6.3. Checkup of the tuberculosis patients by a tuberculosis at chemotherapy


Checkup of the patients before the beginning of treatment is necessary for:

  1. definition of the form, extent and phase of process;
  2. definition of the MBT expectoration and MBT drug sensitivity;
  3. revealing the disturbances of function of the damaged organ;
  4. revealing of the complications of tuberculosis;
  5. revealing of the accompanying diseases and the control of their current;
  6. revealing of the contra-indications to assignment of drug preparations.

The following complex is obligatory for examination of the patients with all localizations of tuberculosis before the beginning of treatment:

  1. collection of the complaints and anamnestic data;
  2. physical examination of the patient;
  3. examination of sputum (bronchial waters) and other accessible diagnostic material for MBT (bacterioscopy, luminescent microscopy, bacterial inculation with definition of drug sensitivity);
  4. chest rentgenography in direct and lateral projections, including X-ray tomography on optimal cuts;
  5. The clinical analyses of blood, urine and faeces;
  6. serologic examination for syphilis;
  7. investigation of blood on VIH antibodies;
  8. investigation of blood on antibodies to viruses of hepatitis;
  9. definition of the contents bilirubin, ALT, AST in blood;
  10. definition of protein and its fractions in blood;
  11. definition of the glucose contents in blood;
  12. ECG;
  13. oculist inspection (before assignment of ethambutol);
  14. examination be the otolaryngologist (before assignment aminoglycosides);
  15. tuberculin test for children (definition of a threshold sensitivity to tuberculin, skin divided test-Pirquet).

In case of presence of accompanying diseases during examination, consult appropriate experts and carry out necessary examinations. The monitoring examinations of the tuberculosis patients serve for definition of dynamics of MBT expectorations and involution of tubercular changes in organs, for monitoring of efficiency of a treatment and its tolerance, and also for the monitoring of accompanying diseases.

Obligatory components of the monitoring laboratory investigations are:

  1. the clinical analyses of blood and urine, carried out in an intensive phase of treatment, not less then once a month, and in a continuation phase once per 3 months;
  2. evaluation of the bilirubin content, ALT, AST in blood in intensive phase of treatment not less then once a month, and in а phase of continuation – once per \ 3 months intervals;
  3. investigation of diagnostic material for MBT, according to localization of tuberculosis process (bacterioscopy, luminescent microscopy, bacterial inoculation with definition of drug sensitivity) not less, than triplicate. In an intensive phase of treatment investigation is organized once a month, and in phase of continuation – at the end of the second month (20-th week from the beginning of treatment) and after the end of treatment;
  4. the X-ray examination of the damaged organ (organs) during an intensive phase of is organized once per 2 months, and also at the moment of making decision about to move the treatment to a phase of continuation and at the end of a phase of continuation;
  5. among children – complex tuberculin testing should be organized after each phase of treatment.

If there are complications of the tubercular process or necessity to go for surgical intervention it is advisable to conduct necessary investigations. The consultants – experts are invited for the monitoring of changes accompanying diseases and correction of chemotherapy side effects.

Share this Article: