THE INFLUENCE OF LYME BORRELIOSIS AND GIARDIASIS ON THE COURSE OF PULMONARY TUBERCULOSIS

Abstract

The aim of the study was to identify the influence of concomitant Lyme borreliosis (LB), giardiasis and their combination on the course of tuberculosis by mycobacteria excretion and the spread of the pathological process in lungs.

Patients and Methods. We observed 99 patients with tuberculosis treated at the Ternopil Regional TB Dispensary during 2015-2017. The influence of concomitant LB, giardiasis and their combination on the course of tuberculosis was studied by the presence of mycobacteria excretion, clinical and radiological data. M. tuberculosis was detected on the basis of sputum smear microscopy, culture on nutrient media and GeneXpert / RIF studies. The radiographic picture in the lungs was evaluated by radiography and computed tomography of the thoracic cavity. LB was diagnosed on the basis of serological testing by enzyme-linked immunosorbent assay for the presence of antibodies to antigens of B. burgdorferi sensu lato using test systems from Euroimmun AG (Germany). Giardia was detected by triple parasitoscopy of feces after preliminary preparation of patients (taking choleretic tea). Statistical processing of indicators was performed with the definition of Student’s criterion (t) and. nonparametric Mann-Whitney U-test. The analysis of the relationship between the two traits was performed according to the Pearson correlation coefficient (r) and Spearman’s rank correlation coefficient (R).

Results. Focal, infiltrative and disseminated processes of tuberculosis were significantly more common in patients with mycobacteria excretion (p <0.01- 0.001). The frequency of mycobacterial excretion was the lowest in patients without giardiasis and LB – in 54.8%, the highest – in patients with concomitant giardiasis in – 81.3% of people (p <0.01). A direct very strong correlation (r = 0.940, p˂0.05) was found between the disseminated form of TB and the presence of concomitant LB in the LB group and in the group where LB was associated with giardiasis. A strong correlation (r=0.817, p˂0.05) was found between the infiltrative form of TB and the presence of concomitant LB in the group with LB and in the group with a combination of LB and giardiasis. It should be noted that a moderate correlation was found between the infiltrative form of TB and the presence of concomitant giardiasis (r = 0.379, p˂0.05). There is a tendency for more frequent isolation of mycobacteria in patients with disseminated and infiltrative forms of TB with concomitant LB and giardiasis.

Conclusions. Among the available forms of pulmonary TB in patients, infiltrative and disseminated prevailed. The incidence of mycobacteria excretion was highest in patients with pulmonary TB in combination with concomitant giardiasis (p˂0.05). The disseminated form of pulmonary TB in patients was correlated with the presence of concomitant LB by a strong statistically significant correlation (r = 0.940, p˂0.05).