RU2159440C1 - Differential diagnosis method for determining tuberculosis and nonspecific kidney inflammation - Google Patents

Abstract

FIELD: medicine. SUBSTANCE: method involves setting tuberculin provocation test. Changes in urine analysis results being revealed, preventive ex juvantibus therapy is carried out with flemoxine, ucasine and cephobide in combination with furadonine. Positive effect being achieved, nonspecific kidney inflammation is diagnosed, otherwise tuberculin provocation test is carried out. EFFECT: accelerated examination method.

Description

 The invention relates to medicine, namely to phthisiourology.

 Currently, the incidence of all forms of tuberculosis, including kidney tuberculosis, has increased rapidly, becoming an epidemic. In extrapulmonary tuberculosis, bacterial excretion is usually scanty and difficult to perceive, but this localization of the disease has no other pathognomic symptoms (with the exception of mycobacteriuria, which is detected by the bacteriological method for 3 months). If 10-15 years ago, mycobacteriuria was registered in 75-84% of newly diagnosed patients with genitourinary tuberculosis, then over the past 5 years this indicator has decreased to 44% (1). To improve diagnosis, there is a subcutaneous provocative tuberculin test. Many modifications of the tuberculin test have been created, in which it is proposed to take into account changes in the proteinogram, lysozymeria, a number of immunological parameters, etc. It was proved that subcutaneous administration of tuberculin increases the seeding rate of mycobacterium tuberculosis with genitourinary tuberculosis by 4-15% (2).

 Nevertheless, a provocative tuberculin test does not always give an unambiguous result and is often not informative, since the presence of pyuria (or, in the best case, leukocyturia) prevents the fixation of a focal reaction).

 The previous therapy in general medical institutions provides for the unjustifiably widespread use of drugs of the tetracycline group, fluoroquinolones, which obscures the clinical manifestations of genitourinary tuberculosis and prevents its timely recognition.

 The proposed method for the differential diagnosis of tuberculosis and non-specific inflammation of the kidneys allows you to establish a diagnosis within the first 2-3 weeks. For this, with a change in urine tests, ex therapy is preliminarily performed. juvantibus (flemoxin, ukazin, or cefobide in combination with furadonin) and if there is a positive effect of treatment, they diagnose nonspecific inflammation of the kidneys, and if not, they provoke a provocative tuberculin test and, if characteristic changes occur after 24-48 hours, they diagnose kidney tuberculosis.

 The proposed treatment with Flemoxin, Ukazin, or Cefobide preparations has a bactericidal effect on the main types of banal microflora, while not inhibiting the growth of mycobacterium tuberculosis, and therefore, without adversely affecting bacteriological diagnostics.

 The method is as follows. The patient is prescribed treatment according to the scheme: flemoxin salutab (amoxicillin) per os at a dose of 1.5 per day for 2-3 doses simultaneously with furadonin at a dose of 100 mg 4 times a day. After complex nonspecific etiopathogenetic therapy, if complaints of pain in the kidneys and frequent painful urination stop, urine tests normalize - the diagnosis of urotuberculosis can be rejected. Such a patient is subject to observation by a urologist of the general medical network. In case of incomplete improvement of urine analysis and persistence of complaints, tuberculin diagnostics are indicated.

 Example 1. B-th H., 54 years old, an employee, a resident of the city of Novosibirsk.

 Considers herself ill for 15 years. Annually at least 2-3 times exacerbations of cystate occur, pain in the region of the kidneys is almost constantly disturbing, in the analysis of urine - transistor leukocyturia.

 It was examined in a hospital 5 years ago, on excretory urograms - cup deformity, some retention. Treated about hr. pyelonephritis under the supervision of a local physician; took 5-NOC, nevigramon, oxacillin, palin, abactal. Each time received a satisfactory, but short-lived effect.

 In 1997, she was admitted to the clinic for examination of extrapulmonary forms of tuberculosis at the Novosibirsk Research Institute of Tuberculosis.

On admission: complaints of frequent urination with pains, constant dull pain in the lumbar region, weakness, increased fatigue, temperature 37.6 ^o C. Hemogram: Er-3,9-10 ¹² / l, -8,4 • 10 ⁶ / l, E-O, p-6, s-52, l - 34, m-8, ESR-18 mm / h. An. urine: protein 0.033 ^o %, pH 6.0, u.v. 1022, white blood cells completely cover the field of view; Er - 8-10 fresh, mucus, bacteria. Received growth of E. coli 100 million, multiresistant im vitro. The patient was started treatment: flemoxin salutab 0.5x3 p. per os, furadonin 0.1x4 times per os; pathogenetic therapy was carried out.

 Positive dynamics were observed from the 2nd day of treatment. After 10 days of complex therapy, the patient did not complain, the analysis of urine and blood returned to normal, there was no growth of flora in the urine. To consolidate the effect obtained, the patient was vaccinated with solco-level. The observation period was 14 months. There was no relapse of pyelonephritis.

 Thus, the quickly obtained clinical result from the non-specific antibacterial treatment allowed eliminating renal tuberculosis. Persistent remission subsequently confirmed the correctness of the diagnosis.

 Example 2. B-naya, S. 51, employee, resident of Novosibirsk.

 About 10 years notes periodic pain in the lumbar region, usually dull, less often - cramping, like colic. Three times there were episodes of dysuria. In the analyzes - transient leukocyturia, the growth of piloresistant E. coli. Twice I gave urine for sowing BC - the result is negative.

 In 1998, she was admitted to the clinic for extrapulmonary forms of tuberculosis at the Novosibirsk Research Institute of Tuberculosis. Excretory urograms show the deformity and fuzziness of a number of calyxes, but there is no convincing evidence for tuberculous destruction.

 With a differential diagnostic purpose, the patient is shown a subcutaneous provocative tuberculin test. However, the initial L-uria (L up to 60 in the field of view) would not allow to catch the response focal reaction. Therefore, the patient underwent a 10-day course of nonspecific therapy (flemoxin-salutab 0.5x3p + furadonin 0.1x4 times), as a result of which the nonspecific component of the combined tuberculous and nonspecific inflammation of the kidneys was stopped.

 After treatment, there is no growth of flora in the urine, L - 35-40 in the field of view. Against the background of the introduction of a subcutaneous tuberculin test, an increase in the number of leukocytes in the urine, a decrease in the number of lymphocytes in the peripheral blood was observed; after 48 hours, MBT uria was detected by PCR. The patient was diagnosed with 016.0 - tuberculous papillitis of both kidneys, BK +.

 Irrational therapy, carried out before entering the NNIIT, obscured the clinical and laboratory manifestations of kidney tuberculosis, prevented the detection of MBT (tuberculosis mycobacteria) in the urine. The absence of a significant effect of complex nonspecific antibiotic therapy made it possible to exclude nonspecific pyelonephritis and created the conditions for a subcutaneous provocative tuberculin test, as a result of which an open form of kidney tuberculosis was established.

 Long-term unsystematic therapy caused a total of 780 days of disability, and led to the formation of an epidemic focus. At the same time, the differential diagnosis of the proposed method for 10-14 days allows you to set the correct diagnosis.

 From 1994 to 1998 274 patients with suspected genitourinary system tuberculosis were admitted to the clinic of extrapulmonary forms of tuberculosis of the Novosibirsk Research Institute of Tuberculosis. In 68 of them, urotuberculosis was subsequently established. Of these, 27 people had a characteristic anamnesis, pronounced destructive changes in the renal cavity system, and massive pyuria; during the first 2-3 weeks, one way or another, they discovered mycobacteriuria. The remaining 41 patients were diagnosed after a subcutaneous provocative tuberculin test. Initial urine tests of 15 patients allowed tuberculin diagnostics to be performed without special preparation, and 20 ex therapy was required. juvantibus type I.

 Thus, carrying out a trial treatment additionally allowed 63.5% of patients to complete the whole range of diagnostic measures and establish the correct diagnosis.

Literature
1. Kulchavenya E.V., Brizhatyuk E.V., Zhukova I.I. Analysis of the effectiveness of the traditional treatment of genitourinary tuberculosis according to the materials of clinical observations. // Probl. tub., 1998 - N 5. S. 21-23.

 2. Tuberculosis of the genitourinary system: Manual / under. ed. T.P. Mochalova - M., 1993.

Claims (1)

 A method for the differential diagnosis of tuberculosis and non-specific inflammation of the kidneys by staging a provocative tuberculin test, characterized in that ex therapy is preliminarily performed. juvantibus (flemoxin, ukazin, or cefobide in combination with furadonin) and if there is a positive effect, they diagnose nonspecific inflammation of the kidneys, and in the absence, they provoke a tuberculin test and, when characteristic changes appear after 24 to 48 hours, they are diagnosed with kidney tuberculosis.