Предикторы летального исхода у пациентов с сочетанием туберкулеза, с устойчивостью к рифампицину, и ВИЧ-инфекции

A misdiagnosis of isolated pulmonary tuberculosis (pTB) is highly likely when a patient has nontuberculous mycobacterial pulmonary disease (NTMPD) or a combination of nontuberculous mycobacterium pulmonary disease and pulmonary tuberculosis. Frequently, bacterial excretion is absent or only Mycobacteria tuberculosis (MBT) is found. This often results in an incorrect diagnosis and subsequent misinformed treatment regimes. In order to determine possible clinical and radiographic differences between patients with NTMPD (Group 1), destructive drug-resistant pulmonary tuberculosis (Group 3) and a combination of NTMPD and pTB (Group 2) we compare clinical and radiographic signs for these three patient groups. When comparing with Group 3 (2.5%), Groups 1 (25%) and 2 (17.4%) have a substantially higher incidence of pulmonary haemorrhages. Thus, upon clinically observing the combination of pTB and NTMPD, there are no pathognomonic clinical and radiographic detected symptoms. However, the presence of an indolent course, hemoptysis and bronchiectasis in the presence of acid-fast bacteria (or identified MBT) in the sputum makes it possible to suspect not simple pTB, but a combination of pTB and NTMPD. To clarify this necessitated in-depth bacteriological examination.

Objective. The aim of this study was to identify significant risk factors associated with postoperative complications, relapses, and exacerbations of pulmonary tuberculosis, with the intention of elucidating their cumulative effect on the likelihood of adverse outcomesMaterials and methods. An observational retrospective cohort single-center study included patients operated on for destructive pulmonary tuberculosis in the period 2004-2010. Inclusion criteria were the presence of a known long-term outcome of treatment or death in hospital. The exclusion criterion was unknown long-term outcome.. Out of 1338 patients operated in this period, 439 (32.8%) met the inclusion criteria.Results. 111 complications have developed in 87 (19.8%) patients in the postoperative period. In-hospital mortality (within 30 days after surgery) was observed in 4 cases (0.9%) and was associated with tuberculosis progression in all cases. Relapses have occurred in 114 (26.0%) of 439 patients within 15 years after surgical treatment. 16 main risk factors for postoperative complications and relapses of tuberculosis have been identified; the most significant were the presence of XDR MBT, the palliative nature of surgical treatment, duration of the disease, the presence of cachexia and bacterial excretion at the time of surgery. For each patient, the sum of factors in points was calculated (one factor = 1 point). A significant increase in the likelihood of tuberculosis reactivation (>50%) corresponded to a score >5 points. All cases of hospital mortality were observed in patients with a risk level of 9-10 points, late mortality from tuberculosis – 7–11 points.Conclusion: Patients with a risk score for tuberculosis reactivation exceeding 5 points demonstrate unsatisfactory treatment outcomes. This underscores the necessity for a more judicious approach to surgical indications, discouraging palliative interventions, while emphasizing the imperative development of preventative strategies tailored to individual risk level.

The OBJECTIVE was to reduce the risk of complications and mortality after pleuropneumonectomy in patients with pulmonary tuberculosis complicated by pleural empyema.METODS AND MATERIALS. The immediate and long-term results of surgical treatment were analyzed in 910 patients who underwent pneumonectomy between 1984 and 2021. Among these, 342 patients (37.6 %) underwent pleuropneu- monectomy (Group I), while 568 patients (62.4 %) underwent pneumonectomy (Group II). Group I was further divided into two subgroups. Subgroup Ia consisted of 278 patients (main group) who received stump-free suturing of the main bronchus according to D. B. Giller’s method, long-term drainage management of the pleural cavity using an original technique, and the proposed staged surgical tactics. Subgroup Ib comprised 64 patients who were treated using traditional methods for the main bronchus and puncture management of the pleural cavity.RESULTS. Postoperative complications were more frequent after pleuropneumonectomy (PPE); however, the mortality rate in Subgroup Ia and Group II did not significantly differ. In contrast, the hospital mortality rate in Subgroup Ib, which utilized traditional approaches for the treatment of the main bronchus and puncture management of the pleural cavity, was 2.3 times higher than the mortality rate after pneumonectomy (PE). The incidence of complications, mortality, recurrence of tuberculosis, and empyema differed significantly between Subgroups Ia and Ib, with the best outcomes observed in Subgroup Ia. These results are attributed to the applied method of treating the main bronchus, pleural cavity management, and differentiated surgical tactics.

With the annual increase in the prevalence of multidrug-resistant (MDR) pathogen, the effectiveness of etiotropic chemotherapy of tuberculosis is decreasing; the demand for surgical treatment, the use of which remains limited in the world and in the Russian Federation, is increasing.The aim of the study is to evaluate the effectiveness of the strategy of treatment of first detected destructive pulmonary tuberculosis based on early and wide application of surgical treatment, including minimally invasive techniques.Materials and methods. A retrospective cohort multicenter study included patients of tuberculosis institutions in 51 regions of the Russian Federation, analyzed the performance of phthisiosurgical departments for the period 2007–2016. The long-term results of treatment were evaluated in 1090 patients operated for MDR/XDR tuberculosis (Group 1) and in 888 patients who refused surgery (Group 2).Results. In Penza region, 92.8% of patients were abacilliated one year after application of the developed strategy, lethality decreased 3 times compared to the results of treatment in the previous 2 years; in 3 years clinical cure was registered in 94% of operated patients. During 4 years of active surgery in Chuvashia the contingent of patients with fibrotic cavernous tuberculosis was reduced 2.3 times, in Tambov region “bacillary core” in the region was reduced 3.6 times. Effective course of treatment was noted in 92,6% of patients of group 1 (operated) and only in 17,1% of patients of group 2 (refused surgery), р < 0,001. Clinical cure in 3 years was achieved in 85.7% of group 1 patients and only 5.2% of group 2 patients (р < 0,001).Conclusion. Wide application of surgical treatment and collapse therapy is a prerequisite for achieving the target indicators of treatment efficiency in tuberculosis patients.

Objective: To investigate the impact of delayed video-assisted thoracoscopic surgery (VATS) on the rate of postoperative complications and tuberculosis recurrence following pneumonectomy.Materials and methods: A retrospective, open, cohort, nonrandomized, multicenter study conducted between 1984 and 2022 included 815 patients with destructive pulmonary tuberculosis who underwent pneumonectomy with delayed VATS thoracoplasty (group 1, 214 patients) or without it (group 2, 601 patients). Both groups were further divided into 3 subgroups based on multislice computed tomography findings of the remaining lung condition: А, no pathology; Б, foci or tuberculoma without cavitation; В, cavitation (CV+).Results: In group 1, postoperative complications occurred in 7 patients (3.27%); there was no hospital mortality, and the short-term effectiveness of the surgery was 95.79% (205 patients). In group 2, these parameters were 28.95%, 7.49%, and 85.36%, respectively. In group 1, the effectiveness at 1, 3, and 5 years after discharge was 98.54%, 95.51%, and 93.20%, respectively; 32 (15.53%) patients had recurrence or progression of tuberculosis. Eight patients (3.88%) died from tuberculosis, and 11 (5.24%) experienced late bronchopleural complications. The 5-year survival rate for group 1 was 93.96%. The long-term outcomes in group 2 were worse. The effectiveness at 1, 3, and 5 years was 91.33%, 89.81%, and 87.28%, respectively. Recurrence or progression of tuberculosis was observed in 74 patients (18.88%); 34 patients died from tuberculosis (8.67%), and 42 patients had late bronchopleural complications (10.71%). The 5-year survival rate was 85.52%.Conclusions: Delayed VATS thoracoplasty significantly improves both short-term and long-term outcomes of pneumonectomy in patients with tuberculosis, especially in case of a destructive process affecting the remaining lung.