Treatment and Prevention

Tuberculosis in diabetes mellitus: the course of the disease and treatment

The combination of pulmonary tuberculosis and diabetes mellitus is a dangerous combination of two complex diseases. A weak immune system and a low resistance of the patient to hyperclimy to infections contribute to the active development of inflammation and its adverse effect on the course of diabetes.

Without a skillful chemotherapeutic treatment, a proper diet and a strict regimen, the prognosis for recovery from tuberculosis in a patient with insulin dependence is extremely low. You can avoid the sad outcome only with timely detection of the infection and correct measures to eliminate it, as from the attending physician, that to and the patient.

What you need to know about the tandem of diabetes with tuberculosis?

Tuberculosis Clinic for Diabetes

Phthisiology pays special attention to the problem of hyperglycemia. This is due to the fact that in diabetes mellitus, due to impaired phagocytic activity of leukocytes, carbohydrate-fat balance and general metabolism, the process of healing and regeneration of the lungs is extremely difficult.

Often, tuberculosis infection on the background of diabetes is transformed into chronic pathology, causing destructive changes in the tissues and leading to the formation of limited infiltrative forms (tuberculosis, foci) or disintegration of the organ.

According to statistics from epidemiological observations, in insulin-dependent patients, the incidence of tuberculosis is 5-10 times higher than that of ordinary people. In 9 out of 10 such patients, diabetes mellitus was a pathology preceding the infection.

Moreover, due to metabolic and immunological transformations caused by insulin deficiency, the course of tuberculosis in diabetics is characterized by greater aggressiveness, which, in turn, significantly aggravates the clinical situation and leads to serious complications - exudative-necrotic reactions in organs, early destruction and bronchogenic seeding.

Tuberculosis develops in diabetes mellitus as a secondary form with a focus mainly in the lower pulmonary regions. The clinical manifestations of the infection are very specific and depend on the degree and form of the underlying disease (DM). Identified at an early stage, tuberculosis has a more favorable trend than pathology in the later stages of its progression.

The most difficult infection occurs in insulin-dependent children of childhood and adolescence. In this case, there is often a powerful intoxication of the body, a rapid increase in the disease, the formation of fibrous-cavernous formations and the disintegration of the organ.

But in each case, the nature of the deviations depends directly on the timeliness of diagnosis of the disease and the strict adherence to chemotherapy.

There are several groups of patients according to the period of onset of diabetes and tuberculosis:

  1. Single or with a minimum interval of 1-2 months;
  2. Detection of infection on the background of diabetes of any stage;
  3. Detection of hyperglycemia on the background of tuberculosis.

Infection may be associated with both primary infection and reactivation of old foci (scars) due to previous tuberculosis. The specificity of the parallel course of two pathologies is that due to the lability of diabetes, even with successful treatment of infection, in an insulin-dependent patient, the tendency to exacerbations and recurrence of tuberculosis remains.

Etiology of tuberculosis in patients with diabetes

In most cases, the infection joins an already existing diabetes. The main reasons for the progression of tuberculosis are underestimating the severity of tuberculosis during its initial manifestation and, therefore, the late treatment.

Other factors provoking the aggravation of infection can be:

  • Disruption of the diet during chemotherapy;
  • Skipping medication;
  • Smoking and drinking;
  • Unhealthy lifestyle and lack of day regimen;
  • Poor diet;
  • Stress;
  • Excessive physical exertion
  • Diabetic coma;
  • Errors in chemo or insulin therapy;
  • Acidosis (increase in acidity and decrease in pH in the body;
  • Acute or chronic pancreatitis;
  • Removal of the pancreas;
  • Imbalance of homeostasis and immunobiological reactivity of the organism.

With the increase in the severity of diabetes, the course of infection becomes heavier. In insulin-dependent non-complicated stages of diabetes mellitus, the general morphology does not differ in any specificity.

Symptomatology

Despite the seriousness of the pathologies, the signs of tuberculosis in diabetes are not always obvious and may disguise decompensation, acidosis or other diseases.

The following symptoms cause the infection to be present in the body:

  • Rapid weight loss and lack of appetite;
  • Constant weakness and quick fatigue;
  • Increased diabetes;
  • Blood sugar fluctuations in the direction of its increase;
  • Increased glucose and diuresis;
  • Constant thirst and dry mouth;
  • Frequent urination;
  • Irritability;
  • Permanent paroxysmal cough in the morning and evening hours;
  • Excessive sweating;
  • Subfebrile condition;
  • Sputum discharge, possibly with blood impurities;
  • Heat;
  • Frequent colds - acute respiratory infections, herpes;
  • Hypodynamic and bad mood.

Transformations are also observed at the physiological level - the insulin-dependent patient begins to slouch strongly, and his chest cell becomes hollow. The gait of a person also changes, becoming shuffling and slow.

Tuberculosis is a very insidious disease and can often not manifest itself. Only with regular x-ray and fluorography examination can the infection be detected in time and its development stopped.

Treatment technology

Pulmonary tuberculosis and diabetes mellitus are a difficult combination for standard chemotherapy. The number of complications and side effects of treatment in insulin-dependent patients is 1.5 times more than in patients without diabetes. The therapy itself lasts much longer and takes place only in a dispensary hospital.

Selection of combinations of drugs and their reception system is carried out according to an individual scheme, in accordance with the diagnosis, diabetic group, phase of tuberculosis, its distribution and the intensity of the release of the office. The main principle of the whole therapeutic course is diversity and balance.

The infection is diagnosed using standard methods of clinical and laboratory research:

  1. General analysis of blood and urine;
  2. Biochemistry analysis;
  3. Routine and in-depth X-ray examination;
  4. Tuberculin test or Mantoux / Pirque vaccination;
  5. Sputum microscopy and culture for the detection of mycobacterial activity;
  6. Bronchoscopic diagnosis;
  7. Taking tissue or cells for histological biopsy;
  8. Immunological diagnostics aimed at identifying antibodies to bacilli in the serum.

Treatment of tuberculosis in insulin-dependent patients is carried out with the help of combination therapy with continuous monitoring of sugar level. Violation of the medication regimen leads to multiresistance of tuberculosis or the development of its resistance to drugs.

The standard for diabetics regimen of anti-tuberculosis treatment includes:

  • Chemotherapy - Isoniazid, Rifampicin, Ethambutol and other antibiotics;
  • Immunostimulants - Sodium Nucleinate, Taktivin, Levamiol;
  • Inhibitors - b-tocopherol, sodium thiosulfate, etc .;
  • Hormonal drugs with constant monitoring of sugar;
  • Antidiabetic agents, including insulin;
  • Medical diet number 9.

With slow regression of infection, the use of auxiliary non-medical methods of anti-tuberculosis therapy - ultrasound, laser and induction therapy is allowed.

In extremely severe cases, resorted to direct surgical treatment of the lungs, the so-called economical resection.

The whole process of curing a patient with diabetes from consumption takes place under close medical supervision. In addition to eliminating the infiltrate, the main task during this period is to achieve a state of compensation, as well as the normalization of glucose, protein, lipids and metabolism.

With the successful completion of chemotherapy and recovery, sanatorium treatment is shown to the patient with diabetes.

Preventive actions

Since insulin-dependent patients are in the main risk group for infection with tuberculosis infection, they are recommended to use a number of preventive methods in order to prevent the development of the disease.

To protect yourself from consumption, you must:

  1. Undergo an X-ray or fluorography annually;
  2. To live an active lifestyle;
  3. Often walk in the fresh air;
  4. Adhere to the correct daily routine, food and work-rest mode;
  5. Exclude possible sources of infection, including direct contact with a patient with tuberculosis;
  6. Improve living conditions;
  7. To give up bad habits - alcohol, smoking;
  8. To treat chronic diseases, including diabetes;
  9. Observe personal hygiene;
  10. Ventilate and clean the room regularly;
  11. Eat foods rich in vitamins, carbohydrates and microelements.

In addition, an insulin-dependent patient is required to undergo Isoniazid chemoprophylaxis for 2 to 6 months. The diabetic’s entire lifestyle for tuberculosis should be aimed at its active position, healthy diet and moderate exercise, allowing the body to accumulate living energy and strengthen the immune system.

Do not forget about safety precautions. and try to avoid coughing people, seasonal viruses (flu, acute respiratory infections), hot steam and sauna visits. Excessive consumption of ultraviolet radiation is also contraindicated. Eat should be rationally, in several stages. Be sure to regularly visit the attending physician.

With a responsible and medically correct approach to the problem of tuberculosis and diabetes, the infection does not carry a catastrophic threat and is always characterized by a favorable prognosis.

Watch the video: Tuberculosis. Clinical Presentation (September 2019).