[Analysis of lethal outcomes in patients with newly-diagnosed tuberculosis of the respiratory organs in combination with HIV-infection].

AIM: To analyse lethal outcomes in patients with newly-diagnosed respiratory tuberculosis comorbid with HIV-infection depending on initial count of CD4+ lymphocytes. MATERIAL AND METHODS: Of 304 HIV patients with newly-diagnosed tuberculosis treated in Moscow Tubercusis Hospital N 7 in 2006-2010, 40 (13.2%) patients died. Tuberculosis diagnosis was made after detection of M. tuberculosis (MT) by different tests, MT DNA in different biological material, histological verification or by effectiveness of specific antituberculous therapy. Postmortem examinations were made according to the protocol. RESULTS: Significant differences were detected in patients with initial count of CD4+ lymphocytes less than 50 in 1 mcl. Specific CNS affection was found in patients with initial lymphocyte count CD4+ less than 100 in 1 mcl. Most of autopsy examinations registered generalized acutely progressive tuberculosis with multiple lesions of internal organs and lymph nodes (LN). Microscopy revealed obscure morphological picture of specific inflammation with prevalence of alternative-exudative tissue reactions in the absence of a productive inflammation component. Cases with submiliary dissemination which was invisible in macroscopic examination due to a bright picture of exudative tissue reaction (rare plethora of the lungs, alveolar and interstitial edema, perifocal inflammatory reaction of nonspecific reactive nature) and small size of the lesions. The comparison of clinical and autopsy diagnoses revealed that involvement of intrathoracic LN and miliary dissemination, according to autopsy, occurred much more frequently than shown by antemortem standard x-ray examination of the chest. CONCLUSION: It is strongly recommended to perform computed tomography of the chest in all HIV-infected patients with long-term fever but without visible alterations on chest x-ray.

[Organization of emergency health care to patients with tuberculosis].

Tuberculosis hospital No. 7 is an emergency general tuberculosis institution. In 2005, a total of 3847 patients were sent to the reception room; out of them 2045 were delivered by ambulances. That year, there were 568 emergency surgical interventions for comorbidity (n=343) and tuberculosis and its complications (n=225). The high availability of current diagnostic procedures and the presence of different skilled medical specialists enable one to promptly establish the diagnosis, which improves prognosis and reduces the length of hospital stay and the number of admission to tuberculosis and general hospitals. Tuberculosis hospital No. 7 provides diagnostic and therapeutic (primary) aids to patients who need no hospital care, which reduces the potential time of disability. The activity of tuberculosis hospital No. 7 is aimed at upgrading the quality of medical aid, reducing the number of wrongful admissions and the length of hospital stay, improving the occupational and social prognosis in patients with tuberculosis, and considerably saving the budgetary funds of the Moscow Department of Health Care.