Aktualʹnaâ Infektologiâ (Nov 2018)
Analysis of the risk factors for pulmonary tuberculosis in ATO participants, the clinical course, diagnosis and dependence on them of the duration of treatment
Abstract
Background. The incidence of tuberculosis (TB) among military personnel is constantly increasing due to the antiterrorist operation (ATO) (deterioration of living conditions, irregular food, disturbed sleep and rest, staying under constant stress), which adversely affects the immune system and increases susceptibility to mycobacteria. The purpose was to study the clinical course, diagnosis and duration of treatment of pulmonary tuberculosis in military personnel participating in the ATO, who were hospitalized at the tuberculosis clinic of the National Military Medical Clinical Center “Main Military Clinical Hospital” (NMMCC “MMCH”) from August 2014 to December 2017. Materials and methods. The data were processed of 229 journals for registration of inpatients and case histories of servicemen participating in the ATO who were treated for pulmonary TB during the period from 2014 to 2017 at the tuberculosis clinic of the NMMCC “MMCH”. The main categories of ATO participants who were treated at a tuberculosis clinic are military volunteers and officers. The following age groups of patients with TB are identified: I — 21–29 years old; II — 30–39; III — 40–49 years old; IV — over 50 years. We have selected and analyzed 129 case histories of servicemen — ATO participants, who were completely examined. Among the 129 patients, men prevailed (120 vs 9 women). The diagnosis was made on the basis of patients’ complaints, anamnesis of the disease, clinical picture, laboratory and radiological data, confirmed culturally and on the basis of sputum staining according to Ziehl-Neelsen. Medical and statistical methods were used, statistical data processing was carried out using Microsoft Excel. Results. 229 servicemen participated in the ATO were hospitalized to the tuberculosis clinic: in 2014 — 29 (12.7 %), in 2015 — 66 (28.8 %), in 2016 — 81 (35.4 %), in 2017 — 53 (23.1 %). The patients with pulmonary TB was represented by military volunteers: soldiers (sailors), sergeants, petty officers, warrant officers (midshipmans) — 88.4 % and officers — 11.6 %. The incidence of pulmonary TB among military volunteers increased from 2014 to 2016: in 2014 — 13 cases, in 2015 — 30, in 2016 — 48, and in 2017, the number of patients decreased by half (23 cases). There were significantly fewer officers: in 2014 — 1 patient, in 2015 — 6, in 2016 — 6, in 2017 — 2 patients. The average age of the patients was: Me = 37 years, min — 20 years, max — 57 years. Most cases were detected at the age of 30–39 years, which is 58 cases, the next group suffering from pulmonary TB is people aged 40 to 49 years (n = 36), a smaller proportion are patients aged 20–29 years and over 50 years (23 and 12, respectively). The causes of hospitalization were: in 2014 — 12 referrals to treatment and 2 to the medical evaluation board (MEВ); in 2015 — 24 referrals to treatment, 11 to the MEВ and 1 to examination; in 2016 — 36 referrals to treatment and 18 to the MEВ; in 2017 — 13 referrals to treatment, 11 to the MEВ and 1 to examination. In total, from 2014 to 2017, the study group (129 people) stayed in the tuberculosis clinic for 5748 beddays. Patients with infiltrative and focal pulmonary TB, 2763 and 1222, respectively, had the longest stay in four years, compared with those with disseminated and fibrous-cavernous forms of pulmonary TB (811 and 372). Conclusions. From August 2014 to December 2017, 229 ATO participants with pulmonary tuberculosis were admitted to the tuberculosis clinic. When analyzing the cohorts, it was established that officers made up 5.4 military volunteers — 94.6 %. Given the military rank, it was found that the largest share belonged to soldiers (sailors), sergeants (petty officers) — 72.1 %, and the smallest — lieutenants, captains, and majors — each 0.8 %. The most common nosological forms of pulmonary tuberculosis were: infiltrative tuberculosis (55 %), the average duration of treatment is 39 bed-days, focal (24.8 %), the average duration of treatment is 38 bed-days, disseminated (10.1 %), the average duration of treatment is 62 bed-days. There is a tendency to reduced detection of destruction in patients from 2014 to 2017 — from 71.4 to 36 %. The number of of patients with active TB decreased from 33.3 to 24 %, the frequency of resistant forms of pulmonary tuberculosis in 2016 was 25.9 %, and in 2017 — 12 %. The cause of hospitalization was mainly treatment (65.9 %). Patients were mainly admitted to the tuberculosis clinic by the referral from the doctor of the military unit (55.8 %), the military hospital (30.2 %), and the least — military registration offices (0.8 %). The servicemen admitted to the hospital generally had a satisfactory state of health (90.7 %).
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