[The diagnostic significance of detecting L forms of Mycobacterium tuberculosis].
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Biomedical subjects
Publications and source records attributed to V G Meshcheriakov.
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Clinical implications of L-form pulmonary tuberculosis have been investigated in 268 patients. Of them 223 had active respiratory tuberculosis, 45 demonstrated residual disease. New cases of L-form tuberculosis were characterized by poor clinical symptoms and favourable outcomes. Association of L-forms with bacterial discharge produced apparent symptoms and progressive trends. Detection of L-forms in inactive pulmonary process indicated latent activity of tuberculosis apt to recur.
A clinical and bacteriological study was made of 144 patients with new-onset pulmonary tuberculosis who had been treated within the first 3-4 weeks in the out- and in-patient settings for non-specific lung disease. Detailed studies found changed variants of the pathogen as L-forms in 28 (19.4%) patients, bacterial forms being undetectable. The paper shows how difficult to diagnose tuberculosis.
Acute rheumatic fever (ARF) is a systemic inflammatory disease etiologically related to infection with group A streptococcus characterized by a broad spectrum of disorders of cellular and humoral immunity. To estimate the activity of the immunopathological process and to forecast myocardial derangement in ARF patients, measurements were made of neopterin in the serum of ARF patients. Nine men with ARF serving in the armed forces were examined. The control group comprised 24 donors. The reference group included 13 patients with dilated cardiomyopathy and 14 with chronic myocarditis. The mean level of neopterin in ARF patients was equal to 14.5 +/- 12.2 nM/l and was significantly higher than in the donors (5.0 +/- 2.0 nM/l). In patients with dilated cardiomyopathy and chronic myocarditis, it was 9 +/- 6 and 16 +/- 11 nM/l, respectively. On more careful clinical analysis the highest level of neopterin was recorded in 3 patients with impairment of the valvular apparatus of the heart. That level was observable during the whole period of the follow-up of the patients. In other patients, no impairment of the valves was detected, whereas the concentration of neopterin fell to normal. Therefore, the rise of the level of neopterin was described for the first time in patients with ARF. Besides, a relationship was found between the high level of neopterin and impairment of the valvular apparatus of the heart.
The clinical features of a tuberculous process were studied in 101 patients with active pulmonary tuberculosis among whom 76% of the patients lost their social adaptation. The patients were divided into 2 groups: group 1 comprising 61 (60.4%) subjects who excreted tuberculosis mycobacteria and L-forms and group 2 consisting of 40 (39.6%) who excreted only tuberculosis mycobacteria. The frequency and degree of drug resistance were more manifest in 63.8% of the patients of group 1 and in 40% of those of group 2 (p less than 0.01). Drug resistance to relatively new antituberculosis drugs (ethambutol and rifampicin) was found in 30% of the patients. Mixed bacillary population was found 2 times more frequently in patients with serious progressive forms of tuberculosis, which gives evidence to consider it as a prognostically unfavourable indicator.
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