Is infiltrative pulmonary tuberculosis contagious and why is it dangerous? Infiltrative tuberculosis of the upper lobe of the right lung in the phase of disintegration and seeding

Infiltrative pulmonary tuberculosis can be determined by the presence of a new formation in them, which can occupy both a small area of ​​tissue and entire lobes. You can see this by the results of x-ray or clinical examination. Moreover, the final diagnosis cannot be made only on the basis of one diagnostic method. Moreover, the final etiology of the disease sometimes remains not fully elucidated.

Infiltrative tuberculosis upper lobe the left lung is a continuation of focal pulmonary tuberculosis. In this case, both the restoration of the activity of old foci and the appearance of new ones are possible. In both cases, inflammation begins around them. lung tissue.

Very often, infiltrative pulmonary tuberculosis leads to perifocal pleurisy or to the occurrence of bronchial lesions. In this case, the infiltrate that appears can dissolve without a trace or leave behind various pathologies on the lung surface making destructive tissue breakdown inevitable. It should be explained: in this case, the disease in the stage of decay passes into the form of cavernous tuberculosis.

Let's consider the reasons. Pathologically altered thoracic lymph nodes become the source of the spread of mycotic bacteria, and in this situation, mainly the middle and lower divisions lungs.

Caseous pneumonia, caused by infiltrative changes in the lungs, is recognized International classification separate clinical type of tuberculosis.

However, there are some nuances. Is this type of tuberculosis contagious? When a patient coughs, sputum flies out of his lungs, which is actually an infiltrate, the concentration of mycobacteria in which many times exceeds all permissible norms. Even when it hits the ground, it continues to infect everyone passing by. The degree of danger of this disease should not be underestimated.

The cough of a tuberculosis patient is accompanied by the release of sputum containing many viral microorganisms that are highly contagious. If a patient with infiltrative tuberculosis expectorates discharge in the street, he exposes great danger even bystanders nearby.

There are many ways to get infected:

• by airborne droplets;
• during direct contact with the patient;
• when using contaminated hygiene items, etc.

Information about what strong immunity can protect against infection, to date, no.

Like other types, infiltrative pulmonary tuberculosis is most common among low-income segments of the population. There are many reasons for this:

1. Lack of concern for one's own health.
2. Immunity weakened by alcohol or drug abuse.
3. Non-recognition of the rules of personal hygiene.
4. Lack of medical care for children.
5. Unfavorable environment for the development of the child's immunity.

Mantoux test, mandatory for all students of educational institutions, helps to determine the presence of this disease and prevent the escalation of this phase of tuberculosis into a more dangerous one. But unfortunately, not all children from these segments of the population are covered by these samples.

Mycobacteria, as a rule, enter the human body by airborne droplets. In a new place, microorganisms behave very quietly, so the immune system does not react to their presence in any way. There are no changes in the lungs. However, the tissues themselves retain their structure.

The lull does not last long, and mycobacteria, once in the lymphatic flow, rapidly spread throughout the body. At the same time, they actively multiply, since immunity has not yet formed its attitude towards them.

Bacteria leave the lymphatic stream at the most different places body:

• lungs;
• tubular bones;
• lymph nodes, etc.

Tuberculosis in its decaying stage is a danger. Favorite places for colonies of microorganisms are tissues containing a large number of moisture. After some time, an infiltrate forms in their place.

In the phase of tissue decay, the center of such a colony undergoes necrotic decomposition, and a cavity is formed in lung tissue. Thus, a lesion appears, the contents of which soften and destructure over time. The resorption of the infiltrate is a rather rare phenomenon, it usually thickens, and the foci can be activated at any time. The reasons for the collapse are obvious.

Tuberculosis is the same age as mankind. The danger posed to people by tuberculosis was known in ancient times and they tried to do everything possible to prevent the spread of this dangerous disease. Unfortunately, this did not lead to anything, and we still periodically encounter this disease.

The weakening of immunity observed in the population has already acquired the character of an epidemic, which is very worrying for physicians around the world.

What are the risk factors? Statistics say that out of every 100 people in contact with an infected person, only 5 get sick. And all these people have weakening factors immune system:

• acquired immunodeficiency syndrome;
• diabetes mellitus;
• drug addiction and alcoholism;
• pregnancy
• constant malnutrition;
• are undergoing treatment with hormones or immunosuppressants;
• constantly experiencing stress.

Like any other disease, the phases of pulmonary tuberculosis are characterized by their individual characteristics.

1. The primary stage of the development of tuberculosis takes place against the backdrop of inactivity of the immune system, so there are no symptoms. Moreover, very often tuberculosis is limited to this phase. The disease ends in self-healing, with the formation of a small scar on the surface of the lungs. In this phase, tuberculosis may be accompanied by a slight fever and cough. intensifies general fatigue. After about 2 months, the immune system begins to consciously resist mycobacteria, and the spread of the disease stops, but the virus persists in the foci of infiltration.
2. If he manages to break out of the focus and get into one of the vessels, then many new areas of changes in the lungs appear, usually along the veins. This is manifested by the formation of specific foci of small size. Most often, one part of the lungs is affected. As a rule, tuberculosis of the right lung begins. The mechanics of its formation is described earlier. Infiltrative tuberculosis of the upper lobe of the right lung through the defeat of the bronchi makes it possible and the appearance of a similar type. There is a disease of the neighboring tissue - infiltrative tuberculosis of the upper lobe of the left lung.
3. Further changes lead to the most severe phase of tuberculosis - caseous pneumonia. This is a condition when necrosis of the foci leads to the formation of through cavities in the tissues of the lungs. This phase of tuberculosis is very difficult to treat. In an unfavorable combination of circumstances, cirrhosis of the lungs is not excluded.

In the modern medical arsenal, the tuberculin test, also known as the mantoux test, has long been the most effective way to determine infiltrative tuberculosis. Determines the presence of immunity to mycobacteria. A microscopic dose of extract of mycobacteria injected under the skin clearly shows how familiar this infection is to the body and its immune system. The amount of skin compaction and the presence of its infiltration are assessed.

Detection positive reaction for mycobacteria means the need for further examination, namely:

• bronchoscopy;
• lung tomography;
• fluoroscopy of the organ in 3 projections;
• a general blood test to determine leukocytosis, a decrease in hemoglobin and an ESR level.

Typically, the duration of treatment, depending on the phase of the disease, can last up to 1 year. The phthisiatrician will prescribe anti-tuberculosis medications:

• Isoniazid;
• Ofloxacin;
• Rifampicin;
• Ciprofloxacin;
• Ethambutol.

Complex forms of tuberculosis often require the use of entire multi-stage treatment complexes that require the use of several drugs at once.

When necrosis affects large areas of the lungs, direct surgical intervention for the opening and cleaning of foci of tuberculosis. Such interference continues until complete resorption of infiltrates. Even after this, one should undergo anti-relapse treatment for some time and be regularly shown to a phthisiatrician.

Preventive measures

To avoid such serious illness should be taken in multiple steps. These steps in medicine are usually divided into primary and secondary.
Primary prevention measures include the following:

1. Regular nutritious meals.
2. Sufficient amount of vitamins and minerals in the diet.
3. Rejection of bad habits.
4. Strict observance of the canons healthy lifestyle life.
5. Regular exercise.
6. hardening.

Secondary methods:

1. Systematic medical examinations.
2. Exclusion of any possibility of contact with tuberculosis patients.
3. Compliance with hygiene rules.

Treatment of infiltrative pulmonary tuberculosis: small foci with infiltrates have a generally favorable prognosis. If scars, fibroses, tuberculomas and other changes in the lungs have already been formed, it becomes only relatively safe. The presence of caverns makes the prognosis of treatment rather unfavorable. It will be very difficult to stop the transition of the disease to the fibrous-cavernous stage.

In any case, treatment should be completed with a course of sanatorium-resort activities, including therapeutic gymnastics, breathing exercises and diet therapy.

Pulmonary tuberculosis is a very serious disease that humanity has not been able to cope with for several millennia, and it is not worth experiencing its symptoms. It is much easier to perform those simple preventive measures to help avoid it. Having found at least the slightest sign of illness, at least contact a therapist who will prescribe a further examination.

The main pathological process of tuberculosis is inflammation, which also consists in the formation of a tuberculous granuloma, or tubercle (infiltrate). Focal inflammation is accompanied by proliferation of connective (fibrous) tissue. The tuberculous focus may undergo cheesy or caseous decay, in which cavities (cavities) are formed. With exudative inflammation, serous exudate is secreted into the alveoli and pneumonia develops. Sometimes tuberculous pneumonia proceeds acutely with subsequent cheesy disintegration of the lung tissue (transient consumption).

Occurs with progression various forms pulmonary tuberculosis. In this case, softening and subsequent disintegration of tuberculous foci occurs with the formation of cavities (cavities), mainly in the upper lobes of the lung. If the cavity is located superficially and communicates with the bronchus, then it is quite accessible to diagnosis by listening, percussion (tapping with a finger), and other simple tricks. If the cavity lies deep in the tissues of the lung, besides being small in size, then wheezing is heard only after coughing at the height of inspiration. But this phenomenon is also absent if the draining bronchus is closed. Such blocked cavities, even of considerable size, remain “silent” for a long time. Sometimes at the lower edge of the cavity there is a shadow of the liquid, which shifts when the position of the patient changes. This symptom, associated with a violation of the drainage function of the bronchi, acquires an important diagnostic value with unclear contours of the caverns.
Recognition. With blocked or healed caverns, in which the inner membrane has been torn off, there are no Mycobacterium tuberculosis in the sputum. With open decay cavities that have not yet been completely sanitized, bacilli excretion is a natural phenomenon. If the cavity is small with scanty mucous or mucopurulent discharge, mycobacteria can only be detected using special techniques. In the initial period of cavity formation, the blood picture (hemogram) changes, the ESR accelerates to 30-40 mm/h. Conservative treatment is effective. The dimensions of the cavity decrease relatively quickly and the walls of the cavity become thinner. And even without its complete closure and scarring, after the elimination of an acute outbreak, the hemogram and ESR return to normal. Neglect of health-improving measures is fraught with negative consequences: thickening of the membranes of the lung and a significant proliferation of its connective (fibrous) tissue can occur. If the process is hidden, expressed only in the growth connective tissue, then it is designated by the letter A (compensated pulmonary tuberculosis). If there is an inflammatory pulmonary process with sputum, often containing tubercle bacilli, then it is designated Latin letter B (subcompensated pulmonary tuberculosis). Rapidly flowing tuberculosis with rapid decay of lung tissue is designated by the Latin letter C (decompensated pulmonary tuberculosis). IV. Bacilli shedding - BK +, BK-, BK± '(periodic bacilli shedding). At open forms Tuberculosis bacilli are found in sputum and are conventionally denoted by the letters BK. The presence of a cavity is conventionally denoted by the letters KV.
General symptoms. The most typical various kinds fever. Simultaneous increase in temperature, and sometimes preceding it, - irritability or, conversely, apathy; insomnia or drowsiness; tearfulness or euphoria (high spirits). Frequent sweating, especially at night or in the morning, palpitations, poor appetite, nausea, headache. These signs are expressed significantly during the outbreak of the process, when it subsides, they are fuzzy or absent altogether, creating the illusion of well-being. Almost 1/3 of patients early forms pulmonary tuberculosis patients feel healthy, and only a thorough examination reveals the existing pathology.

Cough - dry or with sputum. The reason is inflammatory process, accumulation of mucus, pus, blood in the respiratory tract, compression of the bronchi by enlarged lymph nodes, displacement of the mediastinal organs. The resulting irritation nerve endings in the mucous membrane of the pharynx, larynx, trachea, bronchi, sometimes in the pleura cause excitation of the corresponding brain center and cough reflex. The most sensitive areas in the mechanism of coughing are the posterior wall of the larynx, the lower surface of the vocal cords, the area of ​​division of the trachea into bronchi and the mouths of the lobar and segmental bronchi. The underlying sections of the bronchial system and lung tissue (alveoli) are characterized by low sensitivity. The effectiveness of the cough impulse is greater, the better and more fully preserved respiratory function lung. That is why, with a massive lesion of the lungs, the cough is more often dry or with a small amount of sputum difficult to separate. The cough is aggravated by inhalation of cold air, loud talking, rapid movement. Often this gives the impression that the patient bronchial asthma, and the use of various sedatives is often ineffective. sometimes frequent and agonizing cough greatly disturbs the patient, does not let him sleep, causes pain in a difficult cell, accompanied by cyanosis (blue), vomiting. It happens that its paroxysms lead to rupture of the lung tissue and even damage to the integrity of the ribs. However, it should be borne in mind that in many patients, mainly with early and limited changes in the lungs, cough - dry or with sputum - may be absent or occasionally observed. Sometimes coughing does not happen with a cavernous process if there is a blockage of the outlet bronchus.

Sputum- mucous, mucopurulent and purulent, odorless. Has an unpleasant odor when mixed infection and associated putrefactive bronchitis. The bulk is allocated in the morning or in the evening. With extensive destructive processes in the lungs, it can reach 100-200 ml or more per day. Sputum is rarely excreted mouthful"or only in a certain position (on one side or another with the head down). In such cases, an associated abscess (abscess) or bronchiectasis (bronchodilation) should be suspected. In cirrhotic tuberculosis with multiple decay cavities, the amount of liquid watery sputum reaches 1000-1500 ml. When under the influence of a doctor's prescription antibacterial drug secretion in the bronchi quickly decreases, and then completely disappears, the cavity is cleared and, as a result, coughing with sputum stops - this is an important clinical sign of a successful treatment result. Hemoptysis - in the form of streaks or an admixture of a small amount of blood in the sputum, it occurs as a result of the destruction of capillaries and small blood vessels in the area of ​​inflammation. It happens in patients with infiltrative or exacerbated focal and disseminated tuberculosis. Pulmonary bleeding - the discharge of pure blood from a teaspoon to several hundred milliliters is associated with the destruction of large vessels - ulcerated branches of the pulmonary artery or dilated veins in the tissues of the lung, in the walls of the bronchi, cavities. Accompanied mainly forms - chronic cavernous and cirrhotic, others less often.

Hemoptysis and bleeding It is two to three times more common in older people than in children and adolescents. In some cases, having arisen, “like a bolt from the blue”, they first bring to the doctor a patient with a recently discovered or latent process, they are single and do not significantly affect the course of the disease in the future. Worse, when they serve as a formidable warning of far advanced tuberculosis. Constant bleeding causes extensive contamination of the body with mycobacteria, some patients develop pneumonia, sometimes leading to death.

Chest pain when breathing and coughing are quite common in tuberculosis. Their reason: involvement in the process chest, diaphragm, damage to the trachea and large bronchi, a significant displacement of the mediastinal organs. Sometimes there are distant pains sciatic nerves, which is associated with irritation of the nerve trunks by toxins - the waste products of bacteria. Shortness of breath - mainly as shallow rapid breathing is observed due to a decrease in the respiratory area of ​​\u200b\u200bthe lungs. Occurs during muscular work, less often at rest. Patients with widespread, disseminated, and filtrative, chronic fibrous-caverious and cirrhotic pulmonary tuberculosis suffer from it with pronounced intoxication of the body.

Heart and pulse. Tuberculosis toxins poison the heart muscle, cause its degeneration (myocardial dystrophy), as a result of which a weakening of the activity of the heart is observed: shortness of breath increases, the pulse becomes frequent, weak filling. Anemia and weight loss. With tuberculosis, especially with hemoptysis and bleeding, anemia develops. Constant fever, exhausting sweats and poor appetite lead to weight loss and general exhaustion of the body.
Flow. Tuberculosis can proceed in a variety of ways: starting with mild forms, when the patient is practically healthy and does not even suspect the presence of the disease, and ending with severe forms (cheesy pneumonia, miliary tuberculosis), which are now quite rare. There are cases of complete cure of pulmonary tuberculosis. In most cases, tuberculosis lasts for years, slowly, chronically. Usually fluctuations are observed during the course of the disease, periods of deterioration are replaced by periods of improvement and even visible recovery. Exacerbations of the process are observed more often in spring and autumn, followed by improvement in winter and summer. The course of the disease worsens sharply if they join various complications in the form of a transition of the tuberculous process from the lung to other organs: the intestines, kidneys, peritoneum, etc. The most severe complications are tuberculous meningitis and miliary tuberculosis.
Recognition. must be distinguished from others lung diseases: bronchitis, pneumonia, lung abscess, bronchiectasis. An accurate diagnosis can sometimes be made only after Koch's sticks are found in the sputum or during an X-ray examination. Miliary tuberculosis, which sometimes occurs without cough and other pulmonary symptoms, can be mixed with typhoid fever, sepsis, endocarditis.

Bronchoadenitis.

The defeat of the Koch bacteria (BC) of the intrathoracic lymph nodes and adjacent bronchi (see also Primary tuberculosis complex).
Symptoms and course. Depend on the age of the patient, the immunobiological state of his body and the degree of damage to the intrathoracic lymph nodes. If the foci of inflammation in them are small, and the overall reactivity is reduced, then the disease can proceed latently, or with slight intoxication. With more massive bronchoadenitis, high fever, general weakness, and sweating are noted. A common symptom is a dry cough, but wheezing is rarely heard. Tuberculin reactions are often, but by no means always, pronounced, the number of leukocytes is somewhat increased, and the ESR is accelerated. Mycobacterium tuberculosis is more likely to be found in the study of bronchial washings than sputum. Radiologically, the expansion of the root of one or both lungs is different.
Forecast. Tuberculous lesions of the intrathoracic lymph nodes, even with vigorous specific treatment, are cured relatively slowly (1-2 years). Often the course of the disease is complicated by pleurisy, the transition of the process to neighboring areas of the lung. When the lymph node is melted, a cavity may occur.
The spread of the process through the circulatory system (hematogenous disseminated tuberculosis) from the lymph nodes is rare. Bronchial tuberculosis. It can occur in the form of infiltrate, ulcers, fistulas and scars. Clinically, its symptoms are a hacking dry cough, pain behind the sternum, shortness of breath, dry wheezing, the formation of atelectasis (falls) of the lung or emphysematous swelling of the lung, "bloating" or blockade of the cavity, the appearance of a level in it liquids. Sometimes asymptomatic course of bronchial tuberculosis is also possible.
The diagnosis is confirmed by bronchoscopy or bronchography using contrast agents. Sometimes a biopsy is used (microscopic examination of the affected tissue, taken by one method or another).

Hematogenous disseminated tuberculosis.

It occurs as a result of contamination of the lungs with mycobacteria that have spread through the bloodstream.
Symptoms and course varied. Some patients after lung period malaise, there are signs resembling acute infectious diseases, most often typhoid fever. In others, at first, it proceeds under the guise of influenza or prolonged bronchitis, in some cases with hemoptysis. Sometimes the reason for going to the doctor is pain when swallowing. Examination shows damage to the tonsils, soft palate, larynx. Precedes or accompanies the disease of tuberculosis of the kidneys, bones, joints, etc.
The most common precursor or companion of hematogenous disseminated pulmonary tuberculosis is pleurisy with the presence of fluid in pleural cavity. A latent asymptomatic course of the process is also possible, which can be detected by chance during an X-ray examination of the patient. With all the diversity clinical manifestations hematogenous disseminated pulmonary tuberculosis draws attention to a satisfactory general state parts of patients. They relatively easily tolerate subfebrile (small - up to 38 ° C) temperature and even febrile (high). They have a mild cough with a small amount of mucopurulent sputum, in which it is not always possible to detect tuberculosis mycobacteria. With an unexpressed process in the lungs, there are almost no wheezing. Skin tuberculin reactions are often normal, only sometimes pronounced. In the blood, a slight increase in ESR. An x-ray examination in both lungs (mainly in the upper sections) shows symmetrically scattered small, medium-sized or larger foci.
Forecast. Timely detected under acute and hematogenous disseminated tuberculosis can be completely cured. Launched leads to the disintegration of foci, the formation of cavities (caverns), seeded with mycobacteria, and damage to the bronchi. This entails shortness of breath, suffocation, cough with copious sputum and even hemoptysis. In the lungs, various wheezing begins to be heard in large numbers, the content of leukocytes in the blood rises, the ESR accelerates, and the general condition of the patient worsens significantly. Accordingly, the disease is delayed for a longer period and is less treatable.

Infiltrative-pneumonic tuberculosis.

It usually develops during an exacerbation of focal tuberculosis, mainly due to inflammation of the tissues around old or newly formed tuberculosis foci in the lungs or against the background of sclerotic changes. Perhaps the formation of an infiltrate and as a result of an exacerbation of the process in the lymph nodes of the root of the lung. The factors contributing to its development are different: the flu, a massive additional infection, etc. Infiltrate ( local seal and an increase in tissue volume during inflammation) is 1.5-2 cm or more in size. It can even capture an entire lobe of the lung, and then they talk about cheesy pneumonia (see below).
Flow infiltrative pulmonary tuberculosis can either be latent or asymptomatic, or, conversely, acute and severe. Often the process begins under the guise of flu, pneumonia or fever of unknown cause. Sometimes the first sign is hemoptysis or pulmonary bleeding. Even with a significant amount of infiltrate, a small amount of wheezing is usually heard. The number of leukocytes in the blood rises to 10000-12000 units, ESR accelerates to 20-40 mm/h. Mycobacterium tuberculosis is found in sputum or bronchial washings in almost 75% of patients.
Forecast- Favorable with timely treatment.

Cavernous pulmonary tuberculosis.

Occurs with the progression of various forms of pulmonary tuberculosis. In this case, softening and subsequent disintegration of tuberculous foci occurs with the formation of cavities (cavities), mainly in the upper lobes of the lung. If the cavity is located superficially and communicates with the bronchus, then it is quite accessible to diagnosis by listening, percussion (tapping with a finger), and other simple tricks. If the cavity lies deep in the tissues of the lung, besides being small in size, then wheezing is heard only after coughing at the height of inspiration. But this phenomenon is also absent if the draining bronchus is closed. Such blocked cavities, even of considerable size, remain “silent” for a long time. Sometimes at the lower edge of the cavity there is a shadow of the liquid, which shifts when the position of the patient changes. This symptom, associated with a violation of the drainage function of the bronchi, acquires an important diagnostic value with unclear contours of the caverns.
Recognition. With blocked sludge and healed caverns, in which there was a rejection of the inner membrane, there are no Mycobacterium tuberculosis in the sputum. With open decay cavities that have not yet been completely sanitized, bacilli excretion is a natural phenomenon. If the cavity is small with scanty mucous or mucopurulent discharge, mycobacteria can only be detected using special techniques. In the initial period of cavity formation, the blood picture (hemogram) changes, the ESR accelerates to 3040 mm/h.
Conservative treatment is effective. The dimensions of the cavity decrease relatively quickly and the walls of the cavity become thinner. And even without its complete closure and scarring, after the elimination of an acute outbreak, the hemogram and ESR return to normal. Neglect of health-improving measures is fraught with negative consequences: there may be a thickening of the membranes of the lung and a significant proliferation of its connective (fibrous) tissue (see Fibrous-cavernous tuberculosis).

Miliary tuberculosis.

It develops when a large number of Koch's sticks enter the bloodstream and seeding occurs not only in the lungs, but also in other organs of the pleura, peritoneum, intestines, kidneys, meninges, etc., where numerous small foci appear. Usually this form of tuberculosis is generalized, i. distributed throughout the body, but sometimes the process is concentrated in one organ, mainly in the lungs and even in their individual parts, for example, in the tops.
Symptoms and course. Usually starts with general malaise, slight fever, headache. Soon the patient's condition deteriorates sharply, fever appears, the temperature reaches 39-40 ° C, shortness of breath, palpitations occur. In the lungs, small wheezing is heard. Tuberculin tests are weakly expressed. ESR is accelerated in the blood, the number of leukocytes moderately increases, mycobacteria in sputum are usually absent. X-ray in the lungs are determined by multiple foci the size of a millet grain (hence the name miliary tuberculosis). They are not sharply defined and are located symmetrically in both lungs. Despite the significant severity and acuteness of the course of miliary tuberculosis, patients with this form of the process, with its timely recognition, can be completely cured.

Focal tuberculosis.

The initial and most common form of lung damage. It accounts for 50-60% of newly diagnosed cases of tuberculosis in adults. With a continuous fluorographic examination of the population, up to 70-75% of cases are detected. Occurs during the initial infection. In the secondary - after exacerbation of old foci and sclerosis, as well as as a result of re-infection.
Symptoms and course. Clinically, in most patients, intoxications are noted: decreased ability to work and appetite, accelerated heartbeat, fast fatiguability, high temperature. There is no cough, or it is rare and dry. Mycobacterium tuberculosis can be found in a small amount of mucopurulent sputum. Asymptomatic development of the disease is also possible. Wheezing in the lungs with fresh focal tuberculosis is usually not audible. They appear as the disease develops. In the blood, the formula of leukocytes changes with an increase in the number of lymphocytes, ESR is often accelerated (15-20 mm / h). Skin tuberculin reactions for the most part in the norm and only in the primary forms of the process they are positive. Recognition. In x-ray examination, more often in the upper sections of the lungs, separate or merging with each other foci of various sizes up to 1.5 cm in diameter, irregularly round or oblong are found. In case of exacerbation of old foci around them, the zone of inflammation expands.
Forecast. With a favorable course of the disease, fresh foci resolve. If the process has passed into a chronic course, the foci, gradually decreasing in size, become denser, sometimes form separate conglomerates, cicatricial changes and fusion of the membranes of the lungs occur. In the future, the collapse of foci with the formation of caverns is possible (see Cavernous tuberculosis).

Primary tuberculosis complex.

It is characterized by a more or less voluminous focus of inflammation of the lungs, usually its upper sections. At the same time, inflammation of the local lymph nodes and vessels adjacent to the focus occurs.
Symptoms and course. Most of the disease begins acutely with high fever, cough, chest pain. At the same time, the blood picture changes, the number of leukocytes increases in it, the ESR accelerates. Recognition. Characteristic rales are heard in the lungs, Mycobacterium tuberculosis is found in the sputum. Tuberculin skin tests (Pirquet, Mantoux) are pronounced in about 50% of cases. In the primary complex, changes in the lungs are bipolar. During the x-ray examination, two foci are visible: one in the lung tissue, the other in the root of the lung - enlarged intrathoracic lymph nodes. These two foci are interconnected by a "path" of inflamed lymphatic ducts.
Forecast. Even with a favorable course, the primary complex heals slowly. Only after a few months, and often after 1-2 years of continuous treatment, complete resorption or encapsulation and calcification of all elements occurs. With a complicated course of the disease, disintegration is possible primary focus in the lung and the formation of a cavity. Often there is inflammation of the membranes of the lung (pleurisy) with fluid effusion into the pleural cavity. Large bronchi are often affected with the formation of long-term non-healing fistulas in them. With the progression of the process, mycobacteria may spread through the lymphatic and circulatory systems with the formation of tuberculous foci in the bones, kidneys, meningeal membranes (meninges of the brain) and other organs. In these cases, the extraction of the disease, of course, is delayed for a longer period. If primary tuberculosis affects only the intrathoracic lymph nodes and adjacent bronchi, they speak of bronchoadenitis (see Bronchoadenitis).

Tuberculous pleurisy (inflammation of the membranes of the lung).

It occurs at all ages and corresponds to various forms of tuberculosis of the lungs and lymph nodes. Distinguish between extensive tuberculosis of the pleura (shells), local pleurisy (near-pulmonary tuberculosis focus) and allergic pleurisy. Pleural tuberculosis occurs when the infection spreads by contact or lymphatic route from fresh or exacerbated tuberculous foci in the lungs or intrathoracic lymph nodes. The pleura also becomes infected when the integrity of the wall of the peripherally located cavity or areas is violated. emphysema. Changes in the pleura are limited or widespread. Foci can be of various sizes - from a pea to large foci.
Local (perifocal) inflammation of the pleura is formed as a result of exposure to toxic substances and decay products of the lung tissue (foci close or directly adjacent to the pleura) or lymph nodes.
allergic pleurisy may occur far from the lesion and even on the opposite side. Symptoms and course. Clinically distinguish between dry pleurisy and pleurisy with a variety of effusion into the pleural cavity - serous ( clear liquid), hemorrhagic (bloody), purulent, lymphatic, etc. Signs of dry pleurisy are often obscured by manifestations of the underlying disease (tuberculosis of the lungs, lymph nodes or other organs). But for the most part, even in these cases, chest pains characteristic of dry pleurisy, shallow breathing, pleural friction noise, limited mobility of the corresponding dome of the diaphragm, and other signs are noted. With effusion pleurisy, the severity of the disease depends on the amount of effusion and its nature. If a large amount of fluid accumulates in the pleural cavity, then shortness of breath most often occurs. With an increase in respiratory failure, the patient takes a forced position, sitting. He is pale, his lips and nails are cyanotic (cyanotic), breathing is rapid, shallow. In the place of accumulation of pleural effusion, breathing is weakened or not heard at all. When percussion of the place of accumulation of fluid, the sound is dull.
Forecast. The most favorable results are observed in the treatment of allergic or perifocal pleurisy. Slower liquidated serous effusion in pleural tuberculosis. In the acute stage of pleurisy, the number of leukocytes rises to 12000-15000 units, ESR accelerates to 50-60 mm/h. In other cases, the number of leukocytes is normal or even reduced, the blood formula changes. With hemorrhagic pleurisy, blood hemoglobin decreases, anemia appears. Curdled pneumonia. An extremely severe form of complication of the Primary Tuberculosis Complex, in which the lung tissue disintegrates into a curdled consistency - the so-called. earlier fulminant consumption.
Symptoms and course. It begins, as a rule, with a high temperature, proceeds with chills, chest pains, debilitating sweat, cough with purulent sputum, palpitations, skin acquire a bluish tint. Over the site of pneumonia, sonorous wheezing can be heard. In the blood, the number of leukocytes significantly increases (up to 20,000 units), the ESR is sharply accelerated (50-60 mm / h). Radiologically, infiltrates of various sizes are observed, from them to the root of the lung usually leaves a "path" or "leg", which is a projection of the inflammatory compacted walls of the bronchi and blood vessels. When the process subsides, the infiltrates gradually decrease or completely resolve. Sometimes they are compacted, covered with a capsule, forming tuberculomas. With the collapse of the infiltrate, a cavity (cavity) appears with a massive zone of inflammation around it. At the bottom of the formed cavity, liquid is sometimes determined radiologically, which is associated with a violation of the patency of the bronchi or damage to their walls. As a result of colonization of the bronchi with mycobacteria, single or multiple foci of various sizes, and sometimes large foci (the so-called daughter infiltrates), are formed in various parts of the lungs. With cheesy pneumonia, large confluent foci of irregular shape are found. Forecast. The process is characterized by a tendency to rapid progression. With timely treatment, it is possible to cure this form of the disease, sometimes resulting in massive cirrhosis of the lung.

Tuberculoma of the lung.

A peculiar form of the process, characterized by the presence in the lungs of a rounded and limited focus of 2 cm or more from the surrounding tissue. It can form during the involution of primary pneumonia and infiltrate, as well as as a result of the merger of several small foci in the chronic course of a focal or hematogenous disseminated process. Often it is a stable formation, which, without changing in shape and size, can remain in the lung for many years. Sometimes tuberculoma is a large focus of continuous decay with curdled contents. Tuberculomas of this nature quickly melt, the bronchi are contaminated with myco-bacteria with the formation of foci in various parts of the lungs.
Symptoms and course. They depend on the nature, magnitude, and also on the dynamics of the process. At stable condition tuberculoma, there are no painful symptoms. They occur when the process is exacerbated, when the focus in the lung increases, and even more so when it melts with the formation of cavities. Then there are signs of intoxication, cough with sputum, hemoptysis. Wheezing is heard in the tuberculoma area. Mycobacterium tuberculosis is found in the sputum, in the blood there is an acceleration of ESR, a decrease in the number of lymphocytes, etc.
Recognition. Tuberculin reactions in this form of the disease are often significantly pronounced. At x-ray examination in the upper parts of the lungs, foci of various sizes with clear edges are determined; near tuberculoma, one can see single or multiple small dense or calcified foci. With the collapse of tuberculoma, an enlightenment appears in them with an inflammatory path to the root of the lung. When emptying tuberculoma from molten curdled masses, it. looks like a cavity. Forecast. Tuberculomas are usually very difficult to succumb to treatment with antibacterial agents. Most effective in this case surgical intervention.

Fibrous-cavernous tuberculosis.

Previously referred to as pulmonary consumption, it occurs with the progression of various forms of tuberculosis. Symptoms and course. The process proceeds in long waves. Periods of relative well-being are replaced by exacerbations with pronounced symptoms of intoxication. The cough intensifies, the amount of sputum increases, hemoptysis and pulmonary bleeding appear, new foci form in various parts of the lungs due to the contamination of the bronchi with mycobacteria. As the process develops, there is a violation of all body systems, damage to various organs. At the same time, a lot is heard in the lungs different nature wheezing. There are pronounced shifts in the hemogram, acceleration of ESR. Radiologically, large cavities of various sizes are determined in the lungs, near which there are usually many fresh and old foci of tuberculosis, thickening of the lung tissues, as well as its membranes.
Forecast. With long-term complex treatment, as a rule, favorable for life. Tuberculous cirrhosis of the lungs. The disease is long-term. It can be unilateral and bilateral. In both cases, limited or widespread sclerotic changes in the lung tissue are formed, the bronchi and blood vessels are deformed, the mediastinal organs are displaced, and emphysema (increased airiness) occurs in neighboring areas of the lungs.
Symptoms and course. Patients complain of significant shortness of breath, sometimes asthmatic attacks, cough with sputum bad smell, periodic hemoptysis. At the same time, the activity of the cardiovascular system is disrupted, the size of the liver increases, edema, ascites (fluid in the peritoneal cavity) appear. Sometimes cirrhosis of the lungs is accompanied by a non-tuberculous peculiar lesion of the liver and kidneys, called amyloidosis. In the lungs, when listening, a lot of different wheezing is determined. The hemogram and ESR correspond to the phase of the process: exacerbation or remission. In sputum, Mycobacterium tuberculosis can long time be absent, but appear during an exacerbation of the process. X-ray in cirrhosis, there is a massive compaction of the corresponding lobe of the lung with a displacement towards it of the trachea and median shadow, emphysematous swelling of the lower lobe of the same or opposite lung. The prognosis is favorable for life. Even with systematic treatment the disease lasts a very long time.

The rapid progression of the pathology as a result of mycobacteria damage leads to the destruction of tissues, in place of which cavities are formed. This form of the disease is called infiltrative pulmonary tuberculosis in the decay phase. This stage of the inflammatory process of the perifocal type, which is accompanied by hypersensitivity, pathological changes functions of the endocrine system. In the absence of adequate treatment, the infection spreads through the bloodstream to other organs. The therapeutic course is quite long, the prognosis is favorable in case of timely measures, when MBT (mycobacterium tuberculosis) do not have time to develop resistance to all groups of drugs.

Etiology

The basis for the development of the disseminated form is an endogenous or exogenous infection. Reactivation occurs with progression in the foci of old or newly formed areas in which an exudative process occurs. With repeated massive penetration of MBT, hyperergy occurs - an acute reaction of the body to the effect of a provoking pathogen. The risk group includes people suffering from the following pathologies and conditions:

• Patients who have previously had MBT infection
• With alcohol and drug addiction
• People leading an asocial lifestyle
• For diabetes
• With serious chronic diseases of the respiratory system
• In people with HIV infection.

Pathogenesis

The body's defense systems in mucociliary clearance, when a specific secret is produced that glues the invading MBT. In the future, the pathogen is eliminated. If immunity under the influence of a number of reasons does not have time to form, bacteria begin to accumulate in the departments with the most developed microcirculation channel - in the lungs, lymph nodes. At the same time, its population is increasing exponentially.

At the site of the formation of extensive MBT colonies, a phagocytic process develops with the participation of macrophages. But the pathogen creates virulent factors that contribute to the destruction of lysosomal compounds. As a result, bacteria continue to multiply, but already extracellularly.

In the case of deactivation of macrophages, the phagocytic process is inefficient, so the growth of MBT colonies is not controlled. Cells are not able to cover such a volume of damage, mass death occurs. Many mediators and proteolytics are released, which leads to tissue destruction. At this time, a nutrient medium is created that contributes to the life of the MBT.

Inflammation takes on an extensive character, the walls of the vessels become permeable, due to which protein, plasma, leukocyte compounds form granulomas in the tissues. In these formations, necrosis begins, caseoses occur. Infiltration intensifies, individual foci merge into large areas.

The progression of the pathology develops in three stages: infiltration, decay, seeding, which indicates an active stage. Moreover, in some patients one of the phases can be observed, while in others - two or three. Each has its own symptoms that help to correctly diagnose and prescribe treatment.

The main feature is the exudative process. Infiltrative tuberculosis of the upper lobe of the right lung or the left side of the system is characterized by the formation of fluid in the alveolar lumens. This secret consists of protein fibrin and dead epithelial cells. Complications are pneumonia with lesions of the lobar areas and the formation of cavernous cavities.

Phthisiologists subdivide several types of pathology with accelerated seeding:

• Tuberculosis of the right lung or left lung with a cloud-like infiltrate is characterized by a rapid process of decay and the appearance of new caverns. On the radiograph, it is noted in the idea of ​​blurry shadows.
• A focus with clear boundaries, which is localized in the subclavian zone and has light areas in the center, is a round infiltrate.
• Irregular darkening in the form of a combination of several localizations has a characteristic disintegration spot in the middle - this is the lobular stage.
• A triangular shadow with a sharp end facing the root and limited by a furrow along the lower edge is the periscissurite stage of decay.
• Extensive seeding and lesion with large areas of infiltrates, merging into common cavities, occupying an entire lobe of the left or right lung, is a lobar form.

All species, without exception, have a common feature - the presence of infiltration and seeding of the bronchogenic type. The difficulty lies in the fact that up to a certain point the pathology has symptoms characteristic of pneumonia, influenza respiratory infections. Therefore, tuberculosis in the decay stage is recognized by X-ray examination.

Clinical picture

The disease develops from 14 to 120 days. Signs vary, depending on the degree of development:

Infiltration phase

With this form, there are still no destructive changes, but there is an inflammatory process, accompanied by exudation. Symptoms are expressed in the following manifestations:

• Weakness, fatigue
• Decreased appetite
• Pain in the chest area
• Dry cough with wet rales
• pyoderma
• muscle strain
• The sound of friction of the pleural tissues.

Decay phase

Melting of the epithelial layer with caseous necrotic formations begins. The disintegrated masses are rejected, released through the bronchi by air. Pneumoniogenic cavities characterize the degree of decay. If the lymph nodes are involved, there is a breakthrough of the caseous secretion through the fistulas that have appeared. The clinical picture is as follows:

• Cough with wheezing of varying intensity and sputum
• Hemoptysis
• Persistent shortness of breath
• Feeling of pressure in the chest
• Increased sweating
• Temperature jumps from subfebrile to very high
• Sleep disturbance
• Cyanosis of the oral mucosa
• Decreased skin turgor.

Seeding phase

Often, tissue breakdown leads to the spread of MBT to unaffected organs. They get into healthy areas of the lung along with sputum during coughing. To all characteristic symptoms signs of severe intoxication are added. First, the disease spreads to nearby areas, then moves further.

The foci have irregular shapes, the transition of the inflammatory process is carried out through the alveolar passages and bronchioles. This stage of tuberculosis is also called open.

Diagnostics

When examining a patient, the doctor collects data on his condition, finds out information about the primary infection. Auscultation and percussion are necessary to assess breathing and the characteristics of wheezing, they are more pronounced in the lobar form.

The most effective way to determine any form of tuberculosis is a tuberculin test. This technique is designed to determine the reaction of the body's immune system to MBT, which greatly helps in the treatment. Upon receipt of a positive result, following tests and analyses:

• X-ray in 3 projections
• Tomographic examination
• Bronchoscopy for sputum analysis
• Biochemical test to determine the level of leukocyte elements.

Treatment methods

If tuberculosis is detected in the decay phase, therapy is carried out in a hospital. Tactics is aimed at resorption of infiltrates, closure of caverns and a negative result. tuberculin test. Anti-tuberculosis drugs for chemotherapy are prescribed in combination to avoid the development of resistance. There is a principle of three groups, which involves the use of the following antibiotics:

First scheme

The course of treatment includes two medications. The first of these is Isoniazid, a compound that can inhibit the production of mycolic acid, which is a building material for the walls of the MBT. Bactericidal means affects pathogens in the stage of reproduction and bacteriostatically - on the pathogen in the resting phase. The dosage is 5-10 mg/kg of body weight. The duration of treatment for children is two months, for adults - 6-12 months.

The second drug of the regimen is Rifampicin, which belongs to the group of broad-spectrum antibiotics. It disrupts the production of ribonucleic elements directly in the bacterial cell. Creates a maximum concentration in the blood 2 hours after ingestion, retains it throughout the day. The average daily dose is 0.45 g, but in the phase of tissue breakdown it can reach 0.6 g/kg of body weight. The total duration of treatment is 12 months.

Second scheme

The technique is aimed at preventing contamination, involves the use of 4 drugs. The first is Ethambutol, which destroys pathogens that have developed resistance to Isoniazid. His active substance penetrates into the cells of the pathogen, disrupts cellular metabolism, but only in strains that are in the stage of reproduction. It is prescribed at a dose of 25 mg / kg of body weight for two months, total duration treatment is 6-12 months.

The second medication of the scheme is Protionamide, which stops the production of protein elements in the structure of mycobacteria. Works against both intracellular and extracellular pathogens. Affects strains at the stage of rest, reproduction and atypical forms. Adults are prescribed 0.5 - 1 g, divided into 3 doses per day, children - 20 mg / kg of weight.

The third in the group is Pyrazinamide, which penetrates well into tubercular foci. Most active in an acidic environment, it can work bacteriostatically and bactericidal. Daily dosage - 1.5-2 g.

Another agent included in the treatment regimen is Streptomycin. This is one of the first aminoglycoside antibiotics, which began to be used in the treatment of tuberculosis. It inhibits the protein synthesis of the pathogen, due to which the division of bacteria is suppressed, and their development stops. The dosage is 0.5-1 g per day. Only if all 4 drugs are used, it is possible to block the resistance of the strain.

Third scheme

It is prescribed in case of ineffectiveness of other methods of treatment. Para-aminosalicylic acid has a low possibility of resistance formation. The composition displaces the molecules of benzoic elements folic acid, due to which there is a replication disorder in the structures of ribonucleic compounds MBT. The average dose leaves 10-12 g per day, divided into several doses. For the treatment of children, 200 mg / kg of body weight per day is required. Long-term therapy is required for 6 to 12 months.

The second drug in the group is Tibon (thioacetazone), which has the ability to prevent the growth of mycobacteria. It prevents the resistance of pathogens, is effective in the presence of fistulas or involvement of lymph nodes in the pathological process. The tool is considered toxic, so it is rarely used. It is also used in the first and second scheme, if necessary. The dosage starts with 0.01 g twice a day, gradually increased to 0.5 g for 6 months.

• Methyluracil stimulates protective factors at the cellular level, helps tissues regenerate. Dosage - 0.5 g 4-6 times a day.
• Etimizol belongs to the group of analeptic drugs. It stimulates the respiratory centers, increases the level of corticosteroids in the blood. It is used for complications - atelectasis, impaired ventilation and gas exchange of the lungs. Effective in bronchial seeding. It is prescribed in the amount of 0.1 g three times a day.
• - an immunostimulant that activates the action of macrophages and leukocyte compounds. The dosage is 150 mg per day, divided into 3 doses.
• - liposaccharide with interferonogenic properties. It improves recovery processes, increases the effectiveness of chemotherapy treatment. Maximum therapeutic dose per day - 1000 units.
• – hormonal agent, which has an anti-inflammatory, anti-exudative effect. Prevents the development of shock and allergic reactions. Helps with diffuse lesions of the connective tissue. For treatment, 20-30 mg per day is used.

Prevention and prognosis

A favorable outcome of the treatment of pathology is the resorption of the infiltrate. At the same time, fibrous and focal tissue changes remain. With a worse prognosis, tuberculoma may form, caseous pneumonia develops. For a patient with increasing intoxication, the risk lethal outcome quite high, but with modern therapeutic methods such an outcome is extremely rare.

In order to prevent the following activities are carried out:

• Timely vaccination
• Isolation of patients with developing pathology
• Mandatory examination upon admission to work
• Early identification of people at risk
• Carrying out anti-epidemic measures.

The development of tuberculosis is less susceptible to people who lead a healthy and fulfilling lifestyle. Plays a big role normal nutrition, giving up bad habits, hardening, staying on fresh air, physical exercise and sports. To maintain the immune forces of the body, it is necessary to compensate for the deficiency of vitamins.

The infiltrative form of tuberculosis is one of the most common tuberculous lesions of the respiratory organs, while it stands out as one of the most socially dangerous varieties of this pathology.

Infiltrative pulmonary tuberculosis is contagious at all stages of its course, which requires special attention to it. In an advanced stage, the disease is extremely dangerous for the life of a sick person. Only effective treatment and preventive measures can save him from tragedy, and the people around him from infection.

AT general case Tuberculosis is an infectious disease caused by the microbacterium tuberculosis (Mycobacterium tuberculosis complex). It can develop into different options, incl. have different localization, pathogenesis and clinical picture. Infiltrative pulmonary tuberculosis is one of the types of the disease, which is characterized by the formation of exudative-pneumonic zones in the lung tissue with a tendency caseous necrosis in its central area.

The type of disease under consideration is classified as secondary form. It can occur as an independent pathology when re-infected with a large number of pathogens or be generated by the progression of mild and fibrous foci. An infiltrate develops at the site of organ damage, which may have various sizes(from 20 mm to coverage of the entire lung lobe). The lesion may affect the right or left lung and have different localization within the organ.

From a morphological point of view, the infiltrate forms an exudate of a polymorphic type - fibrin, macrophages, mononuclear cells, leukocytes, alveolar epithelium. It is located in the alveolar lumen. With the progression of the disease in the affected tissues, caseous transformations occur with the formation of a non-absorbable mass. It is prone to melting, which gives rise to the formation of cavities. Treatment of infiltrative tuberculosis provides resorption of the exudate, but in its absence, a capsule is formed that promotes the formation of tuberculoma.

Many people have a natural question about whether infiltrative pulmonary tuberculosis is contagious or not. Experts give an unequivocal answer - it is very contagious, and already at the initial stage. Patients with such a diagnosis for treatment are necessarily placed in a special hospital.

Varieties of pathology

According to the nature of the course, the pathology under consideration is divided into 2 types:

1. Tuberculosis with involutive course. It is characterized by the fact that within 85-95 days pathogenic bacteria disappear from the exudate secreted in the organ, which leads to the elimination of signs of the disease. If the correct treatment is provided, then this type of infiltrative pulmonary tuberculosis is completely cured, and the affected tissues are restored within 3-4 months.
2. progressive tuberculosis. With this variant of the course of the pathology, the tissues begin to disintegrate quite quickly, which requires energetic curative measures. The process of treatment of the progressive form is complex and lengthy. Moreover, it is characterized by an imaginary recovery, when obvious manifestations disappear, but the lesion remains.

When conducting radiography, 5 main varieties of the clinical picture of the lesion are distinguished:

1. Cloud-like infiltrate. In the picture, it looks like a homogeneous darkening of low intensity with an irregular configuration and fuzzy boundaries, i.e. kind of "cloud". This variant is prone to accelerated necrosis and cavern formation.
2. Round infiltrate. This is a fairly clear rounded spot on the image with an area of ​​enlightenment in the presence of a focus of necrosis. The most common localization is the pulmonary area in the subclavian region (1-2 or segment). The diameter of the affected areas can be 4-6 cm.
3. broncholobular infiltrate. On the radiograph, it appears as an uneven darkening of an irregular configuration with rounded borders. The average size the spot is 2-4 cm. It is usually formed by the fusion of several small foci, and sometimes has a necrosis area in the central zone. Most often, this is how infiltrative tuberculosis of the upper lobe of the right lung manifests itself, although it can also be found in the 1-2 segment of the upper lobe on the left.
4. Periscisuritis. This marginal infiltrate is one of the earliest manifestations of the disease. It largely resembles the cloud-like type, but is localized in the upper lobe near the interlobar fissure. At the same time, the lower bound is expressed explicitly, because limited to the adjacent pleura, but the upper border has a blurred outline. In shape, the darkening looks like a triangle, the apex of which is directed towards the pulmonary root. Quite often, the process passes to the interlobar pleura (sometimes with the appearance of effusion and the development of tuberculous pleurisy).
5. Lobit. This type of lesion is able to cover the entire lung lobe, respectively, and darkening is located on the X-ray image. In general, the shadow is not uniform. It shows large, single or multiple foci of necrosis.

Caseous pneumonia stands out separately, when infiltration activity is observed, but necrotic processes predominate, i.e. develops infiltrative pulmonary tuberculosis in the decay phase. Caseous zones can cover the entire lobe, sometimes the entire lung.

In addition to these classifications of the disease into varieties, it is also customary to subdivide lesions according to their size. Such a series is distinguished - small (up to 20 mm), medium (up to 35-40 mm), large (5-6 cm) and common (more than 6.5 cm) lesions.

Etiological features

The emergence of infiltrative tuberculosis can occur through two main mechanisms:

• Internal (endogenous) activation. This secondary form is generated by the complicated course of the focal type of the disease, incl. without proper treatment. In this case, an exudative reaction begins around the tuberculous focus.
• Superinfection is an exogenous etiological mechanism. Pathology appears due to the presence of sensitized zones in the organ in areas that have already become acquainted with the pathogen. Against the background of secondary infection, a hyperallergic reaction begins, provoking an inflammatory process with the formation of an infiltrate.

Based on these mechanisms, it is possible to identify the main factors provoking infiltrative tuberculosis - contact with people who are carriers of bacteria; neuro-psychological overload and stress; deficiency of immunity (especially HIV pathology); addiction; alcoholism; smoking; some diseases chronic nature(in particular, diabetes mellitus); hyperinsolation; poor nutrition (starvation).

Features of pathogenesis

The initial stage of the type of pathology under consideration begins with the appearance of an infiltrate no larger than 25-30 mm in size. Typically, such a focus has exudation of a polymorphic structure. Initial infiltrates tend to expand their boundaries. In addition, small foci merge together. As a result of this process, a broncholobular or lobital type of tuberculosis develops.

In the central part of the affected area, disintegration (necrosis) of tissues begins as a result of caseous melting. This is how infiltrative tuberculosis begins in the decay phase. At the same time, a pleural reaction is recorded. This manifests the lymphatic transfer of infection from the pleura to the cortical lung parenchyma.

The progression of the disease goes in the direction of expanding the lesion of the organ with the transition to pneumonia of the caseous type (“consumption”) or cavernous tuberculosis. Even more severe consequences occurs when infection is transmitted through the bloodstream and lymphatic vessels throughout the body, when lung tissue damage is combined with dissemination of tuberculosis to other organs. Disseminated pulmonary tuberculosis in the infiltration phase is considered to be very dangerous complication infiltration processes.

Symptoms of pathology

Character initial manifestations disease depends on the type of infiltrate. The round and lobular type is characterized by an asymptomatic onset. At the same time, lobitis, periscissuritis and most cases of cloudy infiltrate cause acute course pathology is already at the first stage. Statistics say that asymptomatic onset is recorded in ¼ of all cases of infiltrative tuberculosis, acute - 18-19 percent. In more than half of sick people, the initial phase proceeds with a gradual increase in the intensity of symptoms.

The initial symptoms in many ways resemble the development of bronchitis or pneumonia, even influenza. The most pronounced sign is an increase in body temperature to 38.3-38.6 degrees, and it does not subside for 15-20 days. Adds clinical picture increased sweating, muscle pain, cough with phlegm.

Gradually, characteristic signs appear - pain in chest area right or left depending on the affected lung; loss of appetite; insomnia; general weakness; tachycardia. The progression of the disease leads to coughing up blood and internal pulmonary bleeding.

The development of the infiltrative phase into the decay phase is accompanied by an increase in body temperature above 40 degrees, shortness of breath, purulent sputum when coughing, weight loss, and severe pain in the chest. There are pronounced signs of tuberculosis intoxication. Further development of the pathology can lead to complications such as pulmonary atelectasis, pneumothorax, tuberculous pleurisy and meningitis, cardiac problems, incl. reactive myocarditis.

Features of diagnostics

If the goal is to provide effective treatment, then infiltrative pulmonary tuberculosis must be detected on initial stage. However, the diagnosis during this period is difficult due to the absence of obvious signs or the coincidence of symptoms with other respiratory diseases. It is necessary to differentiate this pathology from pneumonia, echinococcosis, pulmonary cysts, lymphogranulomatosis, and oncology.

The initial diagnosis is based on the history and physical examination findings. During auscultation, wheezing is detected, and percussion is aimed at identifying dull sounds over the lesion. Such signs are especially pronounced in lobit and in the decay phase. Complete blood count is done, but blood changes have little information content. Only small deviations in the leukoformula and an increase in ESR are found.

The study of sputum for bacterial culture makes it possible to detect the presence of infection, which already clearly indicates a tuberculous process. Its presence is also shown by a tuberculosis test. One of the most effective diagnostic methods is radiography. According to the above criteria, the infiltrate is classified. Its location and dimensions are established. It is possible to trace the progressing dynamics. Clarification of the diagnosis is provided with the help of computed tomography and MRI.

Healing principles

First of all, it should be taken into account that due to the increased epidemiological danger, anti-tuberculosis treatment is mandatory in specialized hospital(dispensary). It is provided potent means using complex methods.

First of all, treatment is carried out with anti-tuberculosis drugs that provide pathogenetic chemotherapy. After conducting the necessary studies, drugs are prescribed - Isoniazid, Pyrazinamide, Rifampicin, Ethambutol. Intensive therapy can last 2-5 months, before the appearance of real positive results. The criterion in this case is the resorption of the infiltrate, and the effectiveness is monitored using X-ray.

In addition to chemotherapy, measures are taken to eliminate the inflammatory process with the appointment of corticosteroids, normalize metabolic processes and increase immunity. Antioxidants and immunostimulants are taken. At proper treatment symptomatic manifestations stop after 25-30 days, fixation of secretions with bacteria - after 1-2 months, and complete resorption of foci of infiltration occurs by the end of the 3rd month. Surgical treatment in the form of operative collapse therapy can be carried out in the decay phase. In general, surgical treatment of infiltrative tuberculosis is rarely used.

Tuberculosis is an insidious disease, its danger lies in latent forms, which are characteristic not only for primary infection, but also for the first stages of the disease. It is the patients who are infected and sick with the initial form that are more likely to recover or stabilize their condition. But latent forms are difficult to diagnose.

Most often, a terrible diagnosis is made when a patient addresses for severe symptoms, and they appear if the disease progresses. But even a cough with sputum does not always frighten patients who consider it a sign of a common cold or a complicated flu and prefer to be treated on their own. In such cases, tuberculosis may be detected when lung decay has already begun. Even at this stage, treatment is possible, but its effectiveness will be much lower.

Symptoms of tuberculosis in the last stage

It is difficult not to notice the collapse of the lungs with tuberculosis, since clinical picture very similar to a severe form of pneumonia:

• persistent subfebrile temperature;
• cough with serous sputum and blood impurities;
• severe chest pain;
• increased sweating, more at night and in the morning;
• shortness of breath (more than 20 respiratory movements per minute even in the prone position).

The initial phase of decay in tuberculosis requires a mandatory differential diagnosis using clinical studies:

• bronchoscopy, which will reveal endobronchitis on the side where the infiltrate develops;
• clinical blood test - tuberculosis in the decay stage is accompanied by leukocytosis, an increase in ESR and a decrease in the number of lymphocytes;
• bacteriological analysis of sputum, which allows you to determine the type of possible secondary infection and select the optimal treatment regimen;
• radiography, with which you can determine the type of infiltrative tuberculosis.

It is the X-ray that is the most informative. The last stage of tuberculosis is accompanied by atypical symptoms, and only in the picture is the exact localization and degree of lung damage clearly visible.

Lung decay: types of infiltrative tuberculosis

The decay process begins with the smoothing of the lung tissues in the presence of an infiltrate: in this case, active mycobacteria freely penetrate into the blood, which leads to general intoxication. By this time, the patient's body is also sufficiently depleted by concomitant diseases, therefore last stage Tuberculosis can be accurately diagnosed only by X-ray. The following types of infiltrates are determined on the pictures:

1. caseous - even in the picture it looks like necrotic processes in pneumonia, when large and numerous cavities of decaying tissues are formed;
2. round - the shape of the infiltrates is round, but not more than 6 cm in diameter, with a progressive course, shadows appear in the direction of the root of the lung;
3. likes - an extensive lesion of a lobe or several lobes of the lung, accompanied by the formation of numerous and large cavities of the decay of the lung tissue;
4. lobular - lesions merge, shadows are visible towards the root of the lung;
5. cloudy - the outlines of caverns are poorly expressed in the picture, the shadows are blurred;
6. periocissuritis - the infiltrate is localized in the upper lobes of the lung, the shadows have clear lower boundaries and blurry upper ones.

This examination allows not only to diagnose tuberculosis with lung collapse as accurately as possible, but also to prescribe effective treatment.

Features of treatment

The last stage of tuberculosis is the most difficult in terms of treatment, which is carried out in a hospital, since constant clinical monitoring of effectiveness is required. Phased chemotherapy remains a mandatory method.

At the first stage, bacteriostatic drugs are prescribed to stop the active reproduction and spread of mycobacteria (isoniazid and rifampicin). At the same time, a specific antibiotic therapy streptomycin, kanamycin, pyrazinamide, or ethambutol to avoid possible resistance pathogenic microflora to the medications used. Simultaneously, immunostimulating and symptomatic therapy is carried out. If the infiltrate resolves slowly, then surgical removal of pus from the lungs and the introduction of drugs into the affected tissues are used. For a warning pulmonary bleeding Collapse therapy is prescribed - filling the pleural cavity with air. In severe cases, surgical removal of necrotic tissues and lymph nodes is performed using lung resection or osteoplastic surgery.

Prevention

Preventive measures are aimed at separating patients with an active form of tuberculosis from healthy people. Such a separation is important not only in a hospital setting, where it is easy to do. It is more important to provide partial quarantine for patients who receive outpatient treatment.