Сложность диагностики туберкулеза в учреждениях общей лечебной сети

Abstract

Aim. The aim of the study is to analyze the reasons for the erroneous diagnostics of TB in the general health care institutions and identify ways to improve diagnostics. Materials and methods. 147 medical cards of inpatients who were in the Donetsk Republican Clinical Tuberculosis Hospital, for whom active TB was excluded were analyzed. Groups were identified: 89 HIV-negative (group 1) and 58 HIV-infected (group 2). Laboratory, radiation and instrumental examinations, sputum examination by microscopy, molecular genetic analysis GeenXpertMBT/Rif, culture on Middlbrook medium and Lowenstein-Jensen medium were performed. Statistical analysis was performed using the MedStat package. Results and discussions. Hospitalization in the anti-tuberculosis hospital was considered justified in 24.7% of HIV-negative and 34.5% of HIV-infected patients due to the similarity of the clinical and radiological picture of the disease, as well as false-positive results of sputum examination before hospitalization (in 49.1% of examined HIV-negative patients). These patients required in-depth examination, and in 18.0% and 10.3%, respectively, test therapy with anti-tuberculosis drugs. Most often, pneumonia and oncological pathology were mistaken for pulmonary tuberculosis: 31.5% and 25.8% in the 1st group and 48.4% and 25.8% in the 2nd group, in both groups the verification of tumor processes was the most difficult: out of 31 cancer patients, 17 (54.8%) people received anti-tuberculosis treatment, of 7 fatal cases, in 6 the diagnosis was verified by autopsy. Development of secondary forms of pulmonary tuberculosis is not accompanied by hilar lymphadenopathy in immunocompetent patients: in group 1 enlarged lymph nodes were observed in 29 (32.6%) patients, of whom oncological pathology was revealed in 11 (37.9%), sarcoidosis – in 8 (27.6%), pneumonia – in 6 (20.7%), interstitial lung diseases (ILD) – in 2 (6.9%). Of 31 HIV-infected patients with suspected pulmonary tuberculosis, 8 (25.8%) were diagnosed with Pneumocystis pneumonia, requiring treatment outside the TB dispensary. The reasons for the erroneous diagnostics of tuberculous meningitis in HIV-infected people were insufficient coverage of neuroimaging, genetic molecular testing of cerebrospinal fluid and serodiagnosis of blood (cerebrospinal fluid). An important counterargument against the tuberculous etiology of CNS damage is the absence of active tuberculosis of the lungs and/or other organs: 77.7% of patients with suspected TM had no fresh changes in the lungs. Conclusion. Improving the quality of sputum microscopy, carrying out, if indicated, antibacterial (antifungal) treatment, diagnostic bronchoscopy, CT/MRT, consultations with specialists can reduce the frequency of erroneous diagnosis of tuberculosis and avoid hospitalization in the anti-tuberculosis infectious diseases department.