[Present-day aspects (diagnosis, clinical course and treatment) of acute progressive pulmonary tuberculosis]

A total of 103 patients with acute progressive pulmonary tuberculosis whose age ranged from 18 to 60 years were examined. Caseous pneumonic, infiltrative-caseous, disseminated, and rapidly progressive fibrocavernous tuberculosis was found in 45.6, 17.5, 16.5, and 20.4% of cases, respectively. The clinical picture was characterized by its acute onset with significant intoxication syndrome. Moreover, all the patients had respiratory and immunological failure, varying disseminated intravascular coagulation syndrome, non-specific bronchopulmonary infection; some presented with pulmonary hemorrhage, spontaneous pneumothorax and pleural empyema. The sputum smear test was positive in all the patients. If there was no evidence for drug resistance, patients had a 4-month regimen using isoniazid, rifampicin, pyrazinamide, ethembutol, and kanamycin. In the subsequent 10-12 months, isoniazid, rifampicin, and ethambutol were given. The patients with multidrug resistant tuberculosis were administered protionamide, ofloxacin, amikacin, supplemented by pyrazinamide and ethambutol. The combined chemotherapy could stop bacterial isolation in more than 80% of patients, make the process stable, and prepare them for planned surgical treatment. When complications occurred and the disease was in steady progress, salvage operations were made, which was the only possible way of preventing the progression of disease at times and of saving life in the patient.