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March 8, 2012
Tuberculosis is an illness of infectious character which developing is provoked by tuberculosis mycobacteria. In development of a disease the cellular allergy, specific granulomas in a number of bodies and fabrics, and also a polymorphic clinical picture is shown.
Tuberculosis was known in the most ancient times. And at the moment its distribution is very serious problem from the medical and social point of view. Statistically, every year in the world about eight million people have tuberculosis, at the same time three million patients die. Incidence increased in recent years. Specialists state several reasons which led to a similar situation. This general decrease in a standard of living of people which negatively influences quality of food; deterioration and reduction of number of the actions directed to fight against tuberculosis; and also emergence of new strains which show high resistance to specific therapy.
Tuberculosis arises as a result of impact on a human body of a mycobacterium. According to the statistics, approximately in 92% of cases the illness is provoked by Mycobacterium tuberculosis bacterium, in other cases it arises under the influence of M. of bovis. Characteristic of the causative agent of tuberculosis is the stick form. This bacterium is an aerobic organism. The most optimum temperature for its existence — +38 °C. It well burgeons on Wednesdays which contain egg, potatoes, milk, glycerin. The causative agent of tuberculosis shows high resistance to action of various factors, he does not perish at influence of alcohols, acids, alkalis. However under direct solar and ultraviolet rays causative agents of tuberculosis perish already in a few minutes. At a temperature of 70 °C the death occurs in 30 minutes, and in the course of boiling the activator perishes in five minutes. Also pernicious impact on it is made by a number of the means used for disinfection: 5% solution of formalin, 5% solution of carbolic acid, 2% solution of chloric lime.
Symptoms of tuberculosis are shown equally often at people of different age, both at newborns, and at elderly patients. Sick people, and also meat and milk from animals who are suffering from tuberculosis become the main sources of distribution of an infection, as a rule. Most often tuberculosis is transmitted in the airborne way. In more exceptional cases the alimentary way of transfer is possible. There is also a possibility of infection with a transplacental way when the infection is transmitted to a fruit from the pregnant woman. As the factors promoting a transmission of infection it is necessary to call long contact with the carrier of bacteria, existence in unsatisfactory social conditions, bad food, failures in functioning of immune system. Contageousness is not high and directly depends on in what state protective forces of an organism stay. For distribution of tuberculosis seasonality and frequency does not matter.
Most often certain groups of the population risk to catch tuberculosis. First of all carriers of HIV infection and the people having other illnesses weakening immunity of the person can ache with tuberculosis. Also high risk of infection at those who closely contact to TB patients, at the people who are not passing in time medical examination at addicts, alcoholics, people without permanent residence. The citizens who visited the countries where high concentration of cases of this illness in an active form takes place have a risk of infection also.
In spite of the fact that it is not accepted to carry tuberculosis to high-contagious diseases, to fifty percent of people who have close contact with bakteriovydelitel, catch an infection. However infection with tuberculosis does not mean yet that the disease will develop. The manifest form of tuberculosis is shown only in 5-15% of cases, in other cases of infection people have a forming of an immunitas non sterilisans.
Most often the source of an infection does not manage to be defined. One more feature of tuberculosis at children: the infected child is younger, the risk of development of tuberculosis is higher.
Development of tuberculosis
The pulmonary tuberculosis and extra pulmonary tuberculosis develops in three stages. First of all there is an infection of the person, further in a certain body primary center of an illness then the illness progresses develops, and the person has new symptoms of tuberculosis.
After infection the activator gradually gets in lymphatic and blood vessels and extends on all human body. In four-eight weeks after infection at the person positive tuberkulinovy tests are already observed.
The main feature of a tuberculosis infection is the possibility of preservation of a disease-producing factor, capable to life, in primary center. In a viable state it can stay many years, and in certain cases — and until the end of human life. In turn, after essential decrease in immunity owing to a number of diseases the centers can pass into an active stage, and at the person symptoms of tuberculosis are shown.
Manifestations of symptoms of tuberculosis directly depend on that, where exactly mycobacteria are implemented into an organism whether take place of complication, and also from other factors. Tuberculosis develops rather slowly, the illness can sometimes last even decades.
Symptoms of tuberculosis are not shown at people at whom the latent tuberculosis developed. Therefore, they do not extend an illness. At patients with an active form of tuberculosis symptoms depend on that, the infection – in lungs or in other parts of a body develops where exactly. The pulmonary tuberculosis is shown at the person gradually and can develop for several weeks and even months. In this case the person can notice emergence of several symptoms of an illness, but at the same time even not guess its development. At this form of tuberculosis one of the main symptoms of an illness is cough at which dense slime, sometimes with blood impurity is expectorated. Such cough proceeds more than two weeks. Besides, symptoms of a pulmonary tuberculosis are the fever and heat in the evenings, fever. The person constantly feels weakened and tired, he loses appetite, respectively, body weight quickly decreases. Besides, the patient is disturbed by severe short wind and pain in a breast.
Tuberculosis at children and teenagers is most often shown in primary form and develops after infection with organism tuberculosis bacteria, so not infected. Most often tuberculosis of intrathoracic lymph nodes occurs among forms of primary tuberculosis. In development of tuberculosis most often there is a damage of lungs of the patient. At the same time extra pulmonary forms of an illness are shown as a result of hematogenous dissimination of an infection of tuberculosis from primary center. In this case at the patient take place mainly organism intoxication symptoms, and signs of inflammatory process of local character are expressed considerably to a lesser extent.
At the same time, than the age of the child, especially high risk of emergence of severe local and generalized forms of a disease is less.
The following forms of tuberculosis at children and adults are most often shown.
Tubercular intoxication. This form is most often shown at teenagers and children. As a rule, the illness arises at children of preschool age, and also at younger school students. Of a disease it is characteristic manifestations of irritability, fatigue, problems with appetite and a dream. In the course of survey the specialist pays attention to pale skin, weight reduction, a micropolyadenia. Sometimes at this form of an illness manifestation of a knotty erythema, inflammation of a conjunctiva and cornea, reactive arthritis, etc. is possible. At diagnosis in this case the most important is detection of a bend of tuberkulinovy tests. Development of an infection can continue for years, wavy. Sometimes perhaps independent treatment and forming of immunity.
Primary tubercular complex. Such form of tuberculosis prior to development of complications proceeds without symptoms. It can be found only in the course of inspection by means of a X-ray. However as complications of an illness development of pneumonia, etc. is possible. If courses of an illness favorably, then at the patient calcification of the caseous center in easy and lymph nodes is shown. If the current is complicated, then hematogenous dissimination, lymphogenous dissimination can develop, and also be formed a cavity.
Tubercular bronkhadenit. This form of an illness is called also tuberculosis of intrathoracic lymph nodes. It is the most often shown local form of primary tuberculosis at children. Owing to increase in lymph nodes the tree is squeezed to the trakheobronkhialena. If at the patient takes place expressed bronkhadenit, then the osiply voice, a pertussoid, existence of symptoms of acute or chronic intoxication will be displays of a disease. In development of an illness lymph nodes increase, the venous network under breast skin, etc. extends. To confirm the diagnosis, X-ray inspection and a bronkhoskopiya is necessary. As complication of this state passability of bronchial tubes can be broken, develop pleurisy, tuberculosis of bronchial tubes. If courses of an illness favorably, then at the patient calcification of lymph nodes is shown. If the current is complicated that hematogenous dissimination, lymphogenous dissimination can develop, and also to be formed a cavity.
The disseminated pulmonary tuberculosis. The illness arises as a result of extensive hematogenous distribution of an infection of tuberculosis. An onset of the illness, as a rule, is febrile fever then very quickly there are displays of intoxication. The person complains of dry cough and an asthma. Diagnosis of a pulmonary tuberculosis is carried out by a X-ray analysis method. At the same time research of a phlegm often of results does not bring in view of absence mycobacteria there. Also the diagnosis is confirmed by a transbronchial biopsy. Anemia, cardiopulmonary insufficiency, hematogenous eliminations in different bodies, etc. can become complications of this state.
Tuberculosis of uric and generative organs. Today this form of extra pulmonary tuberculosis is the most eurysynusic. This disease is also defined as tuberculosis of kidneys, these bodies in this case are surprised most often. Symptoms of tuberculosis of kidneys are similar to symptoms of a nonspecific inflammation of uric system. The diagnosis is established by research of bacteriological crops of urine, the modified tuberkulinovy tests, blood test and other researches of uric ways and kidneys. As complication of tuberculosis of kidneys the stricture of ureters, a cavernous nephrophthisis can develop. If treatment is carried out in time, the outcome of a disease will be favorable. In case of inadequate therapy development of a pyonephrosis is possible and, as a result, at tuberculosis of kidneys happens removals of a kidney.
Tuberculosis of bones and joints. Very often the tuberculosis of bones and joints affects children at early age. At tuberculosis of bones most often there is a defeat of average departments of a backbone. Owing to an erosion of a front surface of bodies of vertebrae they gradually fall down, and the expressed kyphosis without scoliosis as a result develops. At tuberculosis of bones of the patient complains of noticeable restriction of mobility, pain, hypostasis of departments of a backbone which were struck. If the tuberculosis of bones and joints progresses, then further pathological process passes to underlying departments of a backbone. Most often tuberculosis affects knee and coxofemoral joints. Feature of a tuberculosis of bones and joints is that manifestation of destruction of bone and cartilaginous fabrics is expressed later. Therefore, in the course of X-ray inspection of changes of a backbone and joints it is possible not to find. Therefore at diagnosis it is important to reveal primary center of an infection. Owing to this disease at the patient the hump, a contracture of the affected joint, and, as a result, an early invalidism is often formed.
Tubercular meningitis. Seldom found tuberculosis form which often arises at children at early age. Initially at the child the behavior begins to change, a number of symptoms of a febricula, subfebrile fever is shown. In development of an illness the child suffers from a photophobia, a headache, drowsiness, spasms. Later cranial nerves are surprised, the coma develops. As complications at tubercular meningitis the gipertenzionno-gidrotsefalny syndrome, wet brain is possible. If not to treat this disease, the lethal outcome comes inevitably.
Tuberculosis cutis. The disease arises as a result of penetration into skin of tubercular mycobacteria. The tuberculosis cutis is practically always shown as a secondary endogenous disease. As a rule, the activator gets into skin from the tuberculosis centers in the limfogematogenny way. Through injuries of skin the infection gets very seldom. The tuberculosis cutis can have the focal and disseminated forms. Diagnosis of a tuberculosis cutis is carried out by studying of the anamnesis, carrying out tuberkulinovy tests, allocation of tubercular mycobacteria and other researches which are appointed in an individual order. There are also kinds of tuberculosis striking other bodies.
Diagnosis of tuberculosis
Qualitatively to carry out diagnosis of active pulmonary tuberculosis, the specialist first of all studies a case history of the patient, conducts his physical examination. Diagnosis of tuberculosis assumes careful studying of symptoms – existence of cough, fever, fatigue, etc. Also researches of crops of a phlegm are carried out. In this case exact diagnosis of tuberculosis is carried out when studying results of such research. To choose the most effective drugs for treatment of tuberculosis, it is necessary to carry out the test on bacteria.
Besides, at suspicion on tuberculosis the X-ray of chest department is carried out. Such research is appointed if tuberkulinovy skin test positive, or is observed ambiguous reaction to such test and also if the patient has symptoms of active tuberculosis.
At suspicion on a latent pulmonary form of tuberculosis its existence is shown by tuberkulinovy skin test. Also diagnosis of tuberculosis in this case provides carrying out special blood test.
To establish the diagnosis at extra pulmonary tuberculosis, it is necessary to carry out a number of analyses and researches. Depending on a specific situation diagnosis of tuberculosis can include carrying out a biopsy, urine crops, research of cerebrospinal liquid, MRT, computer tomography.
Also in the course of diagnosis of a pulmonary tuberculosis and extra pulmonary forms very often appoint test for existence of HIV infection and the analysis for hepatitis.
A number of additional analyses is carried out already to time of treatment of tuberculosis.
Besides, carrying out regular inspections on existence of a disease is recommended to carry out for those categories of people which have an increased risk of infection with tuberculosis.
Early tuberculosis detection at children is based on research of level of a specific sensitization which develops as a result of infection with mycobacteria. Tuberkulinovy tests — intracutaneous tests Manta are for this purpose carried out. Standard solution of tuberculine is entered into an internal surface of a forearm. Several days later on dream where tuberculine was entered, the hyperemia with a papule in the center is shown. The Mantoux test is determined by papule size. Carrying out a Mantoux test is made to children aged from 1 year till 18 flyings annually. If a Mantoux test positive, the child needs to pass inspection at the phthisiatrician.
Treatment of tuberculosis
Treatment of tuberculosis is carried out by the tuberculotherapist together with doctors of other specialties. The main method of treatment of tuberculosis is the etiotropic chemotherapy today. When carrying out such therapy it is surely considered age of the patient, a disease form, activity of process. Very important at treatment of tuberculosis to pay attention to the correct diet, exercise stresses, way of life in general. Treatment of tuberculosis – process very long therefore demands patience. So, all stages of treatment of an illness can take about 18 months.
When carrying out chemotherapy, as a rule, appoint two and more drugs. There is a certain classification of drugs with antitubercular action: depending on efficiency of influence they are divided into three groups.
Drugs an isoniazid and rifampicin are considered as highly effective; Kanamycinum, streptomycin, biomycin, Etioniamidum, Ethambutolum, Pyrazinamidum, Prothionamidum – preparta of average efficiency; aminosalicylic acid – means with moderate efficiency.
At treatment the specialist considers that all means with antitubercular action have a number of side effects, therefore, it is necessary to accept them strictly on the appointed mode.
Operational methods of treatment are applied generally sick with bone and joint tuberculosis, and also the TB patient of kidneys. Besides, treatment of tuberculosis provides use of a number of actions which strengthen protective forces of an organism.
Prevention of tuberculosis
Prevention of tuberculosis provides, first of all, protection against infection with an active form of an illness. For this purpose the long time is undesirable to be in the close room with the people having active tuberculosis. The people who are in places of accumulation of patients as prevention of tuberculosis should carry protective face packs and to follow all rules of hygiene. It is impossible to allow transition of a latent form of a disease to active. Prevention of tuberculosis at children provides protection against infection. For this purpose examination of all who work in children's institutions has to be conducted regularly.
Prevention of tuberculosis at children provides obligatory carrying out vaccination of BTsZh, and also chemoprophylaxis of a disease.
Besides, for the purpose of prevention of tuberculosis mass examinations of the population by carrying out fluorography are conducted. Early identification of symptoms of tuberculosis allows to begin treatment at the initial stages and to make it the most effective.
It is not less important to take all measures for strengthening of immune system. In this case the healthy lifestyle, the healthy and regular nutrition, full refusal of smoking, drugs, abuses of alcoholic drinks is important.