Search

The results of treatment of 12 patients, suffering complicated forms of abdominal tuberculosis and external intestinal fistulas, were presented. Late diagnosis of abdominal tuberculosis in the patients, suffering the complications phase of the disease, is caused by unclear symptoms presence in early stages of the disease. Clinical and laboratory indices in peritonitis of a phthisis origin are nonspeciphic. In 91% of patients, admitted to the hospital for complicated forms of abdominal tuberculosis and external intestinal fistulas, the operative treatment was indicated. Surgical intervention (more frequently right-sided hemicolectomy, enterostomy, the abscesses opening, the caseously-changed lymph nodes excision, formation of anastomosis) was performed in 11 patients for peritonitis and external intestinal fistulas. The method of a secure invagination anastomoses formation was elaborated, permitting to perform primary restoration operations. An early diagnosis, early effective therapy and radical surgical intervention conduction for complicated abdominal tuberculosis promote the patients to survive.

The data of a comprehensive study of 86 children aged 6 to 14 years, who were examined and treated at the Research Institute of Phthisiology for various manifestations of tuberculous infection: 25.6% with infected Mycobacterium tuberculosis with varying specific sensitization; 34.9% with minor forms of intrathoracic lymphatic tuberculosis (ITLT), 39.5% with disseminated processes into the intrathoracic lymph nodes, are analysed. Of the greatest informative value in the determination of the activity of tuberculous infection are RM V, VI, VII, and VIII dilutions in combination with immunological parameters of specific immunity: blast transpormation reaction (BTR) to PPD, a complex of serological reactions, IL-8, and lysosomal cationic test (LCT). Most children with ITLT showed a significant cellular response to PPD in the BTR test. It should be noted that on admission to the clinic, neutrophilic granulocytes were functionally inadequate in all the children as shown by LCT. The currently available immunological tests used in combination with the existing methods in the diagnosis of ITLT adequately evaluate the activity of tuberculous infection in children.

In modern society, there is a rise in the incidence of tuberculosis in all age groups, including children and adolescents. In old age group, a specific inflammation is detectable from Mantoux test results only in every four children. Tuberculous infection is diagnosed in half of cases when they turn to physicians for complains. Disseminated and complicated forms of tuberculosis are more frequently identified in these situations. The immune system has a particular emphasis on the course and outcome of the disease. The authors have established that caseous masses actively form, followed by the stimulation of the adequate cell pathway promoting the limitation of specific inflammation in old-age group children with primary tuberculosis. In secondary forms of tuberculous infection, there is an increase in the level of monocytes where the persistence and multiplication of the causative microorganism, as well as the activation of the humoral pathway inadequate for tuberculous infection are likely to occur, i.e. the infectious agent may be inhibited until activation of the Th-2 pathway of an immune response takes place.

The paper presents data on surgery for tuberculosis of the lymphatics and abdominal organs. Removal of tuberculosis-affected peripheral lymph nodes during etiotropic therapy yields positive therapeutical results in 84.6% of patients. The efficiency of early operations has been first evidenced by a dynamic study of the systemic immunity. Complicated abdominal tuberculosis is encountered in 44.2% and forced emergency and planned operations on the abdomen to be performed; good late results should be consolidated by combined bactericidal therapy.

Based on their own experimental (55 rabbits) and clinical (114 patients) findings, the authors propose a new immunopathogenetic approach to diagnosing tuberculous lymphadenitis under the present-day conditions by taking into account the environmental situation. They describe an original enzyme immunoassay for lymph nodal extracts, which has yielded positive results: 88% sensitivity, 92% specificity, and 90% diagnostic efficiency.

T- and B- cell immunity, levels of antituberculous antibodies, M. tuberculosis antigens and circulating immune complexes (CIC) were studied in 61 children with clinical manifestations of intrathoracic tuberculosis. T-cell immunity was subnormal in 39.5% of the examinees. Moderate inhibition of this immunity occurred in 14%. 46.5% of the examinees had normal T-cell immunity. B-lymphocyte count, IgG levels were normal, whereas IgA and IgM were low and elevated, respectively. T-cell immunity appeared the weakest in children with more advanced disease. Acute tuberculosis was associated with more frequent occurrence of CIC, antituberculous antibodies, tuberculous antigen. Administration of sodium nucleinate promoted normalization of T-cell immunity in the above patients. If they had antituberculous antibodies, antigens and CIC 2.5-12 months after chemotherapy, this indicated the persistence of the process activity and required continuation and perfection of chemotherapy.

To study the cellular component of local immune defence, bronchoalveolar lavage fluid (BALF) was examined in 69 patients: 24 children and adolescents with primary tuberculosis and 45 patients with secondary patterns of tuberculosis complicated by catarrhal and purulent endobronchitis. With no appreciable lesions in the bronchial mucosa the cellular composition of BALF and functions of alveolar macrophages (AM) in patients with primary tuberculosis are determined by the phase of specific process. In secondary tuberculosis associated with endobronchitis, the cellular composition of BALF is mainly determined by the character of bronchial pathology whereas AM function by the patterns of both specific and nonspecific processes.