rss_2.0Pneumologia FeedSciendo RSS Feed for Pneumologia 's Cover strategy for COVID-19 in India – A need to move further ahead from purposive testing to a clinical testing strategy for lung metastases in a testicular seminoma<abstract> <title style='display:none'>Abstract</title> <p>Invasive testicular cancer develops from carcinoma in situ (CIS)/testicular intraepithelial neoplasia (TIN), and these histological types are often identified in residual non-malignant testicular tissues. The objective was to highlight the need for an immediate multidisciplinary approach in a case of seminoma with lung metastases in a young patient, to approach optimal therapeutic behaviour. We present the case of a 33-year-old patient, a smoker, who presents with an influenced general condition, bilateral crackling rales, the right testicle slightly enlarged in volume. Emergency chest radiography raises suspicion of lung metastases. Computed tomography (CT) sustains the suspicion of secondary malignancies, which is why the pulmonary formation is approached endobronchial, having as a histopathological result seminoma metastasis. Blood tests, before urological intervention show an alpha-fetoprotein (AFP) = 11.05 mUI/mL, beta human chorionic gonadotropin (hCG) = 20.47 mUI/L, lactate dehydrogenase (LDH) = 754 U/L, subsequently performing right radical orchiectomy (2016), pT1N3M1a-stage IIIB. Repeating the blood tests after the fourth chemotherapy session [bleomycin, etoposide and cisplatin (BEP)] reveals a normalisation of AFP = 0.4 mUI/mL, beta hCG &lt; 0.1 mUI/L, LDH = 276 U/L results, and at positron emission tomography-computed tomography (PET-CT) examination the pulmonary tumour formations were not metabolically active. Subsequently, lung metastases were removed by laser surgery (2020), with significant resorption and preservation of healthy lung parenchyma, and is classified according to the TNM8 staging in stage IV-pT3N0M1a. The particularity of this case was the multiple pulmonary secondary malignancies, which, although imagistically persisted, were not metabolically active, and is interpreted as remainings after oncological treatment. Considering the modifications, the advanced stage and the estimated prognosis, the case can be summarised as a therapeutic success.</p> </abstract>ARTICLE2022-09-27T00:00:00.000+00:00Options of Treatment in SARS-CoV-2 Infections<abstract> <title style='display:none'>Abstract</title> <p>Starting December 2019, in China, the SARS-CoV-2 infection became a local health issue, but its high infectiveness quickly turned it into a pandemic, to be declared an epidemiological emergency of international concern less than two months from identifying the first cases. Despite tremendous efforts aimed at discovering new drug classes that would slow down or stop the evolution of the COVID-19 disease and curb the number of severe cases and related complications, there is no specific antiviral treatment to date. The only efficient measure proved to be the prophylaxis, through vaccination.</p> </abstract>ARTICLE2022-09-27T00:00:00.000+00:00Summary syndrome in SARS CoV2 infection<abstract> <title style='display:none'>Abstract</title> <p>SARS-CoV-2 is a new virus belonging to the Betacoronaviruses genus, from the Coronavirus family. The main clinical symptoms encountered in COVID 19 are fever, cough and shortness of breath and they have been affecting more than 80% of patients. Compared to the patients that are infected with MERS Co-V or SARS-Co-V, where diarrheal syndrome was present in approximately 25% of cases, in SARS-Co-V 2 infection, diarrhea syndrome is present in less than 10% of cases.</p> <p>Clinical case: A 59-year-old patient, smoker, known to have a history of cardiovascular disease and type II Diabetes, presented to the emergency unit with fever, productive mucopurulent cough and multiple diarrhea stools. Pulmonary radiography was performed and showed multiple oval opacities with a tendency to confluence disseminated basally bilateral. A RT-PCR SARSCo-V-2 test was performed with a positive result. The patient was admitted to the hospital and received specialized treatment during which the previous symptoms gradually recovered, including diarrhea syndrome. After 4 days of treatment, the diarrhea of the stools reappeared, and it was decided to investigate for Clostridium Difficile. The test proved to be positive. Treatment was established according to the protocol with favorable clinical and biological evolution.</p> <p>Conclusions: The newly diagnosed diarrhea syndrome in a hospitalized patient should constantly raise the suspicion of a Clostridium Difficile infection, which may worsen the prognosis of patients infected with SARS-CoV-2.</p> </abstract>ARTICLE2022-09-27T00:00:00.000+00:00Cerebral tuberculosis - a diagnostic challenge<abstract> <title style='display:none'>Abstract</title> <p><bold>Background:</bold> Central nervous system (CNS) tuberculosis (TB) accounts for 1% of all cases of TB and is a major cause of mortality and morbidity. Cerebral tuberculomas represent 30% of CNS TB and is a diagnostic challenge.</p> <p><bold>Case presentation:</bold> A 42-year-old male patient, known with alcoholic cirrhosis, performs a cerebral computer tomography (CT) after a lipothymic episode accompanied by right hemiparesis, which showed multiple parenchymal ring-lesions (inflammatory-infectious substrate/secondary tumours). Subsequently, the thoracic-abdominal-pelvic-CT-scan reveals micronodular diffuse pulmonary infiltrate and right pleural effusion. Cerebral Magnetic resonance imaging (MRI) describes bilateral infra/supratentorial lesions, raising the suspicion of tuberculomas. HIV serology was negative, cerebrospinal fluid showed no pleocytosis, but high protein level, pleural lymphocytosis in the pleural effusion and positive GeneXpert test in bronchial aspirate. The diagnosis of military TB with cerebral tuberculomas was established. The outcome was favourable under antituberculous treatment initially associated with corticosteroids. At two months the patient had a significant improvement in pulmonary lesions, but while some cerebral lesions decreased in size other lesions increased (paradoxical reaction). At the 14-month end-of-treatment re-evaluation there was an important regression in number and size of the brain lesions.</p> <p><bold>Conclusions:</bold> The diagnosis of cerebral tuberculoma remains a challenge for the clinician due to non-specific clinical and radiological findings. The survival rate is over 80% with early diagnosis and correct treatment.</p> </abstract>ARTICLE2022-09-27T00:00:00.000+00:00Tuberculosis at the time of Coronavirus disease (COVID-19) lockdown - Back to the days of yore!!!<abstract> <title style='display:none'>Abstract</title> <p><bold>Background:</bold> The coronavirus disease (COVID-19) pandemic and the lockdown imposed due to it have served as a major setback to tuberculosis (TB) control. We therefore conducted this study to assess the profile of TB patients presenting to our department immediately after COVID-19 lockdown, which was imposed in India from 24 March 2020 and continued for &gt;3 months, and to compare it with the pre-pandemic pattern.</p> <p><bold>Methods:</bold> This was an observational study conducted at the pulmonary medicine department of our tertiary care institute. We evaluated the consecutive cases of TB referred to or diagnosed new by our department as soon as the lockdown was lifted and non-COVID services resumed. The data of 2020 and 2019 during September and October month were gathered and analysed retrospectively.</p> <p><bold>Results:</bold> A total of 162 patients were hospitalised from September to October 2019, while 40 non-COVID patients were hospitalised during September to October 2020 in our unit. The mean duration of symptoms was 1 month in both the groups. The incidence of TB cases amongst the patients needing hospitalisation after lockdown was more in 2020 [57.5%; 23 diagnosed TB cases (12 males and 11 females) out of 40 non-COVID hospitalised cases] than in 2019 [13.5%; 22 diagnosed TB cases (13 males 9 females) out of 162 hospitalised cases], and this was statistically significant (chi-squared test: p &lt; 0.00001). There was a statistically significant increase in transfers to the TB hospital where patients requiring further long-term medical care were referred to; in 2020 (12.5%; 5 out of 23 diagnosed TB cases) as compared with those in 2019 (0 out of 22 diagnosed TB cases) (p = 0.049, Fischer’s exact test). There was a statistically significant increase in the duration of hospital stay in 2020 than that in 2019 (p = 0.0076, unpaired t-test). There was no statistical difference in occurrence of pulmonary versus extrapulmonary TB (EPTB) or in occurrence of complications of TB in the two years.</p> <p><bold>Conclusion:</bold> The COVID-19 pandemic and its lockdown have skewed the profile and pattern of the clinical manifestations and the complications of TB with a more severe trend.</p> </abstract>ARTICLE2022-09-27T00:00:00.000+00:00Therapeutic challenges in a case of sarcoidosis<abstract> <title style='display:none'>Abstract</title> <p>Sarcoidosis is a chronic systemic inflammatory disease with unknown etiology, whose diagnosis is based on suggestive symptoms/imaging, histopathological examination with non-caseous granuloma, and exclusion of other etiologies. Corticosteroid therapy is the treatment of choice for moderate/severe forms, but medication intolerance or unfavorable evolution may require immunomodulatory therapy. A 40-year-old patient known with poly-allergy was hospitalized for resting dyspnoea, dry cough, night sweats, and itching. Objective examination identifies roughened breathing, wheezing and SpO<sub>2</sub> = 98%. Spirometry shows a medium mixed ventilatory dysfunction. Computed tomography (CT) describes multiple mediastinal lymphadenopathies and inhomogeneous hepatomegaly. Osteomedullary biopsy refutes the suspicion of lymphoma. Bronchoscopy detects bronchial hypervascularization. Due to the suggestive imaging context, a transbronchial biopsy was performed (EBUS-TBNA) from the mediastinal lymphadenopathy. Histopathological examination suggested sarcoidosis: granulomas with epithelioid histiocytes, without caseous necrosis, associated with Langerhans cells and lymphocytes. We initiated corticosteroid therapy, but the patient had an allergic reaction that required the interruption of treatment and administration of methotrexate. After eight months, the clinical and imaging aspect worsened, and we replaced the treatment with cyclophosphamide. However, side effects occurred after a few months, it was replaced with azathioprine. The patient’s condition deteriorates significantly with desaturation. We requested a consultation with the ‘Sarcoidosis Center’ in Rotterdam, which recommended treatment with anti-TNF-α or human immunoglobulin. The patient shows a slightly favorable evolution under human immunoglobulin. The poly-allergy and drug intolerance, including corticosteroid therapy, led to the initiation of immunomodulatory therapy for a young patient with moderate/severe sarcoidosis. The choice of medication was difficult due to the side effects.</p> </abstract>ARTICLE2022-09-27T00:00:00.000+00:00Oligosymptomatic tumors – Traps for doctors and patients<abstract> <title style='display:none'>Abstract</title> <p>Few patients are fortunate enough to get detected in the early stages of tumors whether benignant or malignant. This chance, with multiple hidden ethical issues, has pitfalls for both doctors and patients. We are presenting two cases, a male and a female with diagnosis problems successfully managed even if they are not convinced about the necessity of the surgery. The male, aged 63 years, non-smoker, with occupational exposure for 41 years, oligosymptomatic, during a preoperative routine X-ray and thorax CT for a left hydrocele operated in June 2020, was identified an acidophilic tumor formation, located in the anterior mediastinum. Additional investigations revealed a left vocal cord paresis and the transthoracic needle biopsy raised suspicion of thymoma with glandular areas and clear cells, also confirmed by surgery, an N0 stage. In the second case, a 42 years female with a recent history of SARS-COV-2 viral infection, mild clinical form, while performing a CT scan to assess COVID status, discovered a tumor mass located in the anterior mediastinum. ENT examination establishes the diagnoses of subacute laryngitis, dysphonic syndrome under etiological observation, and chronic rhinitis. The excision of the mediastinal formation is performed with favorable postoperative evolution. Histopathological examination highlighted changes that argue the diagnosis of mature intrathymic teratoma. Apparently, there were fortunate cases with curative resection, but being oligosymptomatic also involved substantial efforts to convince the patient and the caregivers about the need for urgent surgery.</p> </abstract>ARTICLE2022-09-27T00:00:00.000+00:00COVID-19 complicated by multiple germs infection -case report and short literature review<abstract><title style='display:none'>Abstract</title><p><bold>Introduction:</bold> Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is characterised by a varied clinical picture. In some cases the evolution may be unfavourable, progressing to pneumonia and acute respiratory distress syndrome.</p><p><bold>Clinical case:</bold> A 70-years-old woman, with multiple comorbidities, was admitted for low-grade fever, dry cough and loss of appetite, symptoms that started 4 days prior to hospitalisation. She was initially diagnosed with mild coronavirus disease 2019 (COVID-19). On the 18th day of illness, there was an increase in inflammatory markers, progression of radiological lesions and SpO<sub>2</sub> dropped to 88% room air. Treatment with tocilizumab, remdesivir and high-flow oxygen therapy was initiated. Chest Computed tomography with pulmonary artery angiography ruled out suspected pulmonary embolism, but revealed a new pneumonic process and right pleural effusion, therefore antibiotic therapy was started. Imaging reassessment revealed excavation of the pneumonic process and persistence of pleural effusion. Reverse transcription polymerase chain reaction (RT-PCR) retesting for SARSCOV2 was negative and the patient was transferred to another hospital to undergo bronchoscopy and continue the treatment. Bacteriological examination of the induced sputum revealed the presence of Stenotrophomonas maltophilia, and in the bronchial aspirate was isolated Legionella pneumophilla; whereas the pharyngeal exudate highlighed the presence of Candida glabrata. Finally, the evolution was favorable. The patient was discharged with the recommendation to continue antibiotic therapy at home.</p><p><bold>Conclusions:</bold> The evolution of SARS-CoV-2 infection may be unpredictable, the superinfection with other pathogens may influence the prognosis and progression of the disease.</p></abstract>ARTICLE2022-05-28T00:00:00.000+00:00Side effects induced by using the protective equipment and tips for avoiding them<abstract><title style='display:none'>Abstract</title><p>Severe acute respiratory distress syndrome (SARS)-CoV-2, the cause of Coronavirus disease 2019 (COVID-19), has caused a global pandemic with worldwide morbidity, mortality and disruptions to society. Undoubtedly, the global spread of the COVID-19 pandemic had warranted universal precautions to slow the rate of infection. Hand hygiene, social distancing, regular disinfection of surfaces and avoidance of touching one’s face are some of the measures which have been used in an attempt to decrease exponential disease spread. The epidemiology of SARS-CoV-2 had indicated that most infections were spread by respiratory droplets, through exposure to an infected individual at close range. For this reason, healthcare professionals are mandated to wear personal protective equipment (PPE) for a prolonged period of time when caring for COVID-19 patients. On the other hand, the COVID-19 pandemic has led to an increased use of face protection such as surgical masks and eye protection not only amongst healthcare workers but also now the general public. Prolonged use of N95 and surgical masks by healthcare professionals during COVID-19 has caused adverse effects such as headaches, rash, acne, skin breakdown and impaired cognition. This review delves into various adverse effects of prolonged mask use and provides recommendations to ease the burden on healthcare professionals. The magnitude of this condition is clinically significant and might worsen if the current outbreak further continues to spread widely and stays for a longer time, affecting the work performance of healthcare workers. Perhaps better strategies are needed for designing various PPE and reducing the duration for which healthcare workers are required to use them.</p></abstract>ARTICLE2022-05-28T00:00:00.000+00:00Tuberculosis in Romania during COVID-19. Some new concerns. Some new answers. metastases revealing primary pulmonary soft part sarcoma<abstract><title style='display:none'>Abstract</title><p>Alveolar soft part sarcoma (ASPS) is a rare mesenchymal soft-tissue tumour. It commonly arises in the lower extremities in adults and the head and neck in children. Primary pulmonary involvement, without evidence of soft tissue tumour elsewhere, is very rare. We present the seventh case ever reported in the literature of primary ASPS of the lung, which was revealed by brain metastases in a 28-year-old male patient. The parietal brain tumour was resected. The radiological and histological study led to the diagnosis: metastasis of an alveolar sarcoma. The patient then had brain radiotherapy and chemotherapy. Using this case as a starting point, we reviewed the characteristics and the main therapeutic options in these uncommon neoplasms.</p></abstract>ARTICLE2022-05-28T00:00:00.000+00:00COVID-19 disease in the pulmonology unit of a dedicated COVID-19 hospital – our experience<abstract><title style='display:none'>Abstract</title><p><bold>Background:</bold> The Coronavirus disease 2019 (COVID-19) pandemic caused by the severe acute respiratory syndrome Coronavirus 2 (SARS-CoV-2) has led to a global health care crisis. We report profiles of cases admitted to our hospital.</p><p><bold>Methods:</bold> We conducted this study at the pulmonology unit of a Dedicated COVID Hospital (DCH) of Western India. This is a prospective observational study which analysed the demographical data, clinical parameters, comorbidities, complications and laboratory and outcome parameters.</p><p><bold>Results:</bold> Our study included 101 patients. The mean age was 43 years; 64 (63.3%) were men and 37 (36.7%) women. Out of 101, 6 (6%) had mild, 30 (30%) had moderate and 65 (64%) had severe COVID-19 disease. Severity increased with age and comorbidities. Ninety-four (94%) had pneumonia. Of these 94, 65 (69%) patients had acute respiratory distress syndrome (ARDS). Twenty-one (21%) were mild, 20 (31%) moderate and 24 (37%) severe ARDS. ARDS severity increased with age and in men. Thirty-six (36%) required oxygenation only and 29 (29%) required additional ventilatory management – mostly non-invasive ventilation (NIV). The laboratory values analysis revealed elevation of D-dimers level in 66 (65.3%) and IL6 in 68 (67.3%). Diabetes mellitus (DM) and hypertension (HT) were the common comorbidities. Totally three (2.97%) patients died due to COVID-19 infection. Mortality was associated with HT and myocarditis. Mean duration of hospital stay was 15 days, and it increased with increasing severity of disease and ARDS.</p><p><bold>Conclusion:</bold> COVID-19 is common in the adult with male preponderance. The majority recovered with a good outcome. Comorbidities affected outcome adversely.</p></abstract>ARTICLE2022-05-28T00:00:00.000+00:00The unpredictable diagnosis of pulmonary nodules<abstract><title style='display:none'>Abstract</title><p>Pulmonary nodules are single or multiple rounded opacities with a size of minimum 1 cm diameter visualised in the lung parenchyma. From an anatomopathological point of view, they can be benign or malignant. Most often, these nodules are asymptomatic or with minimal symptoms. Now, we present the case of a 62-year-old patient, a smoker, with exposure to occupational respiratory noxious (cellulose industry – 10 years and printing industry – 30 years) without significant personal respiratory pathological history. He has dyspnoea on moderate exertion, irritable cough, myalgia, arthralgia and physical asthenia. The physical examination reveals the presence of a right bayonet sign. Biologically, an inflammatory syndrome was present, the urine test shows no pathological changes, but the imaging is intriguing. On the other side, the imagistic workup [chest X-ray and computed tomography (CT) scan] was quite surprising: micro/macronodular opacities with variable wall thickness, irregular contours and a tendency to confluence at the bilateral lower lobes level. A bronchoscopy was also performed with bronchioloalveolar lavage (BAL) in the right upper lobe (RUL) and bronchial biopsy at the level of the right upper ventral. The hypotheses are multiple: pulmonary rheumatoid nodules, polyangiitis with granulomatosis, lymphangitis carcinomatosis and tuberculosis. Thoracic surgery determined the diagnosis.</p></abstract>ARTICLE2022-05-28T00:00:00.000+00:00Case of severe treatment resistant cryptogenic organising pneumonia<abstract><title style='display:none'>Abstract</title><p>Cryptogenic organising pneumonia (COP) is a rare interstitial lung disease with different onset of symptoms, which responds rapidly to glucocorticoid treatment. We present a case of COP which manifested as progressive 3-year dyspnoea that has led ultimately to acute respiratory failure. Moreover, treatment with prednisone for this patient exhibits slow onset of the effect.</p></abstract>ARTICLE2022-05-28T00:00:00.000+00:00Summary epidemiological surveillance of healthcare professionals working in an inpatient rehabilitation facility<abstract><title style='display:none'>Abstract</title><p><bold>Background:</bold> Healthcare Workers (HCW) represent one of the most vulnerable subject groups to be infected by severe acute respiratory syndrome Coronavirus 2 (SARS-CoV-2).</p><p><bold>Aims:</bold> Between March 2020 and May 2020, we decided to implement a surveillance programme for HCW that aimed to (1) strengthen the safety of the employees; (2) estimate the punctual prevalence of SARS-CoV-2 infection in asymptomatic operators; (3) use the results to train personnel and to strengthen surveillance for applying and validating preventive strategies; and (4) compare the observed prevalence and the infection characteristics with a real-life (RL) sample from non-healthcare settings.</p><p><bold>Methods:</bold> A nasopharyngeal (NP) swab in HCW, representative of all mansions, and RL subjects was performed after informed consent signing (T0), then after 6 d ± 24 h (T1) and after 12 d ± 24 h (T2). The presence of SARS-CoV-2 mRNA was tested by commercially available real-time PCR.</p><p><bold>Results:</bold> A total of 219 HCW and 100 RL subjects were enrolled; and among all the subjects, only 1 HCW resulted positive at the swab testing throughout the study period. The positive subject was an asymptomatic nurse without any comorbidities or risk factors.</p><p><bold>Conclusions:</bold> Our experience supports the utility of implementing dedicated surveillance programmes for the HCW. The efficiency in keeping low the number of the infection, maintaining the psychological well-being of the personnel and the availability of a tool which in case of infection may allow the early identification of clusters are critical issues which encourage the planning and implementation of such programmes NIH (NCT04913701).</p></abstract>ARTICLE2022-05-28T00:00:00.000+00:00Is the allergic reaction to Aspergillus a contraindication for biological therapy in severe asthma?<abstract><title style='display:none'>Abstract</title><p><bold>Introduction:</bold> According to the available speciality data, a study from the Netherlands has proven that 24% of patients are in Stage 4–5 of the Global Initiative for Asthma guide (GINA) treatment. Among them, 17% have difficult-to-treat asthma and only 3.7% have severe asthma. Patients with severe asthma have a poor prognosis, with numerous exacerbations that are usually severe. Therefore, add-on biological treatments used for eligible patients may change the outcome.</p><p><bold>Case report:</bold> A 56-year-old female patient, diagnosed 10 years ago with asthma, without professional exposure, treated at home with maximal inhalation treatment, with multiple exacerbations and therefore multiple admissions to the hospital, one of which in the intensive care unit where she received endotracheal intubation and mechanical ventilation, is admitted to the hospital for persistent dyspnoea at rest, wheezing and chest tightness. Investigations revealed obstructive ventilatory dysfunction with a decreased value of forced expiratory volume (FEV1) by 37.57% and a reversibility ratio of 156%. Radiography results indicated absence of acute pleuropulmonary lesions; white blood cells (WBC) at 13,550 and eosinophils at 5566/µL; and 4.107% confirmed immunoglobulin E (IgE)-mediated allergy. The score for asthma control test (ACT) taken on 26 April 2018 was −8 and total IgE was 513 UI/L. Allergology evaluation results did not indicate allergies at prick test. Specific IgE was done for allergy for cat epithelium, guinea pig, rabbit, Penicillium notatum, Cladosporium herbarum and Aspergillus fumigates. Negative fungal test after bronchoscopy was performed to exclude pulmonary Aspergillosis. Omalizumab at 900 mg/month treatment was started. The outcome after 1 year showed no exacerbations, no admissions and no systemic corticotherapy usage.</p><p><bold>Discussion:</bold> Allergic reaction to Aspergillus does not overlap with the diagnosis of pulmonary Aspergillosis; the condition is rather associated with immunosuppression and with a poor outcome. Severe asthma with prolonged progression and multiple risk factors must be treated with maximal therapy.</p></abstract>ARTICLE2022-05-28T00:00:00.000+00:00Multidrug-resistant tuberculosis and diabetes mellitus as a problem of modern medicine<abstract><title style='display:none'>Abstract</title><p><bold>Aims:</bold> To carry out a comprehensive retrospective assessment of the prevalence, features and course of treatment of patients with multidrug-resistant tuberculosis (MDR-TB) and diabetes mellitus (DM).</p><p><bold>Materials and Methods:</bold> Our study is based on a retrospective analysis of statistical data obtained from 762 current and former MDR-TB patients (74% of patients with resistance only to first-line drugs – isoniazid (H) and rifampin (R); 36% with resistance to H, R and second-line drugs) included in the register of tuberculosis (TB) patients from different regions of Ukraine and the Grodno region of the Republic of Belarus between 2015 and 2019.</p><p><bold>Results and Discussion:</bold> In both groups of the study recurrent TB prevailed: 49 cases (55.7%) of relapse TB compared to 39 cases (44.3%) of primary TB in the main group; 363 cases (53.9%) of relapse TB compared to 311 (46.1%) primary TB in the control group (P &lt; 0.05). The rate of successful treatment in the control group is higher than in the main group (64.7% vs. 61.4%; P &lt; 0.05). A significant difference between the two groups was observed owing to the difference in frequency of treatment, which in the main group has recorded 27.3%, as against 40.3% in the control group (almost two times lower; P &lt; 0.05).</p><p><bold>Conclusions:</bold> The association between TB and DM increases the morbidity, chemoresistance and proportion of recurrences. Pulmonary TB developed significantly more often in middle-aged patients with type 2 DM with moderate and severe states, with subcompensated form and with a complicated course.</p></abstract>ARTICLE2022-05-28T00:00:00.000+00:00en-us-1