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Динамика структуры туберкулеза почек за 20 лет
Динамика структуры туберкулеза почек за 20 лет
Кульчавеня Е.В., Холтобин Д.П. Динамика структуры туберкулеза почек за 20 лет. Терапевтический архив. 2022;94(11):1239–1245. DOI: 10.26442/00403660.2022.11.201930
© ООО «КОНСИЛИУМ МЕДИКУМ», 2022 г.
© ООО «КОНСИЛИУМ МЕДИКУМ», 2022 г.
________________________________________________
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Аннотация
Введение. Туберкулез является серьезной медицинской и социальной проблемой, не теряющей своей значимости, несмотря на все достижения фармакологии и хирургии. Диагностика урогенитального туберкулеза (УГТ), как правило, запаздывает в силу низкой настороженности в отношении туберкулеза, отсутствия патогномоничных симптомов.
Цель. Определение изменения соотношения клинических форм туберкулеза почек с 1999 по 2020 г.
Материалы и методы. Было проведено ретроспективное когортное сравнительное неинтервенционное исследование структуры заболеваемости внелегочным туберкулезом (ВЛТ). Среди 13 852 больных ВЛТ, выявленных с 1999 по 2020 г., выделены пациенты с туберкулезом почек, а также проанализирована структура их клинических форм в 3 периодах: 1-й период – 1999–2004 гг. (1155 пациентов), 2-й – 2005–2014 гг. (2657 больных) и 3-й – 2015–2020 гг. (671 больной). Также изучена клиническая картина нефротуберкулеза у 88 пациентов.
Результаты. За 20 лет анализируемого периода число больных УГТ уменьшилось на 80,6%; за год пандемии этот показатель сократился еще на 1/3. В 1-м периоде преобладали распространенные и осложненные формы нефротуберкулеза [922 (79,8%) пациента], в то время как так называемые малые формы диагностированы у 233 (20,2%) больных. Во 2-м периоде ситуация была статистически значимо более благоприятной: доля распространенных и осложненных форм туберкулеза почек уменьшилась до 43,8% (1124 пациента), «малые формы» диагностировали у 1443 (56,2%) больных. В 3-м периоде распространенные и осложненные формы нефротуберкулеза диагностированы у 531 (77,6%) пациента, а доля «малых форм» по сравнению с предыдущим периодом уменьшилась вдвое, до 22,4%. Анализ клинической картины туберкулеза почек в зависимости от распространенности процесса показал, что возможно бессимптомное течение и с разной частотой присутствуют боль, дизурия, интоксикация и почечная колика, причем клиническая картина туберкулеза паренхимы почек значительно отличается от клинической картины туберкулезного папиллита, кавернозного нефротуберкулеза и сводной симптоматики, присущей туберкулезу почек в целом.
Заключение. В настоящее время полностью отсутствует активное выявление УГТ. Выявление происходит в связи с обращаемостью, это больные с длительным анамнезом, после получения многократных курсов антибактериального лечения, преимущественно через патоморфологическое исследование операционного материала. Таким образом, резкое снижение доли больных УГТ отнюдь не означает исчезновение туберкулеза этой локализации, а лишь констатирует трагичные дефекты несвоевременной диагностики и низкую настороженность врачей общей лечебной сети в отношении УГТ.
Ключевые слова: туберкулез почек, нефротуберкулез, урогенитальный туберкулез, клиническая картина, мочеполовой туберкулез, диагностика
Aim. Determining the change in the ratio of clinical forms of renal tuberculosis from 1999 to 2020.
Materials and methods. A retrospective cohort comparative non-interventional study on the spectrum of the incidence of extrapulmonary tuberculosis (EPTB) was carried out. Among all 13852 extrapulmonary tuberculosis patients which were diagnosed from 1999 to 2020, patients with renal tuberculosis were selected, and the spectrum of their clinical forms in three periods was analyzed: 1st period 1999–2004 (1155 patients), second period 2005–2014 (2657 patients), and the third period 2015–2020 (671 patients). The clinical features of nephrotuberculosis in 88 patients was also estimated.
Results. Over the 20 years of the analyzed period, the number of patients with UGTB decreased by 80.6%; for the year of the COVID-19 pandemic, this figure fell by another third. In the first period, destructive complicated forms of nephrotuberculosis prevailed (922 patients – 79.8%), while the so-called "minor forms" were diagnosed in 233 patients (20.2%). In the second period, the situation was statistically significantly more favorable: the proportion of destructive and complicated forms of renal tuberculosis decreased to 43.8% (1124 patients), "small forms" were diagnosed in 1443 patients (56.2%). In the third period, destructive and complicated forms of nephrotuberculosis were diagnosed in 531 patients (77.6%), and the proportion of "small forms" in comparison with the previous period decreased by half, to 22.4%. Analysis of the clinical features of renal tuberculosis, depending on the prevalence of the destruction, showed that an asymptomatic course is possible, and pain, dysuria, intoxication and renal colic are present with different frequencies, and the clinical picture of tuberculosis of the renal parenchyma differs significantly from the clinical picture of tuberculous papillitis, cavernous nephrotuberculosis and symptoms of renal tuberculosis as whole.
Conclusion. Currently, there is no screening on urogenital tuberculosis at all. Patients are diagnosed by referral, with a long history, after receiving multiple courses of antibacterial treatment; mainly through the pathomorphological examination of the operating material. Thus, a sharp decrease in the proportion of UGTB patients does not mean the disappearance of tuberculosis of this localization, but only states the tragic defects in timely diagnosis and low index of suspicion of medical doctors in relation to UGTB.
Key words: renal tuberculosis, nephrotuberculosis, urogenital tuberculosis, clinical picture, genitourinary tuberculosis, diagnosis
Цель. Определение изменения соотношения клинических форм туберкулеза почек с 1999 по 2020 г.
Материалы и методы. Было проведено ретроспективное когортное сравнительное неинтервенционное исследование структуры заболеваемости внелегочным туберкулезом (ВЛТ). Среди 13 852 больных ВЛТ, выявленных с 1999 по 2020 г., выделены пациенты с туберкулезом почек, а также проанализирована структура их клинических форм в 3 периодах: 1-й период – 1999–2004 гг. (1155 пациентов), 2-й – 2005–2014 гг. (2657 больных) и 3-й – 2015–2020 гг. (671 больной). Также изучена клиническая картина нефротуберкулеза у 88 пациентов.
Результаты. За 20 лет анализируемого периода число больных УГТ уменьшилось на 80,6%; за год пандемии этот показатель сократился еще на 1/3. В 1-м периоде преобладали распространенные и осложненные формы нефротуберкулеза [922 (79,8%) пациента], в то время как так называемые малые формы диагностированы у 233 (20,2%) больных. Во 2-м периоде ситуация была статистически значимо более благоприятной: доля распространенных и осложненных форм туберкулеза почек уменьшилась до 43,8% (1124 пациента), «малые формы» диагностировали у 1443 (56,2%) больных. В 3-м периоде распространенные и осложненные формы нефротуберкулеза диагностированы у 531 (77,6%) пациента, а доля «малых форм» по сравнению с предыдущим периодом уменьшилась вдвое, до 22,4%. Анализ клинической картины туберкулеза почек в зависимости от распространенности процесса показал, что возможно бессимптомное течение и с разной частотой присутствуют боль, дизурия, интоксикация и почечная колика, причем клиническая картина туберкулеза паренхимы почек значительно отличается от клинической картины туберкулезного папиллита, кавернозного нефротуберкулеза и сводной симптоматики, присущей туберкулезу почек в целом.
Заключение. В настоящее время полностью отсутствует активное выявление УГТ. Выявление происходит в связи с обращаемостью, это больные с длительным анамнезом, после получения многократных курсов антибактериального лечения, преимущественно через патоморфологическое исследование операционного материала. Таким образом, резкое снижение доли больных УГТ отнюдь не означает исчезновение туберкулеза этой локализации, а лишь констатирует трагичные дефекты несвоевременной диагностики и низкую настороженность врачей общей лечебной сети в отношении УГТ.
Ключевые слова: туберкулез почек, нефротуберкулез, урогенитальный туберкулез, клиническая картина, мочеполовой туберкулез, диагностика
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Aim. Determining the change in the ratio of clinical forms of renal tuberculosis from 1999 to 2020.
Materials and methods. A retrospective cohort comparative non-interventional study on the spectrum of the incidence of extrapulmonary tuberculosis (EPTB) was carried out. Among all 13852 extrapulmonary tuberculosis patients which were diagnosed from 1999 to 2020, patients with renal tuberculosis were selected, and the spectrum of their clinical forms in three periods was analyzed: 1st period 1999–2004 (1155 patients), second period 2005–2014 (2657 patients), and the third period 2015–2020 (671 patients). The clinical features of nephrotuberculosis in 88 patients was also estimated.
Results. Over the 20 years of the analyzed period, the number of patients with UGTB decreased by 80.6%; for the year of the COVID-19 pandemic, this figure fell by another third. In the first period, destructive complicated forms of nephrotuberculosis prevailed (922 patients – 79.8%), while the so-called "minor forms" were diagnosed in 233 patients (20.2%). In the second period, the situation was statistically significantly more favorable: the proportion of destructive and complicated forms of renal tuberculosis decreased to 43.8% (1124 patients), "small forms" were diagnosed in 1443 patients (56.2%). In the third period, destructive and complicated forms of nephrotuberculosis were diagnosed in 531 patients (77.6%), and the proportion of "small forms" in comparison with the previous period decreased by half, to 22.4%. Analysis of the clinical features of renal tuberculosis, depending on the prevalence of the destruction, showed that an asymptomatic course is possible, and pain, dysuria, intoxication and renal colic are present with different frequencies, and the clinical picture of tuberculosis of the renal parenchyma differs significantly from the clinical picture of tuberculous papillitis, cavernous nephrotuberculosis and symptoms of renal tuberculosis as whole.
Conclusion. Currently, there is no screening on urogenital tuberculosis at all. Patients are diagnosed by referral, with a long history, after receiving multiple courses of antibacterial treatment; mainly through the pathomorphological examination of the operating material. Thus, a sharp decrease in the proportion of UGTB patients does not mean the disappearance of tuberculosis of this localization, but only states the tragic defects in timely diagnosis and low index of suspicion of medical doctors in relation to UGTB.
Key words: renal tuberculosis, nephrotuberculosis, urogenital tuberculosis, clinical picture, genitourinary tuberculosis, diagnosis
Полный текст
Список литературы
1. World Health Organization. Global Tuberculosis Report. Executive Summary; 2019. Available at: https://www.who.int/tb/publications/global_report/GraphicExecutiveSummary.pdf?ua=1. Accessed: 18.11.2022.
2. World Health Organization. TB disease burden. In: Global tuberculosis report 2018. Geneva: World Health Organization, 2018.
3. Sy KTL, Haw NJL, Uy J. Previous and active tuberculosis increases risk of death and prolongs recovery in patients with COVID-19. Infect Dis (Lond). 2020;52(12):902-7. DOI:10.1080/23744235.2020.1806353
4. Осадчий А.В., Кульчавеня Е.В., Рейхруд Т.А., и др. Социально-демографическая характеристика больных туберкулезом легких и внелегочных локализаций. Туберкулез и болезни легких. 2015;2:46-8 [Osadchiy AV, Kulchavenya EV, Reykhrud TA, et al. Socio-demographic characteristics of patients with pulmonary tuberculosis and extrapulmonary localizations. Tuberculosis and Lung Diseases. 2015;2:46-8 (in Russian)]. DOI:10.21292/2075-1230-2015-0-2-46-49
5. Щербань М.Н., Кульчавеня Е.В., Брижатюк Е.В. Диагностика, предупреждение и лечение нарушений репродуктивной функции у мужчин, больных туберкулезом легких. Туберкулез и болезни легких. 2010;87(10):31-6 [Shcherban MN, Kulchavenya EV, Brizhatyuk EV. Diagnostics, prevention and treatment of reproductive disorders in men with pulmonary tuberculosis. Tuberculosis and Lung Diseases. 2010;87(10):31-6 (in Russian)].
6. Benbella A, Aboulmakarim S, Hardizi H, et al. Infertility in the Moroccan population: major risk factors encountered in the reproductive health centre in Rabat. Pan Afr Med J. 2018;30:195. DOI:10.11604/pamj.2018.30.195.13849
7. Кульчавеня Е.В., Жукова И.И. Внелегочный туберкулез – вопросов больше, чем ответов. Туберкулез и болезни легких. 2017;95(2):59-63 [Kulchavenya EV, Zhukova II. Extrapulmonary tuberculosis – there are more questions than answers. Tuberculosis and Lung Diseases. 2017;95(2):59-63 (in Russian)]. DOI:10.21292/2075-1230-2017-95-2-59-63
8. Arnedo-Pena A, Romeu-Garcia MA, Meseguer-Ferrer N, et al. Pulmonary Versus Extrapulmonary Tuberculosis Associated Factors: A Case-Case Study. Microbiol Insights. 2019;12:1178636119840362. DOI:10.1177/1178636119840362
9. Ahasan HA, Bala CS. Hurdles in management of extrapulmonary tuberculosis. J Bangladesh Coll Phys Surg. 2016;34(4):182-3. DOI:10.3329/jbcps.v34i4.32406
10. Furin J, Cox H, Pai M. Tuberculosis. Lancet. 2019;393(10181):1642-56. DOI:10.1016/S0140-6736(19)30308-3
11. Кульчавеня Е.В., Брижатюк Е.В., Хомяков В.Т. Туберкулез экстраторакальных локализаций в Сибири и на Дальнем Востоке. Проблемы туберкулеза и болезней легких. 2005;6(82):23-6 [Kulchavenya EV, Brizhatyuk EV, Khomyakov VT. Tuberculosis of extrathoracic localizations in Siberia and the Far East. Problems of Tuberculosis and Lung Disease. 2005;6(82):23-6 (in Russian)].
12. Figueiredo AA, Lucon AM, Srougi M. Urogenital Tuberculosis. Microbiol Spectr. 2017;5(1). DOI:10.1128/microbiolspec
13. Gilpin C, Korobitsyn A, Migliori GB, et al. The World Health Organization standards for tuberculosis care and management. Eur Respir J. 2018;51(3):1800098. DOI:10.1183/13993003.00098-2018
14. Hsieh HC, Lu PL, Chen YH, et al. Urogenital tuberculosis in a medical center in southern Taiwan: An eleven-year experience. J Microbiol Immunol Infect. 2006;39:408-13.
15. Huang TY, Hung CH, Hsu WH, et al. Genitourinary tuberculosis in Taiwan: a 15-year experience at a teaching hospital. J Microbiol Immunol Infect. 2019;52(2):312-9. DOI:10.1016/j.jmii.2018.10.007
16. Шевченко С.Ю., Кульчавеня Е.В. Есть ли скрининг для мочеполового туберкулеза? Урология. 2017;6:15-7 [Shevchenko SYu, Kulchavenya EV. Is there a screening for genitourinary tuberculosis? Urologiia. 2017;6:15-7 (in Russian)].
17. Грунд В.Д. Ошибки в диагностике и лечении туберкулеза мочеполовой системы. М.: Медицина, 1975 [Grund VD. Oshibki v diagnostike i lechenii tuberkuleza mochepolovoi sistemy. Moscow: Meditsinа, 1975 (in Russian)].
18. Шевченко С.Ю., Кульчавеня Е.В. Информативность пробы с диаскинтестом в скрининге мочеполового туберкулеза. Туберкулез и болезни легких. 2017;95(8):49-51 [Shevchenko SYu, Kulchavenya EV. Informativeness of the test with diaskintest in the screening of urogenital tuberculosis. Tuberculosis and Lung Diseases. 2017;95(8):49-51 (in Russian)]. DOI:10.21292/2075-1230-2017-95-8-49-51
19. Bedi N, Rahimi MNC, Menzies S, Kalsi J. Atypical testicular pain. BMJ Case Rep. 2019;12(2):e226697. DOI:10.1136/bcr-2018-226697
20. Kulchavenya E, Kholtobin D. Diseases masking and delaying the diagnosis of urogenital tuberculosis. Ther Adv Urol. 2015;7:331-8. DOI:10.1177/1756287215592604
21. Banerji JS. Primary tuberculosis of the glans penis in an immunocompetent male. Lancet Infect Dis. 2020;20(4):509. DOI:10.1016/S1473-3099(19)30753-4
22. Benbella A, Aboulmakarim S, Hardizi H, et al. Infertility in the Moroccan population: an etiological study in the reproductive health centre in Rabat. Pan Afr Med J. 2018;30(6):204. DOI:10.11604/pamj.2018.30.204.13498
23. Khanna A, Agrawal A. Markers of genital tuberculosis in infertility. Singapore Med J. 2011;52:864-7.
24. Kulchavenya E, Naber K, Bjerklund Johansen TE. Urogenital tuberculosis: Classification, diagnosis, and treatment. Eur Urol Suppl. 2016;15(4):112-21.
DOI: 10.1016/j.eursup.2016.04.001
25. Gambhir S, Ravina M, Rangan K, et al; International Atomic Energy Agency Extra-pulmonary TB Consortium. Imaging in extrapulmonary tuberculosis. Int J Infect Dis. 2017;56:237-47. DOI:10.1016/j.ijid.2016.11.003
26. Gaudiano C, Tadolini M, Busato F, et al. Multidetector CT urography in urogenital tuberculosis: use of reformatted images for the assessment of the radiological findings. A pictorial essay. Abdom Radiol (NY). 2017;42(9):2314-24. DOI:10.1007/s00261-017-1129-0
27. Коган М.И., Набока Ю.Л., Ибишев Х.С., Гудима И.А. Нестерильность мочи здорового человека – новая парадигма в медицине. Урология. 2014;5:48-52 [Kogan MI, Naboka YuL, Ibishev HS, Gudima IA. Non-sterility of the urine of a healthy person is a new paradigm in medicine. Urologiia. 2014;5:48-52 (in Russian)].
28. Gutierrez C. Benefits and challenges of molecular diagnostics for childhood tuberculosis. Int J Mycobacteriol. 2016;5 Suppl. 1:S4-S5. DOI:10.1016/j.ijmyco.2016.08.011
29. Chen Y, Wu P, Fu L, et al. Multicentre evaluation of Xpert MTB/RIF assay in detecting urinary tract tuberculosis with urine samples. Sci Rep. 2019;9(1):11053.
DOI:10.1038/s41598-019-47358-3
30. Decroo T, Henríquez-Trujillo AR, De Weggheleire A, Lynen L. Rational use of Xpert testing in patients with presumptive TB: Clinicians should be encouraged to use the test-treat threshold. BMC Infect Dis. 2017;17(1):674. DOI:10.1186/s12879-017-2798-6
31. Atherton RR, Cresswell FV, Ellis J, et al. Detection of Mycobacterium tuberculosis in urine by Xpert MTB/RIF Ultra: A useful adjunctive diagnostic tool in HIV-associated tuberculosis. Int J Infect Dis. 2018;75:92-4. DOI:10.1016/j.ijid.2018.07.007
32. Broger T, Nicol MP, Székely R, et al. Diagnostic accuracy of a novel tuberculosis point-of-care urine lipoarabinomannan assay for people living with HIV: A meta-analysis of individual in- and outpatient data. PLoS Med. 2020;17(5):e1003113. DOI:10.1371/journal.pmed.1003113
33. Shekar PA, Kumar PS. Microbiological diagnosis in urogenital tuberculosis: the Holy Grail still Eludes. World J Urol. 2021;39(9):3693-4. DOI:10.1007/s00345-020-03293-x
34. Supriyadi R, Darmawan G, Pranggono EH. Renal tuberculosis: The Masquerader. Acta Med Indones. 2019;51(4):353-5.
35. Rodriguez-Takeuchi SY, Renjifo ME, Medina FJ. Extrapulmonary tuberculosis: pathophysiology and imaging findings. Radiographics. 2019;39(7):2023-37. DOI:10.1148/rg.2019190109
36. Muneer A, Macrae B, Krishnamoorthy S, Zumla A. Urogenital tuberculosis – epidemiology, pathogenesis and clinical features. Nat Rev Urol. 2019;16(10):573-98.
DOI:10.1038/s41585-019-0228-9
37. Mosina N, Kayukov I. Renal tuberculosis following BCG therapy for bladder cancer. QJM. 2020;113(3):230-1. DOI:10.1093/qjmed/hcz262
38. Eswarappa M, HJ GD, John MM, et al. Tuberculosis in renal transplant recipients: Our decade long experience with an opportunistic invader. Indian J Tuberc. 2020;67(1):73-8. DOI:10.1016/j.ijtb.2019.05.001
39. Almeida APF, Silva DFD, Petruccelli KCS, et al. Urogenital tuberculosis in a patient with end-stage renal disease. Rev Soc Bras Med Trop. 2020;53:e20190284.
DOI:10.1590/0037-8682-0284-2019
2. World Health Organization. TB disease burden. In: Global tuberculosis report 2018. Geneva: World Health Organization, 2018.
3. Sy KTL, Haw NJL, Uy J. Previous and active tuberculosis increases risk of death and prolongs recovery in patients with COVID-19. Infect Dis (Lond). 2020;52(12):902-7. DOI:10.1080/23744235.2020.1806353
4. Osadchiy AV, Kulchavenya EV, Reykhrud TA, et al. Socio-demographic characteristics of patients with pulmonary tuberculosis and extrapulmonary localizations. Tuberculosis and Lung Diseases. 2015;2:46-8 (in Russian). DOI:10.21292/2075-1230-2015-0-2-46-49
5. Shcherban MN, Kulchavenya EV, Brizhatyuk EV. Diagnostics, prevention and treatment of reproductive disorders in men with pulmonary tuberculosis. Tuberculosis and Lung Diseases. 2010;87(10):31-6 (in Russian).
6. Benbella A, Aboulmakarim S, Hardizi H, et al. Infertility in the Moroccan population: major risk factors encountered in the reproductive health centre in Rabat. Pan Afr Med J. 2018;30:195. DOI:10.11604/pamj.2018.30.195.13849
7. Kulchavenya EV, Zhukova II. Extrapulmonary tuberculosis – there are more questions than answers. Tuberculosis and Lung Diseases. 2017;95(2):59-63 (in Russian). DOI:10.21292/2075-1230-2017-95-2-59-63
8. Arnedo-Pena A, Romeu-Garcia MA, Meseguer-Ferrer N, et al. Pulmonary Versus Extrapulmonary Tuberculosis Associated Factors: A Case-Case Study. Microbiol Insights. 2019;12:1178636119840362. DOI:10.1177/1178636119840362
9. Ahasan HA, Bala CS. Hurdles in management of extrapulmonary tuberculosis. J Bangladesh Coll Phys Surg. 2016;34(4):182-3. DOI:10.3329/jbcps.v34i4.32406
10. Furin J, Cox H, Pai M. Tuberculosis. Lancet. 2019;393(10181):1642-56. DOI:10.1016/S0140-6736(19)30308-3
11. Kulchavenya EV, Brizhatyuk EV, Khomyakov VT. Tuberculosis of extrathoracic localizations in Siberia and the Far East. Problems of Tuberculosis and Lung Disease. 2005;6(82):23-6 (in Russian).
12. Figueiredo AA, Lucon AM, Srougi M. Urogenital Tuberculosis. Microbiol Spectr. 2017;5(1). DOI:10.1128/microbiolspec
13. Gilpin C, Korobitsyn A, Migliori GB, et al. The World Health Organization standards for tuberculosis care and management. Eur Respir J. 2018;51(3):1800098. DOI:10.1183/13993003.00098-2018
14. Hsieh HC, Lu PL, Chen YH, et al. Urogenital tuberculosis in a medical center in southern Taiwan: An eleven-year experience. J Microbiol Immunol Infect. 2006;39:408-13.
15. Huang TY, Hung CH, Hsu WH, et al. Genitourinary tuberculosis in Taiwan: a 15-year experience at a teaching hospital. J Microbiol Immunol Infect. 2019;52(2):312-9. DOI:10.1016/j.jmii.2018.10.007
16. Shevchenko SYu, Kulchavenya EV. Is there a screening for genitourinary tuberculosis? Urologiia. 2017;6:15-7 (in Russian).
17. Грунд В.Д. Ошибки в диагностике и лечении туберкулеза мочеполовой системы. М.: Медицина, 1975 [Grund VD. Oshibki v diagnostike i lechenii tuberkuleza mochepolovoi sistemy. Moscow: Meditsinа, 1975 (in Russian)].
18. Shevchenko SYu, Kulchavenya EV. Informativeness of the test with diaskintest in the screening of urogenital tuberculosis. Tuberculosis and Lung Diseases. 2017;95(8):49-51 (in Russian). DOI:10.21292/2075-1230-2017-95-8-49-51
19. Bedi N, Rahimi MNC, Menzies S, Kalsi J. Atypical testicular pain. BMJ Case Rep. 2019;12(2):e226697. DOI:10.1136/bcr-2018-226697
20. Kulchavenya E, Kholtobin D. Diseases masking and delaying the diagnosis of urogenital tuberculosis. Ther Adv Urol. 2015;7:331-8. DOI:10.1177/1756287215592604
21. Banerji JS. Primary tuberculosis of the glans penis in an immunocompetent male. Lancet Infect Dis. 2020;20(4):509. DOI:10.1016/S1473-3099(19)30753-4
22. Benbella A, Aboulmakarim S, Hardizi H, et al. Infertility in the Moroccan population: an etiological study in the reproductive health centre in Rabat. Pan Afr Med J. 2018;30(6):204. DOI:10.11604/pamj.2018.30.204.13498
23. Khanna A, Agrawal A. Markers of genital tuberculosis in infertility. Singapore Med J. 2011;52:864-7.
24. Kulchavenya E, Naber K, Bjerklund Johansen TE. Urogenital tuberculosis: Classification, diagnosis, and treatment. Eur Urol Suppl. 2016;15(4):112-21.
DOI: 10.1016/j.eursup.2016.04.001
25. Gambhir S, Ravina M, Rangan K, et al; International Atomic Energy Agency Extra-pulmonary TB Consortium. Imaging in extrapulmonary tuberculosis. Int J Infect Dis. 2017;56:237-47. DOI:10.1016/j.ijid.2016.11.003
26. Gaudiano C, Tadolini M, Busato F, et al. Multidetector CT urography in urogenital tuberculosis: use of reformatted images for the assessment of the radiological findings. A pictorial essay. Abdom Radiol (NY). 2017;42(9):2314-24. DOI:10.1007/s00261-017-1129-0
27. Kogan MI, Naboka YuL, Ibishev HS, Gudima IA. Non-sterility of the urine of a healthy person is a new paradigm in medicine. Urologiia. 2014;5:48-52 (in Russian).
28. Gutierrez C. Benefits and challenges of molecular diagnostics for childhood tuberculosis. Int J Mycobacteriol. 2016;5 Suppl. 1:S4-S5. DOI:10.1016/j.ijmyco.2016.08.011
29. Chen Y, Wu P, Fu L, et al. Multicentre evaluation of Xpert MTB/RIF assay in detecting urinary tract tuberculosis with urine samples. Sci Rep. 2019;9(1):11053.
DOI:10.1038/s41598-019-47358-3
30. Decroo T, Henríquez-Trujillo AR, De Weggheleire A, Lynen L. Rational use of Xpert testing in patients with presumptive TB: Clinicians should be encouraged to use the test-treat threshold. BMC Infect Dis. 2017;17(1):674. DOI:10.1186/s12879-017-2798-6
31. Atherton RR, Cresswell FV, Ellis J, et al. Detection of Mycobacterium tuberculosis in urine by Xpert MTB/RIF Ultra: A useful adjunctive diagnostic tool in HIV-associated tuberculosis. Int J Infect Dis. 2018;75:92-4. DOI:10.1016/j.ijid.2018.07.007
32. Broger T, Nicol MP, Székely R, et al. Diagnostic accuracy of a novel tuberculosis point-of-care urine lipoarabinomannan assay for people living with HIV: A meta-analysis of individual in- and outpatient data. PLoS Med. 2020;17(5):e1003113. DOI:10.1371/journal.pmed.1003113
33. Shekar PA, Kumar PS. Microbiological diagnosis in urogenital tuberculosis: the Holy Grail still Eludes. World J Urol. 2021;39(9):3693-4. DOI:10.1007/s00345-020-03293-x
34. Supriyadi R, Darmawan G, Pranggono EH. Renal tuberculosis: The Masquerader. Acta Med Indones. 2019;51(4):353-5.
35. Rodriguez-Takeuchi SY, Renjifo ME, Medina FJ. Extrapulmonary tuberculosis: pathophysiology and imaging findings. Radiographics. 2019;39(7):2023-37. DOI:10.1148/rg.2019190109
36. Muneer A, Macrae B, Krishnamoorthy S, Zumla A. Urogenital tuberculosis – epidemiology, pathogenesis and clinical features. Nat Rev Urol. 2019;16(10):573-98.
DOI:10.1038/s41585-019-0228-9
37. Mosina N, Kayukov I. Renal tuberculosis following BCG therapy for bladder cancer. QJM. 2020;113(3):230-1. DOI:10.1093/qjmed/hcz262
38. Eswarappa M, HJ GD, John MM, et al. Tuberculosis in renal transplant recipients: Our decade long experience with an opportunistic invader. Indian J Tuberc. 2020;67(1):73-8. DOI:10.1016/j.ijtb.2019.05.001
39. Almeida APF, Silva DFD, Petruccelli KCS, et al. Urogenital tuberculosis in a patient with end-stage renal disease. Rev Soc Bras Med Trop. 2020;53:e20190284.
DOI:10.1590/0037-8682-0284-2019
2. World Health Organization. TB disease burden. In: Global tuberculosis report 2018. Geneva: World Health Organization, 2018.
3. Sy KTL, Haw NJL, Uy J. Previous and active tuberculosis increases risk of death and prolongs recovery in patients with COVID-19. Infect Dis (Lond). 2020;52(12):902-7. DOI:10.1080/23744235.2020.1806353
4. Осадчий А.В., Кульчавеня Е.В., Рейхруд Т.А., и др. Социально-демографическая характеристика больных туберкулезом легких и внелегочных локализаций. Туберкулез и болезни легких. 2015;2:46-8 [Osadchiy AV, Kulchavenya EV, Reykhrud TA, et al. Socio-demographic characteristics of patients with pulmonary tuberculosis and extrapulmonary localizations. Tuberculosis and Lung Diseases. 2015;2:46-8 (in Russian)]. DOI:10.21292/2075-1230-2015-0-2-46-49
5. Щербань М.Н., Кульчавеня Е.В., Брижатюк Е.В. Диагностика, предупреждение и лечение нарушений репродуктивной функции у мужчин, больных туберкулезом легких. Туберкулез и болезни легких. 2010;87(10):31-6 [Shcherban MN, Kulchavenya EV, Brizhatyuk EV. Diagnostics, prevention and treatment of reproductive disorders in men with pulmonary tuberculosis. Tuberculosis and Lung Diseases. 2010;87(10):31-6 (in Russian)].
6. Benbella A, Aboulmakarim S, Hardizi H, et al. Infertility in the Moroccan population: major risk factors encountered in the reproductive health centre in Rabat. Pan Afr Med J. 2018;30:195. DOI:10.11604/pamj.2018.30.195.13849
7. Кульчавеня Е.В., Жукова И.И. Внелегочный туберкулез – вопросов больше, чем ответов. Туберкулез и болезни легких. 2017;95(2):59-63 [Kulchavenya EV, Zhukova II. Extrapulmonary tuberculosis – there are more questions than answers. Tuberculosis and Lung Diseases. 2017;95(2):59-63 (in Russian)]. DOI:10.21292/2075-1230-2017-95-2-59-63
8. Arnedo-Pena A, Romeu-Garcia MA, Meseguer-Ferrer N, et al. Pulmonary Versus Extrapulmonary Tuberculosis Associated Factors: A Case-Case Study. Microbiol Insights. 2019;12:1178636119840362. DOI:10.1177/1178636119840362
9. Ahasan HA, Bala CS. Hurdles in management of extrapulmonary tuberculosis. J Bangladesh Coll Phys Surg. 2016;34(4):182-3. DOI:10.3329/jbcps.v34i4.32406
10. Furin J, Cox H, Pai M. Tuberculosis. Lancet. 2019;393(10181):1642-56. DOI:10.1016/S0140-6736(19)30308-3
11. Кульчавеня Е.В., Брижатюк Е.В., Хомяков В.Т. Туберкулез экстраторакальных локализаций в Сибири и на Дальнем Востоке. Проблемы туберкулеза и болезней легких. 2005;6(82):23-6 [Kulchavenya EV, Brizhatyuk EV, Khomyakov VT. Tuberculosis of extrathoracic localizations in Siberia and the Far East. Problems of Tuberculosis and Lung Disease. 2005;6(82):23-6 (in Russian)].
12. Figueiredo AA, Lucon AM, Srougi M. Urogenital Tuberculosis. Microbiol Spectr. 2017;5(1). DOI:10.1128/microbiolspec
13. Gilpin C, Korobitsyn A, Migliori GB, et al. The World Health Organization standards for tuberculosis care and management. Eur Respir J. 2018;51(3):1800098. DOI:10.1183/13993003.00098-2018
14. Hsieh HC, Lu PL, Chen YH, et al. Urogenital tuberculosis in a medical center in southern Taiwan: An eleven-year experience. J Microbiol Immunol Infect. 2006;39:408-13.
15. Huang TY, Hung CH, Hsu WH, et al. Genitourinary tuberculosis in Taiwan: a 15-year experience at a teaching hospital. J Microbiol Immunol Infect. 2019;52(2):312-9. DOI:10.1016/j.jmii.2018.10.007
16. Шевченко С.Ю., Кульчавеня Е.В. Есть ли скрининг для мочеполового туберкулеза? Урология. 2017;6:15-7 [Shevchenko SYu, Kulchavenya EV. Is there a screening for genitourinary tuberculosis? Urologiia. 2017;6:15-7 (in Russian)].
17. Грунд В.Д. Ошибки в диагностике и лечении туберкулеза мочеполовой системы. М.: Медицина, 1975 [Grund VD. Oshibki v diagnostike i lechenii tuberkuleza mochepolovoi sistemy. Moscow: Meditsinа, 1975 (in Russian)].
18. Шевченко С.Ю., Кульчавеня Е.В. Информативность пробы с диаскинтестом в скрининге мочеполового туберкулеза. Туберкулез и болезни легких. 2017;95(8):49-51 [Shevchenko SYu, Kulchavenya EV. Informativeness of the test with diaskintest in the screening of urogenital tuberculosis. Tuberculosis and Lung Diseases. 2017;95(8):49-51 (in Russian)]. DOI:10.21292/2075-1230-2017-95-8-49-51
19. Bedi N, Rahimi MNC, Menzies S, Kalsi J. Atypical testicular pain. BMJ Case Rep. 2019;12(2):e226697. DOI:10.1136/bcr-2018-226697
20. Kulchavenya E, Kholtobin D. Diseases masking and delaying the diagnosis of urogenital tuberculosis. Ther Adv Urol. 2015;7:331-8. DOI:10.1177/1756287215592604
21. Banerji JS. Primary tuberculosis of the glans penis in an immunocompetent male. Lancet Infect Dis. 2020;20(4):509. DOI:10.1016/S1473-3099(19)30753-4
22. Benbella A, Aboulmakarim S, Hardizi H, et al. Infertility in the Moroccan population: an etiological study in the reproductive health centre in Rabat. Pan Afr Med J. 2018;30(6):204. DOI:10.11604/pamj.2018.30.204.13498
23. Khanna A, Agrawal A. Markers of genital tuberculosis in infertility. Singapore Med J. 2011;52:864-7.
24. Kulchavenya E, Naber K, Bjerklund Johansen TE. Urogenital tuberculosis: Classification, diagnosis, and treatment. Eur Urol Suppl. 2016;15(4):112-21.
DOI: 10.1016/j.eursup.2016.04.001
25. Gambhir S, Ravina M, Rangan K, et al; International Atomic Energy Agency Extra-pulmonary TB Consortium. Imaging in extrapulmonary tuberculosis. Int J Infect Dis. 2017;56:237-47. DOI:10.1016/j.ijid.2016.11.003
26. Gaudiano C, Tadolini M, Busato F, et al. Multidetector CT urography in urogenital tuberculosis: use of reformatted images for the assessment of the radiological findings. A pictorial essay. Abdom Radiol (NY). 2017;42(9):2314-24. DOI:10.1007/s00261-017-1129-0
27. Коган М.И., Набока Ю.Л., Ибишев Х.С., Гудима И.А. Нестерильность мочи здорового человека – новая парадигма в медицине. Урология. 2014;5:48-52 [Kogan MI, Naboka YuL, Ibishev HS, Gudima IA. Non-sterility of the urine of a healthy person is a new paradigm in medicine. Urologiia. 2014;5:48-52 (in Russian)].
28. Gutierrez C. Benefits and challenges of molecular diagnostics for childhood tuberculosis. Int J Mycobacteriol. 2016;5 Suppl. 1:S4-S5. DOI:10.1016/j.ijmyco.2016.08.011
29. Chen Y, Wu P, Fu L, et al. Multicentre evaluation of Xpert MTB/RIF assay in detecting urinary tract tuberculosis with urine samples. Sci Rep. 2019;9(1):11053.
DOI:10.1038/s41598-019-47358-3
30. Decroo T, Henríquez-Trujillo AR, De Weggheleire A, Lynen L. Rational use of Xpert testing in patients with presumptive TB: Clinicians should be encouraged to use the test-treat threshold. BMC Infect Dis. 2017;17(1):674. DOI:10.1186/s12879-017-2798-6
31. Atherton RR, Cresswell FV, Ellis J, et al. Detection of Mycobacterium tuberculosis in urine by Xpert MTB/RIF Ultra: A useful adjunctive diagnostic tool in HIV-associated tuberculosis. Int J Infect Dis. 2018;75:92-4. DOI:10.1016/j.ijid.2018.07.007
32. Broger T, Nicol MP, Székely R, et al. Diagnostic accuracy of a novel tuberculosis point-of-care urine lipoarabinomannan assay for people living with HIV: A meta-analysis of individual in- and outpatient data. PLoS Med. 2020;17(5):e1003113. DOI:10.1371/journal.pmed.1003113
33. Shekar PA, Kumar PS. Microbiological diagnosis in urogenital tuberculosis: the Holy Grail still Eludes. World J Urol. 2021;39(9):3693-4. DOI:10.1007/s00345-020-03293-x
34. Supriyadi R, Darmawan G, Pranggono EH. Renal tuberculosis: The Masquerader. Acta Med Indones. 2019;51(4):353-5.
35. Rodriguez-Takeuchi SY, Renjifo ME, Medina FJ. Extrapulmonary tuberculosis: pathophysiology and imaging findings. Radiographics. 2019;39(7):2023-37. DOI:10.1148/rg.2019190109
36. Muneer A, Macrae B, Krishnamoorthy S, Zumla A. Urogenital tuberculosis – epidemiology, pathogenesis and clinical features. Nat Rev Urol. 2019;16(10):573-98.
DOI:10.1038/s41585-019-0228-9
37. Mosina N, Kayukov I. Renal tuberculosis following BCG therapy for bladder cancer. QJM. 2020;113(3):230-1. DOI:10.1093/qjmed/hcz262
38. Eswarappa M, HJ GD, John MM, et al. Tuberculosis in renal transplant recipients: Our decade long experience with an opportunistic invader. Indian J Tuberc. 2020;67(1):73-8. DOI:10.1016/j.ijtb.2019.05.001
39. Almeida APF, Silva DFD, Petruccelli KCS, et al. Urogenital tuberculosis in a patient with end-stage renal disease. Rev Soc Bras Med Trop. 2020;53:e20190284.
DOI:10.1590/0037-8682-0284-2019
________________________________________________
2. World Health Organization. TB disease burden. In: Global tuberculosis report 2018. Geneva: World Health Organization, 2018.
3. Sy KTL, Haw NJL, Uy J. Previous and active tuberculosis increases risk of death and prolongs recovery in patients with COVID-19. Infect Dis (Lond). 2020;52(12):902-7. DOI:10.1080/23744235.2020.1806353
4. Osadchiy AV, Kulchavenya EV, Reykhrud TA, et al. Socio-demographic characteristics of patients with pulmonary tuberculosis and extrapulmonary localizations. Tuberculosis and Lung Diseases. 2015;2:46-8 (in Russian). DOI:10.21292/2075-1230-2015-0-2-46-49
5. Shcherban MN, Kulchavenya EV, Brizhatyuk EV. Diagnostics, prevention and treatment of reproductive disorders in men with pulmonary tuberculosis. Tuberculosis and Lung Diseases. 2010;87(10):31-6 (in Russian).
6. Benbella A, Aboulmakarim S, Hardizi H, et al. Infertility in the Moroccan population: major risk factors encountered in the reproductive health centre in Rabat. Pan Afr Med J. 2018;30:195. DOI:10.11604/pamj.2018.30.195.13849
7. Kulchavenya EV, Zhukova II. Extrapulmonary tuberculosis – there are more questions than answers. Tuberculosis and Lung Diseases. 2017;95(2):59-63 (in Russian). DOI:10.21292/2075-1230-2017-95-2-59-63
8. Arnedo-Pena A, Romeu-Garcia MA, Meseguer-Ferrer N, et al. Pulmonary Versus Extrapulmonary Tuberculosis Associated Factors: A Case-Case Study. Microbiol Insights. 2019;12:1178636119840362. DOI:10.1177/1178636119840362
9. Ahasan HA, Bala CS. Hurdles in management of extrapulmonary tuberculosis. J Bangladesh Coll Phys Surg. 2016;34(4):182-3. DOI:10.3329/jbcps.v34i4.32406
10. Furin J, Cox H, Pai M. Tuberculosis. Lancet. 2019;393(10181):1642-56. DOI:10.1016/S0140-6736(19)30308-3
11. Kulchavenya EV, Brizhatyuk EV, Khomyakov VT. Tuberculosis of extrathoracic localizations in Siberia and the Far East. Problems of Tuberculosis and Lung Disease. 2005;6(82):23-6 (in Russian).
12. Figueiredo AA, Lucon AM, Srougi M. Urogenital Tuberculosis. Microbiol Spectr. 2017;5(1). DOI:10.1128/microbiolspec
13. Gilpin C, Korobitsyn A, Migliori GB, et al. The World Health Organization standards for tuberculosis care and management. Eur Respir J. 2018;51(3):1800098. DOI:10.1183/13993003.00098-2018
14. Hsieh HC, Lu PL, Chen YH, et al. Urogenital tuberculosis in a medical center in southern Taiwan: An eleven-year experience. J Microbiol Immunol Infect. 2006;39:408-13.
15. Huang TY, Hung CH, Hsu WH, et al. Genitourinary tuberculosis in Taiwan: a 15-year experience at a teaching hospital. J Microbiol Immunol Infect. 2019;52(2):312-9. DOI:10.1016/j.jmii.2018.10.007
16. Shevchenko SYu, Kulchavenya EV. Is there a screening for genitourinary tuberculosis? Urologiia. 2017;6:15-7 (in Russian).
17. Грунд В.Д. Ошибки в диагностике и лечении туберкулеза мочеполовой системы. М.: Медицина, 1975 [Grund VD. Oshibki v diagnostike i lechenii tuberkuleza mochepolovoi sistemy. Moscow: Meditsinа, 1975 (in Russian)].
18. Shevchenko SYu, Kulchavenya EV. Informativeness of the test with diaskintest in the screening of urogenital tuberculosis. Tuberculosis and Lung Diseases. 2017;95(8):49-51 (in Russian). DOI:10.21292/2075-1230-2017-95-8-49-51
19. Bedi N, Rahimi MNC, Menzies S, Kalsi J. Atypical testicular pain. BMJ Case Rep. 2019;12(2):e226697. DOI:10.1136/bcr-2018-226697
20. Kulchavenya E, Kholtobin D. Diseases masking and delaying the diagnosis of urogenital tuberculosis. Ther Adv Urol. 2015;7:331-8. DOI:10.1177/1756287215592604
21. Banerji JS. Primary tuberculosis of the glans penis in an immunocompetent male. Lancet Infect Dis. 2020;20(4):509. DOI:10.1016/S1473-3099(19)30753-4
22. Benbella A, Aboulmakarim S, Hardizi H, et al. Infertility in the Moroccan population: an etiological study in the reproductive health centre in Rabat. Pan Afr Med J. 2018;30(6):204. DOI:10.11604/pamj.2018.30.204.13498
23. Khanna A, Agrawal A. Markers of genital tuberculosis in infertility. Singapore Med J. 2011;52:864-7.
24. Kulchavenya E, Naber K, Bjerklund Johansen TE. Urogenital tuberculosis: Classification, diagnosis, and treatment. Eur Urol Suppl. 2016;15(4):112-21.
DOI: 10.1016/j.eursup.2016.04.001
25. Gambhir S, Ravina M, Rangan K, et al; International Atomic Energy Agency Extra-pulmonary TB Consortium. Imaging in extrapulmonary tuberculosis. Int J Infect Dis. 2017;56:237-47. DOI:10.1016/j.ijid.2016.11.003
26. Gaudiano C, Tadolini M, Busato F, et al. Multidetector CT urography in urogenital tuberculosis: use of reformatted images for the assessment of the radiological findings. A pictorial essay. Abdom Radiol (NY). 2017;42(9):2314-24. DOI:10.1007/s00261-017-1129-0
27. Kogan MI, Naboka YuL, Ibishev HS, Gudima IA. Non-sterility of the urine of a healthy person is a new paradigm in medicine. Urologiia. 2014;5:48-52 (in Russian).
28. Gutierrez C. Benefits and challenges of molecular diagnostics for childhood tuberculosis. Int J Mycobacteriol. 2016;5 Suppl. 1:S4-S5. DOI:10.1016/j.ijmyco.2016.08.011
29. Chen Y, Wu P, Fu L, et al. Multicentre evaluation of Xpert MTB/RIF assay in detecting urinary tract tuberculosis with urine samples. Sci Rep. 2019;9(1):11053.
DOI:10.1038/s41598-019-47358-3
30. Decroo T, Henríquez-Trujillo AR, De Weggheleire A, Lynen L. Rational use of Xpert testing in patients with presumptive TB: Clinicians should be encouraged to use the test-treat threshold. BMC Infect Dis. 2017;17(1):674. DOI:10.1186/s12879-017-2798-6
31. Atherton RR, Cresswell FV, Ellis J, et al. Detection of Mycobacterium tuberculosis in urine by Xpert MTB/RIF Ultra: A useful adjunctive diagnostic tool in HIV-associated tuberculosis. Int J Infect Dis. 2018;75:92-4. DOI:10.1016/j.ijid.2018.07.007
32. Broger T, Nicol MP, Székely R, et al. Diagnostic accuracy of a novel tuberculosis point-of-care urine lipoarabinomannan assay for people living with HIV: A meta-analysis of individual in- and outpatient data. PLoS Med. 2020;17(5):e1003113. DOI:10.1371/journal.pmed.1003113
33. Shekar PA, Kumar PS. Microbiological diagnosis in urogenital tuberculosis: the Holy Grail still Eludes. World J Urol. 2021;39(9):3693-4. DOI:10.1007/s00345-020-03293-x
34. Supriyadi R, Darmawan G, Pranggono EH. Renal tuberculosis: The Masquerader. Acta Med Indones. 2019;51(4):353-5.
35. Rodriguez-Takeuchi SY, Renjifo ME, Medina FJ. Extrapulmonary tuberculosis: pathophysiology and imaging findings. Radiographics. 2019;39(7):2023-37. DOI:10.1148/rg.2019190109
36. Muneer A, Macrae B, Krishnamoorthy S, Zumla A. Urogenital tuberculosis – epidemiology, pathogenesis and clinical features. Nat Rev Urol. 2019;16(10):573-98.
DOI:10.1038/s41585-019-0228-9
37. Mosina N, Kayukov I. Renal tuberculosis following BCG therapy for bladder cancer. QJM. 2020;113(3):230-1. DOI:10.1093/qjmed/hcz262
38. Eswarappa M, HJ GD, John MM, et al. Tuberculosis in renal transplant recipients: Our decade long experience with an opportunistic invader. Indian J Tuberc. 2020;67(1):73-8. DOI:10.1016/j.ijtb.2019.05.001
39. Almeida APF, Silva DFD, Petruccelli KCS, et al. Urogenital tuberculosis in a patient with end-stage renal disease. Rev Soc Bras Med Trop. 2020;53:e20190284.
DOI:10.1590/0037-8682-0284-2019
Авторы
Е.В. Кульчавеня*1,2, Д.П. Холтобин1,3
1 ФГБУ «Новосибирский научно-исследовательский институт туберкулеза» Минздрава России, Новосибирск, Россия;
2 ФГБОУ ВО «Новосибирский государственный медицинский университет» Минздрава России, Новосибирск, Россия;
3 МЦ «Авиценна», Новосибирск, Россия
*urotub@yandex.ru
1 Novosibirsk Tuberculosis Research Institute, Novosibirsk, Russia;
2 Novosibirsk State Medical University, Novosibirsk, Russia;
3 Medical Center "Avicenna", Novosibirsk, Russia
*urotub@yandex.ru
1 ФГБУ «Новосибирский научно-исследовательский институт туберкулеза» Минздрава России, Новосибирск, Россия;
2 ФГБОУ ВО «Новосибирский государственный медицинский университет» Минздрава России, Новосибирск, Россия;
3 МЦ «Авиценна», Новосибирск, Россия
*urotub@yandex.ru
________________________________________________
1 Novosibirsk Tuberculosis Research Institute, Novosibirsk, Russia;
2 Novosibirsk State Medical University, Novosibirsk, Russia;
3 Medical Center "Avicenna", Novosibirsk, Russia
*urotub@yandex.ru
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