Tuberculosis

The text is presented for informational purposes only. We urge you not to self-medicate. When the first symptoms appear, consult a doctor. Recommended reading: " Why not self-medicate?". Tuberculosis is the leading infectious cause of morbidity worldwide of bacterial etiology affecting various organs: skin, kidneys, eyes, intestines. Most often, tuberculosis affects the lungs. Every year, approximately 3 million people in the world die from this disease, and about the same number get sick again.

Epidemiology

About a quarter of the world's population is infected (based on tuberculin skin test results). Rates vary considerably by country of residence, age, race, gender, and socioeconomic status. WHO estimates that 10 million people worldwide fell ill with TB in 2019, including 5.6 million men, 3.2 million women and 1.2 million children.

In 2019, the 30 high-burden countries accounted for 87% of new TB cases. Two-thirds of cases were in eight countries, with India leading the way, followed by Indonesia, China, the Philippines, Pakistan, Nigeria, Bangladesh and South Africa. Globally, TB incidence is declining by about 2% per year, and between 2015 and 2020, the cumulative decline was 9%. This is less than half of the End TB Strategy target of 20% for 2015-2020.. One of the health targets of the Sustainable Development Goals (SDGs) is to end the TB epidemic by 2030.

Pathogen and mechanism of development

Tuberculosis is caused by acid-resistant mycobacteria (Koch's bacillus) that spread in water, soil, among humans and animals. To date, 74 species of these bacteria have been identified.

Tuberculosis is usually transmitted through airborne particles (teardrop nuclei) containing M. tuberculosis. They are transmitted primarily by coughing, singing and other respiratory movements by people who have active tuberculosis of the lungs or larynx and whose saliva contains a significant amount of the pathogen.

The greatest likelihood of contracting tuberculosis is where there are a large number of people. Infection occurs when bacteria manage to pass through protective barriers and penetrate deep into the lungs. If the upper respiratory tract is healthy and working properly, they manage to retain and remove most of the Koch rods and other dangerous bacteria with mucus. In theory, one stick is enough to infect people with weak immunity, but for more resistant organisms, repeated contact is still required.

The bacteria are then taken up by alveolar macrophages. Non-neutralized pathogens begin to reproduce, local inflammation occurs in the area of ​​​​infection penetration. Through the nearest lymph nodes, infected macrophages enter the bloodstream, penetrating into other organs. But if a person has at least partial immunity, spread through the bloodstream is unlikely.

It should be understood that the 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 the most common, but the disease can also affect the bones, liver, kidneys, larynx, and even the eyes.

About one quarter of the world's population is infected with tuberculosis. This means that people are infected with TB bacteria but are not (yet) sick and cannot transmit it.

People infected with TB bacteria have a 5-15% chance of developing TB during their lifetime. People with weakened immune systems, such as those with HIV infection, malnutrition or diabetes, and "long-term" smokers are at a much higher risk of developing the disease.

Classification of pulmonary tuberculosis

Classification of pulmonary tuberculosis is carried out according to clinical forms, according to the nature of the course of the process, according to residual effects after treatment.

Infiltrative

Infiltrative tuberculosis is characterized by 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 by X-ray examination. Basically, the disease occurs under the guise of other diseases. These include pneumonia, influenza, bronchitis. One of the symptoms of tuberculosis is hemoptysis (in the general normal condition of the patient).

Disseminated

Disseminated tuberculosis is characterized by the presence of multiple foci in the lungs. At the same time, the patient has general malaise, hyperthermia, shortness of breath, wet cough, and hemoptysis. To suspect the disease allow characteristic changes on radiographs.

Miliary

Miliary tuberculosis is a dangerous form of tuberculosis that occurs without a pronounced lymphogenous stage. Tuberculous tubercles can form in various organs. The spread of the pathogen is hematogenous, a disease with a potential fatal outcome, however, with timely treatment, it can be treated. The main danger of this pathology is that miliary tuberculosis is difficult to diagnose, the clinical picture of this disease is usually blurred.

Tuberculous pleurisy

Tuberculous pleurisy is an inflammation of the pleura that occurs against the background of tuberculosis of the lungs 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. Pleurisy is diagnosed in 2-3 percent of patients. Most often, this disease is detected in children, adolescents and young people.

Cavernous

Cavernous pulmonary tuberculosis is a stage in the development of pulmonary tuberculosis, which proceeds with the formation of a thin-walled cavity - a cavity. Mostly adults are affected by this. In children, the formation of cavities is much less common. Cavernous tuberculosis develops approximately in the third or fourth month of ineffective tuberculosis treatment. Symptoms of the disease are a wet cough and hemoptysis.

Fibrous-cavernous

Fibrous-cavernous tuberculosis results from the development of a form of pulmonary tuberculosis. If the cavity does not have a tendency to scarring, then connective tissue grows around the cavity. Because of this, the deformation of the thin-walled cavity occurs, the cavity ages and the fibrous-cavernous stage of tuberculosis develops. In general, the process takes 1.5-3 years. Patients suffering from fibrous-cavernous tuberculosis complain of poor health and weakness in the body, wet cough and shortness of breath. The state of health of patients is generally satisfactory. Body temperature before treatment is usually elevated. The disease is accompanied by weight loss,66 sweating and pallor of the skin.

Cirrhotic

In patients with cirrhotic pulmonary tuberculosis, gross cicatricial changes in the lung parenchyma and pleura are observed, which are combined with minimal inflammation activity.

The disease develops after other forms of tuberculosis. This variety is quite rare. In order for cirrhotic tuberculosis to form, a long period of untreated inflammation is necessary. It is important to understand that with advanced cases of this form of the disease, a fatal outcome is possible. The severity of manifestations of cirrhotic tuberculosis depends on the extent and localization of changes in the lungs. Symptoms are generally mild. Outside of exacerbation, there may be slight shortness of breath and occasional dry cough.

Focal

Focal pulmonary tuberculosis is a specific tuberculous lesion 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, most often occurs in adult patients who have recovered from the disease. Distinctive features of this lung disease are latency, limited area of ​​damage, non-destructive nature of inflammation.

In addition, there are no symptoms in this disease, so the disease can be detected mainly with prophylactic fluorography. Signs of the disease are fever, fever, loss of appetite, sleep disturbance, sweating. In some cases, there are also signs of hyperthyroidism: the thyroid gland enlarges, tachycardia and irritability appear. In women, there may be a change in the menstrual cycle.

Chronic

Chronic tuberculosis is observed in patients with a long course of the disease in the case when complex treatment does not give the expected results. With this disease, foci of infection appear in the lungs of a person. Patients are concerned about cough with sputum, subfebrile condition, night sweats, weakness. The danger of the disease lies in the fact that other human organs are also affected. Anemia develops, skin manifestations, inflammation in the urinary system are possible.

Extrapulmonary tuberculosis

Extrapulmonary tuberculosis is most often a secondary disease that occurs due to tuberculosis infection of the lungs. Extrapulmonary tuberculosis affects a variety of organs: the intestines, the central nervous system, the meninges, lymph nodes, bones, joints, the genitourinary system, the skin, and the eyes.

Tuberculosis of the central nervous system

Tuberculosis of the central nervous system begins slowly, symptoms increase gradually. The person has intermittent headache, weakness in the body, apathy, drowsiness and decreased appetite. All this is observed several months before the main symptoms of the disease. The disease itself is characterized by severe headache, which is aggravated by noise, bright light. It is also accompanied by vomiting and mental disturbance. There may be confusion or agitation.

There is dilated pupils, strabismus, facial asymmetry, changes in speech and deterioration in visual acuity. There may be a violation of swallowing, choking, hearing loss.

Infection of the gastrointestinal tract and abdominal organs

The development of gastrointestinal tuberculosis is promoted by various chronic diseases, as well as a decrease in immunity. Patients have weakness, fatigue, sweating, fever. In addition, there is severe abdominal pain, bloating, constipation or diarrhea. Complications include intestinal obstruction, peritonitis, and internal bleeding.

Osteoarticular tuberculosis

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 a person may feel slight pain in the damaged areas. If the disease spreads to the joints and tissues nearby, then the pain intensifies, mobility is limited and even the affected joint or spine is deformed.

Urinary tract inflammation

Urinary TB is the most common extrapulmonary disease. These include: damage to the kidneys, urinary tract (ureter, bladder, urethra), male (prostate, testicles) and female (ovaries, endometrium) genital organs.

Disease of the eye

Eye tuberculosis is one of the most severe forms of extrapulmonary tuberculosis. This disease is found in approximately 10 percent of cases of diagnosed extrapulmonary forms. Most often, the tuberculous process is localized in the vascular system of the eye. A complication may be cataract or glaucoma. Also, Koch's wand can affect the skin, lymph nodes, spleen, heart muscle. But all these cases are extremely rare.

Main symptoms

Main symptoms are:

  • persistent cough with phlegm;
  • hemoptysis;
  • increased sweating;
  • marked weight loss;
  • causeless fatigue and weakness;
  • decreased or no appetite;
  • deterioration in performance.

In addition, pain is felt in the chest and upper limbs, 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 lung diseases. Therefore, only a specialist can make an accurate and correct diagnosis. The symptoms also depend on the affected area. If this is tuberculosis of the gastrointestinal tract, then the patient will be disturbed by pain in the abdominal cavity, nausea, and digestion will be disturbed.

If we are talking about the central nervous system, then mainly headaches, dizziness and other similar and unpleasant symptoms will disturb.

Stages and types of course

Tuberculosis is characterized by certain stages and periods of the infectious process.

Incubation period

a certain period of time, 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 enter the respiratory system are attacked by the immune system. If the immune system copes with its functions, then all bacteria die. If the immune system fails, then mycobacteria cause an inflammatory process in the lungs. In this case, the first symptoms of the disease will appear. It is worth noting that all this time a person is not contagious 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 the infected person does not have any symptoms, and the tuberculin test is positive. At the same time, radiography does not reveal pathologies, and the person is not contagious to other people.

In the active form, the patient feels general malaise, he has almost all the symptoms of tuberculosis. Specific tests are positive, and the person is contagious to others.

Closed and open

Tuberculosis is a contagious disease, but patients may or may not be contagious. 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 an open form of tuberculosis, the patient releases the causative agent of the disease into the environment. This mainly concerns pulmonary tuberculosis, since the release of these microbes occurs during coughing and expectoration.In the closed form of tuberculosis, the mycobacterium is not excreted from the patient's body.

Disease outcomes

Tuberculosis outcomes can be recovery with adequate timely therapy 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 turn into dangerous and undesirable consequences.

Diagnosis

For the diagnosis of tuberculosis, tuberculin allergy tests are performed, sputum is tested for mycobacteria by PCR, blood and urine tests are carried out for a general analysis, an x-ray examination of the lungs, if necessary, a CT scan of the lungs.

Recently, to confirm the diagnosis, blood is examined for T-POS, the determination of lymphocytes sensitized to Mycobacterium tuberculosis.

Mantoux test

Mantoux test is the main method of screening children for 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 whether there is a tuberculosis infection in the body. With this test, you can determine the presence of the disease in advance.

T-spot

T-SPOT is an immunological method for determining the causative agent of a disease. To do this, the blood taken for analysis is properly prepared, and then the CFP-10 and ESAT-6 antigens, which are specific for Mycobacterium tuberculosis, are added to it. If the blood sample contains T-lymphocytes already familiar with these antigens, an immune response is triggered. The resulting immune complexes (antibodies associated with antigens) form spots (spots, from the English spot - “spot”), clearly visible under a microscope. The presence of a significant number of such spots in the sample allows us to conclude that it is infected with tuberculosis (positive result). The absence of spots, respectively, indicates that there is no infection (negative result).

The test makes it possible to detect the presence of infection, but it cannot be used to determine whether an active pathological process or a passive carrier is taking place.

PCR

Recently, PCR (polymerase chain reaction) has been used for diagnosis. This test has high sensitivity, which makes it possible to detect fragments of nucleic acids in the test material.

PCR can identify various forms of tuberculosis, especially in young children, even when microbiological tests are negative.

X-ray

X-ray of organs in tuberculosis is a study that is included in the mandatory diagnostic standards. This method is prescribed in order to establish or, conversely, to refute the fact of the disease. It can also be used to determine the nature of lung damage.

Methods of treatment

Tuberculosis is curable. Treatment consists in the constant and long-term use of drugs that are selected by the doctor for this form of the disease. A long time is due to the need for the complete destruction of all mycobacteria in the patient's body. At the same time, the patient must lead a healthy lifestyle, follow the treatment regimen and the recommended diet. Mycobacteria are quite resistant, therefore, if the dose of drugs is reduced, then the bacteria develop resistance to the drugs used. Usually, positive results are achieved within six months of active treatment. During this period, the foci of infection heal, symptoms disappear, the disease becomes closed.

  • Patients with an open form are placed in a tuberculosis dispensary. There, phthisiatricians deal with them until they stop isolating bacteria. But complete healing takes about a year, and sometimes it takes more time.
  • In addition to drug treatment, patients are advised to do breathing exercises, strengthen the immune system, and undergo physiotherapy.
  • During the recovery period, it is recommended to continue treatment in specialized sanatoriums.

Special groups of patients

Children

Children infected with tuberculosis are more likely than adults to develop active a disease that usually presents as an extrapulmonary disease. Lymphadenitis (scrofula) is the most common extrapulmonary manifestation, but tuberculosis can also affect the spine (tuberculous spondylitis), the highly vascularized epiphyses of long bones, or the CNS and meninges. The clinical manifestations of active TB in children are variable, making diagnosis challenging. Most children have few symptoms other than a loud, metallic cough.

The elderly

Recurrent disease can affect any organ, but especially the lungs, brain, kidneys, long bones, spine, or lymph nodes. A relapse may cause isolated symptoms and may be missed for many weeks or months, delaying appropriate evaluation. The frequent presence of other disorders and diseases in old age complicates the diagnosis.

HIV-infected patients

Patients with untreated HIV infection develop active TB in approximately 5–10%/year, whereas people who are immunocompromised it develops in about the same percentage of cases, but throughout life. In the early 1990s, half of HIV-infected TB patients who were untreated or infected with a multidrug-resistant strain died with a median survival rate of only 60 days. Now, outcomes are somewhat better in developed countries due to early TB detection and antiretroviral therapy, but TB among HIV patients continues to be a major problem. In developing countries, mortality continues to be high among patients co-infected with HIV and infected with multidrug-resistant or highly resistant TB.

How to protect yourself

Disease prevention consists of several components. It is extremely important to protect yourself and follow preventive measures in places where TB infection is possible. It is necessary to carry out a whole range of measures that are aimed at preventing the transmission of infection from a sick person to a healthy one.

Specific prophylaxis is a method of fighting infection, the purpose of which is to create immunity against it. This includes compulsory vaccination of the population. Specific prophylaxis 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 has a hidden character. Often the sick person believes that he just caught a cold and is tired. Therefore, he turns to the doctor after the appearance of more serious symptoms, when complex and lengthy 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 responsibly approach this issue and engage in treatment, then over time you can completely forget about this problem, and life expectancy will depend on the lifestyle of a person. Of course, this can take a long time - from several months to two years. This period depends on the form of the disease and its neglect.

What is contraindicated for patients

Of course, in the fight against tuberculosis, it is necessary to conserve strength and direct it to the main task - the victory over the disease. Patients can and should walk more, walk, do exercises, and do physiotherapy exercises. At the same time, they are strictly forbidden to smoke, follow strict diets, and 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 true. There are diseases in which you can not stay under the sun for a long time and sunbathe, as it adversely affects the human body. Tuberculosis is one of these diseases.

Tuberculosis is a serious disease, but with timely diagnosis and adequate therapy it is curable.

Sources
  1. Wikipedia. - Treatment of tuberculosis.
  2. Portal Ravijuhend. – Pulmonary and extrapulmonary tuberculosis (PJ-A/19.1-2017).
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  4. JSC "Medicine". - Tuberculosis.
  5. World Health Organization. - Tuberculosis.
  6. Ministry of Health of the Altai Territory. – All about tuberculosis.
  7. Group of companies “Invitro”. - Pulmonary tuberculosis.