Signs of open form of tuberculosis. Open form of tuberculosis: who can get infected? How does open tuberculosis manifest?

What is the open form of tuberculosis, how is it transmitted? This question worries many people, because, despite progress in the field of medicine, the number of people suffering from this terrible disease is growing every year. But the good news is that the percentage fatal outcome from this disease has decreased compared to previous years. No one, unfortunately, is immune from open tuberculosis lungs, such a formidable and intractable disease. Many famous personalities died from this disease. Therefore, we will try to understand how the disease occurs and how it is transmitted, we will consider the stages of the disease and methods of treatment. Because forewarned means forearmed!

The whole danger is that tuberculosis in its open form can be transmitted through contact with a sick person in just a few minutes. This happens when talking, coughing by airborne droplets. The form of open tuberculosis is very dangerous. Diseaseful microbes found in the patient’s sputum easily enter the airspace when coughing. Therefore, people who become ill with this form should be strictly in hospitals! As long as their sputum contains harmful bacteria.

The dangerous thing is that pathogenic microbes persist for a very long time. They can live even in dry form. For example, if a patient spits sputum on the ground, the germs of this sputum remain in it for a very long time. terrible disease. And people can become infected by simply stepping on it or picking up something from the ground.

In addition, these bacteria are not affected by treatment chemicals. They survive even after applying alkali to the surface. Therefore, they are difficult to kill, for example, with ordinary bleach.

Open pulmonary tuberculosis is characterized by the appearance of small bubbles and cavities on the surface of the lungs. As a result of this, the person begins to cough up hemoptysis. It is necessary to know the main signs of open tuberculosis.

A sick person has the following symptoms:

1. Suffocating pulmonary cough, worse at night. In this case, hemoptysis is often observed.
2. Very large volume of sputum, reaching up to 100 ml.
3. Sweating at night.
4. Body temperature is above 38.
5. Lack of appetite.
6. Rapid weight loss.
7. Pain in the chest area.
8. Severe weakness, fatigue.

Possible variants of infection

Now let's try to figure out how this disease is transmitted. The open form of tuberculosis is an aggressive form of the disease, when pathogenic microbes contained in sputum and released into the air can harm other creatures. They can get on various objects. Therefore, the air in the room is contagious, as well as all objects located there! You can also become infected through utensils in public catering establishments. Places large cluster people (this could be: a cafe, transport, train station, etc.) represent great danger in terms of infection. Through cuts and wounds, infection can also occur and tuberculosis can develop.

One long, but close contact with a sick person can be more dangerous in terms of infection than many short ones. It is clear that kissing or sexual contact with a sick person is the most dangerous way of infection for healthy person. Therefore, it is extremely important to avoid casual relationships.

In order to prevent infection, entrances to TB doctors are usually located separately, or these doctors are seen in special remote dispensaries.

If the sputum no longer contains germs of the disease, then this is a closed form of tuberculosis. It is considered not contagious.

Sometimes the source of infection can be ordinary livestock. A sick animal can infect humans.

Main stages of the disease

A person infected with the bacteria of this disease can live for many years without even knowing that this infection has settled in his body. Having accidentally met a person with tuberculosis or picked up bacteria by touching objects on which they were located, a person initially does not experience anything. The infection lives in it, the immune system works to suppress the bacteria, and the disease does not manifest itself. This may be the case for several years.

Then the manifestation of tuberculosis intoxication may begin.

A person may suddenly feel:

• fever;
• weakness;
• lethargy.

He may have a slightly elevated temperature. But this is not a disease, but an allergic reaction to the virus.

Further, primary tuberculosis develops. At the site where the bacteria enters the lungs, inflammation appears. It is then covered with fibrous tissue. It absorbs calcium from the body and gradually hardens. Nodules form. This change will already be noticeable on the x-ray. This is not yet an open form of tuberculosis. Koch bacteria already live in the human body, but this has not yet manifested itself much.

Secondary tuberculosis begins when the immune system fails. This could be for many reasons. Perhaps the person had a cold, or took some drugs that reduce immunity (for example, antibiotics). Or another infection has entered the human body. In this case, the disease develops rapidly and takes an open form.

Sometimes this stage manifests itself in low temperature, lethargy. Therefore, sometimes this condition is mistaken for a cold.

But more often the temperature rises to high numbers, a suffocating cough, and increased sweating.

In this case, it is necessary to test the sputum for tuberculosis bacteria as quickly as possible. If for some reason this procedure cannot be done, an examination method such as bronchoscopy will help.

Prevention and treatment methods

The open form of tuberculosis is treated exclusively in a hospital setting, since it is the most contagious to others and occurs in a severe form. Treatment is usually prescribed antibacterial. IN complex therapy others are also appointed various drugs, which are selected individually. Typically therapy lasts about six months. Many people are interested in the question: how long do people with this disease live? The answer is comforting. At correct diagnosis And effective treatment symptoms may disappear for a long time.

The main thing is to do the following:

• follow all doctor's orders;
• after the course of treatment, lead a correct lifestyle without bad habits;
• increase immunity and undergo regular examinations on time.

Patients with the closed form can be treated at home, but often visit the doctor.

Prevention includes: healthy image life, mandatory presence of fresh air, avoidance of bad habits, sufficient quantity sunlight. It is important to strengthen your immune system. It can be various ways. From taking multivitamins to daily hardening. It is very useful to carry out frequent wet cleaning of the room. Be sure to eat well. Sometimes proper diet helps speedy recovery already sick people. It is advisable to use individual dishes and avoid coughing people. It is also useful to undergo examinations and diagnostics more often. Every year it is necessary to undergo fluorography. This will help you notice the beginning changes in the lungs. Diaskintest can be performed once a year. It is freely sold in pharmacies.

If a person with tuberculosis lives in your house, you need to visit a phthisiatrician. He will probably appoint prophylactic drugs. It is necessary to regularly clean the premises using special solutions. You can call specialists from the sanitary and epidemiological station to your home.

Even if infection has already occurred, visiting a doctor will help you take the necessary measures for recovery.

How is open tuberculosis treated? Tuberculosis is one of the most dangerous infectious diseases of our time, which has already become a social problem. The number of patients is growing every year; according to statistics, out of 100 thousand residents of Russia, 80 suffer from tuberculosis, of which about 2% of cases end in death.

Main danger of this disease is that there are cases in which you can become infected even after short period time of communication with the patient. This form is called open form tuberculosis.

Since this disease is transmitted by airborne droplets and household contact, in which the patient becomes a carrier of the virus, open tuberculosis is very dangerous. When you cough, you produce sputum containing bacteria that are transmitted to others.

The open form of the disease can only be treated in special medical institutions- anti-tuberculosis hospitals. During treatment, the patient is isolated while his sputum contains bacteria dangerous disease.

The causative agent of the disease is also called Koch's bacillus or tuberculosis bacillus. Bacillus Koch retains its infectious properties even in dry sputum, on the ground, and also on the surface of objects. In addition, it is highly resistant to acids, alkalis and other disinfectants.

When infected, inflammation appears in the lung tissues different sizes, looking like tubercles. Also, the open form may be accompanied by the formation of cavities, resulting in coughing accompanied by hemoptysis.

In humans, in most cases, the development of the disease is provoked by human (more than 90%) and bovine mycobacteria, but there are many more varieties of them.

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How is open pulmonary tuberculosis transmitted?

It is important for everyone to know how the open form of tuberculosis is transmitted! The main carrier of the disease is a person already suffering from tuberculosis. The infection process can occur through any objects during a conversation. Dust contains mycobacteria; when inhaled with air, they enter the body and infection occurs. However, not all people with a dangerous disease are contagious.

Forms in which microbes are not excreted with sputum are not infectious to others. This is closed tuberculosis.

IN in rare cases the source of the disease may be a large cattle. If an animal is sick, then the milk contains a bovine type of mycobacteria and if it gets into food, the infection is transmitted to humans. As a result, the disease can develop into either a closed or open form.

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Signs of an open form

The symptoms of tuberculosis infection are very similar to the symptoms of other infectious diseases, but they have some peculiarities.

The time from the moment of penetration of microbes into the body until the development of allergization of the body is very difficult to identify. Currently, doctors agree that it is approximately 2-3 months.

The first signs of infection can be detected using tuberculin, which is injected under the skin. This procedure is called the Mantoux test. Cases where the reaction to a tuberculin test is negative, but a year later is positive, with an increase in the size of the papule by 0.5 cm, indicate infection.

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Stages of the disease

In cases where a person leads a healthy lifestyle: follows a daily routine, proper diet, goes in for sports, hardens, strengthens your immune system, the stage of infection and sensitization can last for years. That is, a person is infected, but in fact his health is normal.

Painful condition, lethargy, fever - these are all intoxications. It manifests itself during stress, when protective forces the body is weakened. The cause of such intoxication is not toxic substances secreted by bacteria, but an allergy to the pathogen. This phase can also last for a very long time.

Lung develops in people who first came into contact with the pathogen. An inflammatory reaction develops around the site of infection. Gradually, the focus of inflammation hardens, as a result, fibrous tissue forms in its place. It absorbs calcium and thickens. Such nodules are visible when examined by x-ray. At this stage, the disease is rarely open.

Despite the fact that the body continues to be in the process allergic reaction, under favorable circumstances, the disease can proceed hidden.

The latent stage of the disease occurs when Koch's bacilli live on the periphery of the inflammation, without showing obvious symptoms.

- this is the stage when, after the primary stage, immunity drops sharply or another infection enters the body. It can affect large areas of lung tissue. The disease progresses aggressively, mycobacteria are present in the sputum.

Sometimes at this stage the inflammation can develop into pneumonia, and in some cases it progresses to other internal organs. This is the miliary form of the disease. the lungs usually have an open shape.

Wherein open tuberculosis can proceed almost unnoticed, manifesting itself only with symptoms such as:

• lethargy;
• slight increase in temperature.

But there are also acute symptoms of the disease:

• heat;
• persistent cough;
• heavy sweating.

The best way to diagnose an infection is to laboratory conditions check sputum for the presence of bacilli.

Bronchoscopy is another method of detecting the disease and is performed in cases where it is impossible to obtain sputum.

Humanity has known about tuberculosis for a long time; it used to be called consumption. Just a couple of centuries ago, almost all patients died from tuberculosis. But, despite the availability of anti-tuberculosis drugs, tuberculosis is still considered a dangerous and very common disease.

According to the latest data, about 9 million cases of illness are registered annually around the world. The increase in tuberculosis patients is associated with an increase in the number of people with HIV infection, because it is they who most often develop tuberculosis as a complication of the underlying disease.

How can you become infected with tuberculosis? The causative agent of this infectious disease is the tuberculosis bacillus, which is also called Koch's bacillus. Tuberculosis (in open form) is transmitted from a sick person to a healthy person through the air. Most often, transmission of infection occurs through contact with infected people, as well as through general subjects everyday life. The immune system of a healthy person can destroy the pathogenic bacillus, however, too frequent contact with a sick person increases the likelihood of infection even with active work immune system.

With a weakened immune system, any infections penetrate the body faster and multiply faster in it. So the risk of infection is high for both strong and weakened organisms.

Open form

What is the open form of tuberculosis? There are several types of tuberculosis, among which open and closed forms can be distinguished. The open form of tuberculosis, unlike the closed form, is transmitted from a sick person to a healthy one. In the closed form, the disease is not contagious, since in this case the disease proceeds without the release of a pathogenic bacillus into external environment. The open and closed forms of the disease are most often determined by tuberculosis of the lungs, but there is also tuberculosis of the intestines, genital organs, and so on. All of them are accompanied by the release of bacteria into the environment.

The incubation period of open tuberculosis is about a month from the moment of infection; after this period of time, vivid symptoms begin to appear.

The mechanism of development of tuberculosis is quite complex; once the bacillus enters the body, it will never leave it. The development of the disease depends entirely on hereditary predisposition and from environmental factors. As mentioned above, strong immunity resists infection, and a person with weak immunity or someone who is predisposed to this disease becomes ill.

The causative agents of the disease have a very complex metabolism, so they are very stable and changeable as a result. external conditions, and to conditions within a person.

Open tuberculosis is divided into primary and secondary. From the terminology it is clear that the primary form develops in a person who has not previously had tuberculosis and has not been in contact with the tuberculosis bacillus. The secondary form is a recurrent disease. In this case, the lesion that existed previously is scarred, and another lesion develops.

Open form symptoms

How does the open form of tuberculosis manifest? The symptoms do not increase immediately; at first they do not cause discomfort to the patient, but after the incubation period ends, the patient develops a cough. At first the cough is dry, but over time it becomes wet. This symptom can last for a month or more. At this moment (at wet cough) open tuberculosis can be transmitted to healthy people. The rods are transmitted through the air or through household objects. They're in a huge number are contained in the patient’s sputum, and accordingly, end up not only in the air, but also on surrounding objects.

The following signs of open tuberculosis are weight loss, hemoptysis and low-grade fever, which most often rises in the evening.

With secondary open tuberculosis, the symptoms are somewhat different:

• the temperature rises to critical levels;
• the patient suffers from very profuse sweating at night;
• the cough is painful and almost incessant, most of all it bothers the patient at night and in the morning;
• chest pain and joint aches occur;
• the skin turns grey.

Diagnosis of the disease

Open tuberculosis is diagnosed when laboratory research pulmonary discharge of the patient or by bronchoscopy. Bronchoscopy is the removal of a small sample of lung tissue to determine the presence of an infectious agent. In addition, the patient must have an x-ray of the lungs.

In some cases, a tuberculin test (Mantoux test) is done. Most often this research is carried out on children. This test makes it possible to identify the degree of infection and tissue reactivity.

If there is a suspicion of a non-pulmonary form of the disease, a Koch test is performed. As additional measures diagnostics can be prescribed by ultrasound, CT scan, consultation with a neurologist, gastroenterologist, dermatologist and other specialized specialists.

Treatment of the disease

First of all everything therapeutic measures aimed at destroying bacteria. Four groups are used for this antibacterial drugs. Treatment is usually carried out inpatient, after the release of bacteria into the sputum, and from it into the environment, stops, the patient can continue treatment on an outpatient basis. Treatment is long-term – it can take a year or more. After the therapeutic course, the patient is recommended to undergo treatment in sanatoriums that specialize in the treatment of tuberculosis.

Bed rest is prescribed to those patients whose lung destruction is very severe. Everything else, on the contrary, is highly recommended active work– walks, therapeutic exercises, and so on.

If therapeutic treatment does not have an effect, it may be prescribed surgery. Most often, incomplete resection of the lung is performed, as well as removal of segments that have been affected. The main problem in treating the disease is the extreme resistance of the bacillus to drugs. Moreover, with such long-term treatment the patient may experience various side effects antibacterial therapy.

As for the life expectancy of a patient with tuberculosis, this is very individual. It all depends on the correctness of the chosen therapy, the patient’s lifestyle, and the form of the disease. Completely defeat tuberculosis modern medicine can not. Everyone around the patient needs to undergo diagnostic examination, if necessary, they are prescribed treatment to prevent the disease.

Complications of the disease

Tuberculosis is dangerous disease, which can cause severe complications and consequences. As a result of lack of therapy or failure to comply with all medical recommendations The following conditions may develop:

• pulmonary hemorrhage;
• oxygen deficiency – respiratory failure;
• inflammation of the outer membrane of the lungs - pleurisy;
• air may accumulate in the pleural area; this phenomenon is possible when the alveoli or the bronchus itself rupture;
• heart failure, which develops as a result of pathological processes in the pulmonary system;
• TB infection can spread to other organs.

Prognosis for the disease

If the disease is detected on time and the patient strictly follows all the doctor’s instructions, then the prognosis can be called favorable. After the tuberculosis lesions heal and the symptoms disappear, they speak of clinical recovery.

If there is no treatment, death from tuberculosis occurs in 50% of cases. The risk of death increases in HIV-infected people, older people, and people with diabetes.

Disease prevention

The most effective prevention of tuberculosis today is vaccination. The child receives the first vaccine within the walls of the maternity hospital. As for adults, they are vaccinated according to indications.

Knowing how tuberculosis is transmitted, it is necessary to take preventive measures. The main prevention of tuberculosis is compliance with sanitary standards and annual preventive examination. Besides, preventive measure is to improve immunity.

If a person follows simple prevention rules, the risk of infection is noticeably reduced, and, consequently, the prevalence of this terrible disease in society is reduced.

The open form of tuberculosis is a form of the disease in which Mycobacterium tuberculosis is large quantities found in the patient's saliva and sputum. When coughing, sneezing and talking, the pathogen is released into the environment.

Characteristics of the pathogen

The disease is caused by Mycobacterium tuberculosis, which is also called Koch bacilli in honor of the researcher who discovered them. I distinguish two types of mycobacteria - human and bovine. Bacteria have the appearance of polymorphic immobile rods. The formation of spores and capsules is not typical for them. Representatives of the bovine species are thicker and shorter than human mycobacteria.

Mycobacteria reproduce very slowly. For normal life they need oxygen, so Koch bacilli most often affect the lungs, although tuberculosis can develop in all tissues and organs.

Microbes are resistant to adverse environmental conditions and are capable of long time will persist in food, water, street and book dust. But under the influence ultraviolet rays and high temperatures, mycobacteria die within a few minutes.

Certain types of Koch bacilli have developed resistance to anti-tuberculosis drugs. When exposed to drugs, they acquire the ability to branch or become cocciform.

Spread of infection: how can you become infected with an open form of tuberculosis?

Tuberculosis is most often transmitted from person to person, but infection is possible through contact with sick animals and birds, or consumption of infected food products, use of household items. There are known cases of transplacental transmission of the pathogen from a sick mother to a child.

Not in all cases, when a pathogen enters the body, tuberculosis develops. In the body of a healthy person, the infection can persist for years. latent form. The first signs of the disease are observed when immunity decreases.

The likelihood of getting tuberculosis increases with:

• congenital or acquired immunodeficiencies;
• living in unfavorable living conditions;
• working in hazardous industries;
• malnutrition;
• hypovitaminosis;
• chronic systemic pathologies;
• long-term use of glucocorticosteroids;
• mental illness;
• depression;
• alcohol and cigarette abuse.

Actually only chance To definitely get sick means communicating with a person who has an open form of tuberculosis. In order to understand the mechanism of infection, you do not need to have medical education, you just need to understand the principle. The disease provokes the development inflammatory process in the body, accompanied by the appearance of small tubercles. In most cases, the disease affects the lungs and bronchi. The infection process is carried out in the following way: enter the body pathogenic bacteria and spread by bronchopulmonary, lymphogenous and hematogenous routes. Single or multiple tubercles form in the patient's lungs. Tuberculosis has two forms: closed and open. At first, mycobacteria are contained in the tubercles themselves, without leaving them. In this case, the patient does not pose a threat to others, and it is impossible to become infected from him. The second form is extremely dangerous because the pathogen is released along with sputum.

Open tuberculosis is more often diagnosed in men than in women. The age of most patients is 30-40 years.

Symptoms of the disease

In the first 2-3 months after infection, tuberculosis can only be detected using laboratory methods. About the beginning pathological process indicates a positive Mantoux test. Mycobacteria are also found in the lymph nodes, from which they spread throughout the body.

Tuberculosis can be:

• primary - beginning at the first contact with the pathogen;
• secondary - arising as a consequence of an existing disease.

On initial stage disease, inflammation develops in the tissues of the lungs and intrathoracic lymph nodes. Then the lesion gradually resolves, and a lime capsule forms around it. Clinical picture depends on the state of the patient’s immune system and the presence of concomitant diseases.

At improper treatment or infection with drug-resistant mycobacteria, open tuberculosis becomes chronic. In older people or those with immunodeficiencies, bacteria spread throughout the body through the lymph flow. Miliary tuberculosis develops.

The following symptoms of pulmonary tuberculosis are distinguished:

• cough that gets worse at night;
• allocation large quantity sputum;
• fever;
• hemoptysis;
• chest pain;
• decreased appetite;
• sleep disorders;
• severe weight loss;
• general weakness.

The patient sweats heavily at night. Breathing becomes difficult. Patients with primary tuberculosis show signs of intoxication without visible changes in the lungs.

Diagnostic methods

When tuberculosis is suspected, the patient's social history is of great importance. After a survey and examination, the doctor prescribes:

• fluorographic or X-ray examination lungs;
• Mantoux test or Diaskintest;
• bacteriological examination of sputum or bronchial washings;
• blood test for the presence of antibodies to the causative agent of tuberculosis;
• testing for the presence of mycobacterial DNA in the blood;
• blood chemistry;
• general blood and urine analysis.

X-rays help determine the extent of lung damage. As a preliminary diagnostic method, sputum is examined under a microscope.

The bacteriological method for diagnosing tuberculosis is highly effective and is also used to determine the resistance of mycobacteria to various drugs, monitoring the success of treatment and identifying virulent forms of the pathogen. But it takes at least 3-4 weeks to obtain a culture of mycobacteria. To identify the pathogen, use accelerated methods cultivation.

In order to identify drug resistance of mycobacteria, they are placed on media containing antibiotics in different concentrations. The study is carried out before starting treatment, after 3 months and then every 6 months.

To detect L-forms of mycobacteria, biological method diagnostics - the test material is injected into white mice or guinea pigs and monitor the development of the disease in animals.

A specific way to detect tuberculosis is the Mantoux test. 0.1 ml of tuberculin is injected subcutaneously into the patient's forearm. After 2 days, the severity of the reaction is assessed. The appearance of a papule with an infiltrate of 5 mm or more in diameter at the injection site is regarded as a positive result. In this case, an additional examination is prescribed.

The patient's blood shows an acceleration of ESR and leukocytosis. Biochemical analysis blood shows increased levels of cholesterol, copper, uric acid, squirrel.

Function evaluation external respiration for tuberculosis helps doctors make choices optimal methods treatment, decide on the need surgical intervention, assess the effectiveness of the patient’s condition after the course of treatment.

Treatment

The open form of tuberculosis is treated in a hospital setting, where the risk of infecting other people is minimized. The patient is prescribed complex anti-tuberculosis chemotherapy, including the following drugs:

• Streptomycin,
• Pyrazinamide,
• Ethambutanol,
• Isoniazid.

To suppress the activity of Mycobacterium tuberculosis, a combination of several drugs is used. Treatment results are assessed every 3 months. The disease caused by drug-resistant strains of microorganisms should be treated with second-line drugs: Fluoroquinolones, Ethionamide, Capreomycin, Cycloserine and para-aminosalicylic acid.

For general strengthening the patient is prescribed immunomodulators and vitamins. Antibiotics and antifungal drugs prevent secondary infections. Glucocorticoids for tuberculosis are prescribed with caution, as they suppress the immune system.

In case of insufficient effectiveness drug therapy and the presence of vital signs are carried out surgical removal lung or part thereof.

The disease tuberculosis has been known to mankind under the name consumption since ancient times. The disease was first described by the physician Hippocrates, who believed that it was a genetic disease. Another ancient doctor, Avicenna, found that the disease can be transmitted from one person to another. In the 19th century, the German scientist Robert Koch proved the infectious nature of the disease by discovering a mycobacterium that caused the disease. The causative agent of the disease, Koch's bacillus, is named after its discoverer. The scientist received the Nobel Prize for his discovery.

Tuberculosis in our time is still one of the most common diseases in all countries of the world. According to WHO, many cases of tuberculosis infection are registered annually in the world - about 9 million. In Russia, 120,000 people become ill with tuberculosis every year. The mortality rate from infection in Russia is higher than in European countries.

So what is tuberculosis? How does a person become infected with tuberculosis, and is this disease always dangerous? What treatment is effective and can tuberculosis be completely cured? Let's look at these questions in detail.

What kind of disease is tuberculosis?

The causative agent of tuberculosis is Mycobacterium ( Mycobacterium tuberculosis). Tuberculosis is infection. The most common route of transmission of tuberculosis is airborne. The tuberculosis bacillus is transmitted through contact during talking, sneezing, singing or coughing, as well as through household items. The immune system of a healthy person copes with the infection by destroying the Koch bacillus in respiratory tract. Too massive an infection or frequent contact with a sick person can cause illness even in a healthy person. In people with a weakened immune system, its cells are not able to destroy mycobacteria.

The incubation period of pulmonary tuberculosis is from 3 to 12 weeks. Symptoms of the disease during the incubation period include mild cough, weakness, slight increase temperature. During this period, the disease is not contagious. However, the absence of pronounced symptoms of the incubation period explains why tuberculosis is dangerous for the infected person. After all, mild symptoms are not noticeable special attention, they can be taken as respiratory disease. If the disease cannot be recognized at this stage, it becomes pulmonary. The main cause of tuberculosis is low level quality of life. Crowding of people contributes to the spread of the disease, especially in prisons. Decreased immunity or concomitant diabetes promotes infection and its progression.

The first signs of tuberculosis

Signs of pulmonary tuberculosis in the early stages vary depending on the form, stage and localization of the process. In 88% of cases, the infection takes a pulmonary form.

Symptoms of pulmonary tuberculosis at an early stage of its development:

• cough with phlegm for 2–3 weeks;
• periodically elevated temperature up to 37.3 °C;
• night sweats;
• sudden weight loss;
• presence of blood in sputum;
• general weakness and loss of strength;
• chest pain.

The initial manifestations of tuberculosis infection can be mistaken for any other disease. Exactly at initial stage the patient is dangerous to others. If the patient does not consult a doctor in a timely manner, the tuberculosis infection will progress and spread in the body. That is why it is so important to undergo annual fluorography, which will promptly identify the source of the disease.

Forms of tuberculosis according to clinical course

There are primary and secondary tuberculosis. Primary develops as a result of infection with Koch's bacillus in an uninfected person. The process most often affects children and adolescents. The manifestation of the disease in old age means activation of tuberculosis of the lymph nodes suffered in childhood.

In children, tuberculosis occurs in the form of the primary tuberculosis complex. IN infancy the process affects a lobe or even a segment of the lung. Symptoms of pneumonia include cough, fever up to 40.0 °C and chest pain. In older children, the lesions in the lung are not so extensive. The disease in the lungs is characterized by an increase in cervical and axillary lymph nodes.

The primary complex consists of 4 stages of disease development.

1. Stage I - pneumonic form. X-ray shows a small lesion in the lung, enlarged The lymph nodes at the root of the lung.
2. Stage II of resorption. During this period it decreases inflammatory infiltrate in the lung and lymph nodes.
3. Next stage Stage III, it is manifested by compaction of residual lesions in lung tissue and lymph nodes. In these places, the X-ray image shows small pinpoint pockets of lime deposits.
4. In stage IV, calcification of the former infiltrate occurs in the pulmonary and lymphatic tissue. Such calcified areas are called Ghon lesions and are detected by fluorography.

The primary tuberculosis process in children and adults often occurs in chronic form. In this case, the active process in the lungs and lymph nodes persists for many years. This course of the disease is considered chronic tuberculosis.

Open and closed forms of tuberculosis infection

Open form of tuberculosis - what is it and how does it spread? Tuberculosis is considered to be in open form if the patient secretes mycobacteria in saliva, sputum, or secretions from other organs. Isolation of bacteria is detected by culture or microscopy of the patient's secretions. Bacteria spread through the air very quickly. When talking, the infection with saliva particles spreads over a distance of 70 cm, and when coughing it reaches up to 3 meters. The risk of infection is especially high for children and people with reduced immunity. The term “open form” is more often used in relation to patients pulmonary form diseases. But the release of bacteria also occurs during active tuberculosis process in the lymph nodes, genitourinary system and other organs.

Symptoms of open tuberculosis:

• dry cough for more than 3 weeks;
• pain in the side;
• hemoptysis;
• causeless weight loss;
• enlarged lymph nodes.

A patient in open form is dangerous to everyone around him. Knowing how easily open tuberculosis is transmitted, in case of prolonged and close contact with a patient, you need to undergo examination.

If the bacteriological method does not detect bacteria, this is a closed form of the disease. Closed form of tuberculosis - how dangerous is it? The fact is that laboratory methods Koch's bacillus is not always detected; this is due to the slow growth of mycobacteria in the culture for inoculation. This means that a patient who has no bacteria detected can practically excrete them.

Is it possible to get tuberculosis from a patient with closed form? With close and constant contact with a sick person, in 30 cases out of 100 you can become infected. In a patient with a closed form, the process in the lungs or any other organ can be activated at any time. The moment the process transitions into an open form is initially asymptomatic and is dangerous for others. In this case, closed-form tuberculosis is transmitted, like open tuberculosis, through direct contact during communication and through household items. Symptoms of the closed form of tuberculosis are practically absent. Patients with a closed form do not even feel unwell.

Types of pulmonary tuberculosis

Based on the degree of spread of tuberculosis, there are several clinical forms diseases.

Disseminated tuberculosis

Disseminated pulmonary tuberculosis is a manifestation of primary tuberculosis. It is characterized by the development of multiple lesions in the lungs. Infection in this form spreads either through the bloodstream or through lymphatic vessels and bronchi. Most often, mycobacteria begin to spread hematogenously from the mediastinal lymph nodes to other organs. The infection settles in the spleen, liver, meninges, bones. In this case, an acute disseminated tuberculosis process develops.

The disease manifests itself high temperature, severe weakness, headache, general serious condition. Sometimes disseminated tuberculosis occurs in a chronic form, then sequential damage to other organs occurs.

The spread of infection through the lymphatic tract occurs from the bronchial lymph nodes to the lungs. With a bilateral tuberculosis process in the lungs, shortness of breath, cyanosis, and cough with sputum appear. After a prolonged course, the disease is complicated by pneumosclerosis, bronchiectasis, and pulmonary emphysema.

Generalized tuberculosis

Generalized tuberculosis develops due to the spread of infection through the hematogenous route to all organs simultaneously. The process can occur in acute or chronic form.

The reasons for the spread of infection are different. Some patients do not comply with treatment regimen. In some patients it is not possible to achieve the effect of treatment. In this category of patients, the generalization of the process occurs in waves. Each new wave of the disease is accompanied by the involvement of another organ. Clinically, a new wave of the disease is accompanied by fever, shortness of breath, cyanosis, and sweating.

Focal tuberculosis

Focal tuberculosis lungs manifests itself small foci inflammation in the lung tissue. Focal appearance The disease is a manifestation of secondary tuberculosis and is more often detected in adults who suffered from the disease in childhood. The source of the disease is localized in the apices of the lungs. Symptoms of the disease include loss of strength, sweating, dry cough, and pain in the side. Hemoptysis does not always appear. The temperature during tuberculosis rises periodically to 37.2 °C. A fresh focal process is easily cured completely, but with inadequate treatment the disease takes on a chronic form. In some cases, the lesions level out on their own with the formation of a capsule.

Infiltrative tuberculosis

Infiltrative tuberculosis lungs occurs during primary infection and chronic form in adults. Are being formed caseous lesions, around which an inflammation zone forms. The infection can spread to the entire lobe of the lung. If the infection progresses, the caseous contents melt and enter the bronchus, and the vacated cavity becomes a source of formation of new lesions. The infiltrate is accompanied by exudate. If the course is favorable, the exudate does not completely dissolve; in its place, dense strands of connective tissue. Complaints from patients with the infiltrative form depend on the extent of the process. The disease can be almost asymptomatic, but can manifest itself acute fever. Early stage tuberculosis infection is detected by fluorography. In people who have not undergone fluorography, the disease develops into a widespread form. Possible death due to pulmonary hemorrhage.

Fibrous-cavernous tuberculosis

symptom of fibrocavernous tuberculosis - weight loss

Fibrous-cavernous pulmonary tuberculosis is formed as a result of the progression of the cavernous process in the lungs. With this type of disease, the walls of caverns (empty cavities in the lung) are replaced by fibrous tissue. Fibrosis also forms around the cavities. Along with caverns, there are foci of contamination. Cavities can connect with each other to form a large cavity. The lung and bronchi are deformed and blood circulation in them is disrupted.

Symptoms of tuberculosis at the onset of the disease include weakness and weight loss. As the disease progresses, shortness of breath, cough with sputum, and temperature rise. The course of tuberculosis occurs continuously or in periodic outbreaks. It is the fibrous-cavernous form of the disease that is the cause fatal outcome. A complication of tuberculosis manifests itself in the formation pulmonary heart With respiratory failure. As the disease progresses, other organs are affected. A complication like pulmonary hemorrhage, pneumothorax can be fatal.

Cirrhotic tuberculosis

Cirrhotic tuberculosis is a manifestation of secondary tuberculosis. At the same time, as a result of the age of the disease, there are extensive formations fibrous tissue in the lungs and pleura. Along with fibrosis, there are new foci of inflammation in the lung tissue, as well as old cavities. Cirrhosis may be localized or diffuse.

suffer cirrhotic tuberculosis aged people. Symptoms of the disease include cough with sputum and shortness of breath. The temperature rises as the disease worsens. Complications occur in the form of cor pulmonale with shortness of breath and bleeding in the lungs; they cause the death of the disease. Treatment consists of a course of antibiotics with sanitation bronchial tree. When the process is localized in the lower lobe, its resection or removal of a segment of the lung is performed.

Extrapulmonary types of tuberculosis

Extrapulmonary tuberculosis develops much less frequently. Tuberculosis infection of other organs can be suspected if the disease cannot be treated for a long time. According to the location of the disease, extrapulmonary forms of tuberculosis are distinguished, such as:

• intestinal;
• osteoarticular;
• genitourinary;
• cutaneous

Tuberculosis of the lymph nodes often develops during primary infection. Secondary tuberculous lymphadenitis can develop when the process is activated in other organs. The infection is especially often localized in the cervical, axillary and inguinal lymph nodes. The disease is manifested by enlarged lymph nodes, fever, sweating, and weakness. The affected lymph nodes are soft, mobile on palpation, painless. In case of complications, caseous degeneration of the nodes occurs, other nodes are involved in the process, and a continuous conglomerate is formed, fused to the skin. In this case, the nodes are painful, the skin over them is inflamed, a fistula is formed, through which the products of specific inflammation of the nodes are discharged. At this stage, the patient is contagious to others. If the course is favorable, the fistulas heal and the size of the lymph nodes decreases.

Tuberculosis of the female genital organs is more susceptible to young women 20–30 years old. The disease is often erased. Its main symptom is infertility. Along with this, patients are concerned about menstrual irregularities. The disease is accompanied by an increase in temperature to 37.2 °C and nagging pain lower abdomen. To establish a diagnosis, X-ray examination and culture of uterine discharge are used. The x-ray shows displacement of the uterus due to adhesive process, pipes with uneven contours. On overview photo Calcifications are found in the ovaries and tubes. Complex treatment includes several anti-tuberculosis drugs and lasts for a long time.

Diagnostics

How to diagnose tuberculosis early stage? Initial and effective method diagnostics is carried out in the clinic during fluorography. It is performed for each patient once a year. Fluorography for tuberculosis reveals fresh and old foci in the form of infiltration, focus or cavity.

If tuberculosis is suspected, a blood test is done. Blood counts are very different when varying degrees severity of infection. With fresh lesions, neutrophilic leukocytosis with a shift to the left is noted. At severe form lymphocytosis and pathological granularity of neutrophils are detected. ESR indicators increased by acute period diseases.

An important method examination for the detection of Koch bacillus is sputum culture for tuberculosis. Mycobacteria are almost always detected in culture if a cavity is visible on the x-ray. With infiltration in the lungs, Koch's bacillus is detected by culture only in 2% of cases. A 3-fold sputum culture is more informative.

A test for tuberculosis is a mandatory method for mass diagnostics. Tuberculin test() is based on the skin reaction after intradermal injection of tuberculin in various dilutions. The Mantoux test for tuberculosis is negative if there is no infiltrate on the skin. With an infiltrate of 2–4 mm, the test is doubtful. If the infiltrate is more than 5 mm, then the Mantoux test is considered positive and indicates the presence of mycobacteria in the body or anti-tuberculosis immunity after vaccination.

Treatment

Is it possible to recover from tuberculosis and how long will it take to undergo treatment? Whether the disease will be cured or not depends not only on the place of development infectious process, but also on the stage of the disease. Great importance The success of treatment depends on the body's sensitivity to anti-tuberculosis drugs. These same factors influence how long the disease will take to be treated. If the body is sensitive to anti-tuberculosis drugs, treatment is carried out continuously for 6 months. At drug resistance Tuberculosis treatment lasts up to 24 months.

Modern scheme Treatment of tuberculosis infection involves taking a complex of drugs that have an effect only when used simultaneously. For drug sensitivity complete cure open form is achieved in 90% of cases. If treated incorrectly, an easily treatable form of infection turns into difficult-to-treat drug-resistant tuberculosis.

Complex treatment also includes physiotherapeutic methods and breathing exercises. Some patients require surgical treatment. Rehabilitation of patients is carried out in specialized dispensary.

Drug treatment carried out according to a 3, 4 and 5 component scheme.

The three-component regimen includes 3 drugs: Streptomycin, Isoniazid and PAS (para-aminosalicylic acid). The emergence of resistant strains of mycobacteria has led to the creation of a four-drug treatment regimen called DOTS. The scheme includes:

• "Isoniazid" or "Ftivazid";
• "Streptomycin" or "Kanamycin";
• "Ethionamide" or "Pyrazinamide";
• "Rifampicin" or "Rifabutin".

This scheme has been in use since 1980 and is used in 120 countries.

The five-component regimen consists of the same drugs, but with the addition of the antibiotic Ciprofloxacin. This regimen is more effective for drug-resistant tuberculosis.

Medical nutrition

Nutrition for pulmonary tuberculosis is aimed at restoring body weight and replenishing the lack of vitamins C, B, A and minerals.

The diet for tuberculosis includes the following categories of products.

1. Required increased amount proteins due to their rapid breakdown. Easily digestible proteins found in dairy products, fish, poultry, veal and eggs are preferred. Meat products you need to boil, stew, but not fry.
2. Healthy fats recommended to be obtained from olive, butter and vegetable oil.
3. Carbohydrates contained in any foods (cereals, legumes). Honey is recommended flour products. Easily digestible carbohydrates are found in fruits and vegetables.

Food should be high in calories and served freshly prepared. The diet consists of 4 meals a day.

Prevention

The main means of preventing tuberculosis is vaccination. But besides this, doctors recommend:

• lead a healthy and active image life, including walks fresh air;
• consume foods containing fats of animal origin (fish, meat, eggs);
• do not eat fast food products;
• consume vegetables and fruits to replenish the body with vitamins and minerals that support immune system;
• In order to prevent infection, young children and elderly people should not have close contact with the sick. Even short-term contact with a sick person in an open form can cause them to become infected.

Vaccination

Prevention of tuberculosis in children and adolescents comes down to preventing infection and preventing the disease. Most effective method tuberculosis prevention is vaccination. The first vaccination against tuberculosis is carried out in the maternity hospital for newborns on days 3–7. Revaccination is done at 6–7 years of age.

What is the tuberculosis vaccine called? Newborns receive a gentle vaccine against tuberculosis BCG-M. Vaccination during revaccination is done BCG vaccine.

As a result, we come to the conclusion that tuberculosis is a common infection and poses a danger to everyone around us, especially to children and people with reduced immunity. Even patients with a closed form are potentially dangerous to others. Tuberculosis is dangerous due to its complications and often ends in death. Treatment of the disease requires a lot of time, patience and money. A severe and debilitating disease deprives a person of their quality of life. The best measure to prevent the disease is vaccination.