Pulmonary tuberculosis. All about the initial stage of development of tuberculosis

Tuberculosis is a disease caused by the microbacterium tuberculosis (Koch bacillus). It is characterized by the development of specific granulomatous neoplasms in tissues various organs, polymorphic clinical picture, as well as cellular allergy. The disease most often affects the respiratory system. But there are cases when they suffer:

• peripheral lymphatic system;
• genitourinary system;
• kidneys;
• bone and joint tissues;
• digestive system;
• skin;
• eyes.

Let's consider the most common of tuberculosis infections - pulmonary.

Stages of development of tuberculosis

There are two stages of pulmonary tuberculosis:

• primary. Occurs in people whose body has been infected for the first time. As a rule, it is asymptomatic for many years. However, some small lumps can be seen on x-ray. This indicates the presence of foci of inflammation in which pathogenic microorganisms “sleep”;
• secondary. When a person, after successfully curing tuberculosis, becomes infected again.
• The secondary stage of the disease may be:
• infiltrative. When several inflammatory foci merge into one, forming a fairly large area;
• focal. When there is the formation of several foci of inflammation, which are productive;
• tuberculoma (caseoma). It is asymptomatic and is often detected accidentally during examination. Mainly affects strong and physically developed people;
• disseminated. When multiple foci of inflammation develop gradually, accompanied by clear manifestations of intoxication;
• fibrous-cavernous. It is considered the most dangerous to the health and life of the patient;
• cavernous. It is characterized by the formation of isolated cavities containing decomposed lung tissue. There is also sputum with microbacteria in the cavities. Most often it is a consequence of the development of other types of secondary stages of tuberculosis.

Forms of development of tuberculosis

There are two forms of tuberculosis - closed and open.

In the closed form, the infection is located within isolated infiltrates (foci of inflammation) and does not have the ability to spread beyond its boundaries. Man in in this case is not contagious, but only a carrier of the disease.

The open form of tuberculosis is transmitted by airborne droplets and is more dangerous. After the collapse of the lung tissue, the infection begins to come out along with expectorated sputum.

Thus, we can conclude that the closed form is the primary stage of the disease, and the open form is the secondary stage.

Causes of tuberculosis development

Tuberculosis occurs when a pathogen such as Koch's bacillus enters the body. A special feature of this microbacterium is the presence of a dense protective shell, which allows it to survive in rather harsh environmental conditions. This shell protects the microbe from the harmful effects of many medications.
It is also worth noting that the peculiarity of tuberculosis microbacteria lies in their division rate - it occurs quite slowly. This causes difficulties in diagnosing the disease.

What is the risk of getting infected?

Tuberculosis microbacteria, entering the body of a healthy person, do not always cause the development of the disease. It all depends on the degree of individual susceptibility of the body to infectious agents, as well as on the state of the immune system.

The risk of contracting tuberculosis largely depends on the following factors:

• the duration and nature of contact between a healthy person and an infected patient. The longer and more closely it is carried out, the correspondingly higher the risk of infection;
• age. According to statistics, tuberculosis most often affects young people. Women become infected between the ages of 25 and 34;
• availability chronic diseases blood and hematopoietic organs;
• availability renal failure(provided that the patient regularly undergoes hemodialysis procedures);
• the presence of malignant neoplasms in the upper respiratory tract;
• the degree of infection of the patient (in what form and at what stage the disease is). For example, the risk of infection increases several times if the upper Airways(larynx, trachea, bronchi), there are tuberculous cavities in the lungs, and the patient also suffers from an open form of the disease;
• presence of a disease such as diabetes(when the patient requires insulin administration);
• the presence of pathologies in which immunity is reduced. The record holder among such diseases is HIV infection. This disease contributes to the development of “active” tuberculosis. This is due to the fact that during HIV infection the immune response is quite weak or completely absent.

The risk of infection also increases with prolonged stay in poorly ventilated places with large crowds of people.

Who is at risk?

According to experts, real threat Only people whose immune response is significantly suppressed can become infected with tuberculosis:

• elderly people;
• children;
• HIV-infected;
• people who live in damp, poorly ventilated and heated buildings;
• people suffering from drug and/or alcohol addiction;
• people systematically taking steroid drugs;
• people who eat poorly and expose their bodies to frequent hypothermia.

How is tuberculosis transmitted?

Pathogens of this disease They are thin, immobile rods (aerobes). They have the ability to reproduce both in macrophages and in the extracellular space. They are extremely resistant to various influences environment. For example, they can retain their viability:

• in street dust – about 10 days;
• on the surface of paper sheets (newspapers, books, etc.) - at least 2 months;
• in water - about 1 year;
• frozen - for many decades.

It is also worth noting that when exposed to heat and ultraviolet irradiation, tuberculosis pathogens die within a few minutes.

Koch's bacillus can enter the body:

• by airborne dust. When the pathogens are quite long time preserved in dust and mold. A healthy person becomes infected when inhaling contaminated dust;
• food (alimentary) route. The causative agents of tuberculosis enter the body through food - meat or milk, which were obtained from an infected animal. To avoid this, you only need to subject the products to thorough heat treatment.

The routes of transmission of tuberculosis described above are less common, in contrast to the entry of Koch's bacillus into the body by airborne droplets.

Thus, an infected person, when coughing, talking or sneezing, secretes environment pathogens that are contained in microscopic droplets. After a short time, the moisture evaporates, which leads to the formation of even smaller particles, which consist of 1-2 microbial cells. These cells do not succumb to gravity, that is, they do not settle on the floor or furniture. They continue to “float” in the air. A healthy person inhales this air and becomes infected.

Many people are interested in whether tuberculosis is sexually transmitted if one of the spouses (partners) has had it previously or is currently infected. Such questions are related to the fact that tuberculosis can affect the tissues of the genital organs. But doctors are quick to assure that this disease cannot be transmitted sexually. First, the pathogen must penetrate the respiratory or digestive organs. And then, through the general bloodstream of the body, into the tissues of the genital organs, causing tuberculous lesions.

In addition, some fear that tuberculosis can be transmitted genetically, in other words, by inheritance. In this case, there is also no need to worry - the disease cannot be transmitted through this route. However, it is worth mentioning that a person can inherit from his parents only a high degree of sensitivity to tuberculosis pathogens. But if one of the parents has a high resistance to Koch’s bacillus, the child may well inherit this indicator.

Symptoms of tuberculosis

Due to the fact that the primary form of the disease is often asymptomatic, it is necessary to describe the manifestations of the secondary form of tuberculosis. So.
At the very beginning of development, symptoms are mild and almost invisible. As the disease progresses, it intensifies, becomes specific and distinct. Such manifestations include:

• shortness of breath;
• respiratory failure;
• increased sweating (mainly at night);
• prolonged cough. At first it is dry, then it becomes wet. Then pus and blood appear in the expectorated sputum;
• loss of appetite and, accordingly, weight;
• painful sensations in the chest area. The pain intensifies when inhaling;
• fever, chills;
• general weakness.

With tuberculosis, the walls of the blood vessels of the lungs are often destroyed. As a result, pulmonary hemorrhage may begin.

Diagnosis of tuberculosis

People who notice a slightly elevated body temperature, general malaise and dry cough do not immediately consult a doctor, believing that this is the case. colds. But tuberculosis begins precisely with the presence of such symptoms. When, after treatment for a cold, the symptoms do not go away, but become more pronounced and change their character, patients usually turn to a therapist.

The doctor assesses the patient’s condition at the time of treatment - they take the temperature and inquire about their well-being. Then a survey is carried out during which the patient answers a number of questions:

• what are his social conditions of existence? Perhaps the patient is a refugee, homeless person or migrant;
• how much time has passed since the last fluorographic examination of the lungs and bronchi;
• have you ever had tuberculosis before?
• whether you have been to places of deprivation of liberty or lived with people who served time in the relevant institutions;
• whether there are relatives who are or have previously suffered from tuberculosis;
• is he registered with a tuberculosis dispensary;
• have you had contact with people with tuberculosis?
• whether the patient was invited to undergo additional examination after undergoing fluorography.

These questions help the doctor make a diagnosis and determine the severity of the disease.

After the interview, the doctor may prescribe the following tests for the patient:

• general blood clinic. A slight decrease in hemoglobin may indicate the development of a fibrous-cavernous form of pulmonary tuberculosis. And an increased erythrocyte sedimentation rate (ESR) will tell about the activity of the tuberculosis process;
• Mantoux test. During this diagnostic procedure, a special drug – Tuberculin – is injected under the patient’s skin. After 3 days an assessment is carried out allergic reaction the body to the administered drug;
• laboratory examination of sputum. This method allows you to determine not only the presence of tuberculosis microbacteria in a patient, but also their qualitative indicators, as well as sensitivity to certain drugs;
• fluorography. It is carried out by photographing X-ray images from a fluorescent screen. It is used in medicine to detect the latent course of tuberculosis and the presence of tumor neoplasms;
• radiography. Organ tissues are projected onto x-ray film. This method allows doctors to see a more complete picture pathological changes in the lungs;
• fluoroscopy. The condition of the lung tissue is assessed by a specialist during the procedure (at the moment when the patient’s lungs are exposed to x-rays). As a rule, this diagnostic technique is additional and is carried out with the aim of drawing preliminary conclusions;
• tomography. This type of diagnostic activity is carried out using special devices, which are equipped with an X-ray machine. The result is layer-by-layer images of the patient's lungs. Allows you to define clear boundaries and area tuberculosis lesions, their topography, the depth of decay of lung tissue and the nature of the ongoing pathological processes.

Treatment of tuberculosis

The success of tuberculosis treatment largely depends on the stage at which the disease was detected. Unfortunately, cases of tuberculosis detection in early stages developments occur in medical practice quite rare.

The main tasks that should be addressed in the treatment of this disease are as follows:

• in restoring the patient’s performance and functionality;
• in eliminating symptomatic manifestations of the disease;
• in the regression of radiological manifestations, which include destruction, infiltrates, inflammatory foci;
• in suppressing the process of formation of secretions.

Doctors take a comprehensive approach to the treatment of tuberculosis. Therapy includes the following stages:

• collapse therapy;
• pharmacotherapy;
• pathogenetic therapy, as well as treatment of concomitant pathologies;
• surgery.

Each stage must be described in more detail.

1. Collapse therapy

Indications for collapse therapy are:

• pulmonary hemorrhage;
• the presence in the lung tissues of a fresh elastic cavity without significant infiltrates (fibrous compactions);
• lower lobe localization of pulmonary tissue decay.

This therapy is called artificial pneumothorax and involves the introduction of a special gas into the pleural cavities. As a result, the patient's affected lungs are compressed, which leads to a decrease in elastic traction and partial or complete collapse of the decay cavities. Due to hemostasis, there is less dispersion of tuberculosis microbacteria, and the absorption of toxic agents is minimized.

2. Pharmacotherapy

It is one of the most leading methods of treating tuberculosis today. During this therapy, doctors use medications that have a detrimental effect on tuberculosis microbacteria and also have bactericidal and bacteriostatic properties. Such drugs include:

• thiamides;
• polypeptides;
• fluoroquinolones;
• aminoglycosides;
• rifamycins.

Table of the main medications prescribed for the treatment of tuberculosis

3. Pathogenetic therapy

This therapy is syndromic in nature and is aimed at eliminating functional disorders caused by MBT toxins. During its implementation, it is necessary to adhere to the following principles:

• symptomatic treatment;
• therapeutic nutrition;
• detoxification;
• compliance with the motor regime;
• immunomodulatory therapy;
• hormonal therapy.

4. Surgical treatment

This treatment method is used for tuberculosis:

• pleura;
• lungs;
• bronchi;
• bronchioles;
• intrathoracic lymph nodes.

Most often, surgical treatment is used in the presence of the following tuberculosis lesions:

• cirrhotic;
• polycavernous;
• single cavernous;
• tuberculomas.

This treatment method is used much less frequently if the patient has:

• caseous-necrotic damage to lymph nodes;
• caseous pneumonia;
• tuberculous pleural empyema.

To contraindications surgical treatment may include the presence of a large area of ​​tissue affected by tuberculosis in the patient, as well as serious functional disorders at work:

• kidney;
• liver;
• vascular beds;
• hearts;
• respiratory system.

In addition to the basic methods of treating tuberculosis, doctors recommend that patients:

• spend more time in the fresh air;
• visit sanatoriums located in coniferous forests;
• completely stop drinking alcohol and smoking;
• take vitamin complexes;
• follow a therapeutic diet.

How to treat tuberculosis with traditional methods?

1. Treatment using bears (tops)

These insects are pests because they eat plant roots. However, they have proven themselves to be excellent in the treatment of tuberculosis. The fact is that the leukocytes contained in the blood of mole crickets, penetrating into the body of an infected person, seem to “envelop” the tuberculosis bacteria and completely dissolve them.

Of course, almost all leukocytes have such properties of “enveloping” bacteria, but only mole cricket leukocytes have the ability to dissolve Koch’s bacillus. This effect is achieved due to the presence of an enzyme in the leukocytes of mole crickets - ferase, which is capable of dissolving the waxy shell of tuberculosis microbacteria.

Take powder from dried mole crickets in two stages. The first lasts for three days. The patient may gain weight, develop an appetite and improve immunity. After 10-15 days, the patient usually develops productive cough. Recovery can occur after the first stage of treatment, but only if the disease is not advanced.

The second stage of treatment with mole cricket powder must be carried out after 3 months.

2. Treatment with apples and nails

It is a rather “interesting” method of enriching the body of a tuberculosis patient with such an essential microelement as iron. To do this, take an apple and stick several pre-washed construction nails (5-7 pcs.) into it. Of course, it is advisable to use new nails. The apple should remain in this state for a day. Then the nails are removed and the apple is eaten. It is recommended to eat 2-3 pieces per day. such apples.

3. Treatment with wax moth

For the first time, treatment with an extract from wax moth larvae was used by the outstanding scientist I.I. Mechnikov. The enzymes of these larvae are capable of quickly and efficiently digesting waxy materials, including the waxy shell of tuberculosis microbacteria.

Taking a drug made from the enzymes of wax moth larvae does not provoke the development of any side effects. The drug is rich in magnesium, zinc, as well as biologically active substances produced by bees.

This remedy prepared as follows: 1 teaspoon of wax moth larvae is poured into 50 g of alcohol and infused in dark place for 7 days. Adult patients take 20 drops orally, diluted with water, twice a day. Children under 14 years of age are given medicine at the rate of 1 year of life - 1 drop. And from the age of 15, the dose prescribed for adults is taken.

4. Treatment with oats, bran and honey

Pour a mixture of bran and oats, taken in equal proportions, with water (500 ml of water is required per 100 g of mixture). Boil for about an hour over low heat. Then squeeze and strain through gauze or a strainer. You can use the decoction instead of water. Before use, add a little natural honey (to taste) to the broth.

5. Treatment with walnuts, badger fat and honey

All components are taken in equal proportions. Before use, nuts must be crushed using a coffee grinder, and natural honey and badger fat- reheat. Then all the ingredients are mixed. The resulting mass is consumed 4 times a day, 1 teaspoon. It is advisable to consume it warm, but it is also acceptable to consume it cold. Can be spread on bread.

Prevention of tuberculosis

1. Vaccination (BCG). As a rule, it is performed on the 7th day of life for infants, children aged 7, 12 and 17 years, adults under 30 years old, who have a negative or questionable Mantoux test result.
2. Annual fluorographic examination.
3. Increased protective functions of the body.
4. A complete diet with sufficient amounts of fats, proteins, minerals and vitamins.
5. Avoid contact with people who have tuberculosis.

In conclusion, it is worth saying that tuberculosis, although a “formidable” disease, is treatable if it is identified in time, competent treatment is prescribed and all doctors’ instructions are followed.

There are few diseases in medicine that have such a wide variety of forms and varieties as tuberculosis. Many organs are susceptible to attacks by the tuberculosis pathogen - skin, intestines, skeletal bones, but the pulmonary variety of the disease is more “popular” and widespread. When affecting the human body, the infection goes through a certain “life path”, consisting of several stages - it penetrates, gains strength, spreads, capturing new territories, destroys and destroys healthy cells of the affected organs. How does infection occur, what causes the disease, what stages of tuberculosis of the lungs and other organs are observed, what precautions will help avoid the penetration of a dangerous infection into the body - this article is about this.

The disease occurs from the penetration of special bacteria into the body, which in medicine are called “Koch’s bacillus”, named after the German scientist-microbiologist who first identified the source of infection dangerous infection. Its other name is Mycobacterium tuberculosis (MBT), which is the main causative agent of the disease. The bacilli are extremely tenacious and have unique adaptability not only to their environment, but also to pharmacological drugs, they are not at all affected by the destructive external environment. In nature, the infection survives well in the elements, air, soil, and on household objects - the tuberculosis pathogen remains active for several months. Tuberculosis, especially in late stages treatment takes a long time, using an extensive list of medications, often required surgical treatment. There are 3 (with certain conditions- 4) phases, or stages of the disease.

Reasons contributing to infection

Doctors name several probable causes as the main sources of tuberculosis infection, including:

1. poor social conditions of stay;
2. constantly deteriorating environment;
3. insufficient nutrition, depleted of vitamins, as well as an imbalance of essential nutrients;
4. prolonged stay in a stressful situation, unstable psychological background;
5. bad habits (alcohol, smoking, drug addiction);
6. concomitant diseases (gastrointestinal ulcer, diabetes, lung diseases);
7. consumption of contaminated dairy products from sick animals.

Most probable reasons Tuberculosis infection is caused by weak body resistance, as well as personal contact with a carrier of open tuberculosis. Constantly increasing in Lately the number of cases is an adequate response to the deterioration of social living conditions. An important reason is the high cost of drugs, especially if a long course of treatment is required. However, even very prosperous citizens can be subject to a tuberculosis attack, for two reasons: irresponsibility and carelessness. The traditional hope for “maybe”, generated by elementary medical illiteracy, leads to an annually increasing flow of requests for help only in the last stages of the disease.

How to recognize the disease: symptoms

A special insidiousness of the infection is its long-term “secret” presence without the slightest sign infection that has occurred. The beginning of the process (the moment of penetration of the tuberculosis bacillus into internal organs, the formation of latent tuberculosis) passes completely unnoticed by humans. Further distribution infection throughout the body is accompanied by changes in well-being, and there are external symptoms, indicating the presence of the tuberculosis pathogen in the body.

What should you be wary of in your own condition? Particular attention must be paid to the appearance persistent cough, pain in the chest, increased fatigue, loss of appetite. You should also be concerned about rapid weight loss, the formation of small subcutaneous nodules on the lower leg, brownish/red in color. Medical workers It is recommended to consult a doctor promptly if your body temperature has been constantly elevated for several days, especially in the afternoon. We must not forget that the appearance of characteristic symptoms indicates the development of tuberculosis, this is a reason to urgently contact a specialist for examination.

Initial, hidden stage

The initial “invasion” of the infection goes completely unnoticed: the general condition does not cause alarm. Often the doctor misses the disease in initial stage development of tuberculosis - examination is not performed due to the lack of symptoms. Unambiguous opinion about timely diagnosis No. Experts believe that detection of the virus is possible, but on the part of the patient it is necessary to external signs illness or test abnormalities.

Primary site of entry pathogenic bacteria- lungs. Then the disease gradually spreads to the lymph nodes, covering a larger area. The first stage does not pose a danger to others. The infection remains in a closed form, the body tries to cope with the emerging source of inflammation on its own. If a person has a strong immune system, the body successfully fights tuberculosis infection on its own.

Second, hidden stage

The most simple ways, which determines the second, latent stage of tuberculosis - fluorography, tuberculin tests. Tests will show the destruction of the walls of the lungs or previous changes in the structure. Damage to the pulmonary system at this stage is already noticeable in tests, but the disease still has a closed form. The body can remain in this state for a long time. The active development of bacteria occurs for several reasons:

• immunity sharply decreases;
• there are unfavorable living conditions;
• the body is exposed to infection (even the common cold).

The second stage is difficult to miss even without examination, however, an increased cough, problems with the respiratory system, decreased motor ability are often mistaken for symptoms of other, less serious illnesses. If you conduct a timely examination and detect tuberculosis in the latent stage, you will achieve full recovery as simple as possible, in a shorter time. A feature of the second phase is its borderline state: the disease can either be completely cured or enter the third, active stage.

The third “stage” of the disease

In the third period of tuberculosis, the carrier of the disease becomes not only infected, but also a distributor of tuberculosis infection. It is not for nothing that this stage is called open - the disease goes on the offensive, affecting the healthy internal systems of the body. Especially clear signs has a pulmonary variety, the following changes in condition are observed:

• sputum comes out with blood;
• night sweats become especially severe;
• breathing problems worsen;
• the cough becomes protracted;
• body temperature is maintained at elevated levels for a long time.

If tuberculosis is detected at this stage for the first time, the treatment process will be complex, long, and with an unpredictable result. However, with persistent treatment up to surgical intervention (lung removal) cure is possible.

Last phase

Tuberculosis disease in some cases has a recurrent form - after successful treatment, the disease can reappear. In this case, we can talk about stage 4 of the disease, when it is especially difficult for the body to fight pathogenic bacilli. The patient's condition in the fourth stage is constantly deteriorating, coughing attacks turn into hemoptysis, pain becomes constant and severe. The result of the confrontation between the immune system and the pathogenic effects of the second “coming” of tuberculosis can be very sad - even death.

Prevention measures

It is easier to prevent any disease than to spend a lot of time and money getting rid of a debilitating disease. Before asking the question: how dangerous is tuberculosis, is it curable, what is the likelihood of re-infection, you need to remember that neglect of your own body is costly for a person. To save good health on long years It is recommended to take certain precautions by firmly adhering to a few simple rules:

1. do not refuse vaccinations, especially if a predisposition to the disease has been identified (the vaccination schedule should be confirmed with a doctor);
2. regularly undergo fluorographic examinations, and, if necessary, x-ray examinations;
3. if there is an open-phase carrier in your close circle, reduce contact with him to a minimum, or completely stop personal communication (this especially applies to children, they are especially vulnerable due to weak immunity);
4. carefully observe personal hygiene, be active healthy image life;
5. if you are addicted to smoking, or abuse alcohol, you should completely give up bad habits.

The diagnosis of tuberculosis is established by the medical commission of the anti-tuberculosis institution. The goals of diagnostics are to identify cases of suspected tuberculosis among the population, phases of tuberculosis, confirm and diagnose correct diagnosis. Have you had a cough for more than two weeks, fever, weakness and night sweats? If necessary, the doctor will prescribe additional tests.

People with low immunity are susceptible to infection and have a risk of becoming infected while being with an infectious patient in a closed room or public transport. The open form of tuberculosis is dangerous for others. The closed form does not pose a risk of infection. Patients who are carriers of latent infection do not release tuberculosis bacteria into the environment. The primary and secondary stages of pulmonary tuberculosis are an exacerbation of the primary foci and the secondary entry of the bacterium into the body. Misunderstanding of the principles of treatment and distrust of the doctor hinder successful treatment. Long-term treatment under constant supervision the only way defeat the disease.

Spread of tuberculosis

About two billion people in the world are carriers of tuberculosis. Most of them are unaware of this. About 9 million people worldwide fall ill with tuberculosis every year. A third of them die from complications of tuberculosis. The stages and symptoms of the disease depend on the organ in which the disease develops and the state of the person’s immunity.

Photo 1. Koch's bacillus is the cause of the occurrence and development of tuberculosis in the human body.

If the body's defenses are not able to restrain the proliferation of the tuberculosis bacillus, the disease develops. Depending on the stage of tuberculosis, the organ affected and the immunity of the sick person, the appearance of certain symptoms depends.

Mycobacterium tuberculosis is present in the human body in small quantities and in a state of “sleep”. Under the control of the body's defenses, bacteria do not provoke the development of the disease. This condition is called latent TB infection.

Forms of tuberculosis

There are two forms of tuberculosis:

• closed;
• open.

People with latent tuberculosis do not complain. This form of tuberculosis is not contagious to others. The examination reveals a positive tuberculin test, but the x-ray shows no changes in the lungs, and there are no mycobacteria in the sputum. In fact, a person with closed tuberculosis is considered healthy.

Photo 2. When a patient with open tuberculosis sneezes or coughs, those around him risk becoming infected.

The risk of becoming infected from a patient with closed form of tuberculosis is low. With it, the bacterium is not released into the environment, as with extrapulmonary tuberculosis.

Open pulmonary tuberculosis is the main source of infection. A patient with open form of tuberculosis releases bacteria into the environment. Moisture droplets containing mycobacteria enter the air when coughing, sneezing, talking, singing, or breathing.

With one cough, up to three thousand particles are released, with a sneeze - a million, with a conversation - two hundred. If there are nine people in a closed room healthy person and one is sick with an open form of tuberculosis, then within a minute everyone is breathing air with the causative agent of the disease. Bacteria live in the air for about six hours.

The body's defenses may not be able to cope with the task of limiting the proliferation of tuberculosis bacteria. As a result, a disease develops. Mycobacterium enters the human body mainly through airborne droplets; through milk and meat of animals; less often - from mother to child during pregnancy.

Photo 3. By eating meat or milk from animals infected with tuberculosis, you can become infected with Koch's bacillus.

Extrapulmonary tuberculosis affects various organs and tissues:

• lungs, bones, lymph nodes;
• genitourinary system, Gastrointestinal tract;
• eyes, skin, meninges.

Any human organ can become infected. Pulmonary tuberculosis is a form of the disease that occurs more often than other forms.

Photo 4. Pulmonary tuberculosis is a common form of tuberculosis in cause of lung penetration into these organs.

Pulmonary tuberculosis

Primary infection develops after the first contact with Mycobacterium tuberculosis. Features of active primary disease is that it develops unnoticed. The Koch wand multiplies and invades new territories. The first symptoms of the disease are minor, as there is no significant deterioration in the condition.

Clinical stages pulmonary tuberculosis:

1. Primary - exacerbation of primary foci of infection.
2. Secondary - re-entry of bacteria into the body.

After the primary stage, secondary tuberculosis develops, which lasts from several months to several years. The development of the disease is possible as a result of an old tuberculosis focus or reinfection - the resumption of bacterial growth or re-infection.

Secondary tuberculosis begins to occur when re-infection patient or upon awakening of an early focus of the disease. Since the immune system knows what the causative agent of tuberculosis is, the process is different than during the primary form.

In secondary tuberculosis, the lungs are affected. Such patients are the main source of infection. If the patient has previously completed treatment for tuberculosis, then the resumption of the disease is regarded as a relapse.

Miliary tuberculosis

Exists special shape disease miliary tuberculosis. Infection develops in the primary stage of tuberculosis. From the source of inflammation in the lungs, mycobacterium affects the lymph nodes near the large bronchi. On an x-ray they appear as light-colored formations.

Photo 5. View of a sample of miliary pulmonary tuberculosis on a microslide when examined under a microscope.

Such changes indicate compaction and enlargement of the intrathoracic lymph nodes. Bacteria from them are carried through the bloodstream to organs. The immune system fights infection. With high immunity, bacterial activity stops and self-healing is possible. The development of the disease depends on the degree of weakening of the body.

Miliary tuberculosis is translated from Latin as “millet.” With this type of disease, small lesions, like millet grains, are located throughout all lobes of the lungs. This form of tuberculosis occurs in people with weak immunity- children, elderly and HIV-positive people. They have common generalized forms of tuberculosis, when several organs are affected and nervous system.

With profound immune deficiency (HIV), the clinical picture and subtype of the disease are unusual. Tuberculosis foci are located in the lower lobes of the lung, and not in the upper ones, as during primary infection. There are no clear boundaries of tuberculosis foci. The structure of the forms of the disease is dominated by widespread disseminated processes and tuberculosis of the intrathoracic lymph nodes.

There are two phases of tuberculosis:

• sensitive to anti-tuberculosis drugs;
• chemoresistant or drug-resistant.

Anti-tuberculosis drugs are divided into two groups: 1st and 2nd line. 1st line drugs are used to treat sensitive tuberculosis. 1st line antibiotics:

• rifampicin;
• isoniazid;
• ethambutol;
• pyrazinamide;
• streptomycin.

Second-line drugs include capreomycin, levofloxacin, PAS, and prothionamide. Treatment should not be interrupted, as this leads to the development of a resistant form of tuberculosis.

Treatment of the disease is a long process, lasting from six months to two years. The patient takes medications according to a strict regimen, from four to eight anti-tuberculosis drugs per day. Medicines are taken under the supervision of a medical or social worker. The treatment does not end even if the patient does not excrete bacteria and his health has improved.

Photo 9. Drug treatment shows itself as effective method in the fight against tuberculosis diseases.

A course of treatment

The main course of treatment consists of two stages

1. Intensive.
2. Supportive.

During the intensive treatment phase, the patient uses four to eight medications. The goal is to destroy the developing bacterium. With the correct classification of tuberculosis and an adequate approach to treatment, at the end of the intensive phase, bacterial excretion stops. This does not mean that the patient is healthy. If you stop taking medications at this stage, the disease may return in severe form.

It is important to continue taking the medications during the maintenance phase as prescribed by your doctor. This stage is longer and more intense. The goal is to destroy slow-growing tuberculosis bacteria.

The duration of treatment for sensitive tuberculosis in this phase is from four to six months, for chemoresistant tuberculosis - up to one year. The number of drugs in the second phase is less. The main goal is to consolidate the effect of treatment and prevent relapse.

Treatment prognosis depending on stage

Interruption of treatment risks the development of a resistant form of tuberculosis. In the chemoresistant form, the mycobacterium becomes insensitive to the action of the main anti-tuberculosis antibiotics. As a result, the doctor is forced to prescribe second-line drugs. Such drugs are more expensive, not as effective and more likely to cause adverse reactions. The duration of treatment increases.

If the full course of treatment for sensitive tuberculosis is six to nine months, then for chemoresistant tuberculosis it is two to three years. At the same time achieve positive result more difficult.

The main principle of treatment is control of medication intake, which is carried out by a medical or social worker for full course treatment. To remove disability, patients are provided with free Spa treatment.

Photo 10. In a sanatorium, anti-tuberculosis therapy will take place as quickly and comfortably as possible for the patient.

Anti-tuberculosis antibiotics also cause adverse reactions, like other medicines. Most of them are not severe and do not require discontinuation of the drug. Severe adverse reactions occur rarely.

Side effects disappear after treatment adjustment. The doctor decides to stop the drug, reduce the dose, adjust the dosage regimen, or prescribe additional medications to eliminate adverse reactions. It is unacceptable to discontinue the drug without consulting a doctor.

Patients should understand that treatment for tuberculosis is long and complex and is carried out under the constant supervision of medical staff. Anti-tuberculosis drugs cause side effects that should be reported to your doctor. Failure to comply with the treatment regimen leads to the development stable forms tuberculosis. Remember the main thing - the disease is curable!

• What is tuberculosis
• Other classification
• Causes and symptoms
• Treatment of the disease

Tuberculosis is an infectious disease caused by the microorganisms tuberculosis bacillus. Highlight various stages tuberculosis. There are two large subtypes of the disease: and the extrapulmonary type (affecting the genitourinary system, bones, skin, and so on). A special form of the disease is tuberculosis intoxication, when the source of the disease cannot be identified.

Previously, experts identified two stages of the disease:

1. Primary stage (immediate course of the disease).
2. Reinfectious degree (repeated disease or relapse of previously untreated tuberculosis).

But since the mid-20th century, doctors have agreed that there are three stages of tuberculosis. But there is no unity about what these stages are. Some highlight:

1. Primary type.
2. After the primary type of disease.
3. Stage of pleurisy.

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Other classification

Another classification suggests distinguishing the following stages of tuberculosis:

1. Primary tuberculosis infection (inflammation at the site of infection).
2. Latent infection(spread of infection throughout the body).
3. Recurrent type (inflammation of various organs that were infected after the infection entered the human body).

In general, the disease progresses the same in any case, regardless of the location. Most often, doctors encounter lung diseases. They, in turn, can be open or closed. The open form is highly contagious; infection from the lungs causes pneumonia and can be transmitted through the airways by airborne droplets. In addition, this phase of tuberculosis is characterized by increased symptoms of the disease and rapid spread of infection to other organs.

But the lungs are the most common. This phase is characterized by a complete absence of symptoms; determining the disease through sputum tests or x-rays is not possible; the only indicator of the disease is the Mantoux test; microorganisms are not active, do not multiply and can remain in the body for the rest of their lives without causing any discomfort.

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Causes and symptoms

Experts call the causes of the disease not only infection, although this is undoubtedly the main factor, but also:

• low social standard of living;
• maintaining an unhealthy lifestyle;
• stress;
• decreased immunity;
• presence of concomitant diseases.

Symptoms of pulmonary tuberculosis, as a rule, are the same for all stages and forms, except, perhaps, primary and closed tuberculosis when the infection does not manifest itself. Symptoms include:

• long cough;
• temperature increase;
• decreased performance;
• increased fatigue;
• changes in appetite;
• nausea;
• general malaise;
• joint pain;
• increased sweating;
• the appearance of brown subcutaneous nodules.

There are various degrees of pulmonary tuberculosis, the main ones are:

• pleural disease;
• tracheal problems;
• fibrous-cavernous tuberculosis of organs;
• cirrhotic (destruction of the lung);
• caseous pneumonia (with necrosis of lung tissue);
• cavernous appearance (appearance of cavities in the lung tissue);
• organ tuberculoma (tumor formation);
• acute miliary (breakthrough of infection into the blood and the appearance of new foci of infection in the lung);
• enfiltrative-pneumonic disease of organs;
• focal appearance of the lungs;
• hematogenous disseminated type of lungs (symmetrical lesion).

Tuberculosis develops against the background of infection with mycobacteria and is considered one of the most dangerous infectious diseases. Despite the availability of successful treatment regimens, the issues of combating the prevalence of tuberculosis remain open. And this is explained by the fact that the pathological rod is capable of mutating. Bacteria, causing disease, successfully adapt to medicines and unfamiliar conditions. Therefore, the disease itself can both progress and take on new forms. To pick up correct treatment, you need to thoroughly study the features of a particular case, taking into account the types of tuberculosis.

Type of tuberculosis

The mycobacterium is transmitted by airborne droplets, contact or intrauterine contact. Infection cannot be ruled out even through food or from sick animals. Only strong immunity or properly administered vaccination can partially protect a person from the activation of bacteria that have entered the body.

The primary classification of tuberculosis is based on the ease of transmission of infection. Infection with mycobacteria can occur more than once. And a person who has had tuberculosis is not protected from secondary infections.

Therefore in medical classification primary and secondary tuberculosis are distinguished:

1. Primary pulmonary tuberculosis is diagnosed in patients who do not have a specific immune defense, with the development of tissue infiltration in the lungs against the background of damage by pathogenic bacteria. More common in children and adolescents.

With primary tuberculosis the following may develop:

• PTC – primary tuberculosis complex;
• VGLU – tuberculosis of intrathoracic lymph nodes;
• current chronic tuberculosis.

2. Secondary pulmonary tuberculosis is diagnosed in patients with repeated contact with MBT. Reactivation possible primary focus inflammation in the lung. With this type of disease, they often develop dangerous complications, which poses a threat to the patient’s life.

Typically, with a secondary lesion, the following is diagnosed:

• focal form;
• cirrhotic pulmonary tuberculosis;
• fibrous-caverous form;
• tuberculoma.

In this case, foci of inflammation can concentrate both in the tissues of the lungs and spread to other organs.

The degree of danger of tuberculosis for others

The disease is initially considered contagious. But not all stages of pulmonary tuberculosis pose a danger to others. Mycobacteria can be in closed capsules, not excreted with sputum, or they can break out from limited foci, infecting everything around.

It is on these features that the classification of tuberculosis according to the degree of infectiousness is based:

1. The closed form during diagnosis is designated as MBT-, which means the absence of mycobacteria in the sputum. With this form of the disease, the bacilli are not released into the air. This means that the patient cannot infect the people around him. However, the lack specific symptoms does not allow recognizing the disease without specific diagnosis, which causes late visits to doctors and false diagnoses. Precious time is wasted, and in the meantime the disease progresses and moves into more dangerous and contagious stages.
2. The open form is diagnosed as MBT+. If bacteria are detected in the sputum, the patient becomes dangerous to loved ones. Therefore, patients with the open form are often isolated for anti-tuberculosis measures in special medical institutions. In this form of the disease, bacilli are released into the environment with sputum. The patient may be bothered by hemoptysis or cough with pus.
3. The periodic or mixed form occurs when periods of release of pathogenic bacilli from sputum alternate with temporary relief of the active phase.

Conclusion: patients with open or mixed forms of tuberculosis pose a danger.

Rate of disease development

The disease without specific treatment is prone to gradual progression. Therefore, the main classification of tuberculosis reflects the stage of development. There are 4 main phases of disease development.

initial stage

The invasion of a pathogenic infection into the lungs occurs unnoticed by humans. His general well-being does not cause concern either. Even doctors often miss the initial stage of tuberculosis due to the absence of complaints and alarming signs.

The location of mycobacteria after infection is the lungs. Later, the microbes can spread, affecting minor areas of the lymph nodes. At the same time, the form remains closed and the patient does not pose a threat to others.

The main thing is that with a strong immune system, the body is able to cope with the infection on its own at this stage. In such cases, the person does not even know that he has suffered the primary stage of tuberculosis. And when repeated infections or relapses is already encountered secondary forms diseases.

Second stage

At the second stage of tuberculosis, which has a latent form, specific signs of lung problems arise. The patient experiences increased coughing, excessive fatigue, and breathing problems. But such symptoms do not give a specific clinical picture, and treatment for a respiratory disease often begins.

The disease is detected after tuberculin tests. To confirm it, it is necessary to conduct a fluorographic examination, which will show changes in the structure of the lungs. Sputum examination does not give results, since the disease occurs in a closed form.

With timely treatment, the prognosis is favorable. Since there is a real opportunity completely. However, with a weakened immune system, the presence of concomitant chronic diseases, bad habits, and an asocial lifestyle of the patient, the situation worsens, and the disease moves into the next, already active phase.

Third active phase

Tuberculosis in the decay stage takes on an open form. That is, bacteria become aggressive and begin to attack lung and other tissues. The infection breaks out from limited foci and spreads through the blood and lymph flow, affecting both new parts of the lungs and bones, organs, and brain.

In the pulmonary form, the symptoms are especially striking.

The collapse of the lungs in tuberculosis can manifest itself:

• discharge of sputum mixed with blood and pus;
• increased night sweats;
• persistent cough;
• elevated temperature.

Even at this stage, when the lungs are disintegrating, the disease can be stopped, although this is problematic. Persistent and long-term treatment with the use of properly selected anti-tuberculosis drugs allows you to stop the process. In some cases it is required surgical intervention, during which part of the affected lung is removed.

Fourth stage

The last stage of tuberculosis is distinguished by some doctors as a stage of attenuation inflammatory process in the lungs. At this stage, tissue resorption or scarring occurs. But this does not mean that the disease passed without a trace. Lung tissue is replaced by scar tissue, and the organ cannot function at full capacity. The disease becomes disseminated. Against the background of tuberculosis sepsis, the infection penetrates into the most unexpected parts of the body. Symptoms of failure of organs affected by bacteria come to the fore.

Types of tuberculosis

There is also clinical classification tuberculosis, which takes into account morphological, clinical and radiological signs diseases. It is problematic to consider absolutely all types of pulmonary tuberculosis. But it’s worth focusing on the most common ones.

Primary tuberculosis complex

Refers to a primary lesion with a predominant location in the lungs. Gives signs of inflammation in the lungs or regional bronchitis. But more often it is hidden under the symptoms of colds or is completely asymptomatic.

It is detected through mass tuberculin testing of children and annual preventive fluorographic studies in adults.

There is a subacute manifestation with a dry cough, a slight increase in temperature, the appearance of weakness and sweating.

The acute phase gives signs nonspecific pneumonia with high fever, chest pain, severe cough and shortness of breath.

The prognosis for PTC is most often favorable. After treatment, Gon lesions with calcified areas form in the lungs or complete resolution of inflammation.

If the course is unfavorable, cavities form, tuberculous aleuritis and caseous pneumonia develop. In the most severe cases complications are manifested by miliary tuberculosis with damage to the entire lung tissue or dissemination with the spread of infection to the bones, kidneys, and brain.

Damage to the intrathoracic lymph nodes

The development of this type of disease occurs against the background of enlarged lymph nodes. Usually the cough in this case is dry, whooping cough-like or bitonic in nature. Are increasing The lymph nodes in the neck, armpits.

The patient has:

• loss of appetite, which leads to weight loss;
• pale skin;
• there are dark circles under the eyes;
• A venous network appears on the skin in the chest area.

• pulmonary atelactasis of lobar or segmental type;
• chronic pneumonia;
• bronchial tuberculosis;
• exudative pleurisy.

If tuberculous masses rupture the lymph nodes, pulmonary lesions may develop.

Focal form

This type of tuberculosis is diagnosed with secondary or recurrent lesions.

Does not give a clear clinical picture:

• the occurrence of tuberculosis cough is rare;
• sputum production is quite scanty;
• possible pain in the side;
• hemoptysis is rarely observed.

Signs of general intoxication predominate with a slight increase in temperature, malaise, and decreased performance.

There are groups of fresh and chronic tuberculosis, which depends on the time that has passed since the relapse. Degeneration into more dangerous destructive forms is possible: disseminated, cavernous or cirrhotic pulmonary tuberculosis.

Infiltrative type of tuberculosis

The manifestation of this type of disease will directly depend on the extent of damage to the lung tissue. Therefore, there are both mildly clinically expressed cases and subacute, acute conditions.

In the acute type, the patient is in a feverish state, accompanied by chills, weakness, and night sweats. In this case, the cough is hysterical with the release of sputum with blood. If in pathological process the pleura is involved, tenderness occurs on the affected side, as well as pleural effusion.

The disease can be complicated by atelectasis, pneumonia, and bleeding.

Disseminated species

1. In the typhoid form, symptoms of intoxication predominate, relegating pulmonary symptoms to the background. Begins with a significant increase in temperature, followed by a strong headache, tachycardia, significant weakness and symptoms digestive disorder. Against the background of increasing poisoning, consciousness changes, up to the occurrence of hallucinations and delirium.
2. The pulmonary form is characterized by respiratory disorders with dry cough, cyanosis, shortness of breath. In complicated cases, heart failure occurs.
3. The meningeal form manifests itself with signs of brain failure.

In the subacute course, performance decreases due to loss of appetite, weight loss, and weakness. The temperature rises periodically, and the cough is not a serious concern. Bleeding may occur.

The chronic form in remission is asymptomatic. Relapses produce symptoms similar to those of the subacute form.

Complications include extrapulmonary forms, bleeding, and spontaneous pneumothorax.

Tuberculoma

It is the final phase of development of many forms of tuberculosis, including focal, infiltrative, disseminated. The lesions become encapsulated with the formation of caseous cavities.

The chronic course does not give signs of tuberculosis and is most often diagnosed during random examinations. Progression is manifested by an increase in temperature, signs of poisoning, and sputum discharge during coughing.

The decay phase gives impetus to the development of caverous tuberculosis. There are cases of improvement in the patient's condition.

Cavernous appearance

The disease progresses in waves. Around the cavities, the tissue often degenerates into fibrous tissue. With a long course, periodic relapses are observed, accompanied by infectious signs. Often during an attack there is severe respiratory failure.

During the decay phase, symptoms increase with an increase in sputum volume and the addition of hemoptysis.

Against the background of destruction of lung tissue, pulmonary hemorrhage, fistulas, and pleurisy may occur. The prognosis is not favorable if endocrine changes, heart failure, meningitis, and kidney problems occur.

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Video - types of tuberculosis

Cirrhotic appearance

Cirrhotic pulmonary tuberculosis develops with fibrous and sclerotic changes in tissue.

This diagnosis is characterized by:

• bronchial deformation;
• reduction of bronchi;
• thickening of the pleura.

• pulling pain in the sternum;
• discharge of purulent sputum;
• hemoptysis;
• severe shortness of breath.
• External changes are also observed. Rib cage looks flattened, the intercostal spaces are retracted and narrowed.

Cirrhotic pulmonary tuberculosis is irreversible and can provoke the development of cor pulmonale.

Separately, it is worth mentioning extrapulmonary forms of tuberculosis, which are a complication of pulmonary damage. Direct infection of bone and soft tissues is less common.

Any form, type and stage of tuberculosis poses a threat to human life. Therefore, it cannot be said that a certain type of disease is less dangerous. Specific treatment necessary in any case. And the sooner it is started, the greater the patient’s chances of not encountering complications.

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