Tuberculosis

March 8, 2012

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Tuberculosis   - A disease of an infectious nature, the occurrence of which provoke Mycobacterium tuberculosis. In the development of the disease is manifested Cell allergies Specific granulomas in many organs and tissues, as well as polymorphic clinical picture.

About tuberculosis was known in the most ancient times. And at the moment its distribution is a very serious problem with the medical and social point of view. According to statistics, every year in the world suffer from tuberculosis of about eight million people, with three million patients die. The incidence has increased in recent years. Experts cite several reasons that led to this situation. This is a general decline in living standards, which negatively affects the quality of food; deterioration and decrease in the number of measures aimed at combating tuberculosis; and the emergence of new strains, which exhibit a high resistance to a particular therapy.

Causes TB

Tuberculosis occurs as a consequence of human exposure mycobacteria . According to statistics, about 92% of cases the disease provokes bacteria Mycobacterium tuberculosis In other cases it occurs under the influence M. bovis . A characteristic feature of the causative agent of tuberculosis is the form of sticks. This bacterium - it aerobic organisms . The optimum temperature for most of its existence - +38 ° C. It grows well in media which contain egg, potato, milk, glycerin. The causative agent of tuberculosis exhibits high resistance to a variety of factors, it does not die when exposed to alcohol, acids, alkalis. However, in direct sunlight and ultraviolet rays TB germs are killed within a few minutes. At a temperature of 70 ° C death occurs within 30 minutes and during boiling pathogen die within five minutes. It is also a devastating effect on him have a number of tools used to disinfect 5% formalin solution, 5% solution of carbolic acid, 2% solution of bleach.

The symptoms of TB appear equally often in people of different ages, both in infants and in older patients. The main sources of infection, as a rule, are sick people, as well as meat and milk from animals that have TB. The most common tuberculosis is transmitted by droplet infection . In more rare cases possible nutritional pathway. There is also the possibility of infection by transplacental, when the infection is transmitted to the fetus of a pregnant woman. The factors contributing to transmission of infection, should be called prolonged contact with a carrier of bacteria exist in poor social conditions, malnutrition, failures in the functioning of the immune system. Contagiousness is not high and depends on the condition of staying defenses. For the spread of tuberculosis does not matter seasonality and frequency.

Most often get TB risk of certain groups of the population. In the first place can get TB carriers   HIV infection   and People with other illnesses that weaken the immune system of man. Also at high risk of infection from those in close contact with TB patients, people who do not pass the medical examination in time, drug addicts, alcoholics or people with no fixed abode. The risk of infection is also a citizens visiting the country, where there is a high concentration of cases of the disease in its active form.

Despite the fact that TB is not usually referred to highly contagious disease Up to fifty percent of people who have close contact with MbT, infected infection. However, TB infection does not mean that the disease will develop. Manifest forms of tuberculosis occurs only in 5-15% of cases, in other cases of infection in humans is the formation of non-sterile immunity.

The most common source of infection can not be determined. Another feature of TB in children: the younger the child is infected, the greater the risk of developing tuberculosis.

The development of TB

Pulmonary tuberculosis   and extrapulmonary tuberculosis   It develops in three stages. The first human infection occurs, then developed in a certain organ primary site of disease, then the disease progresses and symptoms appear new human tuberculosis.

After infection, the pathogen is gradually penetrate into lymphatic and blood vessels and is distributed throughout the human body. After four to eight weeks after infection in humans have observed the positive tuberculin test.

The main feature of TB infection is the ability to save a life capable of pathogen in the primary focus. In a viable state it may remain for many years, and in some cases - to the end of life. In turn, after a significant decrease in immunity due to a number of disease foci may go into an active stage and a person showing signs of tuberculosis.

Tubercular symptoms

TB symptoms directly depend on where in the body are introduced mycobacteria, have there been complications, as well as other factors. Tuberculosis is developing quite slowly, sometimes even illness can last for decades.

Symptoms of TB do not appear in people who developed latent tuberculosis . Consequently, they do not spread disease. Patients active tuberculosis   Symptoms depend on where it is developing an infection - in the lungs or in other parts of the body. Pulmonary tuberculosis manifests itself in humans and may develop gradually over several weeks or even months. In this case, a person may notice the appearance of several symptoms, but did not speculate about its development. In this form of TB one of the main symptoms of the disease is a cough, expectoration in which thick mucus, sometimes mixed with blood. Such a cough lasting more than two weeks. In addition, signs of pulmonary TB are fever and glow in the evening . fever . The man constantly feels weak and tired, he loses his appetite, respectively, rapidly decreases body weight. In addition, the patient worried about the strong breathlessness   and pain in the chest.

Tuberculosis in children and adolescents is most often seen in primary forms and develops after infection with tuberculosis bacteria organism had not previously infected. The most common among the forms of primary tuberculosis is found Tuberculosis of intrathoracic lymph nodes . In the process of developing tuberculosis it is most often the patient's lung. At the same time extrapulmonary disease occur as a result of hematogenous dissemination of tuberculosis infection from the primary tumor. In this case the patient occur predominantly intoxication symptoms and signs of the local inflammatory character are expressed to a much lesser extent.

At the same time, the younger the child, the higher the risk of severe local and generalized forms of the disease.

Forms of Tuberculosis

The most commonly occur following forms of tuberculosis in children and adults.

Tuberculous intoxication . This form is most often seen in children and adolescents. As a rule, the disease occurs in children of preschool age, as well as in primary school children. For the manifestation of the disease is characterized by irritability, fatigue, problems with appetite and sleep. During the inspection the expert drew attention to the pale skin, weight loss, mikropoliadeniyu. Sometimes this form of the disease may be a manifestation erythema nodosum , Inflammation of the conjunctiva and cornea, Reactive arthritis   et al. In the diagnosis in this case the most important is the detection of a bend tuberculin test. The process of developing an infection can last for years, in waves. Sometimes it is possible to self-healing and the formation of immunity.

Primary tuberculosis complex . This form of tuberculosis before the onset of complications occurs without symptoms. It can be found only in the course of examination using X-rays. However, as complications of the disease may develop pneumonia and others. If a positive flow of disease, the patient manifests calcification caseous focus in the lungs and lymph nodes. If the flow is complicated, it can develop hematogenous dissemination, lymphogenous dissemination, as well as form a cavity.

Tuberculosis bronchoadenitis . This disease is also called Tuberculosis of intrathoracic lymph nodes . It is most often manifested by the local form of primary tuberculosis in children. Due to the increase of lymph nodes squeezed tracheobronchial tree. If the patient has a distinct place bronchoadenitis, the manifestations of the disease will hoarseness, pertussoid, signs of acute or chronic intoxication. In the development of the disease increased lymph nodes, expanding venous network under the skin of the chest, and others. To confirm the diagnosis, it is necessary X-ray and bronchoscopy. As a complication of this condition can be broken patency bronchi develop pleurisy Tuberculosis bronchi. If the current positive disease, the patient manifests calcification of lymph nodes. If for some can develop complicated by hematogenous dissemination, lymphogenous dissemination, as well as form a cavity.

Disseminated tuberculosis . The disease occurs as a result of extensive hematogenous spread of tuberculosis infection. The beginning of the disease, as a rule, is febrile, and then quickly appear symptoms of intoxication. The man complains of a dry cough and shortness of breath. Diagnosis of pulmonary tuberculosis carried out by radiography. At the same time sputum often does not bring results because of the lack there of mycobacteria. Also confirms the diagnosis transbronchial biopsy . Complications of this condition can be anemia . cardiopulmonary failure , Hematogenous screenings in different organs, and others.

Tuberculosis urinary and genital . Today, it is this form of extrapulmonary tuberculosis is the most widespread. This disease is also defined as renal tuberculosis Because these bodies in this case are most often affected. Signs of renal tuberculosis are similar to the symptoms of non-specific inflammation of the urinary system. Diagnosis is made by examining the bacteriological urine culture, modified tuberculin tests, blood tests and other studies of the urinary tract and kidneys. As a complication of renal tuberculosis can develop ureteral stricture, cavernous tuberculosis of the kidney. If the treatment is carried out on time, outcome will be favorable. In the case of inadequate therapy may develop pyonephrosis   and, as a consequence, renal tuberculosis occurs nephrectomy.

Tuberculosis of bones and joints . Very often, tuberculosis of bones and joints affects children at an early age. In tuberculosis of bones most often occurs defeat middle spine. Due to the erosion of the anterior surface of the vertebral bodies they gradually subside, and eventually develops a pronounced kyphosis   without Scoliosis . When bone tuberculosis patient complains of marked limitation of mobility, pain, swelling of the spine that were hit. If tuberculosis of bones and joints progresses, the more the pathological process proceeds to the lower spine. Tuberculosis most commonly affects the knee and hip joints. Especially tuberculosis of bones and joints is that the manifestation of destruction of bone and cartilage tissue expressed later. Therefore, in the process of X-ray studies of changes in the spine and joints may not be detected. Therefore, the diagnosis is important to identify the primary site of infection. As a result of the disease the patient is often formed hump, contracture of the affected joint, and as a result, early disability.

Tuberculous meningitis . A rare form of tuberculosis, which often occurs in children at an early age. Initially, the child begins to change behavior, manifest some symptoms of general malaise, low-grade fever. In the development of the disease the child suffers from photophobia, headache, sleepiness , Seizures. Later affects the cranial nerves, developing coma . As complications of tuberculous meningitis is possible hypertension-hydrocephalic syndrome, cerebral edema. If you do not treat the disease, death comes inevitably.

Lupus . The disease occurs as a result of penetration into the skin of tubercle bacilli. TB skin is almost always seen as secondary endogenous disease. Typically, the agent gets into the skin of the centers of tuberculosis lymphohematogenous way. Through penetrate damaged skin infection is very rare. TB skin may have focal   and disseminated   form. Diagnosis of tuberculosis of the skin is carried out by studying the history, of the tuberculin tests, isolation of Mycobacterium tuberculosis and other studies that are assigned individually. There are also varieties of TB affecting other organs.

Diagnosis of tuberculosis

To spend quality diagnosis of active pulmonary tuberculosis Specialist primarily studies the history of the patient, he spends his physical examination. TB diagnosis requires a thorough study of the symptoms - the presence of cough, fever, fatigue, etc. Also, studies are carried out sputum culture. In this case, an exact diagnosis of tuberculosis is carried out in the study of the results of such a study. To select the most effective drugs for treatment of tuberculosis should be tested for bacteria.

In addition, in cases of suspected tuberculosis carried out X-rays of the thoracic. Such a study is assigned if the tuberculin skin test is positive, there is a mixed reaction to this trial, and if the patient has symptoms of active tuberculosis.

If you suspect a latent form of tuberculosis pulmonary its presence shows   tuberculin skin test . Also the diagnosis of tuberculosis in this case provides for a special blood test.

To establish a diagnosis of extrapulmonary tuberculosis when it is necessary to conduct a series of analyzes and studies. Depending on the situation diagnosis of TB may include biopsy, urine culture, the study of cerebrospinal fluid, MRI, CT.

Also in the process of diagnosis of pulmonary tuberculosis and extrapulmonary forms often prescribe testing for HIV infection and analysis hepatitis .

A number of additional analyzes carried out already during the treatment of tuberculosis.

In addition, regular screening for the disease is preferably carried out for those categories of people who are at increased risk of contracting tuberculosis.

Early detection of TB in children is based on a study of the level of specific sensitization which develops as a consequence of infection by mycobacteria. To do this, conducted tuberculin skin test - intradermal Mantoux . Standard tuberculin solution is injected into the inner surface of the forearm. After a few days on a dream, which was introduced tuberculin manifested hyperemia with papule in the center. Mantoux test is determined by the magnitude of the papules. Carrying Mantoux test is performed in children aged 1 year to 18 years. If the Mantoux test is positive, the child should be examined by a tuberculosis specialist.

Treatment of tuberculosis

Treatment of TB TB specialists conducted jointly with other doctors. The main method of treatment of tuberculosis is by far the causal chemotherapy. In carrying out such therapy must take into account the patient's age, form of the disease, the activity of the process. It is very important in the treatment of tuberculosis to pay attention to proper diet, exercise, lifestyle in general. Treatment of tuberculosis - the process is very long, so it requires patience. For all stages of the treatment of the disease can take up to 18 months.

When chemotherapy is usually administered two or more drugs.

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