CLINICAL, RADIOLOGICAL AND EPIDEMIOLOGICAL CONSIDERATIONS IN BACTERIOLOGICALLY UNCONFIRMED PULMONARY TUBERCULOSIS
Abstract:
Pulmonary tuberculosis, with its numerous clinical-radiological and progressive aspects,
puts some real difficulties in finding the causing agent (M.tuberculosis), despite all the progress
that has been made in the field of laboratory techniques in the last years. Because of the
bacteriological confirmation’s absence, the anamnesis, the clinical and radiological examination,
the patient’s epidemiological and biological data contributes to give a good diagnosis. The study
examines the features of 108 patients hospitalized, having the diagnosis of pulmonary TB,
clinically unconfirmed (code: A160), at the Pneumophtysiology Hospital in Mihăeşti, Vâlcea,
between 01.01.2006 and 31.12.2008. The study illustrates the data related with the signs and
symptoms of the disease recorded at admission, the aspect and location of the pulmonary
modifications, the epidemiological impact of this type of patients on the contractions in the pest
hole of tuberculosis. Symptomatology was dominated by cough, with or without expectoration, in
85% of the cases and there were also recorded a „tuberculous impregnation syndrome“(loss of
appetite with weight loss, night sweats, asthenia). 70% of the patients claimed that the duration of
symptoms until hospitalization varied between two and four weeks. The pulmonary X-ray findings
included nodular infiltrative-type of changes, for 74% of the patients, caseous-cavity lesions in
23% of the cases, miliaria in 3% and pleurisy associated with lung changes in 4% of the cases. The
distribution of lesions prevailed in the upper lobes (93%), and the right upper lobe represented
72% of sites.The pulmonary radiological examination of the people who came into contact with the
patients of the study group, proved to be normal for 73 (86%) of the ones examined, in eight cases
there were found disabling type changes and in four cases the lesions were infiltrative-nodular
type. Two patients diagnosed with nodular infiltrative changes, were received treatment for TB.
Tuberculin skin testing (TST) of the children involved, pointed out a positive reaction, diameter of
10-14mm, in five cases (18%) and nine children (33%) had a hyperergic reaction, (diameter of
induration > 15 mm). Bacteriologically unconfirmed pulmonary tuberculosis was clinically
expressed by cough with or without expectoration and the tuberculous impregnation syndrome, the
duration of these events being of about 2-4 weeks. Infiltrative nodular pulmonary lesions located at
the upper lobes were the ones that prevailed. Detection of new cases of the disease on the adults
involved, of M. tuberculosis infection in children from the pest hole draws attention upon the
potential source of infection for this category of patients
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