Faults in dispensary observation of a female patient with disseminated destructive pulmonary tuberculosis

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Resumo

Current data from the World Health Organization indicate an annual increase of tuberculosis incidence worldwide. In addition, there is an increase in drug resistance of the pathogen, as well as an increase in the frequency of widespread destructive forms of the tuberculosis process among patients, which is due, among other reasons, to mistakes in dispensary observation. Clinical case presented in the article (2024) demonstrates systematic faults that occurred in the previous period of curation of a female patient with tuberculosis both during treatment in 2014 and after the end of the course of anti-tuberculosis chemotherapy. Due to the lack of X-ray examination over the past 5 years before applying to the Central research institute of tuberculosis (CRIT), the patient developed fibrous-cavernous tuberculosis of the left operated lung together with the presence of extensive drug resistance. Due to the integrated approach to treatment at CRIT, including the surgical stage, it was possible to achieve significant clinical improvement, persistent cessation of bacterial excretion, and eliminate the chronic focus of tuberculosis infection in observed patient.

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Sobre autores

Nikita Chumovatov

Central Research Institute of Tuberculosis

Autor responsável pela correspondência
Email: Necro5412@mail.ru
ORCID ID: 0000-0001-8745-7940
Código SPIN: 7088-5717
Scopus Author ID: 57459472600

MD, PhD (Medicine), Researcher of the Department of Phthisiology

Rússia, 2, Yauzskaya All., Moscow, 107564

Natalya Chernykh

Central Research Institute of Tuberculosis

Email: natadok@inbox.ru
ORCID ID: 0000-0001-6787-2362
Código SPIN: 9144-7729
Scopus Author ID: 36957272200

MD, PhD (Medicine), Senior Researcher of the Department of Phthisiology

Rússia, 2, Yauzskaya All., Moscow, 107564

Andrey Khozikov

Central Research Institute of Tuberculosis

Email: hozikov96@mail.ru
ORCID ID: 0000-0003-0308-9592
Código SPIN: 2969-5800

MD, Pathologist

Rússia, 2, Yauzskaya All., Moscow, 107564

Oksana Komissarova

Central Research Institute of Tuberculosis; Pirogov Russian National Research Medical University

Email: oksana.komissarova.72@mail.ru
ORCID ID: 0000-0003-4427-3804
Código SPIN: 6006-6732
Scopus Author ID: 15051823500

MD, Dr. Sci. (Medicine), Associate Professor, Deputy Director for Scientific and Medical Work of the Department of Phthisiology; Professor of the Department of Phthisiology

Rússia, 2, Yauzskaya All., Moscow, 107564; 1/6, Ostrovityanov St., Moscow, 117513

Bibliografia

  1. World Health Organization. Global tuberculosis report 2024. URL: https://www.who.int/publications/b/74877 (date of access – 21.03.2025).
  2. Чумоватов Н.В., Антонов Н.С., Сахарова Г.М., Романов В.В., Эргешов А.Э. Количественная оценка связи табакокурения и туберкулеза легких. Профилактическая медицина. 2022;25(1):48–53. [Chumovatov NV, Antonov NS, Sakharova GM, Romanov VV, Ergeshov AE. Quantitative assessment of the influence of tobacco smoking on the development and course of tuberculosis. Profilakticheskaya meditsina= Russian Journal of Preventive Medicine. 2022;25(1):48–53 (In Russ.)]. EDN: WDRNNP. https://doi.org/10.17116/profmed20222501148
  3. Абдуллаев Р.Ю., Комиссарова О.Г., Чумакова Е.С., Одинец В.С., Эргешов А.Э. Гепатотоксические реакции при лечении впервые выявленных больных туберкулезом легких с множественной лекарственной устойчивостью возбудителя. Туберкулез и болезни легких. 2019;97(7):21–27. [Аbdullаev RYu, Komissаrovа OG, Chumаkovа ES, Odinets VS, Ergeshov AE. Hepatotoxic reactions during treatment of newly diagnosed patients with pulmonary multiple drug resistant tuberculosis. Tuberkulez i bolezni legkikh = Tuberculosis and Lung Diseases. 2019;97(7):21–27 (In Russ.)]. EDN: EOPNOJ. https://doi.org/10.21292/2075-1230-2019-97-7-21-27
  4. Васильева И.А., Тестов В.В., Стерликов С.А. Эпидемическая ситуация по туберкулезу в годы пандемии COVID-19 – 2020–2021 гг. Туберкулез и болезни легких. 2022;100(3):6–12. [Vasilyeva IA, Testov VV, Sterlikov SA. Tuberculosis situation in the years of the COVID-19 pandemic – 2020–2021. Tuberkulez i bolezni legkikh = Tuberculosis and Lung Diseases. 2022;100(3):6–12 (In Russ.)]. EDN: DPMDCF. https://doi.org/10.21292/2075-1230-2022-100-3-6-12
  5. Скорняков С.Н., Мотус И.Я., Кильдюшева Е.И., Медвинский И.Д., Баженов А.В., Савельев А.В. Хирургия деструктивного лекарственно-устойчивого туберкулеза легких. Туберкулез и болезни легких. 2015;(3):15–21. [Skornyakov SN, Motus IYa, Kildyusheva EI, Medvinsky ID, Bazhenov AV, Savelyev AV. Surgery of destructive drug-resistant pulmonary tuberculosis. Tuberkulez i bolezni legkikh = Tuberculosis and Lung Diseases. 2015;(3):15–21 (In Russ.)]. EDN: TQBCQZ.

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2. Fig. 1. Axial slices of computed tomography of the chest organs of the observed patient (October 2014}, pulmonary window: A, B - focal infiltrative changes in the left lung with the presence of a decay cavity

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3. Fig. 2. Axial slices of computed tomography of the chest organs of the observed patient (July 2016), pulmonary window: A, B - focal infiltrative changes in the left operated lung

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4. Fig. 3. Axial slices of computed tomography of the chest organs of the observed patient (July 2024), pulmonary window: A - massive decay cavity in the left lung; B - focal infiltrative changes in the left lung

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5. Fig. 4. Axial slices of computed tomography of the chest organs of the observed patient (September 2024), pulmonary window: A - massive decay cavity without significant dynamics; B - partial resorption and consolidation of focal and infiltrative changes in the left lung

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6. Fig. 5. Macropreparation of the surgical material of the observed patient: left lung after pleuropulmonectomy

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7. Fig. 6. Pathohistological examination of the operative material of the observed patient

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8. Fig. 7. Axial slices of computed tomography of the chest organs of the observed patient (November 2024), pulmonary window: A, B - persisting focal changes in the right lung, left - fibrothorax formation after pulmonectomy

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