Tuberculosis – the chronic infection caused by bacteria of Mycobacterium tuberculosis complex. At defeat from tubercular mikobakteriya respiratory organs most often suffer, besides, tuberculosis of bones and joints, urinogenital bodies, eyes, peripheral lymph nodes meets. Diagnosis of tuberculosis consists in conducting tuberkulinovy test, a radiological research of lungs, the identification of mikobakteriya of tuberculosis in a phlegm, washouts from bronchial tubes separated skin elements, additional tool inspection of the bodies affected with tuberculosis. Treatment of tuberculosis represents complex and long system antibiotic treatment. According to indications surgical treatment is carried out.
Tuberculosis – the chronic infection caused by bacteria of Mycobacterium tuberculosis complex. At defeat from tubercular mikobakteriya respiratory organs most often suffer, besides, tuberculosis of bones and joints, urinogenital bodies, eyes, peripheral lymph nodes meets. Most often infection happens in the airborne way, is more rare - contact or alimentary.
Characteristic of the activator
Mycobacterium tuberculosis complex represents group of species of the bacteria capable to cause tuberculosis in the person. Most often the activator is Mycobacterium tuberculosis (. – Koch's stick), represents grampolozhitelny acid resisting sticks of family of actinomycetes, sorts of mikobakteriya. In rare instances tuberculosis is caused by other representatives of this sort. Endotoxins and ekzotoksin are not emitted.
Mikobakteriya are extremely steady against influence of the environment, it is long remain out of an organism, but perish under the influence of a direct sunlight and ultra-violet radiation. Can form the low-virulent L-forms promoting at presence at an organism to form specific immunity without development of a disease.
The tank of an infection and source of infection with tuberculosis are sick people (most often infection occurs at contact with TB patients of lungs in an open form – when tubercular bacteria are allocated with a phlegm). At the same time the respiratory way of infection is implemented (inhalation of air with scattered bacteria). The patient with active allocation of mikobakteriya and the expressed cough is capable to infect more than ten people within a year.
Infection from carriers with poor allocation of bacteria and the closed tuberculosis form perhaps only at close continuous contacts. Sometimes there is infection alimentary (bacteria get into a digestive tract) or a contact way (through damages of integuments). The sick krupnorogaty cattle, poultry can become a source of infection. Tuberculosis at the same time is transmitted with milk, eggs, at hit of excrements of animals to water sources. Not always hit of tubercular bacteria in an organism causes development of an infection. Tuberculosis – the disease often connected with adverse living conditions, decrease in immunity, protective properties of an organism.
During tuberculosis allocate primary and secondary stages. Primary tuberculosis develops in a zone of introduction of the activator and is characterized high sensitivity of fabrics to it. In the very first days after infection the immune system becomes more active, developing specific antibodies for destruction of the activator. Most often in easy and intra chest lymph nodes, and at an alimentary or contact way of infection – and in digestive tract and skin, the inflammation center is formed. At the same time bacteria can dissipate with current of blood and a lymph on an organism and to form primary centers in other bodies (kidneys, bones, joints). Soon primary center begins to live, and the organism gains resistant antitubercular immunity. However at decrease in immune properties (at youthful or senile age, when easing an organism, a syndrome of an immunodeficiency, hormonal therapy, diabetes, etc.) there is an activization of an infection in the centers and secondary tuberculosis develops.
Classification of tuberculosis
Tuberculosis is distinguished on primary and secondary. Primary in turn can be dolokalny (tubercular intoxication at children and teenagers) and localized (primary tubercular complex representing the center in the place of penetration of an infection and tuberculosis of intra chest lymph nodes).
Secondary tuberculosis differs on localization on pulmonary and not pulmonary forms. Pulmonary tuberculosis depending on prevalence and extent of defeat happens miliarny, disseminirovanny, focal, infiltrative, kavernozny, fibrous , tsirroticheskiya. Also allocate kazeozny pneumonia and tuberkuly. As separate forms tubercular pleurisy, an empiyema of a pleura and is allocated.
Out of lungs tuberculosis of a head and spinal cord and brain covers, tuberculosis of intestines, a peritoneum, mezenterialny lymph nodes, bones, joints, kidneys, genitals, mammary glands, skin and hypodermic cellulose, eyes meets. Defeat of other bodies is sometimes noted. In development of tuberculosis allocate phases of infiltration, disintegration, an obsemeneniye, a rassasyvaniye, consolidation, scarring and calcification. Concerning allocation of bacteria distinguish an open form (with allocation of bacteria, MBT-polozhitelnuyu) and closed (without allocation, MBT-otritsatelnuyu).
Owing to large number of clinical forms, tuberculosis can be shown by the most various simptomokompleks. The course of a disease chronic, usually begins gradually (long time can proceed asymptomatically). Over time, symptoms of the general intoxication – a hyperthermia, tachycardia, weakness, decrease in working capacity, loss of appetite and weight loss, perspiration are shown. When progressing an infection and its distribution on an organism intoxication can be quite intensive. Patients considerably lose in body weight, features are pointed, the painful flush appears. Body temperature does not rise above subfebrilny figures, but long time keeps. Fever arises only in case of massive defeat.
- Tuberculosis of lungs, as a rule, is followed by the cough (originally dry) which is becoming aggravated at night and since morning. Existence of persistent cough on an extent more than is three weeks a disturbing symptom, and it is necessary to see surely in such cases a doctor. When progressing a disease the blood spitting can appear. Tuberculosis of lungs can be complicated by a life-threatening state – pulmonary bleeding.
Tuberculosis of other bodies and systems happens much less often and comes to light, as a rule, after an exception of other pathologies.
- Tuberculosis of brain covers and brain. Develops gradually for 1-2 weeks, most often at children and persons with an immunodeficiency, at patients with diabetes. Originally, besides intoxication symptoms, there are frustration of a dream, and headaches, from second week of a disease vomiting joins, the headache becomes intensive and persistent. By the end of the first week the meningealny symptomatology (a rigidnost of occipital muscles, symptoms of Kerniga and Brudzinsky), neurologic frustration is noted.
- Tuberculosis of bodies of a digestive tract is characterized by a combination of the general intoxication to violation of a chair (the locks alternating from ponosa), dyspepsia symptomatology, belly-ache, sometimes bloody impurity in Calais. Tuberculosis of intestines can promote impassability development.
- Tuberculosis of bones, joints and backbone. At tuberculosis of joints the symptomatology of arthritises is noted (the affected joint pain, restriction in mobility), At damage of bones their morbidity, tendency to changes is noted.
- Tuberculosis of bodies of urinogenital system. At localization of the center of an infection in kidneys patients note nephrite symptomatology, back pain, emergence of blood in urine is possible. Quite seldom tuberculosis of urinary tract can develop, in this case the dizuriya (violation of process of an urination), morbidity at an urination will be manifestations. Tuberculosis of genitals (genital tuberculosis) can be the cause of infertility.
- Tuberculosis of skin is characterized by emergence of dense small knots under skin, when progressing of the white curdled masses increasing and opened on skin with allocation.
Tuberculosis of lungs can be complicated by a blood spitting and pulmonary bleeding, atelektazy, pheumothorax and warm and pulmonary insufficiency. Besides, tuberculosis can promote developing of fistulas (bronchial and thoracic, other localization at extra pulmonary forms), an amiloidoza of bodies, a renal failure.
Diagnosis of tuberculosis
As often tuberculosis at first proceeds asymptomatically, the significant role in its diagnostics is played by preventive inspections. Adults need annually to make fluorography of bodies of a thorax, to children – test to Mant (tuberkulino-diagnostics technique revealing degree of contamination of an organism a tubercular stick and reactivity of fabrics). The main method of diagnosis of tuberculosis is the X-ray analysis of lungs. At the same time it is possible to find the infection centers, both in lungs, and in other bodies and fabrics.
Make crops of a phlegm, washing waters of bronchial tubes and the stomach separated from skin educations for definition of the activator. At impossibility to sow a bacterium from biological materials, it is possible to speak about MKB-otritsatelnoy to a form. Data of laboratory analyses are not specific and points to an inflammation, intoxication, sometimes (a proteinuria, blood in Calais) can speak about localization of the center. However the comprehensive investigation of a condition of an organism at tuberculosis matters at the choice of tactics of treatment.
In certain cases for specification of the diagnosis carry out KT of lungs, immunological tests, a bronkhoskopiya with a biopsy, a biopsy of lymph nodes. At suspicion on an extra pulmonary form of tuberculosis quite often resort to more profound, than Mant, tuberkulinovy diagnostics – Koch's test. Diagnosis of tubercular meningitis or encephalitis is carried quite often out by neurologists. The patient is examined by means of a rheoencephalography, by brain EEG, KT or MRT. From a likvor make a lyumbalny puncture for allocation of the activator.
At development of tuberculosis of digestive organs consultation of the gastroenterologist, ultrasonography of abdominal organs, a koprogramma is necessary. Tuberculosis of musculoskeletal system demands carrying out the corresponding radiological researches, KT of a backbone, an arthroscopy of the affected joint. Ultrasonography of kidneys and a bladder belongs to additional methods of inspection at tuberculosis of urinogenital system. Patients with suspicion of tuberculosis of skin need consultation of the dermatologist.
Treatment of tuberculosis
Treatment of tuberculosis is directed to healing of the centers and elimination of symptomatology. The started tuberculosis will respond to treatment much worse, than in due time revealed, even heavier current (destructive forms). Treatment of tuberculosis takes year and more, is complex (combines methods of medicamentous therapy, physical therapy). Originally treatment is carried out in a tubercular clinic to the termination of allocation of microorganisms. Then patients are written out for continuation of out-patient treatment. Treatment in specialized sanatoria and dispensaries is recommended to the patients who completed a course of therapy of tuberculosis.
Surgical treatment is shown in cases when conservative therapy is not sufficient for achievement of treatment (a kavernozny form of tuberculosis of lungs, various complications). The most frequent surgical technique of treatment of tuberculosis is the partial resection of a lung with excision of the struck segments. Also operational kollapsoterapiya is applied. To the patients having tuberculosis the special high-calorific diet (table No. 11) rich with digestible protein, vitamins C and groups B is appointed.
The bed rest is prescribed only the patients with high extent of destruction of lungs expressed by a blood spitting. In other cases walks, physiotherapy exercises, vigorous physical activity are recommended to patients.
The forecast at tuberculosis
Now in most cases at timely identification and observance of necessary medical favorable died the forecast – there is a healing of the tubercular centers and subsiding of clinical signs that it is possible to consider clinical recovery. After treatment in the place of localization of the centers there can be hems, sites of fibrosis, the encapsulated centers containing bacteria in the dozing state. At deterioration in a condition of an organism perhaps retsidivirovany diseases therefore patients after clinical treatment are on the dispensary account at the phthisiatrician and are exposed to regular inspection. After transferring and treatment of tuberculosis tuberkulinovy test remains positive.
In case of lack of treatment or non-compliance with recommendations tuberculosis mortality reaches 50% of cases. Besides, the forecast worsens at elderly people, HIV-positive people and people having diabetes.
Prevention of tuberculosis
The preventive measures which are carried out by specialized TB medical institutions together with institutions of the general medical profile include routine inspections of citizens (obligatory annual fluorography), identification of the patients suffering from open forms of tuberculosis, their isolation, inspection of contact persons, specific prevention of tuberculosis.
Specific prevention (vaccination) is directed to formation of antitubercular immunity, includes introduction of vaccine BTsZh or preventive chemical means. At the persons vaccinated by BTsZh, tuberculosis proceeds in easier, good-quality forms, will more simply respond to treatment. Immunity is usually formed in 2 months after vaccination and stukhat in 5-7 years. Measures of chemoprophylaxis are applied among persons with the increased risk of infection: to the persons contacting to TB patients with negative tuberkulinovy test (primary chemoprophylaxis) and the infected persons (secondary).