to the diagnosis of peripheral lung lesions (PLL). The differential diagnosis of PLL poses challenges due to the diversity of underlying pathologies, which may include tuberculoma, cancer, and benign tumors. The absence of a unified diagnostic algorithm often necessitates surgical intervention. Non-invasive methods, including radiography, computed tomography (CT), positron emission tomography (PET), and sputum analysis, exhibit limited diagnostic yield, particularly for small lesions. The combination of fiberoptic bronchoscopy with endoscopic ultrasound (EUS) and transthoracic biopsy enhances diagnostic accuracy; however, they carry risks such as pneumothorax. Video-assisted thoracoscopic surgery (VATS) is an effective modality when biopsies are inconclusive, especially for lesions of less than 3 cm. It ensures high diagnostic accuracy and reduces hospitalization duration. Videoassisted thoracoscopic biopsy offers diagnostic accuracy comparable to that of open biopsy, while exhibiting reduced invasiveness. Conventional thoracotomy remains indicated for large or hard-to-reach lesions. It is recommended that a comprehensive approach combining CT, characterized by high informative value, and PET scan, characterized by high sensitivity and specificity for nodules >10 mm, with invasive methods be used. VATS proves effective for lesions below 3 cm, while thoracotomy is applied to large lesions. An individualized approach remains essential for optimal diagnosis. Despite the advancements, the challenge of differential diagnosis persists.

Secondary respiratory infections are frequent and serious complications in patients diagnosed with pulmonary tuberculosis (TB), often complicating clinical management and increasing morbidity and mortality rates. This study assessed the prevalence, demographic profile, and microbiological characteristics of secondary respiratory infections among newly diagnosed microbiologically positive pulmonary TB patients attending a tertiary care hospital. Identifying factors associated with secondary infections could provide insights for improving patient outcomes and guiding targeted interventions. A cross-sectional observational study was conducted at the Respiratory Medicine Outpatient Department of AVBRH JNMC from January 2023 to January 2024. One hundred ten newly diagnosed sputum-positive pulmonary TB patients were enrolled on the basis of the inclusion criteria. Patients with drug-resistant TB, extrapulmonary TB, those unable to expectorate sputum, and those unwilling to provide informed consent were excluded from the study. Demographic details, occupational history, addiction status, differential blood counts, and sputum analysis results (including sputum Gram staining and culture results) were recorded. The prevalence of secondary respiratory infections was determined, and associations with demographic and clinical parameters were statistically analyzed via chi-square tests. Of the 110 patients, 40 (36.4%) were diagnosed with secondary respiratory infections. The study revealed that most patients were male (70, 63.6%), with a significant number belonging to the 41–50-year age group (35, 31.8%). Manual labor was the most common occupation (45, 40.9%), and 50 (45.5%) patients reported a history of tobacco use. Among those with secondary infections, Streptococcus pneumoniae was the predominant pathogen identified in 15 (37.5%) patients, followed by Klebsiella pneumoniae (10, 25.0%) and Staphylococcus aureus (8, 20.0%). A significant association was observed between secondary infection and age group (p=0.033) as well as addiction history (p=0.017). Patients with secondary infections presented increased total leukocyte counts, neutrophil percentages, and erythrocyte sedimentation rates (ESRs) and decreased hemoglobin and lymphocyte percentages, indicating a heightened inflammatory response. This study revealed a considerable prevalence of secondary respiratory infections among newly diagnosed pulmonary TB patients, particularly those with certain demographic and clinical characteristics. Early recognition and management of these infections are crucial for reducing disease burden and improving patient prognosis. Further research is recommended to explore effective prevention and treatment strategies for secondary infections in this vulnerable population.

Patients with chronic obstructive pulmonary disease (COPD) often experience acute exacerbations characterized by elevated neutrophilic inflammation in the lungs. Currently, this condition is diagnosed through visual inspection of sputum color and volume, a method prone to personal bias and unsuitable for patients who are unable to expectorate spontaneously. In this manuscript, we present a novel approach for measuring and monitoring exhaled myeloperoxidase (MPO), a biomarker of neutrophilic airway inflammation, without the need for sputum analysis. The method involves analyzing an unmodified surgical facemask worn by the patient for 30 min using biosensing decals that transfer antibody-coated nanoparticles. These colloids specifically interact with MPO trapped by the facemask in a dose-dependent manner, enabling the quantification of MPO levels, with a dynamic range up to 3 · 101 µg·mL-1. The proposed diagnostic approach successfully differentiated patients with acute exacerbations from stable patients with 100% sensitivity and specificity. Healthy individuals also showed significantly lower MPO levels compared to COPD patients. Our results suggest that facemask analysis could be a non-invasive diagnostic tool for airway diseases, particularly in patients unable to expectorate.

This study intends to determine how microscopic sputum analysis could potentially aid in identifying environmental toxins associated with breathing issues in order to develop better management approaches for lowering pollution's impact on the lungs. This project used a mixed method technique, which included both quantitative and qualitative research. The study included 50 participants from various socioeconomic backgrounds. A structured questionnaire was created to collect data from participants. The sputum specimens were examined under a bright field microscope. Microscopic investigation of the material using Giemsa stain determined the presence of environmental pollutants in the sample. It is clear that microscopic analysis is an effective technique for investigating the intricate interactions between environmental contaminants and respiratory hazards. Furthermore, microscopy provides a cost-effective and efficient method of assessing respiratory health in people exposed to pollutants, allowing for early identification and intervention to prevent the development of significant respiratory disorders. Thus, this study seeks to establish how microscopic sputum analysis could potentially aid in pinning down environmental toxins linked with breathing difficulties so as to come up with better management approaches towards reducing pollution impacts on lungs.

Microplastics exposed by respiratory tract and exacerbation of community-acquired pneumonia: The potential influences of respiratory microbiota and inflammatory factors.

The co-infection of Pulmonary Tuberculosis (TB) and hydatid disease is rare. Diagnosis and treatment of this co-infection may be challenging as both diseases present with overlapping clinical manifestations, especially in war zones where the health system is destroyed. We are reporting a 45-year-old female police officer transferred to Sinnar Sudan due to ongoing conflict. She was admitted with chronic cough, shortness of breath, and weight loss. The preliminary diagnosis of pulmonary TB was made based on chest X-ray examination and sputum analysis. Further imaging showed cystic lesions in both the liver and the lungs, and thus a diagnosis of Echinococcosis was made. Surgical intervention was done successfully followed by the courses of Albendazole and anti-TB medication. The clinical condition of the patient improved, with the disappearance of all symptoms. This case represents the diagnostic dilemma of dual infections in the areas of their endemicity because of the symptomatology overlap that might occur and result in an erroneous diagnosis. It does demand an appropriate diagnostic approach, thus, with advanced imaging applications, and once more, emphasizes the interdisciplinary attitude in its treatment for the best possible result.

Systemic vasculitis is a large area of disease characterized by the induction of inflammation in the vessel wall due to various immune disorders. The formation of anti-neutrophil cytoplasmic antibodies which determine the development of the so-called anti-neutrophil cytoplasmic antibodies-associated vasculitis is of the variants of such disorders: microscopic polyangiitis, granulomatosis with polyangiitis (formerly known as Wegener’s granulomatosis) and eosinophilic granulomatosis with polyangiitis (formerly known as Churg-Strauss syndrome). These features determine the exceptional importance of understanding their pathologic behaviour, clinical picture, and treatment, which will be discussed in this article Objectives: The main goal of the article is to investigate the frequency of lung damage in patients with ANCA-SV, to assess their impact on the course, and to adequately select immunosuppressive therapy that allows for achieving disease remission. To identify the incidence of lung damage in patients with ANCA-SV. To track the dynamics of pulmonary function indicators and outcomes of ANCA-SV under the treatment. Material and methods: To do this, we conducted a retrospective analysis of the medical records of 50 patients with a clinical diagnosis of ANCA-SV who were treated in the Department of Internal Medicine No. 2 of the Research Institute of Cardiology and Internal Diseases in Almaty, the Republic of Kazakhstan, through 2015 to 2024. The diagnosis was verified based on a life history, physical examination, immunological study (detection of ANCA), as well as by assessing kidney function indicators (creatinine, urea, electrolytes, the presence of proteins, diuresis volume), assessing pulmonary function indicators (spirography, peakflowmetry), instrumental survey such as CT scan of the chest, MRI of the brain, sinuses. Results and discussion. 29 women and 21 men aged 25 to 75 (average 50 years) were identified among those suffering from ANCA-SV. Our goal was to investigate the incidence of lung damage in patients with ANCA-SV. To do this, we have conducted some survey methods. In most cases, changes in the lungs were confirmed by clinical data, decreased saturation, laboratory parameters (general sputum analysis, sputum culture for MTB and GeneXpert), and results of an immunological blood test: enzyme multiplied immunoassay (Immunoglobulin E), CT scan of the chest, сhest X-ray, spirography, blood gases test. Among 50 patients with ANCA-SV, changes in the lungs were detected in 28 patients. Changes in the lungs with ANCA-SV are different. Some patients experience more than two changes in the lungs. Conclusions: Lung damage in the form of infiltrates, cavities of destruction, diffuse alveolar damage, interstitial fibrosis, pleurisy and bronchial asthma, destructive processes, ventilation disorders, changes in the lungs in the form of granulomas, pulmonary hemorrhages are symptoms of ANCA-SV. Timely hospitalization and modern diagnostic methods make it possible not only to determine the causes of pulmonary complications in the shortest possible time but also to begin therapy as quickly as possible and obtain a positive clinical response to treatment. ANCA-associated vasculitis is a difficult condition to diagnose, which is characterized by a high rate of progression, and malignancy and leads to the death of the patient in a short time. However, advances in medicine and pharmacology with the discovery of genetically engineered biological therapy (Rituximab) have improved the prognosis for patients.

To evaluate markers of bacterial infection and features of antibiotic therapy in patients hospitalized with exacerbation of chronic obstructive pulmonary disease (COPD) once and again during the year. Analysis of 423 medical records of inpatients hospitalized in the therapeutic department of a city hospital with exacerbation of COPD over 4 years. 276 cases were hospitalized once during the year (control group), 147 - hospitalized repeatedly (main group). In the control group 36.9% of patients complained of cough with purulent sputum, while in the main group - 25.2% (p<0.05). 31.5% of patients in the control group and 17% of the main group reported fever during hospitalization (p<0.05). A high level of CRP during hospitalization was observed in 62.8% of patients in the control group and 49.1% in the main group (p<0.05); 47.1% of patients in the control group and 28.6% of patients in the main group had an increased level of leukocytes in sputum. According to the results of bacteriological analysis of sputum, there were no differences in the inoculation of infectious agents in the groups. At the same time, in almost 90% of cases, patients in both groups were prescribed antibiotic therapy, and in some cases, the same antibiotic for 2 and 3 hospitalizations in a row. Patients of the main group had extremely severe obstructive disorders twice as often. The degree of respiratory failure in patients with repeated exacerbations increased by 2 times from the first to the third hospitalization. Arterial hypertension and chronic heart failure of the 2nd stage were more common in the main group. The severity of obstructive disorders, the severity of the comorbidity, and the general condition of patients may have a more significant effect on the recurrence of severe exacerbations requiring repeated hospitalizations than bacterial infection. In this regard, in this group of patients, special attention should be paid to assessing the indications for prescribing antibiotic therapy, as well as optimizing its regimens.

Tuberculosis treatment outcomes and their related factors in patients with tuberculosis treated at the Antituberculosis Center of Brazzaville, Republic of Congo

Asthma is driven by complex interactions amongst structural airway cells, cells of the immune system, and the environmental. While sputum cell characterization has been instrumental in studying asthma pathogenesis and refining treatment strategies, the nuances of cellular transcriptomes and intercellular communication in asthmatic sputum remain poorly understood. We employed single-cell RNA sequencing to analyze cells isolated form the sputum from 16 asthma patients and 8 non-asthmatic controls. Cell identities were established using curated marker genes and SingleR annotation. We compared cell-specific gene expression and communication networks between asthmatic and control groups, correlating findings with distinct pathways that were dysregulated in asthma. 37,565 cellular transcriptomes were captured and analyzed. 15 distinct cell populations were identified, including various macrophages, monocytes, dendritic cells, and lymphocytes, along with rare cell types such as mast cells, innate lymphoid cells, bronchial epithelial cells, and eosinophils. Intercellular communication analysis indicated heightened signaling activity in asthma compared to controls, particularly in CD4+ T cells and dendritic cells which exhibited the most significant increases in RNA expression of outgoing signaling molecules. Notably, the ADAM12-SDC4 and CCL22-CCR4 ligand-receptor pathways demonstrated the strongest shifts between asthma and control subjects, particularly between dendritic cells and CD4 lymphocytes. SC RNA seq profiling the asthma cellular transcriptome analysis of sputum highlights both innate and adaptive immune mechanisms that are significantly amplified in asthma. The elevated expression of ADAM12-SCD4 and CCL22-CC4 point to their critical role in asthma pathogenesis, suggesting potential avenues for targeted therapies and improved management of this chronic condition. Evidence Before This Study: Asthma is a chronic inflammatory disease of the airways driven by intricate interactions between airway structural and immune cells. Previous transcriptomic studies have focused on bulk RNA samples from the airway, leaving significant gaps in our understanding of the cellular dynamics that characterize the disease.Added Value of This Study: This study pioneers the use of single-cell RNA sequencing on sputum samples from patients with asthma, revealing a detailed landscape of cell phenotypes and dynamic communication patterns that distinguish asthmatic individuals from those without the disease. Notably, heightened intercellular communication was observed in asthma, particularly between CD4+ T cells and dendritic cells, confirming that there is a robust network of interactions between immune and structural cells. The notable increase of ADAM12-CCR4 communication from dendritic cells to other cell populations further emphasizes the dysregulation present in asthma.Implications of All Available Evidence: Our transcriptomic profiling illuminates distinct and amplified communication pathways involving CD4+ T cells and dendritic cells, aligning with established paradigms of both adaptive and innate immune responses in asthma pathogenesis. The identification of ADAM12 and CCR4 pathway dysregulation adds a critical layer to our understanding of the molecular mechanisms underpinning asthma, paving the way for potential therapeutic targets and personalized treatment strategies. Single cell profiling of the sputum has the capacity to characterize the breadth of cellular phenotypes, their functional status, and the communication in the airway at a level not previously attainable.