Groups of dispensary registration for tuberculosis of the adult population. GDN (Dispensary observation groups for adult patients with tuberculosis). Types of medical examinations

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is an insidious disease that anyone can become infected with. Every person is required to undergo a preventive examination annually, which will show whether or not there is a mycobacterium infection. In case of questionable results or obvious infection, the person is sent to a tuberculosis dispensary. This is an institution where examination continues and treatment is carried out if necessary. According to regulatory documents, there are several groups of dispensary registration for tuberculosis. Let's look at them in detail.

Definition

Dispensary groups are special cells that are divided according to the form and severity of tuberculosis. Before treatment begins for a patient, the TB specialist must assign him to the appropriate group. This makes it possible to approach each individual individually, simplifying the path to recovery and symptom relief.

In total, there are 4 groups for recording tuberculosis patients (they are also divided into subgroups).

Groups of tuberculosis patients are based on the therapeutic and epidemiological principle. Approved by the Ministry of Health of the Russian Federation.

It should be noted that the groupings under consideration are systematically revised.

Order 109 on tuberculosis, which was issued in 2003, was amended in 2017 and states the advisability of all measures against tuberculosis.

Purposes of registration

When registering a patient at a dispensary, the following goals are pursued:

1. Creation of separate groups of similar forms or severity of pathology, which makes it possible to correctly observe patients and promptly call them for examination.
2. Saving time allocated for visits, consultations and treatment periods.
3. Clear observation of dynamics by transferring the patient from group to group.
4. Coordinated work in maintaining documentation.
5. Correct and quick determination of treatment tactics.
6. Timely implementation of various activities and deregistration of patients (who have undergone treatment and overcome the disease).

Surveillance groups and what do they mean?

As mentioned above, there are 7 groups in total. Each has its own special characteristics.

0 group

This group includes people:

• having an unspecified active process;
• requiring a high-quality examination, after which a residual diagnosis will be made and the form and localization of the infection will be clarified.

There are also divisions into subgroups.

0-A

These are patients who have an unspecified diagnosis of the presence of MBC in the body.

0-B

Those who are waiting for differentiated diagnostics, which will show which group they will be assigned to.

If tuberculosis is in doubt, or rather its active form, then this group is for such cases. Means:

• various unclear changes on x-rays;
• positive tests of Mantoux, Diaskintest, Quantiferon test, etc.;
• deviations in analyzes and so on.

1 group

There are tuberculosis cases here, in which the form is in the active phase. Localization doesn't matter. Here there is a division into 2 subgroups.

1A

This refers to people who were infected with Koch's bacillus for the first time.

1B

Patients who have recurrent pathology.

In both subgroups there is a division into patients who:

1. Mycobacteria are isolated. As a rule, this includes the presence of MBC not only in sputum, but also in urine, feces, etc. If Koch's bacillus is found in the puncture fluid, then this does not count.
2. MBC is not isolated. There are no active microorganisms that enter the external environment. Patients are also transferred here when they stop excreting bacteria after a therapeutic course. This condition is called abacillation - the disappearance of mycobacteria.
3. Those patients whose treatment was interrupted or were not examined after the therapeutic course. Such individuals may still have active tuberculosis.

2nd group

The 2nd group is characterized by the fact that it contains people with chronic pathology, while the form is active. Localization is not important.

It is also divided into additional groups.

2A

Here are tuberculosis patients whose disease may be cured, but this requires strong medication or other therapy.

2B

Individuals classified in this subcategory triggered the disease. It cannot be cured with any anti-tuberculosis drugs.

3 group

There are people here with any location of tuberculosis who have cured it. This is the so-called control group.

4 group

Individuals who end up here are in systematic contact with the carrier of the infection. These are people from the risk zone.

4A

People who come into contact with a person with tuberculosis at home or at work.

4B

Here are all the workers of tuberculosis dispensaries and other medical institutions who are forced to communicate and come into contact with infected people, as this is inevitable in their professional activities.

Indicators and criteria for tactics of dispensary observation and recording

There are some features and indicators that guide TB specialists.

• Questionable activity. If there are unknown changes in the lung tissue or other organs, this is a zero group. In it, people undergo a complete diagnosis, using several methods at once. Most often, during a comprehensive examination, patients are under the dispensary supervision of qualified specialists. This lasts no more than three weeks. If the diagnosis is not confirmed and the person mistakenly ends up in a tuberculosis clinic, he is sent home. In another case, he is sent to the next group (first) or sent to a special therapeutic and preventive sanatorium.
• Active phase of tuberculosis. There is a specific inflammation here that is caused by MBC. Such patients fall into group 1. This form is identified after a comprehensive diagnosis. It includes X-ray, fluoroscopy, tomography, bronchoscopy, fluorography, PCR, sputum microscopy, serological method, tests, etc. After this, treatment for tuberculosis of the lungs or other organs is required. Next is diagnostics again. If everything is normal, then they resort to staying in specialized sanatoriums, where the patient’s rehabilitation takes place.
• Chronic form of the disease. This is the one that is present in a person for more than 24 months. Even if there are periods of remission, and then exacerbation again. The remaining active form belongs to the second group. Pathology usually reaches this level in those patients who:

1. they did not start treating her on time;
2. not identified in a timely manner;
3. have a weakened immune system;
4. were on treatment that did not give the expected result;
5. had concomitant diseases that interfered with the cure of tuberculosis.

This group also includes those people who did not experience positive dynamics during their stay in the first group for two years.

• Bacteria eliminators. People who shed Koch's bacillus can infect others as a result. This includes discharge in the form of menstruation, sputum, saliva, urine, feces, etc. Bacterial discharge is detected immediately upon entering the TB dispensary.
• Abacillation. This is when the tuberculosis bacillus stops being released. This usually happens after long-term and competent treatment. This can be determined by cultural and bacterioscopic examination.
• Post-tuberculosis residual changes. This implies the presence of foci and foci, cirrhotic and fibrous foci, postoperative changes, pleural formations, and improper functioning of the organ after a therapeutic course. There are small changes - if the formations are no more than three cm (single in nature) or 1-2 cm, fibrous no more than two segments. Large – all those that exceed the listed standards.
• Tuberculosis of a destructive nature. In pathology, tissue breakdown is present. To identify this, you need to undergo an X-ray examination.
• Progressive or aggravated disease. Here new signs of the disease are found. They may appear during treatment and after visible improvement. This indicates that treatment is not suitable.

Formulation of diagnosis

Here are examples of including a person in category 1:

• There is a lesion of the lung on the left upper lobe, of an infiltrative nature. It is in the decay phase, there is contamination. Mycobacteria are isolated.
• There is cavernous tuberculosis of the left kidney with the release of mycobacteria.

An example of transferring a patient to group 2:

• The person had infiltrative tuberculosis. The course of the pathology was unfavorable, which resulted in a cavernous form.

Transfer to group 3:

• Pathology is present in the right lung of the lower lobe. There are large residual changes that have spread to neighboring lobes.
• The lung of the upper lobe is affected on the right. There are minor residual changes. These are single lesions no more than 3 cm.

Conclusion

All groups of dispensary registration for tuberculosis have their own characteristics. Before including or transferring a person to one category or another, the doctor conducts a thorough examination and examines the patient. Such divisions make the doctor’s work easier, make it possible to observe the dynamics of the disease, and save time. Treatment of tuberculosis in children and adults becomes more effective, since it is possible to promptly identify negative dynamics and change treatment if necessary.

Tuberculosis is known as a serious infectious disease, fraught with many complications. The disease poses not only an individual, but also a general social threat, therefore, specialized medical institutions - anti-tuberculosis dispensaries - are created to combat it.

You can find out more about pulmonary tuberculosis at the following link:

Clinical examination of patients

Treatment in dispensaries is voluntary, absolutely free and provided at public expense. The only exception is the open type of tuberculosis, which requires medical examination in accordance with a court order.

A dispensary is an organizational structure that includes a hospital, an outpatient department and a physiotherapy service. The diagnostic center is based on an X-ray room, microbiological and clinical diagnostic laboratories, as well as functional and endoscopic diagnostic rooms. In some cases, a sanatorium and workshops may be located on the territory of the dispensary.

The main goal of the institution is to maintain dispensary records, which includes early detection of signs of the disease for timely initiation of treatment. As a result of complete relief from signs of the disease, the patient is removed from the register. In case of irreversible changes in the body, the patient remains registered throughout his life.

Purpose of dispensary registration

The most important therapeutic measure is the distribution of patients into specialized observation categories, classified according to the form and severity of the disease. This division makes it possible to individualize the approach to consultation and treatment of certain categories of patients, making it easier to cure or alleviate symptoms.

Appointing a monitoring group allows you to achieve the following results:

• Productive treatment process according to the schedule of consultations and examinations
• Individual selection of effective therapy algorithms
• Comfortable rehabilitation and timely deregistration of recovered patients.

Dispensary registration for adult patients

There are slight differences in medical examinations for adults and children. Patients who have reached adulthood usually undergo regular medical examinations in order to prevent and early diagnose changes in the lungs.

The formation of specialized categories is classified according to the severity of the disease and the level of its social danger. The following categories of observation are divided:

The zero observation group covers patients with implicit activity of the process of changes in the respiratory organs, as well as persons with an unconfirmed diagnosis.

• 0-A – it includes patients who need additional examination to clarify the diagnosis
• 0-B – includes patients referred for additional studies to confirm or refute the diagnosis.

The first observation group is people with an active form of the disease, characterized by an inflammatory process in the respiratory organs. Includes:

• I-A – tuberculosis detected for the first time
• I-B – acute form of tuberculosis, lasting more than two years
• I-B – treatment was interrupted or not completed properly due to the lack of a follow-up examination at the end of therapy.

The second group includes patients with active subsiding tuberculosis. Divided into:

• II-A, which includes patients for whom cure can be achieved through an intensive course of treatment
• II-B, which includes people with relapses, as well as with advanced tuberculosis, a complete cure for which is impossible, but patients still need strengthening and anti-relapse therapy.

The third category of observation was created for those who have achieved recovery and is a control category. Being in it gives a high chance of being completely deregistered as a result of passing standard control in the form of bacteriological and x-ray examinations.

The fourth group includes people who are at high risk due to contact with patients with open forms of the disease, but who are not carriers themselves.

The fifth group is people with extrapulmonary forms of tuberculosis, as well as those who have completely recovered from it.

The sixth group includes children with a positive Mantoux test who are at high risk.

The seventh group covers patients suffering from residual symptoms after cured tuberculosis, due to the high likelihood of relapse.

Features of assigning an observation group for children

Prevention of tuberculosis among children and detection of its signs, as well as predisposition to it, is carried out annually through Mantoux (for newborns - BCG).

Important! In most cases, the risk of infection in children is associated with their contact with sick adults.

A positive reaction to Mantoux is the basis for registration and assignment to observation group VI. In this case, it is divided into the following categories:

• VI-A, including children with identified signs of primary development of the disease
• VI-B, which includes children with an overly active reaction to tests
• VI-B, which includes children with an increased level of sensitivity to tuberculin.

It is worth noting that, regardless of the observation group to which children are classified, with reversible forms of the disease there are serious chances for a complete cure and timely deregistration at the dispensary.

Tuberculosis is a common infectious disease, so identification of patients with tuberculosis must be timely. Improving methods of disinfection of tuberculosis foci and the appropriate organization of anti-epidemic measures among contact persons, especially among children, are extremely relevant measures, since they are aimed at reducing the rate of spread of tuberculosis infection and improving the epidemiological situation of the disease in the country. To achieve these goals, groups for dispensary registration for tuberculosis were allocated.

The development of tuberculosis is caused by the entry of Koch's bacillus into the human body and is manifested by a long course and damage to various organs and systems. In 1993, the World Health Organization declared tuberculosis a “global threat”: 17 million people were infected with Mycobacterium tuberculosis, and about 8 million new cases of the disease occurred each year.

People with tuberculosis are generally not socially settled in life. They live in unfavorable conditions, are unemployed, often without a fixed place of residence. Approximately 2/3 of all patients are drug addicts and alcoholics. However, the disease can also affect established people, including children, pregnant women and the elderly. The infection progresses if a person has a weakened immune system, if he is emotionally unstable and is often exposed to stress. Poor nutrition, lack of physical activity and neglect of one's health increase the risk of developing an infection in the body.

You need to know that tuberculosis is curable in most cases. A patient who regularly takes chemotherapy with anti-tuberculosis drugs, which are selected correctly, after some time ceases to be a source of infection.

What is medical examination and the purposes of registration

In most countries of the world, anti-tuberculosis services are centralized. The main place in its work is occupied by anti-tuberculosis dispensaries - the main centers for the fight against tuberculosis and various diseases of the respiratory system of non-specific etiology.

The first primitive dispensaries were founded in the 70s of the last century in Great Britain. Today, the dispensary is an institution for providing the most progressive medical care to the population. The main work carried out there is medical examination. In many European countries, such medical institutions, in addition to diagnostic and therapeutic work, engage in environmental health work. To carry out this activity, management constantly studies the epidemiological situation regarding tuberculosis in the service area.

Clinical examination includes the whole range of measures that help reduce morbidity, reduce the epidemic of tuberculosis among the country's population, as well as mortality from this disease.

To implement a comprehensive plan to combat tuberculosis, the general medical network and the sanitary and epidemiological service are involved. The fight against tuberculosis is a state program, therefore the tuberculosis dispensary coordinates anti-tuberculosis activities with regional government bodies, receives the necessary allocations from them and reports on the work done.

Clinical observation is the main method in the work of an anti-tuberculosis dispensary. The essence of this method is that from the very detection of tuberculosis, the person who fell ill, his family members and their living and working conditions were under the supervision of a TB doctor in order to improve the focus of tuberculosis infection, prevent new infections and primary tuberculosis disease.

Criteria for clinical observation tactics

To carry out dispensary observation, the tuberculosis dispensary maintains the necessary documentation. There is a corresponding order for medical examination for this pathology. An outpatient tuberculosis patient card is created for each patient. The card is filled with data characterizing the characteristics of the disease (history, results of objective, laboratory, bacteriological, x-ray examinations).

Next, a preliminary and then a final diagnosis is made according to the clinical classification of tuberculosis. Depending on it, it is determined which accounting group the patient will belong to. Then the doctor develops a treatment plan and carries out health measures at the source of infection.

During each visit by a patient to a dispensary or a doctor to a patient at home, the doctor fills out a diary in which he reflects not only the consequences of treatment, but also health work in the focus of tuberculosis infection.

For each patient, a control card is filled out, in which the following is noted:

• diagnosis, whether bacterial excretion is present, concomitant diseases. If the diagnosis changes, make a corresponding note on the control card;
• accounting group;
• necessary treatment (inpatient, sanatorium-resort, outpatient)
• presence of temporary or permanent (disability) loss of ability to work;
• information about the patient’s visit to the dispensary or doctor to the source of infection.

All control cards are placed in appropriate boxes with 12 divisions (for each month). After seeing the patient, the doctor fills out the control card, sets the date of the next visit and places the card in the slot corresponding to this date.

With the onset of a new calendar month, the doctor, based on control cards, plans work. This allows you to control diagnosis, treatment and preventive work at the place of residence of each patient. The card index gives concreteness to the doctor’s work and ensures planning. All persons under medical supervision receive treatment free of charge. If the patient does not visit the dispensary on time, the doctor or visiting nurse identifies the reasons and takes measures to ensure that the treatment of the patients is not disrupted.

All patients are divided into groups depending on the stage and severity of the disease. This allows the local phthisiatrician to correctly formulate an observation plan, effectively monitor the progress of the disease, and organize preventive and rehabilitation measures. Thus, it is easier to deregister and resolve issues of transfer to other groups.

In adults

The following groups are distinguished:

In children

Among the child population records, several more groups are distinguished. This is due to active monitoring of children of different ages with different courses of the disease. There are the following groups for tuberculosis in children:

1. Zero – involves analyzing a child of any age for the presence of a pathogen in the body.
2. The first includes children with tuberculosis with and without complications.
3. The second is that it includes patients with a long course of the disease.
4. The third group is children with the greatest risk of relapse of the disease. This also includes first-time cases and children transferred from the first and second observation groups.
5. The fourth includes children who are in direct contact with the carrier of the infection, from parents to neighbors.
6. Fifth – children with complications.
7. Sixth – children who have a very high risk of developing the disease. This group includes children of different age categories who are suspected of having a mycobacterium infection in the body. This can also include, as a separate subgroup, patients who experience an increase in the sensitivity of the pathogen to the drug.

Removal from the register

Patients with tuberculosis are removed from the register two years after the elimination of the pathogen in the body. After this, once every 3 months, bacteriological and bacterioscopic examinations of sputum and bronchial lavage water are carried out without fail. Radiologically, positive dynamics should also be observed - the disappearance of small and large cavities, resorption of pathological infiltrative foci, etc.

In some cases, they may be deregistered after a year. This is possible only when the mycobacterium disappears after powerful antibacterial treatment, confirmed by culture of sputum and bronchial lavages, as well as by an x-ray picture.

Employees of children's institutions are removed from the register with extreme caution. The decision to terminate observation is made by the VKK commission, the head of the department and the attending TB doctor.

From the above it follows that clinical examination today is a very important link in phthisiatric practice. It allows doctors to monitor the course of the disease and influence its outcome.

The appointment of a dispensary group for tuberculosis is an important therapeutic measure that allows us to provide the necessary level of consultation and treatment support for all categories of patients, according to the form and severity of their disease. Thanks to this approach to treatment, TB doctors are able to achieve adequate results in providing patients with the necessary level of medication and counseling. Moreover, if the diagnosis is reversible, the onset of complete recovery allows the patient to be removed from observation. If the degree of the disease is classified as chronic, observation is carried out for life, allowing the patient to maintain the most comfortable and safe living conditions in society. By establishing special records, dispensary employees have the opportunity to:

• effectively monitor patients according to the severity of their illness;
• select a convenient individual schedule for examinations and consultations;
• choose the most productive therapeutic regimens;
• ensure timely implementation of preventive measures and rehabilitation of recovering patients;
• timely set deadlines for removing observation from patients recognized as healthy.

How are patients monitored?

Dispensary observation groups are formed according to a number of criteria, the basis of which is the severity of the diagnosed disease and the level of its public danger. In particular, in the course of a disease with unclear activity, which cannot be diagnosed with a sufficiently high degree of probability even in the presence of tuberculous changes in the body, the patient receives group 0 (zero) and remains under the supervision of a doctor until the exact diagnosis is determined. If the likelihood of infection is not confirmed, the suspicion is removed and the patient goes under the care of general practitioners. When the diagnosis is confirmed and clarified, the patient receives the I (first) tuberculosis registration group.

If a patient is diagnosed with an active form of the disease (regardless of whether it is initially established or as a result of a relapse of the disease), they are subject to registration at the dispensary and the implementation of therapeutic, anti-epidemic, as well as rehabilitation measures aimed at achieving a complete cure or transition of the disease to a lesser degree. dangerous form. If, with active tuberculosis, the disease takes a chronic form, and the course of the disease lasts more than 2 years, the patient is transferred to the care of Group II dispensary observation. At the same time, observation can still be removed from him - once the clinical picture of complete recovery is achieved.

Traditionally, to identify signs of the development of tuberculosis upon reaching adulthood, regular medical examinations are carried out, within the framework of which a diagnostic examination of the lungs is carried out using fluoroscopic equipment.

It is important to note that in children, the risk of developing tuberculosis is most often associated with infection from adult patients with whom they come into contact. If factors requiring registration are identified, the patient is sent to an anti-tuberculosis dispensary, where he is assigned a registration group, according to the severity of the disease. There are the following groups:

1. zero - with an unconfirmed diagnosis or implicit activity of tuberculous changes in the respiratory organs.
2. I - when active tuberculosis is detected in the pulmonary form (with damage to the respiratory system). Subgroups are identified: I-A, which includes patients who are diagnosed for the first time, as well as patients with relapses and exacerbations, and I-B - for patients with chronic forms of tuberculosis.
3. II - for patients with detected active respiratory tuberculosis in a fading form.
4. III - for persons who have achieved clinical cure. They have standard controls within the framework of X-ray examinations and a tank. sowing at intervals of at least once every 6 months. Group 3 gives the patient a high chance of being completely deregistered.
5. IV - it includes persons who are not carriers of tuberculosis, but come into contact with patients and, accordingly, are at risk.
6. V includes persons who are carriers of extrapulmonary forms of tuberculosis or who have completely recovered from this disease.
7. VII is intended to monitor individuals who experience residual effects upon completion of treatment for respiratory tuberculosis and who are at risk (high probability of relapse).

Features of registering children

In children, tuberculin tests are carried out on an annual basis, by checking the Mantoux test or administering BCG (for newborns).

In this case, the child can be registered (taken under dispensary observation) as a person included in a high-risk group, with the assignment of risk group VI. Diagnostic studies and clinical observations for such a child are carried out in accordance with the deadlines established by law. You need to know that under the control of group VI, children observed for tuberculosis or suspected development of this disease are divided into 3 additional categories. Subgroup 6 A includes those who have identified signs of primary development of tuberculosis. For children who have an overly active (hyperergic) reaction to the introduction of a tuberculin test, observation is prescribed in subgroup 6-B. For children with a high level of sensitivity to tuberculin, there is a subgroup 6-B. Whatever the established group of dispensary observation, in adult patients and children with reversible (curable) forms, if they receive appropriate therapy, there is always a chance to be completely cured of tuberculosis and to achieve deregistration in the PTD.

V.A. Koshechkin, Z.A. Ivanova

The provision of anti-tuberculosis care to patients with tuberculosis is guaranteed by the state and is carried out on the basis of the principles of legality, respect for human and civil rights, free, and generally accessible.

Anti-tuberculosis care is provided to citizens upon their voluntary request or with their consent. At the same time, dispensary observation of tuberculosis patients is established regardless of the consent of such patients or their legal representatives.

Patients with contagious forms of tuberculosis who repeatedly violate the sanitary and anti-epidemic regime, as well as deliberately evading examination, are hospitalized, based on court decisions, in specialized medical anti-tuberculosis institutions for mandatory examination and treatment.

Heads of medical organizations and citizens engaged in private medical activities are obliged to inform the relevant authorities about tuberculosis patients identified in their jurisdictions and about each tuberculosis patient released from the penal system.

Patients with tuberculosis who need anti-tuberculosis care receive it from medical anti-tuberculosis organizations that have the appropriate licenses.

Persons under dispensary observation due to tuberculosis, when providing anti-tuberculosis care, have the right to:

1. respectful and humane treatment;
2. obtaining information about the rights and responsibilities of tuberculosis patients, the nature of the disease they have and the treatment methods used;
3. maintaining medical confidentiality;
4. diagnosis and treatment;
5. Spa treatment;
6. stay in medical anti-tuberculosis organizations, hospitals for the period necessary for examination and (or) treatment.

Persons under dispensary observation due to tuberculosis are required to:

1. treatment and health measures prescribed by medical workers;
2. internal regulations of medical anti-tuberculosis organizations;
3. sanitary and hygienic rules established for tuberculosis patients in public places.

Citizens who have temporarily lost their ability to work due to tuberculosis retain their place of work (position) for the period established by the legislation of the Russian Federation.

During the period of suspension from work (position), patients with tuberculosis are provided with state social insurance benefits in accordance with the legislation of the Russian Federation.

Persons under dispensary observation due to the disease are provided with medicines for the treatment of tuberculosis free of charge.

Patients with contagious forms of tuberculosis have the right to improved living conditions, taking into account the reduction of the epidemiological danger to others and additional living space in accordance with the legislation of the Russian Federation.

Violation of the legislation of the Russian Federation in the field of preventing the spread of tuberculosis entails disciplinary, civil, administrative and criminal liability in accordance with the law.

The activities of the anti-tuberculosis (TB) service are determined by regulatory documents (orders, guidelines, instructions, etc.) approved by the Ministry of Health of the Russian Federation.

Orders and other documents are developed on the basis of existing laws of the Russian Federation; they are documents that specify the activities of the anti-tuberculosis service in providing medical care to patients with tuberculosis within the limits of existing laws.

The anti-tuberculosis service consists of a network of state, specialized, independent medical institutions, the main task of which is the fight against tuberculosis.

The head institution of this network is the tuberculosis dispensary. The anti-tuberculosis dispensary manages all treatment and preventive institutions that ensure the fight against tuberculosis.

Dispensaries are organized on a territorial basis. In small towns there is one dispensary. In large cities, one dispensary serves one or two areas with populations ranging from 200,000 to 400,000 people.

The dispensary provides medical and diagnostic assistance to residents, as well as all workers and employees of enterprises, institutions, and educational institutions located in the region.

The main goal of the dispensary is to systematically reduce the incidence, prevalence, infection rate of tuberculosis and mortality from it among the population of the serviced territory.

To achieve this goal, dispensary employees must thoroughly study their area in sanitary, socio-economic terms, and have close contact with all treatment, preventive and sanitary institutions.

Each TB dispensary within its territory ensures the functioning of a centralized control system, which is based on two principles:

1. unification of measures for identifying, diagnosing and treating tuberculosis in accordance with the instructions for organizing dispensary observation and recording the contingents of anti-tuberculosis institutions;
2. differentiation of these activities, making it possible to develop an individual monitoring scheme for each patient in both urban and rural areas, depending on geographical and economic characteristics, the state of communications, the characteristics of everyday life and other social conditions, the nature of the tuberculosis process, etc.

The main objectives of the dispensary are:
1. Organization and implementation of preventive measures.
1.1. Anti-tuberculosis BCG vaccination and revaccination.
1.2. Improvement of tuberculosis foci through timely and long-term hospitalization of bacilli excretors.
1.3. Improving the living conditions of patients who pose an epidemiological danger to others.
1.4. Carrying out chemoprophylaxis in foci of tuberculosis infection.
1.5. Referral of infected children to health institutions (tuberculosis sanatoriums).
1.6. Sanitary educational work with the population.
2. Identification of patients with early symptoms of tuberculosis disease.
3. Organization and conduct of qualified and continuous treatment of tuberculosis patients in outpatient and inpatient settings to achieve clinical cure.
4. Dissemination of knowledge about tuberculosis among doctors and nursing staff of treatment and preventive institutions in the region.

There are no open appointments at dispensaries. If tuberculosis is suspected, the patient is admitted to the dispensary from the district clinic on the direction of a therapist, surgeon, neurologist, pediatrician, school doctor or health center paramedic.

Fluorography is a method of mass, quick and cheap examination of the chest organs among large groups of the population. If changes are detected in the lungs, the fluorography office refers patients to the dispensary for diagnosis. Early recognition of the disease is possible only with universal preventive examination of healthy people.

When a patient is diagnosed with tuberculosis, he is registered at the dispensary to monitor:

with reversibility until clinical cure;
if irreversible - until the end of life.

The grouping of dispensary contingents is based on the therapeutic-epidemiological principle and allows the local TB doctor to:

1. correctly form observation groups;
2. involve them in a timely manner for examination;
3. determine treatment tactics;
4. carry out rehabilitation and preventive measures;
5. remove from dispensary observation.

The specific grouping of dispensary contingents is constantly reviewed and approved by the Ministry of Health of the Russian Federation.

Zero group - (0).
In the zero group the following persons are observed:

1. with unspecified activity of the tuberculosis process;
2. those in need of differential diagnosis in order to establish a diagnosis of tuberculosis of any localization;
3. in whom it is necessary to clarify the activity of tuberculous changes, they are enrolled in the zero - A - subgroup (0-A);
4. for differential diagnosis of tuberculosis and other diseases, they are included in the zero - B - subgroup (0-B).

First group (I).
In the first group, patients with active forms of tuberculosis of any localization are observed.
There are 2 subgroups:

• first (I-A) - patients with newly diagnosed disease;
• the first (I-B) - with relapse of tuberculosis.

Patients are divided into both subgroups:

• with bacterial excretion (I-A - MBT+, I-B - MBT+);
• without bacterial excretion (I-A - MBT-, I-B - MBT-).

Additionally, patients are identified (I-B) who interrupted treatment or were not examined at the end of the course of treatment (the result of their treatment is unknown).

Second group (II).
In the second group, patients with active forms of tuberculosis of any localization with a chronic course of the disease are observed. It includes two subgroups:

• the second (2 A) - patients in whom clinical cure can be achieved as a result of intensive treatment;
• the second (2 B) are patients with an advanced process, the cure of which cannot be achieved by any methods and who require restorative, symptomatic treatment and periodic (if indicated) anti-tuberculosis therapy.

Third group (III).
The third group (control) includes persons cured of tuberculosis of any localization.

Fourth group (IV).
The fourth group takes into account persons in contact with sources of tuberculosis infection. It is divided into two subgroups:

• fourth (IV-A) - for persons who have household and work contact with the source of infection;
• fourth (IV-B) - for persons who have professional contact with the source of infection.

Some indicators and criteria for dispensary observation and recording tactics

Tuberculosis of doubtful activity. This concept refers to tuberculous changes in the lungs and other organs, the activity of which seems unclear. To clarify the activity of the tuberculosis process, a 0 (zero) subgroup of dispensary observation was identified, the purpose of which is to carry out a set of diagnostic measures.

The main set of diagnostic measures is carried out within 2-3 weeks.

From the zero group, patients can be transferred to the first or sent to treatment and preventive institutions of the general network.

Active tuberculosis is a specific inflammatory process caused by MBT and determined by a complex of clinical, laboratory and radiation (x-ray) signs.

Patients with an active form of tuberculosis need therapeutic, diagnostic, anti-epidemic, rehabilitation and social measures.

All patients with active tuberculosis, diagnosed for the first time or with relapse of tuberculosis, are enrolled only in Group I of dispensary observation.

Chronic course of active forms of tuberculosis- long-term (more than 2 years), including a wave-like (with alternating subsidence and exacerbation) course of the disease, in which clinical, radiological and bacteriological signs of activity of the tuberculosis process persist.

The chronic course of active forms of tuberculosis occurs due to late detection of the disease, inadequate and unsystematic treatment, characteristics of the body's immune state, or the presence of concomitant diseases that complicate the course of tuberculosis.

Clinical cure is the disappearance of all signs of the active tuberculosis process as a result of the main course of complex treatment.

The statement of clinical cure of tuberculosis and the moment of completion of an effective course of complex treatment are determined by the absence of positive dynamics of signs of the tuberculosis process within 2-3 months.

The observation period in group I should not exceed 24 months, including 6 months after effective surgical intervention.

Bacteria Eliminators- patients with an active form of tuberculosis in whom MBT was found in the biological fluids of the body released into the external environment and/or in pathological material.

Among patients with extrapulmonary forms of tuberculosis, those who have MBT are found in the discharge of fistulas, urine, menstrual blood or secretions of other organs are classified as bacteria-excreting patients.

Patients whose MBT were isolated during culture of puncture, biopsy or surgical material are not counted as bacteria excretors.

In order to establish bacterial excretion in each patient with tuberculosis, before treatment, sputum (bronchial water) and other pathological discharge must be carefully examined at least three times by bacterioscopy and culture.

The examination is repeated monthly during treatment until the MBT disappears, which must subsequently be confirmed by at least two consecutive studies (including cultural ones) at intervals of 2-3 months.

Cessation of bacterial excretion (synonym - abacillation) is the disappearance of MBT from biological fluids and pathological discharge from the patient’s organs that enter the external environment.

Abacillation is confirmed by two negative sequential bacterioscopy and culture (culture) studies with an interval of 2-3 months after the first negative test.

Residual post-tuberculosis changes. Residual changes include dense calcified foci and foci of various sizes, fibrous and cirrhotic changes (including with residual sanitized cavities), pleural layers, postoperative changes in the lungs, pleura and other organs and tissues, as well as functional abnormalities after clinical cure.

Single (up to 3 cm), small (1 cm), dense and calcified lesions, limited fibrosis (within 2 segments) are regarded as minor residual changes.

All other residual changes are considered major.

Destructive tuberculosis- an active form of the tuberculosis process with the presence of tissue decay, determined by a complex of radiation research methods.

The main method for identifying destructive changes in organs and tissues is radiation examination (x-ray - survey radiographs, tomograms).

Closing (healing) the decay cavity They consider its disappearance, confirmed by radiological diagnostic methods.

Exacerbation (progression)- the appearance of new signs of an active tuberculosis process after a period of improvement or intensification of signs of the disease before the diagnosis of clinical cure.

The occurrence of an exacerbation indicates ineffective treatment and requires its correction.

Relapse- the appearance of signs of active tuberculosis in persons who previously had tuberculosis and were cured of it, observed in group III or removed from the register due to recovery.

The appearance of signs of active tuberculosis in spontaneously recovered persons who were not previously registered in anti-tuberculosis institutions is regarded as a new disease.

Formulation of the diagnosis upon inclusion or transfer to the dispensary registration group

When a patient is included in Group I of dispensary registration.
Example:

1. Infiltrative tuberculosis of the upper lobe of the right lung (SI, S2) in the phase of disintegration and seeding, MBT+.
2. Tuberculous spondylitis of the thoracic spine with destruction of vertebral bodies Th 8-9, MBT-.
3. Cavernous tuberculosis of the right kidney, MBT+.

When transferring a patient to group II (with chronic tuberculosis), indicate the clinical form of tuberculosis that currently occurs.

At the time of registration, the patient had an infiltrative form of tuberculosis. With an unfavorable course of the disease, fibrous-cavernous pulmonary tuberculosis has formed (or a large tuberculoma persists with or without decay). The translated epicrisis must indicate the diagnosis of fibrous-cavernous pulmonary tuberculosis (or tuberculoma).

When transferring a patient to the control group (III), the diagnosis is formulated according to the following principle: clinical cure of one or another form of tuberculosis (the most severe diagnosis during the period of illness is given) with the presence of residual post-tuberculosis changes (major and minor), the nature and prevalence of residual changes are noted.

Examples of formulating a diagnosis when transferring a patient to the control (III) group of dispensary records.

1. Clinical cure of focal pulmonary tuberculosis with the presence of small residual post-tuberculosis changes in the form of single small, dense foci and limited fibrosis in the upper lobe of the left lung.
2. Clinical cure of disseminated pulmonary tuberculosis with the presence of large residual post-tuberculosis changes in the form of numerous dense small foci and widespread fibrosis in the upper lobes of the lungs.
3. Clinical cure of pulmonary tuberculoma with the presence of large residual changes in the form of scars and pleural thickenings after minor resection (SI, S2) of the right lung.

In patients with extrapulmonary tuberculosis, diagnoses are formulated on the same principle as in patients with pulmonary tuberculosis.

1. Clinical cure of tuberculous coxitis on the right with partial dysfunction of the joint.
2. Clinical cure of tuberculous gonitis on the left with outcome in ankylosis.
3. Clinical cure of tuberculous gonitis on the right with residual changes after surgery, joint ankylosis.