[Pulmonary tuberculosis in patients with different types of diabetes mellitus]

Comparing the clinical and X-ray characteristics of pulmonary tuberculosis developed in 110 patients with type 1 diabetes mellitus (Group 1) and in 40 patients with type 2 (Group 2) revealed significant differences between these groups. An acuter onset and rapid progression, formation of extensive lesions with multiple, but small decay areas were typical for type 1 diabetes patients. Intensive chemotherapy for tuberculosis according to the standard WHO regimens is successfully tolerated by patients with different types of diabetes mellitus. Slight changes in hepatic functions (elevated levels of total bilirubin and aminopherases) are not beyond the ranges of allowable fluctuations and they do not prevent the first stage of treatment to be performed. The short duration of this stage of treatment is a determinant of a satisfactory tolerance of intensive chemotherapy at its first most loaded stage. The outcomes of the therapy were more favourable in patients with type 1 diabetes mellitus. Their bacterial isolation ceased early and more frequently and decay cavities closed in a larger number of cases as compared with patients with type 2 diabetes mellitus. The higher efficiency of treatment in Group 1 patients was caused not only by the specific features of the genesis of a tuberculous process and the nature of its clinical and X-ray manifestation, but also by differences in isoniazid inactivation processes. The significantly higher incidence of a slight inactivation of this drug in Group 1 patients determined its higher blood concentration and more pronounced therapeutical effect.