Development of fibrous-cavernous form of tuberculosis. Fibrosis of the lungs: what is it and how to treat Contagious or not fibro-cavernous tuberculosis

The fibrous-cavernous process in the lungs is a far advanced and epidemiologically most dangerous form of tuberculosis, since patients with fibrous-cavernous tuberculosis in most cases are bacilli excretors. The initial form of fibrous-cavernous pulmonary tuberculosis can be any form of tuberculous lesions of this organ.

Most often, fibrous-cavernous tuberculosis develops from an infiltrative, less often from a disseminated and focal pulmonary process.

Fibrous-cavernous tuberculosis has specific signs, and only if they are present and severe can an appropriate diagnosis be made.

Fibrous-cavernous tuberculosis is characterized by the presence of a cavity with a pronounced fibrous capsule, fibrous changes in the lung on the side of the localization of the process, displacement of the mediastinal organs to the diseased side, bronchogenic dissemination in the lungs and the duration of the disease.

The destruction of lung tissue and the formation of a cavity can be observed in any clinical form of tuberculosis, but the transition to the fibrous-cavernous form is proved not by the fact of destruction, but by a change in the nature of the morphological process in the cavity and in the lung and often by a change in the entire clinical syndrome of the disease.

Pathological changes in the lungs with fibrous-cavernous tuberculosis are very characteristic. On fig. 42 (pathoanatomical preparation) one can see an isolated cavity on the left with a wide tortuous draining bronchus and foci of various sizes and density; cicatricial changes and single foci are visible in the apex of the lung on the right; in the lower lobe there is a group of foci.

The above illustration cannot give a complete picture of the whole variety of changes in the lungs in fibrous-cavernous tuberculosis, but only clearly demonstrates the characteristic features of this form: the presence of an old cavity, the development of connective tissue and bronchogenic metastases in various parts of the lungs.

The clinical diagnosis of fibrous-cavernous tuberculosis in most cases is not difficult, as there are a number of symptoms characteristic of this form of tuberculosis, but in some cases these symptoms are not very pronounced or are incorrectly interpreted.

Clinical manifestations and a variety of symptoms depend on the prevalence of the process, its localization, complications and concomitant diseases.

In the anamnesis of most patients with fibrous-cavernous tuberculosis, there are indications of a long and often undulating course of the disease, i.e., a change in periods of exacerbation of tuberculosis with periods of clinical well-being. The intervals between these periods can sometimes be very long, and in a number of patients, on the contrary, short-term.

Symptoms of fibro-cavernous tuberculosis are cough, sputum production, chest pain, weakness, weight loss, poor sleep and appetite, hemoptysis, fever, sweating during sleep at night.

Each patient may have one or another of the listed symptoms, and in different periods of the disease, the severity of the symptoms may be different.

The most common symptom is cough. It can be insignificant in some periods of the disease and disturb the patient a little, in others - painful, not stopping from taking various medicines. A painful cough develops mainly as a result of tuberculosis of the bronchi, which is often observed in fibrous-cavernous tuberculosis. Patients with fibrous-cavernous pulmonary tuberculosis may have a large amount of mucopurulent sputum, mostly viscous, separated with difficulty. The patient is forced to cough repeatedly and for a long time in order to excrete 30-50 ml of sputum.

Rapid fatigue and general weakness are usually observed during the period of exacerbation of the fibrous-cavernous process.

In patients with fibrous-cavernous tuberculosis, during the period of remission of the process, the body temperature may not rise, despite large changes in the lungs. More often, normal body temperature is observed with the development of fibrotic changes. The occurrence of infiltrative paracavernous changes, as well as bronchogenic metastases, is accompanied by severe fever. With the formation of pneumonic areas in the lungs, the body temperature reaches high numbers and lasts a long time. In patients with large and giant caverns containing a large amount of pus, caseous masses and abundant microbial flora, high body temperature can be recorded as a result of a secondary infection on the body and, to a lesser extent, due to tuberculosis.

Hemoptysis and pulmonary bleeding are common symptoms of fibro-cavernous tuberculosis. It is with this form that abundant, sometimes prolonged and life-threatening pulmonary hemorrhages occur. Complications of pulmonary bleeding from aspiration pneumonia also occur more often in patients with fibrous-cavernous tuberculosis than in other clinical forms of this disease.

When examining patients suffering from fibrous-cavernous pulmonary tuberculosis, one can sometimes note a normal appearance, the correct configuration of the chest, satisfactory and even good development of the subcutaneous fat layer, but more often the appearance of the patient still has characteristic features for a chronic tuberculous process.

The duration and extent of the pathological process in the lungs and pleura, the presence of chronic intoxication lead to a change in the external appearance of the patient. A significant loss of body weight, a wrinkled face, a dull look, dry, flaky skin, weakly expressed muscles are characteristic of a patient suffering from extensive pulmonary tuberculosis for a long time. Retraction of the supraclavicular and subclavian spaces, retracted intercostal spaces, an acute epigastric angle, a flattened and elongated chest, lagging behind one half of it when breathing, and sometimes a sharp flattening of the same side indicate large changes in the lungs and pleura on the side of the lesion.

Habitus phthisicus is observed most often in patients with fibrous-cavernous and cirrhotic pulmonary tuberculosis.

When percussion in patients, a shortening of the sound is determined in places of thickening of the pleura and extensive development of fibrosis in the lungs, as well as over massive infiltrative and pneumonic foci.

In areas of fibrous compaction of the lung and pleural thickenings, weakened breathing is heard, over massive infiltrative-pneumonic foci - vesico-bronchial, over a large cavity (4-6 cm in diameter) with wide draining bronchi - bronchial, and with a smooth-walled giant cavity (more than 6 cm in diameter) - amphoric. Above the cavity, large-bubble voiced moist rales are also heard.

Over small caverns or deep-seated rales, the sonority of wheezing will be less. With a thick consistency of the contents of the cavity, wheezing can be heard only at the height of inspiration or, conversely, when coughing, that is, with forced exhalation. Directly around the cavity, the patient may develop a zone of infiltrative changes in the lung tissue. On auscultation, small bubbling and less often medium bubbling wet rales are heard in these areas.

The number and sonority of large-bubbly moist rales that occur in the cavity decrease as the liquid content of the cavity decreases, and, finally, when the walls of the cavity are cleaned and epithelialized, the rales disappear, although the cavity has not closed. When the cavity is closed and scar tissue forms in its place, catarrhal phenomena disappear. Above the old cavity with a cirrhotic capsule, often coarse rales are heard, resembling a "squeak" and "creak".

With the closure of the lumen of the bronchus, listening to all the listed signs of the cavity ceases and the cavity turns into a "silent" one. Depending on the reasons for the closure of the lumen of the bronchus, the absence of auscultatory signs of a cavity can be temporary or permanent. "Silent" cavities are determined only by X-ray examination.

Altered breathing and wheezing are also not audible over deep-seated caverns in a fibrous-altered lung due to a massive layer of lung tissue and a thickened pleura. Such cavities are not “silent”, since the bronchi that drain them function and there are conditions for the occurrence of wheezing. There are only no conditions for the conduction of wheezing. In such cases, you can hear "oral" wheezing.

X-ray examination in most patients with fibro-cavernous tuberculosis determines various changes in the configuration of the chest and the position of the organs of the chest cavity. Pathological changes in the lungs in this form of tuberculosis can be unilateral, and if the process is bilateral, then the pathological changes are asymmetrically located.

Only in cases of development of fibrous-cavernous tuberculosis from disseminated, signs of symmetry remain. As a consequence of the extensive development of fibrous tissue in the lung, radiographically, the displacement of the mediastinal organs in the direction of the localization of the fibrous-cavernous process is very often determined.

Due to the duration of the course of fibrous-cavernous tuberculosis in the lungs and its high prevalence, changes in the pleura occur, therefore, with fluoroscopy or on an x-ray in patients with this form of the process, thickening of the pleural sheets, pleural adhesions, restriction of diaphragm mobility are almost always determined. On the radiograph, you can find, in addition to cavities, heaviness from cicatricial changes in the lungs (Fig. 43).

With massive and extensive fibrous transformations of the lung parenchyma, one can see a decrease in lung volume due to its wrinkling.

Bronchogenic metastases are displayed as foci of various sizes and intensity. The cavern with fibrous-cavernous tuberculosis has characteristic features on the radiograph. Surrounded by a little elastic lung tissue, it rarely retains the correct rounded shape, may have an irregular shape, with a dense internal capsule and often with an inflammatory zone around. In one lung there can be several cavities of various sizes: gigantic, large and small.

With temporary or permanent closure of the draining bronchus, the contents of the cavity are not released through the bronchi, and the horizontal level in the cavity can be determined on the radiograph.

In the sputum of patients with fibrous-cavernous tuberculosis, a large amount of Mycobacterium tuberculosis is found. With the introduction into practice of antibacterial drugs that have a bacteriostatic effect, in fibrous-cavernous tuberculosis, sometimes a cessation of bacilli excretion is observed despite the presence of a cavity. This should be considered a positive epidemiological factor, since the use of chemotherapy drugs can maintain the state of abacillarity for a long time.

In addition to Mycobacterium tuberculosis, elastic fibers are found in sputum, and staghorn elastic fibers are characteristic of the fibrous-cavernous form.

When endoscopy of the cavity, as well as when opening the cavity surgically, you can see its inner surface. The inner surface of the cavity before treatment is an extensive ulcer, covered with dirty-gray, sometimes grayish-yellow masses, consisting of mucus, pus, fibrin clots and caseous masses. In some areas, necrosis of the lung tissue is sometimes visible. Under the influence of treatment with antibacterial drugs, the inner surface of the cavity is cleaned and the wall of the cavity becomes clean, smooth, pinkish-pale, shiny. In smears from the inner surface of the cavity in such cases, microbial flora is not detected.

In the blood of patients with fibrous-cavernous pulmonary tuberculosis, there may be changes characteristic of active pulmonary tuberculosis in general, and not for this clinical form. Anemization of the patient can occur only with abundant or prolonged pulmonary or intestinal bleeding, amyloidosis. Without these complications, no noticeable pathological changes are observed in the red blood of patients with cavernous tuberculosis. Significant changes can be observed in the white blood of the patient. During an exacerbation of tuberculosis, the number of leukocytes increases to 10 10 9 / l - 12 10 9 / l (10,000-12,000 per 1 mm 3 of blood). Higher leukocytosis in patients with fibrous-cavernous tuberculosis is observed with secondary infection of the contents of the cavity. With the elimination of nonspecific inflammation and with the suppression of the secondary flora by various medicinal substances, leukocytosis also disappears. From the side of the leukocyte formula during the outbreak of the tuberculosis process, an increase in the number of stab neutrophils is noted, and the number of lymphocytes decreases in the peripheral blood; there is an increase in ESR.

In the urine of patients with fibrous-cavernous pulmonary tuberculosis, changes occur when the disease is complicated by amyloidosis of the internal organs or severe intoxication. It is with this form of tuberculosis, mainly due to the impact on the body of the joining infection, that amyloidosis most often develops compared to other clinical forms of the disease.

With a long progressive course of fibrous-cavernous pulmonary tuberculosis, pulmonary heart failure develops due to extensive tuberculous and mainly fibrotic changes developing in the lungs.

Fibrous-cavernous pulmonary tuberculosis has to be differentiated from such chronic diseases as bronchiectasis, lung cancer, pneumosclerosis of various etiologies.

These diseases have a number of very similar diagnostic features; in addition, the same person may have a mixed lung disease; tuberculosis and bornchoectatic disease, tuberculosis and cancer, tuberculosis and nonspecific pneumosclerosis.

Rarely occurring chronic lung diseases (syphilis, actinomycosis, cystic lung) also have clinical and radiological signs similar to fibrous-cavernous tuberculosis.

Clinically pronounced bronchiectasis has peculiar manifestations. The appearance of a patient with bronchiectasis differs markedly from that of a patient with fibro-cavernous tuberculosis. A puffy face, thickened lips, changes in the terminal phalanges of the fingers and toes in the form of "drumsticks" are characteristic of a patient with bronchiectasis. The amount of sputum in patients with bronchiectasis; at the same time, sputum is separated easily, it is purulent in nature and may have a putrid odor.

The rales in the bronchiectasis cavities are coarser, resembling the crunch of snow: these rales are sometimes audible at a distance of 20-30 cm from the chest. On x-ray, unfilled bornchiectasis may appear as multiple, round, thin-walled cavities. In addition to round saccular bronchiectasis, there may be cylindrical bronchiectasis.

Often, bronchography is necessary to diagnose the disease. An X-ray bronchogram more clearly reveals the location and shape of bronchiectasis and helps to establish the correct diagnosis of the disease.

Differential diagnosis between fibrous-cavernous tuberculosis and lung cancer in many cases, especially with decaying cancer, is very difficult due to the great similarity of clinical symptoms. Cough with sputum, hemoptysis, fever, chest pain, catarrhal phenomena in the lungs are observed, moreover, and another disease. One can note a significantly greater intensity and persistence of pain, a painful cough and frequent admixture of blood in the sputum in lung cancer. Characteristic of lung cancer is often observed recurrent hemorrhagic pleurisy. A more pronounced dullness of the percussion sound is noted above the canary area of ​​the lung. On the radiograph, you can find significantly more diagnostic differences between cancer and tuberculosis than with all other research methods.

The high intensity of darkening in the root zone with heaviness to the lateral parts of the lung, detected in cancer, is sometimes very similar to the massive fibrous changes in the lungs observed in tuberculosis. The absence of focal shadows in the lung, both on the side of the lesion and on the opposite side, indicates a cancerous etiology of the disease. The collapse of the lung in bronchogenic cancer occurs only in an advanced stage of the disease.

Pneumosclerosis of non-tuberculous etiology may present with symptoms similar to those of fibro-cavernous tuberculosis. Pneumosclerosis can develop after exudative pleurisy, traumatic injuries of the chest organs, lung abscesses and other inflammatory processes in the lungs and pleura.

Radiologically with pneumosclerosis, homogeneously darkened areas of the lung can be detected. The absence of focal shadows and visible caverns, the uniformity of darkening are the basis for the X-ray determination of pneumosclerosis and the denial of the diagnosis of fibrous-cavernous tuberculosis. Mycobacterium tuberculosis is absent in the sputum of patients with pneumosclerosis.

Actinomycosis of the lungs is a rare disease; it has symptoms similar to those of fibro-cavernous tuberculosis. Prolonged fever, persistent chest pain, cough with sputum, frequent hemoptysis are typical of actinomycosis. The pathological process in most cases spreads from the pleura and peripheral parts of the lung to the center. The superficially located actinomycotic process causes a sharp compaction and soreness of the tissues of the chest wall, followed by the formation of fistulas.

On the radiograph with actinomycosis of the lung, large, merging foci of compaction can be seen, sometimes with areas of enlightenment in them, heaviness and wrinkling of the affected lung, massive thickening of the pleura.

For differential diagnosis between actinomycosis and pulmonary tuberculosis, the detection of radiant fungus drusen in the sputum, the causative agent of actinomycosis, is of paramount importance.

In the differential diagnosis of fibrous-cavernous tuberculosis, it is necessary to exclude cystic formations in the lungs. The rounded outlines of the cyst are very similar to the display of the cavity on the radiograph.

In the vast majority of cases, patients with cystic lung do not complain and cysts are found during an accidental examination of the patient or in connection with any disease.

Treatment of patients with fibrous-cavernous tuberculosis should always be long, continuous and complex. With this form of pulmonary tuberculosis, in most cases it is impossible to limit oneself to any one treatment method. The task of the doctor in the treatment of fibrous-cavernous tuberculosis is the correct combination of several methods and means and the timely transition from one method to another, for example, from therapeutic (antibacterial) treatment to surgical, from hospital to sanatorium and resort-climatic.

Before the introduction of antibacterial drugs into practice, cavern closure and sputum abacillation occurred in a small group of patients, mainly with the use of collapsotherapy and extrapleural surgical treatment.

At present, with the use of antibacterial drugs and operations on the lungs, it has become possible to cure many patients with fibrous-cavernous tuberculosis.

Treatment begins in a hospital setting. Until the elimination of severe clinical symptoms, all three main drugs are used: streptomycin or rifadin, isoniazid and PAS. After the disappearance of symptoms of intoxication, treatment with isoniazid and PAS should be continued in combination with second-line drugs. In many patients, after 6-7 months of chemotherapy, bronchogenic metastases disappear, the size of the cavity decreases. In such cases, surgical treatment is necessary. For some patients, after treatment in hospitals, sanatorium treatment, and then treatment on an outpatient basis, may be recommended. With this scheme, the patient is treated for 3-4 months in a hospital, 2-3 months in a sanatorium and 6-8 months on an outpatient basis.

Naturally, the treatment should be individualized depending on the severity of the course of the process, its prevalence, as well as on the tolerability of chemotherapy drugs and the sensitivity of Mycobacterium tuberculosis to them. In patients with fibrous-cavernous pulmonary tuberculosis, side effects are often observed when using antibacterial drugs and resistance to them of Mycobacterium tuberculosis is formed, therefore, along with the main antibacterial drugs, it is necessary to use second-line drugs in various combinations. It is possible to enhance the effect of anti-tuberculosis drugs by their intravenous and intratracheobronchial administration in combination with pathogenetic therapy, which increases the permeability of histohematic tissue barriers, facilitating the penetration of tuberculostatic drugs into tuberculous foci. Complex antibacterial treatment is carried out against the background of restorative therapy and a sanatorium-hygienic regimen.

With all types of treatment, the healing of a cavity with a dense fibrous capsule occurs slowly, and such a cavity never disappears without a trace. Under the influence of antibiotic therapy, extrapleural operations, a stellate (rarely linear) scar or a dense focus remains at the site of the cavity.

In some cases, under the influence of antibacterial drugs, the inner wall of the cavity is cleaned, epithelialized and the cavity is likened to a cyst, the so-called open cure of the cavity occurs.

The cleansing of the cavity can be considered a favorable result of antibiotic therapy, but temporary, since Mycobacterium tuberculosis can still remain in such a cyst-like cavity, which, under certain conditions, can later give rise to new outbreaks of tuberculosis with a recurrence even of bacillus excretion. In addition, such cavities can be secondarily infected with a variety of microflora or pathogenic fungi - aspergillus. It is always necessary to strive to eliminate the cavity.

Collapse

Tuberculosis can occur in various forms and forms, depending on the type of pathogen, the route of entry into the body and the individual characteristics of the person. Fibrous-cavernous tuberculosis is one of the fairly common forms of pathology due to the fact that it can develop with any strain of the pathogen and regardless of how the pathogen entered the body. In this material, we will consider how this pathology manifests itself, what clinical picture it forms, and how to cure it.

Definition

This condition is considered quite common. Fibrous-cavernous tuberculosis is a form of pathology in which a cavity surrounded by fibrous walls forms in the patient's lung tissue. Why does such a cavity appear? Under the action of pathological mycobacteria in the lung, its tissues disintegrate, resulting in the formation of a specific cavity - a cavity.

At the initial stages of its formation, it is in no way delimited from the lung tissue, that is, it is present directly in it, but over time, the cavity forms first two-layer and then three-layer walls, closing and delimiting from the lung tissue.

Depending on the characteristics of the process, such a cavity can be filled with both caseous contents (destroyed lung tissues) and air.

The walls at the initial stage of cavity formation are elastic and thin, they have two layers - pyogenic and granulation. But with fibrous tuberculosis, many connective fibers form in the lungs, which form a thick and inelastic fibrous wall around the cavity, completely isolating it. At the same time, an excess of fibrin also affects other parts of the organ - the affected lung tissue is replaced by fibrous tissue.

In general, it can be noted that this is a fairly frequent and not the most favorable type of tuberculosis precisely because of the activity of fibrin in tissue replacement and the formation of adhesions. Caverns do not form immediately, usually they appear only for 3-4 months of ineffective treatment or its absence. Their presence does not indicate a specific type of tuberculosis, but a regular stage in the development of pathology.

The reasons

Fibrous tuberculosis develops as a result of the body's own peculiarity - a tendency to excessively active production of fibrin. The appearance of cavities, as mentioned above, occurs over time, as more and more lung tissue is destroyed. Why does tuberculosis develop? The pathogenic bacterium enters the body from the outside, secreted by a sick person, and this can happen in several ways:

1. Airborne (when coughing, sneezing);
2. Air-dust (when inhaling dust, on which particles of the patient's saliva have fallen);
3. Contact-household (when using common textiles, dishes, etc. with a sick person).

Secondary ingestion of bacteria is also possible, for example, if intestinal tuberculosis has developed, then many pathogenic bacteria are released into the blood and lymph, which spread throughout the body and enter, including the lungs. But this is a rather rare scenario, since, usually, everything happens the other way around, and it is the lungs that are affected first, but secondary foci occur in other areas.

Thus, the question of whether such tuberculosis is contagious or not can be answered unambiguously in the affirmative. Any pulmonary tuberculosis is contagious, regardless of the form and type of its course.

Groups and risk factors

Risk groups are groups of people who are more likely than others to develop the disease. With regards to cavernous fibrous tuberculosis, the following risk groups are distinguished:

1. People who have not been vaccinated with the BCG tuberculosis vaccine;
2. Those who live together with the sick person or otherwise had contact with him;
3. Employees of medical institutions of anti-tuberculosis orientation;
4. Livestock workers, since cattle also suffer from the disease, and it can be successfully transmitted from livestock to humans;
5. People who suffer from immunodeficiency conditions (including HIV) and have weak immunity.

Risk factors that increase the likelihood of developing the disease are poor living conditions, excessive physical activity, poor-quality, unbalanced or insufficient nutrition, and bad habits.

Symptoms and signs

At the initial stage, fibrous-cavernous pulmonary tuberculosis proceeds as simple tuberculosis and gives general symptoms, such as:

1. Elevated temperature (subfebrile in chronic course, very high in acute);
2. Weakness, fatigue, increased fatigue and pallor, anemia;
3. Increased sweating, especially at night;
4. Symptoms of intoxication (especially pronounced in the acute course of the disease);
5. Dry cough;
6. Pain in the lungs.

When the cavity is formed, no other symptoms appear, specific symptoms are detected only at the stage of its decay. At this time, moist rales are heard in the lungs, an admixture of blood appears in the sputum, possibly hemoptysis. In the future, the cavity may form and close, and all these specific symptoms will disappear.

Diagnostics

At the stage when caverns appear, tuberculosis is usually already diagnosed, and the patient is already registered with a phthisiatrician. The formation of the cavity is visible on the radiograph, usually it turns out to be a unilateral process. To diagnose this type of tuberculosis, the following methods are used:

1. Inspection;
2. Medical history and history taking;
3. radiograph;
4. Bacteriological examination of sputum;
5. Tuberculin tests;
6. General and biochemical blood test;
7. ELISA blood test, etc.

But often, if tuberculosis has already been diagnosed, then the appearance of caverns becomes apparent when blood appears and the cough acquires a wet character.

Treatment

Treatment of this pathology, most often, is carried out exclusively with medication. Usually, the use of specific chemotherapy is sufficient. But in some cases it is not possible to avoid combined treatment. With this approach, in addition to medications, surgical methods are also used. But such an intervention is shown quite rarely, since it is often impossible to perform it in full.

The therapy is long and is divided into inpatient, spa and outpatient periods. All of them are very important.

Medical

The average duration of therapy for tuberculosis is one and a half years, but it can last from six months to two years. At this stage, drug treatment is applied, represented by a complex of specific drugs. Usually, at first there are three of them - isoniazid, rifampicin, streptomycin or their analogues. But if caverns appear at 3-4 months of treatment, then this indicates that the effectiveness of the treatment is not too high, and a fourth drug is prescribed - pyrazinamide or its analogue. Completely treatment in this case is not replaced.

Additionally, agents that reduce the active production of fibrin and corticosteroids are prescribed. At the same time, the first improvements may occur after 3-4 months of therapy - the cavities will close and decrease.

At the recovery stage, spa treatment and physiotherapy are indicated. They, in combination with massage and therapeutic exercises, contribute to the resorption of excess fibrous tissue.

If the initial stages of treatment are carried out in a hospital, then the further stages can take place in isolation at home, then the patient can be treated completely on an outpatient basis. But he remains registered with a phthisiatrician for about two more years. It is removed from the register when there are no signs of tuberculous lesions, as well as its consequences.

Surgical

Surgical treatment can also be carried out if there is an indication for this. It is not used very actively, but can be used with significant lesions. Most often, an artificial pneumothorax is used. Occasionally, lung resection may also be involved, but this is the exception rather than the rule.

The most common manipulation is the sanitation of the cavity. It is used only for large formations, when the likelihood that resorption will occur is minimal. In this case, caseous and granular contents are removed from the cavity by the methods of low-traumatic surgery, and it is sanitized. After that, the cavity closes and is no longer a source of infection, although it may be visible on the radiograph permanently.

Forecast

Fibrous pulmonary tuberculosis is not the easiest form of the disease, however, it can have a fairly favorable prognosis. But only if the diagnosis of tuberculosis and the start of treatment were timely, and then, in time, the formation of caverns was noticed (that is, the low effectiveness of treatment) and an additional drug was prescribed. In most cases, the disease ends with a complete recovery after two years, with a significant improvement in the condition after about 4 months.

Effects

Any serious consequences and complications are extremely rare. Of the more frequent consequences, one can single out the preservation of a closed sanitized cavity in the lung. In addition, during treatment, a negative reaction to the drugs may develop. Sometimes they cause severe dysbacteriosis and an allergic reaction.

As for severe complications, suppuration of the cavity, the formation of pseudotuberculoma, and the development of an abscess are extremely rare. Complications of this nature sometimes occur regardless of the actions of doctors and

Prevention

All prevention of this disease can be divided into two subspecies - specific and nonspecific. Specific protects against tuberculosis and acts directly. It includes vaccination with the BCG vaccine, limiting contact with the sick, conducting chemoprophylaxis for family members of the sick, doctors and workers of the livestock complex. Educational activities about tuberculosis also belong to this group.

Non-specific preventive measures include those that protect the body in a complex and indirectly protect against tuberculosis. These are activities aimed at strengthening immunity, improving living conditions and nutrition quality, giving up bad habits, etc.

Conclusion

Sometimes fibro-cavernous tuberculosis in a patient develops regardless of his actions and the actions of doctors. But it is very important to diagnose it in time to adjust the treatment regimen. Therefore, patients with tuberculosis should be attentive to their well-being.

Fibrous-cavernous pulmonary tuberculosis refers to diseases of a long course. Diseases are:

• periodic remissions and exacerbations;
• the presence of several chronic foci of tissue necrosis;
• deformation of the pleura and lung.

Development of the disease

The disease is provoked by acid-resistant Mycobacterium bacteria. Medical practice has about seventy-four varieties. Tuberculosis provocateurs live in living organisms, land and water. You can get sick with a reduced function of the immune system.

The indisputable species characteristic of the fibrous-cavernous bacterium is pathogenicity, manifested in the ability of the infection to infect the human body.

This ability, in direct proportion to the impact of the external environment and the manifestation of the disease, allows you to change shape. In the lungs infected with bacteria, inflammation and swelling progresses. The disease has a necrotizing form.

The cavernous form is manifested by the next stage in the development of tuberculosis - an infiltrative form that is easily diagnosed and occurs against the background of inflammatory phenomena. it is impossible to get infected from the outside, this is the result of a long action of pathogenic factors and a primary infection.

In small doses, bacteria are present in the body of every healthy person. The difference with fibrous-cavernous tuberculosis is that in the latter form there are focal manifestations of bronchogenic screening of the old type. First of all, the lesion concerns the bronchi.

With fibrous-cavernous tuberculosis in the lung tissue occur:

• fibrinous sclerosis;
• tissue rejection;
• there is increased airflow.

The diagnosis of patients with fibro-cavernous manifestations of the lungs is accompanied by complaints about the duration of the course of the disease and, regardless of treatment, short periods of remission. Indeed, the disease has a tendency to undulating course. Some patients tolerate the disease easily without experiencing side effects.

Doctors know two forms of manifestation of fibrous-cavernous tuberculosis:

A sharp thinness sets in, muscle atrophy is present, the skin becomes dry, bruises appear under the eyes. Outbreaks of the disease provoke the development of pulmonary insufficiency of the second and third degree, the skin acquires an earthy color. As the disease progresses, the liver enlarges.

Diagnostics

Previously, before the use of chemotherapy by physicians, the average life expectancy of patients was limited to three years. The process was considered irreversible and compared to lung cancer. In our years, there are all possibilities to prevent the development of the fibrous-cavernous process. To do this, an x-ray of the lungs must be included in the list of mandatory preventive examinations.

With negative images, regardless of the timing and form of the disease, a trusting contact should be established between the doctor and the patients. All prescriptions and prescriptions of the doctor must be strictly observed by the patient, only the outcome of the treatment of the disease depends on this.

Nowadays, fibrous-cavernous pulmonary tuberculosis is quite easy to diagnose. However, the age of the patient must be taken into account. In elderly people, the disease can be diagnosed as pneumonia, chronic bronchitis. Consequently, the diagnosis can be made incorrectly and, as a result, treatment is incorrectly prescribed.

To exclude this situation, the patient should be ensured that he undergoes additional studies:

• sampling for presence;
• lung x-ray was performed.

Regardless of the fact that the prescribed treatment of patients with tuberculosis of this form with antibacterial agents often leads to remission and increases the duration and quality of life, the prognosis remains disappointing, because, in old age, the protective functions of the body do not work to the full extent.

Patients with chronic fibro-cavernous pulmonary tuberculosis are conditionally divided into groups. Patients with a unilateral isolated cavity, which is formed after prolonged therapy with antibacterial drugs, deserve special attention.

Such patients often undergo surgical manipulations:

• resection;
• excretion of sputum.

For the purpose of diagnosis, a pleural puncture can also be performed. It detects the composition of sputum and abscesses. Microscopic examination in the laboratory reveals the predominance of lymphocytes, up to eighty-five percent of the content. Mycobacterium tuberculosis in the fluid taken for a sample is rarely detected, but using the enrichment method, it is not difficult to identify them.

It should be noted that the danger of an epidemic of this disease is high. It is aggravated by the fact that patients often become addicted to antibacterial agents and at this stage it is important to notice in time that the healing process does not bring any effect and take appropriate measures.

Failure to comply with these measures can lead to the spread of infection.

With a disease in the blood:

• a shift of neutrophils to the left is detected;
• the erythrocyte sedimentation reaction is accelerated.

Treatment and prevention of the disease

Is this disease curable or not? The use of complex treatment with the use of endocrine drugs and antibiotics relatively quickly leads to the resorption of excess. If there is a lot of fluid in the lungs, it is pumped out.

As antibiotics, one gram of Streptomycin, half a gram of Ftivazid, twelve grams of PAS are prescribed (twice a day after meals). To receive endocrine drugs write out:

• thirty grams per day ACTH;
• ten grams of prednisolone twice a day.

Treatment continues for three weeks. In this case, the patient is placed in the clinic under the supervision of a phthisiatrician. A prerequisite for the successful treatment of the diseased is the rejection of bad habits, such as alcohol and smoking.

Fibrous-cavernous pulmonary tuberculosis in advanced forms is also able to be cured well. Treatment is carried out by long, continuous and complex courses. The patient's intolerance to some antibacterial drugs should be taken into account by the doctor, and second-acting drugs should be selected instead.

The healing process of cavities with a fibrous wall is slow, but gives good results. When indicated, surgical intervention is added to the course treatment.

The lung is cut to a certain extent. On the second day, the patient is transferred to the intensive care unit. A good result is achieved with a one-sided process and good indicators of the body's immune defense. The rehabilitation process is no more than twenty-one days.

After discharge, the patient remains able to work, and most importantly, his life expectancy is significantly increased due to the fact that the release of mycobacteria by the affected area stops.

Tuberculosis ranks first in the list of social diseases. Its manifestations directly depend on the standard of living of a person. The main reasons for the unfavorable epidemiological state of tuberculosis in the Russian Federation are a significant deterioration in the living standards of the population, a significant deterioration in social and economic conditions, an increase in unemployment and the number of people without a fixed place of residence.

The deterioration of the unfavorable background is exacerbated by the ongoing migration processes, which reached their peak in 2016.

To prevent fibro-cavernous pulmonary tuberculosis, on an epidemic scale, everyone needs to take a number of measures:

• passing preventive examinations;
• general medical examination of the population at the place of registration and residence.

These activities will help reduce outbreaks. Children of the first year of life, as well as 7 and 14 years of age, are vaccinated with BCG. For the same purpose, mandatory preliminary and periodic inspections are shown when hiring.

This is especially true for the reception of employees involved in animal husbandry, food production and service. Persons suffering from an active form of tuberculosis must be isolated from healthy ones. Many dispensaries and clinics have been built for these purposes.

It is worth saying that the implementation of these rules does not guarantee one hundred percent safety from infection, however, it significantly reduces the risks and even with infection and the development of the disease, it helps to minimize complications.

Fibrous-cavernous pulmonary tuberculosis is a chronically occurring form of the disease, in which there is a formation of a cavity in the lungs and the growth of fibrous tissue around this neoplasm. According to statistics, a similar form of tuberculosis is observed in 10% of people suffering from this disease.

This form of the course of the disease is considered extremely dangerous, since during the development of cavities, too much healthy lung tissue can be converted into fibrous foci, which can lead to a violation of the respiratory process. Usually, the development of this form of tuberculosis is observed in patients who do not receive the necessary care and treatment and at the same time lead an asocial lifestyle that aggravates the course of the disease.

Etiology and pathogenesis of development of fibrous-cavernous tuberculosis

The main reason for the development of fibrous-cavernous pulmonary tuberculosis is the damage to the lung tissue of one of the varieties of mycobacteria that can cause the development of the disease in humans. It is far from always possible to determine by external signs whether a patient with tuberculosis with this form is contagious or not. In most cases, the spread of mycobacteria occurs during an exacerbation of the disease and the appearance of a severe cough, along with which pathogenic microorganisms can also spread. Since the exacerbation of this form of tuberculosis in most patients is observed constantly, but has short periods of remission, such people can be contagious.

• irrational nutrition;
• addiction to alcohol;
• addiction;
• reduced immunity;
• increased physical activity;
• hypothermia;
• chronic lung diseases.

Fibrous-cavernous pulmonary tuberculosis is a kind of complication of the course of a milder form of the disease. The pathogenesis of the development of fibrous-cavernous pulmonary tuberculosis is currently fully understood. It is believed that after a certain time, infiltrated tuberculosis creates favorable conditions for the formation of a cavity. In addition, in some cases, a hematogenous disseminated form of tuberculosis can become a source of formation of cavities. As fibrotic processes develop in one or both lungs, the formation of one or more cavities may occur.

The cavity is a rather specific formation in the lung tissue. The walls of such a neoplasm have a complex structure, consisting of 3 main layers: fibrous, cavernous and granulation. A mature cavity has a very thick fibrous layer, so the density of the cavity is very similar to that of cartilaginous tissue. Around the cavity, there is an overgrowth of fibrous tissue, and in the vast majority of cases this occurs along the bronchi or blood vessels, which leads to compression of normal lung tissue and disruption of its functioning.

Considering that fibrous-cavernous pulmonary tuberculosis proceeds in a chronic form, the cavity of the cavity cannot be cleaned, respectively, favorable conditions are created for the development of necrotic processes, which often affect blood vessels. Thus, with this form of tuberculosis, the risk of developing pulmonary hemorrhages is extremely high. In addition, with fibrous-cavernous tuberculosis, other morphological changes in the lung tissue may also appear, for example, emphysema, bronchoecstasis, pneumosclerosis, etc.

Clinical picture in fibrous-cavernous tuberculosis

Symptoms of fibrous-cavernous pulmonary tuberculosis are extremely diverse. This form of tuberculosis can proceed according to 2 main scenarios: limited and progressive. A limited variant of the course of tuberculosis, as a rule, is observed against the background of successful chemotherapy. In this case, for several years, symptomatic manifestations indicating an exacerbation of the disease may be absent. The progressive form of the course of the disease, as a rule, is accompanied by frequent relapses of the acute course of the disease, and the periods of improvement over time are significantly reduced. The characteristic symptomatic manifestations of an exacerbation of a disease such as fibrous-cavernous pulmonary tuberculosis include:

• increase in body temperature;
• prolonged hacking cough;
• wheezing;
• asthma attacks;
• significant loss of body weight;
• increased sweating;
• severe weakness;
• hemoptysis.

As the disease progresses, as a rule, the patient's chest becomes barrel-shaped, there is a pronounced atrophy of the muscles of the back and intercostal group. One of the most dangerous complications of the course of this form of tuberculosis is extensive pulmonary bleeding, since in the absence of timely assistance, the patient can suffocate in the shortest possible time.

How is fibro-cavernous tuberculosis diagnosed?

Diagnosis of fibrous-cavernous pulmonary tuberculosis is currently not very difficult. Due to the fact that usually patients with this form of tuberculosis already had a previously diagnosed diagnosis confirming the defeat of the respiratory organs by mycobacteria, when a patient is treated, a pulmonologist should first of all take an anamnesis and percussion of the lungs. With fibrous-cavernous tuberculosis, a shortening of the sound is clearly audible in places of thickening due to the formation of cavities. In addition, with this variant of the course of tuberculosis, a shortening of the percussion sound may occur, which in the vast majority of cases is associated with the spread of an additional infection due to a decrease in local immunity of the tissues of the affected lung.

Despite the fact that listening to the lungs provides enough information to the pulmonologist about the nature of the existing damage in the lungs, additional studies are often required to clarify the clinical picture of the course of the disease. First of all, radiography is performed, which accurately determines the location of the cavities and the spread of fibrous tissue. A blood and sputum test is also performed, establishing the presence of additional pathogenic microflora and the phase of the development of the disease. If there are complaints from other authorities, additional tests may be prescribed.

Methods of treatment of fibrous-cavernous tuberculosis

Treatment of fibrous-cavernous pulmonary tuberculosis is a significant challenge. More recently, after confirming this form of the course of the disease, the life expectancy of patients did not exceed 2-3 years, since standard anti-tuberculosis therapy is not able to stop or at least slow down the process of formation of fibrosis foci.

Currently, the treatment of pulmonary tuberculosis occurring in this form is more effective and can significantly increase the life expectancy of patients. Since patients in the phase of exacerbation of the disease pose a danger to others, as they are contagious, treatment is carried out in a hospital in the infectious diseases department. Depending on the characteristics of the patient's condition, his motor mode is determined. In addition, a patient with fibro-cavernous tuberculosis requires diet No. 11.

Given that anti-tuberculosis drugs are ineffective in this form, chemotherapy is the main method of treatment. The chemotherapy scheme is selected for each patient individually, based on the available clinical manifestations and the general condition of the body. The combination of drugs used in chemotherapy usually includes:

1. Kanamycin.
2. Cycloserine.
3. PASK.
4. Protionamide.
5. Fluoroquinolone.

Fibrous-cavernous pulmonary tuberculosis requires a sufficiently long treatment. The main course of chemotherapy is about 15-18 months. The thing is that the cavities that form in the lung tissue heal very slowly, and if the treatment was interrupted, an exacerbation of the disease and a significant deterioration in the condition can be observed.

It is now known that if a patient has interrupted a course of chemotherapy, its resumption may no longer give the desired effect.

In the process of treatment, the therapy of concomitant deviations, which are the result of tuberculous intoxication, is also prescribed. Maintenance therapy involves the appointment of metabolite immunomodulatory and hormonal drugs. In addition, a long course of taking vitamins is required. If the healing of cavities against the background of ongoing chemotherapy is too slow, to improve the general condition, surgery may be prescribed, during which not only cavernous tissues are removed, but also foci of fibrosis. Such a reconstruction of the lungs is considered too radical a measure and is used only in very severe cases, when further progression of the disease can lead to the death of the patient. After improvement of the patient's condition, a course of physiotherapy is required. With complex treatment, the prognosis is quite favorable, but at the same time, the patient must follow all the recommendations of doctors in the future in order to prevent an exacerbation of the course of the disease.

Prevention of fibrous-cavernous tuberculosis

To prevent the development of such a disease as fibrous-cavernous pulmonary tuberculosis, it is very important to take measures aimed at timely detection and treatment of milder forms of the disease. Tuberculosis is now known to be a social disease. Most often, this disease affects people with low incomes and living in adverse conditions. Usually, the most active part of the population aged 25 to 30 years is infected, and often patients belonging to this age category do not seek medical help in a timely manner. Thus, in order to prevent the spread of tuberculosis and the development of its complications, all people at risk must:

• timely preventive examinations;
• undergo fluorography at least 2 times a year;
• do not contact with carriers of an open form of tuberculosis;
• lead an active lifestyle, including sports and proper nutrition;
• engage in hardening of the body.

This video talks about the disease of tuberculosis and its prevention:

Despite the fact that preventive measures do not allow 100% to exclude the possibility of contracting tuberculosis, nevertheless, these measures help to detect the disease in a timely manner and carry out directed treatment of the disease, preventing its transition to more severe forms.

• Pathogenesis of development of fibrous-cavernous tuberculosis
• How is fibro-cavernous tuberculosis diagnosed?
• Treatment of fibrous-cavernous tuberculosis

Fibrous-cavernous is a chronic form of the disease, accompanied by the appearance of cavities surrounded by tissue of fibrous origin, as well as degenerative changes in the surrounding surfaces of the lungs. Among other varieties of tuberculosis, the fibrous-cavernous form occurs in approximately 5-10% of cases. Caverns, which are the main indicator of the transition of the disease to a chronic form, are formed as a result of a necrotic process occurring in the lungs under the influence of pathogenic mycobacteria.

Fibrous tissue is the result of the body's attempts to prevent the process of growth of the area of ​​necrosis. It is worth noting that fibrous-cavernous is not an independent form, but develops against the background of another type of this disease. Most often, the fibrous-cavernous form occurs against the background of infiltrating pulmonary tuberculosis. Fibrous-cavernous pulmonary tuberculosis is dangerous because it can turn into cirrhotic, accompanied by a significant replacement of healthy tissues and cause a decrease in lung volume and pulmonary insufficiency.

Fibrous-cavernous tuberculosis can develop as a result of the progression of any other form of this disease. After Mycobacterium tuberculosis enters the lungs, as a rule, minor tissue changes are observed as the disease progresses, but if adequate measures have not been taken to relieve symptoms and eliminate pathogenic microflora, the disease may be complicated by the appearance of caverns and fibrous tissue. In the normal course of the disease, cavities usually do not scar, so they do not cause significant damage to the lungs.

However, in the case of fibrous-cavernous tuberculosis, everything is different, since the caverns have a tendency to scarring, which provokes an uncontrolled proliferation of connective tissue. Over time, the processes of growth of fibrous tissue lead to deformation of the caverns themselves. This process is known in medical practice as the aging of caverns, since it is extremely long in time and takes about 1.5-3 years. Thus, fibro-cavernous tuberculosis is diagnosed when several cavities are found in one or both parts of the lungs, surrounded by a significant ring of fibrous tissue that has replaced the normally functioning lung. The wall of the old cavity has a three-layer structure, including:

• caseous layer;
• granulation layer;
• fibrous layer.

Despite the complex structure, it must be taken into account that in fibrous-cavernous tuberculosis, fibrous tissue still prevails, due to which the walls of the cavernous formation have a density similar to cartilage. In addition, there are always areas of growth of fibrous tissue around the neoplasm, spreading to the bronchi and blood vessels, which contributes to a strong deformation of healthy cells. The form of cavernous formations can be:

• rounded;
• slit-like;
• geometrically incorrect.

In rare cases, cavities can be represented by a complex system of cavities and be complicated by damage to the bronchi that conduct their drainage.

A detailed examination of the cavity reveals that the caseous layer in this form of the course of the disease does not resolve, as is often the case with other variations of pulmonary tuberculosis.

In this case, the cavity is not cleared and continues its destructive effect on healthy lung cells. The erosive effect of the neoplasm on the blood vessels that permeate the lungs is of great danger, since if one of them is damaged, there is a high risk of developing severe pulmonary hemorrhage and asphyxia as a result.

In the event of the development of such a complication as pulmonary bleeding against the background of fibrous-cavernous lesions, in most cases, immediate surgical intervention is required, since conservative methods of exposure, as a rule, are ineffective. Fibrous-cavernous pulmonary tuberculosis develops over a long period of time, so later it can be accompanied by disseminated areas of small foci of caseous tissue, which are located outside the cavity, as well as epithelioid cell granulomas and infiltrates that do not have clear boundaries. It is these tissue changes observed in the last stages of the development of the disease that cause a strong decrease in the area of ​​\u200b\u200bhealthy lung tissue and the development of respiratory failure.

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Symptomatic manifestations of fibrous-cavernous tuberculosis

The main symptoms accompanying fibrous cavernous pulmonary tuberculosis do not differ from those that occur in other forms of this disease. Most patients complain about:

• severe cough;
• shortness of breath
• general weakness;
• the release of a large amount of sputum.

In addition, subfebrile temperature may be present for a long time. However, despite the severity of lung damage, the condition of most patients with fibrous-cavernous tuberculosis remains stable and satisfactory for a long time. The progressive stage of the development of the disease is always accompanied by:

• the strongest weakness;
• weight loss;
• increased moisture of the skin;
• acrocyanosis.

If the process of a progressive course has been going on for a long time, cachexia may develop. The chest changes its shape to a barrel-shaped one. If one lung is affected, then the subclavian and supraclavicular cavities may sink on its side, and in addition, there may be a delay in lifting the chest during breathing.

Breathing in most people suffering from fibro-cavernous tuberculosis is bronchial with obvious moist rales. In the later stages of lung damage, there may be:

• chest pain;
• cardiopalmus;
• hemoptysis;
• profuse pulmonary bleeding;
• muscle atrophy due to lack of oxygen;
• flabbiness of the skin;
• dry skin;
• muscle weakness;
• premature appearance of wrinkles.

The disease can occur in 2 main types. In some cases, after therapy, a stable remission is achieved, and the disease may stop progressing for many years. In other cases, with the help of drug therapy, it is not possible to achieve a long-term remission, so the disease constantly manifests itself with strong and long periods of exacerbation. With this variant of the course of the disease, the life of patients is significantly reduced.