Tuberculosis - I.T. Pyatnochka 2005

Pulmonary tuberculosis combined with other conditions and pregnancy
Tuberculosis and diabetes mellitus

Pulmonary Tuberculosis occurs 5 times more frequently in patients with Diabetes Mellitus than in the general population, and over the past decade, the number of patients with this comorbidity has doubled. Notably, latent diabetes mellitus is observed 8-10 times more often in tuberculosis patients and tends to exacerbate as the tuberculosis progresses.

Pathogenesis. In the majority of patients, tuberculosis develops against the Background of diabetes mellitus As a result of the reactivation of old, incompletely healed foci in the Lungs or intrathoracic Lymph Nodes, and is predominantly of endogenous origin. Contributing factors to the onset and severe course of tuberculosis in diabetic patients include profound Metabolic Disorders that lead to suppressed phagocytosis and impaired immune responses. Furthermore, tissue acidosis in decompensated diabetes accelerates the proliferation of MBT and reduces the efficacy of INAH medications.

Pathological anatomy. Many patients with diabetes mellitus exhibit a predominance of exudative forms of tuberculosis with a tendency toward tissue breakdown and bronchogenic dissemination, with the pathological process frequently localized in the lower lobes of both lungs.

The Clinical presentation of tuberculosis depends on the chronological order in which diabetes and tuberculosis develop. Tuberculosis takes a more severe course if it develops prior to the onset of diabetes. The progression of tuberculosis developing against the backdrop of existing diabetes depends on the specific form of the pathological process and may be acute—mimicking Pneumonia or Influenza—gradual, or asymptomatic. Limited forms of pulmonary tuberculosis in patients with diabetes present with mild clinical signs, which is sometimes attributable to the severely diminished reactivity of patients with advanced diabetes.

The Diagnosis of tuberculosis largely relies on regular radiological examinations of patients with diabetes mellitus. Because diabetic patients belong to a high-risk group, they must undergo fluorographic screening at least once a year.

Tuberculin sensitivity is frequently reduced, particularly in severe forms of diabetes mellitus. Bacterial excretion depends on the presence of destruction cavities in the lungs.

The Treatment of pulmonary tuberculosis complicated by diabetes mellitus must primarily aim to correct metabolic disorders through a physiological diet and optimal Insulin dosing. Antimycobacterial therapy is administered following standard regimens, taking into account potential adverse drug reactions.