Clinical, microbiological and radiological features of severe infiltrative pulmonary tuberculosis within DOTS strategy

Abstract

Introduction: Epidemiological state of tuberculosis in Republic of Moldova rests tensioned, with unsignificant deviation. Global incidence of tuberculosis (new cases and relapses), registered in 2011 is 114,3/100.000 populations, 37,4% of cases been very contagious, 38,0% with extensive destructions. In 2001 our country adopted DOTS strategy, recommended by World Health Organization in the control of tuberculosis, engaging the detection of least 70% of new cases of pulmonary tuberculosis by microscopy of the smear. As consequence, increased the rate of extensive tuberculosis with bilateral localizations, with lung destructions and dissemination, with vital complications, followed by the reduction of treatment success rate and increased of early mortality rate. Purpose and Objectives: Assessment of clinical, microbiological and radiological features of severe infiltrative pulmonary tuberculosis within Directly Observed Treatment Short course chemotherapy strategy. Material and methods: A total amount of 95 new pulmonary severe forms of tuberculosis were investigated, including gender and age features, clinical aspects, microbiological results of Ziehl Neelson staining, culture on Lowenstein Yensen medium and drug sensibility testing, diagnostics of co-morbidities and results of blood count. Results: Men /female rate 1,5/1, average age 42,6 yrs, 68% were late detected (complaining more than 3 month from the onset), by general practitioner through the passive way. Intoxication sings revealed were: asthenia 99%, loss of weight 96%, loss of appetite 78%, nights sweats 67%, vesperal fever 45% cases. Broncho-pulmonary signs were established: cough 100%, muco-purulent expectorations 100%, thoracic pain 34%, hemoptysis 26% cases. Co-morbidities had 40% cases. Radiological aspects were established: bilateral localizations in 78% cases, extension to more than 3 pulmonary segments at 96% cases, all being in evolution phase, with destructions 98% and bronchogenic dissemination 87% cases. Microbiological analysis established smear positive results for Ziehl-Neelson staining in 83% cases, Lowenstein-Yensen culture being positive in 84% cases, showing any resistance to the first anti-tuberculosis drugs in 34% cases. Conclusions: Assessment of clinical, microbiological and radiological features of severe infiltrative pulmonary tuberculosis within DOTS strategy revealed its predominance in male sex, in economicaly and reproductible age. Late detection by passive way, with well defined clinical signs, showing bilateral and extensive lung localizations, with high degree of bacilli emission, confers continuous epidemiological danger on health population. All enumerated characteristics are the consequence of the implementation of DOTS strategy in the control of tuberculosis in our country. Innovative contribution: For the first time in R. Moldova was established the features of severe pulmonary tuberculosis, according DOTS strategy.