Tuberculosis - I.T. Pyatnochka 2005

Pulmonary tuberculosis in combination with other diseases and pregnancy
Tuberculosis and non-specific respiratory diseases

In recent years, a global increase in chronic nonspecific lung diseases (CNSLD) has been observed, ranking them among the leading causes of morbidity right after cardiovascular diseases. CNSLD frequently co-occurs with chronic forms of Pulmonary Tuberculosis, or, following its cure, with residual post-tuberculous Changes in the Lungs.

Pathogenesis. Pulmonary tuberculosis may develop against the Background of CNSLD or precede them. The Development of nonspecific pulmonary diseases in tuberculosis patients is associated with fibrotic alterations in the lung tissue, deformation, impaired trophic status, and compromised bronchial drainage function, all of which create a favorable environment for the proliferation of pathogenic flora. With the rising incidence of tuberculosis among the elderly population, There is a corresponding increase in the frequency of Chronic Bronchitis, protracted and recurrent pneumonias, emphysema, Bronchiectasis, and suppurative lung diseases.

The Clinical presentation of co-existing tuberculosis and CNSLD is characterized by more pronounced intoxication phenomena, prominent bronchopulmonary syndrome signs, catarrhal symptoms, and significant pathological changes in peripheral Blood.

The clinical manifestations of chronic bronchitis and bronchiectasis developing on the background of post-tuberculous changes are less pronounced than in other patients. The relative benignancy of their course is attributed to the upper-lobe localization of the process and superior conditions for drainage and sputum clearance. Protracted Pneumonia is characterized by more pronounced intoxication symptoms compared to chronic bronchitis, obstructive impairments, and occasionally abscess formation.

In patients with allergic alveolitis, Bronchial Asthma, and inactive post-tuberculous lung changes, prolonged corticosteroid therapy may trigger the development of «steroid» tuberculosis, which is distinguished by its widespread nature and propensity for tissue breakdown.

Diagnosis relies heavily on patient history, auscultatory, laboratory, and radiological findings—specifically, the comparison of serial chest radiographs over time—and occasionally, trial therapy.

The Treatment of patients with active pulmonary tuberculosis and an exacerbation of CNSLD must target both conditions simultaneously, typically involving 3-4 antituberculous drugs combined with broad-spectrum nonspecific Antibiotics, sulfonamides, expectorants, bronchodilators, and Vitamins B₁, B₆, and C.