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Tuberculosis - the first signs, symptoms, causes, treatment and prevention of tuberculosis

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Symptoms of this disease are very diverse. Common symptoms for all types of fish: first, a sick fish loses its appetite, becomes lethargic, loses weight, its color fades, fins collapse, scales fall out, sometimes there is a darkening of the iris of the eye, bulging eyes, open sores, black spots on the body. The listed signs can appear both singly and in combinations. The specific symptoms of the disease depend on the type of fish. In pecillia, sick fish keep isolated from others, stop eating, exhaustion occurs, which is outwardly characterized by the fact that the back bends, the abdomen retracts, the eyes fall in, bones protrude from under the skin and scales. In sick macro pods, the skin is damaged and red, the scales are lifted under the pressure of the fluid accumulated in the scaly pockets, and then it falls out, sometimes there is an eyesore, bulging eyes, after which blindness occurs, the body becomes covered with black dots. In males, the abdomen gradually increases, the skin begins to stretch and after 4-8 weeks it becomes transparent, apathy occurs in fish, but they move in jerks, often on the side or belly up, stop eating. In zebrafish, an ocular comes on, and after some time the eyes fall out of the orbits, the abdomen gradually increases.


Photo: Fish tuberculosis, or Mycobacteriosis

Causes: Infectious disease. The causative agent is the bacterium Micobacterium piscum - a motionless thick stick of 2-13 microns in length. It affects the internal organs of fish. At the same time, a large number of fish get sick. The most susceptible to the disease fish: labyrinth, haracin, cyprinids, tropical cyprinids. Peciliae, cichlids, and cetrarchs are less susceptible. It enters the aquarium from a reservoir where fish are found along with food, plants and soil, if it has not been boiled or calcined, as well as with fish, shellfish, plants, water and equipment from an infected aquarium. In addition, mosquitoes, ants, cockroaches crawling into the aquarium in search of water can be bacteria carriers. Most often, the disease is found in aquariums with poor living conditions, you can even say that this disease is poor in maintenance and a weakened fish organism. The causative agent is resistant to acid solutions, develops at a temperature of 18-25 degrees.

Treatment: At the very beginning of the disease, when the fish have not yet refused to feed, kanamycin 10 mg per 10 g of feed is added to it. An effective treatment for the subsequent stages of the disease has not been developed (The disease is incurable. For this reason, all therapy is reduced to improving the conditions of keeping fish). Some slightly affected fish can heal themselves, provided that the conditions are optimal. Heavily diseased fish, other aquatic animals and plants are destroyed, the soil is boiled, the aquarium and equipment are disinfected with a 5% solution of bleach or 3% solution of chloramine. For disinfection, pour 1 liter of solution into the aquarium and thoroughly wipe the internal and external walls and corners several times a day with a cloth moistened in it. After this, the aquarium is rinsed several times, the soil is poured, and it is poured with fresh, settled water, plants are planted and after a few days the fish are launched.

Prevention: Mycobacteriosis is a typical disease of a weakened organism, which was facilitated by poor fish keeping conditions, such as poor sanitary conditions, overcrowding, poor filtration, and lack of oxygen. Therefore, the prevention of such diseases consists in creating impeccable, from the point of view of hygiene, conditions for keeping fish in the aquarium. The level of microbes in the aquarium should be as low as possible. To do this, you can use ultraviolet lighting, which kills part of the germs.

Important: These microbacteria can affect not only fish, but also humans. When working with an infected aquarium, you should be as careful as possible to avoid infection through the mouth (when the mouth sucks water through a hose), through wounds or abrasions on the hands. After microbacteria enter the wound site after an incubation period (3 weeks), papular skin changes begin in these places. Self-healing can occur after only 2 years. Therefore, you should immediately consult a dermatologist who will perform the treatment.

What is tuberculosis?

Tuberculosis - a contagious infectious disease, the main cause of which is infection of the body with Koch sticks (Mycobacterium tuberculosis complex). The main symptoms of tuberculosis, in its classic course, are cough with sputum (often with an admixture of blood), weakness, fever, significant weight loss, night sweats, and others.

Among the other names of the disease, especially in antiquity, it can be noted - "consumption", "dry disease", "tubercle" and "scrofula". The origin of the name tuberculosis takes in Latin "tuberculum" (tubercle).

The most common organs susceptible to tuberculosis are the bronchi and lungs, less commonly the bones, skin, lymphatic, genitourinary, nervous, lymphatic systems, as well as other organs and systems. Infection can affect not only people, but also representatives of the animal world.

Mycobacterium tuberculosis complex infection is transmitted predominantly by airborne droplets - through coughing, sneezing, talking at close range with an infected interlocutor.

The insidiousness of tuberculosis infection lies in the nature of its behavior - when it enters the body, a person does not feel anything. At this time, the infection in a passive form (asymptomatic course of the disease - tuberculosis) can be in the patient for many days, and even years, and only in 1 out of 10 cases, go into active form.

If we talk about the types of tuberculosis, then the most significant for most people is the classification of the disease in form - they distinguish an open and closed form of tuberculosis.

Open tuberculosis characterized by the detection of mycobacteria in sputum, urine, feces, as well as obvious signs of the disease, while at the point of contact of the affected organ and the external environment, the infection cannot be detected. An open form of tuberculosis is the most dangerous, and represents a threat of infection to all people who are nearby.

Closed form it is characterized by the difficulty of detecting infection in sputum by available methods, and is a non-hazardous form of this disease for others.

The main methods for diagnosing tuberculosis are fluorography, radiography, Mantoux tuberculin test, PCR and microbiological examination of sputum, urine and feces.

Prevention of tuberculosis is mainly based on screening, mass screening and vaccination of children, but despite the large amount of data on the diagnosis, prevention and treatment of tuberculosis, this disease continues to march on Earth, infecting a large number of people, many of whom die from it.

Tuberculosis development

How is tuberculosis transmitted? (ways of infection). The cause of tuberculosis is the ingestion of a tuberculosis infection - Mycobacterium tuberculosis complex, or, as it is also called, Koch's bacillus.

The main source of tuberculosis infection (Koch's bacillus) are carriers of infection, i.e. people or animals with an open form of tuberculosis that excrete it into the environment.

In order for tuberculosis to settle in the body and gain its further development within the body, a number of conditions must be met.

1. Mycobacterium tuberculosis entering the body

The main mechanisms of infection in the body:

Airborne path - the infection enters the external environment through conversation, sneezing, coughing a patient with an open form of the disease, and even when dry, the wand retains its pathogenicity. If a healthy person is in this room, especially poorly ventilated, then the infection gets inside him through breathing.

Alimentary path - the infection enters a person through the digestive tract. This is usually caused by eating food with unwashed hands or if food products that are infected and unprocessed are not washed. For example, homemade milk can be noted - a cow suffering from tuberculosis produces infected milk. A person who purchases homemade dairy products rarely checks it for infection. A special animal that carries many diseases dangerous to humans is a pig.

Contact way - the infection enters the person through the conjunctiva of the eyes, with kisses, sexual contact, through the contact of contaminated objects with human blood (open wounds, scratches, manicure, pedicure, tattooing with contaminated objects), the use of patient hygiene items. You can also become infected with tuberculosis when caring for a sick animal - a cat, a dog, and others.

Intrauterine infection - the infection is transmitted to the infant through the placenta damaged by tuberculosis, or during childbirth, from the mother. However, this occurs when the infection of the whole organism is defeated, if the expectant mother has pulmonary tuberculosis, the probability of infection of the baby is minimal.

2. Impaired functioning of the upper respiratory tract

Respiratory organs (nasopharynx and oropharynx, trachea, bronchi) are protected from infection of the body with mucociliary clearance. In simple terms, when an infection enters the body, special cells located in the mucous membrane of the respiratory system secrete mucus, which envelops and glues pathological microorganisms together. Further, by sneezing or coughing, the mucus along with the infection is ejected from the respiratory system to the outside. If inflammatory processes are present in the respiratory system, the functioning of the body’s defense is at risk because the infection can freely enter the bronchi, and then into the lungs.

3. The weakening of immunity against tuberculous mycobacteria

Such diseases and conditions as diabetes mellitus, AIDS, peptic ulcers, stressful situations, hypothermia, starvation, hypovitaminosis, alcohol and drug abuse, treatment with hormones and immunosuppressants, pregnancy, smoking can weaken the immune system, especially sweat against the Koch’s wand. other. It is established that a pack of cigarettes smoking a day increases a person’s risk of developing the disease by 2-4 times!

Koch's wand, settling in the lungs, if the immune system does not stop it, begins to multiply slowly. The delayed immune response is also due to the properties of this type of bacteria not to produce exotoxin, which could stimulate the production of phagocytosis. Absorbing into the blood and lymphatic system, the infection spreads throughout the body, enslaving primarily - the lungs, lymph nodes, cortical layer of the kidneys, bones (pineal glands and metaphyses), fallopian tubes and most other organs and systems.

The incubation period of tuberculosis

The incubation period of tuberculosis, i.e. the period from the moment of getting the Koch stick to the appearance of the first signs of the disease is from 2 to 12 weeks, an average of 6-8 weeks, sometimes a year or more.

Doctors note that with the initial entry of Koch's bacillus into the body, the development of tuberculosis occurs in 8% of cases, with each subsequent year, this percentage decreases.

Fighting the immune system with tuberculosis

At this stage, the immune system, if it is not immune to Koch's wand, begins to produce it, and leukocytes enter the fight against infection, which die due to their low bactericidal potential. Further, macrophages are involved in the fight, however, due to its peculiarity, Koch's wand penetrates into the cells, and macrophages cannot do anything with them at this stage, and also begin to die gradually, and the infection is released into the intercellular space.

An effective fight against tuberculosis mycobacteria begins when macrophages begin to interact with lymphocytes (T-helpers (CD4 +) and T-suppressors (CD8 +)). So, sensitized T-lymphocytes, secreting gamma-interferon, interleukin-2 (IL-2) and chemotoxins activate the movement of macrophages towards the settling of Koch's bacillus, as well as their enzymatic and bactericidal activity against infection. If tumor necrosis factor-alpha is synthesized by macrophages and monocytes at that time, then nitric oxide is formed in combination with L-arginine, which also has an antimicrobial effect. Together, all these processes inhibit the activity of mycobacterium tuberculosis, and the formed lysosomal enzymes generally destroy them.

If the immune system is in good condition, each subsequent generation of macrophages becomes more stable and competent in the fight against Koch's bacilli, the body develops a stable immunity to tuberculosis.

The formation of tuberculous granuloma indicates a normal immune response to infection of the body, as well as the ability of the immune system to localize mycobacterial aggression. The appearance of tuberculosis granuloma is due to the production of B-lymphocytes by macrophages, which in turn produce opsonating antibodies that can envelop and adhere to the infection. The increased activity of macrophages and the production of various mediators by them are transformed into epithelioid giant Langhans cells, limiting the site of infection sedimentation, and, accordingly, localization of the inflammatory process. The appearance in the center of the granuloma of a small area of ​​caseous necrosis (curdled, white shade soft tissue) is caused by the bodies of the dead in the fight against tuberculous infection of macrophages.

The expressed adequate immune response to mycobacterium tuberculosis in the body usually forms after 8 weeks from the moment the infection enters the person, and it usually begins after 2-3 weeks. After 8 weeks, thanks to the destruction of Koch's wand, the inflammatory process begins to subside, but the immune system fails to completely remove the infection from the body. The saved infection remains inside the cells, and preventing the formation of phagolysosomes, they remain inaccessible to lysosomal enzymes. This helps to maintain a sufficient level of immunological activity, but at the same time, the infection can be in the body for many years, or even for life, and if necessary, i.e. adverse factors weakening the immune system, re-activated and causing an inflammatory process.

Tuberculosis statistics in figures and facts:

  • More than tuberculosis, people only die from AIDS,
  • Against the backdrop of HIV infection, a quarter of patients infected with Koch's bacillus die from tuberculosis,
  • As of 2013, during the year, tuberculosis was recorded in 9,000,000 people, of which 1,500,000 died. In 2015, according to WHO statistics, there were 10.4 million new cases of the disease, of which 5.9 million were men, 3.5 million were women and 1 million were children.
  • About 95% of all infections occur in people in Africa and Asia,
  • One person with a chronic open form of tuberculosis infects about 15 people in one year,
  • Most often, the disease is noted in persons aged 18 to 26 years, as well as in old age,
  • Thanks to the efforts of modern medicine, and of course the grace of God, in recent years the tendency for the number of deaths from tuberculosis has decreased, and every year it continues to decline. For example, in Russia, compared with 2000, in 2013 the number of deaths decreased by about 33%.,
  • In many cases, tuberculosis develops among health care providers of TB facilities.

The story of tuberculosis

The first mention of tuberculosis was made in ancient times - during the time of Babylon, ancient India. The excavations of archaeologists, who noticed signs of tuberculosis on some bones, also testify to this. The first scientific notes about this disease belong to Hippocrates, and later to the medieval Persian doctor Avicenna. The disease was noted in the ancient Russian chronicles - the Kiev prince Svyatoslav Yaroslavich in 1076 suffered from tuberculosis of the lymphatic system.
The tuberculosis epidemic first spread in the 17th and 18th centuries, when people began to actively build cities, develop industry, transport, expand trade, work in distant countries, and travel. Thus, the Koch wand began an active migration around the world. During this period, the number of deaths from tuberculosis in Europe was about 15-20% of the total number of deaths.

Among the most active researchers of this disease, we can distinguish Francis Sylvia, M. Bailey (1761-1821), Rene Laennec (1781-1826), G.I. Sokolsky (1807–1886), Jean-Antoine Wilman, Julius Kongheim.

For the first time, the term "tuberculosis", with a description of several of its species, was introduced by the French scientist Rene Laennec.

Koch’s wand was able to identify, and in 1882 the German doctor Robert Koch, using a microscope. He managed to do this by staining the infected sample with methylene blue and vesuvine.

Robert Koch was also able to isolate a solution with a bacterial culture - Tuberculin, which is used for diagnostic purposes in our time.

First signs of tuberculosis

  • Feeling of weakness, malaise, tiredness, fatigue, increased drowsiness,
  • The patient has no appetite, there is increased irritability,
  • May have insomnia, nightmares,
  • Increased sweating
  • Elevated body temperature of 37.5-38 ° C, which does not subside for a long time (a month or more), slight chills,
  • Dry cough, worse at night and in the morning, having a paroxysmal character,
  • The face becomes pale in color, while there is an unnatural blush on the cheeks,
  • Eyes have an unhealthy glow.

The main symptoms of tuberculosis

For greater accuracy, we suggest you familiarize yourself with a brief overview of the signs of tuberculosis, depending on the organ or system where the disease has developed.

Pulmonary tuberculosis characterized by chest pain, sometimes with a return in the hypochondrium or region of the scapula, intensifying with a deep breath, wheezing in the lungs, runny nose, rapid weight loss, an increase in the size of the lymph nodes (lymphadenopathy). Cough with pulmonary tuberculosis is wet, with sputum. With an infiltrative form of tuberculosis, particles of blood are present in the sputum, and if blood literally flows from the patient, urgently call an ambulance!

Genitourinary tuberculosis usually accompanied by turbid urine with the presence of blood in it, frequent and painful urination, aching pains in the lower abdomen, bloody discharge, painful bloating of the scrotum with exudate,

Tuberculosis of bones and joints accompanied by the destruction of cartilage, intervertebral discs, severe pain of the musculoskeletal system, and sometimes kyphosis, a violation of the motor function of a person, up to complete immobility,

Digestive tract tuberculosis accompanied by bloating and aching pains, constipation, diarrhea, the presence of blood in the feces, rapid weight loss, persistent low-grade fever,

Lupus accompanied by the appearance under the skin of the patient dense painful nodules erupting when combing, from which a white curdled infiltrate is allocated,

Tuberculosis of the central nervous system (central nervous system) accompanied by headaches, impaired visual function, tinnitus, impaired coordination, hallucinations, fainting, and sometimes mental disorders, inflammation of the lining of the brain (tuberculous meningitis), the appearance of granulomas in the brain,

Miliary tuberculosis characterized by numerous foci of lesion - the appearance of multiple microspheres, the size of each of which is up to 2 mm in diameter. The reason for this process is the spread of infection throughout the body against the background of a weakened immune system.

Pulmonary tuberculosis often proceeds in an asymptomatic form, and is detected only during a routine check, using fluorography or chest x-ray, as well as with tuberculin samples.

Causes of tuberculosis

The causes of tuberculosis lie in two main factors - infection of the body and immunity vulnerable to this infection.

1. The causative agent of tuberculosis - Mycobacterium tuberculosis (MBT, Mycobacterium tuberculosis - affects a person), or as they are also called - Koch's bacilli, as well as Mycobacterium bovis (causing disease in cattle), Mycobacterium africanum (African type of MBT), Mycobacterium microti, Mycobacterium can. To date, scientists have identified 74 types of MBT, but this type of infection is prone to mutation, and in a fairly short time, which in a sense also complicates the timely diagnosis and adequate treatment of tuberculosis.

Koch’s stick under the influence of various factors tends to break up into small particles, then re-assemble into a single organism and continue to infect a person or animal. The sizes of the office are only 1-10 microns (length) and 0.2-0.6 microns (width).

Outside of a living organism, the office remains viable from a few days to many years, depending on environmental conditions, for example, in dried form - 18 months, in dairy products - 12 months, in water - 5 months, dried up sputum on clothes - about 4 months, on the pages of the book - 3 months, while on a dusty road - 10 days. Koch's sticks do not like sunlight, boiling water.

The best conditions for settling and propagation of the office is a temperature of 29-42 ° C, a dark, warm and humid room. Tuberculosis bacteria freeze freely, retaining their pathological activity even 30 years after thawing.

Important! The clinical manifestations (symptoms) of tuberculosis largely depend on the type of MBT, as well as the health status of the infected organism.

Mycobacterium tuberculosis is transmitted by airborne droplets, contact and alimentary routes, as well as in utero. We talked about ways to transmit the Office at the beginning of the article.

2. Weakening of the immune system mainly due to the presence of chronic diseases, especially of an infectious nature (HIV infection, AIDS, acute respiratory infections), diabetes mellitus, adverse living conditions (stress, antisocial and unsanitary conditions), hypothermia, poor or insufficient nutrition, hypovitaminosis, taking certain medications ( immunosuppressants, etc.), smoking, the use of alcoholic beverages and drugs.

3. If we talk about human infection by airborne droplets, then for the settling and penetration of the office inside the body, an inflammatory process in the upper respiratory organs is necessary, otherwise the infection will simply be glued together and thrown back into the environment through a cough or sneeze.

According to the localization of the disease:

Pulmonary form - tuberculosis of the lungs, bronchi, pleura, trachea and larynx, which can proceed as follows:

  • primary tuberculosis complex (tuberculous pneumonia + lymphadenitis, lymphangitis)
  • tuberculous bronchoadenitis, isolated lymphadenitis.

Extrapulmonary form:

  • Tuberculosis of bones and joints,
  • Lupus,
  • Digestive system tuberculosis,
  • Genitourinary tuberculosis
  • Tuberculosis of the central nervous system and meninges,
  • Tuberculosis of the eyes.

In shape:

  • tuberculoma
  • latent tuberculosis,
  • focal (limited) tuberculosis,
  • miliary tuberculosis,
  • infiltrative tuberculosis,
  • disseminated tuberculosis,
  • cavernous tuberculosis,
  • fibrocavernous tuberculosis,
  • cirrhotic tuberculosis,
  • caseous pneumonia.

Type:

Primary tuberculosis is an acute form of the disease. The development of the disease occurs for the first time, and is usually observed in children under 5 years of age, which is due to the incompletely formed immune system. There is no threat to those around him, although the course of the disease is acute, with a pronounced clinical picture.

Secondary tuberculosis characterized by the development of the disease after remission, due to its exacerbation, or due to infection of the body with another type of Koch bacillus. In this regard, adult patients are more susceptible to the secondary form of the disease. The internal course of the disease is accompanied by the formation of new foci of inflammation, sometimes merging with each other, forming extensive cavities with exudate. Secondary tuberculosis is a chronic form of the disease, and with complications, despite the efforts of doctors, many patients die. It is very rare to spontaneously return the disease from the stage of exacerbation to the stage of remission. A patient with a chronic form of tuberculosis is a danger to people around him, because when coughing, sneezing and other aspects of life, a pathogenic infection is released into the environment.

Tuberculosis treatment

How to treat tuberculosis? Tuberculosis treatment can only begin after a thorough diagnosis, as well as identifying the type of Koch bacillus, stage of the disease and associated pathologies.

Tuberculosis treatment includes:

1. Drug treatment
1.1. Chemotherapy,
1.2. Supportive care
2. Surgical treatment
3. Rehabilitation in sanatorium and specialized institutions.

Important! A patient with tuberculosis must strictly adhere to the treatment regimen prescribed by the attending physician, otherwise the results of many months of work may come to naught.

1.1. Chemotherapy

Mycobacterium tuberculosis (MBT) refers to bacteria, so the treatment of tuberculosis is primarily based on the use of antibacterial drugs.

Due to the predisposition of the office for rapid mutation and a large number of its genotypes, as well as resistance (resistance) to certain substances, antibiotic therapy most often involves the use of several antibiotics simultaneously. Based on this, modern medicine has identified 3 treatment regimens:

  • ternary (2 antibiotics + PASK) - Isoniazid, Streptomycin and Paraaminosalicylic acid (PASK)
  • four component (4 pairs of antibiotics), in international practice is indicated by the term “DOTS” - “Isoniazid” / “Ftivazid”, “Streptomycin” / “Kanamycin”, “Rifabutin” / “Rifampicin”, “Pyrazinamide” / “Ethionamide”.
  • five-component - 4 pairs of antibiotics of the DOTS scheme + 1 antibiotic of the 2nd, 3rd or 4th generation (Ciprofloxacin, Cycloserin, Capreomycin and others)

For best effectiveness, the attending physician selects and combines certain drugs, as well as the duration of their administration.

Tuberculosis treatment also consists of two main phases of therapy:

  • Intensive (duration 2-6 months), which is aimed at stopping the infection and stopping the destructive process in the body, preventing the active release of the infection into the environment and resolving the infiltrate with exudate,
  • Prolonged (up to 2-4 years) - is aimed at the complete healing of tissues damaged by infection, as well as the restoration and strengthening of the patient's immune system.

1.2. Supportive therapy

The following groups of drugs are aimed at improving the course of the disease, strengthening the body and accelerating recovery.

Probiotics This group of drugs restores the normal microflora in the digestive organs, which is necessary for the normal absorption and digestion of food. This is due to the fact that antibiotics, along with pathogenic microflora, destroy the majority and beneficial bacteria that are in the intestines of any healthy person. Among the probiotics can be distinguished - "Linex", "Bifiform".

Hepatoprotectors. The conditional group, which includes funds aimed at strengthening and restoring liver cells. In fact, hepatoprotectors protect the liver from the pathological effects of antibiotics on it. Among the hepatoprotectors, one can distinguish - “Karsil”, “Lipoic acid”, “Silimar”, “Ursonan”, “Phosphogliv”, “Essentiale”.

Sorbents. Microflora in the process of its life emit toxins, which, together with the infection that died from antibiotics, poison the body, causing symptoms such as loss of appetite, nausea, vomiting, and others. Sorbents (detoxification therapy) are used to remove toxic substances from the body, among which are Acetylcysteine, Atoxil, Albumin, Reosorbilact, as well as heavy drinking, preferably with the addition of vitamin C.

Immunostimulants. This group of drugs stimulates the immune system, which in turn leads to an increase in the fight of immunity against infection and to a faster recovery. Among the immunostimulants can be distinguished - “Biostim”, “Galavit”, “Glutoxim”, “Imudon”, “Ximedon”.

Vitamin C (ascorbic acid) is a natural immunostimulant, a large amount of which is present in rosehips, viburnum, raspberries, cranberries, and lemon.

Antipyretic drugs. They are used to relieve high body temperature, but remember that this group of drugs is recommended to be used at a high temperature - from 38.5 ° C (if it lasts 5 or more days. Among the antipyretic drugs, Ibuprofen, Nurofen, Paracetamol can be distinguished) .

Nonsteroidal anti-inflammatory drugs (NSAIDs) - are used to relieve pain. Among them can be distinguished - “Indomethacin”, “Ketanov”, “Naproxen”, “Chlotazole”.

Glucocorticoids (hormones) - are used in cases where the pain could not be stopped by NSAIDs, as well as in the severe course of tuberculosis with unbearable pain. However, they can not be used for a long time, since they have an immunosuppressive effect, as well as a number of other side effects. Among glucocorticoids can be distinguished - "Prednisolone", "Hydrocortisone."

To preserve the central nervous system from damage, as well as to maintain its normal functioning, are prescribed - B vitamins, glutamic acid and ATP.

To accelerate cell regeneration and restoration of tissues affected by the infection is prescribed - “Glyunat”, “Methyluracil”, “Aloe vera” and others.

2. Surgical treatment of tuberculosis

Surgical intervention in the treatment of tuberculosis implies the following types of therapy:

  • Collapsotherapy (artificial pneumothorax or pneumoperitoneum) - based on squeezing and fixation of the lung by introducing sterile air into the pleural cavity, which leads to the gradual fusion of caverns and preventing the active release of the Koch bacillus into the environment,
  • Speleotomy or cavernectomy - the removal of the largest caverns that are not amenable to conservative treatment,
  • Lobectomy, bilobectomy, pneumonectomy, pulmonectomy - removal of one lobe or part of the lung that is not amenable to conservative treatment, or complete removal of such a lung.
  • Valvular bronchial blocking - is designed to normalize the respiration of patients, and is based on the installation of miniature valves in the mouths of the bronchi to prevent them from sticking together.

Treatment prognosis

With the early detection of Koch bacillus in the body, a thorough diagnosis and strict adherence to the prescriptions of the attending physician, the prognosis for recovery from tuberculosis is very positive.

The unfavorable outcome of the disease in most cases is due to the advanced form of the disease, as well as the frivolous attitude of patients to it.

However, remember that even if doctors put an end to the sick, there is a lot of evidence when such a person turned to God in prayer and received a full recovery, even with such deadly diseases like cancer.

Folk remedies for tuberculosis

Important! Before using folk remedies for the treatment of tuberculosis, be sure to consult your doctor!

Pine Pollen. Essential oils of conifers have a bactericidal effect, in addition, they fill the air with pure ozone, improving the functioning of the respiratory system, and more simply, it is much easier for a person to breathe among conifers. For the preparation of folk remedies for tuberculosis based on coniferous gifts, you need 1 tbsp. mix a spoonful of pine pollen with 150 g of linden honey. You need to use the drug for 1 teaspoon 20 minutes before eating, 3 times a day, for 60 days, after a 2-week break is made and the course is repeated. Keep this folk remedy for tuberculosis in the refrigerator.

Tea made from pine pollen. Mix 2 tbsp. tablespoons of pine pollen, chamomile, dried linden blossom and marshmallow root. Prepared collection pour 500 ml of boiling water, let it insist for about an hour. After pouring 100 g of infusion into a glass and add boiling water to it so that the glass is full. You need to drink such tea 4 times a day, in a glass, 30 minutes before a meal.

Garlic. Grind 2 cloves of garlic, pour them with a glass of water, let it brew for a day, and in the morning, before eating, drink the infusion. The course of treatment is 2-3 months.

Garlic, horseradish and honey. Make a slurry of 400 g of garlic and the same amount of horseradish, then mix it with 1 kg of butter and 5 kg of honey. Next, the mixture must be infused in a boiling water bath for 5-10 minutes, stirring it periodically, cool and take 50 g before meals. The drug is considered effective for pulmonary tuberculosis.

Icelandic Moss (Cetraria). Put 2 tbsp in an enameled saucepan. tablespoons of chopped Icelandic moss and pour it in 500 ml of clean cold water, then bring the product to a boil, simmer it for another 7-10 minutes with the lid closed. Next, the remedy needs to be filtered, set aside in the bank for insisting. The remedy needs to be drunk during the day, for 3-4 approaches, before meals. The course of treatment is 1 month, with advanced forms - up to 6 months, however, after each month do a 2-3 week break. To improve the taste, a little honey or milk can be added to the broth.

Aloe. Mix in a enameled saucepan 1 chopped large meaty leaf of aloe with 300 g of liquid linden honey and fill them with half a glass of clean cold water. Bring the mixture to a boil, then simmer it for about 2 hours with the lid tightly closed. Next, the tool must be filtered and taken for 1 tbsp. spoon before meals, 3 times a day, for 2 months, and you need to store it in a glass jar in the refrigerator.

Vinegar. Add in a glass container 100 g of fresh grated horseradish, 2 tbsp. tablespoons of 9% apple cider vinegar and 1 tbsp. spoon of honey, mix thoroughly and take this folk remedy for tuberculosis 1 teaspoon 20 minutes before meals, 3 times a day until the medicine is over. Then a 2-3-week break is made and the course is repeated. Store the product in the refrigerator.

Dill. Pour in a small enameled saucepan 1 tbsp. spoon with a hill of dill seeds and fill them with 500 ml of clean cold water. Bring the product to a boil, boil it under a covered lid over low heat for about 5 more minutes, then set the product aside for the night to insist. In the morning strain the product and drink it throughout the day, in 5 receptions. You need to take this medicine for tuberculosis for 6 months, and it is better to store it in a glass container in a refrigerator or a cool dark place.

Tuberculosis prevention

Prevention of tuberculosis includes the following activities:

  • Vaccination is a BCG vaccine (BCG), but in some cases this vaccine itself may contribute to the development of certain types of tuberculosis, such as joints and bones,
  • Conducting tuberculin samples - Mantoux reaction,
  • Periodic (1 time per year) fluorographic examination,
  • Personal hygiene
  • You need to save yourself from stress, if necessary, change jobs,
  • Avoid hypothermia,
  • Try to eat foods enriched with vitamins and minerals,
  • In the autumn-winter-spring period, take additional vitamin complexes,
  • Do not allow the transition of various diseases into a chronic form.

General information

Pulmonary tuberculosis is a disease of infectious etiology that occurs with the formation in the lungs of specific inflammatory foci and general intoxication syndrome. The incidence of pulmonary tuberculosis has an ancient history: tuberculosis infection was known to representatives of early civilizations. The former name of the disease “phtisis” in Greek means “consumption, exhaustion”, and the doctrine of tuberculosis was called “tuberculosis”.

Today, pulmonary tuberculosis is not only a biomedical, but also a serious socio-economic problem. According to the WHO, every third inhabitant of the planet is infected with tuberculosis, the death rate from infection exceeds 3 million people a year. Pulmonary tuberculosis is the most common form of tuberculosis infection. The specific gravity of tuberculosis of other localizations (joints, bones and spine, genitals, intestines, serous membranes, central nervous system, eyes, skin) in the structure of morbidity is significantly lower.

Pathogen Characterization

Specific agents that determine the infectious nature of the disease are mycobacterium tuberculosis (MBT). In 1882 Robert Koch for the first time described the basic properties of the pathogen and proved its specificity, so the bacterium got the name of its discoverer - Koch's wand. Microscopically, mycobacterium tuberculosis has the appearance of a straight or slightly curved fixed stick, 0.2-0.5 nm wide and 0.8-3 nm long.

A hallmark of the office is their high resistance to external influences (high and low temperatures, humidity, exposure to acids, alkalis, disinfectants). Pathogens of pulmonary tuberculosis demonstrate the least resistance to sunlight. Tuberculosis bacteria of the human and bovine type are dangerous for humans; cases of infection with avian type of mycobacteria are extremely rare.

Infection pathways

The main route of infection in primary pulmonary tuberculosis is aerogenic: from a patient with an open form of a person, mycobacteria spread with particles of mucus released into the environment when talking, sneezing, coughing, can dry out and spread with dust for long distances. In the respiratory tract of a healthy person, the infection most often gets by airborne droplets or dust.

A lesser role in infection is played by the alimentary (when eating contaminated products), contact (when using common hygiene items and utensils), and transplacental (intrauterine) routes. The cause of secondary pulmonary tuberculosis is the re-activation of a previous infection or re-infection.

Risk factors

However, the entry of MBT into the body does not always lead to disease. Factors against which pulmonary tuberculosis develops most often are considered:

  • adverse social conditions
  • smoking and other chemical addictions
  • malnutrition
  • immunosuppression (HIV infection, glucocorticoids, condition after organ transplantation)
  • silicosis
  • diabetes
  • Chronic renal failure
  • oncological diseases, etc.

At risk for the development of pulmonary tuberculosis are migrants, prisoners, people suffering from drug and alcohol addiction. The virulence of the infection and the duration of contact with the sick person are also important.

Pathogenesis

With a decrease in local and general protective factors, mycobacteria freely penetrate into the bronchioles, and then into the alveoli, causing specific inflammation in the form of individual or multiple tuberculous tubercles or foci of curdled necrosis. During this period, a positive reaction to tuberculin appears - a turn of the tuberculin test. The clinical manifestations of pulmonary tuberculosis at this stage often remain unrecognized. Small foci can independently dissolve, scarring or calcify, but the office remains in them for a long time.

“Awakening” of infection in old tuberculosis foci occurs when exposed to exogenous superinfection or under the influence of adverse endogenous and exogenous factors. Secondary pulmonary tuberculosis can occur in exudative or productive form. In the first case, perifocal inflammation develops around the initial focus, in the future, infiltrates can undergo decay, melting with rejection of caseous masses and the formation of caverns. With productive forms of the tuberculous process in the lungs, connective tissue grows, which leads to pulmonary fibrosis, deformation of the bronchi, and the formation of bronchiectasis.

Classification

Primary pulmonary tuberculosis is the first developed lung tissue infiltration in individuals without specific immunity. Diagnosed mainly in childhood and adolescence, less common in older and older people who in the past had a primary infection that ended in a complete cure. Primary pulmonary tuberculosis can take the form of:

  • primary tuberculosis complex (PTC)
  • hilar lymph node tuberculosis (HLH)
  • chronically ongoing tuberculosis.

Secondary pulmonary tuberculosis develops upon repeated contact with the office or as a result of reactivation of the infection in the primary focus. The main secondary clinical forms are presented:

Separately distinguish konyotuberculosis (tuberculosis, developing on the background of pneumoconiosis), tuberculosis of the upper respiratory tract, trachea, bronchi, tuberculous pleurisy. When patients with MBT are released into the environment with sputum, they speak of an open form (VK +) of pulmonary tuberculosis, in the absence of bacilli, they speak of a closed form (VK–). Periodic bacillus excretion (VK ±) is also possible.

The course of pulmonary tuberculosis is characterized by successive interchangeable phases of development:

  • 1) infiltrative
  • 2) decay and seeding
  • 3) resorption of the focus
  • 4) compaction and calcification.

Primary tuberculosis complex

The primary tuberculosis complex combines the signs of specific inflammation in the lung and regional bronchoadenitis. It may be asymptomatic or in the guise of colds, therefore, screening of primary pulmonary tuberculosis is facilitated by mass screenings of children (Mantoux test) and adults (preventive fluorography).

More often a subacute occurs: the patient is concerned about a dry cough, subfebrile condition, fatigue, sweating. In acute manifestations, the clinic resembles non-specific pneumonia (high fever, cough, chest pain, shortness of breath). As a result of treatment, resorption or calcification of the PTC occurs (Gon's focus). In adverse cases, it can be complicated by caseous pneumonia, the formation of caverns, tuberculous pleurisy, miliary tuberculosis, dissemination of mycobacteria with damage to the kidneys, bones, and meninges.

Tuberculosis of the intrathoracic lymph nodes

With tuberculosis of HHF, the symptomatology is due to compression of large bronchi and mediastinal organs with enlarged lymph nodes. This form is characterized by dry cough (pertussis-like, bitonal), an increase in cervical and axillary nodes. In young children, a difficult exhalation often occurs - an expiratory stridor. The temperature is low-grade, febrile candles can occur.

Signs of tuberculous intoxication include lack of appetite, weight loss, fatigue, pallor of the skin, dark circles under the eyes. Venous congestion in the chest cavity may indicate an expansion of the venous network on the skin of the chest. This form is often complicated by bronchial tuberculosis, segmental or lobar atelectasis of the lungs, chronic pneumonia, exudative pleurisy. When caseous masses break through from the lymph nodes through the wall of the bronchi, pulmonary foci of tuberculosis can form.

Focal pulmonary tuberculosis

The clinical picture of focal tuberculosis is not very symptomatic. Cough is absent or rare, sometimes accompanied by the release of scanty sputum, pain in the side. In rare cases, hemoptysis is noted. More often, patients pay attention to symptoms of intoxication: inconsistent subfebrile condition, malaise, apathy, reduced working capacity. Depending on the age of the tuberculosis process, fresh and chronic focal pulmonary tuberculosis is distinguished.

The course of focal pulmonary tuberculosis is relatively benign. In patients with impaired immune reactivity, the disease can progress to destructive forms of pulmonary tuberculosis.

Infiltrative pulmonary tuberculosis

The clinical picture of infiltrative pulmonary tuberculosis depends on the magnitude of the infiltrate and can vary from mild symptoms to an acute febrile state resembling flu or pneumonia. In the latter case, marked high body temperature, chills, night sweats, and general weakness are noted. On the part of the respiratory system, a cough with sputum and streaks of blood is disturbing.

In the inflammatory process with the infiltrative form of pulmonary tuberculosis, pleura is often involved, which causes the appearance of pain in the side, pleural effusion, lag of the affected half of the chest during breathing. Case complications of pulmonary tuberculosis can be caseous pneumonia, pulmonary atelectasis, pulmonary hemorrhage, etc.

Disseminated pulmonary tuberculosis

It can manifest in acute (miliary), subacute and chronic form. The typhoid form of miliary pulmonary tuberculosis is characterized by the predominance of intoxication syndrome over bronchopulmonary symptoms. It begins acutely, with an increase in temperature to 39-40 ° C, headache, dyspeptic disorders, severe weakness, tachycardia. With increased toxicosis, there may be a violation of consciousness, delirium.

In the pulmonary form of miliary pulmonary tuberculosis, respiratory disorders, including dry cough, shortness of breath, cyanosis, are more pronounced from the very beginning. In severe cases, acute cardiopulmonary failure develops. The meningeal form corresponds to the symptoms of damage to the meninges.

The subacute course of disseminated pulmonary tuberculosis is accompanied by moderate weakness, decreased performance, decreased appetite, and weight loss. Occasionally, temperature rises occur. Productive cough, does not bother the patient much. Sometimes the first sign of the disease is pulmonary bleeding.

Chronic disseminated pulmonary tuberculosis in the absence of exacerbation is asymptomatic. During the outbreak of the process, the clinical picture is close to the subacute form. Disseminated pulmonary tuberculosis is dangerous for the development of extrapulmonary tuberculosis, spontaneous pneumothorax, severe pulmonary hemorrhage, amyloidosis of internal organs.

Cavernous and fibro-cavernous pulmonary tuberculosis

The course of the cavernous tuberculous process is undulating. In the decay phase, intoxication symptoms, hyperthermia increase, cough intensifies and the amount of sputum increases, hemoptysis occurs. Often joins bronchial tuberculosis and nonspecific bronchitis.

Fibro-cavernous pulmonary tuberculosis is characterized by the formation of caverns with a pronounced fibrous layer and fibrous changes in the lung tissue around the cavity. It proceeds for a long time, with periodic exacerbations of general infectious symptoms. With frequent outbreaks, respiratory failure of the II-III degree develops.

Complications associated with the destruction of lung tissue are profuse pulmonary hemorrhage, bronchopleural fistula, purulent pleurisy. The progression of cavernous pulmonary tuberculosis is accompanied by endocrine disorders, cachexia, renal amyloidosis, tuberculous meningitis, cardiopulmonary failure - in this case, the prognosis becomes unfavorable.

Cirrhotic pulmonary tuberculosis

It is the outcome of various forms of pulmonary tuberculosis with incomplete involution of a specific process and the development of fibrosclerotic changes in its place. With pneumocirrhosis, the bronchi are deformed, the lung is sharply reduced in size, the pleura is thickened and often calcified.

Changes in cirrhotic pulmonary tuberculosis cause the leading symptoms: severe shortness of breath, pulling chest pain, cough with purulent sputum, hemoptysis. With exacerbation, signs of tuberculous intoxication and bacillus excretion will join. A characteristic external sign of pneumocirrhosis is flattening of the chest on the affected side, narrowing and retraction of the intercostal spaces. With a progressive course, the pulmonary heart gradually develops. Cirrhotic changes in the lungs are irreversible.

Pulmonary tuberculoma

It is an encapsulated caseous lesion, formed at the end of the infiltrative, focal or disseminated process. With a stable course, symptoms do not occur, the formation is detected by x-ray of the lungs by accident. In case of progressive pulmonary tuberculoma, intoxication increases, subfebrile condition appears, chest pain, cough with sputum, possibly hemoptysis. With the collapse of the focus of tuberculoma, it can transform into cavernous or fibro-cavernous pulmonary tuberculosis. Less common is the regressive course of tuberculoma.

Diagnostics

A diagnosis of a particular form of pulmonary tuberculosis is made by a TB doctor based on a combination of clinical, radiation, laboratory and immunological data. For the recognition of secondary tuberculosis, a detailed history is of great importance. To confirm the diagnosis:

  • Radiation diagnostics.X-ray of the lungs is an obligatory diagnostic procedure that allows to identify the nature of changes in the lung tissue (infiltrative, focal, cavernous, disseminated, etc.), to determine the localization and prevalence of the pathological process. Identification of calcified foci indicates a previous tuberculosis process and requires refinement of the data using CT or MRI of the lungs.
  • Analyzes. The detection of MBT is achieved by repeated examination of sputum (including using PCR), bronchial lavage, pleural exudate. But the mere fact of the absence of bacillus excretion is not a basis for the exclusion of pulmonary tuberculosis. Modern immunological tests can detect a tuberculosis infection with almost 100% probability. These include QuantiFERON and T-spot. TB
  • Tuberculin diagnostics. The methods of tuberculin diagnostics include the diaskin test, Pirke and Mantoux tests, however, these methods alone can give false results. Sometimes, to confirm pulmonary tuberculosis, you have to resort to trial treatment with anti-TB drugs with an assessment of the dynamics of the x-ray picture.

According to the results of the diagnosis, pulmonary tuberculosis is differentiated with pneumonia, sarcoidosis of the lungs, peripheral lung cancer, benign and metastatic tumors, pneumomycosis, lung cysts, abscess, silicosis, pulmonary and vascular malformations. Additional diagnostic search methods may include bronchoscopy, pleural puncture, lung biopsy.

Characteristic symptoms

  • The temperature does not fall below 37 °. And sometimes it rises to 40 °. This temperature is difficult to adjust with antipyretic drugs.
  • Hyperhidrosis, worse during sleep.
  • Frequent cough, accompanied by sputum. Sometimes necrotic tissue and blood can be seen in sputum.
  • A feeling of constriction in the chest and constant shortness of breath.
  • Loss of appetite and a sharp decrease in weight.

Patients with infiltrative tuberculosis often become a source of infection for healthy people.

The course of the disease is divided into three phases, depending on the severity of the symptoms:

  • Easy phase. The formation of an infiltrate of 3-4 cm is characterized. The symptomatology is moderate, expressed in a low temperature and cough. At this stage of the disease, symptoms can be confused with manifestations of viral infections. The initial phase can last up to one and a half months.
  • The acute phase. The inflammatory zone increases, becomes more than 5 cm in area. Symptoms are increasing: the cough is increasing, the temperature may rise to high values ​​or be absent. An x-ray of inflammation with clear contours will be visible on the radiograph.
  • Decay phase. Symptoms of the disease are pronounced, so a person gets to the hospital more often at this stage of the disease. Tissues in the focus melt and toxins enter the bloodstream. The patient has respiratory failure.

Infiltrative tuberculosis is the most dangerous form of pulmonary tuberculosis. With ineffective treatment, infiltrative tuberculosis is complicated by other forms of the disease.

Treatment of infiltrative tuberculosis is long and carried out in a hospital. A TB specialist develops a treatment plan depending on the stage of the disease, the presence of complications and the state of the body's immune system.

Comprehensive treatment includes:

  • Chemotherapy and antibiotic treatment.
  • Immunity support
  • Treatment of concomitant diseases or complications, if any.

The success of treatment for this form of tuberculosis lies in strict adherence to the treatment plan. If treated incorrectly, mycobacteria can become resistant to drugs, and then treatment will need to be started again.

Cavernous tuberculosis

It is also a secondary disease. It is characterized by the formation in the lung cavities with decaying tissues. Such cavities are called caverns.

Symptoms of the disease in the initial stages are erased. With the development of the disease, the symptoms are similar to other forms of pulmonary tuberculosis:

  • Temperature.
  • Weakness and breakdown.
  • Dyspnea and chest tightness.
  • Sweating.
  • Weight loss and appetite.

This form of the disease is usually diagnosed in those people who are already registered with a TB doctor. Cavernous tuberculosis is much less common with planned fluorography.

When diagnosing, it is necessary to differentiate cavernous tuberculosis from other lung diseases. For example, lung cancer, lung abscess, or emphysema. In order to accurately establish the diagnosis, it is necessary to pass laboratory tests: general blood and urine tests, blood biochemistry, bacterial sputum analysis.

Cavity formation occurs in several stages. In the place where the lung tissue undergoes decay, a cavity begins to form. At first it has fuzzy edges. Then a shell is formed that separates the cavity from the surrounding lung tissue. Inside are caseous masses and necrotic tissue. After the treatment, a sanitized cavity remains. This is a clearly formed cavity, without content.

Cavernous tuberculosis with ineffective or untimely treatment can provoke complications:

  • Pulmonary hemorrhage. It occurs if the wall of the blood vessel is involved in the decaying tissue.
  • Empyema of the pleura. Formed if the cavity is located at the edge of the lung. In this case, a cavity breakthrough can occur in the pleural cavity.
  • The spread of mycobacteria through the bronchi. Occurs when the cavern opens in the bronchus.

Treatment of cavernous tuberculosis begins with drug therapy. For a greater therapeutic effect, drugs can be administered intravenously or intrabronchially. If conservative treatment does not help, surgery is used.

The prognosis of cure for cavernous tuberculosis depends on at what stage of the disease treatment was started and on the patient’s immune defense.

Open and closed form

Any type of pulmonary tuberculosis can occur in two versions: closed and open.

Open tuberculosis characterized by a large number of mycobacteria contained in sputum. A person is a source of infection, so the patient must undergo treatment in a hospital.

With a closed form of tuberculosis a person is not a source of infection, as it does not release tuberculosis into the external environment. To determine whether a person is a source of infection or not, an analysis of a sputum smear will help.

The forms of pulmonary tuberculosis are diverse. In some cases, a combination of forms or the development of one form into another occurs.

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