GRANULOMATOSIS IN TUBERCULOSIS PRACTICE

Abstract

The article deals with conceptual issues and analysis of the problem of differential diagnosis of various granulomatosis depending on the etiological factor of granuloma, their prevalence in the practice of a phthisiologist, provides an overview of the literature data and own experience of differential diagnosis. The aim of the study. Study of the structure of various granulomatoses in an antituberculous institution based on the analysis of data registered in the Moscow city phthisiological institution. Materials and methods. It is based on data on the detection and observation of sarcoidosis, disseminated tuberculosis, mycobacteriosis, pneumonitis, vasculitis for decades on the basis of the head city joint phthisiological institution of Moscow GBUZ «Moscow City Scientific and Practical Center for Tuberculosis Control of the Department of Health of the City of Moscow». Results. Tuberculosis is an infectious disease, the causative agent of which Mycobacterium tuberculosis (MBT) causes an immune response with the formation of granulomatous inflammation. Granulomatous inflammation is a complex, cell–mediated immune response, the development of which requires the presence of a persistent antigen in macrophages. MBT is the most common, but not the only such antigen. Epithelioid cell granulomas develop in tuberculosis, sarcoidosis, mycobacteriosis, vasculitis, mycoses, pneumoconiosis, alveolitis and in some cases are identical in all diseases, with the same mechanism of transformation of macrophages into epithelioid cells and Pirogov–Langhans cells and the mechanism of granuloma formation. Depending on the etiological factor, granulomas may have certain structural features and involutions that can only be identified by examining a sufficient amount of morphological material. In this regard, in practice, the diagnosis of granulomatosis is traditionally a difficult task. One of the most important competitors of tuberculosis, as granulomatosis, is sarcoidosis. The results of unofficial statistics of sarcoidosis in Moscow for 1961-2019 on the frequency and structure of clinical forms, course variants, and outcomes considered, the incidence in representative samples by year and the prevalence of sarcoidosis of the respiratory organs in the metropolis are determined. The analysis of epidemiological indicators on disseminated tuberculosis in Moscow for 2012-2019 presented. Among various groups of the population. The spectrum of the main types of granulomatoses, other than tuberculosis, dropped out of phthisiological clinics in 2010-2020 has been determined.