Dispensary groups of tuberculosis patients. Specialized anti-tuberculosis service How long do MBTs live in different environments?

In a person. In medical records, this abbreviation carries important information. The microorganism affects almost every organ and has characteristic symptoms. Many methods for identifying the disease will help to begin treatment in a timely manner.

What it is?

MBT (Mycobacterium tuberculosis) are pathogenic microbes that can significantly harm human health and lead to death. The microorganism was first discovered by Robert Koch in 1882. The discovered bacterium was named after the scientist, as it made a significant contribution to the development of medicine.

The prevalence of the bacterium in the environment is due to its high resistance and ability to persist in soil and dairy products. Microbes affect the human and animal body and are actively released when coughing through airborne droplets, household contact, and less often through biological fluids (urine, blood). Tuberculosis can be transmitted to children through the mother's body.

MBT affects almost every organ or tissue in the human body. The most common and well-known form is pulmonary tuberculosis. Slightly less common are lesions of the kidneys, liver, and membranes of the brain.

Koch's wand is dangerous because of its variability. Once upon a time, humanity was already one step away from defeating a microorganism. During the period when the antibiotic streptomycin was isolated, active and not always correct use of the drug caused a mutation of the mycobacterium. After which the era of resistant forms of tuberculosis that could not be treated began.

MBT+ and MBT-

In the medical histories of people suffering from tuberculosis, when formulating a diagnosis, it is necessary to indicate MBT+ or MBT-, as well as the date of detection of the Koch bacillus. This data is decrypted:

• MBT+ – tuberculosis confirmed by the results of bacteriological studies of sputum smear or bronchial washings, which indicates an open form of the disease.
• MBT- – mycobacteria were not identified according to laboratory tests, which is typical for patients with the closed form of tuberculosis.

If the result is positive, the person is an active bacteria excretor. In 5 minutes of loud conversation, a patient can release up to 3,500 microorganisms into the environment, which is equal to one cough attack. Sneezing with droplets of mucus releases up to one million tuberculosis bacilli into the environment. These patients are especially dangerous to society, as they spread the infection at tremendous speed. During treatment at the dispensary, they are assigned a red zone, which corresponds to a high risk of infection.

A negative result indicates that the patient is not dangerous to society and does not release Mycobacterium tuberculosis into the environment. The movement of people with this result is not limited to the dispensary, subject to treatment and constant laboratory monitoring. They can come into contact with healthy populations without risk of spreading infection. However, this does not mean that in the future the patient will not begin to secrete Koch’s bacillus, only creating the illusion of safety.

What do MBTs do in the body?

The introduction of the microorganism into the human body occurs at the moment of inhalation of Koch bacilli isolated by the patient or the bacteria carrier. Mbt in tuberculosis settle in the lungs, where the development of the pathological process occurs in two ways.

1. The bacterium penetrates the lung, where the body successfully prevents the tuberculosis bacillus from moving into the bloodstream, creating restraining barriers. The favorite localization of the pathogen is the upper lobe of the organ. Immediately after infection, incubation of the Koch bacillus begins for a period of 20 to 40 days. The person’s well-being is satisfactory, there are no general or specific symptoms, but the disease at this stage is already actively developing.
2. The bacterium enters the lungs and, after a short resistance of the immune system, enters the general bloodstream, where it spreads to all organs. If the body’s strength is not enough to concentrate microorganisms within one organ, then generalization of the infection occurs (miliary tuberculosis). The incubation period lasts longer - from 30 to 50 days, but the disease is much more severe.

The first clinical manifestations of tuberculosis are weakness, decreased performance, severe night sweats, and cough. The temperature usually rises to subfebrile levels (37.0-38.4 o C), which helps to suspect MBT as the origin of the disease.

Further, in the absence of treatment, Koch's wand fully exhibits its aggressive properties. The affected lungs begin to disintegrate, and streaks and blood clots appear in the sputum. If the infection reaches the bones, pathological fractures occur.

If such symptoms appear, you should immediately consult a doctor. In the early stages, the disease can be stopped with medications. Late presentation often requires surgical operations along with medications.

Diagnostics

To detect a dangerous pathogen, hardware and laboratory diagnostic methods are used. The optimal way to identify MBT carriers among children is to conduct an allergy test with tuberculin. After Mantoux, Diaskintest is prescribed to differentiate the disease from an enhanced immune response.

Working and studying people undergo routine fluorography of the lungs. The study allows for timely identification and isolation of the patient for further treatment. In the resulting image, you can see the damage to the organ left by the bacterium.

For the purpose of specifically identifying MBT, 3 diagnostic methods are used:

1. Bacteriological analysis.
2. Bacterioscopic examination.
3. Biological method.

Each laboratory test requires the donation of biological fluid - sputum, blood, urine, pleural effusion and even cerebrospinal fluid. The studies have a small error, so it is better to collect biomaterial under the supervision of a doctor.

Conclusion

MBT is a serious threat to humanity. The earlier the tuberculosis bacillus was detected, the easier it will be to get rid of it with the help of medications. Timely detection of early symptoms and planned treatment of the disease will help protect yourself and others from infection.

MBT tuberculosis - what is it, what is the danger? All infectious diseases that occur in the human body appear due to the negative effects of pathogenic microflora. It is she who attacks the vital organs and systems of a person with the help of microorganisms that are dangerous to health, which threatens with unpleasant consequences for the patient. Today, medicine has identified a large number of microbes, bacteria and viruses that can cause danger to humans and develop serious diseases, not many of which can be quickly and effectively treated. Many people are interested in the question - what is MBT and how is this abbreviation deciphered.

MBT are pathogenic microorganisms that belong to the type of mycobacteria that are dangerous to human health. Another name for such microorganisms is Koch's bacillus. This family was identified back in 1882 by the then famous scientist Robert Koch.

It was in his honor that dangerous mycobacteria, which are currently quite common in the environment, were named.

Koch's bacillus is found almost everywhere today, including living organisms (humans, animals). It is important to note that these mycobacteria cause tuberculosis of the respiratory system, kidneys, liver, tissues and other body systems. Human infection occurs in several ways - airborne, household, contact and through blood.

Today, tuberculosis is considered the most common disease, affecting 1/5 of the world's population.

MBT refers to prokaryotes that lack a nucleus. Based on this, it can be noted that mycobacteria are considered quite tenacious, which makes it difficult to treat the patient. Due to the elements of MBT dynamics, they are able to mutate in order to survive.

Basically, a mutation occurs when:

1. A sudden change in environment, for example, from a person’s lungs to air currents or to household appliances.
2. Improper adherence to treatment, where taking one or two medications is not enough to completely destroy pathogenic microorganisms.
3. Leading an unhealthy lifestyle and abusing habits hazardous to health.

In this case, the office begins to mutate, adapting to new conditions. Important: the mutated Koch bacillus is quite difficult to destroy and remove from the body, since in the process of its change the cell and outer membranes become denser, which aggravates the treatment and prevents the bacteria from being destroyed from the inside. Therefore, doctors advise treating tuberculosis as soon as the first symptoms are detected, until the microorganisms get used to “their place of residence” and begin to actively develop in it.

If mycobacteria enter the human body in large quantities, only weak individuals will die under the action of antibiotics. In this case, it depends on the genes of the Koch bacillus, since stronger individuals have a kind of protection from external factors. That is why tuberculosis is currently treated with 4-5 antibiotics and medications that can negatively affect all bacteria, gradually weakening and removing them from the body.

Important: due to its structure and protective functions, treatment of tuberculosis of the lungs and other organs is carried out over 2-6 months.

It is during this time that the office becomes inactive. However, if the treatment is interrupted, the Koch bacillus will again begin to multiply in the human body, namely in the lung cavity, and it will already have resistance to previously used drugs. If treatment is not provided at all in a short time, after 1-1.5 months of active presence of bacteria in the lung cavity, a person will experience lung failure, which will lead the patient to death.

Features of MBT

Mycobacteria look like a straight or slightly curved rod, the dimensions of which are very small - 1-10 microns. The diameter of Koch's rod is even smaller - it rarely reaches 0.6 microns. These microorganisms are adapted to exist in any environment, be it water, the human body or household appliances. Important: MBT live and actively develop at any temperature, but if it reaches 37-42 degrees, a change in metabolism will begin in the cells of Koch's bacillus, which will lead to almost the degeneration of bacteria.

Some scientists compare MBT to mushrooms, since they also require oxygen consumption to develop oxidase systems. Bacterial cells have unique properties - alcohol and acid resistance, which helps them survive in almost any habitat.

On average, mycobacteria live about 7 years in favorable conditions. Depending on your place of residence, this period may increase or decrease.

It is important to note that Koch’s wand lives in almost any environment:

• water;
• internal organs and human systems;
• air;
• animals;
• personal belongings;
• Appliances;
• the room in which the patient lives.

Important: Koch's bacillus is a non-motile bacterium that does not have the ability to form spores and capsules. Therefore, when it enters the human body, it needs to go through an incubation period in order to fully settle into new living conditions and begin to create colonies (reproduction). Doctors say that colonies appear in the cavity of the lungs or bronchi 35-55 days after infection, so if the disease is detected in a short time, the Koch bacillus can be neutralized.

The colonies created by MBT are ivory in color, so when performing an X-ray or fluorography, these neoplasms can be easily seen in the lung cavity. If such colonies are orange or pink, it means that mycobacteria multiplied a long time ago - this requires more careful care of the patient and prompt treatment. Basically, such colonies have a rough surface, but it is possible that it will be wrinkled or slimy. This directly depends on the health of the infected person and the duration of the bacteria in the human body.

In the absence of treatment and compliance with complex therapy, the delicate transparent film from the lumpy colonies begins to disappear, after which thin reddish rods with a different number of granules appear on the surface of the lung cavity. This process is the propagation of Koch's bacillus. On average, the growth of new mycobacteria depends on the number of microorganisms - if they develop in groups, the disease will spread faster throughout the lung cavity.

It is impossible to destroy the accumulation of tuberculosis bacilli on your own, since to completely remove them requires taking medications for a long time that will completely destroy the office.

What does MBT consist of?

The mycobacterium that causes pulmonary tuberculosis has a very developed structure, thanks to which Koch's bacillus is provided with excellent protective conditions.

Bacterial cells consist of:

• nuclear substance, which is endowed with only one cell of DNA (circular);
• cytoplasm, which contains granules that help the office to exist and actively reproduce;
• a membrane that protects cells and other components of bacteria;
• cell wall - it contains a special wax that protects Koch's bacillus from the negative influence of the external environment and medications (it ensures the safety of the bacterium, creates its shape and size, and also provides chemical protection).

When multiplying, the cell walls of Koch's bacillus become a little thinner, so at this time it is somewhat easier to destroy the tuberculosis pathogen.

It is also impossible not to notice that the basis of MBT is tuberculin, which can be called the carrier of the antigenic properties of the bacterium. It is this substance that protects cells from negative influences and suppresses the body’s reactions aimed at its destruction.

How does MBT reproduce? Tuberculosis will not progress if the bacterial cells in the lung cavity are inactive. However, if a person’s immune system is weakened, immediately after the completion of the incubation period, the Koch bacillus begins to multiply. Reproduction occurs by dividing into 2 cells, which lasts no more than 18 hours. Sometimes doctors note that reproduction is carried out by branching, which leads to damage to almost the entire lung cavity, as well as by budding, which also causes infection of a large area of ​​the respiratory organ. If treatment was prescribed on time, the Koch bacillus, or rather its colonies, will not be able to survive after the first dose of drugs, so it is important to consult a doctor in a timely manner, since the tuberculosis pathogen can be defeated even at the incubation period. The main thing at this time is not to interrupt treatment, otherwise mycobacteria will get used to the composition of the drugs and will no longer respond to treatment with these drugs.

How long do MBTs live in different environments?

As mentioned earlier, Koch's wand is capable of existing in almost any environment.

But in order to understand how to overcome this mycobacterium, it is important to understand what environment has a detrimental effect on it:

• microorganisms live in water for 5 years;
• in boiling water, Koch's wand dies after 5 minutes;
• in the human body, the bacterium exists for a very long time - several decades (in an inactive state), however, if it begins to multiply, its lifespan is significantly reduced, especially in the absence of treatment, because after 1-2 months the infected person dies;
• the bacterium lives in the soil for six months;
• in dust – up to 2 months;
• in food products the tuberculosis bacillus lingers for 1 year (butter, cheese);
• the tuberculosis bacillus lives on household appliances and personal belongings for 3-5 months;
• In the premises of a sick person, its lifespan is a little more - 7-8 months.

Sun rays and chemicals containing chlorine have a detrimental effect on Koch's bacillus - in this case, MBT, which causes tuberculosis, dies within 5 minutes.

Important: if tuberculosis has not been completely cured, the bacteria can become inactive and turn into L-forms, which live in the body for a long time and wait for a favorable moment to reproduce.

These include:

• decreased immunity;
• the onset of chronic diseases in the body;
• colds and flu;
• poor nutrition with a minimum amount of protein and microelements;
• sedentary lifestyle and lack of physical activity.

If bacteria have entered the human body, they can only be removed with the help of antibiotics and other medications. Therefore, you should not self-medicate, since improper use of medications leads to aggravation of the disease and MBT mutations.

What happens after MBT enters the human body

Depending on the type of infection, mycobacteria act differently in the human body:

• If Koch's bacillus has entered the lungs by airborne droplets, it immediately begins to “settle in,” affecting the upper part of the lungs. Once the bacterium enters the human body, an incubation period begins, lasting from 20 to 40 days. At this time, the patient will not feel any symptoms or changes in the body, however, as this period ends, the disease can no longer be attributed to early tuberculosis, which occurs at the initial stage.

• If the MBT that causes tuberculosis enters the bloodstream (this can also happen during airborne infection), they will be spread throughout the body. This risks the fact that Koch’s bacillus can affect not only the lung cavity, but also other internal organs and systems of a person. However, it is easiest for mycobacteria to get into the lungs, so it is mainly there that inflammation occurs. If microorganisms enter the blood, the incubation period lasts slightly longer - from 30 to 50 days.

It is very difficult to detect pneumonia at an early stage, since during the incubation period the Koch bacillus, which causes tuberculosis, is in an inactive state. However, it is at this time that it is easiest to destroy it, so every person should undergo regular fluorography to detect the onset of the disease at an early stage.

Early symptoms of damage to the lung cavity by MTB include:

• a sharp deterioration in health;
• unreasonable rise in temperature;
• the appearance of a cough, which may be accompanied by sputum or purulent mucus;
• weakness throughout the day;
• excessive sweating;
• rapid fatigue of the body.

If you notice these symptoms, it is better to consult a doctor to identify the disease, since only early diagnosis can quickly cure tuberculosis and overcome unpleasant symptoms.

For convenience, tuberculosis patients are divided into dispensary registration groups, or contingents. Each group has a specific list of mandatory activities.

1. Adult patients subject to registration in the PTD are divided into the following groups.
Group 0 (zero) - persons with respiratory tuberculosis of questionable activity. X-ray examination is carried out upon enrollment in the group, and then once every 2 months. Bacterioscopy and culture are performed before enrollment, then once every 2-3 months.

Group II - patients with subsiding active tuberculosis of the respiratory system; X-ray examination - once every 3 months, bacterioscopy and culture - at least once every 3 months.

Group IV - persons who are in contact with bacteria excretors (including workers of anti-tuberculosis institutions) or farm animals sick with tuberculosis. Fluorography - at least once every 6 months. Detection of any changes in X-rays in persons who have been in contact with a bacterial excretor is an indication for computed tomography (CG) of the chest organs. Bacterioscopy and culture - if pulmonary tuberculosis is suspected.

Group V - patients with extrapulmonary tuberculosis and persons cured of it. X-ray and bacteriological examinations are carried out as in group IV.

2. During dispensary observation of children and adolescents, there is also group VI, which includes children and adolescents with an increased risk of tuberculosis, selected for observation based on the results of tuberculin diagnostics.

There are also features of observation in other groups.
It is important for a general practitioner to know that patients with active pulmonary tuberculosis are observed in groups I and II, and those with extrapulmonary tuberculosis are observed in groups V-A and V-B. Persons of group I of dispensary registration with CD (+) indicated in the diagnosis pose an epidemiological danger to others.

Active tuberculosis is a process in which M. tuberculosis is bacteriologically detected in patients or changes typical of tuberculosis (granulomas) are histologically detected, as well as clinical and radiological signs characteristic of tuberculosis.

The classification of tuberculosis in the Russian Federation identifies the following forms of this disease.

• Tuberculosis intoxication in children and adolescents
• Primary tuberculosis complex
• Tuberculosis of the intrathoracic lymph nodes
• Disseminated tuberculosis
• Miliary tuberculosis
• Focal pulmonary tuberculosis
• Infiltrative pulmonary tuberculosis
• Caseous pneumonia
• Pulmonary tuberculoma
• Cavernous pulmonary tuberculosis
• Fibrous-cavernous pulmonary tuberculosis
• Cirrhotic pulmonary tuberculosis
• Tuberculous pleurisy (including empyema)
• Tuberculosis of the bronchi, trachea, upper respiratory tract, etc. (nose, oral cavity, pharynx)
• Respiratory tuberculosis combined with dust occupational lung diseases
• Tuberculosis of the meninges and central nervous system
• Tuberculosis of the intestines, peritoneum and mesenteric lymph nodes
• Tuberculosis of bones and joints
• Tuberculosis of the urinary and genital organs
• Tuberculosis of the skin and subcutaneous tissue
• Tuberculosis of peripheral lymph nodes
• Tuberculosis of the eye
• Tuberculosis of other organs

In Russia, there is currently a transition to the International Classification of Diseases (ICD), 10th revision. The tuberculosis section in ICD-10 is as follows.

A15 Tuberculosis of the respiratory system, confirmed bacteriologically and histologically
A15.0 Pulmonary tuberculosis, confirmed bacterioscopically with the presence or absence of culture growth
A15.1 Pulmonary tuberculosis, confirmed only by culture growth
A15.2 Pulmonary tuberculosis, histologically confirmed
A15.3 Pulmonary tuberculosis, confirmed by unspecified methods
A15.4 Tuberculosis of the intrathoracic lymph nodes, confirmed bacteriologically and histologically Excluded if specified as primary
A15.5 Tuberculosis of the larynx, trachea and bronchi, confirmed bacteriologically and histologically
A15.6 Tuberculous pleurisy, confirmed bacteriologically and histologically. Tuberculous pleurisy in primary tuberculosis of the respiratory system, confirmed bacteriologically and histologically, is excluded
A15.7 Primary tuberculosis of the respiratory system, confirmed bacteriologically and histologically
A15.8 Tuberculosis of other respiratory organs, confirmed bacteriologically and histologically
A15.9 Respiratory tuberculosis of unspecified localization, confirmed bacteriologically and histologically
A16 Tuberculosis of the respiratory system, not confirmed bacteriologically or histologically
A16.0 Pulmonary tuberculosis with negative results of bacteriological and histological studies
A16.1 Pulmonary tuberculosis without bacteriological and histological studies
A16.2 Pulmonary tuberculosis without mention of bacteriological or histological confirmation
A16.3 Tuberculosis of the intrathoracic lymph nodes without mention of bacteriological or histological confirmation Tuberculosis of the intrathoracic lymph nodes, specified as primary, is excluded
A16.4 Tuberculosis of the larynx, trachea and bronchi without mention of bacteriological or histological confirmation
A16.5 Tuberculous pleurisy without mention of bacteriological or histological confirmation Tuberculous pleurisy in primary respiratory tuberculosis is excluded
A16.7 Primary tuberculosis of the respiratory system without mention of bacteriological or histological confirmation
A16.8 Tuberculosis of other respiratory organs without mention of bacteriological or histological confirmation
A16.9 Tuberculosis of the respiratory system of unspecified localization without mention of bacteriological or histological confirmation

A17+ Tuberculosis of the nervous system
A17.0+ Tuberculous meningitis (G01*)
A17.1+ Meningeal tuberculoma (G07*)
A17.8+ Tuberculosis of the nervous system of other localizations
A17.9+ Tuberculosis of the nervous system, unspecified (G99.8*)

A18 Tuberculosis of other organs
A18.0+ Tuberculosis of bones and joints
A18.1+ Tuberculosis of the genitourinary organs
A18.2 Tuberculous peripheral lymphadenopathy Excluded: tuberculosis of the lymph nodes: mesenteric and retroperitoneal (A18.3); intrathoracic (A15.4, A16.3); tuberculous tracheobronchial adenopathy (A 15.4, A 16.3)
A18.3 Tuberculosis of the intestines, peritoneum and mesenteric lymph nodes
A18.4 Tuberculosis of the skin and subcutaneous tissue Excludes: lupus erythematosus (L93.-) systemic lupus erythematosus (M32.-)
A18.5+ Tuberculosis of the eye Lupus vulgaris of the eyelid is excluded (A 18.4)
A18.6+ Tuberculosis of the ear Tuberculous mastoiditis excluded (A18.0+) A18.7+ Tuberculosis of the adrenal glands (E35.1*)
A18.8+ Tuberculosis of other specified organs

A19 Miliary tuberculosis Includes: generalized tuberculosis; disseminated tuberculous polyserositis
A19.0 Acute miliary tuberculosis of one specified localization
A19.1 Acute miliary tuberculosis of multiple localization
A19.2 Acute miliary tuberculosis of unspecified localization
A19.8 Other forms of miliary tuberculosis
A19.9 Miliary tuberculosis of unspecified localization

FULL NAME. Bogachev Alexander Alexandrovich

Age: 34 years

Date of birth: September 18, 1971

Place of residence: Dukhovshchina, st. Isakovskogo 51, apt. 12

Date of admission to the clinic: 02.11.04

Patient complaints upon admission.

A rare periodic cough, fever.

Complaints at the time of supervision

Doesn't present it.

Family composition: Currently there are 3 people in the family (except for the patient, wife and child). The wife and child are healthy.

Material and living conditions: the family consists of 3 people. They live in an apartment. All family members use separate personal hygiene items.

Anamnesis vitae.

Born from the 1st pregnancy, 1st birth, weighing 3000g. The pregnancy proceeded without complications. The birth was on time, physiological, the baby screamed immediately. She was fed with mother's milk until 10 months. Vaccinated with BCG on day 6 in the maternity hospital. The child was discharged from the maternity hospital on the 7th day with clean skin and a dry umbilical wound.

He started holding his head at 2 months, sitting at 6 months, and walking at 10 months. Started talking at 12 months. Teeth erupted on time, according to age.

He attended kindergarten from the age of 3, school from the age of 7. I studied at "4", "5". In physical and neuropsychic development he did not lag behind his peers.

Dietary history: currently, nutrition is complete in quantitative and qualitative terms. Meals 3 times a day. Appetite is normal.

Previous illnesses: rubella, chicken pox, bronchitis, tonsillitis, ARVI 1-2 times a year, left ear injury.

Allergological history: allergic reactions to food, house dust, pollen, medications,

Animal hair and household chemicals are not noted.

Sanitary and epidemiological history: lives in an area that is favorable in epidemiological terms. Complies with personal hygiene rules. Was not in contact with infectious patients. During the last two months, no vaccinations against infectious diseases or parenteral interventions were performed.

Special anamnesis.

Vaccinated with BCG on day 6 in the maternity hospital, scar 6 mm.

On the review R-gram dated October 25, 2004: infiltrative tuberculosis on the left in S1, S2. No tuberculosis contact has been established. I had never had tuberculosis before.

Anamnesis morbi.

It was first identified when visiting a therapist at a clinic about a cough that appeared after hypothermia.

Objective research data.

Height 172 cm. Body weight 65 kg. Body temperature 36.6˚С.

The condition is satisfactory. I feel satisfactory. Takes an active position in bed. Consciousness is clear. Oriented in space, time and self. Easily comes into contact with others. The mood is even and calm. Sleep and appetite are not disturbed.

Physical development: regular physique, asthenic.

Skin and mucous membranes: the skin is pale, clean, shadows under the eyes. On the left shoulder there is a scar about 6 mm from BCG. The skin is dry. The temperature is normal. Skin elasticity is good. There is no swelling. Visible mucous membranes are pink, moist, clean. The sclera is normal. The hair is long, its structure is not disturbed, it has a healthy shine, the same length, and does not fall out. The nails are smooth, their structure is not disturbed.

Subcutaneous fat layer: underdeveloped, distributed evenly, symmetrically in the same areas of the body. Subcutaneous fat fold thickness:

On the stomach 1 cm

Chest 0.7 cm

On the back 1 cm

On the hip 1.5 cm

On the shoulder 1 cm

Soft tissue turgor is good.

Lymph nodes: submandibular, axillary and inguinal lymph nodes are palpable, about 0.5 cm on both sides, elastic, painless, moderately mobile, not fused to each other and surrounding tissues. The skin over them is not changed.

The tonsils are pink, clean, and do not protrude from the palatine arches.

Musculoskeletal system: active position, correct gait. Body type: asthenic.

The head is round in shape. The skull is symmetrical, the ratio of the brain and facial parts is 2:1. The palpebral fissures, nasolabial folds, and ears are located symmetrically.

The chest has the shape of a truncated cone. The intercostal spaces are the same in symmetrical areas. On palpation the chest is painless.

The posture is correct, there are no curvatures of the spine. The waist triangles are symmetrical. The shoulders, collarbones, and lower corners of the shoulder blades are at the same level.

The upper and lower limbs have the correct shape. Joints of a normal configuration, active and passive movements in them in full. The soft tissues in the joint area are not changed.

The muscular system is developed according to gender and age, evenly, symmetrically on both halves of the body. Muscle tone and strength are sufficient.

Respiratory system.

Examination: the nose is unchanged. Nasal breathing is free. There is no pain on the projection of the paranasal sinuses. The larynx is normal. The voice is sonorous. The chest is in the shape of a truncated cone, asthenic, both halves are equally involved in the act of breathing. The supraclavicular and subclavian fossae are pronounced. The ribs are located obliquely, the intercostal spaces are not widened. Vesicular breathing. Respiratory rate 17/min. Breathing is deep and rhythmic.

Palpation: the chest is painless, elastic, moderate resistance. Skin folds on symmetrical areas of the chest are of the same thickness. Voice tremors are normal.

Comparative percussion: a clear pulmonary percussion sound was detected in symmetrical areas of the chest.

Topographic percussion: the height of the apexes of the lungs in front is 1 cm above the collarbone, in the back - at the level of the 7th cervical vertebra. Krenig margins are 3 cm on both sides.

Lower border of the lungs:

right left lines

Midoclavicular 6th rib ———

Middle axillary 8th rib 9th rib

Scapular 9th rib 10th rib

Paravertebral at the level of the spinous process of the 11th thoracic vertebra

Mobility of the lower edge of the lungs:

lines right left

Sedoclavicular 3 cm ——-

Middle axillary 4 cm 4 cm

Scapular 3 cm 3 cm

Symptoms of Filatov's fields, "Philosopher's cup", Arkavin, Koranya are negative.

Auscultation: vesicular breathing is heard. No wheezing. Bronchophony over symmetrical areas of the lungs is the same.

The cardiovascular system.

Examination: the heart area is unchanged. There is no pulsation of the carotid arteries, swelling and pulsation of the neck veins, pulsations in the heart and epigastric region, or in the jugular fossa. The apical impulse is visually detected in the 5th intercostal space on the left along the midclavicular line.

Palpation: the apical impulse is localized in the 5th intercostal space on the left along the midclavicular line, of sufficient strength, moderate resistance, not high, not diffuse, area 1 cm 2.

The pulse is symmetrical, the same on both hands, uniform, fast, sufficient filling and tension, 76 beats per minute. Capillary pulse is not detected.

Percussion:

Limits of relative dullness:

Right right edge of the sternum

Top 3rd rib

Left 1.5 cm medially from the midclavicular line

The limits of absolute stupidity:

Right left edge of the sternum

Top 4th rib

Left 1 cm medially from the left border of relative dullness.

The vascular bundle is 3 cm. The outline of the heart is normal.

Auscultation: heart sounds of satisfactory sonority, rhythmic, no noise. Blood pressure 110/70 mm Hg.

Digestive system.

Inspection: the tongue is coated with a whitish coating, the mucous membranes of the mouth, gums, tonsils, back of the pharynx, soft and hard palate are pink and moist. The tonsils are not enlarged.

Thick and liquid food passes through the esophagus freely.

The abdomen is round, symmetrical, and actively participates in the act of breathing. The skin in the abdominal area is clean, pale, there are no signs of surgical intervention, the saphenous veins are not dilated. There is no visible peristalsis.

Superficial palpation: the abdomen is soft, there is moderate pain in the right hypochondrium. Symptoms of muscle protection and the Shchetkin-Blumberg symptom are negative. No neoplasms or hernias were detected. No discrepancy of the muscles of the anterior abdominal wall was detected.

Deep palpation: the sigmoid colon is palpated in the form of an elastic cylinder, about 2 cm in diameter, soft consistency, with a smooth surface, painless, moderately mobile, does not rumble.

The cecum is cylindrical in shape, about 2 cm in diameter, soft-elastic, its surface is smooth, painless, moderately mobile, and does not rumble.

The ascending colon is in the form of a cord with a diameter of about 1 cm, soft-elastic consistency, with a smooth surface, painless, moderately displaceable, does not rumble.

The descending colon is in the form of a cord about 1 cm in diameter, elastic, soft, the surface is smooth, painless, limited mobility, rumbling.

The transverse colon is palpated in the form of a soft-elastic cylinder with a diameter of about 2 cm, smooth, painless, moderately mobile.

The greater curvature of the stomach is determined by percussion 3 cm above the navel and is not palpable.

The pancreas is not palpable using the Groth method. There is no pain in the Mayo-Robson, Desjardins points and in the Choffard area. Mayo-Robson, Mendel and Mussi signs (left) are negative.

The lower edge of the liver does not protrude from under the costal arch, the edge is sharp, soft-elastic, smooth, painless. Percussion dimensions of the liver according to Kurlov:

Midclavicular line 9 cm

Midline 8 cm

Oblique size 6 cm

The gallbladder is not palpable.

The fluctuation symptom is not detected. No pain was detected in Sternberg's areas.

The spleen is not palpable. Precutary dimensions: length 6 cm, diameter 4 cm.

Percussion: with comparative percussion, a tympanic sound was detected in the flanks, the same percussion sound in symmetrical areas of the abdomen.

Urinary system.

The lumbar region is not changed, the skin and soft tissues are normal. Urination is free, painless, no dysuric disorders. The kidneys and bladder are not palpable. The ureteral points are painless. Pasternatsky's symptom is not detected.

Nervous system.

The patient is sociable and emotionally labile. The pupils are normal and react quickly to light. There are no obvious signs of damage to the nervous system. Tactile and pain sensitivity and coordination of movements are preserved.

Survey plan.

1. General blood analysis.
2. General urine analysis.
3. Blood chemistry.
4. Blood test for HIV and Hbs Ag
5. R-graphy of the chest.
6. Sputum analysis for MBT.

Additional research methods.

1. General blood analysis

1. General urine analysis

1. Biochemical study of the patient's blood serum

Blood test for HIV and Hbs Ag (11/3/04): negative

In sputum analysis

R-graphy from 10/25/04

ECG from 3.11.04

Sinus rhythm, heart rate 75 per minute. EOS was not rejected.

Supervision diary

02/31/05. The patient's condition is satisfactory. Body temperature 36.6 0 C. No complaints.

The skin is pale and clean. The tongue is not coated. In the lungs there is vesicular breathing, no wheezing. There is a clear pulmonary sound above the lungs. NPV 17 per minute. Heart sounds are of satisfactory sonority, rhythmic, there are no noises. The abdomen is soft, b/w. Physiological functions are normal.

02/04/05. The condition and well-being are satisfactory. Body temperature 36.7 0 C. No complaints.

The skin is pale and clean. The tongue is not coated. Pharynx without signs of inflammation. There were no changes in the respiratory, cardiovascular and urinary systems. The abdomen is soft, b/w. Stool and urination are normal.

Infiltrative tuberculosis S1-2 of the left lung, in the phase of decay and seeding, MBT “+”, group 1A, first identified.

Diagnosed on the basis of: 1. The patient’s complaints upon admission: Rare periodic cough, fever.

1. R-graphs

from 10/25/04

In segments 1 and 2 of the left lung there is focal-focal infiltration. Small areas of destruction.
Conclusion: infiltrative pulmonary tuberculosis.

Compared to 10/25/04, there is a slight positive trend towards resorption of infiltration. Foci of destruction remain.

1. Sputum analysis from 12/17/04. (collection 11/3/04). MBT growth is moderate, from 20 to 100 CFU.

Differential diagnosis.

Differential diagnosis of round tuberculous infiltrate and small encysted pleurisy.

A small encysted pleurisy during X-ray examination can be displayed in the form of a homogeneous round, clear, limited shadow, simulating the shadow of a round tuberculous infiltrate, especially when the pleurisy is localized in the upper part of the pulmonary field. In differential diagnosis, a multiplanar X-ray examination is decisive, which, in the case of encysted pleurisy, establishes the localization of its shadow image directly at the chest wall.

Subsequent pleural puncture confirms the presence of encysted effusion in the pleural cavity.

Fibrin bodies can also serve as a reason for their differential diagnosis from round tuberculous infiltrate. The shadows of these fibrin bodies are usually determined in the supradiaphragmatic zone of the pulmonary field. In some cases, it is possible to observe radiographically a change in their localization when the position of the patient’s torso changes (rolling). When the fibrin bodies are immobilized, they can be distinguished from the pulmonary infiltrate only on the basis of multiplanar fluoroscopy and tomography data, which prove their direct location near the chest wall.

Differential diagnosis of tuberculous infiltrates and

nonspecific atypical pneumonia.

Both diseases are characterized by low symptoms, scanty or no deviations from the norm of stetoacoustic data. When making a differential diagnosis, the following should be taken into account:

1) the basis of pathological changes in atypical pneumonia is damage to the peribronchial and perivascular tissue, which is reflected in the form of pronounced interstitial changes in the lungs identified during x-ray examination;

2) pronounced reactive changes in the root of the lung speak against the tuberculous nature of the detected infiltrative changes;

3) the presence of leukopenia is more typical for atypical pneumonia than for tuberculosis;

4) with atypical pneumonia, more often than with tuberculosis, the involvement of the pleura, mainly interlobar, in the pathological process is noted;

5) during dynamic radiological observation of a patient with atypical viral pneumonia, it is noted that in cases of their favorable course, along with the resorption of inflammatory changes, peribronchial and perivascular compactions of the lung tissue often persist.

Mode: general

Rifampicin 0.15 * 3 times / day.

Pyrazinamide 0.5 *3r/d

Ethambutol 0.4 * 3 times a day

Vit B6 0.02*1r/d

The therapy carried out leads to positive dynamics. The patient's well-being has improved significantly

Forecast for life(quo ad vitam) – favorable.

Health forecast– favorable if the appropriate recommendations are followed.

Forecast for labor – favorable.

- Nutrition - a diet rich in protein.

— Vitamin therapy

- Spa treatment

— Limitation for 2 months. contacts with children and people with immunodeficiencies.

Patient Aleksey Alekseevich Bogachev has been under inpatient treatment in the adult PTD since 02.11.04 with a diagnosis of: Infiltrative tuberculosis S1-2 of the left lung, in the phase of decay and seeding, MBT “+”, group 1A, newly diagnosed.

Treatment provided:

Mode: general

Lek. means: tubazide 0.15 *2 times per day.

Rifampicin 0.15 * 3 times / day.

Pyrazinamide 0.5 *3r/d

Ethambutol 0.4 * 3 times a day

Isoniazid 10% - 5.0 IM, except weekends.

Vit B6 0.02*1r/d

Conducted research:

1. General blood test.

2. General urine analysis.

3. Biochemical blood test.

4.Blood test for HIV and Hbs Ag

5.R-graphy of the chest.

6. Sputum analysis for MBT.

Currently, the patient's condition is satisfactory. Body temperature 36.6 0 C. No complaints. The skin is pale and clean. The tongue is not coated. In the lungs there is vesicular breathing, no wheezing. There is a clear pulmonary sound above the lungs. NPV 17 per minute. Heart sounds are of satisfactory sonority, rhythmic, there are no noises. The abdomen is soft, b/w. Physiological functions are normal. Positive dynamics are observed. The patient continues treatment.