[The specific diagnostic features of pulmonary tuberculosis at the lower and middle lobular sites]

Cases of pulmonary tuberculosis at the lower and middle lobular are not so rare. However, there is evidence that there is a rise in the number of patients with lower lobular tuberculosis (0.56-15.1%) of those with pulmonary tuberculosis. The diagnosis of lower lobular tuberculosis presents certain difficulties; it has to be differentiated from multisegmental pneumonia and tumors in some cases. Middle and lower tuberculosis was notified in 4.7% among the first detected patients in the Brest Region in 2003, in 6.8% among the patients with infiltrative pulmonary tuberculosis during 8 months in 2004. Forty-three cases of pulmonary tuberculosis at the above sites were studied in the inpatients of pulmonary tuberculosis departments of the regional tuberculosis dispensary in 2003 and during 6 months in 2004. All these patients were diagnosed as having infiltrative lower lobular tuberculosis that amounted to 5% of infiltrative pulmonary tuberculosis at all sites treated at the hospital. In most cases, there were first diagnosed patients [n = 35 (81.4%)], 8 (18.6%) patients with recurrences. There were 32 (69.8%) males and 11 (25.6%) females; 24 (55.8%) urban dwellers and 19 (44.2%) rural ones. The patients aged over 60 years were predominant [n = 21 (48.8%)], so were pensioners [n = 19 (44.2%)]. Eleven (25.6%) patients had concomitant cardiovascular diseases, 3 (7%) patients had diabetes mellitus; 1 (2.3%) patient had respiratory diseases and one more (2.3%) patient had gastrointestinal diseases; other abnormalities were observed in 11 (25.6%) patients. Most patients [n = 31 (72.1%)] were identified in those seeking medical advice; 12 (27.9%) patients were detected on prophylactic examinations. Thirty-seven (86%) patients had pulmonary and intoxication complaints of varying duration; 6 (14%) patients had no complaints. Due to the untypical acute onset of the disease, 53.5% of this group of patients were admitted to therapeutic and pulmonological departments for suspected pneumonia or other diseases. The efficiency of treatment was as follows: decay cavities were closed in 10 (66.7%) patients; 16 (69.6%) patients stopped isolating Mycobacterium tuberculosis; 7 (16.3%) patients discontinued therapy themselves.