Clinical, laboratory and radiological associations with extending of the intensive phase of treatment in patients with first diagnosed infiltrative pulmonary tuberculosis

Vasyl Kushnir

doi:10.15587/2519-4798.2021.246236

Abstract

Despite the availability of medical services, timely detection of pulmonary tuberculosis, before the appearance of destructive changes, is often difficult. The management of patients with an infiltrative form in a hospital setting does not always guarantee the same positive effect and sometimes requires prolongation of therapy. The effectiveness of therapy can be associated with various factors and is of interest to study. The aim of this work was to study the effectiveness of standard therapy in patients with first diagnosed infiltrative pulmonary tuberculosis, clinical laboratory and radiological associations with prolongation of the intensive phase of treatment. Materials and methods. The study involved 109 men from 18 to 53 years old with first diagnosed infiltrative pulmonary tuberculosis with preserved MBT sensitivity to 1-st line anti-tuberculosis drugs. Patients were examined before and after 60 doses of the intensive phase of treatment, after which two groups were formed. Group 1 included patients with pronounced positive clinical and radiological dynamics, who entered the continuation phase of therapy. Group 2 included patients with insufficient clinical and radiological dynamics, for whom the intensive phase of treatment was extended to 90 doses. Results. Weak dynamics in patients who needed prolongation of treatment was associated with the characteristics of the initial data of patients in this group compared with similar indicators in Group 1. These were a reliably higher frequency of symptoms of intoxication and coughing, a reliably greater number of patients excreting mycobacterium tuberculosis in large quantities in sputum, with reliably high blood concentrations of haptoglobin and ceruloplasmin levels. Conclusions. Patients requiring prolongation of the intensive phase of treatment are characterized by an initially higher prevalence of infiltrative changes in the lungs, a small number of lung lesions limited to 2 segments, the presence of destructive changes in 100 % of cases, and a significant increase in the factors of the systemic inflammatory response

Highlights

Mycobacterium tuberculosis (MBT) is a causative agent of an infectious disease that has perfected its art of survival in human communities since ancient times [1]
Group 1 consisted of patients with positive clinical and radiological dynamics (n=81), who proceeded to the stage of treatment – the continuation phase (CP)
All patients included in the study were divided into 2 groups according to the degree of clinical and laboratory and radiological dynamics, patients in Group 2 had clearly insufficient, but positive dynamics of clinical and laboratory parameters and were characterized by the presence of destructive changes in the lungs in 100 % of patients, which required prolongation of treatment up to 90 doses

Summary

Introduction

Mycobacterium tuberculosis (MBT) is a causative agent of an infectious disease that has perfected its art of survival in human communities since ancient times [1]. Taking into account the fact that tuberculosis is an infectious, and a social disease in many countries, it was proposed to conduct an X-ray examination in groups with a high risk of this pathology morbidity [7]. Most of these groups are people with socioeconomic problems, which serves as a complicating factor for attracting them to the survey [8]. The detection of active tuberculosis in the early stages of the disease is often difficult, which leads to an increase in the number of common forms with significant destructive

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