CLINICAL AND MORPHOLOGICAL CHARACTERISTICS OF ALTERATIONS OF MUCOUS MEMBRANE OF THE UPPER SECTIONS OF THE GASTROINTESTINAL TRACT IN PATIENTS WITH TULAREMIA

Aim. To study the character and frequency of erosive-ulcerative pathology of the gastroduodenal mucosa in patients with tularemia. Materials and Methods. The study involved 48 adult men and women aged 18 to 76 years, who, during hospitalization, underwent an endoscopic examination of the upper gastrointestinal tract with collection of material for morphological, cytological examination and the diagnosis of helicobacteriosis. Results. Erosive-ulcerative lesions of the mucous membrane of the upper gastrointestinal tract with predominant localization in the antrum, which were reliably more often recorded in severe tularemia (p<0.001) were detected in 26 (54%) patients. In 10 (38.5%) patients, erosive-ulcerative alterations in the gastroduodenal mucosa were with signs of bleeding. The maximum number of acute erosions and ulcers were detected on the 4th-12th day of the disease. Four (8.3%) patients complained of dyspepsia, the remaining 44 (91.7%) had no clinical manifestations of dyspeptic syndrome. In 3 (75±25%) patients with dyspepsia, gastroduodenal erosive-ulcerative alterations were found, in 23 (52±7.681%) of 44 patients without dyspepsia, erosive-ulcer pathology was also detected. Helicobacteriosis with erosive and ulcerative lesions was detected in 11 (42±9.871%) patients. Morphological alterations were characterized by impaired microcirculation, edema, hemorrhage, polymorphic cell infiltration and the formation of lympho-macrophage granulomas in the lamina propria of mucosa and in the submucous layer of the stomach. Conclusions. In patients with tularemia, gastroduodenal erosion and ulcers with primary localization in the antrum were detected with a high frequency, which were reliably more often recorded in severe cases on the 4th-12th days of the disease. Erosive-ulcerative pathology equally often ran both with the development of dyspepsia syndrome, and without it. Helicobacteriosis in patients with erosive and ulcerative lesions of the gastroduodenal mucosa was detected in 42% of cases. Morphological changes were characterized by disturbances in microcirculation due to alterations in the microcirculatory vessels, which leads to local ischemia of mucosa of the upper gastrointestinal tract with formation of acute erosion and ulcers. Typical of tularemia is formation of lympho-macrophage granulomas both in the mucosa and in submucosal layer.