The question of isolation is a question of morality: the specialists of the TB dispensary answer the questions of the readers of the AP. Is the closed form of tuberculosis contagious and how is it transmitted from person to person

Irina asks:

My baby is 3 months old. There were no vaccinations. Diagnosis at birth: asphyxia in labor of moderate severity. Meconium aspiration syndrome. cured aspiration pneumonia. My sister works in a tuberculosis dispensary nurse. How safe is her baby visit?

Your sister's contacts with the child are absolutely safe. There is no cause for concern.

Julia asks:

my mother was sick with a closed form of tuberculosis, she was in the dispensary for almost a year, she says that she can cure, we don’t live with her, but we visit every day, can my 6 months. child get infected? and what precautions are needed?

The closed form of tuberculosis is not dangerous to others. You can get infected only from a patient with an open form of tuberculosis, who actively secretes Mycobacterium tuberculosis in environment. In the situation you described, there is no danger for you and your baby.

Evgeniya asks:

Is it possible to catch tuberculosis when visiting the district TB dispensary?? I have a period of 37 weeks, and I needed a certificate to the maternity hospital, how likely is infection?

Patients with an open form of tuberculosis, entering for treatment, are in closed quarantine departments and do not contact other patients. Learn more about the causes of tuberculosis, the ways of transmission, its clinical manifestations, methods of diagnosis and treatment of this disease, you can read in our medical information section of the same name: Tuberculosis.

Alina asks:

Girls, I don’t know what to think anymore. We have had a fever and a cough for more than a month. We were in the hospital. Now we are on antibiotics, but there is no improvement. The doctor says that bronchitis. it’s impossible to do it). Well, somehow I didn’t bother until I accidentally stumbled upon the symptoms of tuberculosis. All the symptoms are the same. The child is vaccinated. Can he get tuberculosis????

Can you get TB in a TB dispensary? This question worries many who, for a number of reasons - a positive Mantoux reaction, a bad lung scan, adverse social conditions. It is quite possible to become infected with Koch's wand, despite all the measures taken by the employees of the medical institution. In order for the disease to develop, the coincidence of many conditions and factors is necessary.

Main way infection with the disease - airborne. In close contact with a sick microbacterium penetrates to a healthy person through Airways. However, for infection to occur, contact must be prolonged. Theoretically, you can become infected only through contact with a person who has open form disease, for six months at least 7 hours a day. Or stay with the patient 24 hours for 59 days. One-time contact with a carrier of the disease at close range is not dangerous for an absolutely healthy person. If the patient has already been treated, then microbacteria are not transmitted to others.

It is almost impossible for an adult healthy person to get TB when visiting a TB dispensary or places of stay of patients.

However, there is a risk group and people who belong to it should carefully monitor their health and regularly conduct an examination of the body.

Be infected with tuberculosis high probability may:

immunocompromised persons;
drug addicts and alcoholics;
people living in poor social conditions;
diabetics;
taking steroids;
undergoing therapy with drugs that weaken immune defense organism;
aged people;
children.

You should know that active form The disease develops in only 3% of all carriers of the infection. If there is a positive Mantoux test, but there are no changes in sputum tests and on an x-ray, the person is considered healthy. It does not spread the infection and does not pose a threat to other people.

When is infection possible?

A person is exposed to the threat of infection with tuberculosis every day. There is no guarantee that in in public places, on the street or in transport are only healthy people.

To protect yourself and your loved ones, you must follow preventive measures:

to wash hands;
undergo fluorography;
lead healthy lifestyle life.

The chance of contracting tuberculosis increases if you come into contact with a sick person.

In a family with a patient, some rules must be strictly observed:

Children should be examined by a phthisiatrician every three months, adults once every six months.
Take tests, do Mantoux and x-rays of the lungs.
Disinfect the premises.
Do not use the patient's personal belongings.

There is an opinion that pregnant women are more susceptible to tuberculosis than others. However, the probability of getting sick in women expecting a child is the same as in other people. If future mom becomes infected, the pregnancy is not terminated. active therapy carried out immediately after childbirth.

It is possible to become infected with tuberculosis without direct contact with the carrier. Bacteria remain viable indoors for at least 39 days, in the dust of books about 89, and in a warm environment more than 149.

You can get rid of bacilli only with the help of disinfection, which is carried out by sanitary and epidemiological stations. Major repairs or self-treatment of the apartment in this case is not effective.

Infection in the TB dispensary

A tuberculosis dispensary is a place where not only sick people are located, but also those who come for help for employment and medical examinations. Also there are those whose x-rays far from the norm. But this does not necessarily indicate that they have a disease. What to do in a situation where a visit to the TB dispensary is necessary? Is it possible to get sick there? How to protect yourself?

Tuberculosis occurs in two forms: closed and open. The carrier, when open, excretes Koch's bacillus with sputum and other biological fluids. These people are the danger to others. With a closed form of the disease, a person does not release bacteria into the environment.

The chance of contracting tuberculosis from a person with an open form of the disease is low. Infection requires prolonged contact, stay for a long time in a closed space or the exchange of body fluids. It is for this reason that the risk of acquiring tuberculosis in a tuberculosis dispensary is the same as, for example, in transport, in a public place.

The most susceptible to the disease are the elderly, children, adolescents in the period hormonal adjustment, immunocompromised people, diabetics. For everyone else, a person with an open form of tuberculosis is not dangerous.

To reduce the likelihood of the spread of disease in each worker medical institution exists job description, which in without fail observed.

Visitors to the TB dispensary can become infected through contact with objects that biological fluid patient: sputum, saliva, blood.

Therefore, the cleaners of the premises daily carry out the following procedures:

carry out routine cleaning at least three times;
properly store inventory;
carry out general cleaning.

With help ultraviolet lamp Quartzization of premises is carried out. Despite being resistant to many external factors, Koch's wand does not tolerate ultraviolet radiation and dies within a few minutes after the start of quartzization. Proper cleaning of the TB dispensary reduces the chance of contracting TB. In addition, the territory of the institution is divided in such a way that healthy people who come for an examination to receive a statement on their state of health will never contact a long period with the sick.

Tuba is scary dangerous disease, which did not disappear even after the advent of vaccinations. Unfortunately, a huge number of people are still either infected with Koch's wand or sick. It has not yet been possible to cope with the disease, as the bacterium adapts to antibiotics, becomes polyvalent, which makes treatment extremely difficult. Only maintaining immunity, a healthy lifestyle and proper diet can reduce the risk of developing the disease.

Judging by nutrition, you absolutely do not care about immunity and your body. You are very susceptible to diseases of the lungs and other organs! It's time to love yourself and start getting better. It is urgent to adjust your diet, to minimize fatty, floury, sweet and alcohol. Eat more vegetables and fruits, dairy products. Nourish the body by taking vitamins, drink more water(precisely purified, mineral). Harden the body and reduce the amount of stress in life.

You are prone to lung diseases at an average level.

So far, it’s good, but if you don’t start taking care of it more carefully, then diseases of the lungs and other organs will not keep you waiting (if there were no prerequisites yet). And frequent colds, problems with the intestines and other "charms" of life and accompany weak immunity. You should think about your diet, minimize fatty, starchy foods, sweets and alcohol. Eat more vegetables and fruits, dairy products. To nourish the body by taking vitamins, do not forget that you need to drink plenty of water (purified, mineral). Harden your body, reduce the amount of stress in life, think more positively and your the immune system will be strong for many years to come.

Congratulations! Keep it up!

You care about your nutrition, health and immune system. Keep up the good work and problems with the lungs and health in general long years will not disturb you. Don't forget that this is mainly due to the fact that you eat right and lead a healthy lifestyle. Eat healthy and nutritious foods (fruits, vegetables, dairy products), don't forget to use a large number of purified water, harden your body, think positively. Just love yourself and your body, take care of it and it will definitely reciprocate.

In the late 80s, I went to work from the intensive care unit to the tuberculosis dispensary (durin). I was then in my 20s. I took a slightly higher salary. I worked there for a short time, but I left a lot of impressions.

The city TB dispensary in my city was then already a very old, pre-war building. High ceilings, huge offices, wards for 20-30 beds. I don't remember exactly. In total, the hospital had 3 wards. 2 large and one female for 5 people.

The men were in the big rooms. Almost all of them were former prisoners. Difficult people, I feared them. When applying for a job, I was given a briefing. Try not to enter the wards, talk less with patients, do not argue, do not persuade, etc.

My duties included distributing pills, keeping journals, referring patients for tests, everything as it should be. The work was trifling, the most difficult thing was the specifics of the contingent.

Sometimes the men refused the pills, and they were usually prescribed almost in handfuls. Only one thing - everyone demanded codeine preparations. They stepped on the head physician, they used to threaten him if codeine was not prescribed in the dose they needed. They left without permission - they came, they generally ran away from the hospital ... Everything was.
The prisoners were not rude to the medical staff, unless, of course, they were offended (of the patients). But here was one man, with numerous imprisonments, as evil as Satan. Everyone was afraid of him. Although the nurses and doctors were with many years of experience, almost all of them were of retirement and pre-retirement age. This goat was especially hated by the nurses. Insulted, sent to x ... in the open in plain text, not only sisters, but also doctors. Smoked and drank in the ward. He was discharged, and a week later he again acted. open tuberculosis.

I did not last long there, I found Good work. And so one day I met a nurse from a dispensary. She shone with great happiness. It turned out that the goat had died.
And it was like that. Late spring day, almost all the staff went out to clean up the area. And then an excited nurse comes running and shouts: "Nesterov is dead!" Everyone turned to stone, and when it came down to it, they dropped their rakes, started dancing, shouting cheers, well, in general, mass euphoria. Have calmed down.

I myself don’t know why I wrote all this ... But maybe someone, God forbid, will have to lie in a tuberculosis dispensary, it may come in handy, what and how there. I am sure that the contingent there has remained what it was then.

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Tuberculosis dispensary provides outpatient registration and monitoring, inpatient treatment of tuberculosis, outpatient care. There are tuberculosis treatment clinics in every administrative center. The hospital of the TB dispensary is engaged in the treatment of patients in conditions of permanent stay in the department. There is a list of indications for hospitalization of patients. The main one is the control of medical staff over the intake of medicines. From proper observance dosage and timing of drug administration depends on effective treatment tuberculosis in the dispensary.

The decision on hospitalization is made by the administration of the institution, the attending physician and the head of the department on an individual basis. strict indications. In the last century, the standard was the treatment of tuberculosis in the clinic, especially for the first time. Now the issue has been revised under the influence of insurance medicine and ethical issues related to human rights.

Features of the course of tuberculosis

Inpatient treatment of tuberculosis involves the patient being in the quarantine mode of the TB department. For patients and their relatives, who consider the disease a sentence, it is important to know: in order to cure tuberculosis, treatment in a hospital is a necessity. Tuberculosis clinics try to find for each patient best option, and if there is no indication for hospitalization, an outpatient chemotherapy regimen is prescribed. Tuberculosis dispensary controls the course of treatment.

Photo 1. General ward of a tuberculosis hospital.

The disease in its development goes through successive stages.

Mycobacteria entering the respiratory tract are sent to the lungs. There they settle and form the primary focus. Infection with lymph flow spreads to regional The lymph nodes. Clinically, all this manifests itself in the form of inflammation of the node - lymphadenitis and the vessel - lymphangitis. In most people, the immune system is able to fight back and limit further infection. The focus is sclerotic and calcified. But there is a constant risk that favorable conditions for the development of mycobacteria will give impetus to the formation of tuberculosis. The infection proceeds without severe symptoms. Only a proper examination can reveal the disease on early stages.

Photo 2. Unhealthy thinness is a sign of possible tuberculosis.

The patient feels tuberculosis intoxication:

Weakness, decreased performance.
An increase in body temperature to subfebrile indicators.
Loss of body weight.
Coughing - low-intensity dry cough.
Osteoarticular pains.
Hyperhidrosis - excessive sweating at night time. specific symptom"wet sheets" after sleep.

Most people do not pay attention to subtle symptoms. An infectious disease becomes a diagnostic finding on a chest x-ray. Preventive annual examination is a screening for tuberculosis.

If the disease was not diagnosed in early period, then gradually it turns into an open form. Bacterial excretion occurs with sputum, urine, feces, blood. It depends on the organ affected by the process. The most dangerous in epidemiological terms pulmonary forms tuberculosis. Diagnosed as open pulmonary tuberculosis the hospital is the only place for treatment. The reasons are the isolation of the patient and the provision of qualified assistance if necessary.

Photo 3. The presence of high-quality equipment helps to monitor the patient's condition and adjust the treatment.

There is a latent form of infection in which tuberculosis bacteria are in the foci, but the disease does not develop. Hidden tuberculosis does not require treatment in a hospital, since there is no bacilli excretion.

Indications for inpatient treatment

Photo 4. Alcoholics, drug addicts, homeless people are frequent victims of tuberculosis.

TB dispensary patients are divided into two large groups:

Patients who lead an asocial lifestyle: alcoholics, drug addicts, persons without a fixed place of residence, former prisoners. People need medical care. It makes no sense to hope for conscientious medication. Patients diagnosed with pulmonary tuberculosis undergo inpatient treatment under strict control.
Patients with medium and high social level. Category of patients who are interested in get well soon. During the period of tuberculosis treatment in the dispensary, they may lose their jobs, experience psycho-emotional stress, since the contingent of departments consists mainly of socially disadvantaged patients. Separation from family and children aggravates the state of mind. In this case, it is not advisable to conduct long-term inpatient therapy. Only until the cessation of bacillus excretion, if it was. Anti-tuberculosis drugs in case of a closed form of infection are issued in outpatient. Patients do not pose an epidemiological danger to others.

Hospitalization in the inpatient department is carried out according to absolute medical and epidemiological, as well as social indications.

Photo 5. In the tuberculosis dispensary, the doctor has the opportunity to monitor the progress of the patient's treatment.

Availability medical indications to hospitalization:

acute forms of the disease (miliary tuberculosis, caseous pneumonia, tuberculous meningitis);
severe intoxication, which causes serious condition sick;
the need for specific manipulations in a hospital (intracavernous administration of drugs);
open form of the process;
high incidence of injury infectious disease;
multiresistant tuberculosis;
situations in which further diagnostics are required.

Epidemiological aspects:

uninfected children in the family of a bacillus excretor.

By social reasons hospitalize patients without a fixed place of residence, serving sentences in places of deprivation of liberty, people with alcoholism and drug addiction who refuse to receive help of their own free will.

Photo 6. Prisoners are required to undergo treatment for tuberculosis in special dispensaries.

Relative indications for hospitalization in a hospital:

Short periods of hospitalization due to adjustment of the dose of treatment received;
Patients with comorbidities requiring treatment in a tuberculosis dispensary and age-related patients.

Used methods of treatment of the disease

Treatment methods are divided into groups:

Chemotherapy with first-line drugs, and if they are ineffective, with reserve ones.
Surgical care in combination with anti-tuberculosis drugs.
Symptomatic relief of manifestations of the disease, conditions, life threatening or side effects on medications.
Intracavernous administration of drugs.
Palliative care.

Standard Application antibacterial agents divided into an intensive period and support. The first phase of treatment for bacterial excretors lasts three months. Four first-line drugs are used. This time the patient is in the clinic for the treatment of tuberculosis. The length of stay after stopping the decay process, the patient agrees together with the doctor.

Photo 7. Chemotherapy involves the use of effective drugs in the fight against the disease.

For the first time, patients with a small form of the process visit day hospitals with a medication regimen. Hospitalization in the department is indicated if there is pleurisy and respiratory failure.

With chronic destructive tuberculosis patients are in the hospital for at least 4 months.

In case of ineffectiveness of antibiotics, the patient is consulted by phthisiatricians - surgeons. The question of expediency surgical treatment.

When a person is admitted to a hospital to treat an illness, doctors have the opportunity constant surveillance for the state of his health, quality medical measures. It is possible to control the correctness and frequency of taking drugs by the patient, to immediately adjust the appointment, if the need arises.

The tuberculosis treatment hospital is equipped with operating theaters and qualified medical personnel. IN postoperative period restoration of body systems takes place in the ward intensive care. Resuscitation deals with cupping critical conditions associated with tuberculosis: pulmonary hemorrhage, acute respiratory failure.

Photo 8. Highly qualified personnel work in tuberculosis hospitals.

In severe cases of tuberculosis, with ineffectiveness oral intake means, the introduction of chemotherapy drugs parenterally or intracavernously is indicated. The methods offered by the diagnostic and treatment center depend on the professional level of the specialists.

Pros and cons of inpatient treatment

The views of phthisiatricians on the terms and indications for hospitalization in a hospital have been revised. According to foreign researchers, the effectiveness of chemotherapy is so strong that bacterial excretion stops within 1 month after the start of treatment.

Photo 10. Sputum analysis of the patient is carried out to evaluate the effectiveness of treatment.

From the first weeks of therapy, the patient does not pose an epidemiological danger to others. Even if mycobacteria grow after sputum culture, then in negligible amounts. Since the field of TB control is vast, there are many options when inpatient care vital.

pros

Minuses

Quality control medical personnel behind the treatment process
Qualified help specialists at any time of the day
The opportunity to undergo rehabilitation for people with a low social level - in dispensaries, patients have the opportunity to eat normally, observe hygiene standards
For children and age patients it is better to be treated in the department
Control over the epidemiological situation
Implementation of specialized methods of diagnosis and treatment

High economic costs
Big risk reinfection with multiresistant strains of mycobacteria - not all dispensaries have the opportunity to provide boxes for patients with drug resistance
When hospitalizing patients with small forms, there is a possibility of their reinfection
Ethical Issues related to the work, family and environment of the patient

The table shows the pros and cons inpatient treatment tuberculosis.

What is tuberculosis, clinic, treatment, prevention - topics on which it is necessary to carry out sanitary and educational work with the population. Good knowledge of the issues will eliminate many of the myths associated with tuberculosis.