A Clinical Study On The Infection Of L-forms Of Mycobacterium Tuberculosis And Multi-drug Resistant Pulmonary Tuberculosis

Objective This study is to determine the biological states of the L-forms of mycobacterium tuberculosis (L-MT) and the pathological features of its infection, and to explore the changes of L-MT in the course of formation of multi-drug resistant pulmonary tuberculosis (MDR-PTB) and its treatment, so as to improve the diagnosis rate of the pulmonary tuberculosis (PTB) with negative sputum, and to guide the clinical chemotherapy, and to provide the effective, reliable bases and methods for preventing the formation of multi-drug resistant tuberculosis (MDR-TB) and for the immediate, exact diagnosis and treatment.Methods 80 cases with MDR-PTB (the experimentalgroup) were observed and treated for six months by 4 or 5 kinds of drugs: kanamycin or amikacin,pasiniazide, prothionamide, pyrazinamide, levofloxacin, para-aminosalicylic acid, rifapentin etc al; 60 cases (the contrast group) of the primary treatment, with positive sputum bacterium and no-drug resistant pulmonary tuberculosis were observed and treated for six months by the standardized therapy "2HRZE(S)/4HR". The samples of sputum and bronchoalveolar lavage fluid (BALF) were treated and cultured respectively for the L-MT, MT (mycobacterium tuberculosis) and for indentifying their types before treatment. The samples of sputum were also treated and cultured for the L- MT, MT and for indentifying their types after treatment for 1,2,3,6 months respectively. After being cultured for one or two weeks, the cultures were examined for L-MT by the method of coloration by Intensified Kinyoun ( IK ) .Some item such as temperature of the patients , the PPD test and the chest x-ray ,et al were observed at the same time.Results 1.the biological states of the cultured L-MT looked like a ball,an ellipse or a scrambling shape under the microscope, and were different from that of the typical MT, and were negative in the common coloration by Ziehl -Neeselan but positive in the coloration by IK. 2.The caseswith MDR-PTB were not typical in the signs and symptoms and on the chest x-ray, and were not sensitive to the PPD test, and in the common culture, and were not significant in effect with chemotherapy, and were chronic (X2=12.747, 17.864, 20.277; P< 0.001). 3.The positive rate (53.75%, 57.50%, 62.50%, 68.75%, 45.00%) of L-MT in the cases with MDR-PTB after being treated for 0,1,2,3,6 months was significantly higher than that (13.33%,21.67%,35.00%,18.33%, 5.00%) of cases with no-drug resistant pulmonary tuberculosis (X2 =24.184, 18.055,10.374,34.974,27.296; P<0.01 ); Form the the experimental group, we can find that the more the kinds of the drug-resistance increased the higher the positive rate of L-MT was (X2=5.099, 4.383, 5.311,5.921, 1.671; P>0.05) .4. the highest positive rate of L-MT in the cases with MDR-PTB, with no-drug resistant pulmonary tuberculosis was 68.75%, 35.00% respectively after being treated for 3, 2 months. With the time of treatment prolonged, the detected rate of L-MT increased significantly and decreased gradually when it reached a certain stage, but the MT always decreased and L-MT might still be positive in the cases with negative of MT(5.00%). 5. Their positive rates (70.00%, 28.33%) of the samples of the BALF were higher than that (53.75%, 13.33%) of the sputum (X2=4.478, 4.910; P<0.05 ) .Conclusions 1. The infective rate in the cases withMDR-TB is relatively higher. 2. The cases with secondary treatment, exacerbation of illness and drug resistance, are related to the infection of L-MT. 3. To enhance the detection of L-MT can improve the diagnosis rate of MDR-TB and can facilitate the examination in the prevention and treatment of tuberculosis. 4. To examine, detect L-MT, the method of BAL (bronchoalveolar lavage) is superior to that of suptum.