[Acutely progressive pulmonary tuberculosis: morphological and bacteriological features]

The data of autopsies (n = 431) and morphological (n = 52) and bacteriological (n = 47) studies of the operating material obtained from the lungs of patients with tuberculosis during 1980-1989 and 1990-1999 were analyzed at the Research Institute of Pulmonology and Phthisiology, Republic of Belarus. The analysis revealed an increase in the incidence of acutely progressive forms of pulmonary tuberculosis. Autoptic data indicated that in 83.7% of cases, acute progressive tuberculosis was associated with the development of caseous pneumonia as an independent tuberculous process (31.7%) and as a phase of ensuing development of other forms (52.0%). The distinctive morphological features of today's caseous pneumonia were as follows: a great extent of lesion, an unrestrained progression of a process, a predominance of an alterative-and-exudative component of tuberculous inflammation, a rapid decay and suppuration of caseous masses, no differentiation of caseous and pneumonic foci, and suppressed cellular reactions of tissue immunity. The morphological and bacteriological studies of the operating lung material from patients with pulmonary tuberculosis suggested that there was a predominance of a progressive disseminating process at the moment of surgery.