Features and Countermeasures in the Treatment of Paradoxical Responses
Paradoxical responses accounted for 4.0% [31]. The mechanism, treatment, and contradictory reaction: Currently, there is more consensus that isoniazid and rifampicin are strong bactericidal drugs, especially when these two drugs kill TB bacteria in the short term. After the disintegration of the TB bacteria, phospholipids and proteins are released. A large number of free cell phospholipids and proteins act as antigens to stimulate an allergic reaction in the body, causing telangiectasia and neutrophil exudation around the lesions. This enables macrophage and lymphocyte aggregation, forming tuberculous nodules. Central necrosis of the lesion may extend or increase lung lesions, pleural effusion, and temperature multiplexing or persistent fever. Severe cases can also be secondarily exudative pleurisy and t2, packets go far L4J. This phenomenon belongs to the lesion response of the PPD reaction; pleural and lymph node tuberculosis infections are particularly sensitive, more prone to reactions, resulting in priming the lymph nodes or pleural effusion.
It is worth noting that some patients with progressive tuberculosis in the early anti-tuberculosis treatment may not have a fully controlled X-ray response in the lungs. While some parts of the lesions improve, other parts may deteriorate. Pathological examinations have also revealed increased aspiration pneumonia caused by the lesions and the cheese substance being inhaled.
Diagnosis, treatment, and contradiction response: More common in young adults, untreated sputum-positive tuberculosis patients; occurs within 90 days of chemotherapy for pulmonary tuberculosis. Chemotherapy regimens containing rifampin drugs; chemotherapy symptom improvement, sputum conversion, or reduction, but lung lesions increase in number or pleurisy (pericarditis, peritonitis), the phenomenon; chemotherapy temperature is normal after re-l or has been heat; pleural effusion puncture liquid culture TB negative; continue the original chemotherapy Xinjiang Medical 2004 34 program or adjust to maintain chemotherapy treatment for 1 to 2 months or longer, symptoms and contradictions in response to the phenomenon gradually improved.
Note: Deterioration (especially sputum positive or with cavity), untreated lesions in the early anti-tuberculosis treatment (March), non-parallel relationship with clinical, sputum Yin, should exclude secondary infection of the lungs and consider paradoxical responses without having to change the treatment program, but should be closely observed; if massive shadow increases the tendency (or) bloody sputum. Especially in high-risk populations in the lung. Should consider lung cancer and need to find pathology evidence.
Countermeasures, treatment, and contradiction response: Paradoxical responses mainly occur in the early intensive chemotherapy 1 - 3 months and have relatively short effects. With the large number of TB bacteria killed, reduced cellular immune functions gradually increase, so that late chemotherapy kills germs which can be promptly removed, thereby avoiding continued allergic reactions. Isoniazid plus rifampin or rifampicin given to strengthen the patients with chemotherapy-induced paradoxical responses should undergo comprehensive inspection and careful observation, maintaining the original chemotherapy. Timely adjustment for a period of consolidation chemotherapy rather than extending the strengthening treatment to avoid contradiction reaction. Deterioration (late deterioration after treatment in March) and the failure of anti-tuberculosis should undergo tuberculin tests and immune function tests, adjusting the anti-tuberculosis program and applying immunomodulatory agents. Other treatments should take appropriate measures according to different situations.
In cases of pleural effusion, add service strong about loose, 30mg daily, with pumping pleural fluid handling; lymph nodes may increase bile flavin, tuberculosis spirit. Soften superficial lymph nodes, incision and drainage, debridement therapy if ulceration imposes a sanction of isoniazid plus saline gauze drainage dressing. Comprehensive treatment will normally see patients' symptoms improve from 1 to 3 months, temporarily disappearing treatment deterioration. Cure in 8 - 10 months.
Required identification of contradictions, treatment, and contradiction reaction: Tuberculosis, intensive chemotherapy with tuberculosis secondary to pulmonary inflammation or lung cancer must distinguish symptoms caused by the latter two reactions resemble paradoxical responses, so diagnosis should be more cautious. In patients suspected of paradoxical responses, routine inspections such as chest X-rays, sputum acid-fast bacilli, and cancer cells should be conducted. If the diagnosis remains uncertain, further special examinations like bronchoscopy or CT should be done to rule out lung cancer, tracking observations. Clinical manifestations should further exclude the possibility of secondary lung infection, and only in this context can the diagnosis of paradoxical responses be initially established.