Features of endobronchial pathology among patients with chemoresistant tuberculosis of lungs depending on a case of the previous disease

Abstract

Objective – to study character and features of endobronchial pathology among patients with chemoresistant tuberculosis (CRTB) of lungs depending on a case of the previous disease.

Materials and methods. Studying of endobronchial pathology was carried out in 79 patients with CRTB of lungs with lesion of mucosa of bronchi. The patients were divided into 2 groups depending on a case of the previous disease of tuberculosis: the 1^st group included 35 patients with new cases (tuberculosis) of CRTB of lungs (middle age – 39.1 ± 2.2 years), the second – 44 patients with repeated cases of CRTB of lungs (middle age – 39.5 ± 1.7 years diagnosed for the first time). In both groups males prevailed: 23 (65.7 %) and 31 (70.4 %), respectively. Diagnostic fibre-optic bronchoscopy of a tracheobronchial tree was carried out on clinical base of the department of phthisiology and pulmonology of ZSMU at Municipal institution "Zaporizhzhia Regional Antituberculous Dispensary" by the applicant V. M. Khlystun.

The criteria for including of patients into the study were: existence of resistance of micobacteria of tuberculosis to anti-microbacterial drugs among patients with new and repeated episodes of tuberculosis, pathology of the mucosa of bronchi confirmed at fiber-optic bronchoscopy. Serious associated diseases (HIV infection/AIDS, diabetes mellitus, etc.) were criteria of exclusion. The condition of mucosa of bronchi was studied under narcotic anaesthesia by fibrotic bronchoscopes of Olympus (Japan). Pathology of a bronchial tree was described according to classification of М. Shesterina, A. Kalyuk (1975). Results of the research are processed by modern methods of the analysis on the personal computer with use of a statistical package Statistica^® for Windows 6.0 license program (StatSoft Inc., No. AXXR712 D833214FAN5).

Results. All patients with CRTB of lungs with endobronchial pathology, irrespectively of the case of the previous disease excreted micobacteria with prevalence of multirefractory strains of MBT and had infiltrative clinical form and destructive lesion of segmental bronchi of S₁₊₂. Among patients with new cases of CRTB of lungs tuberculosis of bronchi prevailed and among patients with repeated cases of CRTB of lungs the nonspecific endobronchitis prevailed. Irrespective of the case of the previous disease, tuberculosis of bronchi was diagnosed mainly in combination with non-specific endobronchitis. Infiltrative tuberculosis of bronchial tubes (62.9 %) prevailed among patients with new cases of CRTB of lungs, and among with repeated – the frequency infiltrative and infiltrative fistulous was almost identical (27.5 % and 25 % respectively). The frequency of development of stenosis of the affected bronchial tube was seen in 1,6 times more often than in case of the repeated one (65.7 % against 40.9 % respectively). Non-specific endobronchitis among the patients with CRTB of lungs, irrespective of the case of the previous disease, preferentially one-sided localization also had a purulent character.

Conclusions. The obtained data demonstrated that it is necessary to apply both specific and non-specific methods of correction, pathology of mucosa of a tracheobronchial tree among the patients with CRTB of lungs, irrespectively of the case. At the same time this correction among the bigger part of patients, namely, with existence of the combined course of tuberculosis of bronchi and non-specific bronchitis demands simultaneous use of methods of correction of both pathologies.