Tuberculosis: Symptoms, Diagnosis and Treatment
Tuberculosis is a serious infectious disease whose prevalence among the population is directly related to the social and economic conditions in the country.Thus, in states that can not provide a high level of immunization and early diagnosis, in which the majority of the population is malnourished, live in inappropriate conditions and do not receive normal medical care, the incidence of these dangerous ailments grows every year, taking more and more lives.If we assess the overall situation in the world, according to various sources, about 9 million people get tuberculosis every year, and 3 million die from its complications.
Russia is among the countries with a high incidence, mortality from tuberculosis and the recording of a large number of cases of illness caused by microorganisms resistant to anti-TB drugs.Recommended: Table of contents: Causes and at-risk groups Forms of tuberculosis Tuberculosis: symptoms Tuberculosis in children Complications of tuberculosis Diagnosis of tuberculosis Treatment of tuberculosis Prevention
Causes and at-risk groups
The causative agent of tuberculosis is mycobacterium tuberculosis( or tubercle bacillus).A patient with pulmonary tuberculosis( in other forms of the disease, patients are non-communicable) secretes this microorganism in large quantities during coughing, sneezing, and riotous conversation.
Most often, infection occurs by airborne droplets.It is also possible and alimentary infection( through the digestive tract) products containing mycobacteria, but it is very rare.The likelihood of infection increases if a person has any diseases of the respiratory system or he smokes.
Most people in countries with a high incidence of tuberculosis are infected with mycobacteria in childhood, but the disease develops only in 10% of them.That is, a healthy organism resists the tubercle bacillus due to cellular local immunity( in the respiratory tract) and the general immunity obtained during vaccination( anti-tuberculosis antibodies circulating in the blood).
If, for some reason, the immunity decreases, local defense decreases, mycobacterium is activated, and one of the clinical forms of tuberculosis develops.In addition, the probability of the disease is largely determined by the infectious dose, that is, the number of mycobacteria that enter the body. In view of this, the following groups of risk for tuberculosis are identified:
- People who live for a long time and stay in the same room with a tuberculosis patient( relatives, employees).
- Persons suffering from chronic diseases of the respiratory system.Smokers, alcoholics, drug users.
- Infected with HIV.
- Patients taking glucocorticoids, immunosuppressors, cytostatics and other drugs that suppress immunity.
- Medical and social workers, employees of places of confinement.
- People with immunodeficiencies.
- Patients with diabetes mellitus.
- People who once already had tuberculosis.
- Persons without a fixed place of residence.
- Patients of psychiatric hospitals.
Forms of tuberculosis
Tuberculosis is not only a pulmonary pathology, as it is commonly believed.A tubercle bacillus can affect bones, genitourinary, nervous systems, intestines, and other organs.Therefore, there are two types of tuberculosis:
- pulmonary tuberculosis ( more than 80%);
- extrapulmonary tuberculosis .
In addition, tuberculosis is classified into primary( it develops during initial contact with mycobacteria) and secondary( occurs when the infection or activation of an existing tuberculosis focus in the lungs is repeated).
Primary tuberculosis occurs mainly in children and young people, in older age it is a rarity, especially in countries with a high incidence of .
There are three clinical forms of primary tuberculosis( they usually replace one another) :
- Tuberculous intoxication.After entering the body, the mycobacterium settles in the lymph nodes closest to the respiratory organs, and begins to multiply actively, while toxic products are released into the blood that cause intoxication.On the roentgenogram changes in the lungs or lymph nodes at this stage of the disease doctors can not see.
- Tuberculosis of the intrathoracic lymph nodes( bronchoadenitis).This form of tuberculosis can already be diagnosed by X-ray.
- Primary tuberculosis complex, which is manifested by a small focal lesion of the lung and the nearby lymph node.This form of illness develops when the infection lymphatically penetrates into the lung tissue.
After the primary tuberculosis is transmitted in the lungs and lymph nodes there are calcifications in which the mycobacterium can be stored in a "sleeping" form.In patients with immunodeficiency( eg, AIDS), primary infection with tuberculosis immediately leads to massive damage to the lungs or other organs.
Secondary tuberculosis also has various forms( or stages of tuberculosis that pass into each other):
- is infiltrative;
- caseous pneumonia;
- is cirrhotic.
In addition, isolated tuberculosis of open form( when the patient secrete live mycobacteria) and tuberculosis of closed form( the patient is not contagious).
Other forms of secondary tuberculosis, in which the respiratory organs are affected, are disseminated, miliary, tuberculosis of the upper respiratory tract and bronchi, tuberculous pleurisy.
Extrapulmonary tuberculosis in adults also almost always has a secondary character, mycobacterium from bronchopulmonary lymph nodes penetrates into other organs through the blood.
Each of the described forms of pulmonary tuberculosis has some of its characteristics, it is not necessary to know their common man.It will be enough to remember only those possible signs of tuberculosis, the appearance of which should alert and force to see a doctor. These symptoms include :
- Chronic cough or cough.
- Prolonged subfebrile condition( temperature not higher than 38).
- Night sweats.
- Constant malaise, general fatigue.
- Pain in the chest, worse during coughing.
- Shortness of breath.
- Weight loss.
- Enlargement of lymph nodes.
First signs of extrapulmonary tuberculosis :
- Pain in bones and joints.
- Blood in the urine.
- Soreness in the lower back.
- Headache and tension of the occipital muscles.
- Various disorders in the functioning of the intestine.
- Rapid weight loss.
- General weakness.
Important!Symptom requiring urgent examination for tuberculosis:
|Symptoms of inflammatory bronchopulmonary disease||intoxication symptoms( presenting more than 3 weeks)|
|lasts longer than 3 weeks of cough with phlegm||Hyperthermia;excessive sweating, especially night|
|Hemoptysis, pulmonary hemorrhage||weakness, fatigue|
|Chest pain that occur during breathing||Weight Loss|
Tuberculosis in children
ChildrenThere are mainly different primary forms of tuberculosis.It is very important to identify them and treat them so that the secondary form of the disease does not develop later.Therefore, parents should know the first symptoms of tuberculosis in children. These include:
- Weight loss.
- Weakness, fatigue.
- Subfebrile condition.
- Severe sweating.
- Poor appetite.Pale skin.
Complications of tuberculosis
most severe complications of pulmonary tuberculosis - a pulmonary hemorrhage, spontaneous pneumothorax( air outlet into the pleural cavity), pulmonary heart( specific change right heart pumps blood through the lungs).Extrapulmonary tuberculosis has its complications - infertility, kidney failure, ankylosis( complete immobility of the joints), etc.
Diagnosis of tuberculosis
The task of physicians is to identify tuberculosis as early as possible.For this purpose, children are given tuberculin diagnostics every year( Mantoux test), and adults are given fluorography. If there are any suspicions after these studies, as well as the presence of symptoms characteristic of tuberculosis, the patient is sent for consultation to the phthisiatrician and examined in more depth in the following way:
- gathering medical history( any complaint, whether contacts areWith tuberculosis patients, etc.).
- Clinical examination.
- Laboratory tests( blood and urine tests).
- Threefold microscopic and bacteriological examination of sputum.
If necessary, a number of special examinations are carried out: bronchoscopy, pulmonary tissue biopsy, molecular biological diagnosis, and the like.
Treatment of tuberculosis
Tuberculosis - a disease that can be successfully treated if detected early.Treatment is carried out at home or in the hospital( it all depends on the form of the disease, whether the tubercle bacillus is allocated or not, on the conditions in which the patient lives, on his attitude to the doctor's appointments).
|first line drugs( in brackets abbreviation drugs)||Formulations second or back row that are used in drug-resistant tuberculosis|
|Isoniazid( H)||Kanamycin( K)|
|Pyrazinamide( Z)||Prothionamide( Pt)|
|Rifampicin( R)||Amikacin( A)|
|Ethambutol( E)||Ethionamide( Et)|
|Ctreptomiching( S)||Capreomycin( Cap)|
The basis of treatment isChemotherapy with special anti-TB drugs.They are divided into two groups: preparations of the first and second line.In each case, the most optimal treatment regimen is selected, while in the active phase of tuberculosis 4 or 5 antituberculosis drugs are prescribed immediately, then their amount is reduced.Such treatment is always long( at least 6 months).
The following are standard regimens for the chemotherapy of tuberculosis:
course the initial phase of chemotherapy( intensive)
drugs( indicated by their abbreviations)
duration of reception per month.
|duration of admission per month.|
HRZE / S
HRZE plus KFq or PtCap
selection scheme depends on the drug sensitivity of the pathogen
|IV||least 5 preparations which maintain the sensitivity of mycobacteria||Min.6||not less than 3 preparations, including medication of the reserve series|| |
The continuation phase of chemotherapy begins only after confirmation of the absence of mycobacteria in the sputum and improvement of the patient's lungs according to X-ray and clinical data.Treatment at this stage ensures the destruction of the remaining pathogens and prevents the development of relapses of the disease.
Important: The should be exclusively administered by the tuberculosis doctor for the choice of chemotherapy for tuberculosis.
The optimal treatment regimen( preparations, dosing route, multiplicity of procedures, duration) is selected taking into account the following factors:
- infectiousness of the patient( whether he secretes mycobacteria or not);
- the nature of the disease( it was first discovered, or the patient had a relapse of the disease);
- prevalence and severity of the tuberculosis process;
- previously obtained treatment;
- drug resistance( immunity) of tubercle bacilli.
In addition to anti-tuberculosis drugs, patients are prescribed hormones, immunomodulators, vitamins and other medications as needed.
Diet( nutrition), rejection of bad habits and adherence to the regime is of great importance in the treatment of tuberculosis.
TB prevention is carried out in 4 directions :
- Social prevention( implemented at the state level) - a set of measures to improve the life and health of people, educate on tuberculosis, etc.
- Sanitary prophylaxis is a variety of activities in the outbreaks of tuberculosis infection.
- Specific prophylaxis - vaccination and revaccination of BCG.
- Chemoprophylaxis is the prescription of an anti-tuberculosis drug not for the purpose of treatment, but for the prevention of people who have been in contact with a tuberculosis patient, children with a "bend" of Mantoux test( when a negative test is positive) and a high risk of developing the disease,.
It must always be remembered that any person can fall ill with tuberculosis, regardless of social status.You can protect yourself and your loved ones from this dangerous infection if you take care of your family's health, improve your living conditions, eat well, take fluorography on time, make Mantoux and BCG vaccinations for children.
Zubkova Olga Sergeevna, medical reviewer, epidemiologist