Comparative aetio-epidemiological analysis of lung tuberculosis versus sarcoidosis: classical and new concepts

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Abstract


The review presents data on two similar granulomatous inflammatory diseases: tuberculosis and sarcoidosis of the lungs, which together cover about 5% of all pulmonary pathology, albeit occur with different incidence (20 : 1). Despite the established aetiology of tuberculosis, the disease has not disappeared and nowadays has even acquired a new urgency: It is getting out of control due to growing poverty, the comorbidity with HIV infection, increasing cases of drug resistance of Mycobacteria, insufficient effectiveness and the growing costs of its treatment. Against the background of the expansion of anthropogenic influences and other environmental impacts on the immune system, the incidence of lung sarcoidosis is also increasing, while patients are initially often misdiagnosed with tuberculosis, with resulting unjustified anti-tuberculosis chemotherapy, leading to chronization of the disease with frequent relapses and, accordingly, to an increase in disability and mortality rates. In recent years, clinical manifestations of sarcoidosis due to a variety of trigger aetiological factors with adjuvant-like action (from Mycobacteria to xenobiotics) – are considered by a number of authors as a variant of autoimmune/autoinflammatory syndrome induced by adjuvants (ASIA). The article emphasizes the similarity of two granulomatous inflammatory diseases and the concept of two variants of the body’s response to similar or even identical aetiological factors within different human reactivity (possibly on a different mosaic/permissive background). In brief the newest data on experimental models of sarcoidosis are reviewed as well as the role of autophagy disorders and opposite macrophageal polarization in tuberculosis versus sarcoidosis. Authors coined the original hypothesis of the possible therapeutic effectiveness of Rapamycin in sarcoidosis and for the first time posed a question of equivocal character of comorbidity between these granulomatoses and COVID-19 infection.


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About the authors

Alexey V. Nikolaev

Saint Petersburg State University; Medical Center “Magnit”

Author for correspondence.
Email: av@spb24mrt.ru

Russian Federation, Saint Petersburg

Postgraduate Student of the Department of Pathology; MD, radiologist, General Director

Vladimir J. Utekhin

Saint Petersburg State University; St. Petersburg State Pediatric Medical University, Ministry of Healthcare of the Russian Federation

Email: utekhin44@mail.ru

Russian Federation, Saint Petersburg

MD, PhD, Associate Professor of the Department of Pathology; Associate Professor of the Department of Pathophysiology with Courses of Immunopathology and Medical Informatics

Leonid P. Churilov

Saint Petersburg State University; St. Petersburg Research Institute of Phthisiopulmonology

Email: elpach@mail.ru

Russian Federation, Saint Petersburg

MD, PhD, Associate Professor, Head of the Department of Pathology, Deputy Head of Laboratory of the Mosaic of Autoimmunity; Leading Researcher

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