Tuberculosis – infection bacterial etiology. The disease has not only medical, but also social aspect: the most sensitive to the causative agent of tuberculosis are people with a low level of immunity, an unbalanced diet, living in conditions of non-compliance with sanitary and hygienic standards, and poor social and living conditions. The development of the disease is influenced by the level of a person’s quality of life. However, the risk group for tuberculosis consists of all segments of the population, regardless of age and gender.

High frequency deaths(up to 3 million people per year) and the prevalence of the disease is due not only social reasons, but also a long period of latent course of the disease, when the symptoms of tuberculosis do not appear. This time is the most favorable for therapy, and to determine the likelihood of infection, an assessment of the body’s reaction to the Mantoux test is used.

Causes of the disease and routes of infection

The disease develops after infection of the human body with the tuberculosis bacterium Mycobacterium or Koch's bacillus. This microorganism is resistant to environmental influences, high temperatures, and remains viable for a long time at low temperatures.

Koch's bacillus is not considered a highly contagious infectious agent, although a carrier of infection with an open form of the disease spreads bacteria into the environment, the likelihood of getting sick after contact with the pathogen and its penetration into the body in a healthy person is extremely low. A tuberculosis patient (tuberculosis patient) in most cases does not require hospital treatment in an inactive form of the disease and is not limited in movement or social activity. With constant household contact, in families where there is a person with tuberculosis, it is recommended to pay attention not only to his health, but also to maintaining hygiene, measures to strengthen the immunity of other family members and regular checks of the body’s reaction to the Mantoux test to identify possible infection at the earliest stages.

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The main route of infection is the entry of Koch's bacillus into the respiratory system by airborne droplets. Household (contact) and transplacental methods of transmission of infection are less frequently recorded. The bacterium enters the body through the respiratory tract, then migrates to the mucous membrane of the bronchi and alveoli and spreads throughout the body through the bloodstream.

For human body Koch's bacillus is a foreign microorganism. Normally, when it appears and multiplies in the body, immune cells attack the causative agent of the disease, preventing the stage of active reproduction. The development of the disease is likely in two cases: if the immune system is suppressed, there are disturbances in the production of antibodies, conditions of immunodeficiency, the body’s defenses are weakened by other diseases, or are not sufficiently formed due to age or social conditions; or if contact with the pathogen is long-term, constant, the bacilli carrier is at the stage open form illnesses and does not get necessary treatment(in case of undiagnosed tuberculosis in a family member, when kept in closed institutions, etc.).

Among the factors that reduce specific immunity and contribute to the development of the disease upon contact with an infectious agent are the following:

• smoking as a factor in the development of diseases of the bronchopulmonary system, weakening local immunity;
• excessive intake of alcoholic beverages;
• all types of drug addictions;
• predisposition to diseases of the respiratory system due to the presence of structural abnormalities, a history of frequent diseases, the presence of chronic inflammatory processes in the respiratory organs;
• chronic diseases and foci of inflammation in other organs and tissues;
• diabetes mellitus, endocrine diseases;
• unbalanced diet, lack of vitamins and nutrients;
• neurotic disorders, depressive states, low stress resistance;
• pregnancy period;
• unfavorable social and living conditions.

Development of tuberculosis: signs and symptoms of various stages of the disease

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As a rule, the increase in manifestations of tuberculosis occurs gradually. Enough a long period the pathogen does not manifest itself in the body, spreading and multiplying mostly in the tissues of the lungs.
At the onset of tuberculosis there are no symptoms. There is a primary stage, at which the reproduction of pathogenic organisms predominantly occurs, not accompanied by clinical manifestations. After the primary stage, the latent or hidden stage of the disease occurs, at which the following symptoms may be observed:

• general deterioration well-being;
• fatigue, loss of strength, irritability;
• unmotivated weight loss;
• excessive sweating at night.

Cough and elevated body temperature are not typical for the first stages of the disease; these symptoms are noted at the stage of extensive damage to the lung tissue. If the picture of the first stages of the development of the disease is blurred, diagnosis is only possible using tuberculin tests (Diaskin test, reaction to the Mantoux test, etc.) or using a blood test for PCR.
The next stage is characterized by a latent stage, a “closed” form of tuberculosis, in which the pathogen is not released into the environment and, with its moderate reproduction and resistance of the body, no significant harm to health is observed.

The latent form is dangerous due to the possibility of transition to the stage of an active disease, which is not only dangerous for others, but also has an extremely negative effect on the body.

The active stage passes into the secondary stage, the pathogenic microorganism reaches the stage of mass reproduction and spreads to other organs of the body. Severe lesions and diseases occur, leading to death.

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Active stage of tuberculosis: symptoms and manifestations

Symptoms of tuberculosis in acute period diseases:

• long-term (more than three weeks) moist cough with sputum production;
• presence of blood inclusions in sputum;
• hyperthermia in the low-grade range;
• unmotivated weight loss;
• increased fatigue, general deterioration in health, weakness, irritability, decreased appetite, deterioration in performance and other signs of intoxication of the body.

The cough is wet, pronounced, attacks are frequent, with a characteristic increase in the morning. Often at this stage of the disease smoking people accept this symptom for manifestations of "smoker's cough", a sign chronic bronchitis nicotine dependent patients.
With more aggressive rates of disease development, the clinical picture may be supplemented by the following symptoms:

• hyperthermia in the febrile range (body temperature 38-39°C);
• pain in the shoulders, sternum;
• pain when coughing;
• dry cough, hard breathing.

The symptoms of the tuberculosis inflammatory process are similar to the clinical pictures of other respiratory diseases of viral and bacterial etiology. Differentiation of diagnoses is carried out only by a specialist.

Symptoms of extrapulmonary forms of the disease

Koch's bacillus can affect not only lung tissue, but also multiply and cause inflammatory processes in other organs. With such localization they speak of an extrapulmonary type of disease. Non-specific appearance Tuberculosis damage to internal organs and systems is diagnosed, as a rule, by excluding other diseases and pathologies. The clinical picture depends on the severity of the process and the location of the organ or tissue affected by the bacterium.

• When the inflammatory process is localized in the brain, the disease manifests itself in an increase in body temperature, disturbances in work nervous system, sleep patterns, increased irritability, neurotic reactions, enlarged neck and neck muscles. Characteristic pain syndrome in the back area when straightening the legs, tilting the head towards the chest. The disease progresses slowly, and those at risk include preschool children, patients with diabetes, and HIV-infected people.
• Tuberculous organ damage digestive system is expressed in periodic defecation disorders, a feeling of bloating, pain in the intestinal area, signs of hemorrhagic bleeding (blood in the stool), an increase in body temperature up to 40°C.
• Tuberculosis damage to bone and joint tissue manifests itself painful sensations in the affected areas, limiting joint mobility. Due to the similarity of symptoms with other diseases of the musculoskeletal system, it is difficult to diagnose.
• Damage to the genitourinary system by tuberculosis bacteria is usually detected in the kidneys and/or pelvic organs. The clinical picture consists of painful attacks in the lower back, body hyperthermia, frequent, painful, unproductive urge to urinate, and the inclusion of blood in the urine.
• Tuberculous lesions of the skin are expressed in the form of rashes widespread throughout the skin, merging and forming nodular formations that are dense to the touch.

Other symptoms of damage are also possible various organs. A pathogenic organism, penetrating the bloodstream, can spread throughout the body and target almost any organ, tissue or system. Clinical signs In this case, diseases are difficult to differentiate from similar inflammatory processes of a different etiology. The prognosis for treatment of extrapulmonary forms depends on the time of diagnosis, localization pathological process, its stage, the degree of organ damage, the general health of the patient.

Diagnostic techniques

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The diagnosis is established on the basis of tests to determine the presence of the pathogen in the body. Diagnostic measures begin with collecting anamnesis and analyzing the patient’s complaints, studying the medical history. To confirm or refute the diagnosis, a number of examinations are carried out:

• analysis for the Mantoux reaction or Pirquet test, the most common test to determine the presence of infection in the body. Intradermal or cutaneous application of tuberculin and assessment of tension level specific immunity body. The tuberculin test allows you to assess probable contact with Koch's bacillus, but does not mean confirmation of the disease. This method diagnosis, however, is criticized by phthisiatricians and other specialists, as it may indicate contact with other types of microbacteria. Also, tuberculin diagnostics using the test method can lead to incorrect results after BCG vaccination. The Mantoux test is also used before primary vaccination to predict possible allergic reactions to the main component of the vaccine;
• The Diaskin test also applies to skin tests, complementing tuberculin diagnostics with the Mantoux reaction method. Being a more specific test, it detects a reaction only to mycobacterium tuberculosis;
• Quantiferon test or ELISA - enzyme immunoassay diagnostic test, recommended for patients with an allergy to tuberculin, as well as if it is necessary to differentiate a false-positive reaction of the body to the Mantoux test and the Diaskin test after BCG vaccination. The study is carried out on biological material(blood), has no contraindications and is considered the most reliable test (less than 2% of erroneous results, compared to 30% with Mantoux tests). Recommended for identifying latent and extrapulmonary forms of the disease;
• Smear microscopy is carried out as a search for a pathogenic organism in sputum secreted during coughing. If tuberculous mycobacteria are detected in the smear, the method is supplemented bacteriological culture sample in a nutrient medium;
• PCR, the polymerase chain reaction method, is the most accurate research method existing today, allowing you to determine the presence of mycobacterial DNA in various biological fluids;
• histological analysis of tissues removed by biopsy is prescribed in situations where it is impossible to confirm the diagnosis by analysis biological fluids, in particular, with indolent tuberculous lesions of bone tissue.

Using radiography and fluorography, the presence of foci of inflammation in the lung tissues is detected.

Treatment of the disease

The prognosis for recovery for this disease is made based on the stage of the disease, the affected area, and the general health of the patient. Diagnosis in the early stages allows you to prescribe an effective course of therapy that promotes complete healing of the patient.
Treatment is long-term, complex, based on admission antibacterial drugs, anti-tuberculosis drugs, immunomodulators, immunostimulants, probiotics and vitamin therapy. A mandatory part of the course of treatment is dietary food and physical therapy.

Treatment of a patient in the active stage is carried out in a tuberculosis clinic to reduce the likelihood of infection of others. The length of stay depends on the type and stage of development of the process and can range from several months to a year or more. Self-cessation of treatment most often leads to relapse or progression of the disease, the development of severe complications, and death.

Preventive measures

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According to statistics, in Russia about 90% of people are carriers of Koch's bacillus. However, less than 1% of them get sick. The development of the disease depends on the level of immunity, so the main prevention is maintaining a healthy lifestyle.
children, regular samples and tests that allow detection of the disease in the early stages, when the prognosis for treatment is most favorable, also play a significant role in the prevention of the disease.

Timely diagnosis of tuberculosis in adults is necessary to control the incidence rate, because a late detected infection can cause significant damage not only to the patient himself, but also to others - do not forget that tuberculosis, apart from some of its forms, is transmitted by airborne droplets. If you discover alarming symptoms, you should immediately consult a doctor - this way you will protect yourself not only from tuberculosis, but also from many other dangerous diseases.

The main method of detecting the disease is the tuberculin test, also known as the Mantoux test - it is not without reason that it is carried out annually in educational institutions. A dose of tuberculin is injected into the human body, and after three days the result is determined by the size of the button formed at the injection site.

He can be:

• negative;
• positive;
• doubtful.

Everyone hopes for a negative result, which means there is no infection in the body, but there is a possibility of a questionable or positive result. If the result is questionable, the size of the button is four millimeters or less; if the result is positive, the size is five millimeters or more. It can reach sixteen millimeters. In this case, a positive result only indicates the presence of tuberculosis microbacteria in the body, but not the onset of infection.

There is another possible outcome when the diameter of the button exceeds seventeen millimeters and the surrounding tissue begins to die. As in the previous case, you should immediately consult a doctor: such a result may indicate both the onset of the disease and the occurrence of an allergic reaction.

By the way, not only an allergic reaction can affect the result, making it negative, even if there are no tuberculosis microbacteria in the body - it is not for nothing that epileptics and people who have recently suffered from the disease should not carry out the test. It will not benefit an organism weakened after illness, and the result will be incorrect. Chronic diseases, inflammation, runny nose and many other factors can also influence the result.

It is worth talking in more detail about the reasons why the result may be distorted. Possession of such knowledge makes it possible, if not to prevent, then to reduce the risk of distortion.

Interesting fact - tuberculin test It is often mistaken for a vaccine, but this opinion is erroneous. The purpose of the test is not to create immunity to the disease, but to diagnose it. And we can come to the logical conclusion that administering Manta immediately after vaccination is not the most brilliant idea. As already noted, vaccination involves introducing a virus into the body to create immunity. During such a period, the result will never be accurate.

It has already been said about what type a button can acquire as a result of an allergic reaction. Due to the fact that the tuberculin test determines the body's ability to tolerate the influence of certain allergens, any allergy causes sharp increase buttons.

Poor living conditions often cause tuberculosis, but they can also affect the test. People living in areas where chemical emissions occur are faced with body poisoning, which leads to inflammation. But as a result of inflammation, the button increases.

First of all, pay attention to the manifestation of symptoms. If you find them, you should immediately consult a doctor to be on the safe side.

On initial stage The following symptoms may appear:

1. Spitting blood.
2. Temperature change.
3. Increased sweating.
4. Weakness.
5. Decreased activity.

Characteristic signs of the pulmonary form of tuberculosis are coughing up blood and severe coughing; the rest, of course, indicate the development of the disease, but not necessarily tuberculosis.

Before visiting a doctor, try to remember how long ago you interacted with tuberculosis patients and how high the likelihood of becoming infected was. This will make the doctor's job much easier and will help you get the appropriate treatment if necessary.

Visual signs of tuberculosis are detected during an examination. Loss of body weight and inflammation of the lymph nodes may indicate the development of infection.

Further developments depend on the results of the inspection. If the doctor suspects tuberculosis or any other disease, it will be necessary to undergo a full examination for tuberculosis, where, with the help of research, more specific results can be obtained.

The patient is prescribed a sputum test and an x-ray of the lungs. The resulting image allows you to detect the location of foci of infection. Following this, a form of tuberculosis is diagnosed, and based on this, a course of treatment is drawn up, which necessarily includes the use of anti-tuberculosis drugs.

More information about diagnostic methods

Each of the proposed methods has its own characteristics, on which the accuracy of the results depends. You should follow the doctor’s instructions precisely so as not to simply waste your own or someone else’s time.

X-ray method

X-ray of the lungs is considered one of the best ways detection of tuberculosis known to medicine. The resulting image clearly shows the changes that have occurred, after which all that remains is to identify them and establish the cause of their occurrence. It’s worth paying attention to the shadows: what shape they have, how much big sizes. This will help determine the extent of pulmonary damage.

Sometimes additional studies are carried out - analysis of the patient's sputum. The greatest accuracy is possible by carefully following all the instructions given by the doctor. The sputum must be placed in a special box obtained from a qualified employee. The analysis should be carried out according to the rules of hygiene: there should be no pieces of food stuck in the mouth, especially since they should not get into the analysis. Doctors strongly recommend brushing your teeth before the procedure.

The procedure for obtaining an analysis should be carried out in the morning before eating. You should ensure that the box contains sputum, not saliva.

Further actions take place according to the instructions. Inhale twice, stop breathing, inhale deeply, exhale strongly, inhale, cough, take the box and spit out the accumulated phlegm. Immediately close the box with the lid.

Doctors carefully study the analysis received from the patient, using everything for this procedure. available funds. A sure sign of tuberculosis is the accumulation of blood in the secreted sputum. A microscope is used for diagnosis.

If all instructions are followed, sputum analysis can provide results that are even more accurate than x-rays. Sometimes infection is detected precisely through sputum analysis.

Methods for examining sputum are completely different:

• bacterioscopic;
• bacteriological;
• biological.

The first method involves examining the analysis under a microscope and detecting blood in sputum.

The second method a few years ago was considered the most effective, but over time the opposite was proven, and it lost its position. Modern methods Diagnosis of tuberculosis involves several research methods.

Speaking in simple language, the bacteriological method is associated with sputum culture. The point is to detect microbacteria in the analysis.

The biological method is clear - experimental animals are infected with the sputum of the patient and the condition of their body is monitored. It is most profitable to take animals that are most susceptible to Koch's bacillus - guinea pigs.

Bronchoscopy

This method involves the use of a special device that is inserted into the bronchi. You should not eat any food for several hours before the test (if your stomach is not empty, there is a risk that food will end up in your respiratory tract).

To ensure a smooth procedure, anesthesia or general anesthesia is used.

Another method that is not as effective as sputum analysis or x-rays, but still works. The ability to detect tuberculosis by analyzing the blood of a potential patient exists due to minor changes that occur in the blood composition after infection with tuberculosis. Having found these changes, you can make a diagnosis of tuberculosis.

If we talk about general information, it is as follows: changes affect the lung tissue, its gradual destruction occurs. In patients with tuberculosis, anemia occurs, the erythrocyte sedimentation rate increases, the content of leukocytes in the blood changes, and the protein content increases. And this is not all of the possible changes.

No one guarantees that such changes indicate tuberculosis. They only indicate the presence of infection in the body. More accurate results can only be obtained after additional research, which is the reason why the proposed method is not so popular.

Urine tests

One of the least popular methods, which is used in rare cases. It does not give any accurate results and is most often carried out just for show. In rare cases, a urine test can detect changes in organ function.

Diaskintest

The latest technology has already made a great contribution to the methods of detecting tuberculosis and has advanced modern medicine forward. A special feature of Diaskintest is the high accuracy of the results obtained, which gives no reason for doubt.

Two types of proteins are introduced into the body, which can only be found in tuberculosis microbacteria. The conclusion is made based on the body’s reaction: if the diameter of the redness at the injection site is more than five millimeters, the test can be considered positive. Consequently, the body is infected with tuberculosis.

There are several basic principles that doctors follow when prescribing this or that drug against tuberculosis to patients. First of all, when tuberculosis is diagnosed, drugs are needed that can stop the proliferation of bacteria in the body and simply destroy them. In addition, over time, microbacteria develop resistance to many drugs. It is important to choose their combination in such a way that they have the strongest possible effect, before bacteria develop resistance.

The World Health Organization recommends adherence to the following complex of anti-tuberculosis drugs in treatment:

1. Pyrazinamide.
2. Streptomycin.

Some of these drugs are very active.

Isoniazid, which, having a bactericidal effect, kills microbacteria, reducing them protective function by acting on the cell wall. The drug is also able to prevent the growth of bacteria.

Isoniazid has a number of side effects that should be considered. It is better for people with bad habits to temporarily give them up - hepatitis may develop, accompanied by unpleasant symptoms such as nausea and pain. The course of treatment should be temporarily interrupted if all signs indicate advanced hepatitis.

It will not do without a harmful effect on the nervous system and sensory organs. The optic nerve stops functioning, resulting in a sharp deterioration in vision. The possibility of psychosis, feelings of anxiety, fear, and sleep disturbances cannot be ruled out.

The list of side effects includes allergic reactions, which usually manifest themselves in the form of skin rashes.

We are talking about disruption of the proper functioning of not only the nervous system, but also other organ systems: cardiovascular, digestive, endocrine.

Isoniazid is widely used to treat pulmonary forms of tuberculosis, and is especially effective in the initial stages. However, it is used not only for therapeutic, but also for preventive purposes, reducing the risk of developing tuberculosis in people who are most susceptible to it.

Pyrazinamide

Pyrazinamide is most effective in the early stages of infection. It does not do a very good job of destroying Koch's bacillus, but it does sterilize foci of infection.

Here, too, there were some unpleasant surprises in the form of side effects: vomiting, metabolic disorders, disorders of the musculoskeletal system, and liver problems.

The peak activity of Pyrazinamide occurs in the first two months of treatment. Like Isoniazid, it is taken in combination with other anti-tuberculosis drugs so that resistance does not develop in microbacteria for as long as possible.

Accordingly, the drug is contraindicated for people who have problems with the functioning of the endocrine, digestive or nervous systems, or who are intolerant to it.

Ethambutol belongs to a number of drugs that slow down the proliferation of tuberculosis microbacteria in the human body, and is suitable for the treatment of both pulmonary and extrapulmonary forms of the disease.

It has a strong effect on the organs of vision: it decreases, the eye sees colors incorrectly, and in elderly patients, complete blindness can occur (in this case, vision cannot be restored). Joint pain, seizures and pain also occur. The development of allergic reactions is possible.

Streptomycin

Streptomycin is the only drug from the list that can be used alone (although this is not recommended) without the use of other drugs.

The drug leaves the body through the kidneys, so people suffering from kidney problems should take Streptomycin in small dosages.

Side effects may include allergies and increased skin susceptibility to foreign factors. You may feel dizzy and vomit. Taking the drug should be limited, otherwise nerve regeneration will be impossible.

Streptomycin is rarely prescribed to children and never to pregnant women. Long-term exposure of the drug to an unborn child leads to congenital deafness.

The main disadvantage of Rifampicin is that microbacteria quickly adapt to it, and soon its effect has no effect. On the other hand, the range of his actions is enormous.

By using Rifampicin every day, the patient runs the risk of side effects: disorders of the digestive system, allergic reactions, hepatitis is possible, in some cases symptoms resembling flu symptoms, anemia and renal failure appear.

The drug is contraindicated in people with intolerance, renal failure, pregnant women or small children.

It must be realized that the growing incidence of this terrible disease- a problem not only for our country, but for the whole world, and only by uniting our efforts against it can we hope for victory.

Control over the situation is carried out by the same World Health Organization, which offers options for solving this global problem, is pursuing successful policies in some countries and is making every effort to ensure that the incidence rate declines in the near future.

The effectiveness of the policy of the World Health Organization can be judged by the example of China, where it was applied. The strategy was surprisingly successful: it was proposed to treat tuberculosis with chemotherapy. The chance of overcoming tuberculosis is very high, as is the chance of diagnosing the disease at the first station.

Let's look at the principles the WHO has developed to implement its large-scale plans:

1. Patients suffering from tuberculosis should be kept in strict isolation from healthy people, thus preventing further spread of infection. Patients are sent for immediate treatment.
2. Quantity medicines consumed by the patient must be calculated based on individual characteristics the patient's body. The attending physician must strictly ensure that the patient takes all prescribed medications in the indicated dosages.
3. Without the support of the authorities, the strategy may not produce such excellent results, so strong initiative must come from the government and good results must be rewarded. A similar system was successfully implemented in China: the government made it profitable for doctors to diagnose and treat tuberculosis. After diagnosing the disease in one patient, the doctor received a dollar. He was entitled to another five if the patient turned out to be healthy as a result of therapy. This approach worked as it should: doctors began to approach their work with greater responsibility, carry out diagnostics carefully, and soon in some regions of the country healing occurred in more than 90% of cases.

The example of China has shown how the right policies can reduce the incidence rate. It’s not for nothing that doctors say that early diagnosis of pulmonary tuberculosis provides a greater guarantee of healing. The experience with China also showed this: the miraculous healing is largely due to the fact that doctors began to take tests more seriously, diagnosed tuberculosis more often and treated it before a dozen more citizens had time to become infected with it.

The meaning of the strategy is that the health care system takes full responsibility for curing each individual case of tuberculosis.

The same strategy was applied in Russia at the end of the last century. It was based on five elements, and the absence of even one could lead to the complete collapse of the entire system.

Efforts should be aimed at identifying and isolating patients with active tuberculosis, which can be spread by airborne droplets. Most resources should be devoted to curing the spread of infection. Only after this can you think about diagnosing other forms of tuberculosis (there is no extra waste of resources).

Tuberculosis patients are provided with a full course of anti-tuberculosis treatment. Later, by analyzing the data obtained during the treatment of several groups of patients, it will be possible to identify regions where the cure rate does not reach the required level, and send a team there to correct the situation.

The healthcare system is obliged to provide tuberculosis patients with all necessary anti-tuberculosis drugs recommended by the World Health Organization: Isoniazid, Rifampicin, Pyrazinamide, Streptomycin and Ethambutol. Such a responsibility is the basis of the strategy, without which the treatment of patients will not be continuous and, accordingly, the results achieved may not be as excellent as could be expected from them. Access to medicines for patients should not be limited, but everyone gets what they need.

Another “pillar” of the strategy for combating tuberculosis is government support for this system, recognition of it as an important political task facing the country, and financial support. Patients should receive free treatment, as well as the opportunity to contact the head of the union.

A detailed study of the disease control program should be undertaken, outlining plans, programs and goals. Any delay in translating the strategy into reality can lead to undesirable consequences - the morbidity rate will increase again and the number of deaths will increase. But this is far from the worst that can happen. According to analysts, inaction could lead to tuberculosis becoming an incurable disease against which no measures will help. And while we have a chance to prevent such a sad outcome, we must continue to move forward, pursuing the main goal - victory over tuberculosis. Early detection of tuberculosis will allow significant progress in this.

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Time is over

• Congratulations! The likelihood that you will develop tuberculosis is close to zero.

  But don’t forget to also take care of your body and undergo regular medical examinations and you won’t be afraid of any disease!
  We also recommend that you read the article on.

• There is reason to think.

  It is impossible to say with certainty that you have tuberculosis, but there is such a possibility; if this is not the case, then there is clearly something wrong with your health. We recommend that you undergo a medical examination immediately. We also recommend that you read the article on.

• Contact a specialist urgently!

  The likelihood that you are affected is very high, but it is not possible to make a diagnosis remotely. You should immediately contact a qualified specialist and undergo a medical examination! We also strongly recommend that you read the article on.

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1. Task 1 of 17

   1 .

   Is your lifestyle associated with severe physical activity?

2. Task 2 of 17

   2 .

   How often do you take a tuberculosis test (eg Mantoux)?

3. Task 3 of 17

   3 .

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

4. Task 4 of 17

   4 .

   Do you take care of your immunity?

5. Task 5 of 17

   5 .

   Have any of your relatives or family members had tuberculosis?

6. Task 6 of 17

   6 .

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

7. Task 7 of 17

   7 .

   How often are you in damp, dusty or moldy environments?

Or mycobacterium, of the respiratory system and is the cause of pulmonary tuberculosis. More than 1 million children and about 9 million adults on the planet are infected annually, and according to the World Health Organization, 3 out of 10 people are already its carriers. That is why it is so important for everyone to undergo an annual thorough examination for tuberculosis, regardless of age, social status and gender. Modern methods of diagnosing pulmonary tuberculosis make it possible to timely determine the form, severity, predict the consequences of the disease, and prescribe full-fledged intensive treatment. And you shouldn’t think that being diagnosed with tuberculosis is a death sentence. Early detection of tuberculosis and the capabilities that medicine has today contribute to the recovery of more than 70% of all patients who apply.

The modern Koch bacillus and its numerous strains, of which there are more than 74, are very different from the previously discovered mycobacterium. The ability of a virulent bacillus to penetrate healthy host cells and remain undetected in the human body, viability and resistance to acidic environments and disinfectants make the task very difficult for doctors and laboratory staff.

Diagnosis of pulmonary tuberculosis requires more and more new capabilities in order to conduct a full-fledged study. This also applies to people who are in a special risk group and have a predisposition to the occurrence of tuberculosis: HIV-infected patients or diagnosed with AIDS, with dependence on alcohol, drugs and nicotine products, with diabetes mellitus, bronchial asthma and hereditary factor. Newborn children from an infected mother, minors and adolescents under 17 years of age, people of retirement and old age also need medical supervision.

There is another category of potential carriers of the disease - infected prisoners. But “prison” tuberculosis, the causative agents of which are mainly resistant new strains of the Koch virus, and its diagnosis with subsequent treatment can prevent the spread of the disease and the danger of infecting others after a person leaves prison.

How does pulmonary tuberculosis manifest?

The danger posed is that early detection of the disease is not always possible due to the lack severe symptoms. In other cases, the disease actively progresses. How to diagnose tuberculosis and what signs you should pay attention to:

1. dry prolonged cough or with sputum production, wheezing;
2. constant body temperature 37°C;
3. pale complexion and tired appearance;
4. decreased appetite and weight loss;
5. shortness of breath and pain in the side;
6. profuse sweating.

In women, the ways are violations menstrual cycle and frequent headaches, from the urinary system, cystitis or bloody issues in urine.

Early diagnosis of tuberculosis in children and adolescents

Older people are able to objectively assess their health status and monitor it, and seek help from specialists. Minor children do not yet understand the full danger of infectious diseases, therefore, in preschool and educational institutions Measures are constantly taken to prevent tuberculosis.

Clinical examination - basic primary view examinations. A pediatrician or phthisiatrician is obliged to listen to the complaints of a small patient and carefully read his medical card for determining congenital pathologies respiratory system, chronic diseases thyroid gland. The integrity and color of the skin plays an important role, normal indicator temperature - 36.6°C - 36.7°C and no wheezing or shortness of breath when listening with a stethoscope.

If general state assessed by the doctor as satisfactory, further methods early diagnosis Tuberculosis in a child requires mandatory Mantoux test and BCG vaccination once a year. Parents do not trust the composition of the vaccine and refuse to give their child tuberculin. In this case, they are obliged to provide as soon as possible the results of the tuberculosis test, which was done instead of Mantoux.

Detection of pulmonary tuberculosis in adults

Frequent colds or exacerbations chronic diseases, infections and inflammatory processes that are triggered by hypothermia, severe physical work or low immunity, can cause tuberculosis in the older generation. The Mantoux test is an underpowered test for adults. Vaccination is used after treatment of tuberculosis infection or in the presence of pronounced signs of the disease. Exist diagnostic methods examinations on how to recognize tuberculosis in adults.

Most often at the annual medical examination Doctors prescribe fluorography or x-ray of the lungs. An overview method of chest imaging gives an idea of ​​the state of the respiratory organs in the form of a black and white image, on the basis of which a focus of tuberculosis can be detected. Suspicion by a radiologist or detected pathologies of the respiratory system will require additional examination.

Tuberculin diagnostics

In order to prevent the spread of the disease among the younger generation, a subcutaneous injection or Mantoux test is used, which is carried out every year. The child receives the substance tuberculin or a strain of the tuberculosis pathogen created in artificial laboratory conditions. The weakened mycobacterium should cause a reaction from the immune system at the injection site. Evaluate the result of the Mantoux test after 72 hours:

1. negative - up to 1 mm
2. doubtful - 2-5 mm;
3. positive - more than 6 mm;
4. weakly positive - 5-9 mm;
5. average intensity level - 10-14 mm;
6. pronounced - up to 16 mm;
7. hyperergic. In children and adolescents - more than 17 mm, in adults - more than 21 mm.

In addition, there are also false indicators. Previous data is also taken into account. Even a negative result does not guarantee the absence of Koch's bacillus in the body. But even with such shortcomings, the Mantoux test is the most common prevention and diagnosis of tuberculosis in children and adolescents in the early stages. Vaccination is unacceptable for allergies and bronchial asthma, inflammation and diseases of the digestive system, and diabetes.

Tests for tuberculosis

Replace traditional methods prevention and early detection of tuberculosis can be done using an enzyme immunoassay blood test, which is often used instead of the Mantoux test. Principle of implementation this study consists of the body’s immune response, antibodies, to the IgG and IgM antigens of the pathogen, mycobacteria. During the analysis process, protective cells containing a staining substance are placed in a medium containing suspected M. Tuberculosis bacilli, which interact with the source of infection and transfer part of the enzyme to the virus.

"Diaskintest". A trial attempt to replace an existing tuberculin test. Basics active substance not attenuated strain of mycobacterium human and bullish type, as in tuberculin, but a protein with an antigen of the causative agent of tuberculosis, unique to humans. Diaskintext limits the number of false positives and detects only the active virus. At the beginning of the disease it gives negative results.

PCR diagnostic method. For laboratory study It's better to use sputum. Under the influence high temperature release foreign DNA. In order to identify mycobacteria or their strains, the sample is compared with those already obtained previously. Diagnosed tuberculosis can be obtained within 5 hours after the delivery of the starting material. The procedure is often used for children with contraindications for tuberculin diagnostics or to confirm the diagnosis.

X-ray examination

It is prescribed during an annual medical examination for representatives of the older generation. Children are not allowed to undergo the procedure due to the high dose of radiation for the immune system that is not yet strong enough. Radiation diagnostics designed for screening chest organs, searching for foci of tuberculosis and preventing other pathologies.

X-ray and fluorography of the chest organs. Using a special screen, X-rays pass through the body of the person being examined, the shadow image is processed and transferred to film. Development takes a few minutes. Digital fluorography displays a finished image on the monitor, which is printed in black and white on a printer or saved electronically. The fluorography image shows focal, infiltrative and chronic lesions in the form of foci.

Computed and magnetic resonance imaging of the lungs. Methods of a more informative nature for the accurate detection of tuberculosis, which make it possible to accurately determine the size of lesions and fluid accumulations, pathologies. The sensitivity is 100 times higher than fluorography and x-rays.

General blood test for tuberculosis

Study of the composition and quantitative indicators of liquid connective tissue, which, one way or another, collides with the M. Tuberculosis bacillus, is important for the early diagnosis of the disease. With tuberculosis, the patient experiences moderate anemia, the hemoglobin level in men is below 130, in women less than 120. During the period of exacerbation of the pulmonary form, the granularity of leukocytes changes and their number increases from 20% to 50%, the number of eosinophils, young immune cells, decreases.

But the main indicator of tuberculosis activity is the erythrocyte sedimentation rate or ESR. This test shows the ability of red blood cells, whose density is greater than plasma, to settle under the influence of gravity. IN healthy body the norm for women should not exceed 15 mm/hour, for men - 10 mm/hour. Increasing ESR from 20 mm/h to 80 mm/h indicates a large amount of immunoglobulins and low level albumin in the blood, which means the activation of the body’s defenses under the influence of foreign cells.

A leukogram is often used, which is based on changes in the protein composition of the blood during an acute inflammatory process. The indicators of leukocytes such as neutrophils, eosinophils, basophils, monocytes and lymphocytes are taken into account. Examination for pulmonary tuberculosis distinguishes three phases of damage to the body’s immune system:

• neutrophilic. Active defensive reaction. The number of neutrophils increases, the level of monocytes and lymphocytes decreases, eosinophils are absent;
• monocytic. Trying to overcome tuberculosis infection. The number of neutrophils is low, single eosinophils are visible, lymphocytes increase;
• recovery. Observed after the patient has recovered. The number of lymphocytes and eosinophils is increased, but their levels return to normal.

In comparison with ELISA and PCR tests, the tuberculosis pathogen itself will not be detected, but changes in blood composition will be enough to suspect the presence of an inflammatory process in the body and continue the examination aimed at finding the source.

Method for detecting acid-fast mycobacteria

A feature of the cell wall of the tuberculosis bacillus is the lack of reaction to chlorine-containing agents and acidic environments. Therefore, diagnostic measures in laboratory conditions are often impossible to perform. Microscopic methods of examining a smear in such cases are replaced by bacterioscopy or staining of sputum.

Microscopy of a smear or material containing AFB is carried out using the Gram method and a staining method known as. The Koch virus is first exposed to the red substance carbol fuchsin, which penetrates the cell membrane, and then is treated on top with a solution of methylene blue. Positive result the presence of a tuberculosis bacillus will be the presence of red mycobacteria in a smear on a blue background. IN modern medicine Auramine-rhodamine is more often used. After exposure to the ultraviolet spectrum, the bacilli acquire a yellow tint.

Bacteriological study of bronchial lavage waters

Used as additional method collection of sputum and a method for identifying the causative agent of tuberculosis in it, when the patient is unable to collect the material on his own or the amount of secretions is not enough to conduct an examination. It is forbidden to prescribe to people retirement age, for diseases of the cardiovascular system and bronchial asthma, for children under 15 years of age.

The procedure involves local anesthesia of the respiratory tract and the introduction of a heated saline solution into the larynx using a special syringe to increase the level of secretion. After the manipulations, the patient produces intense sputum naturally and is going medical workers in a test tube for subsequent inoculation and cultivation of mycobacteria.

Needle biopsy of the lung

To determine the pathological process occurring in the lungs and obtain an initial sample, invasive diagnostics of tuberculosis in adults is prescribed. It is aimed at studying the causes of coughing up blood, internal pulmonary hemorrhage, obvious respiratory failure, taking material from mucous membranes, bronchial secretions or sputum, obtaining a sample of the affected area.

A prerequisite for puncture biopsy is clear control over the actions performed through an ultrasound machine or using X-rays. The essence of the procedure is local anesthesia chest area and insertion of a Silverman needle to capture and separate the fragment lung tissue. After a biopsy, the degree and form of damage to the respiratory system is determined. In advanced cases, resort to open surgical intervention under general anesthesia.

Bronchoscopy

To study and assess the extent of damage to the pulmonary system, including the trachea, bronchi and mucous membranes, in medical practice they are increasingly giving preference to endoscopic diagnosis of tuberculosis. Indications for the procedure include prolonged cough, which is observed in a person for more than 1 month, sputum with blood, previously identified pathologies in the lungs.

During the examination it is necessary local anesthesia and muscle relaxants to ensure free entry into the airway of a flexible tube with a light-conducting device. Taking material from the mucous membrane or secretion from the trachea and bronchi helps to study the cytological composition of sputum for the presence of foreign cells tuberculosis bacillus.

Diagnosis of tuberculosis is a set of laboratory and molecular genetic methods that make it possible to recognize the Koch bacillus in the body and diagnose accurate diagnosis. Radiation diagnostics also comes to the rescue.

Why is diagnostics carried out?

This pathology belongs to the category that does not go away on its own. Only complex therapy can destroy mycobacteria and reduce the likelihood of irreversible changes in lung tissue.

Diagnostics helps not only to clarify the diagnosis, but also to determine the form of the disease, the degree of severity, which will affect the treatment regimen.

Types of tuberculosis diagnosis

How is tuberculosis defined? For this they use various methods, which make it possible to detect mycobacteria in the body and differentiate the disease from other pathologies of the respiratory system.

• . The method is usually used to diagnose pathology in schoolchildren. The drug is a mixture of killed human and bovine mycobacteria. The result is assessed after three days.
• If it is impossible to carry out the above test, it is carried out.

Laboratory methods for detecting Mycobacterium tuberculosis

Early diagnosis of tuberculosis involves the use of the following methods:

• Collection and processing of sputum. The procedure is carried out in a doctor's office, mucus is collected from the larynx using a swab, preferably after a cough. Immediately placed collected material in a closed container and sent to the laboratory, where analysis is done using bacteriological methods.

Before visiting a doctor on the day of sputum collection, you must thoroughly clean your mouth of food debris and brush your teeth.

• Sputum microscopy. This cytological examination, which makes it possible to detect Koch bacilli in a smear prepared from collected sputum. Microscopy is done according to Ziehl-Neelsen.

If mycobacteria are found in the smear, the patient is immediately sent to a tuberculosis clinic.

Molecular genetic diagnostic methods

It is impossible to begin treatment for the disease unless a thorough diagnosis is carried out using various techniques.

Establishing the form of the pathology will allow the doctor to select an effective treatment regimen that will guarantee the patient’s recovery.

GOU VPO "Ryazan State Medical University"

named after academician I.P. Pavlov Federal Agency for Health and Social Development of the Russian Federation"

Department of Phthisiopulmonology with a course of radiological diagnostics

I.L. Grinyuk, V.L. Dobin, D.N. Oskin

Early detection of tuberculosis

Ryazan, 2008

BBK 55.42-8

UDC 616. 24-002.5-084 (075.83)

Reviewers: E.P. Kulikov, professor, head. Department of Oncology with a course of radiation diagnostics FPDO N.P. Ermoshina, associate professor, head. Department of Dermatovenereology

Grinyuk I.L., Dobin V.L., Oskin D.N.

K 493 Early detection of tuberculosis / Ed. I.L. Grinyuk, V.L. Dobin, D.N. Oskin; State Educational Institution of Higher Professional Education Ryaz State Medical University of Roszdrav. – Ryazan, RIO Ryaz State Medical University, 2008, p.17

The methodological recommendations outline the main organizational and preventive measures, the complete and timely implementation of which will ensure early detection and prevention of the spread of tuberculosis diseases among the population.

. BBK 55.42-8

UDC 616. 24-002.5-084 (075.83)

© Grinyuk I.L., Dobin V.L., Oskin D.N., 2008

State Educational Institution of Higher Professional Education Ryaz State Medical University of Roszdrav, 2008

Preface 4

General questions 5

Identification of tuberculosis patients 7

Organization of early detection of tuberculosis in the adult population 7

Organization of early detection of tuberculosis in children 9

Organization of early detection of tuberculosis in adolescents 10

Registration, recording and state statistical observation of tuberculosis cases 12

Benchmark tests 14

Answers to control tests 15

Situational tasks 15

Answers to situational problems 16

Literature 17

Preface

The guidelines are compiled in accordance with the requirements of the sanitary rules “Prevention of Tuberculosis” and the Federal Laws “On the Sanitary and Epidemiological Welfare of the Population” dated March 30, 1999 No. 52-FZ, “On the Immunoprophylaxis of Infectious Diseases” dated September 17, 1998 No. 157-FZ, “On preventing the spread of tuberculosis in the Russian Federation” dated June 18, 2001 No. 77-FZ.

They set out the main organizational, preventive, sanitary and anti-epidemic (preventive) measures, the complete and timely implementation of which will ensure early detection and prevention of the spread of tuberculosis diseases among the population.

Planning and carrying out events for early detection and tuberculosis prevention are carried out by health care institutions of the general medical network. Methodological guidance on planning and carrying out measures to prevent tuberculosis is carried out by anti-tuberculosis medical institutions.

General issues

Patient identification is an integral part of the fight against tuberculosis, aimed at identifying cases of this disease in the community. Identification of patients with tuberculosis is carried out by medical personnel of medical institutions of the general medical network (LU compulsory health insurance) when examining patients who have sought medical help, as well as during routine preventive examinations of certain population groups.

Identification of patients with tuberculosis should be early or at least timely (identification of patients with limited damage to lung tissue without destruction and release of MBT into the environment). Identifying patients with advanced forms of the tuberculosis process creates great difficulties in treatment, since it is difficult to achieve healing of the tuberculosis lesion even with modern treatment methods. The long course of tuberculosis in patients who are not registered by the anti-tuberculosis dispensary poses a great epidemiological danger to the surrounding population, especially with massive and copious discharge MBT.

Active detection of tuberculosis in Russia is usually understood as the identification of patients during examinations conducted regardless of the presence or absence of signs of tuberculosis. Active detection of tuberculosis is carried out during mass verification (screening) examinations (traditionally called “preventive”), when examining risk groups or when examining persons who have applied to medical institution about any disease and presenting complaints not related to the tuberculosis process.

Responsibility for the timely active detection of tuberculosis patients lies with the heads of medical institutions. Control over the identification of tuberculosis patients is carried out by the heads of municipal health authorities and Rospotrebnadzor. Organizational and methodological assistance is provided by employees of anti-tuberculosis institutions.

For many years, the basis for the active detection of respiratory tuberculosis in adults in Russia was the fluorographic research method, carried out in the entire population every 1-2 years. Mass fluorographic examinations covered the majority of the population and made it possible to identify patients with respiratory tuberculosis at relatively early stages of the disease, mainly with limited processes, mild clinical manifestations of the disease or their complete absence.

The system for actively identifying tuberculosis patients is currently undergoing a period of modernization and transition to new organizational technologies and research methods.

IN modern conditions priority is given to the active detection of tuberculosis among those population groups where tuberculosis is most often detected - in the so-called high-risk groups for tuberculosis. In this case, all available methods for detecting tuberculosis can be used.

To actively identify patients with tuberculosis, three research methods are used:

ray(mainly fluorographic method, preferably using digital X-ray equipment). This method is used to detect tuberculosis in adults and adolescents;

microbiological(examination of sputum and urine in persons with symptoms of respiratory and kidney diseases). Used to examine adults, adolescents and, less commonly, children;

tuberculin diagnostics. It is used as a screening method for examining children and, partly, adolescents.

The main method for detecting tuberculosis is the fluorographic examination method. During screening fluorographic examinations, pulmonary forms of tuberculosis are detected in the early stages, when the symptoms of the disease (subjective and objective) are absent or mild. Without the use of the fluorographic method, about half of the newly identified tuberculosis patients would have remained unknown, and treatment and preventive measures would not have been carried out in relation to them and the people around them.

During screening fluorographic examinations, in addition to tuberculosis, post-tuberculosis changes, lung cancer, metastatic lesions of the lungs, benign tumors, sarcoidosis, pneumoconiosis, pulmonary emphysema, pneumofibrosis, pleural layers, adhesions, calcifications, mediastinal pathology, cardiac pathology, spinal scoliosis, variants of development and pathological changes in the ribs, etc.

The rapid development of digital technologies in x-ray diagnostics over the past 10 years has made it possible to significantly reduce the patient's radiation dose and use all the advantages of computer image processing. The active introduction of digital radiographic technology into practical healthcare has dramatically changed the attitude towards the status of fluorographic examinations and increased the diagnostic capabilities of the method for detecting tuberculosis and other lung diseases.

Tuberculin diagnostics is the main method for early detection of tuberculosis infection in children and adolescents. As a specific diagnostic test, it is used in mass examinations of children and adolescents for tuberculosis, as well as in clinical practice for its diagnosis. For this purpose, a single intradermal Mantoux tuberculin test with two tuberculin units (TU) of purified Linnikova tuberculin (2 TU PPD-L) is used.

Among the most accessible compulsory health insurance in LU are radiation methods Chest examinations and tuberculin diagnostics in children and adolescents.