Morphological changes of a small intestine wall in patients with multidrug resistant tuberculosis

Abstract

Introduction: The results of some studies showed impaired absorption in the small intestine (SI) of patients with multidrug resistant tuberculosis (MDR TB), but there is no data on morphological changes in SI that can lead to such functional changes.

Aims and objectives: The aim was to investigate the morphological structure of SI wall in patients with MDR TB.

Methods: A prospective pathomorphological study included 21 cases of death of patients with MDR TB (group 1) and 20 people without gastrointestinal pathology and tuberculosis (control group (CG)). We used general and special histochemical methods of pathomorphological investigation.

Results: The analysis of micromorphometric parameters of SI tissue showed that the thickness of the mucous membrane in patients with MDR TB was almost 1.5 times smaller than in CG - 523.4±11.27 μm vs. 767.8±15.19 μm (p<0.05).

The average height and width of the villi of SI in group 1 were decreased in 1.31 and 1.23 times compared with CG - 370.4±15.07 μm vs. 482.9±21.66 μm, 117.6±3.52 μm vs. 145.6±8.41 μm respectively (p<0.05).

Increasing of the connective tissue area in the wall of SI was revealed in group 1 - 25.7±2.14% vs. 11.9±1.12% in CG (p<0.05).

In group 1 the increasing of the average value of the distance between basal membrane of epithelial cells to the capillary wall was observed - 14.5±0.51 μm versus 8.6 ± 0.6 ± 0.6 μm in CG (p<0.05).

Conclusions: The presence of atrophic and sclerotic changes in the mucous membrane of the small intestine in patients with multidrug-resistant pulmonary tuberculosis was revealed, that is a probable factor in reducing the absorption capacity of the small intestine.