Tuberculosis is known throughout the world. Development of tuberculosis: signs and symptoms of various stages of the disease. Based on etiology, tuberculosis is divided into

Tuberculosis is the most dangerous disease known for a long time. Despite numerous advances in medicine, it is still not possible to prevent the development of the disease and defeat it.

It is difficult to say what causes tuberculosis. Several million people die from it every year. The pathology is infectious, the symptoms of its appearance and provoking factors will be discussed below.

Only a doctor can answer where tuberculosis comes from. The causative agent of the disease is Koch's bacillus.

Other mycobacteria can also provoke pathology:

1. Tuberculosis humanus- the most common bacteria. During examination, this type is often identified.
2. Tuberculosis africanus- found among residents of African countries.
3. Tuberculosis microti- found in humans only in extreme cases. The carriers are rodents.
4. Tuberculosis bovines– the most dangerous form of the disease, the BCG vaccine was created against it.

After microbacteria multiply, immune reaction. In the presence of favorable conditions bacteria can live up to six months.

Important! Duration incubation period can last up to many years, while the person is unaware that he has a serious illness.

Routes of transmission of tuberculosis

It is important not only to know what causes tuberculosis, but also how it is transmitted.

There are several ways to do this:

Name	Description
	The frequency of infection, therefore, comes first. Approximately 90% of patients get the disease in this way. When you cough, the source of infection releases about three thousand bacteria into the air, and they spread over a radius of a meter or more. Once the mucus particles dry, they will continue to be infectious. People who stay close to a sick person for a long time put themselves at risk.
	This method involves using the personal belongings of the infected person. Pathology can be transmitted through sexual contact, as well as through a kiss. If there are wounds and scratches on the skin, infection can occur through the blood. In medicine, there are many cases where the disease begins in TB doctors.
	This method is often inherent rural areas, people do not analyze milk and meat, but immediately eat it. Cows with tuberculosis produce contaminated milk.
	If a woman is sick with a disease, this does not mean that her child will become infected. However, the risk of this is great. In order to diagnose pathology in a child, it is necessary to examine the placenta. The prognosis in this case is unfavorable because the baby’s immunity is weakened.

Unfortunately, it is easy to become infected with tuberculosis. According to health data, about two billion people have tuberculosis. The video in this article explains exactly how the disease develops.

The first symptoms of tuberculosis

At the first stage of development, it is difficult to differentiate tuberculosis from acute respiratory infections or other diseases. The person feels weakened, overwhelmed, and constantly sleepy.

Appetite disappears, mood disappears, even minor stress can cause a violent reaction. The body temperature remains at 37 - 38 degrees, the cough is paroxysmal, at night and in morning time day is particularly disturbing. The first symptoms can appear both together and separately.

Symptoms progress as follows:

1. Appearance changes– the face of a sick person becomes haggard, the complexion pale. The sparkle in the eyes speaks of poor condition health. The patient rapidly loses weight; at the first stage of the disease, the symptoms are not very noticeable, but with chronic tuberculosis they are a constant concern. The diagnosis at this stage is made without difficulty.
2. Temperature. This is another sign of tuberculosis - the temperature lasts for a month, in addition to it, there may not be any symptoms. A person often sweats, but even this does not help bring down the temperature, as the infection constantly leads to a fever. At a late stage of the development of the disease, the temperature becomes febrile, that is, the mark on the thermometer is 39 and above.
3. Cough- the patient almost constantly coughs, initially it is dry, after which it develops into a paroxysmal. After some time it becomes wet, the patient at this moment experiences significant relief. Important! A cough that does not go away for three or more weeks is a reason to visit a phthisiatrician.
4. Hemoptysis- a dangerous symptom, indicates the development of an infiltrative form of tuberculosis. To make a definitive diagnosis, it is necessary to differentiate the disease from heart failure and malignant tumor, since these pathologies also cause hemoptysis. In tuberculosis, blood is released after coughing, in rare cases it can flow like a “fountain,” which indicates a cavity rupture. To save the life of a sick person, immediate assistance from specialists is required.
5. Chest pain- This is a rare symptom. The symptom most often occurs during the chronic or acute stage.

The photo below is an example of what a sick person looks like when tuberculosis develops.

Is it possible to cure the disease?

Tuberculosis is a pathology that requires long-term and complex treatment, it depends on the stage of development and other nuances.

Therapy may include the following:

• chemotherapy;
• taking medications;
• surgical intervention;
• rest in sanatoriums.

The first and main goal of treatment is to stop the inflammatory process, this will avoid further tissue destruction, the infiltrate will resolve, mycobacteria will no longer be excreted from the body of a sick person. In other words, doctors will do everything possible to ensure that the patient is not contagious to others. Similar treatment takes about six months.

The following treatment regimen is a three-component one. Antibiotics are prescribed: Isoniazid, Streptomycin. There are also additional therapy, which includes the following:

1. Immunostimulants - the body of a sick person will be able to overcome tuberculosis mycobacteria.
2. Sorbents are prescribed when chemotherapy is stopped.
3. Vitamin complexes.
4. Glucocorticoids are the most extreme measure in treatment, helping to eliminate the inflammatory process.

Instructions for taking medications are indicated by the doctor, the course of treatment is different for each patient. In advanced cases, surgery may be required.

The following methods are currently used:

1. Speleotomy - resection of large cavities occurs, conservative methods Treatments in this case are ineffective.
2. Valvular bronchoblocking - small valves are installed, so that the mouths of the bronchi do not stick together, this provides the patient with full breathing.

In order to prevent the development of such a disease, you need to know what causes pulmonary tuberculosis. With timely treatment, the prognosis is favorable.

Every third person on the planet is a carrier of the bacterium that causes tuberculosis. About 10% of carriers of the disease become ill. Tuberculosis ranks second in mortality, second only to AIDS.

Tuberculosis: what is it?

The name of the disease was given Latin word"tubercle" - tuberculum. Painful granulomas - sites of lung damage - look like lumps.
The disease is caused by numerous bacteria of the Mycobacterium tuberculosis complex species.

In more than 90% of cases, the bacterium affects the lungs. A rare 8-9% occurs in damage to the lymphatic, nervous and genitourinary system, bones, skin or the entire body (miliary form of the disease).

When the pathogen enters the body, a small granuloma forms in the lungs. Healthy body With good immunity copes with the disease on his own, the granuloma heals after symptoms similar to ARVI and fatigue. A healed granuloma can only be detected later - through x-ray examination.

An organism weakened by illness, stress, diet or overwork is unable to provide an adequate immune response to the invasion of Mycobacterium tuberculosis.

The granuloma begins to grow, forming a cavity inside itself - a cavern - filled with blood. From the cavern the blood inhabited pathogenic bacteria, enters the general bloodstream and creates new granulomas. The body can still cope with one granuloma, but as soon as there are several of them, without medical care the person will soon die.

Cavities grow in the lungs, close cavities merge and form large cavities filled with pathogenic fluids. Fluid appears in the chest cavity between the lungs and the sternum. A patient with active tuberculosis is highly contagious.

Patients who develop active tuberculosis for the second time die in 30% of cases, despite treatment.

Tuberculosis: when did it appear?

The ill-fated disease has plagued humanity almost since the appearance of the species. Archaeologists have discovered 3,000-year-old skeletons containing bone lesions characteristic of tuberculosis.

Consumption, which is deadly in Rus' - what kind of disease is it? This was the name for pulmonary tuberculosis, which for many centuries was a death sentence for the patient. They tried to treat consumption in Rus' back in the 11th century by cutting out and cauterizing tuberculous cavities in the lungs.

IN Ancient Greece The disease was called phtisis - wasting. From Greek name disease is called "phthisiology" - a branch of medicine that deals with the treatment and prevention of tuberculosis.

Even ancient healers, including Hippocrates and Avicenna, tried to fight the disease. We can say that the struggle of doctors against tuberculosis lasted thousands of years. Tuberculosis was defeated only in the 20th century, when antibiotics came to the aid of doctors - the only drugs that can fight Mycobacterium tuberculosis.

Tuberculosis: how does infection occur?

98% of infections occur by airborne droplets.

A patient with an active form of tuberculosis releases bacteria when he coughs or sneezes and can infect up to 15 people a year. Also, pathogens are excreted in sweat, urine, saliva and other physiological fluids sick.

Science has more than 70 species of mycobacteria - the causative agents of tuberculosis. Mycobacteria live everywhere: in soil, water, air, in the bodies of birds, animals and people.
In addition, the tuberculosis bacillus can be crushed into tiny particles or cling together into a huge octopus, retaining its dangerous properties.

Mycobacteria are amazingly viable in any environment. They live in street dust for 10 days, on the pages of books for 3 months, in water for 5 months.

Dried bacteria caused illness in six months guinea pig. When frozen, bacteria are dangerous even after 30 years!

The most favorable environment for mycobacteria: a moist, warm environment with a temperature of 29-42 °C. At a temperature of 37-38 ° C, mycobacteria multiply intensively, therefore human body is an ideal habitat for the tuberculosis bacillus.

Tuberculosis bacillus is constantly evolving and adapting to environmental conditions. Mycobacteria also adapt to medicines, so we have to develop new more strong drugs to fight the disease.

There are cases when the patient abandoned the treatment he had begun - in this case, the tubercle bacillus in the body became resistant to drugs, and it became impossible to cure the patient.

Tuberculosis: first symptoms

Diagnosing tuberculosis is easy with simple medical tests. Regular examination has saved the lives of millions of people, because the earlier treatment is started, the more favorable the prognosis.

How does tuberculosis manifest?

• Dry cough – more than 2 weeks.
• Weight loss.
• Sweating during sleep. In addition, sleep becomes restless.
• Loss of appetite.
• Constant low-grade fever 37-37.5 °C.
• Chronic weakness, fatigue.

As the disease progresses, secondary symptoms of the disease appear.

• The cough becomes painful, producing large amounts of sputum. After the attack, the patient feels temporary improvement. One of the characteristic signs of tuberculosis is sputum with blood or simply discharge of blood from the throat during coughing.
• Pain appears in the chest, especially when taking a deep breath.
• Under the skin, more in the area of ​​the legs, nodules of a red-brown hue appear, painful when touched.

Tuberculosis: diagnosis

There are simple medical tests to diagnose tuberculosis.

Mantoux test

Tuberculin solution inoculation is injected under the skin of a child older than 1 year or a teenager. After 3 days, a reddish spot appears at the vaccination site, which is used to judge the adequacy of the body's immune response to the pathogen. With a normal reaction of the body, the spot takes on dimensions of 5-15 mm.

Fluorography

A photo of the chest is taken under weak X-rays. All tuberculous granulomas are clearly reflected on it.

Radiography

It is carried out to study existing foci of tuberculosis.

Sputum examination

The patient may require a sputum test for the presence of tuberculous mycobacteria if he has been coughing for a long time.

Enzyme immunoassay blood test

Allows you to determine the presence of a pathogen in the body. The analysis is relevant for identifying extrapulmonary forms of tuberculosis.

Tuberculosis: treatment

Tuberculosis treatment is carried out only permanently under the supervision of a phthisiatrician.

The standard course of treatment lasts six months - during this period the body, supported by intensive treatment, completely gets rid of the disease.

During the treatment period, the person completely falls out of active life because the treatment is very intensive.

The main treatment is antibacterial, aimed at destroying tuberculous mycobacteria that have infected the body.

Tuberculosis: extrapulmonary forms

These forms of tuberculosis are extremely rare and are treated according to the same regimens as pulmonary tuberculosis.

Damage to the genitourinary organs

Diagnosed by urine analysis. The main symptom is cloudy urine and the presence of blood in it. Urination is frequent and painful. Women experience bleeding aching pain lower abdomen. In men, there is a painful swelling in the scrotum.

Damage to joints and bones

This form of the disease is typical for HIV-infected people. The tuberculosis bacillus affects the knees, spine and hip joints. The result is lameness and sometimes a hump.

Damage to the central nervous system

Occurs in HIV-infected patients and infants with congenital tuberculosis. Mycobacterium infects the membranes of the brain. Symptoms: severe headaches, fainting, convulsions, hearing and vision impairment. The disease is practically incurable.

Miliary lesion

Microgranulomas - up to 2 mm in diameter - are scattered throughout the body. Inflammatory process It occurs in addition to the lungs in the kidneys, liver and spleen and requires long-term treatment.

Damage to the digestive tract

This form of tuberculosis is typical for HIV-infected people. The abdomen swells, pain, diarrhea and constipation appear, with feces blood is released. Besides usual treatment surgical intervention is often required.

Skin lesions

The patient's entire body is covered with subcutaneous dense painful nodules. They burst when pressed, and white cheesy contents are released from them.

A simple medical examination can detect tuberculosis in early stages lung lesions, when it can be relatively easily cured. This is especially important for children, weakened and elderly people, whose body has difficulty coping with the disease.

Tuberculosis is an infectious disease caused by various types of mycobacteria (most often Koch's bacillus). The disease usually affects lung tissue, rarely affecting other organs. Mycobacterium tuberculosis is transmitted by airborne droplets when a patient coughs, sneezes or talks. After infection with tuberculosis, the disease often occurs in a latent form (tuberculosis), but sometimes becomes active.

The causative agent is Mycobacterium tuberculosis. Tuberculosis in humans can be caused by Mycobacterium tuberculosis, Mycobacterium bovis, Mycobacterium africanum, Mycobacterium bovis BCG, Mycobacterium microti, Mycobacterium canettii, Mycobacterium caprae, Mycobacterium pinnipedii. There are the following routes of transmission of tuberculosis infection:

• Airborne (most common): Bacteria become airborne when someone with active disease coughs, sneezes, or talks. The infection enters the lungs of a healthy person.
• Nutritional: penetration of bacteria with food.
• Contact: with direct contact. Usually infection occurs through the mucous membrane.
• Intrauterine infection: the possibility of infection of the fetus in utero has been established.

Types of disease: classification of tuberculosis

There are pulmonary and non-pulmonary forms of tuberculosis. Phases of the tuberculosis process: infiltration, decay, contamination; resorption, compaction, scarring, calcification.

More than 90% of cases occur in the pulmonary form of tuberculosis. Damage to the genitourinary organs, brain, bones, intestines and other organs is also possible.

Depending on whether a person fell ill with tuberculosis for the first time or not, primary and secondary tuberculosis are distinguished.

• Primary tuberculosis is an acute form of the disease that begins to manifest itself after the pathogen enters the bloodstream. Primary tuberculosis is often observed in children under 5 years of age. This is because the immune system is not yet fully formed in children, which is not able to cope with mycobacteria. Despite the fact that the disease is severe during this period, it is not dangerous to others. At the beginning of primary tuberculosis, a small granuloma forms in the lungs. This is the primary focus of lung damage, which, if the outcome is favorable, can heal on its own. Thus, the patient may not even suspect that he actually had tuberculosis, attributing his health to a cold. However, after the next X-ray, it turns out that he has a healed granuloma in his lungs. The development of a bad scenario involves the enlargement of the granuloma with the formation of a cavity in which tuberculosis bacilli accumulate. Mycobacteria enter the bloodstream, where they spread throughout the body.
• Secondary tuberculosis. This form of the disease occurs when a person has already had tuberculosis once, but he became infected with another type of mycobacteria. Or secondary tuberculosis can occur in the form of an exacerbation of remission of the disease. Secondary tuberculosis is much more severe than primary tuberculosis. New lesions form in the lungs. In some cases, they are located very close to each other, which merge to form large cavities. Approximately 30% of patients with secondary tuberculosis die within 2-3 months after the onset of the disease.

Symptoms of tuberculosis: how the disease manifests itself

At the onset of the disease, tuberculosis is quite difficult to distinguish from ordinary acute respiratory infections. The patient experiences constant weakness and weakness. In the evening there is a slight chill, and sleep is accompanied by sweating and sometimes nightmares.

Body temperature in initial stage tuberculosis stays at 37.5 - 38 degrees. The patient has a dry cough, which worsens in the morning. Please note that all of the above symptoms may appear simultaneously or all together.

Now let's take a closer look at the main symptoms of tuberculosis:

• Change in appearance. With tuberculosis, the face becomes pale and haggard. The cheeks seem to sag, and the facial features become sharper. The patient is rapidly losing weight. At the initial stage of the disease, these symptoms are not very noticeable, however, in the chronic form of tuberculosis, the changes in appearance are so striking that the doctor is very likely to make a preliminary diagnosis just by appearance.
• Heat. Low-grade fever (37-38 degrees), which does not subside within a month - characteristic feature tuberculosis. In the evening, body temperature may rise slightly - up to 38.3 - 38.5 degrees. Despite the fact that the patient sweats all the time, the body temperature does not subside, since the infection constantly provokes the development of a febrile state. On late stages Tuberculosis may cause febrile fever, reaching 39-40 degrees and above.
• Cough. With tuberculosis, the patient coughs almost constantly. At the beginning of the disease, the cough is usually dry and intermittent. However, as the disease progresses, when cavities form in the lungs, the cough intensifies and is accompanied by copious sputum production. If a person’s cough bothers him for more than three weeks, then this is a reason to contact a TB doctor!
• Hemoptysis. This is enough dangerous symptom, indicating the infiltrative form of the disease. In this case, the diagnosis must be differentiated from a lung tumor and acute heart failure, since these diseases are also characterized by hemoptysis. In severe cases, blood may gush out, indicating a rupture of the cavity. In this case, the patient requires urgent surgical intervention.
• Chest pain. As a rule, pain in the chest and in the area of ​​the shoulder blades bothers patients with both acute and chronic forms of tuberculosis. If pain is observed at the onset of the disease, it is mild and similar to discomfort. The pain intensifies when taking a deep breath.

Patient actions during tuberculosis

At the slightest suspicion of illness, you should contact family doctor. A lingering cough that is not relieved by conventional antitussives should alert a person. You should see a doctor and go through everything necessary examinations for the presence/absence of tuberculosis.

Diagnosis of tuberculosis

To detect tuberculosis, fluorography (or computed tomography) is performed. With a productive cough, a sputum sample is taken for examination to determine the pathogen, as well as its sensitivity to antibiotics. Sometimes bronchoscopy is performed. If you suspect the presence of non-pulmonary forms of tuberculosis, tissue samples of these organs are examined.

Children under 18 years of age undergo the Mantoux test annually. A positive Mantoux test indicates infection with tuberculosis bacilli.

The basis of tuberculosis therapy is multicomponent anti-tuberculosis chemotherapy. There are several treatment regimens:

The three-component scheme of therapy includes the use of isoniazid, streptomycin, para-aminosalicylic acid (PAS). This classical scheme, however, is not currently used due to the high toxicity of PAS, the impossibility of prolonged use of streptomycin.

Quadruple regimen: isoniazid, rifampicin (or rifabutin), ethambutol, pyrazinamide.

Five-component scheme: A fluoroquinolone derivative (ciprofloxacin) is added to the four-component scheme. In the treatment of drug-resistant forms of tuberculosis, drugs of the second, third and next generations of this group are included.

With insufficient effectiveness of 4-5-component chemotherapy regimens, second-line (reserve) chemotherapy drugs (capreomycin, cycloserine), which are quite toxic to humans, are used.

Much attention is paid to the quality, varied nutrition of patients, correction of hypovitaminosis, leukopenia, anemia. Tuberculosis patients suffering from alcohol or drug addiction undergo detoxification before starting chemotherapy.

In the presence of HIV infection in combination with tuberculosis, specific anti-HIV therapy is used in parallel with anti-tuberculosis therapy, and the use of rifampicin is also contraindicated in such patients.

In some cases, glucocorticoids may be prescribed. The main indications for their use are severe inflammation, severe intoxication. Glucocorticoid drugs are prescribed for a short period of time and in minimal doses, which is associated with their immunosuppressive effect.

Plays an important role in the treatment of tuberculosis Spa treatment. Improved oxygenation of the lungs when inhaling rarefied air mountain resorts helps reduce the reproduction and growth of mycobacteria. Hyperbaric oxygenation is used for the same purpose.

IN advanced cases apply surgical methods treatment: application of artificial pneumothorax, drainage of pleural cavity or empyema, removal of the affected lung or its lobe, and others.

Complications of tuberculosis

Complications of tuberculosis include hemoptysis or pulmonary hemorrhage, pulmonary heart failure, spontaneous pneumothorax, atelectasis, renal failure, bronchial, thoracic fistulas.

The main prevention of tuberculosis is the BCG vaccine (Bacillus Calmette-Guerin). Vaccination is carried out in accordance with the calendar preventive vaccinations. The first vaccination is carried out in the maternity hospital in the first 3-7 days of a newborn’s life. At 7 and 14 years old in the absence of contraindications, negative reaction Mantoux is revaccinated.

In order to detect tuberculosis in the early stages, the entire adult population must undergo fluorographic examination at least once a year.

Tuberculosis– one of the oldest diseases of mankind. This is confirmed by archaeological finds: tuberculosis of the vertebrae was found in Egyptian mummies. The Greeks called this disease phtisis, which translates as “exhaustion”, “consumption”. From this word comes the modern name of the science that studies tuberculosis - phthisiology; and specialists who study tuberculosis are called phthisiatricians.

In the 17th - 18th centuries, during the period of urbanization and rapid development of industry, the incidence of tuberculosis acquired the character of an epidemic in Europe. In 1650, 20% of deaths among residents of England and Wales were due to tuberculosis.

However, the exact cause of the disease was not known until 1882, when Robert Koch discovered the causative agent of this disease - the bacterium Mycobacterium tuberculosis, which is still called Koch's bacillus.

In the first half of the twentieth century, the incidence of tuberculosis in developed countries began to decline, despite the absence effective methods treatment, which was due to improved socio-economic living conditions, as well as isolation of patients. However, by the 1980s, a rise in the incidence of tuberculosis was again recorded in developed countries. WHO experts explain this by the spread of HIV infection, the influx of immigrants from disadvantaged tuberculosis countries, as well as social factors– poverty, vagrancy, drug addiction. In a number of places (including Russia), the situation was aggravated by a significant reduction in the control of health authorities over tuberculosis. In Russia, the rise in the incidence of tuberculosis began in 1991 and reached its maximum value - 83 people per 100 thousand population - in 2000, since then the incidence rate has not decreased. Currently, Russia is one of the 22 countries with the highest incidence of tuberculosis.

The causative agent of tuberculosis

The causative agents of tuberculosis are Mycobacterium tuberculosis. A distinctive feature of the tuberculosis bacillus is its special shell, which helps the bacterium survive in very harsh environmental conditions, including resisting major antimicrobial drugs.

In addition, Mycobacterium tuberculosis multiplies extremely slowly, which makes diagnosis somewhat difficult.

Risk of contracting tuberculosis

Most often, Mycobacterium tuberculosis is transmitted by airborne droplets. When patients with tuberculosis cough, sneeze, or talk, they release the pathogen into the surrounding air in tiny droplets. When the droplets dry, even smaller particles are formed, consisting of 1-2 microbial cells; these particles do not settle under the influence of gravity and remain suspended in the air for a long time, from where they enter the lungs of a healthy person.

For another type of mycobacteria - Mycobacterium bovis - which can also cause tuberculosis in humans, is also characterized by a food route of infection - through raw milk. Currently, this route of transmission of infection has lost its relevance.

The risk of infection depends on the nature and duration of contact with the source of infection and the degree of infectiousness of the patient. The likelihood of infection increases many times if the patient has active pulmonary tuberculosis, i.e. in the presence of a tuberculous cavity in the lung, as well as in cases of damage to the upper respiratory tract(bronchi, trachea, larynx).

In addition, infection usually occurs through close and prolonged contact with a sick person - most often if the sick person is a family member.

One of the most significant risk factors for infection is crowding of people in poorly ventilated areas.

Risk of getting tuberculosis

When Mycobacterium tuberculosis enters the lungs of a healthy person, it does not always lead to illness. The risk of the disease depends mainly on individual sensitivity to Mycobacterium tuberculosis, as well as on the state of the immune response.

The risk of getting sick significantly depends on the age of the infected person. Among those infected, the incidence of tuberculosis is highest in youth and at a young age. In women, most cases of the disease occur between the ages of 25 and 34 years; at this age, women get sick more often than men.

A number of diseases contribute to the development of active tuberculosis in infected individuals. The leading place among them is occupied by HIV infection, as a result of which the immune response is suppressed. The risk of developing tuberculosis depends on the degree of immune suppression. For patients with HIV infection, an annual Mantoux test and prophylaxis with anti-tuberculosis drugs are recommended, if necessary.

In addition, the risk of developing tuberculosis increases with chronic lung diseases, blood tumors, and other malignant neoplasms, at renal failure with constant hemodialysis, insulin requirement diabetes mellitus and general exhaustion.

Most often, only people with reduced immunity have a real risk of contracting tuberculosis.

• Young children.
• HIV-infected.
• People who are undernourished and experience frequent hypothermia.
• People living in damp, poorly heated and ventilated areas.

In addition, the risk of infection increases many times over with close and prolonged contact with patients with active forms of tuberculosis.

Pulmonary tuberculosis

The most common form of tuberculosis is pulmonary tuberculosis. Before the advent of HIV infection, pulmonary tuberculosis accounted for 80% of all tuberculosis cases. A pronounced decrease in immunity in AIDS contributes to the formation of extrapulmonary foci of infection (simultaneously with or without pulmonary ones).

The lungs are the primary portal of infection. Bacteria, passing through the respiratory tract, enter the terminal parts of the bronchi - the alveoli - small sacs at the end of the thinnest bronchioles. From there, bacteria are able to enter the bloodstream and spread throughout the body, but to do this, bacteria need to overcome many protective barriers, which is possible either with a decrease in immunity or with massive infection.

Tuberculosis that develops immediately after infection is called - primary tuberculosis. It often occurs in children under 4 years of age, which is associated with insufficient development of the immune system. Therefore, at this age, tuberculosis is often severe, but patients are most often not contagious.

With primary tuberculosis, a primary focus is usually formed - an area of ​​the lung affected by tuberculosis (tuberculous granuloma). The primary lesion may heal on its own and turn into a small area of ​​scar tissue, which is sometimes found on x-rays. healthy people, which indicates previous tuberculosis. However, in some cases, the primary lesion progresses, increases in size, its central part disintegrates and a cavity is formed - the primary pulmonary cavity. From the primary pulmonary focus, Mycobacterium tuberculosis can enter the bloodstream and settle in various organs, forming tuberculosis granulomas (tubercles), which is where the name tuberculosis comes from (tuberculum from Latin - “tubercle”).

Secondary tuberculosis– the result of re-infection or re-activation of an infection already existing in the body. Mostly adults suffer from this form of the disease. New lesions and cavities are formed, which can merge with each other, leading to extensive lesions and severe intoxication. Without treatment, about a third of patients die in the coming months; For others, the infection may become protracted, or the disease may spontaneously subside.

At the very beginning of the disease, symptoms are often mild and nonspecific, but then the symptoms intensify, leading to significant suffering.

• Fever.
• Sweating at night.
• Losing weight.
• Loss of appetite.
• Malaise, weakness.
• Cough: at first dry, then sputum is added, which soon becomes purulent, sometimes streaked with blood.
• Hemoptysis.
• When the vessel wall is destroyed, pulmonary hemorrhage may occur.
• Chest pain that gets worse with breathing.
• Dyspnea – occurs with massive damage and serves as a manifestation of respiratory failure

However, it also happens that the disease is asymptomatic, and the primary lesion is discovered only years later during radiography for another reason.

Tuberculous pleurisy

Extrapulmonary tuberculosis has become increasingly common in recent years due to the widespread spread of HIV infection. Mycobacterium tuberculosis, in addition to the lungs, can affect almost any organs and tissues.

Tuberculous pleurisy- This is a tuberculous lesion of the membrane covering the lungs - the pleura. Occurs as a complication of pulmonary tuberculosis.

Pleurisy can be dry - when the layers of the pleura become inflamed, but fluid does not accumulate between the leaves.

Or it may arise exudative pleurisy– when pleura accumulates between the layers inflammatory fluid– exudate that can compress lung tissue and cause shortness of breath.

Symptoms for tuberculous pleurisy are the same as for pulmonary tuberculosis; chest pain may be more intense due to friction of the inflamed pleura against each other; and if there is liquid in pleural cavity respiratory failure comes to the fore.

Upper respiratory tract tuberculosis

Upper respiratory tract tuberculosis is always a complication of pulmonary tuberculosis.

IN infectious process the pharynx and larynx are involved. In this case, the above-mentioned complaints are accompanied by hoarseness of voice and difficulty swallowing.

Tuberculous lymphadenitis

Tuberculous lymphadenitis- This is a tuberculous lesion of the lymph nodes. Occurs as a complication of pulmonary tuberculosis or independently of it.

The cervical and supraclavicular lymph nodes are most often affected. The lymph nodes are enlarged, but painless.

Tuberculosis of the genitourinary organs

The infection can affect any part of the body urinary tract and genitals. Symptoms depend on the location of the lesion:

• Frequent, painful urination.
• Blood in urine.
• Pain in the lower abdomen and lower back.
• Women may experience menstrual irregularities and infertility.
• In men, when the epididymis is affected, a space-occupying formation is formed in the scrotum, which is somewhat painful.

However, in some cases the disease is asymptomatic.

Tuberculosis genitourinary tract responds well to treatment with anti-tuberculosis drugs.

Tuberculosis of bones and joints

Currently, tuberculous lesions of bones and joints are rare, mainly among HIV-infected people. Most often, intervertebral, hip and knee joints are affected by tuberculosis of bones and joints.

When defeated intervertebral joint the pathological process spreads to the adjacent vertebra, destroying intervertebral disc, which can lead to flattening of the vertebrae and the formation of a curvature of the spine (hunchback).

Damage to the hip and knee joints causes severe pain when walking, accompanied by lameness. If left untreated, joint function may be lost.

Tuberculosis of the central nervous system

Central tuberculosis nervous system(CNS) occurs infrequently, mainly in young children and in HIV-infected people. It includes damage to the lining of the brain - tuberculous meningitis or the formation of tuberculoma in the substance of the brain.

With tuberculous meningitis, the symptoms are varied:

• Headache.
• Mental disorders.
• Disturbances of consciousness: stupor, confusion.
• Sensory disturbances.
• Impaired movement of the eyeballs.

Without treatment, tuberculous meningitis is always fatal. Even after effective treatment neurological disorders may remain.

Tuberculous granuloma of the brain may appear epileptic seizures, local disturbances of sensitivity and/or movement.

Miliary tuberculosis

Miliary tuberculosis is a generalized form of the disease when the pathogen spreads through the blood throughout the body. At the same time, small lesions form in various organs and tissues - granulomas, which are tubercles with a diameter of 1-2 mm, reminiscent of millet grains. Hence the name of this form of the disease – “milium” from Lat. - “millet”.

The main manifestations correspond to the symptoms of pulmonary tuberculosis, but in addition there are signs of damage to other organs: liver, spleen, eyes, meninges.

Tests for tuberculosis

Mantoux test

The Mantoux test (tuberculin test, PPD test) is a method for determining the strength of immunity to the causative agent of tuberculosis.

The test consists of introducing into the area of ​​the inner surface of the forearms special drug– tuberculin, which is a purified product obtained from Mycobacterium tuberculosis after special processing.

Why is the Mantoux test performed?

The first vaccination against tuberculosis - the BCG vaccine - is carried out in the first 3-7 days of life. However, the BCG vaccine does not always provide sufficient immunity to prevent infection. To determine how effective immunity against tuberculosis is, the Mantoux test is performed annually. Based on the test results, children are selected for revaccination, which is carried out at 7 and 14-15 years of age. In epidemiologically unfavorable areas with a high prevalence of tuberculosis, revaccination is carried out at 6-7, 11-12 and 16-17 years of age.

In addition, the Mantoux test allows you to identify infected individuals and begin timely treatment.

How is the Mantoux test performed?

The Mantoux test is carried out annually, regardless of the results of the previous test. 0.1 ml of the drug, which contains 2 tuberculin units (TU), is injected into the middle third of the inner surface of the forearm. After the injection of tuberculin, a small tubercle is formed, which is usually called a “button”.

Is it possible to wet the Mantoux sample with water?

You can swim or shower with a Mantoux test. You should not swim in open water to avoid infecting the wound. You should also not rub the area with a washcloth, or use any liquids or solutions: brilliant green, iodine, peroxide, or cover the wound with a band-aid. You also need to make sure that the child does not scratch the wound. All this can affect the test result and lead to a false positive result.

Evaluation of results

After the administration of tuberculin, if there are antibodies against tuberculosis in the body, an inflammatory reaction is formed at the injection site - protective antibodies react with fragments of the pathogen. In this case, approximately 2-3 days after injection, a small red tubercle forms at the injection site, rising above the skin level, dense to the touch, turning pale when pressed.

Results are assessed on day 3. To do this, measure the diameter of the papule (tubercle) with a transparent ruler in good lighting. It is not the size of the redness that is measured, but the size of the lump.

• Negative reaction - if there is no reaction at all or a pinprick reaction - 0-1mm
• The reaction is questionable - if there is only redness without a papule or the size of the papule does not exceed 2-4mm
• The reaction is positive - if the size of the papule is 5 mm or more. With an infiltrate size of 5-9mm, the reaction is considered mild, with a size of 10-14mm, medium intensity, 15-16mm, a pronounced reaction.
• The reaction is hyperergic (excessive) - if the diameter of the papule exceeds 17 mm in children and adolescents and 21 mm in adults. And also if there are any signs of severe inflammation - pustules, inflammation of nearby lymph nodes, etc.

A negative test indicates the absence of antibodies against the tuberculosis bacillus in the body. This indicates the absence of infection, as well as the absence of a reaction to the previous BCG vaccination.

A questionable sample is actually considered negative.

A positive test may indicate infection with Mycobacterium tuberculosis or the intensity of anti-tuberculosis immunity after vaccination. Distinguishing one condition from another is not always easy.

The following evidence supports infection with a positive Mantoux test:

• The first positive reaction after negative or questionable results in previous years.
• An increase in papule by 6 mm or more compared to the previous year.
• A positive reaction with an infiltrate of 10 mm or more for 3-5 years in a row (except for some cases of an allergic reaction to tuberculin).
• Hyperergic reaction.
• The diameter of the papule is more than 12 mm 3-5 years after vaccination.
• Presence of risk factors for infection: contact with sick people tuberculosis, location in an endemic region, low socio-economic status.

What to do if the test is positive?

If the sample was assessed as positive or hyperergic, and was excluded possible influence immunity after the vaccine, it is recommended to consult a phthisiatrician who conducts a number of additional studies to diagnose primary tuberculosis: X-ray examination chest organs, microbiological examination sputum for the determination of Mycobacterium tuberculosis, examination of family members, etc. If, after a complete examination, no signs of infection are found, a positive or hyperergic test can be assessed, as allergic reaction for tuberculin. Only a TB doctor (tuberculosis specialist) has the right to make such a conclusion.

Contraindications to performing the Mantoux test:

• Skin diseases.
• Acute infectious diseases or exacerbation of chronic diseases. The test is performed one month after all symptoms of the disease disappear.
• Allergic conditions.
• Epilepsy.
• Quarantine in children's institutions. The test can be taken a month after the quarantine is lifted.

The influence of other vaccinations on the Mantoux test:

You cannot take the Mantoux test on the same day as any vaccinations, as this may affect its results. However, immediately after assessing the test results, any vaccination can be carried out.

The Mantoux test should be performed at least 4 weeks after vaccination with inactivated (killed) vaccines: against influenza, tetanus, diphtheria, etc. And 6 weeks after vaccination with live vaccines: against measles, rubella, mumps, etc.

Microbiological examination:

Microbiological examination– this is the detection of Mycobacterium tuberculosis in sputum or in biopsy samples of affected lymph nodes.

Sputum is collected in the morning; 3 sputum samples are required for testing.

X-ray examination:

Fluorography remains a reliable screening test for detecting pulmonary tuberculosis. Thanks to this study, it is possible to identify foci of active or previous tuberculosis.

If a newly detected tuberculosis focus is suspected, the patient is sent for an X-ray of the lungs, where the focus can be examined in more detail.

Treatment of tuberculosis

Treatment of active tuberculosis and tuberculosis in children is carried out in a hospital. Antibiotics are used. First-line drugs include isoniazid, rifampicin, pyrazinamide, ethambutol and streptomycin.

Isoniazid is an integral part of any course of treatment for tuberculosis (except in cases of development of resistance to isoniazid). This drug is usually prescribed orally - it is well absorbed. Taking the drug can be daily or intermittent. When taken daily, the daily dose in adults is 5 mg/kg, in children – 10-20 mg/kg. Maximum daily dose– 300 mg. When taking the drug intermittently - 2-3 times a week, the maximum daily dose is 900 mg.

Side effects of isoniazid:

• Hepatitis. The risk of developing hepatitis increases with age, as well as with concomitant alcohol abuse, concomitant use of isoniazid and rifampicin. While taking isoniazid, it is recommended to monitor the level of liver enzymes; when the first signs of the disease appear (persistent increase in ALT, AST 3-5 times higher than normal), you should stop taking the drug.
• Neuropathy. Develops in 2-20% of cases depending on the dose of the drug.
• Skin rash – 2%.
• Fever – 1.2%.
• Anemia.
• Joint pain.
• Epileptic seizures.
• Mental disorders.

Rifampicin ranks second in effectiveness against Mycobacterium tuberculosis after isoniazid. Rifampicin is prescribed 2 times a week or daily for adults 600 mg (10 mg/kg), for children - 10-20 mg/kg.

Side effects of rifampicin:

• Gastrointestinal disorders.
• Hepatitis: mainly in patients chronic hepatitis or cirrhosis of the liver (especially against the background of alcoholism)..
• Skin rash – 0.8%.
• Hemolytic anemia – 1%.
• Decrease in platelet count.

Pyrazinamide. Mainly used for short courses treatment of tuberculosis. Side effects include a toxic effect on the liver, as well as an increase in blood levels uric acid. However, gout, a disease that is caused by an increase in uric acid in the blood, rarely develops when taking pyrazinamide.

Ethambutol. This drug is somewhat weaker than other first-line drugs. Therefore, it is most often used in combination with other medicines. Ethambutol is usually well tolerated. The heaviest by-effect– neuritis optic nerve, which is manifested by decreased visual acuity, inability to distinguish between red and green colors. These changes are usually reversible, but vision recovery may take 6 months or more.

Streptomycin. This drug is administered intravenously or intramuscularly.

Side effects when using streptomycin occur most often - 10-20% of cases. The most severe of them are toxic effects on hearing and kidneys. The effect on the auditory and vestibular apparatus is manifested by imbalance, dizziness, tinnitus, and hearing loss.

The course of treatment for tuberculosis is usually 6 months. Evaluation of the effectiveness of treatment is carried out monthly based on the results of detection of the pathogen in the patient’s sputum. At severe forms ah disease, as well as in the presence of mycobacteria resistant to anti-tuberculosis drugs, the course of treatment can be extended to 12-18 months.

Complications of tuberculosis

• Complications of the tuberculosis process are varied:
• Pulmonary bleeding. It can develop when a vessel in the lungs is destroyed as a result of tuberculous inflammation. This acute complication, often ending in death.
• Pneumothorax is the accumulation of air in the pleural cavity, the space surrounding the lung. Occurs when an alveolus (the terminal part of the bronchial tree) or a bronchiole ruptures. Air accumulating in the pleural cavity compresses the lung, which leads to shortness of breath and difficulty breathing.
• Respiratory failure. With massive tuberculosis damage to the lungs, the volume of effectively working lungs decreases, which leads to a decrease in blood oxygen saturation. This leads to severe shortness of breath, sometimes attacks of suffocation.
• Heart failure. Usually accompanied by respiratory failure. Caused by an increase in pressure in the vessels of the lungs, and hard work hearts under these conditions.
• Amyloidosis of internal organs. With a long course of tuberculosis in internal organs a specific protein, amyloid, can be formed, which can lead to dysfunction of these organs.
• Reduction or loss of function of the affected joints.

Vaccination against tuberculosis

Currently, vaccination against tuberculosis is included in the mandatory vaccination program and is carried out with the BCG vaccine, which stands for “bacillus Calmette-Guerin” (BCG), named after the names of its creators. BCG was created in 1909 from a weakened strain of Mycobacterium bovis; and was first introduced to humans in 1921. The effectiveness of the BCG vaccine is the subject of much debate. According to various studies, it ranges from zero to 80%. However, it is known for sure that the vaccine is significantly effective in children and provides good protection against the development of severe forms of the disease. Mandatory universal vaccination against tuberculosis has not been adopted in all countries; this decision depends on the level of tuberculosis incidence in the country. In Russia, this level is so high that widespread vaccination is considered necessary and mandatory.

BCG is injected into the middle third of the shoulder; after 2-3 months, a skin reaction appears at the injection site in the form of a small (up to 1 cm) thickening. The infiltrate cannot be treated with any means, rub with a washcloth, or remove the crust that covers the wound. By 6 months, a scar has formed.

BCG vaccination is contraindicated:

• Children suffering from any form of immunodeficiency: congenital or acquired (AIDS); and also if there are people in the newborn’s family who suffer from these diseases.
• In the event that the newborn's siblings experienced complications after BCG vaccination.
• Children suffering from severe congenital diseases of the central nervous system, enzymopathies.

Vaccination is delayed:

• With prematurity.
• For any infectious diseases.
• In case of Rh conflict between mother and child (if positive Rh factor in the child and negative in the mother): if it develops hemolytic disease newborns.

Complications after vaccination:

• Generalization of infection. Since the BCG vaccine contains live, albeit weakened, bacteria, the development of tuberculosis is possible. However, this complication is extremely rare, almost exclusively in children with undiagnosed immunodeficiency.
• Formation of an ulcer at the site of infiltration. The infiltrate begins to grow and ulcerate, i.e. an open, weeping wound surface appears. Most often this is due to improper care of the vaccination site.
• Formation of subcutaneous infiltrate. If the vaccine is administered incorrectly (injected too deeply), a “ball” forms under the skin. Subcutaneous infiltrate can break into the bloodstream and cause the spread of infection. Therefore, if you suspect this complication, you should immediately consult a doctor.
• Damage to regional lymph nodes. There is an increase in nearby lymph nodes - most often axillary ones, which are painless and range in size from a walnut to chicken egg. If the lymph nodes are enlarged, immediate consultation with a phthisiologist is also required.
• Formation of a keloid scar. Formed when hereditary predisposition to the formation of excessive scar tissue at the site of skin damage. It is extremely rare in newborns.

Should my child be vaccinated?

This issue causes constant debate between parents and doctors. It is known that tuberculosis most often affects people of low social status or those suffering from immunodeficiency. Therefore, in many developed countries mandatory vaccination Only people in risk groups are eligible: those living in conditions of low sanitary standards, those who are poorly nourished, and those who have tuberculosis patients in their family. However, in Russia the situation is fundamentally different - the level of general incidence of tuberculosis in our country is extremely high. Therefore, any child from the most prosperous family has a much higher risk of encountering an active form of tuberculosis than, say, in the USA or European countries.

The risk of an unvaccinated child becoming infected with tuberculosis in Russia significantly exceeds the risk of any possible complications vaccinations!

Prevention against tuberculosis

Prevention is vaccination.

In already infected persons, isoniazid is recognized effective means to prevent the development of active tuberculosis. Taking isoniazid daily for 6-12 months reduces the risk of active tuberculosis in those infected by 90% or more. In addition, taking isoniazid reduces the risk of tuberculosis among HIV-infected people.

Indications for drug prevention of tuberculosis:

• Persons in close contact with tuberculosis patients.
• Persons with a positive Mantoux test and signs of previous tuberculosis, detected by radiography or fluorography.
• Changing a negative Mantoux test in the previous year to a positive one is a “turn” of the test.
• HIV infection with a positive Mantoux test.
• Positive Mantoux test and accompanying illnesses, reducing the immune response: taking corticosteroid drugs, patients with diabetes.
• Persons arriving from regions with an increased incidence of tuberculosis: places of imprisonment, psychiatric clinics, houses long term care, as well as homeless people with a positive Mantoux test

Tuberculosis - This is one of the most dangerous and widespread diseases in the world today.

According to WHO, today in Russia 80 people out of every 100 thousand suffer from tuberculosis. The disease kills more than one and a half million people in the world every year. This disease is not only a medical problem, but also an acute social problem.

The danger of tuberculosis is that it is transmitted in the easiest possible way - by airborne droplets, and people do not always even suspect that they are sick. Consider what happens with tuberculosis in the body, where it comes from in humans, and why it is considered such a dangerous disease.

It's called tuberculosis bacterial infection, which is caused by mycobacteria. The disease is caused by several types of these bacteria.

Mycobacterium - it is a microorganism aerobic bacterium, which is shaped a bit like a cylinder or a stick. Therefore, pathogenic ones are also called Koch's sticks, after the name of the German doctor who first described them.

March 24, 2017 marks 135 years since microbiologist Robert Koch discovered the causative agent of tuberculosis, described it and read a report on it. It was a real breakthrough in medicine, and the science of tuberculosis about tuberculosis moved to a qualitatively new level.

Despite the fact that in the 19th century, scientists widely used the microscope, and already concluded that bacterial etiology diseases, the causative agent could not be detected.

Koch was the first to think of staining the drug under study with methylene blue, and was able to see the mycobacterium. The bacillus named after him recalls the doctor's contribution to microbiology and to the development of phthisiology in general.

Briefly describe the history of tuberculosis, it will be the entire history of mankind. Information and information about tuberculosis reach us from ancient times. Because tuberculosis bacteria first entered the human body back in the Stone Age.

Since then, the person has not appeared specific immunity to this disease, and tuberculosis continues to remain almost as dangerous for people as in those distant days.

Currently, the disease has been well studied, doctors know the mechanisms of development and medications have been developed, but it is not possible to stop its spread. continues to remain depressingly high, despite the measures taken by world public organizations.

Previously, it was called consumption, and it was considered incurable; doctors could only slightly alleviate the symptoms and recommended sea air.

Now doctors know how to treat it, but in many countries, including Russia, the definition remains at a rather low level. Because of this, the disease is often detected late, which complicates treatment and worsens the epidemiological situation.

The disease is considered extremely dangerous for several reasons.

Firstly, mycobacteria are extremely resistant to environmental factors. But not only. They also extremely quickly acquire loyalty to anti-TB drugs.

Mutations can occur directly in the human body, and at a certain stage of therapy, the drugs used may become ineffective.

This greatly complicates the healing process, forces doctors to select new regimens for using drugs, and seriously prolongs the patient’s stay in quite unpleasant place- Tuberculosis dispensary.

When the virus does not respond to drugs at all, the person may eventually die.

Types and forms of the disease

There are three forms of the disease: latent, closed and open. According to medical statistics, about a third of all inhabitants of the Earth are carriers of mycobacteria, but do not release them into the environment and do not get sick themselves. This form is called latent.

This can be called a time bomb: if provoking factors appear, the disease begins to manifest itself. This happens in 10% of cases.

One of the most significant provoking factors in the development of tuberculosis is a decrease in immunity for any reason. According to WHO, 35% of people who died from tuberculosis in 2015 were HIV-infected.

For tuberculosis closed form the person is not contagious, does not pose a danger to others. This form is difficult to diagnose, since mycobacteria are not sown in sputum.

The most dangerous is open form diseases. A person with this form constantly expels strains of mycobacteria into the surrounding space, which land on other people, objects, furniture, and the ground, and are able to remain viable for a long time.

Classify the disease also by localization. In most cases, mycobacteria prefer to implant in the lung tissue, so the most common tuberculosis is pulmonary tuberculosis.

The form of pulmonary tuberculosis can also include tuberculous pleurisy, bronchoadenitis and tracheitis. The extrapulmonary form affects bones and joints, the brain and meninges, eyes, organs of the genitourinary system and others.

The tuberculosis process is also classified according to the form of its course. Among the varieties of the course of the disease there are: tuberculoma, focal, milliary, infiltrative, disseminated, cavernous fibrous and cirrhotic tuberculosis.

There are also primary and secondary forms of the disease. The primary form occurs when mycobacteria first enter the body. As a rule, it is diagnosed in very young children with a not fully formed immune system.

The secondary form may appear after re-infection or after remission in the form of an exacerbation.

Routes of transmission of tuberculosis

There are four ways in which the infection can be transmitted. In almost 97% of cases, the disease is transmitted from person to person by airborne droplets. The patient coughs or sneezes, causing a huge number of strains to fly around within a diameter of one and a half meters.

The disease can be transmitted through personal hygiene items, household items, as well as through kissing and sexual relations. This path is called contact.

The rarest are the food and intrauterine routes. With today's level of medicine, transmission from an infected mother to a pregnant child can be prevented.

Very severe cases extensive course of the tuberculosis process, the child may be infected in utero. The prognosis in such cases is unfavorable: newborn children have practically no protective system, and doctors do not undertake to treat them.

Through the food route, mycobacteria enter the human body through meat or milk produced by cattle affected by tuberculosis.

Clinical picture

Symptoms of the disease may be various syndromes and largely depends on which organs are affected by the tuberculosis process.

For clinical picture In general, the signs of all infectious diseases are characteristic. General malaise, low-grade fever, and febrile symptoms may occur. A characteristic manifestation is profuse night sweats.

Also in patients with tuberculosis changes appearance, they become exhausted, constantly look tired and haggard, and lose weight quite quickly due to lack of appetite.

Hemoptysis is the most indicative sign of tuberculosis, but appears only when the disease becomes severe. The appearance of blood in the sputum indicates the appearance of infiltrates and foci of caseous necrosis in the lung tissue.

If there is a lot of blood, this may indicate that a cavity has broken through. In such cases, the patient’s life is threatened and prompt assistance is required.

Pulmonary tuberculosis can manifest itself as pain in the lungs and respiratory tract, and a severe dry cough. At first, the cough may be without sputum. Subsequently, there are different kinds sputum, the nature and impurities in which depend on the form of the course of tuberculosis.

If you suddenly develop a dry cough, and it continues for two or three weeks, against the background of a general decrease in vitality, it makes sense to take a manta test and undergo unscheduled fluorography, as this could be tuberculosis.

When tuberculosis affects the organs of the genitourinary system, one of the main symptoms is a change in the color and consistency of urine, and the appearance of blood in it.

Tuberculosis of bones, joints and meninges is quite rare today and in most cases affects people with extremely weakened immune systems, as a rule, these include HIV carriers. Symptoms in such cases are caused pathological process flowing in the affected organs.

The miliary form of the disease is also a fairly rare species. It occurs when, upon penetration into the body, mycobacteria spread throughout various bodies and systems with blood flow, are implanted into them and begin to multiply.

This happens if the immune system an infected person is weakened and cannot resist microbes.

Symptoms in such cases are varied and depend on the organs in which tuberculosis granulomas have formed.

Complications of tuberculosis

To the most dangerous complications diseases include bleeding, respiratory failure, and spontaneous pneumothorax that are potentially possible in pulmonary forms of tuberculosis. In such cases, immediate surgical treatment is required.

With miliary tuberculosis, as well as with other forms of the disease, the danger of tuberculous sepsis may arise if mycobacteria begin to spread throughout the body through the bloodstream.

Prognosis for tuberculosis

If adequate treatment is started in a timely manner, the prognosis depends on the form of the disease, the speed of its progression, as well as the general health of the patient and the presence of concomitant diseases.

With absence adequate treatment, which can only be prescribed by the attending physician after the necessary thorough diagnosis, the prognosis is 100% negative. Tuberculosis requires integrated approach in treatment, using all methods and means available today.

It is unacceptable to engage in uncontrolled use of drugs and the use of alternative medicine methods.

The importance of prevention

Measures to prevent such dangerous disease, like tuberculosis, are supported at the state level. Today, all citizens are given the opportunity to undergo a free fluorographic examination of the lungs every year. Also, all children are recommended to receive BCG vaccination between three and five days of age.

In children's educational institutions, a diagnostic test is carried out annually to determine the presence of antibodies to mycobacteria in the body - the familiar Mantoux reaction.

To prevent the spread of the disease, all patients with tuberculosis must be treated in closed medical institutions. It is necessary to minimize contact with sick relatives and friends while they are infectious.

It is better not to allow small children near tuberculosis patients at all. After placing the patient in a tuberculosis clinic, it is necessary to clean the apartment where he lived during his illness by SES employees.

Tuberculosis can affect absolutely anyone, despite the widespread myth that it is a disease of the lower social classes and economically backward countries. By the way, Russia is one of the countries with the most unfavorable epidemiological situation for this disease.