Corelaţia clinică şi imunologică la pacienţii cu eşec al tratamentului tuberculozei

Abstract

Background: Tuberculosis is a multipathogenetic disease, the treatment response of which is influenced by the degree of the immune disturbances. The acute progressive evolution of this disease with extensive destructions and dissemination causes the lowest treatment results and in most of the cases is influenced by the heterogeneous immune response. Material and methods: Clinical and immunological data obtained before and after a standard antituberculosis treatment of 54 new pulmonary TB cases with the failed treatment and of 34 new pulmonary successfully treated TB cases have been compared with the data of 50 healthy individuals. Results: It has been established that despite the similar distribution of patients by gender and age in the groups and the similar prevalence of risk factors among the patients (active smoking, alcohol consumtpion, associated diseases) the patients with treatment failure had much longer hospitalisation period due to the persistance of clinical signs (cough, expectorations, chest pain, hemotysis, dyspnoea, asthenia, anorexia, weight loss, fever, night sweats), which have been directly correlated with the severity of the immune disturbances. The patients with antituberculosis treatment failure have had the severe deficiency of all lymphocytes, T subpopulations, the increased level of lymphocytes B, the increased level of all types of immune globulines, the less evident sensibilisation to bacterial antigens (staphylococcus, streptococcus, pneumococcus) and micobacterial antigens; the intoxication indices have increased and the preimmune resistance indices have reduced. Conclusions: All the immune disturbances revealed can be considered as the predictors of antituberculosis treatment failure. On the contrary, the successfully treated patients have had less evident immune disturbances of cellular, humoral and preimune resistance, and some of the indices have returned to a normal level due to the antituberculosis treatment.