RU2735468C1 - Diagnostic technique for renal tuberculosis - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely to phthisiourology, and can be used for diagnosing renal tuberculosis by ex juvantibus type 2 therapy. That is ensured by administering Perchlozone as an anti-tuberculosis preparation. Additionally, the renal region is exposed to radiation of an infrared laser with power 15 mWt for 10 minutes on each kidney alternating sides. Therapeutic course is two months. Before and after therapy, such symptoms as pain intensity by analogue scale in scores, number of daily urination, leukocyturia, haematuria are evaluated. If the above values are increased by 25 % or more, renal tuberculosis is diagnosed.

EFFECT: method provides sensitive specific high-performance diagnostics available for use both in hospital and in outpatient practice.

1 cl, 2 ex

Description

The invention relates to medicine, namely to phthisiourology.

It is extremely difficult to confirm the diagnosis of "genitourinary tuberculosis" in the early stages, before the formation of destruction, which is visualized with radiation research methods. Mycobacteriuria in modern nephrotuberculosis is scarce, unstable and elusive. This is largely due to the suboptimal use of broad-spectrum antibiotics, primarily fluoroquinoloids and amikacin, for the treatment of nonspecific infections of the urinary system, under the guise of which urotuberculosis occurs.

The frequency of bacteriological verification of the diagnosis of renal tuberculosis currently does not exceed 38% [1].

Another method for the diagnosis of renal tuberculosis, radiological, is informative only in destructive forms of the disease [2].

There are also known methods for the diagnosis of renal tuberculosis by setting provocative tests [3], but they are of limited value due to the increase in the number of concomitant diseases and combined forms of tuberculosis, which gives false positive results.

In phthisiourology, there are also known methods for the diagnosis of renal tuberculosis by performing ex juvantibus therapy of the 1st and 2nd types [4].

Ex juvantibus therapy involves the appointment of antibiotics that only affect nonspecific uropathogens and do not inhibit the growth of M. tuberculosis (fosfomycin, furazidin, geitamycin, cephalosporins).

Type 2 ex juvantibus therapy involves the appointment of antibiotics that affect only Mycobacterium tuberculosis and do not have a bactericidal effect against non-specific microflora.

Known methods of carrying out therapy ex juvantibus type 2 by the appointment of isoniazid, pyrazinamide, ethambutol and PASK [5], however, at present, due to the progressively growing resistance of Mycobacterium tuberculosis, this method gives false negative results.

The proposed method involves the use of perchlozone - a new anti-tuberculosis drug with a narrowly targeted activity on Mycobacterium tuberculosis and does not affect the growth of nonspecific uropathogens, which is prescribed 600 mg in the morning after a meal, and additionally carried out laser therapy with an infrared laser with a power of 15 MW, on the kidney area for 10 minutes of the procedure spend every other day, alternating sides. Duration of therapy is 2 months.

An additional purpose of laser therapy provides an increase in the concentration of perchlozone in the renal parenchyma.

The method is carried out as follows. A patient with suspected renal tuberculosis, who was not allowed to confirm or reject the diagnosis of renal tuberculosis by microbiological, X-ray and clinical examination, is prescribed ex juvantibus type 2 therapy with a daily intake of 600 mg perchlozone in the morning after meals, and infrared laser therapy laser with a power of 15 MW, on the kidney area for 10 minutes according to the scheme: Monday - left, Wednesday - right, Friday - left, Monday - right, etc., that is, procedures are carried out every other day, alternating sides. The duration of therapy is 2 months, after which a complete clinical and laboratory examination is carried out, and with the improvement of the main clinical (pain, dysuria, quality of life) and laboratory (pyuria, hematuria, blood leukocytosis, increased ESR) by 25% or more, kidney tuberculosis is diagnosed.

Example 1.

Patient D., 38 years old. Suffering from recurrent urinary tract infections for 7 years, the growth of multi-resistant E. coli in a titer of 10 ⁵ -10 ⁶ CFU / ml was repeatedly found. The patient annually received repeated courses of various antibiotics, however, the disease recurred 3-6 times a year: subfebrile condition, pain in the kidney area, dysuria, pyuria, erythrocyturia appeared. Over the past two years, E. coli growth has been less frequent; some exacerbations have disappeared with sterile pyuria.

She denies contact with patients with tuberculosis, she is socially prosperous and has no bad habits. Two pregnancies proceeded without abnormalities and ended in normal urgent labor.

The gynecologist is examined regularly, sexually transmitted diseases are excluded. Given the continuously recurrent course, the ineffectiveness of standard therapy, urogenital tuberculosis was suspected. The urine was inoculated three times on solid media, the result was negative. According to excretory urograms, renal excretory function is not impaired; the indistinctness of the contours of the cups on both sides is determined. Mantoux reaction with 2 TE - papule 14 mm.

Ex juvantibus type 1 therapy (cephalosporins with furazidine) did not improve clinical and laboratory parameters.

The subcutaneous provocative tuberculin test of Koch-2 is not informative due to the initial pyuria.

The patient was started therapy ex juvantibus type 2 according to the claimed method: Perchlozone was prescribed as an anti-tuberculosis drug, and the kidney area was additionally exposed to a 15 mW infrared laser for 10 minutes on each kidney, alternating sides, for a course of two months.

Two months later, her condition improved significantly: body temperature returned to normal, pain intensity decreased from 8 points on an analog-visual scale to 3, that is, by 62.5%; the frequency of urination decreased from 27 to 14 per day, that is, by 48.1%; decreased pyuria by 33.4%.

Based on the data obtained (improvement of clinical and laboratory parameters by more than 25%), the patient was diagnosed with renal tuberculosis. Bilateral tuberculous papillitis, bladder tuberculosis, MBT-, and standard four-component polychemotherapy was started.

At the follow-up examination after 6 months: no complaints, urine and blood tests within normal limits. A follow-up examination a year later revealed a stable remission of renal tuberculosis.

Example 2.

Patient T., 46 years old. About 8 years have been observed by a urologist for chronic pyelonephritis. In the analysis of urine - persistent leukocyturia, transient growth of uropathogens in a high titer with increasing resistance to antibiotics.

A history of contact with a father with tuberculosis; she herself did not suffer from tuberculosis. Smokes. Three pregnancies: one ended in premature birth, two were terminated.

Upon admission: the condition is satisfactory, the nutrition is low. Body temperature is normal. Urine tests: leukocytes 50-60 in the field of view, erythrocytes 2-4, bacteria, mucus. Blood test - no pathological abnormalities. Ultrasound of the kidneys: echogenic heterogeneity of the parenchyma, compaction of the calyx arches. There is no retention. Mantoux reaction with 2 TE - hyperemia 18 mm.

Type 1 ex juvantibus therapy was performed - without effect. The provocative tuberculin test is not informative due to the initial leukocyturia.

The patient was started therapy ex juvantibus type 2 according to the claimed method: Perchlozone was prescribed as an anti-tuberculosis drug, and the kidney area was additionally exposed to a 15 mW infrared laser for 10 minutes on each kidney, alternating sides, for a course of two months.

After two months, no clinical and laboratory dynamics was noted (dynamics in symptoms and laboratory manifestations was less than 25%). The growth of multidrug-resistant Klebsiella was obtained in the urine. Prescribed imipenem in combination with pyobacteriophage. After 14 days, for the first time in 8 years, the patient's urinalysis returned to normal. Thus, the diagnosis of renal tuberculosis was excluded.

The method was tested in 5 patients at the Federal State Budgetary Institution NNIIT MH RF; in 4 patients the test was positive; Later, the diagnosis was confirmed in 2 patients by the molecular genetic method, all of them continued to have positive dynamics against the background of standard polychemotherapy and ended in recovery.

In one patient with a negative result (change in basic clinical and laboratory data by less than 25%), the growth of multidrug-resistant Klebsiella in a high titer was obtained; she underwent complex antibiotic-phage therapy, which also led to her recovery.

Thus, the claimed method for the diagnosis of renal tuberculosis has a high sensitivity and specificity, highly effective, available for use both in hospital and in outpatient practice.

Literature

1. Challenges and perspectives in the diagnosis of extrapulmonary tuberculosis. / L. Norbis [et al.] // Expert review of anti-infective therapy. - 2014. - V. 12. - No. 5. - P. 633-647.

2. Chen H. Diffuse calcification of the urinary system and miliary tuberculosis due to delayed diagnosis of genitourinary tuberculosis: A Case report. / H. Chen, Y. Liu, D. Wu. // Iranian journal of public health. - 2015. - V. 44. - No. 2. - P. 276-278.

3. Kulchavenya E. Urogenital Tuberculosis: Epidemiology, Diagnosis, Therapy / E. Kulchavenya // Springer Cham Heidelberg New York Dordrecht London, 2014 - 137 p. ISBN 978-2-319-04836-9 DOI 10.1007 / 978-3-319-04837-6

4. Kulchavenya E.V. Almanac of Extrapulmonary Tuberculosis

/E.B. Kulchavenya, V.A. Krasnov, A.V. Mordyk. - Novosibirsk: Sibprint, 2015 .-- 247 p: ill. ISBN 978-5-94301-579-3

5. Kulchavenya E.V. Selected issues of phthisiourology / E.V. Kulchavenya, V.A. Krasnov. - Novosibirsk: Nauka, 2010. - 142 p., [0.25] p. incl.

Claims (1)

A method for diagnosing renal tuberculosis by conducting ex juvantibus therapy of type 2, characterized in that perchlozone is administered as an anti-tuberculosis drug and additionally affects the kidney area with 15 mW infrared laser radiation for 10 minutes on each kidney, alternating sides, for a course of two months, before and after therapy, symptoms such as the intensity of pain on an analogue scale in points, the number of daily urination, leukocyturia, hematuria are assessed, and if these indicators improve by 25% or more, renal tuberculosis is diagnosed.