Abstract
Background: At present, despite the generally favorable pathomorphosis of tuberculosis (TB), a number of factors that have a negative impact on the epidemiological situation, clinical manifestations and treatment outcomes remain. Objective: To determine the role of aggravating factors in the development of destructive pulmonary tuberculosis. Material and methods: A prospective cohort study was conducted. The patients who were admitted to the inpatient department of the Grodno Regional Clinical Center "Phthisiology", as well as to the Republican Tuberculosis Hospital "Novoelnya" were examined. Depending on the prevailing aggravating factor, the patients were divided into 10 groups. In addition, 2 more groups of patients with the presence of extensive drug resistance of mycobacterium tuberculosis (XDR MBT) were formed. The obtained results indicate a significant negative influence of aggravating factors on the formation of destructive processes in the lungs. As more significant cases in terms of these factors should be considered the patients with TB, accompanied by diabetes mellitus (DM), alcohol dependence syndrome (ADS), chronic nonspecific respiratory diseases (HNRD), as well as those who arrived from correctional labor institutions and those with the presence of several factors at the same time. Results: The analysis of the obtained results shows that in all cohorts of patients, the frequency of the decay cavities exceeds that in patients with pulmonary tuberculosis without the presence of significant risk factors. Conclusions: The results obtained indicate that the frequency of the formation of destructive forms of tuberculosis in MDR-TB depends on a number of aggravating factors. The most significant of them in this regard are DM, the presence of several factors at the same time, ADS, staying at correctional labor institutions as well as HNRD. Factors such as contact or diseases of the gastrointestinal tract do not have a significant effect on the formation of destruction in the lungs in MDR-TB. In the presence of XDR-TB, the highest frequency of destructive forms (over 70%) is observed, it reaching 76.0% in patients with XDR-TB combined with ADS.
Highlights
At present, despite the generally favorable pathomorphosis of tuberculosis (TB), a number of factors that have a negative impact on the epidemiological situation, clinical manifestations and treatment outcomes remain
Частота формирования широкой лекарственной устойчивости микобактрий туберкулёза (ШЛУ МБТ) при наличии отягощающих факторов в целом (23,1%) превышает достоверно таковую у пациентов с их отсутствием (9,3%)
Данный фактор более значим у пациентов с ТБ, сопровождающимся сахарным диабетом, синдромом зависимости от алкоголя (СЗА), хронические неспецифические заболевания органов дыхания (ХНЗОД), прибывших из исправительно-трудовых учреждений (ИТУ) и с наличием нескольких факторов одновременно
Summary
Определить роль отягощающих факторов в развитии деструктивного туберкулёза лёгких. Полученные результаты свидетельствуют о наличии зависимости частоты формирования деструктивных форм туберкулёза при МЛУ ТБ от ряда отягощающих факторов. Однако в последние десятилетия возникла проблема сочетания МЛУ и ШЛУ-ТБ с наличием отягощающих факторов, что приводит к усугублению уже имеющегося неблагоприятного воздействия. В то же время еще недостаточно внимания уделяется изучению влияния СЗА при наличии МЛУ-ТБ и ШЛУ-ТБ, которые сами по себе, как известно, оказывают негативное действие на клинику, течение и исход туберкулёзного процесса, являются одной из главных проблем современной фтизиатрии [4]. В целом при ХНЗОД туберкулёз выявляется в 3-4 раза чаще, протекает в целом тяжелее, повышается развитие деструкции, диффузного пневмосклероза, нарушений лёгочного кровотока, а также частота развития МЛУ/ШЛУ-МБТ [9]. Цель – определить роль отягощающих факторов в развитии деструктивного туберкулёза лёгких
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