Determination of the activity of the tuberculosis process. Completion of treatment is important

Determining the activity of the tuberculosis process has become especially important at the present stage of phthisiology. In connection with the widespread use of mass fluorographic examinations, a significant number of individuals are detected who have anatomical changes in the lung tissue in the absence of pronounced intoxication or other clinical manifestations. In such cases, it is necessary to decide on the clinical activity of such changes, since sometimes there is an asymptomatic course of tuberculosis, which at a certain stage can manifest itself only by morphological changes. Establishing activity (or, more precisely, inactivity) is also necessary when the process subsides, when, as a result of the treatment, the X-ray picture indicates the transition of the process to the compaction phase, the symptoms of intoxication disappear, and the dispensary doctor has to decide on the onset of a clinical cure.

The greatest difficulties in determining activity are encountered in identifying the so-called small forms of tuberculosis, which are characterized by a low prevalence (within 1-2 segments), the absence of decay, and in most cases - few symptoms. The diagnostic difficulties that arise in this case are partly due to the lack of clarity of the very concept of tuberculosis activity and the lack of unity of views on this issue. F. A. Mikhailov (1971) believes that any tuberculous process should be considered active, in which the tendency to progression of the disease persists to any extent and is reflected in the functional state of the body and the clinical manifestations of the lesion. It is usually considered to be an active dynamic process, capable of evolution and progression, which requires constant dispensary observation (according to the corresponding accounting group) and complex treatment. However, in practice, the idea of ​​tuberculosis activity does not always fully fit into such formulations.

In addressing this issue, there are two kinds of errors. Sometimes, due to the absence of severe clinical symptoms, the doctor can view the initial phase of the disease, which, as a result, is not treated in a timely manner and is correctly assessed only at a later stage, when the results of therapy may be less effective. And vice versa, it is not uncommon for a carrier of old subsided pulmonary changes to be mistakenly diagnosed with an active form of tuberculosis and subjected to treatment, sometimes quite lengthy, by referring to a hospital. Such an unjustified separation from family and work has a negative psychological impact.

To correctly determine the activity of the process, it is recommended to use all available research methods - clinical, radiological, laboratory, as well as trial treatment with chemotherapy drugs. The most reliable signs of activity are the detection of mycobacteria and the establishment of the dynamics of specific changes during repeated X-ray examination. However, in small forms, obtaining reliable signs requires a long time - in these cases, it is possible to detect Mycobacterium tuberculosis only after a few weeks as a result of sowing, and to establish x-ray dynamics, it is necessary to carry out trial treatment for several months. In this regard, it is important to identify other features, the totality of which also has a certain value.

Clinical observation data. Clinical symptoms in small forms of tuberculosis are usually mild and non-specific. Subfebrile temperature, increased fatigue, weight loss, loss of appetite and other phenomena of intoxication are often observed. Sometimes there is a cough with sputum, scanty moist rales are heard. There are also changes in the blood (a slight increase in ESR, an increase in the number of leukocytes and the percentage of stab neutrophils). However, the mentioned symptomatology can acquire significance with the simultaneous presence of specific changes on the radiograph and tomograms.

X-ray examination. Along with the usual pictures, it is also recommended to make tomograms, which sometimes reveal decay, even in small forms of tuberculosis.

M. A. Ginzburg (1977) proposes the following classification of radiographic signs of tuberculosis activity:

• 1) direct signs indicating a clear activity of the process can be established with a single study: fuzzy contours of the focus, decay, lymphangitis, pleurisy;
• 2) indirect signs of activity: polymorphism of foci, large encysted rounded foci, a "path" to the root, paired strips of compacted walls of the draining bronchus;
• 3) undoubted signs of activity, established during dynamic observation and expressed in a change in the radiological picture during a retrospective analysis of fluorograms and radiographs and during a short trial therapy.

Of decisive importance belongs to the detection of dynamics during repeated X-ray examination. Practice confirms the possibility of establishing activity by comparing radiographs and fluorograms made in the past during mass examinations. In this case, two options are possible. In some cases, there are no pathological shadows on last year's fluorogram, which indicates the activity and relative freshness of the changes found in the picture. Sometimes pathological changes are also noted on the previous fluorogram, but comparison with the image reveals the dynamics in the form of progression (increase in the number or size of foci) or, conversely, involution (resorption) of foci.

Very expressive is the X-ray dynamics with a sufficiently long trial antibacterial treatment. It is expressed in the resorption of the infiltrate, a decrease in the size of the foci, their fragmentation, and the disappearance of lymphangitis. The stability of the x-ray picture speaks in favor of the inactivity of changes, but the lack of dynamics convincingly indicates the inactivity of the process only with normal clinical and laboratory parameters.

Mycobacterium tuberculosis detection refers to the most reliable signs of process activity. To search for them, all available methods should be used - bacterioscopy, flotation, sowing. In small forms of tuberculosis, mycobacteria can be found by conventional research methods only in rare cases, much more often with repeated cultures of sputum or washings of the trachea and bronchi. In most cases, the finding of mycobacteria in these processes is single, but this is enough to confirm the activity of the process (taking into account other manifestations).

Specific reactivity. When determining activity, tuberculin tests are of auxiliary importance. Noteworthy is the establishment of the tuberculin reaction in young people, as well as hyperergic sensitivity.

A more significant role is played by the subcutaneous tuberculin reaction (Koch's test). Prior to the Koch test, it is recommended to establish the sensitivity of the subject, which is determined by the concentration of injected tuberculin and is carried out using a graduated skin test. For a subcutaneous test, the following doses are recommended: with normergy - 20 IU, with hyperergy - 10 IU, and with hypergia, a larger dose can be used - up to 100 IU. Local reaction matters only when the size of the infiltrate is more than 20 mm. The appearance of a general reaction after 24 and 48 hours speaks in favor of the activity of tuberculosis (fever, feeling unwell, accelerated ESR, changes in the hemogram, an increase in the number of neutrophils and stab, a decrease in the number of lymphocytes). Currently, a focal reaction (the appearance of cough and sputum, chest pain, wheezing) is rare. The presence of a general or focal reaction with a high probability indicates the activity of the process and is a sufficient basis for prescribing a trial treatment. The Koch test is recommended to be used before starting chemotherapy, which can distort the result of the test.

Immunological tests. The studies of M. M. Averbakh, A. E. Rabukhin and others (1977) proved the possibility of combined use of subcutaneous administration of tuberculin and in vitro tests of delayed-type hypersensitivity to detect the latent activity of tuberculosis. After determining the immunological parameters, the patient is injected with tuberculin (20 TU PPD-L) under the skin, after 48 hours the test is repeated. For this purpose, 2 delayed-type hypersensitivity tests are used. in vivo- reaction of blast transformation of lymphocytes and reaction of inhibition of migration of leukocytes from capillaries. According to the mentioned authors, with the help of the reaction of blast transformation of lymphocytes in combination with subcutaneous injection of tuberculin, it is possible to reveal the latent activity in 79.5%, and with the help of the reaction of inhibition of migration of leukocytes from capillaries in combination with subcutaneous injection of tuberculin, it is possible to reveal the latent activity of the process in 92 .3% of cases. Tuberculin provocative tests can provide significant assistance in solving an important clinical problem - revealing the latent activity of the tuberculous process without the use of trial treatment.

trial treatment. In cases where all of the above methods do not give an accurate answer to the question of the activity of the tuberculosis process, they resort to a trial course of chemotherapy. If during the trial treatment there is no positive radiological dynamics or other signs indicating improvement, then the activity of tuberculosis is excluded.

The most valuable drug in trial treatment is isoniazid. It is recommended to carry out trial treatment on an outpatient basis under the supervision of a dispensary. But if it is necessary to use more complex research methods or if it is suspected that the subject is taking drugs inaccurately, as well as if they are poorly tolerated, old age, the presence of concomitant diseases, and also if the patient lives in a hostel or has close contact with children, it is necessary place him in a hospital at a dispensary (until the results of mycobacteria culture are obtained, i.e., on average, for up to 3 months). At this time, the subject should be in the zero group of the account, and then, depending on the results of the trial treatment, be transferred to group I or VIIB or removed from the register. Sometimes during the first month of trial treatment, the symptoms of intoxication and physical manifestations of the local process (cough, sputum, wheezing) do not disappear, and the study of sputum or washings for nonspecific flora gives a positive result. In these cases, drugs that affect the flora are recommended, and a positive effect after 1-2 weeks of such treatment indicates a non-specific nature of changes in the lungs.

Tuberculin in doses from 20 TU to 100 TU (0.2 of the 3rd dilution, 0.1 of the 2nd dilution) is injected subcutaneously and after 24-48-72 hours three types of reactions are recorded: 1. Local (prick) - as positive the formation of a skin infiltrate of at least 20 mm in diameter is regarded; with a pronounced injection reaction, a short-term increase in the regional injection sites of the lymph nodes and their soreness is possible. 2. General reaction - the occurrence of malaise, weakness, pain in the joints and muscles, headache, chilling and short-term febrile reaction of varying intensity; the above pseudointoxication syndrome lasts from several hours to several days. 3. Focal reaction - in response to the introduction of a hapten, perifocal short-term allergic inflammation may occur in the tissue adjacent to specific foci - this indicates the presence of a "hypersensitization zone", which indicates the presence of MBT with metabolic activity in the focus; this indicates the activity of the process with certainty. Similarly, this is indicated by a general and positive local reaction. A focal reaction is manifested in increased cough and an increase in the amount of sputum; short-term moist rales may appear in the projection of the foci; sometimes (rarely) a small zone of infiltration around the foci is captured radiologically, which quickly disappears. Koch's test has one drawback - it is not sensitive enough. In this regard, a more sensitive Bobrov's hemotuberculin test was developed: 20 IU or 50 IU of tuberculin are injected subcutaneously (0.2 of the 3rd dilution or 0.5 of the 3rd dilution); before the introduction of the hapten, a clinical blood test is done and platelets are determined; these analyzes are repeated 24 and 48 hours after injection. A positive reaction is considered if: the number of leukocytes increases by 1000, stab leukocytes increase by 6%, lymphocytes decrease by at least 10%, and platelets by 20%; ESR will increase by at least 5mm. Bobrov's test is very sensitive and is considered reliable with at least three positive positions. Mikhailov tuberculin-eosinophilic test: before intradermal or subcutaneous administration of 0.1 of the 6th dilution of tuberculin, the absolute number of eosinophils is determined and their count is repeated half an hour and 2 hours after the administration of the drug, if the result is positive, their number should decrease by at least 5%. The tuberculin eye test is highly sensitive: before subcutaneous administration of 20 TU, the fundus is examined and the examination is repeated after 24 and 48 hours; With a positive reaction, there are: 1. Hyperemia of the fundus vessels and at the same time the arteries can expand to the size of the veins. 2. Disc hyperemia. 3. Blurred borders of the disc. The sample is considered positive if there are two signs, or one pronounced; in addition, the strengthening of signs after 48 hours is taken into account. The protein-tuberculin test is popular: before subcutaneous administration of 20 TEs, the protein profile of albumin, serum globulins and globulin fractions: alpha-1, alpha-2, beta, gamma are examined. The protein profile is re-examined 24 and 48 hours after tuberculin administration. The sample is considered positive when the level of albumin decreases by 10% or more; similarly, the alpha-2 fraction of globulins should increase; sometimes the gamma fraction increases. The protein-tuberculin test is one of the most sensitive markers for the degree of process activity. It is important to understand that all tuberculin provocative tests reflect the degree of increased specific sensitivity, or, in other words, the degree of immunity tension. This only indirectly reflects the state of disease activity. Therefore, naturally, the results of these tests should be evaluated in the context of all other clinical and X-ray laboratory information.

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Active tuberculosis is a secondary type of complex disease that has been known for a very long time. It begins to develop in the presence of bacteria and can be transmitted from person to person through the air. In this case, the lungs are affected, but in the future the disease harms the entire body.

Infected patients may be virus carriers. But according to the results of studies, it was revealed that only one out of 10 such patients suffers from the development of a secondary infection. This is what is called the active form. It develops for a long time, if there is a weakening of the immune system.

What are the differences between active and inactive TB?

• from one person to another, through bacterial excretion;
• through the airborne route;
• when sneezing or coughing.

The possibility of developing an infection increases with the development of HIV in a patient. In this case, the state of immunity worsens and there is no resistance of the body to the bacteria that have entered it. Tuberculosis is on the rise.

How is the disease treated?

1. Medications.
2. Special meals.

Medications are prescribed after the examination, there may be several types. The duration of the reception is usually long. It is necessary to choose funds that belong to the group of antibiotics. They must completely destroy the infection.

An important role in the development of tuberculosis bacteria is played by the state of human immunity.

If it is strong, then the infection that enters the body will not be able to develop and will die. In this case, the person will not get sick. Physicians classify two forms of tuberculosis.

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• Congratulations! The chances of you being over TB are close to zero.

  But do not forget to also monitor your body and regularly undergo medical examinations and you are not afraid of any disease!
  We also recommend that you read the article on.

• There is reason to think.

  It’s impossible to say with accuracy that you are sick with tuberculosis, but there is such a possibility, if these are not Koch sticks, then something is clearly wrong with your health. We recommend that you immediately undergo a medical examination. We also recommend that you read the article on early detection of tuberculosis.

• Contact a specialist immediately!

  The probability that you are affected by Koch sticks is very high, but it is not possible to make a remote diagnosis. You should immediately contact a qualified specialist and undergo a medical examination! We also strongly recommend that you read the article on early detection of tuberculosis.

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Task 1 of 17

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Does your lifestyle involve heavy physical activity?

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   How often do you have a TB test (eg mantoux)?

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   Do you carefully observe personal hygiene (shower, hands before eating and after walking, etc.)?

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   Are you taking care of your immunity?

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   Have any of your relatives or family members suffered from tuberculosis?

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   Do you live or work in an unfavorable environment (gas, smoke, chemical emissions from enterprises)?

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   How often are you in a damp or dusty environment with mold?

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   How old are you?

8. Task 9 of 17

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   What gender are you?

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   Have you been feeling very tired lately for no particular reason?

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    Have you been feeling physically or mentally unwell lately?

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    12 .

    Have you noticed a weak appetite lately?

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    Have you recently seen a sharp decline in yourself with a healthy, plentiful diet?

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    Have you felt an increase in body temperature for a long time lately?

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    Have you been having trouble sleeping lately?

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    Have you noticed excessive sweating lately?

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    Have you observed yourself recently unhealthy pallor?

Forms of a complex disease

Specialists identify an active or latent form of the course of tuberculosis.

Characteristics of the latent form of the disease:

• symptoms of the disease do not appear;
• the virus in the body is in a state of sleep;
• there is a real danger of developing the disease in the presence of favorable conditions.

It follows from this that the patient carries the virus, can infect others, but does not himself suffer from the development of tuberculosis. Many people do not even realize that there is a very dangerous disease in the body. According to doctors, a third of the entire population is carriers of the tuberculosis virus.

With the development of the active form of tuberculosis, the patient develops characteristic signs:

1. Specific cough that can provoke seizures.
2. The weight loss is pretty drastic.
3. Rapid fatigue and almost constant feeling of fatigue.
4. Feeling chilly and feverish.
5. Much perspiration at night.
6. Very poor appetite.

The timing of the onset of active TB varies from patient to patient. Months or years may pass, but the first manifestations will begin to become noticeable after a few weeks.

The form of tuberculosis does not depend on the patient's age or place of residence. Of course, young patients or older people may be more difficult to tolerate this disease. The lungs immediately suffer, and only then the disease affects many other parts of the body.

What is active tuberculosis? When an infection enters the body, an inflammatory process begins. Initially, characteristic granulomas occur, which contribute to the formation of tubercles. They may fall apart. It is necessary to find out the location of the focus of infection.

Active pulmonary tuberculosis is transmitted in several ways:

• through the air, through saliva. A healthy person inhales it, and the bacteria settle in the body;
• entering the body through the digestive organs;
• when touching a sick person. The infection can enter through the conjunctiva of the eye in a young child or adult;
• if the expectant mother is ill with tuberculosis and the placenta is infected, the unborn child becomes infected while still in the womb.

The human respiratory system is protected by mucus, which is able to glue bacteria that have penetrated into it. But, if the patient suffers from chronic bronchitis or tracheitis, the possibility of infection increases significantly.

The movement of harmful microorganisms through the digestive system and its absorption into the body occurs quickly in the presence of damage to the intestinal walls.

With good body resistance, the immune system is able to cope with tuberculosis on its own. But there are still residuals. How will they behave?

1. The immune system will be in control so that the bacteria do not start to progress and get out of its control.
2. The active form of the disease begins to develop in no more than 5% of these patients.
3. Most often this occurs in the first two years of infection in the body.

When conducting sputum examinations, it is not always possible to identify tuberculous bacteria. Therefore, the patient may not know about his infection for a long time and be considered a healthy person. But at this moment he is a danger to the people around him.

The absence of the risk of infection cannot be guaranteed under any circumstances, even with a closed form. They can only be minimized. Experts say that approximately 30% of people who communicate with active patients become infected with tuberculosis. Of course, this happens with prolonged and rather close contact.

People who are already sick are the main way bacteria spread. They must follow safety measures so as not to cause the spread of a complex disease.

Tuberculosis appears gradually, but a characteristic cough immediately begins. What are the characteristics of cough in tuberculosis?

• duration of cough for at least 20 days;
• sputum separation occurs, most often with a cough;
• pain in the chest and when coughing.

In this case, you need to contact the tuberculosis dispensary and take special tests.

With prolonged development, the disease spreads to:

1. Kidneys.
2. Spine.
3. Brain.

If this happens, the symptoms will be slightly different. Pain will be felt at the location of the affected organ. In some cases, bloody discharge will be visible in the urine.

How do you get tuberculosis?

Infiltrative tuberculosis develops very quickly when communicating with the patient, with an active form of tuberculosis. At this point, the sick person may sneeze or cough. Together with his exhalation, a certain amount of saliva should stand out, in which the tuberculosis bacterium will be located.

The main causes of tuberculosis infection:

• frequent communication or living with a patient with tuberculosis in an active form of development;
• you need to be quite close to him or communicate often;
• a TB patient is not being treated and is not taking any medications.

To prevent the infection from progressing, the body needs to maintain immunity. During the course of treatment, a patient with an active form of tuberculosis does not pose a danger to others when taking drugs for 14 days.

Almost everyone can get infected, but there are certain groups that are at risk. This may be due to many factors. What kind of people can get TB?

1. With a weakened immune system.
2. When diagnosed with HIV or AIDS.
3. With high blood sugar.
4. With the progressive development of kidney disease.
5. Cancer patients, but this does not apply to all types of complex disease.
6. After a course of chemotherapy.
7. When using special medications that are taken for engraftment of transplanted organs.
8. The use of drugs that treat arthritis, psoriasis, chronic digestive disease.
9. Malnutrition.
10. Children and the elderly.
11. Living south of the Sahara Desert, India, Mexico, China, Southeast Asia, Eastern Europe.

A person's lifestyle can affect the possibility of developing active TB. What bad habits cause the development of tuberculosis?

• the use by a person of any psychotropic drugs;
• alcohol, especially in large quantities;
• nicotine use.

In these cases, the body is under great stress and cannot resist the bacteria. At this point, tuberculosis bacteria begin to multiply rapidly and infect the lungs of a person.

Separately, medical workers who encounter infected patients are singled out. They must follow certain rules in order not to allow germs to develop.

People serving sentences in places of deprivation of liberty are at risk. The employees of these institutions are in the same situation. There is a certain microclimate that contributes to the accumulation of harmful microorganisms. This is due to the presence of a fairly large number of people in the room, irregular ventilation, and the lack of wet cleaning.

More attention needs to be paid to patients diagnosed with HIV. They should try to avoid any infection, and getting tuberculosis bacteria into their body is generally unacceptable. In this case, death is almost impossible to avoid.

Very often, people who cannot afford drug treatment suffer from active TB. These are patients who have meager incomes or live without funds at all. They usually do not have permanent residence.

Complications in active TB

Without proper treatment, the disease progresses and causes complications. They can cause such harm to the body that it will be impossible to cure. What organs does active tuberculosis cause complications?

1. The lungs are always the first to suffer. The patient coughs violently and bleeds. He is in pain.
2. When the disease is in advanced form, bone pains appear. It will be painful for him to walk, and any movement causes discomfort. Gradually, such a patient becomes bedridden.
3. If bacteria enter the brain, meningitis or swelling may develop. These patients rarely recover.
4. The development of tuberculosis infection in the kidneys or liver - there is a violation of the work of these organs. As a result, harmful substances accumulate in the body, and infection of many organs occurs. The bacteria will spread through the blood.
5. Tuberculosis can disrupt the functioning of the heart. It provokes inflammation, accumulation of fluid. The main organ ceases to perform its functions, and the patient dies.

Specialists have learned to determine the type of tuberculosis infection. There are strains that are not affected by the drug. These are tools developed many years ago.

Bacteria were reborn and strengthened, adapted to the treatment used. They have a kind of immunity. To do this, invent new antibiotics that should destroy harmful microorganisms.

Disease activity

Tuberculosis is a life-threatening disease. Its shape depends on the type of bacteria.

Experts distinguish:

• MBT+, active form;
• MBT-, inactive form.

The active form of the disease is considered very harmful to the outside world. Regardless of the location of the spread of the disease. What are the forms of active tuberculosis?

1. Pulmonary.
2. Skin.
3. Fistulous.
4. Genitourinary-system.
5. Lymph nodes.

Tuberculosis is most often transmitted through the air. The possibility of developing an infection takes place in several stages and depends on the state of immunity.

What happens with the infection?

• it enters the body
• starts to multiply
• the formation of an immune response to the ongoing process in the body.

The development of the disease can be stopped at the very beginning if the patient has good immunity. The reproduction of bacteria stops, but a positive reaction to the test for tuberculosis remains. The remaining pathogenic bacteria are antiagents that are able to develop a protective reaction of the body against tuberculosis.

Such patients need to be registered with a phthisiatrician and undergo regular fluorography.

Immunity fails:

1. If a patient has AIDS or HIV.
2. In children, especially newborns.
3. In elderly patients and in poor health.
4. A person's tendency to develop tuberculosis.
5. The use of large amounts of nicotine, alcohol, drugs.

With a poor protective reaction, tuberculosis begins to develop rapidly. The form of the disease becomes active. The patient is dangerous to others and requires fencing in communication. The situation is corrected with the help of treatment.

Identification of the disease

When a person goes to a medical institution, he undergoes an initial examination. What does the doctor pay attention to?

• examines the lymph nodes, reveals whether there are enlarged ones;
• produces auscultation of the lungs.

To conduct a complete examination for tuberculosis, they carry out:

1. Mantoux test. The drug is injected into the skin and the reaction is observed. With redness, within 3 days it is assumed that there is a tuberculosis infection in the human body. But this method cannot be considered absolutely correct. His results are often wrong. A false result is obtained if a TB vaccination was given before the test. Also, when a patient is diagnosed with AIDS, the results of this study have no role in diagnosing. The Mantoux reaction will be incorrect if the patient has recently recovered from tuberculosis.
2. Laboratory study of blood. With its help, the form of the disease is revealed. There may be a latent or active form of the course of the disease. If there is any suspicion of the development of tuberculosis, a blood test is performed.
3. X-ray examination of the chest is done regularly, as a preventive measure. For people with suspected TB, such testing is mandatory. It helps to determine the foci of the development of the disease and to identify the degree of change in the lungs.
4. Sputum examination is carried out in the laboratory. Find out what bacteria are in it. After that, a test is carried out for the resistance of these harmful microorganisms to antibiotics.

If necessary, the doctor may prescribe any tests or examination methods. At this point, individual characteristics of a person, the presence of chronic diseases are taken into account. Then a decision is made on the treatment of tuberculosis.

Treatment of tuberculosis takes a long time. The infection is difficult to completely defeat. Even with an inactive form of tuberculosis. Antibiotics are taken for six months. In difficult cases, this period is extended to 9 months or more. What are the criteria for choosing drugs and methods?

• patient's age;
• the presence of complex diseases and the general state of human health;
• the type of bacteria that develop in the body;
• form of the course of the disease;
• site of bacteria.

The effect of the use of drugs depends on the form of the disease. In the treatment of the latent form, it can transform into active tuberculosis. In the future, the secondary form of the disease is treated. It is important to complete the entire course, only in this case one can hope for recovery, regardless of the presence of symptoms and signs of tuberculosis.

The danger of incomplete treatment lies in the possibility of a secondary manifestation of the disease, if not all harmful microorganisms have been destroyed.

How is active tuberculosis treated?

1. Medicines, they are used by several types at once.
2. With an open form, when the respiratory organs are affected, the patient is placed in a hospital, or they require compliance with a home regimen.
3. Preparations are selected depending on the bole of bacteria, and so that they do not allow to provoke their resistance to drugs.
4. The primary form of tuberculosis also needs treatment. He has a different scheme, but the medicine is selected by the doctor individually.

What drugs are used?

The phthisiatrician prescribes medication. The active form requires the intake of several agents.

Most often, doctors prescribe:

• pyrazimidine;
• Isoaniside;
• Ethambutol;
• Rifampicin.

Additionally, Vitamin D is used, which has a beneficial effect on the treatment of a complex disease.

During the course of treatment, the patient may experience side effects:

1. Loss of appetite.
2. Nausea, which can lead to vomiting.
3. Change in color of urine. She becomes dark.
4. The appearance of a yellow tint to the skin.
5. Feverish state.

A positive result from the treatment becomes noticeable after a few weeks. The patient feels a significant improvement. The main thing at this moment is not to stop there and not stop treatment. Completion of taking the drugs will occur during an examination that will not reveal the presence of harmful bacteria in the body.

Improper treatment provokes resistance of tuberculosis to drugs, and in the future it is almost impossible to choose a drug that will defeat the disease.

The active type of tuberculosis is transmitted from a person by airborne droplets. Therefore, it is dangerous not only for the patient, but also for others. An important factor is to prevent the transition of primary tuberculosis into a secondary form.

The sick person must take preventive measures so as not to infect their friends and relatives. What needs to be done for this?

• the patient is allocated a separate room for living;
• limit communication with strangers;
• do not visit crowded places;
• do not use public transport;
• wet cleaning in the room is carried out every day;
• the room is ventilated regularly;
• when sneezing or coughing, the patient covers his mouth with a tissue or handkerchief;
• sputum is collected and discarded in a bag;
• when communicating with family members, wear a mask, especially in the first month of treatment.

These measures will help to avoid infection of people who are in contact with the patient.

To prevent infection with tuberculosis, people need to follow preventive measures.

For this you need:

1. Observe all safety measures when dealing with patients with tuberculosis. This is especially true for people who work in such conditions.
2. Avoid contact, if possible, with infected people. This applies to everyone.
3. Give up bad habits that reduce the level of immunity.
4. Get regular check-ups or tests to detect illness.
5. Do not self-medicate, especially with the use of antibiotics.
6. In the presence of chronic diseases, monitor their exacerbations and visit a doctor on time.
7. Give up nicotine and alcohol.
8. Follow nutrition.
9. With the recommendation of a doctor and, if necessary, vaccinate against tuberculosis.
10. Colds should not be carried “on the legs”.
11. Follow the rules of personal hygiene and wash your hands well after visiting the street.

Prevention is also important for TB patients. A healthy lifestyle will help maintain health and save it for many years.

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• Congratulations! Are you OK.

  The probability of getting tuberculosis in your case is no more than 5%. You are a completely healthy person. Continue to monitor your immunity in the same way and no diseases will bother you.

• There is reason to think.

  Everything is not so bad for you, in your case, the probability of getting tuberculosis is about 20%. We recommend that you better monitor your immunity, living conditions and personal hygiene, and you should also try to minimize the amount of stress.

Vladislav

Experienced breathing problems. I don’t know how to describe this state correctly, but if in my own words, then it feels like I can’t breathe deeply (there is no feeling of air saturation, as if I want to yawn, but I can’t).
Against this background, I went to do a fluorography. The conclusion of fluorography:

"In the projection of the C1-2 segments, a group of medium-density foci is traced on the left. There is also a moderate deformation of the vascular.
The rest of the stretch - the pulmonary fields are transparent, the pulmonary pattern is not changed. The roots are structural, not expanded.
The median shadow of the usual configuration, not expanded, not displaced.
The diaphragm is usually located, with a clear, even contour. Sinuses are free.
It is recommended to compare with previous studies, consult a phthisiologist, if indicated, conduct a MSCT study.

I immediately did MSCT out of fright. MSCT conclusion:

"On a series of CT scans of the chest organs, the airiness of both lungs is preserved. The trachea, main, lobar and segmental bronchi are passable, the lumen is not narrowed, the walls are not thickened. The pulmonary pattern is somewhat strengthened, deformed in S1-2 on the left due to the zone of fibrotic changes of the peribronchial, subpleural location , minimally dilated bronchi (like bronchiectasis), with single calcifications up to 3 mm in diameter. Moderate pleuroapical adhesions in the apical parts of the lungs. Lymph nodes of the mediastinum of acceptable sizes. Pleural sheets are not thickened, there is no fluid in the pleural cavities and the pericardial cavity. Heart in the crossbar of normal sizes, the main vessels are not changed.
Conclusion: Post-inflammatory changes in S1-2 on the left are more likely to be specific."

With all this, I went to the PTD at the place of residence. Where they did Diaskintest, which turned out to be positive, 20 mm papule.

Against this background, I was prescribed a test therapy for two months, eremfat + pyrazinamide + isoniazid. With subsequent CT.

I also donated sputum, including GeneXpert, but it contained more saliva than sputum, tk. she doesn't stand out. Everything is negative.
I also took a general blood test, biochemistry, everything is normal in them, only slight changes in the lake. formula. I also donated blood PCR for tuberculosis, it is also negative.

Now, after a month of treatment, I began to cough intermittently, it felt like it was tickling in my throat and I wanted to cough, from which I was prescribed to wash my nose, isophra and lysobacter (it didn’t seem to help much in 3 days). Every day, in the late afternoon, the temperature rises to 36.9, on average, a little more. And there is a burning sensation on the skin of the back and, in general, on the whole body, strange tingling sensations.

What is the probability that it is still tuberculosis? What does "Post-inflammatory changes in S1-2 on the left are more likely to be specific" mean? Can tuberculosis progress during treatment? Given that the CT scan was done in September, how much could his picture have changed until today?

The question is closed

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Good afternoon. What makes you think it's worse for you? According to MRI, there are signs of an infiltrative process in the lungs and pleurisy, transferred earlier. But there is also bronchiectasis; this pulmonary pathology is not associated with tuberculosis. The course of the pulmonary process as an asthmatic, or chronic obstructive process, is such a process - an exacerbation - most likely - that gives your "coughing". MRI can be repeated in three months, just right. Positive dynamics will be visible. Yes, a temperature of 36.9 is normal. And coughing and muscle pain can also be associated with a viral infection that is now walking. Get well.

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Pediatrician, Allergist-Immunologist, Therapist

Hello, of a specific nature, means tuberculosis or other etiology, characteristic. maybe if the treatment does not help or resistance to antibiotics or an open resistant form. Poobsledueytes for herpes viruses and atypical microorganisms. If all TB cultures are negative, look for other organisms. Blood ELISA for EBV CMV Vpg toxoplasma mycoplasma and respiratory chlamydia.

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Gynecologist, Mammologist, Obstetrician

Hello!
All these diagnoses are presumable, in any case, you received good treatment from tuberculosis, the rest could be the result of an infection in the lungs, so today you just need to monitor your immunity. There is a good drug that helps get rid of a cough - a non-tuberculous cough.

Be healthy!

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Therapist

Hello. When they write a non-specific character, it means oncology or suspicion, if specific, then either any bacterial, tbs, viral infection. Your results are negative, but the diaskin test is positive - therefore, according to the standard, you should receive treatment, so the doctor has prescribed treatment for you, your treatment is good, you should not worry. After treatment, check again and everything will be fine.

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Tatyana, I'm more worried about the cough that has appeared, the temperature, which, as I understand it, is quite normal. But before, it was always 36.6. And strange sensations of tingling in the body, and burning, I don’t really understand what it is.
Well, I'm worried that all of a sudden it's all such active tuberculosis, and it is resistant to treatment.

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Orthopedist, Traumatologist

What is the probability that it is still tuberculosis? - Tuberculosis was, but it is not now, although you will be infected all your life. This is evidenced by the conclusion of the CT.
Can tuberculosis progress during treatment? He can progress at any time, but right now you have no progress data. With active tuberculosis, the picture for such a time may change in one direction or another. It will not change for you and will be the same.
The drugs prescribed to you are very toxic. They can tingle and itch.
Stop with this treatment...

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Neurologist, Psychologist

Good evening, Vladislav. According to the described CT picture - you previously had tuberculosis, and for a long time, this is evidenced by changes in the form of calcifications (a long-standing lesion). This is what the phrase means - post-inflammatory changes of a specific nature. You were prescribed adequate treatment, so tuberculosis cannot progress against the background of treatment, and there are no data for progression. Sputum is normal, blood is normal, PCR is normal. Now, about Diaskin... Your CT revealed changes like bronchiectasis, they can also give cough and fever, and this does not mean at all that these are manifestations of tuberculosis. And diaskin shows those people who are suspicious of being infected with tuberculosis or who are ill with it. Also, diaskintest requires special conditions. It can not be put: in acute and exacerbation of chronic diseases, after a recent exacerbation of allergies, in skin diseases. Therefore, if at the time of taking Diaskin you had an exacerbation of, for example, chronic bronchitis or bronchiectasis, then Diaskin could give a false positive result. It has already been almost 3 months since the last CT scan, you can already do a second one, but it seems to me that the picture will not change, because I repeat, there were no fresh changes in the lung tissue in September, these are all changes that have been previously transferred, perhaps years ago. Good health to you, all the best.

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Questions and answers on: active tuberculosis is

2014-11-21 06:50:04

Svetlana asks:

My father smokes and coughs a lot. Since a small child appeared in the family (he is now three months old), she forced her father to do a fluorography. The conclusion of fluorography from 2014: the apical segments of the left lung are reduced in size due to pneumosclerosis. There are dense foci in segments 1-2. The left apical pleura is thickened. The left root is pulled up. Conclusion: residual changes in past tuberculosis of the respiratory system. It turned out that changes had been discovered in him since 2001 and he visited a phthisiatrician and did not tell us anything about it. The phthisiatrician wrote: there is no data for active tuberculosis. From 2009 to 2014, he did not visit a phthisiatrician and did not do a fluorography. Recent studies in 2007 (conclusion: focal changes in the apex of the left lung) and in 2009 (conclusion in the apex of the left lung, small calcifications). Is it possible to determine the stage of the disease and its activity by fluorography? Since they wrote to him "residual changes in the transferred tuberculosis of the respiratory organs", he is not going to go to the phthisiatrician. I am very worried. Is contact with a grandfather dangerous for a child?

Responsible Agababov Ernest Danielovich:

Svetlana, good afternoon! A face-to-face appointment with a phthisiatrician is necessary to decide whether the patient needs additional examination for the presence of active tuberculosis. Without full-time reception, it is incorrect and impossible to draw any conclusions and make recommendations. Be healthy!

2014-07-18 11:16:41

Svetlana asks:

Hello, please explain my diagnosis, during the planned fluorography on 12/13/2013, focal fibrous changes were found in the picture in / lobes of the right lung, the description was sent to the tomogram as follows: on direct tomograms of the rights. lung (sections 6,7,8,9) och.fibrous changes in rights are determined. the tops of the decay cavities were not found. on the right in the / lobe pleuroapipella commissure, fibrous scar. There are no data for active TB. when they raised the fluorography for 2012, the doctor said that changes were already visible at that time, but no one told me about this honey. I passed the commission and no problems arose until next year. I want to understand whether I have tuberculosis or not, now I am pregnant and I am worried about my unborn child. Please explain what my diagnosis means.

Responsible Veremeenko Ruslan Anatolievich:

Hello Svetlana! At the moment, there is no active tuberculosis process (taking into account the statute of limitations in 2012). Focal changes (i.e. Gon's foci) will remain in the lung, it is a dense tissue, it does not resolve.

2013-11-07 19:23:58

Milan asks:

Hello! tell me, please, I have manifestations of genital herpes in the form of rashes. I am also undergoing treatment for active tuberculosis, an intensive phase. Can human immunoglobulin be used in this case? I was told that now any immunostimulants are contraindicated. But this is already a ready-made immunoglobulin, nothing is stimulated?

Responsible Oleinik Oleg Evgenievich:

Good afternoon!
You are absolutely right. This drug does not belong to the pharmacological group of immunomodulatory drugs, since it does not have a direct immunostimulating effect. This effect is manifested indirectly, which means that the body and the immune system in particular are not loaded. At the same time, the nonspecific (congenital) resistance of the body increases (which is very important for the treatment of tuberculosis): opsonization occurs, the neutralization of microorganisms, including viruses, in the bloodstream, and when combined with the membrane of macrophages, neutrophils and monocytes (immune cells), immunoglobulin increases their antibody-dependent cell-mediated cytotoxicity.
Let me remind you: the main drug in the treatment of herpes will be an abnormal second-generation nucleoside (valocyclovir) in a 2-3-fold dose higher than usual. As immunoglobulin therapy, you can use intravenous immunoglobulin (it contains antibodies to almost all pathogens), specific antiherpetic immunoglobulin, or make a similar one at the Hematology Research Institute by donating your own blood. Be healthy!

2013-07-18 06:00:16

Eli asks:

Hello! Tell me, please, can I have tuberculosis and how dangerous can I be to others? Somewhere from mid-April to the end of June, I met a guy who, as it turned out, had active tuberculosis of the closed form. On May 5-6, he began treatment. But before treatment, we had sexual contact. During these 2 months, there were also kisses. From about the middle of June, I began to notice subfebrile temperature, weakness, sometimes dizziness, I can’t really say anything about coughing. Finally got to the phthisiatrician. They took x-rays and they said everything was fine. In the general blood test, everything is normal, in the biochemical analysis, an increase in seromucoids was shown. I will soon pass the rest of the examinations (mantoux, diaskintest, ELISA analysis). How significant are they? Regarding other diseases, everything is out of the question, only the dentist did not go through and the neurological examination did not go through completely. Is it just that there is a high probability of infection and could the disease manifest itself after this period of time? .. The temperature sometimes reaches 37.2-37.3, when I am nervous and worried, mostly 36.8-37.0. Thanks in advance for your reply!

Answers:

Good afternoon, Elya! Close and prolonged contact with a patient with tuberculosis, even with a closed form, does indeed have a certain risk of infection. After all, it is impossible to exclude by 100% the fact that your man did not excrete mycobacteria, for example, yesterday or 10 days ago - YOU do not conduct a bacteriological study daily. In addition, a false negative result (incorrectly collected, processed and interpreted material) cannot be excluded. Still, tuberculosis can be contracted not only by airborne droplets and when infected sputum enters, but bacteria can also enter the body through other body media (urine, purulent discharge from a wound, etc.). Therefore, you are absolutely right that you have decided to undergo a thorough examination, and those diagnostic manipulations that have already been completed and are planned in the near future are completely justified. Trust your phthisiatrician! And lastly, remember that a single negative result immediately after contact with the patient does not mean at all that you do not have this pathological process. Now you should be under special registration with a phthisiatrician and undergo a second examination in a year. All the best!

2010-12-07 13:14:40

Natalia asks:

Hello. I am 22 years old, doctors diagnosed active tuberculosis and prescribed a course of treatment: 4 types of tablets (pyrazinamide, rifampicin and some 2 more types) and injections (tubazid and vitamin, in my opinion B6). Tell me, please, what does ACTIVE tuberculosis mean? Can I infect others? Relatives advise drinking badger fat and eating more butter, should you listen to their advice? I also heard about the drug Tubazit, that it can affect my mind, is that true? And I’m also interested in the question: my husband was recently released from a penal colony, I have an assumption that I could have contracted it from him, but for reasons I don’t understand, he doesn’t want to get tested, says that he has bronchial asthma and that it is not compatible with TB, this is true? And if, after all, he is also sick, could it be that my course of treatment is useless if I live with a person who is not being treated?
Thanks in advance!!!

Responsible Strizh Vera Alexandrovna:

Dear Natalia! All your fears are justified. Active means there is inflammation of the lung tissue. My husband needs to get tested. For the period of intensive care or for the entire course of basic treatment, you can go to a tuberculosis dispensary or hospital. Bronchial asthma is not a cough, but asthma attacks, respiratory disorders. Asthmatics also suffer from tuberculosis. If the husband is sick and does not receive treatment, then he can be a source of additional infection for you. If the spouse is healthy, he should receive a short course of anti-tuberculosis therapy. Eat butter, but avoid badger fat. The latter is not combined with toxic anti-tuberculosis drugs. Tubazid does not lead to mental retardation! During its administration, inhibited reactions may occur, which easily disappear when adequate doses of B vitamins are taken.

2010-01-22 14:18:58

Ludmila asks:

Good afternoon! My husband had active tuberculosis. But he was offered outpatient treatment. Is this correct? My daughter and I are not called as contacts. What should be our actions? How dangerous is it to live in the same apartment with him? Or still insist on hospitalization?

Responsible Gordeev Nikolay Pavlovich:

Hello Ludmila. If the daughter is small and / or the apartment is one-room, it is better to insist on hospitalization. De facto, all patients with active TB produce sputum to some extent and infect others. Observation of you is a fluorography made in time (preferably a survey radiograph), for your daughter - a Mantoux test. Your actions, from my point of view, are the hospitalization of your husband + examinations of both of you as contacts. You can ask the TB doctor who treats your husband for a referral, even if he himself does not insist. The girl can be put on a dispensary account in a children's office and sent to a sanatorium for the first, say, 2 months (of course, according to age). How to carry out disinfection at home, you will be prompted by a leaflet for a patient with tuberculosis, which you should have been given in an anti-tuberculosis dispensary. Health to you.

2010-01-19 13:59:58

Elena asks:

Hello, I had subfebrile temperature for 1.5 months, X-rays (two with a gap of three weeks) showed nothing, I did a CT scan, the result is active tuberculosis. In the upper lobe of the left lung, the focus is 1-1.5 mm, sputum and culture MBT (-) As I understand it, I have active tuberculosis of the closed form. In addition to fever, there are no other symptoms (weight loss, night sweats, fatigue, cough) I am interested in questions: 1. If I work, do I have to go on sick leave? After all, I can take a pill once a day and give an injection without a sick leave. The closed form is practically not dangerous (30% is nothing, considering that 90% of the adult population is already infected). Moreover, I work not in a small room, but in I feel quite normal, and going on sick leave for 6 months is actually losing my job later. I have 2 children, and I am their only breadwinner. 2. Chemoprophylaxis for my children, as I understand it, is mandatory. But my daughter (6 years old) has JP and cholecystitis, a little enlarged liver. Is there an alternative to tubazit, because it is such a toxic drug? Is it possible with folk remedies (inhalation with essential oils of eucalyptus, fir, badger fat, etc.)?

Responsible Strizh Vera Alexandrovna:

Insufficiently convincing data to argue about tuberculosis. Moreover, if dense foci are found on CT, the bacteriological method is ineffective, and in such patients other methods for determining the activity of the process, in particular biochemical methods (determining the amount of sialic acid, C-reactive protein, haptoglobin, and other markers of activity), are used. Biochemical methods are more effective when they are used together with tuberculin tests, in particular when tuberculin is administered subcutaneously (Koch's test). It is not necessary to inject large amounts of tuberculin, a dose of 20 IU PPD-L is recommended. There are also immunological methods for determining the activity of the process. If these methods do not help to establish the activity of the tuberculosis process, one has to resort to the so-called test treatment, when chemotherapy is carried out for 2-3 months and the radiological dynamics is studied, taking into account the subjective state of the patient, changes in blood parameters. Sometimes with focal tuberculosis, in addition to focal changes, pleural changes are determined, which is an important indirect evidence of the activity of the process.
While tuberculosis is active, you will receive intensive treatment (the first 2-6 months) and you cannot go to work - for two reasons: 1 - these are 30% known to you, the second - anti-tuberculosis drugs are toxic and require a sparing daily routine and adequate nutrition. Make sure the treatment is working and you are tolerating it well, and then work with your doctor to decide whether to return to work. About 30%: Colleagues who fall into these percentages will not say thank you. The numbers - 30% of the sick and 90% of the infected are not comparable, because belong to different categories - sick and healthy, but infected! Daughter chemoprophylaxis (CP) is needed. There is an alternative to tubazid - a less toxic isophone, ftivazid, but their anti-tuberculosis activity is also lower. In order to prevent possible adverse reactions, chemoprophylaxis is carried out against the background of multivitamins with minerals, hepatoprotectors and choleretic, beneficial bacteria and plant immunocorrectors. Folk remedies will not work to kill the bacterium. Negative Mantoux and the presence of hr. cholecystitis in a child increases the risk of tuberculosis. HP is a must!!!

2015-01-01 15:25:20

Anatoly asks:

A month and a half ago, as it turned out, there was contact with a tuberculosis patient in an open form (they were in the same room at a distance of about a meter for about half an hour), the patient was without a mask, did not cough or sneeze, but simply talked, periodically turning in my direction). At that time, I had already had a little cold for a couple of weeks - a sore throat, a runny nose, but I was already recovering.

After three weeks without any symptoms, the temperature slightly increased for a couple of days (36.9-37). Because according to the plan, it was already time for me, I went to make a flura in two projections (as a contact type), the doctor said that the heart and lungs were normal.

I calmed down and for two weeks the temperature did not bother me, and I no longer worried about anything, I felt great. After that, for two days in a row, the temperature began to rise to 37.1 in the evening. Then, during the week, too - in the morning everything is fine, in the evening it is up to 36.9-37.0, it freezes. During this week - during the day, the norms, in the evening up to 37.0-37.1 almost every evening.

The therapist said that it was all from what I was experiencing, it was depression, and prescribed sedatives. If there is a desire, she suggested doing an ultrasound scan, looking at a cardiologist and other possible tests.

It is important for me to exclude the possibility of tuberculosis - this problem really “floats” me, because I don’t know if I got sick with something, if I can be dangerous for people close to me with whom I communicate every day. I lead a healthy lifestyle, eat a balanced diet, without a/p.

From the moment of contact 1.5 months now. In addition to the temperature every evening, a slight weakness - nothing bothers. Even when swallowing hot liquids somewhere a little above the sun, but below the neck, such mildly painful irritation is heard.

Does it make sense now to do an X-ray or a CT scan, and if so, which one? Is it worth limiting active communication with people? Is it necessary to bring down this temperature?

I will be very grateful for the answer

Responsible Medical consultant of the portal "site":

Hello! The upper limit of the norm for temperature is 37.2 C, in the evening the body temperature normally rises by 0.3-0.5 C. So your concerns about body temperature are groundless. Do regular fluorography, once a year go through a general examination and medical examination with a therapist and do not create a cause for alarm. As for the risk of contracting tuberculosis, it exists all the time. Modern man constantly communicates with people whose status on tuberculosis infection is unknown. And at any time, a critical dose of mycobacteria can enter the body, capable of causing a clinically significant disease. So your meeting with a tuberculosis patient is just one of many episodes. A healthy lifestyle and regular fluorography will help prevent serious consequences. Take care of your health!

2014-02-28 23:44:44

Yana asks:

Hello! I need your professional opinion about my situation.. I am 30 years old, I am planning a pregnancy. A blood test showed the presence of tuberculosis bacteria in the body. According to the x-ray, the lungs are clean and the "bacterium is not active", but it is in the body and I am at an increased risk of developing tuberculosis. How safe is planning a pregnancy in this situation if I am not undergoing any treatment? What are the risks? According to some sources, there are recommendations to undergo prophylactic treatment BEFORE pregnancy. But it takes 6-9 months, which is a very long time for me. Another question - are there any risks to the fetus if, if less than a month has passed since my X-ray before conception? Thanks a lot!

Responsible Gritsko Marta Igorevna:

You must understand that an X-ray is accompanied by irradiation of the body and, accordingly, the egg, so planning a pregnancy in the same month is not recommended. Regarding tuberculosis, you should consult with a phthisiatrician who will examine you and make prescriptions based on examinations.

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