Plućna tuberkuloza imunokompromitovanih bolesnika
Sažetak
Uvod/Cilj. Imunokompromitujuće bolesti su tokom poslednjih decenija dovele do porasta broja obolelih od tuberkuloze. Cilj rada je bio da se ispita uticaj imunokompromitujućih bolesti na tok tuberkuloze. Metode. Ispitivanjem su obuhvaćene dve grupe od po 40 bolesnika obolelih od tuberkuloze koji su lečeni u Institutu za plućne bolesti Vojvodine tokom 2010. i 2011. godine. Prva grupa nije imala imunokompromitujuće bolesti (kontrolna grupa), dok su u drugoj grupi bili bolesnici sa pridruženim imunokompromitujućim bolestima. Korišćeni su podaci iz istorija bolesti, podaci Centra za mikrobiologiju i Centra za radiologiju. Dve grupe su poređene prema sledećim karakteristikama: starost, pol, bakteriološki status, radiološki nalaz, prisustvo neželjenih efekata lekova, prisustvo rezistencije M. tuberculosis na lekove, trajanje terapijskog režima i dužina hospitalizacije. Rezultati. Grupa imunokompromitovanih bolesnika je bila starija od kontrolne grupe i sa većom zastupljenošću muškog pola. Grupa imunokompromitovanih je imala statistički značajno duže prosečno vreme potrebno za direktnu konverziju sputuma (p = 0,000) i konverziju kultura sputuma na M. tuberculosis (p = 0,010), značajno češće prisustvo kaverne (p = 0,030), prosečno duže trajanje terapijskog režima (p = 0,000) i prosečno veći broj bolničkih dana (p = 0,000) u odnosu na kontrolnu grupu. Najčešća lokalizacija promena kod imunokompromitovanih je bila u svim režnjevima oba plućna krila (32,5%) dok su u kontrolnoj grupi promene bile najčešće lokalizovane u gornjim plućnim režnjevima (62,5%). Nije bilo statistički značajne razlike u nalazu mikobakterija u sputumu direktnom mikroskopijom, prisustvu neželjenih efekata lekova i prisustvu rezistencije na lekove između dve grupe bolesnika. Zaključak. Imunokompromitujuće bolesti menjaju tok tuberkuloze, prvenstveno utičući na bakteriološki status, radiološku prezentaciju, dužinu terapijskog režima i dužinu hospitalizacije.
Reference
Hauck FR, Neese BH, Panchal AS, El-Amin W. Identification and management of latent tuberculosis infection. Am Fam Physician 2009; 79(10): 879‒86.
Butt G, Altaf F, Hussain I. Pulmonary tuberculosis in dermato-logical patients on high-dose, long-term steroid therapy. J Pak Assoc Derma 2015; 15(2): 119‒31.
Oh YW, Effmann EL, Godwin JD. Pulmonary infections in im-munocompromised hosts: The importance of correlating the conventional radiologic appearance with the clinical setting. Radiology 2000; 217(3): 647‒56.
Okafor UH. Pattern of clinical presentations in immunocom-promised patient. In: Metodiev K, Immunodeficiency. Rijeka, Croaia: In Tech; 2012.
Grbac I, Smolčić S, Jurman D, Broz S. Clinical picture of pulmo-nary tuberculosis at the end of the second millennium. Acta Clin Croat 2000; 39: 175‒9.
Euroean Centre for Disease Prevention and Control. Use of inter-feron-gamma release assays in support of TB diagnosis. Stock-holm: ECDC; 2011.
Gooze L, Daley CL. Tuberculosis and HIV: HIV in Site Knowledge Base Chapter. San Francisco: University of Cali-fornia; 2013.
Kisembo HN, Boon DS, Davis JL, Okello R, Worodria W, Catta-manchi A, et al. Chest radiographic findings of pulmonary tu-berculosis in severely immunocompromised patients with the human immunodeficiency virus. Br J Radiol 2012; 85(1014): e130‒9.
Kumar N, Kedarisetty CK, Kumar S, Khillan V, Sarin SK. An-titubercular therapy in patients with cirrhosis: challenges and options. World J Gastroenterol 2014; 20(19): 5760‒72.
Mimi N, Medregoniu D, Olteanu M, Golli A, Olteanu M, Maceseanu A, et al. Tuberculosis and chronic renal failure; therapy patterns. Curr Health Sci J 2011; 37(2): 106‒8.
Malhotra KK. Treatment of tuberculosis in chronic renal fail-ure, maintenance dialysis and renal transplant. Indian J Neph-rol 2003; 13: 69‒71.
Gardam M, Iverson K. Rheumatoid arthritis and tuberculosis: time to take notice. J Rheumatol 2003; 30(7): 1397‒9.
Miras MD, Tenorio CH, Alonso JJ. Tuberculosis in patients with Systemic Lupus Erythematosus: Spain's situation. Reumatol Clin 2013; 9(6): 369‒72.
Borekci S, Atahan E, Demir YD, Mazıcan N, Duman B, Ozguler Y, et al. Factors affecting the tuberculosis risk in patients re-ceiving anti-tumor necrosis factor-α treatment. Respiration 2015; 90(3): 191‒8.
Silva DG, Silva BD, Junqueira-Kipnis AP, Rabahi MF. Tubercu-losis in rheumatoid arthritis patients: The difficulty in making the diagnosis of latent infection. J Bras Pneumol 2010; 36(2): 243‒51. (Portuguese)
Karnak D, Kayacan O, Beder S. Reactivation of pulmonary tu-berculosis in malignancy. Tumori 2002; 88(3): 251‒4.
Happel KI, Nelson S. Alcohol, immunosuppression, and the lung. Proc Am Thorac Soc 2005; 2(5): 428‒32.
Suhadev M, Thomas BE, Murugesan P, Chandrasekaran V, Charles N, Durga R, et al. Alcohol use disorders(AUD) among tuber-culosis Patients: A study from Chennai, South India. PLoS ONE 2011; 6(5): e19485.
Lönorth K, Williams BG, Stadlin S, Jaramillo E, Dye C. Alchocol use as risk factor for tuberculosis-a systematic review. BMC Public Health 2008; 8: 289.
Vasantha R, Sridevi S, Sudhakar G. Association between smok-ing, alcoholism and pulmonary tuberculosis. Int J Sci Res 2015; 4(6): 516‒8.
Yurteri G, Sarac S, Dalkilic O, Ofluoglu H, Demiröz OF. Features of pulmonary tuberculosis in patients with diabetes mellitus: A comparative study. Ch Hop Ýst Turk 2004; 1: 5‒8.
Golubović S, Đorđević I, Radović M, Pejović G, Stanković I. Im-portance of early diagnosis of low respiratory tract infections in patients with diabetes mellitus. Acta Fac Med Naiss 2005; 22(3): 139‒44.
Guptan A, Shah A. Tuberculosis and diabetes: An appraisal. Ind J Tub 2000; 47(1): 3‒8.
Ljubić S, Balachandran A, Pavlić-Renar I, Barda A, Metelko Ž. Pulmonary infections in diabetes mellitus. Diabetolpgia Croat 2004; 33(4): 115‒24.
Kiyan E, Kilicaslan Z, Gurgan M, Tunaci A, Yildiz A. Clinical and radiographic features of pulmonary tuberculosis in non-AIDS immunocompromised patients. Int J Tuberc Lung Dis 2003; 7(8): 764‒70.
Perez-Guzman C, Torres-Cruz A, Villarreal-Velarde H, Vargas MH. Progressive age-related changes in pulmonary tuberculo-sis images and the effect of diabetes. Am J Respir Crit Care Med 2000; 162(5): 1738‒40.
Singla R, Khan N, Al-Sharif N, Ai-Sayegh MO, Shaikh MA, Os-man MM. Influence of diabetes on manifestations and treat-ment outcome of pulmonary TB patients. Int J Tuberc Lung Dis 2006; 10(1): 74‒9.
Jabbar A, Hussain SF, Khan AA. Clinical characteristics of pulmonary tuberculosis in adult Pakistani patients with co-existing diabetes mellitus. East Mediterr Health J 2006; 12(5): 522‒7.
Fiske CT, Hamilton CD, Stout JE. Alchocol use and clinical manifestations of tuberculosis. J Infect 2009; 58(5): 395‒401.
Bacakoğlu F, Başoğlu OK, Cok G, Sayiner A, Ateş M. Pulmonary tuberculosis in patients with diabetes mellitus. Respiration 2001; 68(6): 595‒600.
Arbex MA, Varella Mde C, Siqueira HR, Mello FA. An-tituberculosis drugs: drug interactions, adverse effects, and use in special situations. Part 1: first-line drugs. J Bras Pneumol 2010; 36(5): 626‒40. (English, Portuguese)
Kanabus AInformation about Tuberculosis: TB Statistics-Global, Regional and High Burden. Global Health Education (GHE); 2016. Available from: www.tbfacts.org.
Bashar M, Alcabes P, Rom WN, Condos R. Increased incidence of multidrug-resistant tuberculosis in diabetic patients on the Bellevue Chest Service, 1987 to 1997. Chest 2001; 120(5): 1514‒9.