Tuberculosis epidemic. Tuberculosis in children and adults: causes, manifestations, diagnosis, how to prevent and treat Control of the tuberculosis epidemic process

Integral parts of the epidemic process are the reservoir of tuberculosis infection, its source, the susceptible population and the routes of transmission.

The reservoir of tuberculosis infection consists of individuals infected with Mycobacterium tuberculosis, some of whom become ill during their lifetime. Some animals are also considered to be reservoirs of tuberculosis. The reservoir consists of two parts: potential (infected but not sick people) and active (identified and undiagnosed patients with active tuberculosis).

The source of tuberculosis is people and animals with tuberculosis. releasing Mycobacterium tuberculosis into the external environment.

Susceptible population - people infected with Mycobacterium tuberculosis and susceptible to tuberculosis.

Since Mycobacterium tuberculosis is resistant to many environmental factors and persists for a long time in various substances (liquid and dry sputum, other secretions of patients, food, etc.), tuberculosis infection occurs in various ways.

• Airborne droplets are the main route of infection. At the same time, tiny droplets of sputum containing Mycobacterium tuberculosis penetrate into the alveoli. The most dangerous are patients with massive bacterial secretion, who, even during normal conversation, disperse infected droplets of sputum. Aerosol spread also occurs with strong coughing, sneezing, or loud talking. A sprayed aerosol (tiny infected droplets of sputum up to 5 microns in size) remains in the air of a closed room for up to 60 minutes, and then settles on furniture and the floor. walls, clothing, linen, food, etc. The best conditions for infection are poorly ventilated closed rooms where a coughing patient is located.
• Infection through airborne dust occurs when dust particles containing mycobacteria are inhaled, for example, when shaking out clothing. linen and bedding release bacteria in the room.
• The alimentary route of infection is possible when eating foods contaminated with mycobacteria. Among animals, more than 50 species of mammals and the same number of bird species are known that are susceptible to tuberculosis. Among these animals, cows and goats may be involved in human infection. In this case, infection occurs through the transmission of bovine mycobacteria through milk and dairy products, much less often through eating meat or through direct contact with animals. Tuberculosis in dogs, cats, sheep, and pigs is not of serious epidemiological significance.
• The contact route of infection through the skin and mucous membranes can be observed in persons directly working with the culture of Mycobacterium tuberculosis or infectious material (for example, pathologists, laboratory workers). Livestock workers can become infected in the same way through contact with a sick animal.
• Intrauterine infection (extremely rare) is possible when the placental barrier is disrupted or as a result of ingestion of amniotic fluid containing mycobacteria. Currently, this route of transmission of infection does not have serious epidemiological significance.

Infection and disease with tuberculosis

Tuberculosis is an infectious disease with a long period between infection (infection) and development of the disease. After a person comes into contact with a bacterial release or contaminated material, there is a possibility of infection of a healthy person, which depends on the properties of the pathogen, as well as on the susceptibility of the human body. One bacterial pathogen can infect an average of about 10 people per year. The likelihood of infection increases in the following situations:

• upon contact with a patient with tuberculosis with massive bacterial excretion;
• with prolonged contact with a bacteria-releasing agent (living with a family, being in a closed institution, professional contact, etc.);
• in close contact with a bacterial excretor (being in the same room with a patient, in a closed group).

After infection with mycobacteria, clinically significant disease may develop. The lifetime probability of developing the disease in a healthy infected person is about 10%. The development of tuberculosis primarily depends on the state of the human immune system (endogenous factors), as well as on repeated contact with Mycobacterium tuberculosis (exogenous superinfection). The likelihood of illness increases in the following situations:

• in the first years after infection:
• during puberty;
• in case of re-infection with Mycobacterium tuberculosis:
• in the presence of HIV infection (the probability increases to 8-10% per year);
• in the presence of concomitant diseases (diabetes mellitus, etc.):
• during therapy with glucocorticoids and immunosuppressants.

Tuberculosis is not only a medical and biological problem, but also a social problem. Psychological comfort, socio-political stability, material standard of living, and health literacy are of great importance in the development of the disease. general culture of the population, living conditions, provision of qualified medical care, etc.

The role of primary infection, endogenous reactivation and exogenous superinfection

Primary tuberculosis infection occurs when a person is initially infected. As a rule, this causes adequate specific immunity and does not lead to the development of the disease.

With exogenous superinfection, Mycobacterium tuberculosis may re-enter the body and reproduce.

With close and prolonged contact with the bacterial excretor, Mycobacterium tuberculosis enters the body repeatedly and in large quantities. In the absence of specific immunity, early massive superinfection (or constant reinfection) often causes the development of acutely progressive generalized tuberculosis.

Even in the presence of specific immunity developed after a primary infection, late superinfection can also contribute to the development of the disease. In addition, exogenous superinfection can contribute to the exacerbation and progression of the process in a patient with tuberculosis.

Endogenous reactivation of tuberculosis arises from primary or secondary foci in organs that have remained active or worsened. Possible reasons are decreased immunity due to the presence of background or exacerbation of concomitant diseases. HIV infections, stressful situations, malnutrition, changes in living conditions, etc. Endogenous reactivation is possible in persons of the following categories:

• in an infected person who has never previously had any signs of active tuberculosis:
• in a person who has had active tuberculosis and is clinically cured (once infected, a person retains Mycobacterium tuberculosis in the body for life, that is, biological cure is impossible);
• in a patient with subsiding activity of the tuberculosis process.

The likelihood of endogenous reactivation in infected individuals allows tuberculosis to maintain a reservoir of infection even with clinical cure of all contagious and non-contagious patients.

Control over the tuberculosis epidemic process

The presence of tuberculosis patients with bacterial excretion (identified and undetected) makes it possible to maintain the reproduction of new cases of the disease. Even if the bacteria excretors are cured, the reservoir of tuberculosis infection will persist as long as there is a significant number of infected individuals in the population who have the opportunity to develop tuberculosis due to endogenous reactivation. Therefore, it will be possible to talk about victory over tuberculosis only when a new uninfected generation of people grows up. In this regard, health-improving preventive measures among the entire population with an emphasis on risk groups are especially important.

The goal of anti-tuberculosis work is to establish control over the tuberculosis epidemic process, which will entail a reduction in the true incidence. mortality and prevalence of tuberculosis. To do this, it is necessary to carry out a set of measures. aimed at reducing the number of sources of infection, blocking transmission routes, reducing the reservoir and increasing the population's immunity to infection.

Measures to reduce the number of sources of tuberculosis

• Identification of patients with tuberculosis using all available methods - through mass preventive examinations of the population, as well as examinations of patients with symptoms suspicious of tuberculosis when visiting a doctor of any specialty. Increasing the coverage and improving the quality of preventive examinations usually leads to a short-term increase in morbidity rates.
• Clinical cure of the vast majority of tuberculosis patients (newly identified individuals and patients from contingents of anti-tuberculosis institutions). This is possible only with the use of an integrated approach to treatment (controlled chemotherapy, pathogenetic therapy, collapse therapy, if indicated - surgical treatment, sanatorium treatment, etc.), as well as the establishment of an adequate sanitary and hygienic regime.

Measures to prevent the transmission of tuberculosis

• Hospitalization of bacterial excretors in an anti-tuberculosis hospital until the massive bacterial excretion stops.
• Implementation of measures to limit the spread of infection in anti-tuberculosis institutions (administrative measures, environmental control, use of personal protective equipment).
• Carrying out anti-epidemic measures (current and final disinfection, chemoprophylaxis of contact persons, etc.) in foci of tuberculosis infection (in places of stay of patients, in any medical institutions where a patient with tuberculosis has been identified, in institutions of anti-tuberculosis service).

Measures to reduce the reservoir of tuberculosis and increase the population’s immunity to the disease

Sent to work with infected and uninfected populations.

• Prevention of recurrent cases of tuberculosis among cured individuals through a set of preventive measures (health-improving procedures, sanatorium-resort treatment, anti-relapse courses of therapy).
• Carrying out preventive anti-tuberculosis immunization of the population.
• Increasing the standard of living of the population, improving living conditions, increasing sanitary literacy, general culture, etc.

Indicators characterizing the epidemic process

The main task of analyzing the epidemic process is to clarify the nature and intensity of the spread of tuberculosis infection, identify sources of infection, routes of transmission of the pathogen and determine priority areas for a set of anti-epidemic measures.

The analysis of the epidemic situation is carried out using intensive indicators that describe the spread of the phenomenon. The main intensive indicators characterizing the tuberculosis epidemic process are mortality, morbidity, morbidity (prevalence) and infection.

Extensive indicators are used to characterize the structure of the phenomenon being studied (for example, the proportion of a given clinical form of tuberculosis among all forms).

Absolute values ​​should be taken into account when planning the scope of anti-tuberculosis measures (workload on doctors, calculating the need for drugs, planning the number and profile of beds, etc.).

Visibility indicators reflect changes in the epidemiological situation. The indicator of the initial (or base) year is taken as 100%, and the indicators of subsequent years are calculated in relation to them.

It is important to understand that only the interaction between indicators can more likely characterize a particular epidemic situation in the region and be an indirect reflection of the level of organization of anti-tuberculosis care to the population.

Mortality from tuberculosis is a statistical indicator expressed by the ratio of the number of deaths from tuberculosis to the average annual population in a specific administrative territory for a certain period of time (for example, during the reporting year).

When analyzing the mortality rate from tuberculosis, it is important to determine the proportion of patients identified posthumously and the proportion of patients who died in the first year of observation. An increase in the mortality rate from tuberculosis is the most objective criterion of the unfavorable epidemic process.

The tuberculosis incidence rate, or detection rate, is the number of tuberculosis patients newly identified and registered in a specific administrative territory over a certain period of time (for example, during the reporting year). The incidence rate also includes the number of people diagnosed with tuberculosis posthumously.

It is necessary to distinguish between the tuberculosis incidence rate and the true incidence in the administrative territory.

The incidence rate reflects only cases of the disease identified and taken into account by official registration and directly depends on the following factors:

• coverage and quality of preventive examinations of the population for tuberculosis;
• organization and quality of examination of a patient when visiting a doctor with symptoms suspicious of tuberculosis;
• level of registration of identified cases;
• the level of true incidence of tuberculosis.

In practical work, a phthisiatrician who organizes health care has to assess the quality of the work of the general medical network in identifying patients with tuberculosis. If the population coverage with preventive examinations is low in an administrative territory, the number of undiagnosed patients in the previous year can be approximately calculated. To do this, it is necessary to know the number of people in whom the disease was detected extremely late, which, as a rule, includes the following cases:

• newly diagnosed patients with fibrous-cavernous tuberculosis;
• persons identified posthumously;
• persons who died from tuberculosis in the first year after detection.

When calculating the mortality rate from tuberculosis in the Russian Federation, mortality from the consequences of tuberculosis is also taken into account. However, the total number of such persons is small and does not have a significant impact on the mortality rate.

The calculation of the incidence rate in the Russian Federation differs from the WHO calculation. WHO calculates the incidence rate for all countries, including the number of newly diagnosed patients and relapses of tuberculosis. The WHO European Bureau also includes in the incidence rate a group of patients with an unknown medical history.

Morbidity (prevalence, patient populations) is a statistical indicator reflecting the relative number of patients with active tuberculosis (newly diagnosed, relapses, after early termination of a course of chemotherapy, after an ineffective course of chemotherapy, chronic patients, etc.). registered with the I and II State Administrations at the end of the reporting year in the administrative territory.

Infection of the population with Mycobacterium tuberculosis is determined by the percentage of the number of persons with a positive Mantoux test with 2 TU (except for persons with post-vaccination allergies) to the number of those examined.

In conditions of complete vaccination of newborns and revaccination (given the difficulties in differential diagnosis between infectious and post-vaccination allergies), the use of the infection rate may be difficult. Therefore, an indicator characterizing the annual risk of infection is used - the percentage of the population exposed to primary infection with Mycobacterium tuberculosis.

To assess the epidemic situation regarding tuberculosis, indicators characterizing the level of organization of anti-tuberculosis care to the population are also used. The main ones are the coverage of the population with preventive examinations for tuberculosis, the effectiveness of treatment of patients, as well as indicators characterizing the effectiveness of preventive measures in the source of infection.

The list of listed persons and the approach to calculating the indicator are not final and indisputable. For example, late-diagnosed patients also include patients with cirrhotic tuberculosis. In addition, some of the patients who died in the first year of observation and were identified posthumously may die not from late detection of advanced tuberculosis, but from acute progression of the process. However, information about the individuals listed in the text is available, is calculated and monitored annually, and can be obtained from approved statistical reporting forms.

Increased risk factors for tuberculosis

The phenomenon of “selectivity” of tuberculosis in people infected with Mycobacterium tuberculosis has long attracted the interest of researchers and prompted them to search for the causes contributing to the development of the disease. A retrospective analysis of the spread of tuberculosis infection inevitably leads to the conclusion that the earliest in origin and the most significant in terms of impact are migration, demographic and social factors. This can be confirmed by:

• the epidemic nature of the spread of tuberculosis during the development of urbanization processes (since the Middle Ages in Europe);
• the predominant spread of tuberculosis among the poorest strata of the urban population living in overcrowded and unsanitary conditions;
• the increase in the prevalence of tuberculosis during war, socio-economic and demographic upheavals.

A general mechanism for the rapid spread of tuberculosis in these conditions can be considered an increase in the number of close contacts of healthy individuals with tuberculosis patients (i.e., with sources of tuberculosis infection). An important factor is the reduction in the general resistance of the body in the majority of people under conditions of prolonged stress, malnutrition and unfavorable living conditions. At the same time, even in extremely unfavorable living conditions and in the presence of close contact with patients secreting Mycobacterium tuberculosis, a certain category of people did not develop tuberculosis for a long time. This indicates varying degrees of genetically determined individual resistance to tuberculosis. It should be recognized that the currently available factual material does not allow the formation of risk groups for tuberculosis based on the study of the genetic characteristics of various individuals.

A huge number of studies (most of them were conducted in the second half of the 20th century) are devoted to the analysis of endogenous and exogenous factors or their combinations that increase the risk of tuberculosis. The methodology and ideology of these studies are so dissimilar, and the results obtained are so contradictory (and sometimes diametrically opposed). that at present, with a sufficient degree of certainty, we can only talk about the presence of three main groups of factors that determine the increased risk of tuberculosis:

• close contact with tuberculosis patients (domestic and industrial);
• various diseases and conditions that reduce the body’s resistance and create conditions for the development of tuberculosis;
• socio-economic, household, environmental, production and other factors.

These factors can influence both the various phases of the epidemiological process and the pathogenesis of the development of clinical forms of tuberculosis in an individual, micro-, macro-society or population (society).

This influence is carried out in a certain sequence:

• infection;
• latent (subclinical) infection;
• clinically manifest form of the disease:
• cure, death or chronically ongoing form of the disease.

Basically, studies on the identification of risk groups for tuberculosis were based on a retrospective study of cases of the disease. Nowhere has the likelihood of disease in an individual with one or more risk factors been tracked throughout life. The role of one or another risk group in the overall incidence of tuberculosis is also insufficiently assessed. In some cases it turns out to be not so significant. Thus, persons in contact with tuberculosis patients in 2005 accounted for only 2.8% of all newly diagnosed tuberculosis patients. In addition, various combinations of several risk factors are possible, which is extremely difficult to take into account in statistical studies. The same disease has a different effect on the overall resistance of the body, not only in different people, but also in one individual, depending on the presence and combination of many endogenous and exogenous factors.

In Russia, high-risk groups for tuberculosis are identified based on medical and social characteristics, which is reflected in current regulatory and instructional documents. However, the combination of these factors and the significance of each of them are very dynamic and varied even in the conditions of stable territorial entities. Taking into account the social, ethnic and demographic diversity of Russia, determining the general characteristics of “risk groups” for tuberculosis represents a serious scientific, organizational and practical problem. Experience in individual territories shows that by forming “risk groups” taking into account regional specifics, it is possible to significantly increase the effectiveness of the examination and the effectiveness of tuberculosis prevention among these populations. Thus, carried out in the Tula region in the 90s of the XX century. The study made it possible to develop and implement a differentiated scheme for examining population groups with varying degrees of risk of tuberculosis. As a result, it became possible to identify 87.9% of tuberculosis patients by reducing the volume of fluorographic examinations to 58.7%. The results of other studies indicate this. that increasing the coverage of risk groups with preventive examinations by 10% makes it possible to identify 1.6 times more patients among them. Consequently, in modern conditions, preventive examinations for tuberculosis should be not so much widespread as group and differentiated, depending on the risk of the disease or epidemic danger of each group.

There is also no doubt that homeless people, immigrants and refugees are considered to be at high risk for tuberculosis. Obtaining reliable information about the morbidity level of these populations is hampered by the complexity of their accounting, registration and preventive examinations. Therefore, along with identifying this risk group, it is also necessary to develop interdepartmental measures (with the participation of the general medical network, the Ministry of Internal Affairs and other departments) to involve them in the examination.

For several decades, various pathological conditions, acute and chronic infectious and somatic diseases have been considered factors of increased risk of tuberculosis. The structure and size of these “risk groups” in individual regions may have significant differences, which is associated both with real regional characteristics and with the quality of work of medical institutions in identifying people with various diseases, their examination, treatment and dispensary observation. The general trend in recent years is a significant increase in the number of people with HIV infection; These populations are the highest risk group for tuberculosis. The methodology for monitoring, identifying and preventing tuberculosis among HIV-infected individuals is very labor-intensive and differs in many respects from the activities carried out in other risk groups.

Thus, there are quite a large number of factors (social, industrial, somatic, etc.), the adverse effects of which increase the risk of tuberculosis for both individuals and population groups (often too numerous). The degree of negative impact of each of these factors varies in individual regions and changes dynamically over time. This circumstance makes it relevant to analyze and monitor the incidence of tuberculosis in various population groups, highlighting risk factors characteristic of a particular region in a certain period of time.

At the moment, Decree of the Government of the Russian Federation No. 892 of December 25, 2001 “On the implementation of the Federal Law “On Preventing the Spread of Tuberculosis in the Russian Federation” identifies groups of the population that are subject to additional examination and observation in order to identify tuberculosis. They are considered as persons at risk for tuberculosis or its relapse, and those whose tuberculosis disease can lead to massive contact with infection of a large group of people, including those especially susceptible to tuberculosis (newborns, children, etc.).It should be taken into account that the isolation and examination of risk groups does not mean the cessation of mass preventive examinations of the population - another thing is that examination of risk groups should be close to 100% with full compliance with the frequency of examination, which, unfortunately, is not carried out everywhere.

At present, it is also not determined in which epidemic situation it is necessary to examine the entire population, and in which – mainly the risk group. In those regions of the Russian Federation where the tuberculosis incidence rate over the past few years has been above 100 per 100 thousand population, and the coverage of preventive examinations of the population is below 50%, where the mortality rate from tuberculosis is also increasing, it is necessary to resolve the issue of preventive examination of the entire population with a multiplicity of at least once a year.

In more favorable epidemiological conditions with constant good coverage of the population with preventive examinations, decreasing mortality rates from tuberculosis, where the incidence rate also tends to decrease. a transition to preventive examination of mainly risk groups for tuberculosis is possible.

Worldwide tuberculosis epidemic

Tuberculosis is the oldest infectious disease known to mankind. It can be said with a high degree of probability. that Mycobacterium tuberculosis as a biological species is much older than the species Homo sapiens. Most likely, initially Mycobacterium tuberculosis was predominantly distributed in southern Europe, Asia and northern Africa.

The discovery of America and Australia by Europeans, their advance deep into Africa, and the expansion of contacts with Europeans in Japan led to the widespread spread of Mycobacterium tuberculosis and, as a consequence, to a massive incidence of tuberculosis in the indigenous population of these territories. Retrospective analysis suggests that ethnic groups that have had long-term interaction with Mycobacterium tuberculosis are gradually increasing the number of people in their population who are resistant (or relatively resistant) to tuberculosis. That is why for a significant part of the representatives of the European superethnos, which has a centuries-old history of fighting tuberculosis, Mycobacterium tuberculosis is currently weakly pathogenic, since no more than 10% of all infected people become ill. At the same time, among ethnic groups whose contact with Mycobacterium tuberculosis began after a relatively recent meeting with Europeans, the incidence of tuberculosis is extremely high and still represents not only a social, but also a biological problem. An example of this is the extremely high prevalence of tuberculosis among American Indians. in Latin America, among the indigenous populations of Australia and Oceania.

Judging the true prevalence of tuberculosis is quite difficult, not only because of the inequality (and at times, incomparability and unreliability) of statistical data. Until now, in different countries there are different approaches to diagnosing tuberculosis and verifying the diagnosis, determining a case of the disease, its registration, etc. In connection with the above, many researchers, when retrospectively analyzing the dynamics of the tuberculosis epidemic situation, give preference to the mortality rate, quite rightly emphasizing its informativeness and objectivity compared to other indicators.

The first statistics on mortality from tuberculosis date back to the end of the 17th century. and by the first half of the 18th century. At that time, they concerned only certain cities in Europe. This is quite natural for at least two reasons. Firstly. The problem of the mass spread of tuberculosis became one of the priorities for humanity precisely as a result of the development of cities in which there was close contact (and, consequently, infection) of a healthy population with tuberculosis patients. Secondly, it was in cities that the level of development of medicine made it possible to organize such studies and document their results.

The data presented indicate that in the 17th, 18th and first half of the 19th centuries. Tuberculosis was a widespread and progressive epidemic that claimed a large number of human lives. It should not be forgotten that during this period the population of Europe suffered severely from other infectious diseases: smallpox, typhus and typhoid fever, syphilis, diphtheria, scarlet fever, etc. The more significant is the “contribution” of tuberculosis as a cause of mortality. So. in London in 1669 the extensive mortality rate from tuberculosis was 16%, in 1741 - 19%, in 1799 - 26.3%, and in 1808 - 28%. The proportion of tuberculosis among the causes of death in Plymouth (23%) was close to these indicators. and in Breslavl even 40%. In Vienna in 1648-1669. Tuberculosis was the cause of death for 31% of the local Jewish population.

XX century was characterized by the most rapid dynamics of the prevalence of tuberculosis. This is due to the fact that it was at the turn of the 19th-20th centuries. For the first time, humanity had “tools” for actively influencing tuberculosis. R. Koch's discovery of Mycobacterium tuberculosis made it possible to study the characteristics of the causative agent of the disease, which was initially used to develop bacteriological diagnostic methods and tuberculin diagnostics, and then to create a specific vaccine. Using the discovery of V.K. X-rays and the mass introduction of radiation research methods into practice were the second revolutionary contribution to the development of phthisiology. Thanks to the X-ray method of research, clinicians have significantly expanded their understanding of the nature and characteristics of the course of the tuberculosis process and. What is especially important is that for the first time we were able to diagnose the disease before the onset of its clinical manifestations.

The progressive development of medicine, biological sciences and a number of related specialties, the integration of specialties and the use of scientific and technological progress have made it inevitable to solve a problem that seemed insoluble to many generations of doctors and patients - the development and introduction of specific anti-tuberculosis drugs. The contribution of surgical treatment methods, the development and application of which in the 20th century, cannot be underestimated. saved the lives of hundreds of thousands of tuberculosis patients. Epidemiology, the development and implementation of a system of organizational measures, the creation of accounting methods, statistics, and then monitoring of tuberculosis also made their contribution to the fight against tuberculosis.

The presence of sufficiently reliable factual data allows us to conduct a retrospective analysis of the patterns and dynamics of the tuberculosis epidemic in the 20th century. By the beginning of the 20th century. Tuberculosis remained a widespread disease. In 1900, in Paris, for example, 473 people died per 100 thousand inhabitants, in Vienna -379, in Stockholm - 311, etc. Against the background of economic growth before the First World War, some countries observed a decrease in mortality from tuberculosis (England, Germany, Denmark, the Netherlands, the USA) or a stabilization of this indicator (Austria, Norway, Finland, France).

The economic and social upheavals associated with the First World War caused a significant increase in mortality from tuberculosis in all European countries. Its rise was noted already by the end of the first year of the war, and subsequently this figure had a clear upward trend in England, Austria, Germany, Italy and Czechoslovakia. In Austria in 1918, the mortality rate from tuberculosis exceeded the pre-war level by 56%. and in Germany - by 62%. The mortality rate among the population of large cities (London, Berlin, Vienna) increased at a faster pace. In Warsaw, by 1916, mortality increased almost 3 times.

During the First World War, some features of the course of tuberculosis were noted among various age groups of the population. Young children suffered the least, while older children and the young population (from 15 to 30 years old) suffered the most. In most countries, the typical peacetime differences in mortality rates between men and women have remained. Thus, higher numbers among men in England were observed throughout the war. The reverse relationship that occurred in Switzerland and the Netherlands in peacetime did not change in 1915-1917. After the end of the First World War, against the backdrop of economic recovery and stabilization of the social sphere, mortality from tuberculosis decreased to one degree or another in most European countries and in Australia. New Zealand and USA.

During the Second World War, mortality rates increased again in countries occupied by the German army, in Germany itself and Japan. Mortality from tuberculosis in many countries and large cities increased steadily as hostilities continued. In 1941-1945. it exceeded the pre-war level among the residents of Amsterdam. Brussels, Vienna. Rome, Budapest by 2-2.5 times, and in Berlin and Warsaw by 3-4 times.

It should be taken into account that the data provided concerned only the civilian population; they did not include the huge number of deaths from tuberculosis in the army, captivity and concentration camps. Meanwhile. Among prisoners of war released from concentration camps and sent to Sweden, there were from 40 to 50% patients with tuberculosis. At the same time, in most countries that did not take part in World War II (for example, Sweden and Switzerland), the mortality rate continued to decline. This figure was stable in Canada and the United States, which did not actively participate in hostilities. Thus, the sanitary consequences of the Second World War regarding tuberculosis were not the same in different countries. To a large extent, this depended on the degree of destruction of the material and technical base and economic ties, overcrowding of the majority of the population, high intensity and partial uncontrollability of migration processes, massive violations of sanitary standards, disorganization of the health service and anti-tuberculosis care to the population.

At all times, it was very difficult to talk about the true prevalence of tuberculosis due to the inequality of statistical information coming from different countries. However, at the end of the 20th century. The work carried out by WHO and health authorities in various countries has made it possible to get a general idea of ​​the main epidemiological indicators for tuberculosis in different regions of our planet. Since 1997, WHO has published an annual report on the situation with tuberculosis in the world. In 2003, the report provided information on 210 countries.

Currently, it should be recognized that tuberculosis is widespread in all countries of the world. The highest incidence of tuberculosis is found in Africa, especially in countries with a high prevalence of HIV infection. It accounts for about 1/4 of all newly diagnosed tuberculosis patients. Half of all newly diagnosed patients in the world occur in 6 Asian countries: India. China. Bangladesh, Indonesia. Pakistan. Philippines.

It should be said that if in 1970 the incidence rate of tuberculosis in the world was about 70 per 100 thousand, then at the beginning of the 21st century. it reaches the level of 130 per 100 thousand.

According to WHO, the current rise in incidence rates is primarily due to the rapid spread of undetected HIV infection on the African continent, which has led to a sharp increase in the incidence of tuberculosis.

In the 90s of the XX century. The highest death rate from tuberculosis in the world was recorded. In 1995, according to WHO. 3 million patients died from tuberculosis every year. In 2003, 1.7 million people died. For the period 2002-2003. The mortality rate among all patients with tuberculosis decreased by 2.3%, and among HIV-negative patients with tuberculosis - by 3.5%, nevertheless, about 5,000 patients die every day worldwide. About 98% of deaths occur in the young, working population. In Africa, tuberculosis is the leading cause of death among young women.

In 2003, 8.8 million patients with tuberculosis were identified in the world, of which 3.9 million were identified by sputum microscopy. In total, there were 15.4 million patients with tuberculosis, of which 6.9 million were bacterial isolates according to sputum smear microscopy. According to WHO, the global incidence rate is currently increasing by 1% annually, mainly due to an increase in incidence in Africa. Among the African population with a high prevalence of HIV infection, the incidence of tuberculosis reaches 400 per 100 thousand.

The incidence rate varies very sharply in different countries and regions. It largely depends on socio-economic development, the level of organization of medical care and, as a consequence, methods for identifying patients, the quality of examination of the population using these methods, and the completeness of registration. For example. identification of patients in the United States is mainly carried out through tuberculin diagnostics of persons who have been in contact with a patient with tuberculosis. In the case when it is known that a person from a contact has previously suffered from tuberculosis, radiation diagnostic methods are used, and in the presence of sputum, it is examined using various methods. In Russia and a number of former USSR countries, the identification of patients with pulmonary tuberculosis is based on mass fluorographic examinations of the adult population, tuberculin diagnostics in children and adolescents, and microscopic examination of sputum in coughing patients. In India, African countries and a number of other countries where there is no developed system of medical care for the population, tuberculosis is detected mainly through microscopic examination of sputum in coughing patients. Unfortunately, WHO specialists in their annual reports do not provide an analysis of the incidence rate in regions and countries of the world in terms of detection methods and the presence or absence of population screening. Therefore, the information presented in the annual reports cannot be considered completely reliable. However, WHO has divided the globe into six regions with different incidence rates (the Americas, Europe, Eastern Mediterranean, Western Pacific, Southeast Asia and Africa).

But even within the same region, these indicators vary significantly across countries. If the average incidence in North and South America was 27 per 100 thousand population, then its range on the American continent ranged from 5 to 135. So. for example, in 2002 in the USA and Canada the incidence was 5 per 100 thousand population, in Cuba - 8, in Mexico - 17, in Chile - 35, in Panama - 37, in Argentina - 54, in Haiti - 98, in Peru - 135.

In the countries of Central Europe, incidence rates were also different: in Cyprus, in Iceland - 3 per 100 thousand, in Sweden - 4, in Malta - 6, in Italy - 7, in Germany and Israel - 8, in Austria - 11, in Belgium - 12, in England -14, in Portugal - 44. In Eastern European countries, the incidence of tuberculosis was slightly higher: in Turkey and Poland - 26, in Hungary - 27, in Bosnia and Herzegovina - 41, in Bulgaria - 42, in Estonia - 46, in Armenia - 47, in Belarus -52, in Azerbaijan - 62, in Tajikistan - 65, in Lithuania - 70, in Turkmenistan and Latvia - 77, in Uzbekistan - 80, in Ukraine - 82, in Georgia - 87, in Moldova - 88, in Kyrgyzstan -131, in Romania -133, in Kazakhstan -178. In total, in the countries of Western and Eastern Europe, the average incidence rate was 43 per 100 thousand.

In total, according to WHO. in the countries of the European region in 2002, 373,497 newly diagnosed patients with tuberculosis, with relapses of tuberculosis and other patients were registered. The WHO European Bureau identified 18 countries with relatively high incidence rates for the European Region, accounting for 295,240 patients. These are the countries of the former USSR, as well as Romania and Turkey, which the WHO European Office declared as priority countries for TB work in the “Stop TB in the European Region” plan for 2007-2015.

In the countries of the Eastern Mediterranean, the incidence averages 37 per 100 thousand. It is highest in Djibouti with a population of 693 thousand people - 461 per 100 thousand. The lowest is in the United Arab Emirates - 3 per 100 thousand. In Jordan it is 6 per 100 thousand. , in Egypt - 16, in Iran - 17, in Pakistan - 35, in Iraq - 49, in Afghanistan - 60, in Sudan - 75.

In the countries of the Western Pacific, the average incidence rate is 47 per 100 thousand population, in Australia - 5 per 100 thousand, in New Zealand - 9, in China - 36, in Malaysia - 60, in Vietnam - 119, in Mongolia - 150, in the Philippines - 151, in Cambodia - 178.

In the countries of Southeast Asia, the average incidence rate is 94 per 100 thousand. The highest incidence, 374 per 100 thousand, was registered in the small country of East Timor with a population of 739 thousand people, the lowest - 40 per 100 thousand - in the Maldives. In India, the incidence rate is about 101 per 100 thousand. In Sri Lanka, the incidence rate is 47 per 100 thousand, in Bangladesh - 57, in Indonesia -71, in Thailand - 80, in Nepal - 123, in the Republic of Korea - 178.

Official incidence rates in 2002 in some countries of the African continent: Namibia - 647 per 100 thousand, Swaziland - 631, South Africa -481, Zimbabwe - 461, Kenya - 254, Ethiopia - 160, Nigeria - 32.

In 2002, the average incidence rate in Africa, according to WHO, was 148 per 100 thousand. Over the past decade and a half, the number of newly diagnosed patients in Africa has increased 4 times. The annual death rate from tuberculosis is more than 500 thousand people. The developing tuberculosis epidemic on the continent led African health ministries to declare a tuberculosis emergency in the region in 2005.

The largest number of tuberculosis patients in absolute numbers are detected annually in two countries - India (more than 1 million) and China (more than 1.3 million).

Among the regions of the world, the largest number of patients in 2002 were identified in Southeast Asia (1,487,985 people), Africa (992,054 people) and the Western Pacific (806,112 people). For comparison, a total of 373,497 people were identified in Central and Eastern Europe, 233,648 people in North and South America, and 188,458 people in the Eastern Mediterranean countries.

The highest incidence was recorded in the following countries: Namibia. Swaziland, South Africa, Zimbabwe. Djibouti. East Timor, Kenya. The smallest (up to 4 per 100 thousand population inclusive) is in Grenada, Barbados, Cyprus, Iceland, Jamaica, Dominica. Puerto Rico, United Arab Emirates. “Zero” incidence of tuberculosis was registered in Monaco (population 34 thousand people).

Taking into account the fact that, according to WHO recommendations, tuberculosis in most countries of the world (with the exception of the USA, Russia and the former USSR countries) is diagnosed mainly using simple sputum bacterioscopy, the given incidence rates should be considered underestimated - the true incidence in many countries of the world is undoubtedly higher .

Multidrug-resistant tuberculosis has been detected in all 109 countries where WHO or its partners maintain records. Every year, about 450 thousand such new patients are identified in the world. In recent years, so-called “superdrug resistance,” or XDR, has begun to be diagnosed. It is characterized by resistance to HR, as well as to fluoroquinolones and one of the 2nd line drugs for intramuscular administration (kanamycin/amikacin/capreomycin). In the United States, XDR accounts for 4% of all patients with multidrug-resistant tuberculosis. in Latvia - 19%, South Korea - 15%.

At the end of the 20th century. Humanity has discovered a new dangerous disease - HIV infection. With the spread of HIV infection among a population of people infected with Mycobacterium tuberculosis, there is a significant risk of the transition of the so-called latent tuberculosis infection into the active form of tuberculosis. Currently, tuberculosis has become the leading cause of death in people with HIV infection.

In 2003, 674 thousand patients with a combination of tuberculosis and HIV infection were identified in the world. In the same year, 229 thousand such patients died. Currently, the increase in the incidence of tuberculosis in the world is mainly due to African countries with a high prevalence of HIV infection.

Despite the increase in incidence in the world, the prevalence and mortality rates from tuberculosis have decreased slightly. This is due to the introduction of controlled chemotherapy for patients in a number of countries in the world where patients were not previously properly treated, as well as the receipt of more uniform figures from a larger number of countries submitting reports to WHO.

The prevalence of tuberculosis in 1990 in the world was approximately 309 per 100 thousand population, in 2003 - 245 per 100 thousand population. During the period from 2002 to 2003, the rate of decline in the prevalence of tuberculosis was 5%. About 2 billion people around the globe are infected with Mycobacterium tuberculosis, mainly due to the prevalence of infection in the countries of the so-called “third world”. The infected population constitutes a passive reservoir of tuberculosis infection.

The disease tuberculosis has been known since ancient times, as evidenced by excavations and written documents. Of the ten surviving skeletons of Egyptian mummies dating back to the 27th century BC, four bear traces of tuberculous lesions of the spine.

Tuberculosis was considered a noble disease. Many literary heroes, who, according to the will of the authors, faced a tragic fate, died from “fleeting consumption” (this is exactly the diagnosis that was made in the past and the beginning of this century for patients with pulmonary tuberculosis). From fiction, everyone knows the ominous signs of the disease: coughing attacks, after which traces of blood remain on the handkerchief. The patient’s appearance is also described more than once: fragility, pallor, an unhealthy blush on the cheeks, a feverish shine in the eyes, a stamp of suffering on the face.

There is reason to believe that the causative agents of tuberculosis appeared on earth before humans.

Animals also suffer from this disease. Domestic cats and dogs can also get tuberculosis. Previously, it was believed that predatory animals such as lions, tigers, eagles, and kites were immune to tuberculosis. Indeed, in natural conditions it is observed in them extremely rarely, but as soon as predators come into contact with sick animals in the zoo, a general epidemic begins. Even fish, turtles, snakes, frogs and dolphins suffer from tuberculosis.

The causative agent of tuberculosis was discovered in March 1882 by the German bacteriologist Robert Koch. This event turned out to be so long-awaited that news of it spread throughout the world by telegraph overnight. Koch described the structure and basic properties of microbes, later named Koch's bacilli in his honor.

In different countries of the world, scientists have begun work on studying the resulting microbial cultures. It was necessary to obtain a strain of such weakened bacteria that would be capable of inducing only a semblance of a disease in the human body and at the same time causing a sufficiently strong protective reaction. Thanks to this, the body of a healthy person would be protected from the development of the disease even if a sufficiently strong pathogen enters it. Moreover, the pathogen itself, having been in an organism protected from it, would significantly reduce its virulence (degree of pathogenicity) and would become less dangerous to others.

This problem was solved almost 40 years later. French scientists A. Calmette and C. Guerin, after spending 13 years on experiments, grew harmless tuberculosis bacteria. A vaccine was made from these bacteria, and on July 1, 1921, Calmette first inoculated it on an infant whose mother and grandmother suffered from tuberculosis. The child undoubtedly came into contact with tuberculosis bacteria, but did not become ill.

Preventive vaccination soon became the main means of combating this dangerous disease. And tuberculosis receded. Why did he return?

Trouble came from the direction from which it was not expected. After the discovery of penicillin in 1940, the natural balance in the world of microorganisms was disrupted. The widespread use of antibiotics has saved many human lives; many pathogenic bacteria have lost their potency. But this strengthened the position of viruses. Medicine has concentrated its efforts on fighting viruses - microbes have come to life again, which, by the way, have a unique ability to adapt to new conditions. Therefore, from time to time one or another seemingly defeated infection suddenly gains strength.

Currently, the resistance of tuberculosis bacteria to the most modern drugs has sharply increased. This is one of the reasons for the current wave of tuberculosis spread in the world.

The second, as before, is related to people’s living conditions. The fact is that tuberculosis is one of the so-called social diseases. It affects mainly people living in unfavorable socio-economic conditions. The growth of morbidity in our country is facilitated by the deterioration in the standard of living of a significant part of the population, the appearance of homeless people and refugees. In addition to the fact that these people are malnourished and live in unacceptable conditions, they are not subject to preventive examinations and often become carriers of tuberculosis infection.

In general, in our country, for various reasons, only about 30-40% of the population undergo fluorography. But the most widespread and reliable protection against tuberculosis is regular fluorographic examinations. The fact is that in the early stages tuberculosis occurs unnoticed by a person, and this is its insidiousness.

Infection with tuberculosis in the vast majority of cases occurs through airborne droplets. Therefore, most often (in 95% of cases) it affects the lungs, although bacteria can actively multiply in other organs - bones, joints, eyes, skin, kidneys, nervous system. With any localization of the process, not only the affected organ suffers, but the entire body. In the external environment, tuberculosis bacteria live for a long time, but do not multiply. Once in a warm-blooded body, microbial cells divide in half once every two to three days. The pathogens remain viable in sputum mixed with dry dust for up to 72 days. Viable bacteria can be detected on the pages of books used by the patient and on money for three months. Airborne infection most often occurs through contact and communication with a sick person. At the same time, the high resistance of the pathogen makes it possible to transmit the infection through airborne dust. The severity of tuberculosis depends on the degree of pathogenicity of tuberculosis bacilli, among which there are more or less weakened ones. In addition, the number of microbes introduced into the body also matters. Therefore, people often get sick where they live too closely.

Recently, Danish scientists found that the risk of tuberculosis is directly dependent on people’s marital status. According to their data, tuberculosis affects men more often than women, and single people more often than married people. Apparently, the morbidity is affected by the unsettled life of a bachelor, alcoholism, which is more common among single men, and poor nutrition.

However, if a person becomes infected with tuberculosis, this does not mean that he is sick. The tuberculosis bacillus may not manifest itself in any way for years and even decades, suppressed by special cells of the immune system. But when the body’s protective barriers are weakened, the microbe becomes more active and begins to multiply rapidly. That is why tuberculosis is especially sticky to those whose immunity is weakened by diseases, both chronic and acute. This could be the flu, respiratory infection, pneumonia, diabetes, vitamin deficiency, bronchitis. Any previous operations or neuropsychic shocks also contribute to the development of tuberculosis.

Another group of risk factors consists of poor living conditions, work in hazardous, especially dusty industries, frequent overwork, and addiction to tobacco and alcohol. Pregnant women and women in labor are at risk. Children are especially susceptible to tubinfection. For a child’s body that first comes into contact with the causative agent of tuberculosis, a very small number of microbes is enough to get sick. This is why early tuberculosis vaccinations are so important.

The first vaccination against tuberculosis is given to a newborn on the 5-6th day of his stay in the maternity hospital. Immunity after vaccination lasts 5-7 years, this explains the interval between vaccinations: the next one is given at 6-7 years, then at 14-15 years. It should be borne in mind that immunity to vaccination is developed only after two months. Therefore, parents should closely monitor their child’s contacts during this time. Further vaccinations should be carried out after 5-7 years until the age of 30, until a relatively stable immunity is formed in the body. Now this has turned out to be a big problem: young people 20-30 years old are avoiding vaccination under various pretexts, which allows tuberculosis bacteria to spread quickly.

When a disease occurs, its first signs appear. An increase in body temperature is not felt by all people, especially if this condition has become habitual. Therefore, with the above-mentioned changes in well-being, periodically measuring temperature in the morning and evening hours is far from useless.

If symptoms do not disappear within a month, it is necessary to undergo an X-ray examination - more than two thirds of tuberculosis patients are detected using fluorography. In modern conditions, tuberculosis is curable, especially with early and properly organized treatment. Phthisiatricians, by skillfully selecting anti-tuberculosis drugs and means of pathogenetic therapy aimed at different aspects and phases of the process, achieve a cure for 85-90% of newly diagnosed patients within a year.

Treatment of tuberculosis is the task of a doctor, but an ill person can significantly increase the effect of medical measures. Long before our era, in India, Persia, Italy, and China, patients with tuberculosis were treated with tinctures of oak bark, rose petals, and poppy. Russian healers in the 11th-13th centuries used decoctions of coltsfoot, yarrow infusion, crushed garlic, and grated radish against “dry disease,” as tuberculosis was then called. It is unlikely that these ancient remedies are capable of radically changing the course of the disease, but they undoubtedly bring benefits. Preparations from aloe, birch leaves, flowers, fruits and leaves of lingonberries and strawberries, herbs: burnet, orchis, elecampane, celandine, pine needles (decoctions, infusions, baths), tincture of walnut partitions also help with tuberculosis.

The use of the healing properties of kumiss also retains its importance in the treatment of tuberculosis. Back in 1858, the first kumiss clinic was organized near Samara. Clean, fresh air for a patient with tuberculosis is an indispensable condition for a quick recovery. A sick person should make the most of walking, moderate exercise, even sleeping in the open air, away from busy streets, industrial enterprises, and best of all, in rural conditions.

At the end of the 18th - beginning of the 19th centuries in France, the scientist and doctor R. Laennec fought against tuberculosis. He argued that recovery from tuberculosis is achieved not only by the efforts of the doctor, but also by the forces of nature. He relied on the fact that in the lungs of people who died from other diseases, pathologists often found scars and calcified lesions, that is, traces of tuberculosis that had gone unnoticed and been overcome by the body itself. Over the two hundred years that have passed since then, practical medicine has accumulated vast experience in combating this disease. Now it can be argued that in curing tuberculosis, not only the skill of the doctor is really important, but also the use of natural remedies and the will of the patient. With this combination, the patient has an almost one hundred percent chance of recovery.

Since a person cannot know how great his natural resistance to tuberculosis is, the most important role is played by preventive measures - vaccinations and regular fluorographic examinations. Some countries have even adopted strict laws making such examinations mandatory. In Austria, for example, a person who does not want to undergo fluorography has to pay a fine of $200. Otherwise, he will face a prison sentence of eight months.

Phthisiologists are often asked the question: is tuberculosis inherited? Fortunately, the bacteria do not infect the fetus - a healthy child is born to a sick mother. But it usually becomes infected after birth. If one of the twins is isolated from sick parents immediately after birth, and the other is left with them, then the child who was not isolated will get sick.

Strengthening the immune system and proper nutrition are important in the prevention of tuberculosis. A wide variety of means are good for strengthening the immune system: hardening (contrast shower, dousing with cold water), taking vitamins, medicinal herbs, valuable nutritional supplements, and regular exercise. As for nutrition, it turns out that not only exhaustion of the body is a prerequisite for tuberculosis, as was previously thought. It is also important not to overeat. Each excess kilogram of body weight increases the likelihood of developing tuberculosis, since the resulting fat raises the diaphragm during breathing and greatly impairs lung function.

In the prevention of tuberculosis, as well as other diseases, nutrition is critical. The diet should include a large amount of fruits and vegetables, preferably raw.

Never forget to ventilate the room. When there is a large crowd of people, especially if there is smoking in the room, the body's resistance to tuberculosis infection drops sharply. Country walks, especially in pine and spruce forests, where there are a lot of air ions and phytoncides, are an excellent protection against bacteria. And in winter there are practically no pathogenic microbes in the air of a coniferous forest. Exercising in such conditions is especially beneficial, as it significantly increases the vital capacity of the lungs.

Since there are now many virus carriers in big cities, try to avoid crowds. And especially protect children from it. Avoid dining anywhere, especially in crowded markets. After studying in the library, where you looked through many books or newspaper files, be sure to wash your hands. This way you can protect yourself from many infectious diseases, including one of the most serious - tuberculosis.

Vladimir Kolodkin

Good day, dear readers!

In today’s article we will look at a disease such as tuberculosis, as well as its first signs, symptoms, types, forms, stages, diagnosis, treatment, medications, folk remedies, prevention of tuberculosis and other useful information related to this disease. So…

What is tuberculosis?

Contact path– the infection enters a person through the conjunctiva of the eyes, through kissing, sexual contact, through contact of contaminated objects with human blood (open wounds, scratches, manicure, pedicure, tattooing with contaminated objects), the use of patient hygiene items. You can also become infected with tuberculosis when caring for a sick animal - a cat, a dog, and others.

Intrauterine infection– infection is transmitted to the baby through a placenta damaged by tuberculosis or during childbirth, from the mother. However, this occurs when the entire body is affected by the infection; if the expectant mother has pulmonary tuberculosis, the likelihood of the baby becoming infected is minimal.

2. Impaired functioning of the upper respiratory tract

The respiratory organs (nasopharynx, oropharynx, trachea, bronchi) are protected from infection of the body by mucociliary clearance. In simple terms, when an infection enters the body, special cells located in the mucous membrane of the respiratory organs secrete mucus, which envelops and glues pathological microorganisms together. Further, with the help of sneezing or coughing, mucus along with the infection is expelled from the respiratory system to the outside. If inflammatory processes are present in the respiratory organs, the functioning of the body's defenses is threatened, because can freely penetrate the bronchi, and then into the lungs.

3. Weakening of immunity to tuberculous mycobacteria

Diseases and conditions such as AIDS, peptic ulcers, stressful situations, fasting, alcohol and drug abuse, treatment with hormones and immunosuppressants, pregnancy, smoking and others can weaken the immune system, especially sweat in relation to Koch’s bacillus. It has been established that smoking a pack of cigarettes a day increases the risk of developing the disease by 2-4 times!

Koch's bacillus, settling in the lungs, if the immune system does not suppress it, begins to slowly multiply. The delayed immune response is also due to the properties of this type of bacteria not to produce exotoxin, which could stimulate the production of phagocytosis. Absorbed into the blood and lymphatic system, the infection spreads throughout the body, enslaving primarily the lungs, lymph nodes, renal cortex, bones (epiphyses and metaphyses), fallopian tubes and most other organs and systems.

Incubation period of tuberculosis

Sorbents. Microflora, in the process of their vital activity, release toxins, which, together with the infection killed by antibiotics, poison the body, causing symptoms such as loss of appetite, nausea, vomiting and others. To remove toxic substances from the body, sorbents (detoxification therapy) are used, among which are Acetylcysteine, Atoxyl, Albumin, Reosorbilact, as well as drinking plenty of fluids, preferably with the addition of vitamin C.

Immunostimulants. This group of drugs stimulates the functioning of the immune system, which in turn leads to an enhanced immune response to infection and a faster recovery. Among the immunostimulants we can highlight - “Biostim”, “Galavit”, “Glutoxim”, “Imudon”, “Ximedon”.

A natural immunostimulant is, a large amount of which is present in raspberries, cranberries,.

Antipyretic drugs. They are used to relieve high body temperature, but remember that this group of drugs is recommended to be used at high temperatures - from 38.5 ° C (if it lasts for 5 or more days. Among the antipyretic drugs, one can distinguish - "", "", "".

Nonsteroidal anti-inflammatory drugs (NSAIDs)– used to relieve pain. Among them are “Indomethacin”, “”, “Naproxen”, “Chlotazol”.

Glucocorticoids (hormones)- used in cases where the pain could not be relieved by NSAIDs, also in cases of severe tuberculosis with unbearable pain. However, they cannot be used for a long time, since they have an immunosuppressive effect, as well as a number of other side effects. Among the glucocorticoids we can distinguish - Prednisolone, Hydrocortisone.

To preserve the central nervous system from damage, as well as to maintain its normal functioning, are prescribed - glutamic acid and ATP.

To accelerate cell regeneration and restoration of tissues affected by infection are prescribed - “Glunate”, “Methyluracil”, “Aloe Vera” and others.

2. Surgical treatment of tuberculosis

Surgical intervention in the treatment of tuberculosis involves the following types of therapy:

• Collapse therapy (artificial pneumothorax or pneumoperitoneum) is based on compression and fixation of the lung by introducing sterile air into the pleural cavity, which leads to the gradual fusion of cavities and preventing the active release of Koch’s bacillus into the environment;
• Speleotomy or cavernectomy – removal of the largest cavities that are not amenable to conservative treatment;
• Lobectomy, bilobectomy, pneumonectomy, pneumonectomy - removal of one lobe or part of the lung that is not amenable to conservative treatment, or complete removal of such a lung.
• Valvular bronchoblocking is intended to normalize the breathing of patients, and is based on the installation of miniature valves at the mouths of the bronchi to prevent them from sticking together.

Treatment prognosis

With early detection of Koch's bacillus in the body, careful diagnosis and strict compliance by the patient with the instructions of the attending physician, the prognosis for recovery from tuberculosis is very positive.

The unfavorable outcome of the disease in most cases is due to the advanced form of the disease, as well as the frivolous attitude of patients towards it.

However, remember, even if the doctors put a cross on the patient, there is a lot of evidence when such a person turned to God in prayer and received a complete recovery, even with such deadly diseases as.

Important! Before using folk remedies for treating tuberculosis, be sure to consult your doctor!

Pine pollen. Essential oils of coniferous trees have a bactericidal effect, in addition, they fill the air with pure ozone, improving the functioning of the respiratory system, and, to put it simply, a person can breathe much easier among coniferous trees. To prepare a folk remedy for tuberculosis based on pine gifts, you need 1 tbsp. Mix a spoonful of pine pollen with 150 g of linden honey. You need to take the product 1 teaspoon 20 minutes before meals, 3 times a day, for 60 days, after which a 2-week break is taken and the course is repeated. This folk remedy for tuberculosis should be stored in the refrigerator.

Pine pollen tea. Mix 2 tbsp. spoons of pine pollen, dried linden blossom and. Pour 500 ml of boiling water over the prepared mixture and let it steep for about an hour. Then pour 100 g of infusion into a glass and add boiling water to it so that the glass is full. You need to drink this tea 4 times a day, a glass, 30 minutes before meals.

Garlic. Grind 2 cloves, pour a glass of water over them, let it brew for 24 hours, and in the morning, before eating, drink the infusion. The course of treatment is 2-3 months.

Garlic, horseradish and honey. Make a paste from 400 g of garlic and the same amount of horseradish, then mix it with 1 kg of butter and 5 kg. Next, the mixture should be infused in a boiling water bath for 5-10 minutes, stirring occasionally, cooled and taken 50 g before meals. The drug is considered effective for pulmonary tuberculosis.

Icelandic moss (cetraria). Place 2 tbsp in an enamel saucepan. spoons of crushed Icelandic moss and fill it with 500 ml of clean cold water, then bring the product to a boil, simmer it over low heat for another 7-10 minutes with the lid closed. Next, you need to strain the product and set it aside in a jar to infuse. The product should be drunk during the day, 3-4 times, before meals. The course of treatment is 1 month, for advanced forms – up to 6 months, but after each month take a 2-3 week break. To improve the taste, you can add a little honey or milk to the broth.

Aloe. Mix 1 crushed large fleshy leaf with 300 g of liquid linden honey in an enamel saucepan and pour half a glass of clean cold water over them. Bring the mixture to a boil, then simmer for about 2 more hours with the lid tightly closed. Next, you need to strain the product and take 1 tbsp. spoon before meals, 3 times a day, for 2 months, and it should be stored in a glass jar in the refrigerator.

Vinegar. Add 100 g of fresh grated horseradish, 2 tbsp. spoons of 9% apple cider vinegar and 1 tbsp. a spoonful of honey, mix everything thoroughly and take this folk remedy against tuberculosis, 1 teaspoon 20 minutes before meals, 3 times a day, until the medicine runs out. Then a 2-3 week break is taken and the course is repeated. The product must be stored in the refrigerator.

Dill. Pour 1 tbsp into a small enamel saucepan. spoon with a heap of dill seeds and fill them with 500 ml of clean cold water. Bring the product to a boil, simmer it under the lid over low heat for about 5 minutes, then set it aside overnight to infuse. In the morning, strain the product and drink it throughout the day, in 5 doses. You need to take this medicine for tuberculosis for 6 months, and it is better to store it in a glass container in the refrigerator or a cool, dark place.

Prevention of tuberculosis includes the following activities:

• Vaccination is the BCG vaccine, but in some cases this vaccine itself can contribute to the development of certain types of tuberculosis, for example, joints and bones;
• Conducting tuberculin tests - Mantoux test;
• Periodic (once a year) fluorographic examination;
• Compliance ;
• It is necessary to protect yourself from, if necessary, change jobs;
• Don't allow ;

  Video about tuberculosis

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Questions and answers on: tuberculosis epidemic

2011-12-15 13:14:50

Irina asks:

Please tell me why today, given the existing tuberculosis epidemic in the country, there is such a shortage of ethambutol? They don’t give it out in tuberculosis dispensaries, you can’t buy it at a pharmacy, and even if you order it, it arrives at the wrong time (it’s not expensive)... Is it true that you can’t take isoniazid without ethambutol?

Answers:

Hello Irina! Anti-tuberculosis medications must be taken in strict accordance with the regimen prescribed by the doctor. Otherwise, all your efforts will be in vain. Questions regarding interruptions in the supply of anti-tuberculosis drugs should be asked to officials of the Ukrainian ministries of health. Although they are unlikely to answer you anything intelligible. Take care of your health!

2009-03-20 00:35:08

Victor asks:

How do you explain the tuberculosis epidemic in Ukraine, given that the vast majority give their children BCG? Aren't you afraid of God?

Answers Strizh Vera Alexandrovna:

Dear Victor! Leave your emotions. Assess the situation soberly and filter out illusions. BCG as the cause of the epidemic is nothing more than another myth about TB. Do you know what strains of mycobacteria are contained in the BCG vaccine and which ones support the TB epidemic? How is anti-tuberculosis post-vaccination immunity formed? Is persistence of vaccine-derived MBTs excluded? It has already been written repeatedly that BCG protects not from infection, but from severe forms of tuberculosis and significantly reduces mortality among children. If, in the context of an epidemic of multidrug-resistant tuberculosis, we refuse BCG vaccination and tuberculin diagnostics, our children will die out from tuberculous meningitis, and we along with them.
Question: Who is the source of infection for children? Answer: Adult bacteria excretors, not the BCG vaccine. Question: Why did the tuberculosis epidemic occur among adults and why is the protective effect of the BCG vaccine insufficient? Answer: because the majority of the population of the post-Soviet space is thrown below the poverty line and placed in conditions of chronic stress. The immunogenic effect of the BCG vaccine persists for the first 5-7, maximum 10 years after vaccination. Question: Why does TB love poverty and stress? Answer: TB is a contagious disease (what is the morality of modern society?), a deficiency disease (occurs when the T-link of immunity is insufficient). Question: What other factors, besides nutrition, stress and hygienic culture, significantly reduce the number of T-lymphocytes. Answer: AIDS. Question: Which came first: AIDS or the TB epidemic? Answer: The first case of AIDS was reported in 1881 in the United States. Some scientists believe that HIV jumped from monkeys to humans between 1926 and 1946. However, the oldest human blood sample containing HIV dates back to 1959 - that year an African patient from the Congo from whom the blood was taken died of AIDS. According to other sources, “legs grow” from the 17th century. The modern TB epidemic was registered in 1995 and is characterized by the fact that infection occurs with mycobacteria that are resistant to chemotherapy. Question: Why did resistance to anti-TB drugs arise? Answer: several reasons. The BCG vaccine is not to blame. Health workers calmed down when they realized that they had dealt with the previous epidemic. Relaxed. We decided that tuberculosis as a problem has been eliminated from the planet. Funding for the industry has sharply decreased - hospitals and dispensaries have been closed, sanatoriums have been sold, and the search for new drugs has almost stopped. The patients also relaxed, thinking that good nutrition and prosperity were a shield against the monster - they took medications irregularly and did not complete treatment, which contributed to the formation of resistant mycobacteria.
For discussion: there is such a thing as a hereditary predisposition to TB. If in the past 10 years people with a genetic predisposition to TB disease were cured of TB, it means that the number of their descendants in the human population has increased and today in unfavorable environmental, socio-economic and epidemiological conditions (let us also remember the AIDS epidemic) it is this category joins the ranks of chronicles. And not those vaccinated with BCG in childhood.
Here is a quote from one of the leading phthisiatricians and immunologists in Russia: “Is anti-vaccination propaganda in the media and popular science publications harmful? Without a doubt. This harm is clearly social in nature. Anti-vaccination propaganda, as a rule, is irresponsible and is addressed to an unprepared listener and reader, increases the frequency of groundless refusals of vaccination and gives rise to medical nihilism... Public “Moral and ethical accusations, including criminal ones, have a right to exist.” They are illegal (“harm caused by the dissemination of information discrediting honor, dignity and business reputation” - Article 1100 of the Civil Code of the Russian Federation). In relation to anti-vaccination propaganda on the eve of or during an epidemic, this is a violation of sanitary and epidemiological rules, resulting in... mass disease of people... Art. 236 of the Criminal Code of the Russian Federation. First, you need to prove the legal existence of your criminal charges in court... In the meantime, of course, theoretically, to a number of legal entities - the Publishing Houses "AiF", "Homeopathic Medicine" and others, publishing A.G. Kotoka (aka A.M. Afanasenkov) and G.P. Chervonskaya, you can even now file a lawsuit, which, I’m afraid, will have legal prospects.”
Question for you, Victor: Who should be afraid of God? Do you think doctors inject vaccines into children to infect everyone? This smacks of genocide. However, refusal to vaccinate is a sure path to nowhere, a path to crime and mass extermination of the nation. Who then is the source of genocide? Who is affected by vaccination? Who is stirring up panic? Mostly unvaccinated and undisciplined patients die not from vaccination, but from tuberculosis.

2009-01-28 22:51:09

Louise asks:

My sister is 25 years old, she is the mother of a 3-year-old baby, she lives in a prosperous family. she fell ill with tuberculosis. The disease was treated in a day hospital with first-line drugs. I took these drugs for 2 months. They did a fluorography - tuberculoma remained. 2 months later, after completing the treatment course, a relapse of tuberculosis occurred and a hole appeared in the lung. after a consultation at the regional tuberculosis dispensary, on January 19, we admitted my sister to the Mariupol tuberculosis dispensary, she was prescribed the same anti-tuberculosis drugs as in the first course of treatment (streptomycin and CC-4). On January 23, my sister’s temperature rose to 39 degrees, which remains to this day . Lera underwent another fluorography and it turned out that despite the medications she was taking, tuberculosis was progressing, the process of decay had begun, and in two weeks (from January 15 to January 27), the hole in the lung increased in diameter by 1 mm. Doctors do not change previously prescribed medications. They took a macroscopic analysis to determine the resistance of tuberculosis to drugs, but it will be ready only in 1.5 - 2 months. what to do before that? wait until she burns out from the temperature? With a temperature of 39, my sister takes antipyretics. The doctors explain that the increased temperature is due to the progression of tuberculosis, but they do not change anything! we beg the doctors to save my sister! After all, a young girl, full of vitality before her illness, simply “conceals” before our eyes. Lera no longer has the strength to go down from the fourth floor to the first; she constantly lowers her temperature and sleeps. And at home she has a little three-year-old son waiting for her, who tells her on the phone every evening, “Mommy, I love you very much!!! Come back!!!” In our country, where the need to stop the tuberculosis epidemic is repeated on every corner, where for every hundred patients with tuberculosis there is one girl from a prosperous family, whose relatives are ready to carry her in their arms to the doctor who knows how to treat her and can save the girl - no one no problem!!! Please help. we are not asking for money, we are asking not to be indifferent! we are asking to save Arkhip’s mother!

Answers Strizh Vera Alexandrovna:

Dear Louise! By describing your sister’s story, you have dispelled one of the myths about tuberculosis, when people believe that only homeless people, drunkards and other antisocial elements get tuberculosis. Today there are a lot of severe, difficult-to-treat forms of tuberculosis. In previous decades, when significant advances were made in the fight against tuberculosis during the era of antibiotics, the public calmed down, and almost no new chemotherapy drugs were created. Moreover, irreparable damage was caused to the TB industry when massive layoffs of TB doctors and tuberculosis clinics began, special sanatoriums were closed or not funded, etc. As a result, today we have tuberculosis with the presence of bacilli resistant to many chemotherapy drugs. And the problem is not indifference. Resistant forms of tuberculosis can be treated, it takes a long time, but they can be cured. Although sometimes it is necessary to resort to surgical intervention. The second reason for this condition may be hidden in the presence of severe concomitant diseases in the sister, such as AIDS, diabetes mellitus, rheumatism, chronic hepatitis, etc. Depending on many factors, the set of drugs also changes. The stability of the sticks is determined when they can be sown. With tuberculoma, in most cases there are no rods in the sputum. The principle of treating resistant forms consists of several points: the intensive phase of chemotherapy lasts up to 6 months, and the maintenance phase – up to 1.5-2 years. In the intensive phase, 6-8-10 different anti-tuberculosis drugs are used in certain combinations. The temperature will gradually decrease.

2008-01-24 15:18:54

Asks Dmitry Nikanorov:

How is a tuberculosis epidemic defined? This is a certain number of deaths (how many?) per 100 thousand people, or a certain number of cases (how many?) per 100 thousand. And why exactly this amount, no more and no less? Thank you.

Answers Strizh Vera Alexandrovna:

Hello. The epidemiological situation is considered satisfactory if the incidence of all forms of tuberculosis does not exceed 20 cases per 100 thousand. population According to official statistical reports in Ukraine, as of 2006, the TB incidence rate was 83.2 per 100 thousand. population
A country with low endemicity, if there is an effective system for identifying cases of the disease, is considered to be one in which the number of new cases of bacillary (detection of MBT by microscopy) pulmonary TB, which are registered throughout the year, should not exceed 5 per 100 thousand inhabitants, or the number of cases TB meningitis throughout the year in children under 5 years of age should be below 1 per 10 million inhabitants during the previous 5 years. In such cases, the average annual risk of tuberculosis infection will be below 0.1% (WHO, 2004), which minimizes the risk of the disease and eliminates the need for specific prevention (BCG vaccination, chemoprophylaxis).

2007-03-05 14:43:51

Igor Petrovich asks:

I heard that a tuberculosis epidemic has been declared in Ukraine and a new tuberculosis has appeared that cannot be treated. Is it true?

Answers Denisov Alexey Sergeevich:

Hello!
In 1993, the WHO declared tuberculosis a global threat. In Ukraine, a tuberculosis epidemic was registered in 1995. Nowadays, all segments of the population are at risk of the disease. Tuberculosis has ceased to be a disease of purely asocial circles.
Regarding the second part of the question. Today, resistant tuberculosis, a disease caused by a tuberculosis bacillus that is resistant to certain drugs, is becoming increasingly widespread. But the concept of “cannot be cured” does not apply to this disease. Resistant tuberculosis is also treatable. But the treatment process takes longer and is carried out with those drugs to which the pathogen is sensitive.

2011-10-04 09:41:53

Maria asks:

Hello. Two weeks ago, during a medical examination, focal shadows were found on the X-ray in the upper lobe of the right lung. We were treated for 7 days for pneumonia with amoxiclav. As the control X-ray showed, in the overview image there are no dynamics, but on the topography section, as the doctor said, the dynamics are visible and o An is good. However, the phthisiatrician diagnosed focal tuberculosis of the upper lobe of the right lung in the infiltration phase. bk (-). Please tell me if the doctor can simply play it safe and prescribe anti-tuberculosis drugs
devices to protect both yourself and me. History: a year ago I had a non-specific flu (then there was a swine flu epidemic) for two weeks, six months ago I vacationed in exotic Thailand, there were no poisonings, I don’t suffer from chronic lung disease, there are no symptoms, I work in chemical laboratory without a respirator with toxic amines, hydrazines. Is it possible to change under the influence of chemical vapors? Is it necessary to do a computed tomogram of the lungs to clarify the diagnosis.

Answers Agababov Ernest Danielovich:

Hello Maria, such a scenario with couples is not possible, your TB doctor is absolutely right, follow his further recommendations, there is no reason to doubt it.

2011-02-27 12:16:01

Gulshat asks:

My mother fell ill with infiltrative tuberculosis in the summer. At this time, the child was vacationing with them (during the summer holidays). The child and I underwent fluorography, 1 month of prophylaxis with isodiazide. The child has a good appetite, no fatigue, and did not get sick with the flu during the epidemic. But the soul is not calm. Can tuberculosis appear later? Mom was treated at the PTD, she doesn’t have canes now. In the House where she lives, we disinfected it with chloroamine and “Belizna”, aired the entire bed, wiped the walls, washed the curtains. Can the disease appear in us?

Answers Medical consultant of the website portal:

Hello, Gulshat! It is impossible to answer your question unequivocally - yes or no. It is in your power to prevent the development of tuberculosis in all contact persons - this requires regular examinations by a phthisiatrician (generalist, pediatrician), for adults - timely fluorography of the lungs, for children - Mantoux tests, good nutrition and a healthy lifestyle. Take care of your health!

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Since the 1990s, the number of cases of tuberculosis in Russia has increased significantly. Perhaps today this is the most mythologized disease. Olga NOSKOVA, head of the tuberculosis diagnostics department at Children's Infectious Diseases Hospital No. 3 in St. Petersburg, told the Mercy portal about the reasons for the current situation.

— Is it true that by the time they reach adulthood, 70% of the population is already infected?

- Alas, not 70% but more. By age 40, 100% of the population is infected.

- How so? After all, Russia has a long tradition of fighting tuberculosis. Why has the problem now become so urgent that people are increasingly talking about an epidemic?

— According to official statistics, there is no epidemic in Russia, but the incidence is high. Moreover, in the regions of the Far East and the Far North it is much higher than, say, in Moscow and St. Petersburg.

As for the change in the situation after the collapse of the USSR, epidemic problems have a number of reasons that arose in the 90s. This includes the reorganization of the entire medical service, including children's TB. These are migration processes that are characteristic not only of Russia, but of the whole world. The geographic direction of the flow of migrants has changed over the years: first Azerbaijan prevailed, then Ukraine, Moldova, and Armenia. Now migrants are represented mainly by Central Asia: mainly Uzbekistan and Kyrgyzstan, Tajikistan. There is also internal migration in the Russian Federation. Moreover, migration is not only the movement of people, among whom there may be sick people, it is also stress that causes illness in previously healthy people.

A phenomenon common among migrants is foci of familial tuberculosis - when both parents or several relatives are sick with open forms. We recently treated a girl from such a family. Her parents, brother and aunt, migrants from Central Asia, were sick with an open form of tuberculosis. She fell ill with a complicated form of primary tuberculosis. Fortunately, the girl was vaccinated with BCG, which is generally uncommon for people from the former southern Soviet republics, so she did not develop tuberculous meningitis, which is fatal for the child.

However, foci of familial tuberculosis occur not only among migrants.

- Where else?

- As a rule, in asocial families. Of course, among the factors influencing the epidemic situation are a decline in the material standard of living, the spread of diseases such as HIV infection and AIDS associated with drug addiction, which is also growing. The characteristics of Mycobacterium tuberculosis (formerly called “Koch bacillus”) have also changed - it has become resistant. In the last 3-5 years, resistance has very often been observed in foci of familial tuberculosis.

— What myths about tuberculosis are present in the mass consciousness? Is this really “the disease of hungry times”?

Photo by Maxim Dondyuk on the page http://prophotos-ru.livejournal.com/

— Tuberculosis is usually written with an equal sign with “consumption,” that is, rapidly progressing tuberculosis, a disease when the lung tissue is massively affected. This course of the disease occurs against the background of altered immunity. Alcoholism, drug addiction, HIV infection, as well as diabetes mellitus, treatment with hormones and cytostatics play a significant role here. This disease can have a lightning-fast course. It is worth talking about diabetes mellitus, a disease to which tuberculosis especially likes to “stick” and in which tuberculosis is very difficult to treat. Recently, a boy was treated at our department, almost a youth, one might say. He had type 1 diabetes, meaning he was on insulin. He didn’t have a fluorography done for a year, because his mother didn’t pay attention to the doctors’ recommendations, and he didn’t even care. Upon entering the school, he was diagnosed with complicated tuberculosis during the next preventive examination. Despite all efforts, conservative treatment did not bring lasting improvement. He was faced with the prospect of becoming a “chronic patient,” and then the phthisiosurgeons decided to perform an operation - removing part of the lung. Fortunately, the operation was successful, the boy recovered from tuberculosis, and is now a tall and handsome young man, studying to become a veterinarian.

— What about patients with other forms?

— And patients with other forms of tuberculosis have a good prognosis and live long. As for socially adapted people, they did not immediately become so; their past is full of emotional and physical stress, stress and other predisposing factors. They get sick just like everyone else. There is also a reluctance to take care of one’s health, and there is also a hidden fear of identifying tuberculosis, non-recognition of an already identified disease, the so-called anosognosia.

- For example?

— For example, in a family where the “coming dad” was sick with an open form of tuberculosis, the child had a high Mantoux reaction. The mother swore that the child had no contact with sick people, was indignant at the examination ordered, and did not believe when the doctor told her that the child was sick. However, later, after several months of treatment in the hospital, having seen how her baby’s well-being and mood were improving, she spoke about the contact and naively added: “I didn’t tell you on purpose so that the child wouldn’t be given tuberculosis!”

— What do they mean when they say that tuberculosis is a social disease?

— The fact that tuberculosis is a social disease was noted back in the 18th century by the discoverer of percussion, the Austrian physician Leopold Auenbrugger, although this was known even in the time of Hippocrates. Auenbrugger said that people experiencing various kinds of hardships, separated from loved ones, are more likely to develop consumption.

Photo by Maxim Dondyuk on the page http://prophotos-ru.livejournal.com/

“But among the sick people there are also quite wealthy people. One privately practicing pediatrician told me that he has recently had many clients with tuberculosis from Rublyovka...

— Old Russian phthisiatricians said that tuberculosis spares neither huts nor palaces. Even in the royal family there were cases of tuberculosis.

— What then are the preventive measures?

— Prevention is, first of all, such a simple thing as a healthy lifestyle. Eat regularly and variedly, go to bed on time, walk in the fresh air, exercise, do not abuse alcohol, and do not smoke. It is also necessary to pay attention to your body during a period of decreased immunity - with frequent, recurring colds. In addition, of course, it is necessary to undergo a preventive fluorographic examination, and for children - an annual Mantoux test.

— How can one suspect tuberculosis? What should you do if a loved one gets sick in order to help him and not get infected yourself?

— You can suspect it if a person has a series of acute respiratory infections with recurring symptoms, a cough that does not stop, fever, and increased sweating at night. But tuberculosis in the early stages has few symptoms. It is detected by fluorography in the early stages. Symptoms appear as the disease progresses. In addition, tuberculosis puts on the “masks” of other diseases. The phthisiatrician must be able to recognize them. There are cases about which they say “it’s as if the child has been replaced”: he becomes hyperactive, he can’t get into bed, he won’t wake up in the morning, he’s sweating. He is referred to a neurologist, although this is one of the masks for early tuberculosis intoxication.

— How informative is Mantoux’s reaction? In recent years, many children have papule much larger than normal - are they all really infected?

— It should be said right away that there are no norms in assessing the Mantoux reaction.

The fact is that the Mantoux reaction reflects the state of immunity, moreover, that part of it that plays a decisive role for the development of tuberculosis infection in the body - cellular immunity. The state of immunity is not constant, and the state of health of children, starting from the neonatal period and further, changes from year to year - since there are factors that negatively affect it. Various concomitant pathologies, allergies, nutritional disorders, diseases of the central nervous system, endocrine pathology, infections, for example, ENT organs, kidneys, childhood infections (chickenpox, measles), antibacterial and hormonal therapy, chemotherapy for cancer change the response to administration tuberculin.

Let me explain that tuberculin is a low-molecular-weight specific protein, a hapten, which causes a response in individuals who have either been vaccinated with BCG, or have had an infection or are infected with Mycobacterium tuberculosis. Based on the Mantoux reaction, children are “screened” and should come under the close attention of a TB doctor.

In hospitals, after this, in-depth tuberculin diagnostics are carried out, in which they use not two tuberculin units, as in the standard Mantoux reaction, but one hundredth, one thousandth, one ten-thousandth of a tuberculin unit, as well as a skin prick test with different percentages of tuberculin dilution. This makes it possible to identify different levels of tension of anti-tuberculosis immunity, since the reaction to a small amount of tuberculin indicates a high degree of antigenic irritation, which means that the mycobacteria that have entered the body are active. These tests, like other immunological tests, are assessed by a phthisiatrician. The diagnostic significance of tuberculin diagnostics does not decrease, although the interpretation is quite complex due to the above reasons.

— Why is the population so little informed that tuberculosis treatment is free in our country?

— In our country there is a federal program to combat tuberculosis, which involves providing free assistance to the population. The population is informed, because there are anti-tuberculosis dispensaries in every district of the city, and upon initial visit to the clinic, the therapist will always require fluorography. But there is an internal fear of seeking TB help. Unfortunately, people generally have low literacy regarding tuberculosis infection.

— Tuberculosis is completely curable, but why has the effectiveness of many anti-tuberculosis drugs decreased? Or is this a myth?

- This is not a myth, this is due to drug resistance. It occurs as a result of interrupted courses of treatment in persons suffering from alcoholism, for example. They leave the hospital because there is no compulsory treatment for such persons. When the course is not completed, Mycobacterium tuberculosis adapts to the effects of the drugs. This microorganism is generally extremely stable in the external environment and has a powerful set of enzymes for “self-defense”, and if the course is not completed, a population of drug-resistant “Koch bacilli” is created.

— Why is phthisiology not popular among medical university students? Do future doctors not want to risk their health? Or because of the lack of job prospects in private clinics?

— The main reason is insufficient funding for healthcare. Of course, a tuberculosis hospital is not a private clinic; there is a threat to the doctor’s health. Phthisiatrists are a risk group; they undergo fluorographic examinations twice a year. In addition, TB doctors have almost no benefits: their pension and vacation are the same as other doctors. Yes, there is a 15% increase in salary, but this is practically not noticeable. In addition, becoming a phthisiatrician is not easy. Diagnosis and treatment of tuberculosis require a high professional level and long-term training. A young graduate of a medical university can become a competent specialist only after 5 or more years if he is engaged only in phthisiology.

— What is needed to stop the spread of tuberculosis in Russia?

“It is impossible to say that there is an epidemic in our country based on statistics, but the incidence is extremely high. First of all, it is necessary to solve social problems: improve the standard of living of the population, conduct examinations of migrants, medical examinations, treat drug addiction and alcoholism. Then tuberculosis will recede.