7.4. Tuberculosis and alcoholism


The problem of alcoholism in connection with the lung is very actual. The persons with combined pathology (tuberculosis and alcoholism) represent strong epidemiological danger not only because of high prevalence among them, but also due to sevear destructive forms of the tuberculosis with massive MBT expectoration. These patients owing to personal degradation and low level sanitary education, do not observe elementary rules of hygiene, usually come to hospital late, neglect the recommendations of the doctors and refuse radical therapy. Thus distributing MBT, frequently multi drug resistant they become especially dangerous for surrounding people. Among tuberculosis patients combined with alcoholism the drug resistance of MBT is observed in 2 times more often, and multi drug resistance – in 6 times is more often, than in patients who are not suffering from alcoholism. It indirectly testifies that the treatment of such patients was undertaken repeatedly and mostly they avoided it. Alcohol abuse in 3-5 times more among the patients registered in tuberculosis dispenserary, than among for the first time tuberculosis revealed. The reason of this “subsidence” in the dispenserary of the alcohol abused persons is the low efficiency of treatment. The prevalence of alcoholism is especially great among the patients with chronic destructive lung tuberculosis. The lung tuberculosis in the overwhelming majority of the patients develops on background of alcoholism, proceeds to it less often. It characterizes the majority of the persons with combined pathology as alcoholics with accompanying tuberculosis.

The clinical signs and course of lung tuberculosis combined with alcoholism can be various. The process in lung at the alcoholic patients sometimes turns into acute process and results to lethal outcome. Often complications of lung tuberculosis combined with alcoholism are: lung hemorrhage and hemoptysis, which connect to pneumosclerosis and increased permeability of blood vessels under influence of alcohol. After treatment of tuberculosis among alcoholic patients the expressed residual changes in lungs are observed, that creates conditions for occurrence of relapses of tuberculosis. The main reason of relapse development is the ineffective treatment of the patients during realization of the basic course of chemotherapy in inpatient conditions because of a prescheduled discharge caused by violating the rules. At the alcoholic patients the tubercular process at its relapses proceeds with more aggravations, than at initial disease.

At occurrence of tuberculosis the alcoholism course is sharply worsened, its heavy stages develop quickly with expressed personal psychopathological degradation and social inadequate adaptation. The hard drinking becomes of persistent character, strongest the morning after syndrome appears. The tubercular infection is the additional aggravating factor promoting occurrence of alcoholic psychosis. The basic role in their development is played by intensification of specific process.

The principles of treatment.
One of the basic reasons of adverse tuberculosis course combined with alcoholism is ineffective treatment because of an indiscipline behavior of such patients. Without active anti – alcoholic therapy the treatment of the alcoholic tuberculosis patients is unsuccessful. In connection with combined aggravation by alcoholism and tuberculosis it is necessary to treat such patients simultaneously from alcoholism and tuberculosis. Using highly effective, adequately chosen combinations anti – tuberculosis allows simultaneously to carry out active anti-alcoholic therapy without serious complications. Such approach in treatment allows prolonging time of stay of the patients in hospital for the account of alcoholism remission and by that to increase effectiveness of tuberculosis chemotherapy.

Chemotherapy of lung tuberculosis at the alcoholic patients is obligatory and necessary to carry out in hospital according to the standard principles. Frequently such patients avoid chemotherapy, therefore it is necessary to carry out the strict control of the chemotherapy regularity: the preparations are advisable to administer parenteral, and if internal, in daily single dozes, in presence of medical personal.

Controlled intermittent chemotherapy with once a day drug administration is a method of choice for treatment of the patients with chronic destructive lung tuberculosis (especially at elderly age) at combination with alcoholism and internal diseases.This method, is not less effective than every day drug administration, but causes less toxicity. At the combined pathology it is necessary to apply intra-veinous and per rectal administration of drugs. It is necessary to take care during administration of hepatotoxic drugs: rifampicin (especially together with isoniazid), pyrazinamide, etionamid, protionamide and tyoacetozone for alcoholic patient, patient with alcoholic liver cirrhosis, patient having virus hepatitis and continuing to abuse alcohol. The patients with combined pathology better tolerate Ftivazide and Metazid, and badly tolerate – isoniazid. Multiple somatic diseases combined with alcoholism limit the choice of effective combinations anti-tuberculosis drugs, because of contra-indications to their application. Therefore at the combined disease the individualization of chemotherapy is necessary in view of character accompanying of somatic pathology.

Toxic drug reactions among tuberculosis patients which have been not noticed with alcoholism were observed in 2 times less often, than in patients with combined pathology. Organization of anti-alcohol treatment and preventive measures in the clinic with an open regime promote reduction of frequency of prescheduled discharge for the use of alcohol among the alcoholic tubercular patients.

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