The basic places of tuberculosis treatment in Russian public health services are the divisions of phthisiatric (anti-TB) service. At the same time, in outpatient departments (polyclinics) of general medical networks, medical aid is provided by local general practitioner, for all therapeutic problems of tuberculous patients which are not connected with the basic disease.
Some chronic diseases having independent etiology, accompany tuberculosis, promoting its exacerbation.
The following diseases are most frequently concomitant to tuberculosis:
• diabetes mellitus;
• chronic nonspecific lung diseases;
• alcoholism;
• cardiovascular diseases;
• lung cancer;
• liver diseases;
• stomach and duodenal ulcer;
• tuberculosis in pregnancy;
• neuropsychic disturbances at tuberculosis.
7.1. LUNG TUBERCULOSIS AND DIABETES MELLITUS
In the combination of Diabetes Mellitus (DM) and lung tuberculosis, the
overwhelming majority of cases (up to 90%) DM is a primary disease, on the background of which tuberculosis develops in different time periods. If both diseases come to light simultaneously, that means obviously that DM was latent and has become aggravated under the influence of concomitant tuberculosis.
There is no one common reason to explain the accelerated tuberculosis morbidity among DM patients. No doubt that the tuberculosis in some forms of diabetes develops in conditions of reduced immunity of a host to the infection, which is determined by exhaustion of immunobiological properties caused by reducing the ability to develop antibodies and antitoxins. Develop-
ment of the lung tuberculosis in such cases promotes uncompensated or uncured DM.
Clinical signs of tuberculosis among the DM patients. If tuberculosis is revealed in early stages, then more favorably proceeding forms of disease are observed even in the combination with DM. The malignant, severe course of tuberculosis predispose to fast progression and disintegration mainly due to wrong treatment of DM or late revealing of tuberculosis.