pulmoПульмонологияPULMONOLOGIYA0869-01892541-9617Scientific and Practical Journal “PULMONOLOGIYA” LLCpulmo-2671Research ArticleОРИГИНАЛЬНЫЕ ИССЛЕДОВАНИЯORIGINAL STUDIESЛегочный туберкулез у больных с нормальной рентгенограммой легких в районе с высокой заболеваемостью туберкулезомPulmonary tuberculosis in patients with normal chest radiograph in a region with a high incidence of tuberculosisБиджаниК. А.BijaniK. A.

Баболь

ЭсмаилН. Т.EsmailN. T.

Баболь

ГраэйллиБ.GraeilliB.

Баболь

Пульмонологическое отделение, госпиталь Бехешти; Госпиталь Амикрола; Отделение внутренних болезней, госпиталь БехештиIslamic Republic of Iran200308092021034751Copyright © Биджани К.А., Эсмаил Н.Т., Граэйлли Б., 20212021Биджани К.А., Эсмаил Н.Т., Граэйлли Б.Bijani K.A., Esmail N.T., Graeilli B.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://journal.pulmonology.ru/pulm/article/view/2671

Цель работы — описать ранние симптомы легочного туберкулеза (Т) при нормальной рентгенограмме легких (РГЛ).70 больных с подтвержденным бактериологически легочным Т и нормальной РГЛ были отобраны из 377 с подтвержденным посевом мокроты или бактериоскопией мазка легочным Т в Баболе (Иран) в 1994-2000 г. Больные, имевшие патологические изменения на РГЛ в период постановки диагноза, были исключены из анализа.68 (98%) из 70 больных в период постановки диагноза имели различные симптомы заболевания, наиболее часто отмечался кашель с мокротой (97%). Два пациента обследовались по поводу контакта с больными легочным Т, в то время как остальные 68 были обследованы в связи с имевшимися жалобами.68 (97%) больных жаловались на кашель длительностью более 1 мес, 63 (90%) — на продукцию мокроты, 18 (25%) — на лихорадку более 1 нед, 28 (40%) — на кровохарканье, 21 (30%) — на снижение массы тела, 1 (1,4%) пациент жаловался на хрипы, 5 (7%) — на одышку. В мазке мокроты у 5 (7 % ) больных определялись микобактерии туберкулеза (МБТ). Никто из больных не имел сопутствующей патологии. 56 (80%) пациентов имели положительную пробу Манту. Частота легочного Т, подтвержденного посевом мокроты, при нормальной РГЛ составила менее 1% в период с 1988 по 1989 г. и возросла до 10% в период 1996 по 1997 г.Легочный Т, подтвержденный бактериологически, при нормальной РГЛ встречается не так редко, и его частота возрастает. Больные с такой формой Т обычно имеют клинические проявления заболевания и/или контакт с больными легочным Т. Результаты свидетельствуют, что у пациентов с кашлем продолжающемся, 1 мес, лихорадкой более 1 нед либо документированной потерей массы тела после известного контакта с больным Т необходимо исследовать мокроту на МБТ независимо от нормальной РГЛ.

The objective was to describe early symptoms of pulmonary tubeculosis (T) when the chest radiograph (CXR) is normal.Seventy patients with culture-positive pulmonary T and normal CXR were selected from a review of 377 consecutive patients with smear- or culture-positive pulmonary T in Babol (Iran) in 1994-2000. Patients with abnormal CXR at the time of the diagnosis were excluded from the analysis.Sixty-eight of the 70 patients (98%) were symptomatic at the time of the diagnosis with cough and sputum production being reported most commonly (97%). Two patients were examined due to contact tracing of a case of infectious pulmonary T, while other 68 patients were tested because of symptoms presence. Sixtyeight patients (97%) had cough longer that 1 month, sputum production was in 63 patients (90%), fever for more than 1 week was in 18 patients (25%), haemoptysis was in 28 patients (40%), weight loss was in 21 patients (30%), hoarseness was in 1 patient (1,4%), dyspnea was in 5 patients (7%). The sputum smears of 5 patients (7 % ) were positive. No-one of patients had underlying diseases. Fifty-six patients (80%) had positive Mantoux skin test. The incidence of culture-positive pulmonary T with a normal chest radiograph was less than 1% in the period from 1988 to 1989 and steadily increased to 10% in the period from 1996 to 1997.The culture-positive pulmonary T with abnormal CXR is not uncommon and the incidence of such presentation is increasing. Patients with this presentation of T are typically symptomatic and/or are detected by contact tracing of infectious pulmonary T cases. The results suggest that patients presenting cough for more than 1 month, a fever longer than 1 week or documented weight loss after known exposure to infectious T should undergo sputum examination for a mycobacterium tuberculosis despite a normal CXR.

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The authors declare that there are no conflicts of interest present.