Особенности клинических проявлений и диагностики сочетания туберкулеза органов дыхания с оппортунистическими инфекциями легких у взрослых больных на поздних стадиях ВИЧ-инфекции с иммунодефицитом

Abstract

Aim. To study the features of clinical manifestations and diagnostics of a combination of pulmonary tuberculosis (PTB) and opportunistic lung infections (OLI) in patients in advanced stage of HIV infection with immunodeficiency. Materials and methods. The study included 338 patients with newly diagnosed PTB with isolation of Mycobacterium tuberculosis, aged 25–60 years, having stage 4B and 5 HIV infection in a stage of progression, with no antiretroviral therapy, who were divided into 2 groups: 169 patients with a combination of PTB and OLI (main group) and 169 – with PTB (comparison group). All patients underwent clinical and laboratory, radiation and bronchological examination, as well as microbiological, immunological, molecular and genetic, cytological and histological examination of the diagnostic material from the respiratory tract, cere-brospinal and pleural fluid, blood, urine and feces in order to reveal OLI. Statistical analysis was carried out using Microsoft Office Excel 2010, data are presented as mean and standard deviation, the confidence interval. Results. It was found that tuberculosis in patients of the main group and the comparison group was generalized with multiple lesions and extrapulmonary phe-nomena, which include severe intoxication syndrome, bronchopulmonary lesions and symptoms of other organs and systems disorders. These made it difficult to differentiate between the PTB+OLI combination and PTB, and their diagnosis is possible only when M. tuberculosis and causative agents of other OLI are de-tected. If there is a combination of several lung diseases, chest computed tomography shows dissemination syndrome, adenopathy syndrome and lung pattern pathology syndrome, which looks like ground-glass opacity. In these cases, the PTB+OLI combination played not the least role, which together with direct lung lesions by HIV, made it impossible to differentiate these pathologies. The difference was possible only when M. tuberculosis and causative agents of other OLI were identified. Conclusion. With study data, an algorithm for the sequential etiological diagnosis of the PTB and OLI combination in patients with advanced stages of HIV infection with immunodeficiency was proposed.