RESUMO
Examining the performance of the local protective system has indicated that patients with drug-resistant pulmonary tuberculosis in the presence of the higher count of cytotoxic lymphocytes had the diminished activation of lymphoid elements of bronchoalveolar lavage (BAL) and decreased alveolar macrophageal production of active oxygen forms. However, there was a drastically increased formation of active oxygen forms in the BAL macrophagues during mycobacterial phagocytosis, which may result to their death. At the same time, the decreased production of gamma-interferon in the BAL cells was found in patients with drug-resistant tuberculosis (8.0 +/- 3.0 U/ml versus 10.7 +/- 2.0 U/ml). In such patients, the generation of alpha-interferon was 105.0 +/- 38.0 U/ml versus 187.0 +/- 72 U/ml in patients with tuberculosis caused by drug-resistant Mycobacterium tuberculosis. In patients with drug-resistant tuberculosis, the lower production of alpha- and gamma-interferons in the BAL cells leads to their decreased regulatory effect on the mechanisms of local defense of the lung. The drastically enhanced production of active oxygen forms, which has been ascertained in patients with drug-resistant tuberculosis, is able to result in the death of macrophages, the release of lysing enzymes into the tissues surrounding the lung; the higher count of T cytotoxic lymphocytes, the lower levels of cells in apoptosis, and mycobacterial resistance to antibacterial drugs deteriorate the course of pulmonary tuberculosis in this category of patients.
