Laboratory and morphological manifestations of tuberculous inflammation in patients with pulmonary tuberculoma, multiple and pre-extensive drug-resistant mycobacteria, and diabetes mellitus under different durations of chemotherapy

Introduction. Patients with tuberculosis, multiple and pre-extensive drug resistance, and concomitant diabetes

mellitus represent a difficult cohort for treatment, which is why the search for optimal approaches to the comprehensive

treatment of this category of patients is a topical task. Aim. To investigate laboratory markers of systemic inflammation

prior to surgical intervention and the morphological pattern of the tuberculous process in resection specimens in

patients with pulmonary tuberculoma, multiple and pre-extensive drug-resistant Mycobacterium tuberculosis , and

diabetes mellitus under different durations of chemotherapy. Material and Methods. The study included thirty-three

patients with pulmonary tuberculomas and concomitant diabetes mellitus and thirty-seven patients with pulmonary

tuberculomas without diabetes mellitus, who underwent combined treatment including a surgical method. Activity

of systemic inflammation was assessed by the severity of leukocytosis, elevation of the erythrocyte sedimentation

rate, and levels of C-reactive protein and fibrinogen. The tuberculous inflammation activity degree in the resection

specimens was evaluated by morphological examination. Statistical processing was performed using parametric

and nonparametric tests. Results and Discussion. In patients with diabetes mellitus in the preoperative period, an

increase of the erythrocyte sedimentation rates and the fibrinogen levels were recorded significantly more often, and

the values of these parameters were substantially higher. Leukocytosis was noted somewhat more frequently in the

group of patients with diabetes mellitus, however without statistically significant differences. In both groups examined,

more than half of the patients had elevated C-reactive protein levels, and there was no significant difference between

the groups. According to the morphological examination of the resection specimens, patients with moderate and high

activity of tuberculous inflammation prevailed in all groups. An increase in the proportion of patients with low activity was

noted in the group of patients without diabetes mellitus who received antituberculosis therapy for nine to twelve months;

however, no statistically significant differences were found. In the morphological study among patients with diabetes

mellitus who received chemotherapy for nine to twelve months, the inflammatory process reactivation phenomena

were observed in twenty-five percent of patients. Conclusions. In patients with tuberculosis and concomitant diabetes

mellitus, laboratory and morphological signs of inflammatory activity persist for a prolonged period, and phenomena

of tuberculosis reactivation are frequently observed where accompanied by the organization of the specific process.