The objective: to analyze the course of the new coronavirus infection (COVID-19) in children with active respiratory tuberculosis. Subjects and methods. The article describes results of retrospective analysis of the course of the new coronavirus infection in 25 children (3-12 years old) with active respiratory tuberculosis during the outbreak of COVID-19 in an in-patient TB unit.Results. 24 (96%) persons got infected after the close exposure to the coronavirus infection, and 1 (4%) child didn't get infected. The diagnosis was verified by polymerase chain reaction (detection of RNK of SARS-CoV-2) in 33.3%, by enzyme immunoassay (detection of IgG antibodies to SARS-CoV-2 in 1 month after quarantine removal) in 100%. 58.3% of children with respiratory tuberculosis (14 people) infected with coronavirus infection had minimal respiratory symptoms, that did not differ from signs of other respiratory viral infections; clinical manifestations of the disease were completely absent in 41.7% (10) patients. Coronavirus pneumonia was diagnosed in 4 (16.7%) children who suffered from COVID-19, they had no clinical signs of lower respiratory tract disorders and no body temperature increase; 3 patients had no signs of respiratory viral infection; in all cases, the lung damage detected by computed tomography didn't exceed 10%. In 2 months after the removal of quarantine, no IgG antibodies to SARS-CoV-2 were detected in 2 out of 10 examined children (20.0%), thus there was a chance for re-infection. No mutual aggravating effect of coronavirus infection and tuberculosis was revealed in their combination over the entire observation period (4 months).
Aim of the study. Show the possibilities of diagnosing non - tuberculous mycobacteriosis of the lungs (NTML) in the practice of the pulmonologist. Materials and methods. A survey of 90 patients with a confirmed diagnosis of non - tuberculous mycobacteriosis of the lungs (NTML) was presented. The diagnosis of pulmonary mycobacteriosis was established in accordance with the criteria proposed in 2007 by the American Thoracic Society and the American Society of Infectious Diseases (ATS/IDRS). Among the patients, 55 (61.1%) women prevailed, the average age was 51.2±15.3 years. Patients were evaluated complaints, the presence of concomitant diseases of the lungs, was carried out computed tomography of the chest high - resolution (HRCT), a culture study of sputum, in the absence of sputum or a single determination of the NTM culture in it, a study was conducted on materials of bronchoalveolar washout (ALS/BAL), or lung biopsies. Statistical processing of the research results was performed using descriptive statistics using Microsoft® Excel for Windows xp® on a personal computer. Results and conclusion. As a result of the study, it was revealed that before the diagnosis of NTML was established, 66.7% of patients were long observed for chronic lung diseases (chronic obstructive pulmonary disease, chronic bronchitis), and in 55.6% of cases (50 people) were registered with a phthisiologist about pulmonary tuberculosis. According to the CT scan of OGK, dissemination was determined in 66.7% of cases, in 48.9% - bronchiectasis, single or multiple destruction cavities - 46.7% of cases. In 72.2% of cases, non - tuberculous mycobacteria (NTM) were found in sputum, in 33.3% - in ALS and in 22.2% of NTMs were found in the surgical material. In 14.4% of cases, only surgery allowed to establish the diagnosis of mycobacteriosis.
Objective: to determine, evaluate, and describe different radiological patterns of microbiologically identified nontuberculous pulmonary mycobacterioses (NTPM) based on multislice computed tomography data. Material and methods. The study included 102 patients with radiological signs of lung disease and different types of NTPM. Slowly growing types of NTPM were detected in 62 (60.8 %) patients, and rapidly growing NTPM – in 40 (39.2 %). The diagnosis was established considering a patient’s complaints, a specified case history, radiological and clinical laboratory data including microscopic studies of sputum from 63 (61.8 %) patients, bronchoalveolar lavage and different types of bronchial biopsies data from 19 (18.6 %) patients, samples of lung video-assisted thoracoscopic surgery from 17 (16.7%) patients, pleural fluid samples from 2 (1.9 %) patients, and oropharyngeal wash samples from 1 (1 %) patient. We used the Somatom Emotion 16 multislice computed tomograph (Siemens) and the high-resolution algorithm (HRCT) with 0.8 mm slice thickness and 1.5 mm slice increment. Results. The HRCT data were highly polymorphic and showed interstitial focal changes, different calibre bronchiectasis, conglomerates or cavities, involvements of vessels or pleural layers. In some patients, changes in the axial interstitium were accompanied by single small focal consolidations located either discretely or in small groups. Peribronchovascular spread of dissemination foci in NTPM was detected by HRCT as irregular infiltration of the axial interstitium (vasculitis type). Changes in the bronchial tree in NTPM were characterized by bronchiolitis symptoms (extensive thickening of bronchial walls, bronchioles) with development of the tree-in-bud sign predominantly in the subpleural lung regions. In some cases, bronchiectatic changes formed conglomerate consolidations of sublobular or lobular extent. Changes of the bronchial tree were detected by HRCT predominantly as signs of deforming bronchitis, cylindrical, varicose, or cystic bronchiectasis, either restricted or spread. Changes might be accompanied by single multi-dimensional cystic bronchiectatic cavities. Conclusion. Typical HRCT signs of NTPM are endobronchial and peribronchovascular spread of foci, development of multi-dimensional conglomerates, deforming bronchitis, bronchiectasis, and presence of single multi-dimensional cystic bronchiectatic cavities.
Aim: to study radiological semiotics of peripheral pulmonary lesions (PPLs) detected by CT of the chest, and establish radiological patterns, which significantly increase effectiveness of navigation bronchobiopsies. Materials and methods. A cohort retrospective study included 278 patients with PPLs with verified diagnoses established by invasive diagnostic procedures (navigation bronchoscopy with a complex of biopsies and/or diagnostic thoracic surgery). The study included 162 (58.3%) women aged 13 to 80 yrs. (average age – 46.21 ± 5.23) and 116 (41.7%) men aged 14 to 85 yrs. (average age – 46.05 ± 3.49). The patients were divided into 4 nosological groups: pulmonary TB patients – 158 (56.8%), neoplastic patients – 79 (28.4%), nontuberculous pulmonary mycobacteriosis (NTPM) patients – 21 (7.6%), and protracted course community-acquired pneumonia (CAP) patients (presentations of PPLs) – 20 (7.2%). Results. According to chest CT data, PPLs had three major radiological sings, defined as “infiltrate”, “rounded shadow”, and “focus”. Rounded shadows prevailed in NTPM patients and neoplastic patients. Statistically significant differences between the groups were as follows: the medium maximum size and contour of PPLs (focus / rounded shadow / infiltrate), the presence of bronchiectasis and the type of foci (lobular/sublobular/acinar) in the lung parenchyma surrounding PPLs, the presence of calcification, cavitation, or air bronchograms inside PPLs. The total effectiveness of bronchoscopic verification of PPLs in patients with “CT bronchus sign” was 79.4%, which significantly exceeded diagnosis verification in patients without it (17.9%) (р < 0.001). The effectiveness of diagnosis verification by bronchobiopsy in patients with PPLs less than 20 mm (CT data) achieved 50% irrespective of etiology. The most effective bronchoscopic verification of diagnoses was observed in TB and NTPM patients with PPLs ≥ 20 mm – 83.3% and 100.0% respectively, and in neoplastic patients with PPLs ≥ 30 mm it reached 93.0%. The lobar localization of the process did not affect the diagnostic effectiveness of bronchobiopsies. Conclusion. The highest effectiveness of bronchobiopsies was observed in patients with the CT bronchus sign and with PPLs ≥ 20 mm or ≥ 30 mm (CT data). The volume of diagnostic biopsies obtained by navigation bronchoscopy or surgical resection should be determined by radiological morphology of PPLs with estimation of malignancy or benign signs revealed by CT of the chest.
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