Tuberculosis is a widespread bacterial etiology infectious disease in the world that affects various organs: the skin, kidneys, eyes, intestines. Most often, with tuberculosis affects the lungs. About 3 million people in the world die every year from this disease, and about the same number get sick again.
There is a perception that there is an infection in about a third of the world's population. The number of people who have this disease does not decrease, but due to population growth, on the contrary, continues to increase. In 2007, the number of people with chronic active tuberculosis was 13.7 million. At the same time, 1.8 million deaths were reported. That is, the risk of dying from the disease is. It is worth noting that we are talking mainly about developing countries.
The spread of the disease is not uniform throughout the world. According to WHO statistics, approximately 80 percent of the population of Asian and African countries are infected with tuberculosis. In the US, only 5-10 percent of the population has this disease. In Russia, the incidence of tuberculosis in the period from 2008 to 2018 was reduced by 43 percent.
The causative agent and the mechanism of development
The causative agent of tuberculosis is acid-resistant mycobacteria (Koch's bacillus), which spread in water, soil, among people and animals. Today, there are 74 species of these bacteria.
The main route of entry into the body Koch sticks - airborne. But infection can occur when eating foods, and through contact with objects with which a person has been in contact with tuberculosis.
The greatest chance of contracting TB is where there is a large number of people. Penetrating into the human body, the tubercle bacillus enters the cells of the immune system. In certain cases, the Koch wand can spread throughout the body.
It should be understood that an infection can affect absolutely all organs and tissues of the human body, except for nails and hair. For this reason, the development of extrapulmonary tuberculosis is possible. Pulmonary tuberculosis is most common, but the disease can also affect the bones, liver, kidneys, larynx, and even the eyes.
The classification of tuberculosis occurs according to clinical forms, according to the characteristics of the process, according to residual effects after treatment. Types and forms are grouped according to various principles.
Infiltrative tuberculosis means the presence of inflammatory changes in the lungs. The manifestations of this disease depend on the prevalence and type of changes in the lungs. In most cases, infiltrative tuberculosis is recognized during X-ray examination. Basically, the disease proceeds in the guise of other diseases. These include pneumonia, flu, bronchitis. One of the symptoms of tuberculosis is hemoptysis (in the general normal condition of the patient).
Disseminated tuberculosis is characterized by the presence of multiple foci in the lungs. At the same time, the patient has a general malaise, hyperthermia, shortness of breath, moist cough and hemoptysis. Characteristic changes in radiographs can be suspected.
This is a disease that proceeds with the formation of tuberculous tubercles in the lungs or other organs. In patients with miliary tuberculosis is observed in acute and chronic forms. The acute form is a serious illness of the whole organism. In chronic form, periods of exacerbations and "calm" occur.
Tuberculous pleurisy is an inflammation of the pleura, which occurs against the background of pulmonary tuberculosis and other organs. This disease has three forms: acute, subacute and chronic.
In newly diagnosed patients with tuberculosis of the respiratory system, tuberculous pleurisy is diagnosed in 3-6 percent of cases. The diagnosis of pleurisy is given to 2-3 percent of patients. Most often, the disease is detected in children, adolescents and young people.
Cavernous pulmonary tuberculosis is the stage of development of pulmonary tuberculosis, which proceeds with the formation of a thin-walled cavity - the cavern. Subject to this mainly adults. In children, cavern education is much less common. Cavernous tuberculosis develops around the third or fourth month of ineffective treatment of tuberculosis. Symptoms of the disease is a wet cough and hemoptysis.
Fibrous-cavernous tuberculosis occurs as a result of the development of one form of pulmonary tuberculosis. If the cavern is not prone to scarring, then connective tissue grows around the cavern. Because of this, deformation of the thin-walled cavity occurs, the cavity is aging and the fibrous-cavernous stage of tuberculosis develops. In general, the process takes 1.5-3 years. Patients suffering from fibro-cavernous tuberculosis, complain of poor health and weakness in the body, moist cough and shortness of breath. The health of the patients is generally satisfactory. Body temperature before treatment is usually elevated. The disease is accompanied by weight loss, sweating and pallor of the skin.
In patients with cirrhotic pulmonary tuberculosis, gross cicatricial changes are observed in the lung parenchyma and pleura, which are combined with minimal inflammation activity.
The disease develops after other forms of tuberculosis. This species is quite rare. For cirrhotic tuberculosis to form, a long period of the course of untreated inflammation is necessary. It is important to understand that in the present cases of this form of the disease, death is possible. The severity of manifestations of cirrhotic tuberculosis depends on the extent and localization of changes in the lungs. Symptomatology in general, less pronounced. Outside the exacerbation, slight shortness of breath and occasional dry cough may occur.
Focal pulmonary tuberculosis is a specific tuberculous lesion, which is characterized by the presence of small foci of inflammation in the lungs. Focal tuberculosis is often a secondary tuberculosis infection, and occurs several years after the cure of the primary disease. For this reason, most patients are just adults. Distinctive features of this lung disease are latency, limited area of damage, non-destructive nature of inflammation.
In addition, there is no symptoms in this disease, so the disease can be identified mainly through prophylactic fluorography. Symptoms of the disease are fever, fever, decreased appetite, sleep disturbance, sweating. In some cases, there are signs of hyperthyroidism: the thyroid gland increases, tachycardia, irritability appears. Women may experience a change in the menstrual cycle.
Chronic tuberculosis is observed in patients with a long course of the disease in the case when a comprehensive treatment does not give the expected results. When this disease in the human lungs pockets of infection occur. Patients are worried about cough with sputum, low-grade fever, night sweats, weakness. The danger of the disease lies in the fact that damage occurs and other organs of the person. Anemia develops, skin manifestations are possible, inflammation in the urinary system.
Extrapulmonary tuberculosis is most often a secondary disease that occurs due to tuberculous infection of the lungs. Extrapulmonary tuberculosis affects a variety of organs: the intestines, the central nervous system, the meninges, the lymph nodes, the bones, the joints, the urogenital system, the skin and the eyes.
Tuberculosis of the central nervous system begins slowly, the symptoms increase gradually. In humans, there is a periodic headache, weakness in the body, apathy, drowsiness, and decreased appetite. All this is observed several months before the main symptoms of the disease. For the disease itself is characterized by severe headache, which is aggravated by noise, bright light. It is also accompanied by vomiting and mental disorders. Possible inhibition or agitation.
Pupillary dilation, strabismus, asymmetry of the face, altered speech and deterioration of visual acuity are noted. There may be a violation of swallowing, gagging, hearing loss.
Infection of the gastrointestinal tract and abdominal organs
The development of tuberculosis of the gastrointestinal tract contribute to various chronic diseases, as well as reduced immunity. Patients have weakness, fatigue, sweating, fever. In addition, severe abdominal pain, bloating, constipation, or diarrhea are noted. Complications may be intestinal obstruction, peritonitis and internal bleeding.
The hip and knee joints, as well as the spine are most commonly affected. If the inflammatory process in tuberculosis has not gone beyond the bones, then the person may feel slight pain in the affected areas. If the disease spreads to the joints and tissues nearby, then the pain increases, mobility is limited, and even the interested joint or spine is deformed.
Inflammation of the urinary organs
Tuberculosis of the urinary organs is the most common extrapulmonary lesion. These include: damage to the kidneys, urinary tract (ureter, bladder, urethra), male (prostate, testicles) and female (ovaries, endometrium) genital organs.
Eye tuberculosis is one of the most severe forms of extrapulmonary tuberculosis. This disease is found in about 10 percent of the cases of extrapulmonary forms diagnosed. Most often, the tuberculous process is localized in the vascular system of the eye. A complication can be a cataract or glaucoma. Also, Koch's wand can affect the skin, lymph nodes, spleen, and heart muscle. But all these cases are extremely rare.
The main symptoms are:
- prolonged cough with sputum;
- increased sweating;
- noticeable weight loss;
- unreasonable fatigue and weakness;
- decrease or lack of appetite;
- degradation of performance
In addition, pain in the chest and upper extremities is felt, the body temperature rises, and hard breathing appears. It is important to understand that the symptoms of tuberculosis are very similar to other clinical manifestations of diseases involving lung disease. Therefore, only an expert can deliver an accurate and correct diagnosis. Also, the symptoms depend on the area of the lesion. If it is gastrointestinal tuberculosis, then the patient will be disturbed by abdominal pain, nausea, digestion will be disturbed.
When it comes to the central nervous system, headaches, dizziness and other similar and unpleasant symptoms will mostly bother you.
Stages and types of flow
Tuberculosis is characterized by certain stages and periods of the infectious process.
From the time the Koch wand entered the human body, and until the first symptoms of the disease appeared in a person, a certain period of time elapses, which is called incubation. This period can be from 7 to 12 weeks, in some cases up to several years.
During the incubation period, all mycobacteria that hit the respiratory system are attacked by the immune system. If the immunity copes with its functions, then all the bacteria die. If the immune system fails, then the mycobacterium causes an inflammatory process in the lungs. At the same time, the first symptoms of the disease will appear. It is worth noting that all this time a person is not infectious and dangerous to other people. And even the Mantoux test does not show the presence of the disease, which complicates the situation at an early stage.
Latent and active
Latent tuberculosis is a latent form of the disease in which an infected person has no symptoms, and the tuberculin test gives a positive result. At the same time, radiography does not reveal pathologies, and the person is not contagious to the people around them.
In the active form, the patient feels general malaise, he has almost all the symptoms of tuberculosis. Specific tests are positive, and people are contagious to others.
Closed and open
Tuberculosis is an infectious disease, but patients can be both infectious and non-infectious. At the same time, the status of the patient may vary depending on the stage of development of the disease and the effectiveness of the prescribed treatment. With the open form of tuberculosis, the patient releases into the environment the causative agent of the disease. This mainly concerns pulmonary tuberculosis, since the secretion of these microbes occurs during coughing and expectoration. With the closed form of tuberculosis, mycobacterium is not excreted from the patient.
The outcome of tuberculosis can be recovery with adequate timely treatment or progression of the disease with the development of a fatal outcome. It is obvious that tuberculosis is a dangerous disease, and even more so at the last stage of development. In the absence of proper treatment, responsibility on the part of the patient and attention from the doctors, all this can result in dangerous and undesirable consequences.
For the diagnosis of tuberculosis, allergy tests are conducted with tuberculin, sputum examination for mycobacteria by PCR, blood and urine tests for general analysis, x-ray examination of the lungs, if necessary, CT scan of the lungs.
Recently, to confirm the diagnosis, blood has been examined for T-SPOT, the definition of lymphocytes sensitized to Mycobacterium tuberculosis.
Mantoux test is the main method of examination of children for the presence of tuberculosis. The test is a skin test that detects the presence of a specific immune response to the introduction of tuberculin. According to the Mantoux reaction, it is possible to determine if there is a tuberculous infection in the body. With this test, you can determine in advance the presence of the disease.
T-SPOT is an immunological method for determining disease. Diagnosis takes about 3-4 days. Human blood is required for the test. The method of determining infection is very sensitive and informative. With it, you can eliminate false reactions to the presence of mycobacterium tuberculosis when most tests are mistaken or not entirely accurate.
Recently, PCR (polymerase chain reaction) has been used for diagnosis. This test has a high sensitivity, which allows revealing cells and DNA fragments in the test material.
PCR allows you to identify various forms of tuberculosis, especially in young children, even with negative results of microbiological studies.
Radiography of organs for tuberculosis is a study that is included in the mandatory diagnostic standards. This method is assigned in order to establish or, conversely, refute the fact of the disease. Also, it can be used to determine the nature of the lesion of the lungs.
Tuberculosis can be cured.The treatment consists in the constant and long-term use of medicines prescribed by the doctor. A long time is necessary in order to completely kill all mycobacteria in the tissues of the human body. At the same time, the patient must maintain a healthy lifestyle, adhere to a therapeutic regimen and eat right. Mycobacteria are very tenacious, therefore, if the dose of drugs is reduced, then the bacteria become more resistant to drugs. All this makes further treatment more difficult.
How to protect
Disease prevention consists of several components. It is imperative to protect yourself and abide by preventive measures in places where tuberculosis is possible. It is necessary to carry out a whole range of measures aimed at preventing the transmission of infection from a sick person to a healthy one.
Specific prevention is an infection control method whose goal is to create immunity against it. This includes compulsory vaccination of the population. Specific prevention is one of the most effective methods of tuberculosis control.
Non-specific prophylaxis includes drugs that increase the body's defenses.
Tuberculosis is a dangerous and serious disease, which at the very beginning is hidden. Often, the sick person thinks that he just got a cold and was tired. Therefore, it turns to the doctor after the appearance of more serious symptoms, when complex and long-term treatment is necessary.
Most people, having heard the diagnosis of "tuberculosis" practically put an end to their lives. But in fact, everything is not so bad.
Naturally, without the necessary treatment, a patient with tuberculosis can live no more than six months. But if you take a responsible approach to this issue and engage in treatment, then over time you can completely forget about this problem, and the life expectancy will depend on the lifestyle of the person. Of course, this can take a lot of time - from several months to two years. This period depends on the form of the disease and its neglect.
What is contraindicated in patients
Of course, in the fight against tuberculosis it is necessary to save forces and direct them to the main task - the victory over the disease. Patients can and should walk more, walk, do exercises, and exercise therapy. At the same time, they are strictly forbidden to smoke, follow strict diets, starve.
It is enough to follow simple rules to help the body in the fight against the disease.
For a long time it was believed that the sun and its rays have healing effects. But this is far from the case. There are diseases in which it is impossible to stay under the sun for a long time and to sunbathe, since it adversely affects the human body. These diseases include tuberculosis.
Tuberculosis is a serious disease, but with timely diagnosis and adequate therapy, it is treatable.
Specialty: infectious diseases specialist, gastroenterologist, pulmonologist.
Total experience: 35 years.
Education: 1975-1982, 1MMI, San gig, high qualification, infectious diseases doctor.
Science degree: doctor of the highest category, PhD.
- Infectious diseases.
- Parasitic diseases.
- Emergency conditions.