How long is an open form of tuberculosis treated. The main symptoms of pathology. Open form of tuberculosis

Tuberculosis has long been considered in medicine as one of the most common and dangerous diseases. Despite all the achievements modern science, the disease cannot be defeated, people continue to die from it every year. The disease is insidious in its unpredictability, it has several behaviors.

Depending on the various circumstances tuberculosis infection may go unnoticed or cause serious problems health, up to and including death.

Is tuberculosis contagious, and how much - we will analyze this in more detail.

The degree of danger depends on the form and stage in which the disease is determined in a person. The most dangerous is. A disease in a closed form (latent) has less ability to transmit infection to the external environment.

Having invaded the body, mycobacterium may not manifest itself for years. A person is completely unaware that his condition carries a threat to others - health does not give any signals of an “invasion”. Meanwhile, the infection begins to slowly but methodically spread throughout internal organs- tuberculous intoxication of the body occurs.

Malicious bacteria travel through the cells with the blood stream, choosing the most unprotected organs to stop. human body. Having fixed in a convenient place, mycobacteria begin their destructive work.

From this moment on, a person is considered a carrier of tuberculosis, he becomes especially dangerous for society.

If the body is strong, the immune system is mobilized to fight the aggressor. Weak immunity alone is not able to cope with Koch's wand, it is required to be treated for a long time and seriously.

Tuberculosis begins its development with the formation of a primary affect in the affected area. Macrophages (special cells capable of aggressive capture of other bacteria, particles dead cells, other microparticles harmful to the body) Koch's sticks are captured, while penetrating into the lymphatic system.

Mycobacteria have two routes of penetration into organs: lymphogenous or hematogenous.

In the lesions, a granulomatous process begins to develop: in the central part, focal necrosis is formed, surrounded by lymphocytes, macrophages, and epithelioid cells. The result of a granuloma is sclerosis.

In medicine, it is customary to divide the disease into pulmonary and extrapulmonary form. The first is the most common, the second is numerous and with many options.

Tuberculosis at the beginning of the journey: how contagious is the initial form of the disease

There is an opinion that in the embryonic state, the infection is quite harmless and infection with tuberculosis cannot occur - the bacilli are still too weak and not for a long time act on the body. However, this is not entirely true. It all depends on the form of manifestation of the disease, which regulates the degree of its contagiousness.

An unequivocal answer to the question of whether tuberculosis is transmitted to initial stage, No. First of all, it is necessary to clarify which phase is considered the initial one: the actual introduction of mycobacteria into the organs, or its infiltrative form.

If the definition means the first option, the starting moment of tuberculosis is not terrible. In addition, the disease may not manifest itself in any way throughout the life of an infected person.

Another thing is the infiltrative phase. This stage is highly contagious because hallmark this phase is a characteristic cough, spraying droplets of sputum into environment.

The initial stage, even in the most harmless form - serious reason pay attention to your own health so as not to miss the possible moment of the flow of non-dangerous, “dormant” tuberculosis into an active form with the most serious consequences.

"Risk groups": who is threatened by Koch's wand

A few years ago, it was believed that only disadvantaged sections of the population fall ill with tuberculosis - convicts in places of deprivation of liberty, persons without a fixed place of residence and other citizens leading an asocial lifestyle.

The disease in such cases had an open, chronic form and was as contagious as possible for the environment of the carrier.

Often, the disease was detected in people who are in difficult living conditions, have low incomes, and are socially unprotected. However, in recent times mycobacterium began to be diagnosed in quite prosperous people. It turned out that no one is protected from tuberculosis - the disease is so tenacious and omnivorous.

Particularly attentive to the possibility of "acquisition" of the disease should be diabetics, people with gastrointestinal diseases, as well as in the case of permanent hormonal treatment.

The most "contagious" forms of the disease

If the diagnosis is accurately established, the first thing that interests the sick person and his everyday environment is whether the detected disease is contagious or not, how successfully it is cured.

To the category of the most dangerous diseases open pulmonary tuberculosis. This variety poses a threat to the health of not only the carrier itself, but also everyone who in one way or another comes into contact with him in everyday life.

AT this case there is the highest ability of mycobacteria to infect everyone within a radius of several tens of meters from the owner of the Koch wand.

Transmission of lung infection occurs by airborne droplets when the patient coughs or sneezes.

It "distributes" many of the smallest tuberculosis bacilli into the environment and soil from infected sputum, which the carrier of the disease spits out.

Tuberculosis is insidious and infectiously dangerous, "making a nest" in other organs: kidneys, bone tissue, lymphatic system, reproductive organs. The number of those infected with extrapulmonary species is somewhat less than the owners of pulmonary tuberculosis, however, here too, frequent results are severe complications and lethal outcome.

Infection can be avoided: measures to prevent tuberculosis

Unfortunately, even the most experienced and titled doctor is not able to guarantee protection against tuberculosis infection - the infection spread area is too large. However, several useful knowledge help to take measures to protect against this serious illness.

Firstly, try to avoid direct contact with carriers of an open form of tuberculosis. If contact is unavoidable (in case of illness of family members), it is not always possible to completely eliminate the risk of infection. In this case, you must carefully follow the recommendations of the doctor treating the sick relative.

The room must be ventilated and disinfected - the ability to infect tuberculosis mycobacterium retains for a long time. The patient must be allocated for individual use dishes, personal hygiene items.

The second rule is in public places ah, it is necessary to stay away from coughing or sneezing fellow citizens, especially if saliva is freely sprayed into the air.

The listed measures can reduce the possibility of catching an infection, however, timely vaccinations against tuberculosis, regular visits to the fluorography room and timely treatment of detected tuberculosis serve as a more significant guarantee.

There are few Ukrainians who do not know how sad the situation with tuberculosis is in our country. Denial of proven high efficiency principles of work of the TB service of the times of the USSR, scarce funding of the industry, insufficient vaccination of the population, unfavorable environmental conditions, a decrease in the level of well-being of citizens, alcoholism and drug addiction - all these factors play into the hands of tuberculosis infection, contributing to a decrease in immune protection, an avalanche-like spread of the disease, and the formation of resistant strains of bacteria , not amenable to therapy with standard combinations of anti-tuberculosis drugs. In the absence of real help a person is left alone with a formidable infection from the state, and only from himself, his sanitary literacy and willpower depend on the chances of healthy life. Most main question, exciting the layman, is the risk of contracting tuberculosis in various everyday situations. How not to get sick? - let's figure it out.

In order to have a substantive conversation about the possibility of infection with tuberculosis, first of all, we will analyze the meaning of the terms infection (infection) - in relation to tuberculosis, active tuberculosis, open and closed forms of tuberculosis.

Tuberculosis is a unique infection. The ingestion of tubercle bacillus (Koch's bacteria, Mycobacterium tuberculosis) almost always leads to infection, and very rarely - to the development active disease. Infection (infection) with Koch's bacillus occurs once in a lifetime - usually in childhood or adolescence, at the first contact of a person with a microorganism. One or two Koch sticks that enter the child's respiratory tract along with inhaled air lead to infection and the development of local inflammation, however, due to the high activity of the immune system, the body quickly copes with the infection and self-healing occurs. All these processes occur completely imperceptibly, have no clinical manifestations and, as a rule, do not lead to the development of active tuberculosis. The fact that tuberculosis infection has occurred, doctors learn from the results of the next Mantoux test, which in people infected with tuberculosis bacillus have very specific characteristics. Immunologically, the process of infection with tuberculosis bacillus can be considered as a favorable phenomenon, because, due to the contact with the pathogen, the human body learns to recognize tuberculosis and fight it - this is how anti-tuberculosis immunity is formed.

Despite the fact that the immune system has overcome the pathogen, a certain amount of mycobacteria remains forever in the human body (mainly in the organs lymphatic system) in the inactive state. The presence of "sleeping" bacteria becomes the basis for the development of active tuberculosis in cases where the activity of immunity decreases and tuberculosis bacilli get out of control. However, this does not always happen - according to statistics active form Tuberculosis (that is, tuberculosis with clinical manifestations, specific changes on x-rays and laboratory tests) develops in only 1-5% of infected people. The highest risk of developing tuberculosis is in the first 2 years after primary infection - it is during this period of time that an infected person needs to be monitored by a phthisiatrician and (according to indications) preventive measures. I must say that by the age of 20-25, tuberculosis infection occurs in 90-95% of people, and most of of these people (despite being infected with tuberculosis) remains healthy. That is Tuberculosis is not the same as being infected!

People infected (infected) with tuberculosis do not have tuberculosis, do not spread the tuberculosis bacillus and therefore are not dangerous to others. Usually, a person infected with tuberculosis has positive test Mantoux, while the results of an X-ray of the lungs and sputum analysis do not have deviations from the norm. Repeated contact of an infected person with tuberculosis pathogens either has no consequences or breaks immune defense and lead to the development of active tuberculosis (usually this occurs with a massive bacterial attack, contact with aggressive strains of tubercle bacillus, temporary or permanent immunodeficiency).

Active tuberculosis that has developed for one reason or another can occur in two forms - open and closed. An open form of tuberculosis (bacterioexcretion) is said to be when, with the help of bacteriological research(sowing) or microscopy in sputum, saliva and other secretions of the patient, Koch's sticks are found. If there are no bacteria in the secretions during repeated studies, the patient suffers from a closed form of the disease. The terms open and closed form of tuberculosis are more often used for pulmonary tuberculosis. However, bacterial excretion is also characteristic of other types of tuberculosis - tuberculosis of the lymph nodes, tuberculosis of the reproductive system, tuberculosis of the intestine, etc. The presence of bacterial excretion (BC+) is a very important indicator of the infectious danger of a patient, since it is possible to become infected with tuberculosis only from a person who releases Mycobacterium tuberculosis into the environment. However, there is one nuance here: due to the insufficient power of laboratory research methods, in some patients with an open form of tuberculosis, mycobacteria in sputum (and other secretions) cannot be detected. That is, being, officially, non-contagious, they represent serious danger for those around you. Therefore, no doctor guarantees 100% safety for people who have contacts with patients with a closed form of tuberculosis. It is believed that contact with such a patient with about a 30% probability can lead to the development of an active form of the disease, the risk of infection increases with constant, close, prolonged contact.

So, a patient with an open form of tuberculosis is definitely dangerous, a patient with a closed form is potentially dangerous.

Contact options

The risk of developing tuberculosis directly depends on the nature of the contact and determines the preventive measures necessary in each specific case.

Theoretically, the lowest probability of developing the disease is during short-term contact with a TB patient in public transport, public places, on stairwells, etc. The simplest preventive measures, such as a healthy lifestyle, help to reduce the risk of developing active tuberculosis in such a situation. balanced diet and regular annual examinations (Mantoux test for children and adolescents under 15 years of age, lung fluorography for adolescents over 15 years of age and adults), as well as mandatory hand washing after the street, regular cleaning and airing of the premises.

The risk of developing active tuberculosis increases significantly with prolonged and regular contact with a tuberculosis patient ( Cohabitation, regular communication at work or in free time), as well as during contacts accompanied by an exchange biological fluids(kisses, sexual relations). Healthy people who find themselves in such a situation fall into the category of “contacts for tuberculosis” and should be examined by a TB specialist as soon as possible. The purpose of a TB examination is to rule out an active form of tuberculosis in a contact person and to identify indications for chemoprophylaxis with anti-TB drugs. Contact person screening usually includes tuberculin test(Mantoux test), X-ray examination of organs chest, sputum examination for the presence of tuberculosis bacillus, general clinical blood and urine tests. Contact children and adolescents are examined 4 times, adults - 2 times a year. Chemoprophylaxis is carried out in people with the highest risk of developing tuberculosis (primarily in people with immunodeficiency conditions, people exposed to massive exposure to aggressive strains of tuberculosis) with the help of 1-2 anti-tuberculosis drugs prescribed in minimal dosages.

important preventive measure, aimed at reducing the risk of developing the disease, is to stop contact with the bacteria. For this, a patient with an open form of tuberculosis is hospitalized in a hospital; contact persons are advised to temporarily interrupt personal communication with the patient (until the mycobacterium disappears from the discharge), sometimes patients with an active form of tuberculosis (especially in the chronic course of the disease with permanent bacterial excretion) are provided with a separate living space. The TB patient himself and his relatives should not consider temporary isolation as a life tragedy - in most cases, if the doctor's recommendations are followed in good faith, after 2 months of therapy, bacterial excretion stops and the patient ceases to be dangerous to the people around him. In those situations when it is not possible to interrupt contact with a patient with an open form of tuberculosis, all contact persons are subject to a long preventive therapy anti-tuberculosis drugs.

Children. Children, due to the peculiarities of the immune system, are at increased risk for the development of active tuberculosis. Therefore, when a patient with tuberculosis appears in the family (regardless of the form of the disease), the contact of the child with this relative should be stopped, and the child should be registered with a phthisiatrician. Tuberculosis contacts and/or primarily infected children and adolescents, after examination by a phthisiatrician and exclusion of an active form of tuberculosis, are not contagious, not dangerous to others and can attend children's institutions (kindergartens, schools) even if they receive preventive treatment anti-tuberculosis drugs.

pregnant. Contact with a TB patient during pregnancy leads to the development of the disease with almost the same probability as contact in a non-pregnant state. First of all, the contact must be interrupted and ensured that it does not repeat itself. A pregnant woman who has been in contact with a patient with tuberculosis must carefully monitor her state of health and, if the first signs of pulmonary pathology appear, consult a doctor (therapist, phthisiatrician) for an examination. With prolonged contact with a patient with an open form of tuberculosis, a pregnant woman is examined according to the generally accepted scheme (with the exception of x-ray examination which is carried out using special techniques in the presence of strict indications). In most cases, chest x-rays and anti-tuberculosis drugs are delayed for postpartum period. Contact with a patient with tuberculosis is by no means an indication for termination of pregnancy. If contact high risk occurred at the stage of pregnancy planning, it is necessary to postpone conception until the danger has completely disappeared.

prisoners. There is a very high risk of developing tuberculosis in contact with patients serving sentences in places of deprivation of liberty or former prisoners, since these people in the vast majority of cases are carriers of aggressive strains of tuberculosis that are resistant to most anti-tuberculosis drugs. Relatives visiting sick prisoners (in the event that it is not possible to refuse visits for some reason) are advised to come to visits in clothes made of materials resistant to disinfectants, a headscarf that covers their hair, and a 4-layer gauze mask that covers the mouth and nose. After the visit, clothes must be soaked in a disinfectant solution (chlorantoin, domestos) for 2 hours. During the entire period of increased risk, the contact person should be examined twice a year in a tuberculosis dispensary. You must be prepared for the fact that the phthisiatrician will prescribe prophylactic anti-tuberculosis treatment. Contacts of children with TB patients are highly undesirable.

« Contact without contact". Despite the absence of direct contact with the source of infection, people who have settled in an apartment (house) where used to live sick with tuberculosis. Koch's sticks remain viable in the environment for a long time (they live in room dust for about a month, in books - 3 months, in dark and basement rooms up to 4-5 months) and are quite capable of causing disease in new residents. To avoid health problems, before moving in, it is necessary to find out whether the final disinfection was carried out in the apartment - the treatment of the premises by the forces of the sanitary and epidemic station. If disinfection has been carried out, it is necessary to make cosmetic repairs and then safely move into new housing. If disinfection has not been carried out, it is highly not recommended to live in an apartment before it is carried out.

Concluding the topic, we will list the situations associated with tuberculosis contact, in which an urgent consultation of a phthisiatrician (or therapist) is necessary, and we will also give recommendations for elementary prevention of tuberculosis.

Examination of a phthisiatrician regarding contact with a patient with tuberculosis is indicated in the following cases:

With close, prolonged contact with a bacterioexcretor.
If there are tuberculosis patients among the next of kin (indicates a possible genetic predisposition to disease).
In the presence of diseases or conditions that cause a decrease in the activity of immunity, including when undergoing therapy with hormonal or cytostatic drugs.
In the presence of bad habits(smoking, alcohol abuse, drug addiction), chronic stress.
If children and adolescents came into contact with the patient.

Within a year after cessation of contact with the patient active tuberculosis need to pay attention to the following symptoms, the appearance of which should be the reason for a premature x-ray of the lungs and a consultation with a phthisiatrician:

Prolonged, unexplained weight loss.
Dry cough lasting more than 3 weeks.
Subfebrile body temperature.
Enlarged peripheral lymph nodes.
Increasing weakness, drowsiness.
Chest pain, hemoptysis.

To reduce the likelihood of developing tuberculosis after a known or suspected exposure, it is recommended:

Do not smoke or drink strong alcoholic drinks, beer, low-alcohol mixtures.
Eat at least 150-200 g of foods rich in animal fats per day (meat, fish, eggs, milk, etc.).
Use enough vitamins of all groups.
Do not use synthetic products (chips, fast food).
More likely to be fresh air and lead active image life.
Avoid repeated close contact with patients with active tuberculosis.
Undergo regular preventive examinations (fluorography of the lungs).

Finally

Tuberculosis is dangerous, one cannot but agree with this, but the situation is not hopeless. Modern medicine makes it possible to fight this disease, and timely prevention helps prevent its development. Be attentive to yourself and your loved ones, lead a healthy lifestyle, do not hesitate to seek advice and help from doctors - this will increase your chances of a healthy long life. Take care of your health!

Tuberculosis is a specific infectious process the causative agent, which is tuberculosis bacillus(Koch's wand). Forms of tuberculosis (types of manifestation of the disease) can be very different. The prognosis of the disease, the type of treatment, the risk to the life of the patient, and much more depend on the form of tuberculosis. At the same time, knowledge of the features various forms tuberculosis will help to better navigate the mechanisms of the development of the disease and understand the complexity of the specifics of tuberculosis as a disease.

Open and closed form of tuberculosis

It is well known that tuberculosis is infectious disease, and, as with many other infectious diseases, tuberculosis patients may or may not be contagious. Unlike other infectious diseases (for example, hepatitis B or C), for which the patient's contagiousness is maintained for almost the entire duration of the disease, in the case of tuberculosis, the patient's status (infectious / non-infectious) may vary depending on the stage of the disease development and the effectiveness of the treatment taken. The term open tuberculosis means that the patient releases microbes that cause tuberculosis into the environment. This term is applied mainly to pulmonary tuberculosis, in which the release of microbes occurs when coughing, expectoration of sputum. Open tuberculosis is also called CD+ (or TB+), which means that when microscopic examination The patient's sputum smear revealed the bacteria that cause tuberculosis (KK - Koch's bacillus, TB - tubercle bacillus). In contrast to the CD+ form of tuberculosis, there is a CD- (or TB-) form, which means that the patient does not shed germs into the environment and is not contagious. The term " closed tuberculosis» is rarely used, its equivalents BK- (or TB -) are more often used.
A patient with a closed form of tuberculosis cannot infect other people.

Primary and secondary tuberculosis

It is customary to talk about primary tuberculosis in the case when the disease developed at the first contact of the patient with microbes. In the case of primary tuberculosis, the patient's body is not yet familiar with the infection. Primary tuberculosis ends with the formation of petrified foci of inflammation, in which “dormant” microbes remain for a long time. In some cases (for example, with a decrease in immunity), the infection can reactivate and cause a new episode of the disease. In this case, it is customary to speak of secondary tuberculosis. In the case of secondary tuberculosis, the patient's body is already familiar with the infection and therefore the disease proceeds differently than in people who have contracted tuberculosis for the first time.
Tuberculosis of the lungs can take many forms:

Primary tuberculosis complex (tuberculous pneumonia focus + lymphangitis + mediastinal lymphadenitis)
- isolated lymphadenitis of intrathoracic lymph nodes.

Based on the prevalence of pulmonary tuberculosis, there are:

Disseminated pulmonary tuberculosis

Disseminated pulmonary tuberculosis is characterized by the presence of multiple specific foci in the lungs; at the onset of the disease, a predominantly exudative-necrotic reaction occurs, followed by the development of productive inflammation. Variants of disseminated tuberculosis are distinguished by pathogenesis and clinical picture. Depending on the path of spread of Mycobacterium tuberculosis, hematogenous and lymphobronchogenic disseminated tuberculosis are distinguished. Both variants can have subacute and chronic onset of the disease.
Subacute disseminated tuberculosis develops gradually, but is also characterized by severe symptoms of intoxication. With hematogenous genesis of subacute disseminated tuberculosis, the same type of focal dissemination is localized in the upper and cortical parts of the lungs, with lymphogenous genesis, the foci are located in groups in the hilar and lower sections lung against the background of severe lymphangitis with involvement in the process of both deep and peripheral lymphatic network of the lung. Against the background of foci in subacute disseminated tuberculosis, thin-walled cavities with mild perifocal inflammation can be determined. More often they are located on symmetrical areas of the lungs, these cavities are called "stamped" caverns.

Miliary tuberculosis of the lungs

Miliary pulmonary tuberculosis is characterized by generalized formation of foci, predominantly of a productive nature, in the lungs, liver, spleen, intestines, meninges. Less commonly, miliary tuberculosis occurs as a lesion of the lungs only. Miliary tuberculosis most often manifests itself as acute disseminated tuberculosis of hematogenous origin. According to the clinical course, a typhoid variant is distinguished, characterized by fever and pronounced intoxication; pulmonary, in which symptoms predominate in the clinical picture of the disease respiratory failure against the background of intoxication; meningeal (meningitis, meningoencephalitis), as manifestations of generalized tuberculosis. X-ray examination is determined by a dense homogeneous dissemination in the form of small foci, located more often symmetrically and better visible on radiographs and tomograms.

Focal (limited) pulmonary tuberculosis

Focal pulmonary tuberculosis is characterized by the presence of a few foci, predominantly of a productive nature, localized in a limited area of one or both lungs and occupying 1-2 segments, and asymptomatic clinical course. Focal forms include both recent, fresh (soft focal) processes with lesions less than 10 mm in size, and older (fibrous focal) formations with pronounced signs of process activity. Fresh focal tuberculosis is characterized by the presence of weakly contoured (soft) focal shadows with slightly blurred edges. With significantly pronounced perifocal changes that have developed along the periphery of the focus in the form of broncholobular confluent foci; should be defined as infiltrative pulmonary tuberculosis. Fibrous-focal tuberculosis is manifested by the presence of dense foci, sometimes with the inclusion of lime, fibrous changes in the form of strands and areas of hyperneumatosis. During the period of exacerbation, fresh, soft foci may also be detected. With focal tuberculosis, intoxication phenomena and "chest" symptoms, as a rule, occur in patients during an exacerbation, in the phase of infiltration or decay.
Upon detection of fibrosis focal changes by X-ray fluorography, it is necessary to conduct a thorough examination of patients to exclude the activity of the process. In the absence of pronounced signs of activity, fibro-focal changes should be regarded as cured tuberculosis.

Infiltrative pulmonary tuberculosis

Infiltrative tuberculosis lungs is characterized by the presence of inflammatory changes in the lungs, predominantly exudative in nature with caseous necrosis in the center and relatively fast dynamics of the process (resorption or decay). Clinical manifestations infiltrative tuberculosis depend on the prevalence and severity of infiltrative-inflammatory (perifocal and caseous-necrotic) changes in the lungs. There are the following clinical and radiological variants of infiltrative pulmonary tuberculosis: lobular, round, cloudy, periocissuritis, lobit. In addition, caseous pneumonia, which is characterized by more pronounced caseous changes in the affected area, belongs to infiltrative tuberculosis. All clinical and radiological variants of infiltrative tuberculosis are characterized not only by the presence of an infiltrative shadow, often with decay, but also by bronchogenic seeding. Infiltrative pulmonary tuberculosis can proceed inaperceptively and is recognized only by X-ray examination. More often, the process clinically proceeds under a mass of other diseases (pneumonia, protracted influenza, bronchitis, catarrh of the upper respiratory tract, etc.), in most patients there is an acute and subacute onset of the disease. One of the symptoms of infiltrative tuberculosis may be hemoptysis in the general satisfactory condition of the patient).

Caseous pneumonia

Caseous pneumonia is characterized by the presence in the lung tissue inflammatory response by the type of acute caseous decay. Clinical picture characterized serious condition the patient, severe symptoms of intoxication, abundant catarrhal phenomena in the lungs, a sharp left shift in the leukocyte count, leukocytosis, massive bacterial excretion. With the rapid liquefaction of caseous masses, a giant cavity or multiple small cavities are formed. Caseous pneumonia can be either an independent manifestation of the disease or as a complicated course of infiltrative, disseminated and fibrous-cavernous pulmonary tuberculosis.

Tuberculoma of the lungs

Pulmonary tuberculoma unites encapsulated caseous foci of great size more than 1 cm in diameter, diverse in genesis. There are tuberculomas of infiltrative-pneumonic type, homogeneous, layered, conglomerate and so-called "pseudotuberculomas" - filled cavities. On radiographs, tuberculomas are detected as a rounded shadow with clear contours. In focus, crescent-shaped enlightenment due to decay, sometimes perifocal inflammation and a small number of bronchogenic foci, as well as areas of calcification, can be determined. Tuberculomas are single and multiple. There are small tuberculomas (up to 2 cm in diameter), medium (2-4 cm) and large (more than 4 cm in diameter). Three clinical variants of the course of tuberculoma have been identified: progressive, characterized by the appearance at some stage of the disease of disintegration, perifocal inflammation around the tuberculoma, bronchogenic seeding in the surrounding lung tissue, stable - the absence of radiographic changes in the process of monitoring the patient or rare exacerbations without signs of progression of tuberculoma; regressive, characterized by a slow decrease in tuberculoma, followed by the formation of a focus or group of foci, an induction field, or a combination of these changes in its place.).

Cavernous tuberculosis of the lungs

Cavernous pulmonary tuberculosis is characterized by the presence of a formed cavity, around which there may be a zone of small non-reefing reactions, the absence expressed fibrotic changes in the lung tissue surrounding the cavity and possible presence a few focal changes both around the cavity and in the opposite lung. Cavernous tuberculosis develops in patients with infiltrative, disseminated, focal tuberculosis, with the decay of tuberculomas, with late detection of the disease, when the decay phase ends with the formation of a cavity, and the signs of the original form disappear. Radiologically, the cavity in the lung is defined as an annular shadow with thin or wider walls. Cavernous tuberculosis is characterized by the presence of an elastic, rigid, less often fibrous cavity in a patient.

Fibrous-cavernous pulmonary tuberculosis

Fibrous-cavernous pulmonary tuberculosis is characterized by the presence of a fibrous cavity, the development of fibrous changes in the lung tissue surrounding the cavity. The foci of bronchogenic screening of various prescription are characteristic both around the cavity and in the opposite lung. As a rule, the bronchi draining the cavity are affected. Other morphological changes in the lungs also develop: pneumosclerosis, emphysema, bronchiectasis. Fibrous-cavernous tuberculosis is formed from an infiltrative, tricky or disseminated process with a progressive course of the disease. The extent of changes in the lungs can be different, the process is unilateral and bilateral with the presence of one or multiple cavities.
Clinical manifestations of fibrous-cavernous tuberculosis are diverse, they are caused not only by tuberculosis itself, but also by changes in the lung tissue around the cavity, as well as by developed complications. There are three clinical variants of the course of fibrous-cavernous pulmonary tuberculosis: limited and relatively stable fibrous-cavernous tuberculosis, when, due to chemotherapy, a certain stabilization of the process occurs and an exacerbation may be absent for several years; progressive fibro-cavernous tuberculosis, characterized by a change of exacerbations and remissions, and the periods between them can be different - short and long, during the period of exacerbation new areas of inflammation appear with the formation of "daughter" cavities, sometimes the lung can collapse completely, in some patients with ineffective treatment the progressive course of the process ends with the development of caseous pneumonia; fibrous-cavernous tuberculosis with the presence of various complications- most often this option is also characterized by a progressive course. Most often, such patients develop pulmonary heart failure, amyloidosis, frequent repeated hemoptysis and pulmonary bleeding, exacerbated nonspecific infection (bacterial and fungal).

Cirrhotic tuberculosis of the lungs

Cirrhotic pulmonary tuberculosis is characterized by the growth of rough connective tissue in the lungs in the pleura as a result of involution of fibrous-cavernous, chronic disseminated, massive infiltrative pulmonary tuberculosis, pleural lesions, tuberculosis of the intrathoracic lymph nodes, complicated by bronchopulmonary lesions. To cirrhotic tuberculosis should be attributed the processes in which tuberculous changes in the lungs persist with clinical signs activity of the process, a tendency to periodic exacerbations, periodically there is a meager bacterial excretion. Cirrhotic tuberculosis is segmental and lobar, limited and widespread, unilateral and bilateral, it is characterized by the development of bronchiectasis, pulmonary emphysema, symptoms of pulmonary and cardiovascular insufficiency are observed.
Cirrhotic changes, in which the presence of a fibrous cavern with bronchogonal screening and repeated long-term bacterial excretion, should be attributed to fibrous-cavernous tuberculosis. Cirrhosis of the lungs, which are post-tuberculous changes without signs of activity, should be distinguished from cirrhotic tuberculosis. In the classification, cirrhosis of the lungs is classified as residual changes after clinical cure.

Tuberculous pleurisy

Tuberculous pleurisy often accompanies pulmonary and extrapulmonary tuberculosis. It occurs mainly in the primary tuberculosis complex, tuberculosis of the intrathoracic lymph nodes, disseminated pulmonary tuberculosis. Fibrous-cavernous pulmonary tuberculosis is characterized by the presence of a fibrous cavity, the development of fibrous changes in the lung tissue surrounding the cavity. The foci of bronchogenic screening of various prescription are characteristic both around the cavity and in the opposite lung. As a rule, the bronchi draining the cavity are affected. Other morphological changes in the lungs also develop: pneumosclerosis, emphysema, bronchiectasis. Fibrous-cavernous tuberculosis is formed from an infiltrative, tricky or disseminated process with a progressive course of the disease. The extent of changes in the lungs can be different, the process is unilateral and bilateral with the presence of one or multiple cavities. Tuberculous pleurisy are serous serofibrinous, purulent, less often - hemorrhagic. The diagnosis of pleurisy is established by the combination of clinical and radiological signs, and the nature of pleurisy - with puncture pleural cavity or biopsy of the pleura. Pneumopleuritis (the presence of air and fluid in the pleural cavity) occurs with spontaneous pneumothorax or as a complication of therapeutic pneumothorax.

Tuberculosis of the pleura, accompanied by the accumulation of purulent exudate, is special form exudative pleurisy- empyema. It develops with a widespread caveous lesion of the pleura, as well as as a result of perforation of the cavity or subpleural foci, may be complicated by the formation of a bronchial or thoracic fistula and take a chronic course. Chronic empyema is characterized by an undulating course. Morphological changes in the pleura are manifested by cicatricial degeneration, the development of a specific granulation tissue in the thickness of the pleura that has lost its function. Empyema should be included in the diagnosis.

Tuberculosis is a very dangerous and contagious disease. Due to the widespread prevalence of this disease around the world, people have a quite reasonable question: how does infection occur, and is the risk of infection high when in contact with a sick person? In order to answer this question, it is important to understand what is infection and what is active disease.

Getting into the human body, Mycobacterium tuberculosis leads to the fact that infection occurs (most often this happens in childhood), and in respiratory tract the inflammatory process begins. However, in most cases, it goes unnoticed and, due to the high activity of the immune system, recovery occurs. A person learns that Koch's wand has entered his body only after he makes a Mantoux test.

About carriage and contagiousness

Despite the fact that the immune system was able to cope with inflammatory process, the remains of Mycobacterium tuberculosis are not completely removed from the body, but are deposited in the lymph nodes. If the immune system fails, the activity of mycobacteria can be activated, although the active form of tuberculosis develops in only 5% of carriers. Therefore, it is so important to understand that infection does not equate to disease. No less significant is the fact that the people who carry the Koch wand are not its distributors. They become dangerous to others only when the disease becomes open. In saliva, sputum and other secretions of such people, active Mycobacterium tuberculosis is found, which can penetrate into the body of a healthy person.

It should also be taken into account that people are not always able to independently determine whether their disease has passed into the active phase, because often the onset of the development of tuberculosis can be confused with the usual SARS. Remaining not isolated from society, sick people spread the disease, infecting all large quantity surrounding.

About contacts with TB patients

How high the likelihood of infection can be judged based on the nature of contacts with the bacteriocarrier. It is logical to assume that the shorter the contact will continue and the less close it will be, the lower the risk of infection. However, one cannot be sure that when using public transport, while walking down the street or visiting a crowded institution, you cannot catch tuberculosis. In order to reduce the risk of infection, it is necessary to lead a healthy lifestyle, eat right and avoid bad habits. Annual examinations, such as the Mantoux test and fluorography - mandatory events which should not be ignored.

The risk that a person will develop an active form of the disease increases significantly if he has constant and close contact with a patient with tuberculosis. This may be cohabitation, regular communication at work or after hours. If it turns out that a friend or relative has this disease, it is important to consult a phthisiatrician as soon as possible and undergo the necessary examinations. Most often, they include a Mantoux test, chest x-ray, sputum, blood and urine tests. Adults at risk need to undergo such studies at least once every six months, and children twice as often. If a person lives with a carrier, then special anti-tuberculosis drugs may be prescribed, taken in minimal doses.

It is necessary to completely exclude any contact with a person who has an open form of tuberculosis. The patient should be immediately hospitalized, where he will be prescribed appropriate treatment. Such a person will be in the hospital until the studies show that there is no dangerous mycobacterium in his secretions. Relatives and the patient himself should not panic, because even an open form of tuberculosis with development modern medicine and timely handling- this is not a sentence. Most often, 2 months of therapy is enough, and a person will be able to return to society, as he will become harmless to others.

About risk groups

The risk group for the incidence of tuberculosis includes children, since they are not yet fully formed. If a person with tuberculosis in any form appears in the family, it is important to completely limit the child's communication with him. In addition, it is necessary to register the baby with a phthisiatrician. If infection is not detected, or it is primary, but proceeds in an inactive form, then such children do not pose a threat to others and can continue ordinary life, attend preschool and school. Sometimes they are shown prophylaxis with special drugs.

Pregnancy is not additional factor risk of infection and disease. If there is a suspicion that mycobacterium could enter the body of a woman carrying a fetus, then she is shown all the same studies as ordinary person except for a chest x-ray. Contact with a patient with tuberculosis is not a reason for terminating a pregnancy.

Contact with people who are in prison or have previously served time in places of deprivation of liberty is a risk of contracting an active strain of tuberculosis. Therefore, if it turns out that a person is sick, and his visit cannot be canceled, it is important to take serious precautions: wearing a special mask, a hair scarf, clothing made from materials that are resistant to disinfectants.

It is dangerous not only to have direct contact with the patient, but also to settle in an apartment where a person with tuberculosis used to live. The fact is that Koch's wand is very resistant to environmental factors. She can live in the dust or on the pages of books for up to 3 months, "waiting" for the next owner. Therefore, before moving into new apartment, it is important to ask who lived in it before. If there is data on patients with tuberculosis, then it is dangerous to be in such a house until it is completely disinfected by the sanitary and epidemiological service.

Everyone can get tuberculosis, because the tubercle bacillus is transmitted by airborne droplets from a sick person, and then by contact cough after “irrigation” of household items. People who have an open form of tuberculosis are considered potentially dangerous to others, especially children. To protect yourself from infection, you need to know about the symptoms of an open form of tuberculosis, and how to protect yourself from it.

Most often, the open form is characteristic of the pulmonary form of tuberculosis.

If you do not eat up, constantly be in stressful situation and nervous tension, then when a tubercle bacillus gets in, signs of tuberculosis will develop, which often lead to death.

The number of patients is on the rise. Outbreaks of infection are recurring due to an increase in the number of HIV-infected patients in whom this disease manifests itself as a complication.

What is an open form of tuberculosis?

In addition to HIV-infected patients, the risk group for the disease includes the elderly, medical workers, patients with reduced immunity due to concomitant or previous diseases, children, and people living in poor social and living conditions. Rarely, infection occurs through the consumption of meat, eggs or milk from infected animals.

The open form of tuberculosis has symptoms that are severe in its course and constantly releases mycobacteria that infect the surrounding area. This is its difference from closed form illness. Tank culture (smear microscopy) in sputum and saliva detects Koch's bacillus, which is determined by the method of laboratory staining.

Open tuberculosis is primary and secondary:

The primary type develops in people who have not previously been in contact with a tubercle bacillus carrier. Most often it is asymptomatic, characterized by only a slight inflammation in the lungs. Then the inflamed focus is transformed into a caseous (curdled) node, being replaced by fibrous growth and forming calcifications, which are found on the X-ray of the lungs.
Secondary pulmonary tuberculosis develops in patients who previously had tuberculosis and is called miliary. With this type primary focus scarred and calcified, but with certain conditions, can break through lung tissue or blood to carry mycobacteria to other organs and systems of the body (bones, brain, spleen, liver). The miliary infection got its name because the tissue of organs affected by tuberculosis looks like millet grains. On x-rays of the lungs, this is very clearly visible.

Open tuberculosis is not subject to self-treatment which in any case will be ineffective. It involves therapy in a specialized department of a tuberculosis dispensary for six months (with the help of 4-5 different types medicines), which can take years. With timely access to a doctor and the fulfillment of all prescriptions, the prognosis open tuberculosis favorable. Otherwise, the patient may die from complications.

X-ray and computed tomography confirm the disease.

Symptoms

Clinical manifestations increase gradually. At first, the symptoms are not felt and do not cause discomfort to the sick person, but over time, a persistent dry-type cough appears, which then becomes wet. The duration of the cough symptom is three or more weeks. It is the main risk factor of the open form (with wet expectoration), since sputum contains microbes.

The patient rapidly loses weight, loses appetite, and may develop hemoptysis. The temperature rises in the evenings to subfebrile figures, there is weakness and lethargy. Miliary form of secondary tuberculosis progresses for several months Begins aggressive current disease characterized by the following symptoms:

high fever up to 39°C;
night sweats;
persistent dry cough, especially in the morning and at night;
pain syndrome in the joints and behind the sternum;
pallor of the skin.

Then the general tone of the body decreases and the gastrointestinal tract is upset.

After contact with a patient with tuberculosis, you need to pay attention to changes in your general condition, come for a consultation with a phthisiatrician, especially if the communication was long.

In order not to get infected, you need to eat rationally, do not smoke, increase immunity, take vitamins, avoid close contact with tuberculosis patients, and also not refuse annual medical examinations and do a fluoroscopy. Advice from an experienced phthisiatrician: before visiting public places, it is advisable to eat a hearty meal. Koch's wand more easily infects the body of people who forget to eat on time ("loves hunger").

Signs of open tuberculosis

The moment from the time Mycobacterium tuberculosis enters the body to the development of signs of the disease is approximately 2-3 months. Confirm the diagnosis - fluorography, X-ray, CT.

Signs of open tuberculosis are: clinical (symptomatic), laboratory (the pathogen is detected in the analyzes) and radiographic (all signs of tuberculosis are present - a blackout focus, the presence of cavities different sizes, increased lung pattern).

Signs are detected using the tuberculin Mantoux reaction. At backlash, and a year later, positive, with an increased size of the papule, they talk about infection. In the presence of weakness, persistent subfebrile condition, felt by the patient, we can talk about signs of tuberculous intoxication. An open form may well pass almost imperceptibly with an inactive flow. But with acute fever, sweating and persistent cough more active phase infections.

The open form of tuberculosis has the following main signs, confirmed by laboratory sputum tests for the presence of bacilli or bronchoscopy:

Cough, persistent dry, then with expectoration.
Hemoptysis, which may be complicated by pulmonary hemorrhage.

If a disease is suspected after contact with a tuberculosis patient, infection can be suspected on early stage. With timely access to a doctor, tuberculosis is curable. If the patient delays treatment, then in the future, it will be much more difficult to cope with the infection. The earlier treatment is started, the greater the percentage of recovery.

Health to you!