DIFFERENTIAL DIAGNOSIS OF TUBERCULOSIS AND NON-SPECIFIC PULMONARY INFILTRATS (Lecture)

Abstract

Following the reformation of healthcare system and the dissolution of the specialty "Phthisiology," the extensive anti-tuberculosis efforts in Ukraine now fall under the purview of family doctors and specialists across various fields. According to the Law of Ukraine “On Overcoming Tuberculosis in Ukraine”, enacted on 14.07.2023 under No. 3269-IX, Paragraph 4 (Article 4), individuals afflicted with tuberculosis or latent tuberculosis infection are entitled to specialized medical care. This includes the treatment of all forms of tuberculosis and associated conditions across a spectrum of healthcare institutions. Compliance with this legal mandate necessitates that doctors of various specialties possess not only proficiency in contemporary tuberculosis treatment methods, which will be facilitated by the regional tuberculosis control center, but also competence in diagnosing tuberculosis in its various presentations. When health issues arise, patients typically seek assistance first from primary care specialists. The “Pulmonary infiltrate syndrome” is an X-ray syndrome characterized by the presence of shadows in the lungs exceeding 1 cm in diameter. There are numerous causes for such changes in the lungs. Given that the lungs are the most common site for tuberculosis, particularly in the form of infiltrative shadows, which may signify not only tuberculosis but also pneumonia, tumors, lung infarction, eosinophilic infiltrate, and other conditions, the question of their differential diagnosis becomes quite relevant. The increasing frequency and subtle clinical presentation of the “Pulmonary infiltrate syndrome” necessitate proficiency in the clinical aspects and diagnosis of its most common manifestations. The key differential diagnostic features that distinguish infiltrative pulmonary tuberculosis from other nonspecific infiltrates include contact with a tuberculosis patient or a history of tuberculosis, often subacute onset, heterogeneous infiltrative shadow in 1, 2, or 6 segments with a connection to the lung root, moderate leukocytosis, lymphopenia, elevated ESR, presence of acid-fast bacilli in sputum or bronchial lavage, specific endobronchitis, positive response to antitubercular therapy, and lack of improvement with other nonspecific treatment methods.