[Morphological signs of inflammatory activity in different clinical forms of drug-resistant pulmonary tuberculosis]. / Morfologicheskie priznaki aktivnosti vospaleniia pri razlichnykh klinicheskikh formakh lekarstvenno-ustoichivogo tuberkuleza.

AIM: to determine whether the activity of tuberculous inflammation is associated with different clinical forms of drug-resistant pulmonary tuberculosis. SUBJECTS AND METHODS: The material taken from 310 patients operated on in 2010-2015 were retrospectively examined. The patients underwent economical lung resections of limited extent (typical and atypical ones of up to 3 segments) for circumscribed forms of tuberculosis with bacterial excretion. A study group consisted of 161 (51.9%) patients with drug-resistant variants of pulmonary tuberculosis. A control group included 149 (48.1%) patients with preserved susceptibility of Mycobacterium tuberculosis to anti-TB drugs. The activity of specific changes in tuberculosis was morphologically evaluated in accordance with the classification proposed by B.M. Ariel in 1998. RESULTS: The highest activity of fourth-to-fifth degree specific inflammation, including that outside the primary involvement focus, was obtained in the drug-resistant pulmonary tuberculosis group due to the predominance of patients with cavernous and fibrous-cavernous tuberculosis versus those in whom the susceptibility to chemotherapeutic agents was preserved. A macroscopic study showed that the primary lesion focus had a median size in one-half of the all the examinees; but large tuberculomas, caverns, and fibrous caverns over 4 cm in diameter were multiple and detected in the drug-resistant pulmonary tuberculosis group. Multidrug resistance was observed in more than 60% of the patients with fibrous-cavernous pulmonary tuberculosis, extensive drug resistance was seen in those with cavernous tuberculosis, which is an aggravating factor. The data obtained from the morphological study of the intraoperative material can specify the clinical form of tuberculosis and evaluate the efficiency of preoperative specific therapy. The highest activity of specific inflammation was observed in patients with multiple drug-resistant pulmonary tuberculosis, the prevalence of third-to-fourth degree specific changes was seen in those with multiple and extensively drug-resistant tuberculosis. CONCLUSION: The findings suggest that the activity of tuberculous inflammation is associated with different clinical forms of drug-resistant tuberculosis and with a spectrum of drug resistance.

[Prognostic value of morphological signs of the activity of tuberculous inflammation in patients with circumscribed drug-resistant pulmonary tuberculosis].

The paper provides the morphological characteristics of a specific process in patients with drug-resistant pulmonary tuberculosis. Morphological study of intraoperative samples has shown a predominance of common active inflammatory changes in most cases. There is evidence for an association of the morphological activity of a tuberculous process with the clinical types and duration of the disease and their spectrum of drug resistance. The high morphological activity of specific inflammation (IV-V) substantially increases the risk of specific postoperative complications and relapses in the late follow-up periods.