Let's stop tuberculosis. How to protect yourself from this disease? Nonspecific prevention of tuberculosis

Tuberculosis is included in the list of dangerous diseases with a high probability of death. The disease is caused by a pathogenic microorganism, most often affecting the pulmonary region. In order not to become infected with tuberculosis, it is necessary to follow safety rules that significantly reduce the risk of infection.

Do all those infected with tuberculosis get sick?

Infection with a pathogenic microorganism that causes tuberculosis does not always lead to the development of a pathological condition. With good immunity, virus attacks are successfully repelled, and the activity of the tuberculosis bacillus is minimized.

The disease can be latent for a long time. The presence of infection in the lungs causes the formation of multiple specific tubercles. With a closed form of the disease, mycobacteria do not leave their limits, and the patient does not become a source of infection. In the case of open tuberculosis, there is a constant shedding of microbes into the sputum (pathogens can also be found in saliva and other natural secretions of the human body).

The transition of the disease into an open variety, which poses a danger to others, becomes possible if there are some factors:

• severe hypothermia;
• regular stress;
• malnutrition;
• chronic diseases;
• disturbed metabolism;
• oncological processes.

Active progression of tuberculosis infection often occurs in patients suffering from alcoholism, drug addiction, who have a positive HIV status.

The causative agent of the disease

The development of tuberculosis is associated with increased activity of mycobacteria, referred to as. This microorganism was named after its discoverer, the German scientist Robert Koch, who described it in 1882. There are many varieties of these aerobic pathogens, some of which prefer to settle in the human body, others infect various animals.

Under a microscope, Koch's bacillus looks like a slightly curved or straight bacterium, the length and diameter of which are measured in micrometers. The microbe is characterized by the presence of a dense outer shell, often compared to armor.

Mycobacteria are present in large quantities in the environment, they are characterized by variability, survivability, increased resistance to disinfectants and drugs. Koch's sticks are able to retain their infectious properties for a long time. In water, they can remain viable for about 5 months. Once on household items, microbes can pose a danger to humans for several weeks.

The microorganism is able to survive even in boiling water. Under such conditions, Koch's wand can remain active for about half an hour. Active ultraviolet radiation becomes destructive for pathogens, destroying them within one and a half minutes. Under the influence of chlorine-based products, microbes die within 5 hours. At a temperature of 100°, pathogens are destroyed after 5 minutes.

The weak point of the bacterium is the gradual development in the body and slow reproduction. When the stick enters the human body, it does not release any toxic substances, is not recognized by the immune system for a long time, and can only be detected by laboratory methods. Due to this feature, the initial stage of the disease is quite long, and if the infection is detected in time, it can be overcome without significant difficulties.

Methods of infection

Koch's wand, which causes the development of tuberculosis infection, enters the human body in various ways:

Experts do not exclude the transmission of bacteria through sexual contact, during kissing. Infection can occur when using non-sterile medical instruments that come into contact with human blood.

Doctors say that tactile contacts rarely cause tuberculosis infection, because the skin reliably protects the body from various microbes. Transmission of infection from a sick person to a healthy person can occur in the presence of microdamages of the mucous membranes or epidermis, unhealed cuts or scratches, against the background of weakened immune defenses.

Experts cite the following indicators - from one carrier of the active form of tuberculosis, at least 20 people can become infected. Persons with such a diagnosis are necessarily isolated from the healthy population and placed for treatment in special dispensaries (in case of refusal of medical care, forced hospitalization is provided).

100% infection

The highest risk of infection with Koch's bacillus arises from direct contact with a person with an open form of tuberculosis. Pathogens present in the various fluids of an infected patient are easily transmitted to healthy people who come into contact with him. After entering the human body, pathogenic bacteria gradually spread in the bronchopulmonary, lymphogenous and hematogenous tracts.

An increased likelihood of damage with Koch's sticks occurs when you stay in a poorly ventilated room for a long time with a sick person. In this case, the concentration of bacteria in the air becomes especially high, which leads to almost one hundred percent transmission of a deadly infection.

The following figures will prove this. If air exchange occurs in the room once per hour, the number of pathogenic microorganisms in it reaches 60-65%. After 2 hours, this figure rises to 85%. In the absence of ventilation for 3 hours, the concentration of pathogens can reach 90%. To avoid the accumulation of harmful bacteria in the air, air exchange should be carried out every hour (at least 6 times).

Places where the probability of 100% infection with tuberculosis is especially high are hospital wards of tuberculosis dispensaries, prison cells, army barracks. Persons living together with a sick person are also at high risk of infection.

Prevention of infection with tuberculosis

To avoid infection with Koch's wand and not get sick with tuberculosis, you must follow the recommendations of specialists:

1. Do it regularly (this method is used once every 7 years, until the age of 14).
2. After reaching the age of 15 periodically (once a year).
3. Follow a balanced diet, the presence in the diet of a sufficient amount of protein foods (radical diets are considered extremely dangerous, because they cause severe depletion of the body and reduce resistance to infection).
4. Lead a healthy lifestyle, practice accessible sports.
5. Correctly alternate periods of work and rest, fully sleep.
6. Organize high-quality personal hygiene, monitor the cleanliness of the room.
7. Perform frequent ventilation at any time of the year.

If contact with a patient with tuberculosis is necessary, it is necessary to use individual protective equipment - sterile masks and gloves.

Competent preventive measures can reduce the risk of infection to zero. This is confirmed by phthisiatricians who regularly contact with TB patients, but do not get sick due to the observance of effective preventive measures.

• Infected doesn't mean sick

Everyone who has to come into contact with patients with this dangerous disease thinks how not to get infected with tuberculosis. But there is also a risk of catching the infection for those who have nothing to do with tuberculosis patients and do not come into contact with them.

Tuberculosis is an infection that is transmitted by contact and airborne droplets.

This information may surprise, but it is almost impossible to meet an adult who is not infected with Mycobacterium tuberculosis. Contact with this microorganism usually occurs in early childhood.

A small amount of Koch's sticks enters the child's respiratory tract, inflammation occurs, the immune system copes with it and self-healing occurs. There are no clinical manifestations, and if it were not for the positive Mantoux test in the future, the presence of tuberculosis bacteria in the body would not have been suspected.

Such infection can even be considered a favorable phenomenon for the body - due to it, anti-tuberculosis immunity is formed.

This is how the BCG vaccine works, which until recently was given to all babies immediately after birth. Weakened Mycobacterium tuberculosis was administered to the child, activating the immune defense.

Koch's sticks are dormant in the body and can only wake up under favorable circumstances:

• in direct contact with the patient in an open form;
• in conditions of the body, during which immunity drops sharply: in acute infectious diseases and exacerbations of chronic diseases;
• from the abuse of smoking, alcohol;
• with malnutrition or prolonged malnutrition;
• during prolonged stress.

The active form of tuberculosis appears only in 2-4% of all infected. Those people who have a positive Mantoux test, but there are no changes in x-rays and sputum tests, are not sick. They do not spread tuberculosis bacilli and are not dangerous to others. Anyone who becomes infected with tuberculosis at an early age without clinical manifestations is not considered sick.

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Possibility for infection

The risk of infection with active strains of Koch's bacillus occurs constantly. It is impossible to give guarantees that only healthy people surround in transport, on the street, in a public place. How to protect yourself from tuberculosis?

In most situations, it is sufficient to follow the usual preventive measures:

• wash your hands after coming from the street, especially if you had to visit places where there are a lot of people;
• try to maintain a healthy lifestyle;
• time to do fluorography.

The risk of catching tuberculosis in an active form will be minimized.

It is more difficult not to get sick if you have to come into direct contact with patients with this terrible disease. But again, one must take into account the form in which the disease proceeds and what kind of communication. When exchanging body fluids, the likelihood of possible infection is higher.

Persons who come into direct contact should definitely contact a phthisiatrician. Children under 15 need an examination 4 times a year, adults need 2 times a day. Sputum, urine and blood are taken for analysis, a tuberculin test is performed, and an x-ray of the lungs is taken. There is no need to be afraid of such an examination. No one will conduct chemoprophylaxis to a healthy person!

For those who have been subjected to a massive attack of aggressive strains of mycobacteria, anti-tuberculosis drugs are prescribed in the minimum dosage that cannot damage the general condition of the body.

It is believed that pregnant women are most at risk of infection. The probability of the disease is exactly the same as without it. Even if infection has occurred, the pregnancy is not interrupted, and active treatment begins after childbirth.

You can catch the infection without direct contact with the sick, if you use items that belong to them or live in the room in which they lived. Koch's sticks are able to remain active in a warm, humid environment for up to 5 months, in book dust up to 3, in an apartment, even with regular ventilation, in the winter months - up to 25-38 days.

Measures to prevent infection - disinfection by the forces of the sanitary and epidemiological station. It is impossible to get rid of pathogenic bacilli on your own by treating the apartment and making major repairs.

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Prevention of infection with tuberculosis

To prevent the development of the disease, you must adhere to the following rules.

1. Do not refuse vaccinations, regularly conduct Mantoux tests for school-age children. Adults should monitor their health and do x-rays once a year.
2. Eat rationally and properly. The menu must contain protein foods. If you lead an active lifestyle, you can not torture yourself with constant malnutrition, limit your diet, eat only one type of food.
3. It is required to observe the regime of work and rest, give up bad habits or reduce abuse to a minimum.
4. Perform hygiene measures.
5. Regularly carry out wet cleaning in the room, ventilate it.
6. When you have to be with a TB patient, be sure to take protective measures: wear masks and gloves.

There should be no false shame. TB doctors get sick very rarely, although they are constantly in contact with patients. They are taking precautions.

But can tuberculosis be avoided? How to protect yourself from this disease? And are there many people with tuberculosis in Russia and Moscow?

"AiF": - March 24 will be World TB Day. How are things going with this disease in our country? Should I be afraid or not?

Peter Yablonsky: - You are right, there are many diseases, but the disease is special. In terms of social significance, tuberculosis today is not the number one disease in either pulmonology or cardiology. All of them are ahead of him in terms of social significance, but in terms of the degree of social danger, this is infection number one.

Today, tuberculosis is recognized as a threat to the whole world, there are international programs that are designed to defeat tuberculosis. It's a contagious disease, contagious, and that's probably why it's so hard to fight. It is transmitted through the air. Despite the fact that this disease accompanies mankind throughout the history of its development, it is not possible to defeat it.

To date, there is a list of 22 countries in which, according to the calculations of the World Health Organization, the burden of tuberculosis is the largest. Russia, unfortunately, occupies the 13th place in this list. We can argue about what this place is - honorable or not honorable, because we know for sure that today not a single country in the world can boast of a strict system of registration, registration of tuberculosis. We do not use calculated data, but exact data. However, we are on this list.

Are the numbers going down?

"AiF": - But what is the trend? Are the numbers going down?

P.Ya.: - The trend is favorable. By all the most important indicators, there are signs that Russia is on the right track. If in 2009 the country was at the level of 82.5 per 100 thousand of the population, then already in 2010 it was 77 per 100 thousand of the population, in 2011 - 73 per 100 thousand of the population. In a number of more prosperous regions, this is both 42 and 35 per 100 thousand of the population. These are almost European averages.

"AiF": - And what is the situation in Moscow?

P.Ya.: - Moscow is one of the most prosperous regions of the Russian Federation. Last year, the incidence was 45.5 per 100 thousand of the population, this year it is 44.8 per 100 thousand of the population. In absolute terms, this is a very small number of new cases of tuberculosis, less than 5,000 people in all of Moscow.

Long term observation

"AiF": - In what regions is the worst situation?

P.Ya.: - Indeed, a higher level is observed in the Far Eastern and Siberian federal districts, while they have their own leaders. So far, we are not happy with the situation in the Southern and North Caucasian federal districts. The most prosperous are the central regions of Russia and the North-West region.

"AiF": - What do you think, what is the reason for this? It seemed to me that there were a huge number of people in Moscow, but it turns out that the situation is quite favorable.

P.Ya.: - The figures that I mentioned are the figures for the incidence of tuberculosis. When we talk about the numbers of accumulated pain, which are observed, they are somewhat larger. But they are also not catastrophic. The fact is that TB patients require long-term observation in anti-TB dispensaries, they are not removed from the register, and there are good reasons for this. But these are not completely sick people. First of all, they are not contagious, and secondly, the consequences of tuberculosis should be observed for a long time in order to avoid an early relapse of the disease. The so-called contingents are observed in dispensary registration groups. There are several more such patients, but they do not pose a danger to the population. On the other hand, when we calculated, it turned out that in the structure of the entire work of anti-tuberculosis dispensaries, patients with active tuberculosis occupy from 1% to 7%.

All other patients are under observation, and people like you and me who come for a certificate that they do not have tuberculosis, for employment, etc. This is more like a picture when a dispensary turns from a center that concentrates tuberculosis into a center for healthy lungs, where people come for a consultation with a doctor, to ask if he is doing well. All fluoropathology goes there.

Who is at risk?

"AiF": - Can you identify any risk group? People who may be more susceptible to TB than others?

P.Ya.: - If we talk about tuberculosis, then, of course, people get sick more often: the unemployed, people who are malnourished or malnourished, leading a hectic lifestyle. Moral depression is very important. Tuberculosis is a disease of pessimists. Everything that helps to improve a person's mood, improve his physical condition, good nutrition, constant work, good living conditions, is useful. Crowding, dirt, because it is well known that the leading route of infection with tuberculosis is an aerogenic route, we most often become infected through the air. But in contingents that observe the rules of personal hygiene, wash their hands - the incidence is less. It is difficult to single out any most important factor, but I would single out social stability, good nutrition and optimism as three inevitable attributes and guarantees of victory over tuberculosis.

Most of us know about tuberculosis, mainly from the school literature course, because it is no secret that many Russian writers, like the heroes of their works, died of consumption. The well-established medical system in the USSR made it possible to keep this disease under control. However, in the last two decades, the number of TB patients has been growing rapidly. Why is this happening, and are there any ways to cope with a terrible disease? Questions are answered by Associate Professor of the Department of Phthisiopulmonology of St. Petersburg Medical University, Candidate of Medical Sciences D. Yu. Alekseev.

- Dmitry Yuryevich, why do some people get tuberculosis, while others do not? Are there any defense mechanisms, and can they be stimulated?

- Everyone has a risk of contracting tuberculosis, but not everyone really gets sick. First, each person has an innate immunity to tuberculosis, which is explained by a number of immunogenetic factors. In addition, there is acquired immunity, which is formed with the help of a vaccine. Revolutionary in this area was the discovery in 1919 of the BCG vaccine. Now vaccination is a widespread practice. In our country (perhaps the only one in the world) it is carried out in three stages: mandatory vaccination in the maternity hospital and subsequent revaccination at 7 and 14 years, which is carried out according to individual indications.

- And if a person is vaccinated three times, he will no longer become infected and will not get sick?

“With the vaccine, we really protect the most susceptible part of the population: children and adolescents. Without preventing infection, the vaccine at the same time prevents the development of the disease. Thanks to the BCG vaccine, only 10-15% of those infected become ill with tuberculosis.

In adults, the mechanisms of the disease are somewhat different: there is re-infection and the so-called endogenous reactivation of the infection received in childhood. In addition, it is no secret that when socio-economic cataclysms occur in a country, the incidence of tuberculosis always grows.

Today in Russia, 70-80% of the population at one age or another are infected with Mycobacterium tuberculosis. That is, almost all of us are infected, but not all get sick. Whether you get sick or not depends on a number of social and medical factors. An important role is played by the psychological state of a person, the state of the immune system, the presence or absence of inner harmony in him.

There is no specific incubation period for the causative agent of tuberculosis. You can get infected and get sick in six months, or you can cope with this infection, but then, after 10 or 15 years, it will suddenly make itself felt.

- So, if an infection has got into a person, then it remains with him until the end of his days?

- Almost yes. Once entering the body, Mycobacterium tuberculosis, albeit in an inactive form, remains with us all our lives. This bacterium has extreme vitality, extreme variability and a unique ability to adapt to the environment and medications. As a result, Mycobacterium tuberculosis has been fought for more than 100 years, of which 60 years with the help of antibiotics, but a radical way to get rid of it has not yet been found.

- Among whom are the most sick, among the prisoners?

— Tuberculosis in prisons is a very special article. There, due to overcrowding, poor conditions of detention of prisoners, psychological pressure, the incidence increases. Prison tuberculosis is our grave misfortune. It is the largest reservoir of infection and therefore the source of morbidity in the entire population. In addition, all socially maladjusted groups of the population suffer from tuberculosis: homeless people, alcoholics, drug addicts, people with a low subsistence level - which means poor food and poor living conditions, even if they are quite safe in terms of behavior. The same problem that existed in tsarist Russia before the revolution remained unchanged after it.

- Does the climate affect the incidence?

— Undoubtedly, climatic conditions also affect. Humidity, cold, insufficient number of sunny days per year predispose to bronchopulmonary diseases, in particular, to tuberculosis. St. Petersburg, and in general the entire North-West, is not the best place to live from this point of view.

- What happens in the lungs with tuberculosis, and what can be achieved with the help of modern methods of treatment?

- It all starts with a tubercular tubercle in the lung tissue. Mycobacterium tuberculosis is located and multiplies in such tubercles, and with the further development of the disease, these tubercles merge, the areas of inflammation form in the lung tissue, and then the tissue “melts” and a cavity forms. This is usually a turning point, after which tuberculosis actively progresses.

The process of isolation of mycobacteria with sputum and coughing into the environment begins, and the patient becomes epidemiologically dangerous. If he has destruction (decay) of lung tissue and bacterial excretion, then the tuberculous process has already gone far.

With the help of modern drugs and methods of treatment, it is usually possible to stop bacterial excretion, as well as to achieve closure of the decay cavity. The effectiveness of treatment is judged by two indicators: the absence of the patient's isolation of Mycobacterium tuberculosis and the absence of lung tissue destruction.

- And how was tuberculosis treated before, before the advent of antibiotics?

- 60 years of experience in the use of antibiotics convinces us that no pill is a panacea for all ills. Until the 1940s, there were no antibacterial drugs, and they were treated with traditional folk remedies, which still have not lost their significance. With their help, doctors transferred the disease from the phase of exacerbation or progression to the stabilization phase.

These means primarily include climatotherapy, that is, the creation of favorable climatic conditions for the patient, which we had on the southern coast of Crimea, and abroad, well-known resorts in Italy, mountain resorts in Switzerland and France, which contributed to the stabilization of the tuberculosis process, and sometimes complete clinical recovery. .

In addition to climatotherapy, diet therapy was used. When the doctors could not cure the patient, the only thing they could provide him was good nutrition - high in proteins and vitamins. It contributed to the natural stimulation of the immune forces of the body and the turning point in the course of the disease.

Much attention in the pre-war and post-war years was also paid to the methods of collapse therapy.

- What is it?

- Collapse therapy (in everyday life it was called "blowing") - this is the introduction of air into the pleural or abdominal cavity for medicinal purposes. Increased pressure was created there, which contributed to a more rapid closure of tuberculous caverns.

However, at that time, the causative agent of tuberculosis itself was a little different. Its biological and immunogenetic properties have since changed, and today it is no longer enough to use only the listed methods to combat Mycobacterium tuberculosis.

— But these auxiliary methods have not lost their value?

- Of course not. Treatment can and should only be complex: medicines, climate, diet, normal work and rest regimen - what we call a hygienic dietary regimen. For the patient, this is a complete rest mode. In my deep conviction, the patient should spend the first months of the disease in a hospital bed and be in a sparing, protective regimen, because it is impossible to combine taking drugs with intensive work. Although in the West they approach this differently: they often use exclusively outpatient treatment, without pulling the patient out of his usual working environment, if he is not epidemiologically dangerous, that is, he does not release bacteria.

- Can a person protect himself from the disease?

“To do this, he must first of all be in a psychologically comfortable environment, eat fully, and his standard of living must be sufficient, which is generally determined by the socio-economic conditions of society. Secondly, and I keep repeating this to students and novice doctors, the basis for the prevention and timely diagnosis of tuberculosis is a fluorographic examination. Annual fluorography does not protect against the disease, but allows you to identify it in the early stages and, therefore, avoid serious complications. Previously, this examination was mandatory, but over the past decade, the population has forgotten about it. And if at state enterprises or from people with an increased risk of infection (for example, doctors) they still require the results of an examination, then no one is responsible for everyone else, except for themselves.

- Are there traditional methods of treating tuberculosis?

- In the post-war years, when people lacked nutrition, aloe juice, honey, badger fat were very popular - they simply ate it with spoons. In addition, today it has been proven that both badger fat and lard contain a unique set of trace elements and are useful for the body in small doses. There was an opinion that these things can be cured of tuberculosis, in fact, this effect is not on microbes, but on the body by stimulating its defenses. There was even such a figurative expression in the post-war years: "Tuberculosis caverns are filled with fat." Today it is one of the auxiliary methods, used with many reservations. In fact, the patient needs the quality of protein of any origin: animal, dairy, vegetable, because with tuberculosis there is a large loss of protein.

To stimulate appetite, metabolic processes, a small (within 50-100 g per day) consumption of red wines, including fortified ones, such as Cahors, classic ports, sherry and Madeira, is recommended.

The treatment with koumiss has not lost its significance, although now in many sanatoriums it is prepared artificially from cow's milk. For prevention, honey, any nuts and, of course, as many fresh vegetables, fruits and herbs as possible are very useful.

What would you like to say goodbye to readers?

- Live in harmony with yourself, in harmony with your loved ones, at home - this is exactly what you should strive for, regardless of your material income and opportunities. Try to improve your life in some way. And be sure to undergo a preventive fluorographic examination every year.

Interviewed by Alexander Volt

Doctors have known about the viability of tuberculosis bacteria for a long time. Many scientists predict a new wave of the disease in the near future. How can you protect yourself from this serious illness?

Of course, pulmonary tuberculosis is less likely to visit a prosperous home, where people have the opportunity to take care of their health, eat well, are confident in the future, their immunity very rarely fails.

Among the carriers of consumption there are a lot of former prisoners, migrants, homeless people, drug addicts and alcoholics. The risk group also includes the elderly, old people, poor people: poor nutrition with insufficient protein, nervous tension, fear of being left without a livelihood, stress, lack of sleep, lack of exercise and lack of fresh air, bad habits - all this weakens the body's immunity . These people are not only attacked by any infection from the outside, but the dormant inside is often activated - the same bacterium of tuberculosis.

There is also a hereditary tendency to this disease: natives of the Caucasus and Central Asia become infected with pulmonary tuberculosis much more often than residents of central Russia. Well, it goes without saying that there is a high probability of picking up Koch's wand from those who communicate with a large number of people at work, as well as from family members of a person with tuberculosis.

The bacterium is spread by airborne droplets, through sputum droplets that are scattered around the room when laughing, talking or coughing. Sputum particles with Koch sticks remain in the air for several hours. Then the causative agents of the disease settle on things or simply on the soil, in the dust underfoot.
A person who inhales the bacterium does not necessarily become infected. Only in one person out of twenty immunity will not be able to defeat the infection. Symptoms of pulmonary tuberculosis: fever, cough with sputum, weakness, weight loss, shortness of breath for a month, severe sweating. All these signs are a good reason to go to the doctor. It is necessary to remember the main thing: a disease that has begun recently is well treated. For the prevention of tuberculosis, be sure to do a fluorography once a year.
Tuberculosis bacteria have enormous adaptive abilities. After the advent of the antibiotic, many physicians were convinced that now pulmonary tuberculosis would be defeated. But the more powerfully they acted on Koch's wand, the more it mutated. Thus, absolutely new strains of mycobacteria have arisen that are stable to certain anti-tuberculosis drugs.

Of course, science is progressing. Thanks to scientific research, there was hope for the creation of completely new means of combating tuberculosis bacteria, in particular, immunomodulators. But this is a matter for the future.