CLINICAL MANIFESTATIONS OF PULMONARY TUBERCULOSIS AT EARLY AND LATE STAGES OF HIV INFECTION

Maksumova D. K., Hakimova R. A., Mamarasulova D. Z., Botirova B. T., Abdullayev M. B.

CLINICAL AND EXPERIMENTAL MEDICINE

Scentific article

According to the European Centre for the Epidemiological Monitoring of HIV infection, tuberculosis is the most common AIDS-defining illness. So, is registered in patients with newly diagnosed HIV infection in Eastern Europe for more than 50% of cases of tuberculosis. In the early stages of HIV infection for tuberculosis does not differ from those without HIV infection. HIV infection is on the "late" stages of the disease (stage 4B, 4C and 5) is the most serious risk factor for the development of tuberculosis in individuals infected with Mycobacterium tuberculosis (MBT). Every year the number of patients who survived to the later stages of HIV infection increased by 2-3%, and more than 50% of patients in Russia die from TB. It is well known that tuberculosis is on the stage of secondary diseases of HIV infection (stage 4B, 4B, 5) characterized acutely progressive course and a tendency to generalize, not infrequently with multiple lesions simultaneously extrathoracic localizations. The clinical picture of the disease in this group of patients could be due not only tuberculosis, but also a combination or opportunistic diseases. These features significantly complicate diagnosis and differential diagnosis of tuberculosis, which is a cause of inadequate treatment and often leads to death. Objective: to study the clinical symptoms and characteristics of tuberculosis at different stages of HIV infection. All patients after the establishment of HIV status were examined radiographically and sent for consultation phthisiatrician for suspected tuberculosis. Some patients who are registered in AIDS center at the next prophylactic fluorography study and identify pathology in the lungs to focus on examination at TB hospital. In all patients, the result of sputum analysis BC were negative. Selectively, some patients were sent for detection of tuberculosis accelerated method on GeneXpert machine. Where indicated, the patients underwent laboratory diagnosis of opportunistic infections and tuberculosis (ELISA "AT-TUBES-BEST Strip" (manufacturer - JSC "Vector-Best", similar strips for the determination of cytomegalovirus, herpes simplex virus and Candida and Aspergillus. Analyzed 102 stories disease, HIV-infected children hospitalized in the regional TB hospital for diagnosis and treatment of tuberculosis. Results and discussion: children — 60 (70%) prevailed among the surveyed children with confirmed TB, the villagers prevailed — 61 (71%). In the bulk of TB patients identified in the survey, after a set of HIV status 70; and 16 in the process of observation in the AIDS center (follow-up of 2 years at 8, 3 years — at 6; 4 years y 2). Analysis of the distribution of the clinical forms of the process established the following: among surveyed, with confirmed tuberculosis prevailed tuberculosis of intrathoracic lymph nodes in 70 (81.4%), disseminated tuberculosis was observed in 9 (10.4%), pleural effusion in 7 (8%). The study of the flow of tubercular process in the examined patients showed that among patients with tuberculosis of intrathoracic lymph nodes in 20% of installed small form bronhoadenita, 24% and 56% tumorozny infiltrative bronhoadenit. Accordingly, 80% of patients had acute clinical course with high fever, severe intoxication syndrome and painful, paroxysmal cough, and weight loss. Conclusions Thus, in HIV-infected children with a slight decrease in CD4 lymphocyte levels tuberculosis proceeded without complications, tuberculosis as identified by the uptake, as well as in patients who have contact with patients, was characterized by a sharp decline in immunity, in addition, the accession of secondary diseases, in turn, aggravates during both infections. In determining the HIV status should be carefully evaluated for tuberculosis and regularly fluorography research and consultation phthisiatrician, especially for 2-4 years from the time of detection, the multiplicity of the investigations must be addressed on the basis of the content of CD4-lymphocytes.

tuberculosis, HIV infection, clinical course, research methods (IFA, method on GeneXpert machine, crops on Bactec 960 machine), opportunistic infections

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«Bulletin of problems biology and medicine» Issue 1 part 2 (127), 2016 year, 96-99 pages, index UDK 616.71-007.234-053.