An integrated approach in the treatment of a patient with chronic destructive pulmonary tuberculosis with extensively drug-resistant pathogen

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A clinical example demonstrating the need for a comprehensive approach in the treatment of patients with chronic tuberculosis and extensively drug-resistant pathogen is presented. The patient repeatedly had relapses of a specific process, despite ongoing anti-tuberculosis therapy for several years. During this period, drug resistance to the new anti-tuberculosis drug bedaquiline was formed, which significantly reduces the possibility of selecting adequate anti-tuberculosis therapy. In addition, the patient has a widespread tuberculous process of the trachea and bronchi, accompanied by massive bacterial excretion. Against the background of the complex treatment, by the 6th month of treatment, it was possible to achieve pronounced positive dynamics, however, a massive fibrous cavity remained in the right lung. Given the low functional parameters limiting the use of resection surgery, the patient was able to undergo collapsosurgical treatment in the form of extrapleural pneumonitis

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作者简介

N. Chumovatov

Central Research Institute of Tuberculosis

编辑信件的主要联系方式.
Email: Necro5412@mail.ru
ORCID iD: 0000-0001-8745-7940

Cand. Sci. (Med.)

 

俄罗斯联邦, Moscow

A. Aynsanova

Central Research Institute of Tuberculosis

Email: Necro5412@mail.ru
ORCID iD: 0009-0001-5593-6872
俄罗斯联邦, Moscow

N. Chernykh

Central Research Institute of Tuberculosis

Email: Necro5412@mail.ru
ORCID iD: 0000-0001-6787-2362

Cand. Sci. (Med.)

俄罗斯联邦, Moscow

参考

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2. Fig. 1. Computed tomography of the chest organs in the pulmonary mode (axial slices): a – system of thick-walled caverns with heterogeneous walls; б – focal infiltrative changes in the right and left lung

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3. Fig. 2. Endoscopic picture of the trachea, right main and left main bronchus: a – necrotic deposits of the mucosa of the lower third of the trachea; б – mucosal infiltration with areas of necrotic deposits

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4. Fig. 3. Computed tomography of the chest organs in the pulmonary mode (axial slices): partial resorption and consolidation of foci and areas of infiltration of lung tissue

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5. Fig. 4. Endoscopic picture of the trachea, right main and left main bronchus: regression of infiltrative changes in the tracheobronchial tree

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6. Fig. 5. CT of the chest in pulmonary mode (axial sections): a – a system of thick-walled caverns of the right lung; b – further resorption and compaction of previously identified foci of different sizes

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7. Fig. 6. Computed tomography of the chest organs in the pulmonary mode (axial slices): a – system of thick-walled caverns; б – focal changes in both lungs without significant dynamics

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8. Fig. 7. Computed tomography of the chest organs in the pulmonary mode (axial slices) 1 month after surgical treatment: a – implant is detected in the projection S1-S2 of the right lung, without signs of integrity violation; б – areas of consolidation around the implant are detected, with calcium inclusions

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