Multiple drug resistant tuberculosis in patients addicted to alcohol – a critical issue of the current tuberculosis control

The article presents the comparative description of multiple resistant tuberculosis patients (MDR TB) abusing alcohol (group 1 – 169 people), and not abusing alcohol (group 2 – 122 persons); the frequency and specificity of adverse reaction to anti-tuberculosis drugs, immediate and postponed treatment outcomes have been studied. The negative effect of the alcohol abuse on the majority of the studied rates has been found out. Disseminated forms, fibrous cavernous tuberculosis, intoxication syndrome, chronic respiratory, intestinal and liver diseases, as well as incarceration experience are observed more often among alcohol dependent MDR TB patients. It is confidently true that adverse reactions occur more often (84.6% versus 57.6%), including toxic reactions, they are more severe and intractable, especially hepato- and neuro-toxic ones.

Efficiency of in-patient treatment is confidently lower in the 1st group – 61.7% versus 82.8%. The cessation of bacillary excretion was lower (69.7% versus 85.6%). The hospital mortality was also higher in the 1st group (8.6% versus 0.9%).

The postponed results of 2 – 6 year follow up are worse in the patients abusing alcohol. The successful treatment outcomes with criteria of cured, treatment completed were observed in the 60.4% in the 1st group of patient, while in the 2nd group this rate made 80.8% (p < 0.05), the mortality and disability rates were also higher as well as the number of patients in whom bacillary excretion persisted (38.3% versus 19.2%, p < 0.05).

70% of patients demonstrated favorable treatment outcomes. 

1. Vasil’eva I.А., Bagdasaryan T.R., Samoylova P.G. et al. Efficiency of complex treatment of pulmonary tuberculosis patients with multiple and extensive drug resistance of mycobacteria. Tub., 2011, no. 4, pp. 81. (In Russ.)

2. WHO, Regional Office for  Europe. The  Consolidated Action Plan to  Prevent and Combat Multidrug- and Extensively Drug-Resistant Tuberculosis in the WHO European Region, 2011. 2015, Baku, 2011, 48 p.

3. Gel’berg I.S., Vol’f S.B., Аlekso E.N. et al. Immediate and postponed treatment outcomes in multiple drug resistant tuberculosis patients. Аktual’nye problemy meditsiny: Mater. nauch.-prakt. konf., posv. 50-letiyu UO Grodnenskiy gosudarstvenny meditsinskiy universitet. [Actual medical problems. Materials of the scientific practical conference devoted to the 50th anniversary of Grodno State Medical University]. Minsk, November 3-4, 2013, pp. 153-157. (In Russ.)

4. Gurevich G.L., Skryagina E.M., Аstrovko А.P. Tuberculosis epidemic situation in Belarus Republic and actions taken aimed to reduce the transmission of tuberculosis infection. Tuberkulez sovremennogo perioda: Mater. mezhdunar. nauch.-prakt.konf. [Tuberculosis at the current stage: Materials of the international scientific practical conference]. Minsk, 2012, pp. 19-26. (In Russ.)

5. Krivonos P.S., Vetushko D.А., Khmyz M.E. et al. Efficiency of the intensive stage of chemotherapy in patients suffering from multiple drug resistant pulmonary tuberculosis. Mater. mezhdunar. nauch.-prakt.konf. [Materials of the international scientific practical conference]. Grondo, 2009, pp. 217-219. (In Russ.)

6. Levchuk L.I., Pukhovskiy А.G., Lapich M.I. Specific features of tuberculosis treatment of MDR patients with chronic alcohol addiction. Tuberkulez sovremennogo perioda: Mater. mezhdunar. nauch.-prakt.konf. [Tuberculosis at the current stage: Materials of the international scientific practical conference]. Minsk, 2012, pp. 268-270. (In Russ.)

7. Rudoy N.M., Chubakov T.Ch. Tuberkulez legkikh i alkogolizm. [Pulmonary tuberculosis and alcohol addiction]. Moscow, 1985, 176 p.

8. Rusovich V. Priorities in MDR tuberculosis control in WHO European Region and Belarus. Tuberkulez sovremennogo perioda: Mater. mezhdunar. nauch.-prakt. konf. [Tuberculosis at the current stage: Materials of the international scientific practical conference]. Minsk, 2012, pp. 30-32. (In Russ.)

9. Skryagina E.M., Gurevich G.L., Аstrovko А.P. et al. Klinicheskoe rukovodstvo po lecheniyu tuberkuleza i ego lekarstvenno-ustoychivykh form. [Clinical guidelines on treatment of tuberculosis and its drug resistant forms]. Minsk, 2012, 84 p.

10. Skryagina E.M., Gurevich G.L., Zalutskaya O.M.et al. Risk factors of MDR tuberculosis in Belarus: data of republical representative epidemiological surveillance. Tuberkulez sovremennogo perioda: Mater. mezhdunar. nauch.-prakt. konf. [Tuberculosis at the current stage: Materials of the international scientific practical conference]. Minsk, 2012, pp. 33-34. (In Russ.)

11. Surkova L.K., Dyus’mikeeva M.I., Аdol’f E.V. Pathomorphological aspects of tuberculosis and alcohol addiction. Tuberkulez sovremennogo perioda: Mater. mezhdunar. nauch.-prakt.konf. [Tuberculosis at the current stage: Materials of the international scientific practical conference]. Minsk, 2012, pp. 177-179. (In Russ.)

12. Utkin V.V. Alcohol addiction and tuberculosis (review). Probl. Tub., 2004, pp. 59-65. (In Russ.)

13. Baharoli A. et al. Outcomes of patients with multidrug resistant tuberculosis. Eur. Resp. J., 2005, suppl. 40, vol. 26, pp. 4128.

14. Friedman L.N. et al. Tuberculosis screening in alcoholiсs and drug addicts. Am. Rev. Respir. Dis., 1987, vol. 136, pp. 1188-1192.

15. Global Tuberculosis Control. WHO report 2010. Geneva, 2010.

16. Keshavjee S. et  al. Treatment of  extensively drug-resistant tuberculosis in Tomsk, Russia: a retrospective cohort study. Lancet, 2008, vol. 372, no. 9647, pp. 1403-1409.