Method for differential diagnostics of infiltrative tuberculosis and inspecific pneumonia

FIELD: medicine, phthisiology.

SUBSTANCE: one should carry out test-therapy with antibiotics, moreover, preparation should be introduced into subcutaneous fiber of pre-tracheal area, subaxillary area at the side of lesion once daily at the dosage of 1/2 - 2/3 against the age daily dosage and 7-10 d later in case of roentgenologically proved healing of pulmonary inflammatory alterations one should state upon pneumonia, and in case of kept inflammatory alterations - tuberculosis. The present method enables to shorten the terms of diagnostics that, in its turn, enables to carry out corresponding therapy in due time and, thus, prophylaxis of possible jatrogenic complications.

EFFECT: higher efficiency of diagnostics.

2 ex


The invention relates to medicine, namely to Phthisiology.

The similarity of clinical and radiographic progression in infiltrative tuberculosis and nonspecific pneumonia complicates the diagnosis of tuberculosis.

However, the proposed methods for differential diagnosis of tuberculosis based on the comparison of the characteristic for tuberculosis and pneumonia clinical and radiographic signs have only indirect importance and need objective evidence [1, 2]. Trial therapy with broad-spectrum antibiotics when their traditional introduction (/m, per os), used as a differential diagnostic test between tuberculosis and pneumonia, in some cases even up to 4-6 weeks due to lack of clinical-radiological effect [3].

Our proposed method of differential diagnosis between infiltrative tuberculosis and nonspecific pneumonia is the change in the method of introduction of the antibiotic when conducting the test treatment (use of lymphotropic introduction)that allows you to make the correct diagnosis after 7-10 days. When nonspecific pneumonia, according to x-ray control, this term comes complete resorption of inflammatory changes in the lungs, tuberculosis positive radiological improvement is not observed.

We offer you the method the test treatment with broad-spectrum antibiotics is carried out by the method developed by us [4]. In the subcutaneous tissue pretracheal zone, subaxillary region on the affected side within 7-10 days once a day in a 0.25% solution of novocaine injected antibiotic dose 1/2-2/3 age daily dose. Before the introduction of antibiotic administered 1 ml (5 tised) heparin with 0.25% solution of novocaine (creation lymphotropic effect). Area drug alternate. The total volume of fluid 20 ml (two syringes 10 ml).

Example 1. Patient L., age 16, was on treatment in somatic hospital with a diagnosis of Acute right upper lobe pneumonia. Received antibiotics for 10 days. During this period, the change of the drugs was performed 5 times. When conducting x-ray control (on day 8 of treatment) showed a negative x-ray dynamics in the form of strengthening infiltrative changes in the upper lobe of the right lung and signs of hypoventilation. Suspected infiltrative tuberculosis of the lungs. Transferred to the research RAMS.

The purpose of diagnosis applied to the test-lymphotropic therapy the introduction of cefamezin. The drug was administered at a dose of 1.0 once a day for 7 days.

By the end of the course lymphotropic therapy showed complete resorption of infiltrative hypoventilation changes in the upper lobe of the right lung.

Test therapy using lymphotropic the introduction of the antibiotic on valila 7 days to diagnose pneumonia.

Example 2. The patient Was 17 years old, was treated in somatic hospital for acute, pravostoronnei proximal pneumonia. Within 3 weeks were treated with broad-spectrum antibiotics (ampioks, Cefazolin, ciprolet) with partial clinical and radiographic results. Was discharged for outpatient monitoring of TB diagnosed with Prostornaja proximal pneumonia, a protracted course.

In the PDD by place of residence continued treatment with antibiotics: Sumamed - 6 days ciprofloxacin - 8 days. The General course of antibiotic treatment was 34 days.

When conducting x-ray control a slight positive trend by reducing the intensity of inflammatory changes in the lung. A reliable comparative evaluation of the radiographs was difficult because of the varying quality of the compared images.

For the differential diagnosis between tuberculosis and protracted pneumonia is aimed at the research of the Russian Academy of medical Sciences.

Given the complexity of data interpretation of interarchive due to the low quality of the intermediate x-ray or absence in a patient with sputum smear carried out the test-treatment with gentamicin at a dose of 80 mg once a day, lymphotropic within 10 days.

By the end of the course lymphotropic therapy positive rent is ekologicheskogo effect is not obtained, that has allowed to exclude the nonspecific nature of inflammation and after 10 days the test treatment to the diagnosis of tuberculosis.

After 2 months of diagnosis of tuberculosis has been bacteriologically confirmed, sputum sowing method received abundant growth of the office.

Thus, lymphotropic of antibiotics in patients with nonspecific pneumonia, previously treated with antibiotics other methods (in/m, oral), helps to achieve a marked clinical and radiological improvement for a short period (7-10 days), which reduces the differential diagnosis between infiltrative tuberculosis and nonspecific pneumonia.

The proposed method can be recommended for widespread clinical use in the most difficult diagnostic cases.


1. The respiratory TB / edited Agiamento. - M., 1980. - P.236 - 237.

2. Katorgin N.A., S.M. Fedorov, Karpov I.V. Diagnosis of pulmonary tuberculosis in therapeutic hospital /national Congress on respiratory diseases, 12th: proc. Dokl. - M., 2002. - Page 287.

3. Korovkin B.C. On timeliness of diagnosis of infiltrative pulmonary tuberculosis // national Congress on respiratory diseases, 12: abstracts of the reports. - M., 2002. - S.

4. Firsova, VA, by Ovsyankin Y.S., Gubkin F Patent No. 2104046 February 10, 1998 - “a Method for the treatment of TB is ESA light”.

The method of differential diagnosticity infiltrative tuberculosis and nonspecific pneumonia with the test treatment with antibiotics, characterized in that the drug is injected in the subcutaneous tissue pretracheal zone, subaxillary region on the affected side 1 time a day at a dose of 1/2-2/3 of age daily dose and after 7-10 days when the resorption of inflammatory changes in the lungs, established radiographically, diagnosed with pneumonia, while maintaining the inflammatory changes - TB.


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5 ex

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3 ex, 1 tbl

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9 ex, 1 tbl

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2 ex, 3 tbl

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