[Frequency, pattern, and diagnosis of adverse reactions in patients with pulmonary tuberculosis during chemotherapy with leading drugs].

The frequency and pattern of adverse reactions to essential antituberculous agents were studied in 480 patients with first diagnosed and recurrent pulmonary tuberculosis. Adverse reactions were found to occur in 16.9% of cases and to be mainly associated with concomitant diseases of different organs and systems wherein they occurred 15.6 times more frequently, rather than with the number (3-4-5) of used drugs. Adverse reactions were generally caused by an individual drug and predominantly streptomycin. At the same time no significant difference was established in the frequency of toxic (45.5%) and allergic (37%) reactions, but with a rather low frequency of mixed reactions (17.3%). The firstly performed cytochemical and immunological studies of lymphocytes and eosinophils provided new evidence for the pathogenesis of different patterns of adverse reactions. Lymphocytes from patients with toxic reactions showed significant intracellular structural and metabolic disturbances that led to a higher apoptosis of these cells. In patients with lymphocytic allergic reactions, on the contrary, displayed activated processes of anaerobic oxidation and their cytotoxic activity. In both types of adverse reactions, eosinophils exhibited severe intracellular metabolic disturbances that result in destruction and increased apoptosis, which determined the allergic component in virtually all types of side effects. Rational pathogenetic therapy using hormonal, vitamin, and metabolic agents and plasmapheresis could show a 2-fold reduction in the number of patients with adverse reactions without changing the routine chemotherapy regimen and only in 5.6% of cases, the reactions were intractable, which made a specific drug be discontinued and therapy used on an individual basis.