Critical Conditions in Pulmonary Tuberculosis in Adults - N.I. Fomichova 2010

Preface

Class="center">List of Abbreviations

BP - Blood pressure

Hist0 - histological examination was not performed

ARF - Acute Respiratory Failure

AHF - acute Heart Failure

DIC - disseminated intravascular coagulation syndrome

Destr- - absence of destruction in the lung tissue

Destr+ - presence of destruction in the lung tissue

RF - respiratory failure

ECG - electrocardiography

EchoCG - echocardiography

VC - vital capacity

RPT - residual Pulmonary Tuberculosis changes

C 0 - Mycobacterium tuberculosis was not tested by culture method

C + - positive culture result for MTB

Cat. - category

Coh. - cohort

LII - leukocytic intoxication index

CORF - Cor Pulmonale and heart failure

M- - Mycobacterium tuberculosis was not detected by direct sputum smear Cell/15.html">Microscopy

MTB+ - Mycobacterium tuberculosis present

MTB- - Mycobacterium tuberculosis absent

MVL/PMVL - maximum ventilation of the Lungs / predicted maximum ventilation of the lungs

MRI - Magnetic Resonance imaging

PVC - predicted vital capacity

CI - circulatory insufficiency

PBV - predicted blood volume

CT - chest Organs

FEV₁ - forced expiratory volume in 1 second

BV - blood volume

Resist 0 - drug-susceptibility testing of M. tuberculosis to anti-TB drugs was not performed

Resist - - no resistance of M. tuberculosis to anti-TB drugs

Resist + - presence of M. tuberculosis resistance to anti-TB drugs

IRV/ERV - inspiratory reserve volume / expiratory reserve volume

TB rel. - tuberculosis relapse

SP - Spontaneous pneumothorax

CVS - Cardiovascular system

PE - Pulmonary Embolism

GI - gastrointestinal tract

MV - minute ventilation

CC - Chronic cor pulmonale

CHF - chronic heart failure

CTB - chronic tuberculosis

CVP - central venous pressure

CNS - Central Nervous system

HR - heart rate

ESR - ERYTHROCYTE SEDIMENTATION RATE

Preface

Despite the vast arsenal of guidelines for tuberculosis patient care, regulations, orders, instructions, directives, recommendations, and organizational approaches aimed at overcoming the tuberculosis epidemic, it remains an exceptionally dangerous disease.

Today, tuberculosis in Ukraine has become a severe socio-medical and economic challenge, posing a national security threat as it inflicts substantial economic losses due to high mortality rates and both temporary and permanent disability.

One of the distinctive Features of the modern tuberculosis epidemic is that The Structure of morbidity is heavily dominated by young, able-bodied individuals. They frequently present with widespread, destructive forms of the disease accompanied by bacterial excretion, pronounced Intoxication syndrome, and a complicated clinical course, usually combined with extrapulmonary manifestations. The tuberculosis crisis has been further exacerbated by the spread of HIV/AIDS, drug addiction, and socioeconomic hardships among the population. Consequently, recent years have seen The Emergence of Clinical forms of this disease that were virtually unheard of in past decades: Caseous Pneumonia, miliary pulmonary tuberculosis, tuberculous meningoencephalitis, total polycavitary pulmonary lesions, generalized forms of tuberculosis, Tuberculosis of the Larynx and Bronchi, and others. It is precisely these forms of the disease that trigger various critical conditions requiring urgent medical intervention and, frequently, intensive care measures.

Against the backdrop of a significant rise in untimely and late diagnoses of tuberculosis, coupled with multidrug resistance to anti-tuberculosis drugs, Treatment efficacy is steadily declining. As a result, There is a continuous increase in the number of patients with a progressive disease course, which frequently culminates in multiple critical conditions and the necessity for emergency medical care.

Today, the burden of fighting tuberculosis rests not only on phthisiatricians, but primarily on the general healthcare network. Expectations and demands are growing for emergency medical physicians, medical staff at district and rural health posts, community hospitals, outpatient clinics, and feldsher-midwife stations (FAPs). In life-threatening emergencies, severe disease courses, and often in the terminal stages of progressive tuberculosis, the provision of emergency medical care becomes vital. Patient survival typically depends on its quality; therefore, diagnostic proficiency and The ability to provide qualified medical care are mandatory for physicians of any specialty.

Medical specialization has enabled a deeper understanding of specific issues regarding critical conditions in therapeutic diseases and has improved the quality of emergency therapeutic care. The Development of resuscitology, along with the establishment of intensive care units, blocks, and wards, has provided a strong impetus for introducing Modern Methods of diagnosing and treating critical conditions in cardiology, traumatology, neurology, otolaryngology, gastroenterology, and other fields. While there is ample literature on emergency conditions in internal medicine, there is virtually none dedicated entirely to critical conditions in respiratory tuberculosis. Textbooks and other educational Materials typically cover only isolated topics, such as Pulmonary Hemorrhage and Hemoptysis, spontaneous pneumothorax, internal organ amyloidosis, and chronic cor pulmonale. Consequently, there is a pressing need for a study guide that serves as a comprehensive compendium of the critical conditions most frequently accompanying respiratory tuberculosis in adults in modern clinical practice and capable of causing mortality.

The purpose of this study guide is to help medical students acquire theoretical and practical knowledge regarding the Diagnosis and emergency management of various critical conditions in patients with respiratory tuberculosis. The guide outlines the pathophysiological Prerequisites for the development of critical conditions in tuberculosis and examines their Classification based on the underlying cause of complications, severity, duration, phase, and clinical form of the tuberculosis process. It covers the Pathogenesis, clinical manifestations, and management strategies for pulmonary hemorrhage and hemoptysis, hemothorax, spontaneous pneumothorax, pulmonary embolism, acute heart and respiratory failure, Atelectasis, and intoxication syndrome. Diagnostic and emergency care algorithms have been developed for the critical conditions most commonly encountered in respiratory tuberculosis. The authors also present their own clinical observations regarding various critical states in complicated tuberculosis.

We hope that the publication of this study guide is both timely and useful, that it will be welcomed with interest primarily by students and interns, and that it will prove valuable to residents and practicing physicians across various specialties.

Please send any comments and suggestions to the following address: Department of Phthisiology, Clinical Immunology, Allergology, and Medical Genetics, 12 Krasnodonska St., Luhansk.

The Authors