Tuberculosis - I.T. Pyatnochka 2005

Pulmonary tuberculosis in combination with other diseases and pregnancy
Tuberculosis and alcoholism

Patients suffering from Pulmonary Tuberculosis combined with alcoholism represent the most socially and epidemiologically dangerous group. The incidence and prevalence of tuberculosis among individuals with alcoholism are 18 and 21 times higher, respectively, than in the general population. The proportion of alcoholics among patients registered at anti-tuberculosis dispensaries is quite high (25 %), particularly among newly diagnosed tuberculosis cases (15 %>).

Pathogenesis. Prolonged alcohol intoxication leads to a decline in both General and Specific bodily resistance. In the Lungs, alcohol damages the alveolar epithelium, causes the destruction of pulmonary macrophages, and triggers inflammatory infiltration of the bronchial walls and Blood Vessels, resulting in impaired mucociliary clearance and the dissolution of surfactant. Functional and organic Changes in the Central Nervous system and Internal Organs lead to severe metabolic disturbances.

Tuberculosis in patients with alcoholism most commonly develops As a result of the endogenous reactivation of residual post-tuberculous lesions; however, given the patients' antisocial behavior and disregard for sanitary standards, exogenous superinfection also plays a significant role in The Development of the disease.

Pathological anatomy. The course of the tuberculous process largely depends on the stage of alcoholism. Alcoholics more frequently present with disseminated, severe forms of tuberculosis, notably fibro-cavitary tuberculosis, whereas patients in stage III alcoholism often develop polycavitary tuberculosis, which is frequently complicated by Caseous Pneumonia.

Clinical Features. The onset and progression of tuberculosis in individuals with alcoholism may be acute or insidious, frequently masked by the symptoms of chronic alcoholism. The clinical picture of these comorbid conditions is significantly influenced by concurrent disorders of The Cardiovascular system, gastrointestinal tract, and others. Chronic alcoholism combined with tuberculosis can assume a malignant course (alcoholic psychosis, prolonged binge drinking), which considerably worsens the prognosis of the tuberculous process.

Diagnosis. Tuberculosis diagnosis is based on radiological findings and sputum examination for MBT. For the purpose of early detection, chronic alcoholics are subject to mandatory annual fluorographic screening. Nevertheless, they frequently ignore preventive examinations and seek medical help at general healthcare facilities at a late stage.

Treatment. The management of patients with concurrent tuberculosis and alcoholism involves a combination of anti-tuberculosis and anti-alcohol interventions. Once alcohol remission is achieved, a full course of antimycobacterial therapy can be administered. In cases of treatment failure, surgical interventions are indicated, with the criteria for surgery broadened by shortening the duration of preoperative antimycobacterial preparation. Notably, Chemotherapy is preferably administered parenterally or endobronchially, alongside the extensive use of pathogenetic agents, particularly hepatoprotectors, antioxidants, and Vitamins. In cases of stage III alcoholism, cycloserine and other drugs that adversely affect the central nervous system are contraindicated.