Tuberculosis symptoms causes treatment. Pulmonary tuberculosis

Tuberculosis is a chronic infectious disease that can affect any organs and tissues of a person, but with the greatest frequency - the lungs.

Tuberculosis is characterized by the development of a specific inflammatory process and pronounced symptoms of general intoxication.

Tuberculosis - causes

The causative agent of tuberculosis is the tubercle bacillus, or Mycobacterium tuberculosis (MT). Humans are endangered not only by their own MT, but also by forms of infection circulating among cattle (bovine MT) and, extremely rarely, birds (avian MT).

Over the millennia of its existence, mycobacteria have acquired many properties that allow them to survive in adverse environmental conditions and prevent the destruction of the species.

It is worth noting the unique outer shell - the capsule of a bacterial cell, all the functions of which are still unknown to man. However, it is precisely because of this acid-resistant shell that mycobacteria are insensitive to the action of most common antibiotics. Moreover, MT can exist inside the cells of the human immune system (phagocytes), which absorb and digest all other bacteria with the help of special enzymes. It is believed that this is the reason for the phenomenon of infection activation many years after infection, as well as dissemination (spread throughout the body) of tuberculosis.

Another feature of MT is the ability to pronounced variability. For example, under the influence of treatment, they can become so small or so unlike themselves that they cannot be recognized under an ordinary microscope. They can also hibernate for extended periods. In this case, MTs do not grow on nutrient media, which makes diagnosis difficult. And it is already quite difficult to grow a MT colony, since they divide only once a day, and it takes a month and a half to obtain a culture of mycobacteria.

But only bacteriological confirmation in some cases makes it possible to establish a diagnosis, and only the isolation of MT from sputum or other media makes it possible to determine the sensitivity of the pathogen to the main anti-tuberculosis drugs.

Mycobacterium tuberculosis is highly resistant in the external environment. It retains its activity on objects (clothes, dishes, etc.) for a long time, is resistant to acids and many disinfectants.

Main source of infection is a sick person excreting MT into the external environment, or a sick animal.

Among transmission mechanisms there are two main ones:

Air - airborne and airborne dust,

Food - through products contaminated with MT, the dishes of a sick person or when drinking raw milk from a cow with tuberculosis.

The second mechanism is not so important due to the insignificant distribution.

Basic propagation path infections - airborne. MT are transmitted by inhalation of air containing the smallest droplets of saliva or sputum of a bacterioexcretor. They are released into the air by coughing, sneezing and talking. Due to the slow reproduction of mycobacteria, not many pathogens get outside, but they are well preserved in the external environment. To infect a healthy person, prolonged direct contact with a sick person is necessary. It has been statistically reliably established that in persons in contact with bacterial excretors for 8 hours daily for 6 months, in children's or adult groups, the risk of infection is 50%. To the same extent, those who are in contact with the patient constantly, 24 hours a day, only 2 months, are at risk. This is especially true for children living with relatives with tuberculosis.

But epidemiologically dangerous to others are only bacterial excretors in which tuberculosis is in the active stage - an open form of infection. 2 weeks after the start of treatment with specific anti-tuberculosis drugs (if they are effective), patients are no longer infectious. But still, a person with an open form of tuberculosis, and such patients are called bacillary, should not come into contact with children and pregnant women.

Patients with a closed form of infection, in the absence of mycobacteria in the sputum, do not pose a danger to others. However, with the progression of the infectious process or its exacerbation, the closed form can become open, as a result of which such patients become a source of infection.

To a greater extent, the air-dust route of infection for young children is relevant. When sputum particles dry out and the room is not cleaned properly, a child who can be on the floor inhales dust containing MT and thus becomes infected with tuberculosis. After inhalation, MT with air enters the lungs, and with the food way of infection - into the human gastrointestinal tract. However, unlike most other infectious diseases in tuberculosis, infection does not mean a mandatory disease.

In order for MT to actively multiply and spread throughout the body, it is necessary favorable conditions for the pathogen, which include:

Frequent colds,

reduced immunity,

Weakness of the body due to other causes - endocrine and metabolic disorders,

chronic disease,

Congenital pathology, etc.

These disorders are exacerbated by social disorder, deficiency of proteins and vitamins in food, poor living conditions.

Particular groups of people are most susceptible to developing the disease - high risk groups on tuberculosis.

These include:

Patients with chronic nonspecific lung diseases - chronic bronchitis, bronchial asthma, emphysema, etc.;

Patients with a protracted course of acute respiratory diseases, who have undergone exudative or recurrent dry pleurisy, extensive chest injuries and abdominal operations;

Patients with diabetes;

Persons with excessive reactions to tuberculin;

Persons infected with HIV;

Pregnant women.

Contact of the human body with MT, which usually happens even in childhood, can result in two outcomes: with complete well-being, MT penetrate the body, but do not multiply there, but cause an adequate immune response; under unfavorable circumstances, MTs begin to multiply actively and cause a disease - a primary tuberculosis infection. Further interaction between MT and the body of an infected person proceeds as follows: when treated with specific anti-tuberculosis drugs, mycobacteria stop their active growth and spread, turning into altered forms, but are not completely removed from the body, remaining and, as it were, preserved in it for a long time. If you stop treatment ahead of time, then there will be a secondary activation of tuberculosis infection.

The same thing can happen after a few years and even decades with a sharp deterioration in environmental conditions.

Great importance is also attached to:

stress,

alcohol abuse,

Unsatisfactory nutrition.

As a result, the activation of the primary infection occurs and secondary forms of tuberculosis occur.

Forms and symptoms of pulmonary tuberculosis

Pulmonary tuberculosis occurs in the presence of a variety of not always typical signs that can vary significantly in different patients in severity and severity. There is a direct relationship between the severity of symptoms and changes in the lungs.

The most typical for pulmonary tuberculosis are the following symptoms:

Cough lasting more than 3 weeks, with or without sputum;

Hemoptysis;

Pain in the chest;

Subfebrile (37.0-37.5 °) body temperature or fever from 38.0 ° and above;

night sweats;

Weight loss;

Changes in the lungs on a fluorogram (X-ray).

Increasingly important for the timely detection of the disease in the current epidemiological situation is becoming alert to tuberculosis, concerning ordinary people. Since most often patients do not pay attention to such signs as weakness, excessive fatigue from doing their usual work, excessive sweating at night, especially closer to the morning, and the temperature is not measured at all, and since men still dominate among patients, the main role should be taken their relatives - wives, sisters and mothers. A woman, destined by nature to protect life, should be vitally interested in the earliest possible detection of tuberculosis, from which she herself and her children may suffer. Due to the risk of a woman’s illness, when planning a pregnancy or during it, it is necessary to examine the future father of the child, which obstetricians also insist on, to stop contacts with socially disadvantaged persons, as well as with those who returned from correctional labor institutions. When such signs of intoxication appear, it is necessary to insist that the man undergo a fluorographic examination.

This form usually occurs in childhood and is characterized by the development of three forms of the disease:

tuberculosis intoxication in children and adolescents,

Primary tuberculosis complex,

Tuberculosis of the intrathoracic lymph nodes.

All these forms are considered primary, because they develop immediately after the child is infected with tuberculosis.

The most important role in the development of primary tuberculosis infection belongs to the early stage - the first 3-12 months from the moment of infection, during which it is decided whether the clinical form of the disease or an active immune response will occur. This period is the most dangerous for the child's body. It is called primary tuberculosis infection. Children and adolescents with primary tuberculosis infection must be examined to rule out active tuberculosis, which requires examination by a phthisiopediatrician, complete blood and urine tests, X-ray tomography of the chest organs and follow-up for 1 year.

To detect primary tuberculosis infection, all children, starting from 12 months, undergo an intradermal Mantoux test with 2 TU (standard tuberculin units). The Mantoux test is carried out once a year or 2 times a year in areas unfavorable for tuberculosis. After infection with MT, the Mantoux test in children with previous negative reactions becomes positive for the first time. If the child does not receive prophylactic treatment or primary tuberculosis was not detected in a timely manner, under adverse circumstances, the following forms of primary tuberculosis infection may develop: tuberculosis intoxication, primary complex and tuberculosis of the intrathoracic lymph nodes.

Tuberculous intoxication

Tuberculosis intoxication occurs after primary tuberculosis, therefore, in order to identify this form of tuberculosis in children and adolescents, information is needed on systematic tuberculin diagnostics (on the results of the Mantoux test for several years) to determine the "turn". Tuberculosis intoxication occurs due to the spread of MT throughout the body of a child or adolescent. This is the only non-localized form of tuberculosis infection.

The main manifestations of tuberculous intoxication are changes in the general reactivity of the body, its lymph nodes and the central nervous system. At the same time, the child has an unmotivated subfebrile temperature, especially in the evenings, there may be a short-term increase in temperature and up to high numbers. From the side of the central nervous system, irritability, capriciousness, sleep and appetite disturbances are noted. There may be a non-specific reaction of peripheral lymph nodes in the form of a slight increase in all their groups. No localized changes in the lungs can be detected not only by X-ray, but also by any other research methods. The disease is detected only due to the pronounced signs of intoxication in children with primary tuberculosis infection.

Primary tuberculosis complex

The primary tuberculous complex is a localized form of primary tuberculous infection. It is characterized by a specific tuberculous inflammation of the area of ​​the lung tissue in which MT has settled, the corresponding regional lymph node and lymphatic vessel.

Usually, the disease manifests itself with only minor signs of intoxication, it is diagnosed during X-ray additional examination of children with primary tuberculin infection (“turn” of the tuberculin test). .

In a complicated course of the primary tuberculosis complex, an extensive area of ​​inflammation can be observed with damage to a segment or lobe of the lung, disintegration of its tissue with the formation of a cavity (primary cavity) in it, damage to the bronchi, development of atelectasis (an airless area of ​​the lung), spread of MT through the blood and lymph throughout body, as well as the transition of infection to chronically current primary tuberculosis.

Tuberculosis of intrathoracic lymph nodes

Tuberculosis of the intrathoracic lymph nodes is characterized by the localization of MT only in the lymph nodes without a corresponding lesion of the lung tissue. They can be affected by specific tuberculous inflammation, which exists in several variants, which is manifested by dominant signs of intoxication or a severe, complicated course.

Small forms of damage to the intrathoracic lymph nodes are detected only with a thorough x-ray examination of a tubinfected child. With a complicated course of the primary complex or tuberculosis of the intrathoracic lymph nodes, one of the most severe forms of tuberculosis, miliary tuberculosis, can develop. It occurs in children and adults in both primary and secondary tuberculosis infections.

Miliary tuberculosis

Miliary tuberculosis usually occurs in young children. Miliary tuberculosis is characterized by the formation of multiple foci of specific tuberculous inflammation, both in the lungs and in the liver, spleen, meningeal membranes, kidneys and other organs. According to the predominance of the main symptoms, typhoid, pulmonary and meningeal variants of the course of miliary tuberculosis are distinguished. The predominance of severe intoxication with high fever, clouding of consciousness, convulsions characterizes the typhoid form. In the pulmonary form, signs of respiratory failure with shortness of breath and cardiac disorders come to the fore. In the meningial form, signs of tuberculous meningitis are characteristic, prevailing among all others. In all three forms of the disease, small-focal shadows are found on radiographs of the lungs. In infants and young children, large-focal shadows are more common against the background of a primary tuberculosis complex or damage to the intrathoracic lymph nodes.

Tuberculous meningitis

Tuberculous meningitis develops due to the drift of MT with blood flow into the meningeal membranes of the brain. Tuberculosis of the meninges is not an independent form of the disease, but a complication of primary tuberculosis in children and adolescents.

The development of the disease contributes to low immunity in the presence of a large number of pathogens in the blood. This is the most severe and unfavorable variant of the course of tuberculosis infection.

Signs of tuberculous meningitis develop gradually. First, for 5-7 days, the child has unmotivated behavioral reactions in the form of sudden changes in mood, irritability, lethargy, capriciousness. In addition, there may be a headache, subfebrile temperature, periodic vomiting, constipation. In the second week of the disease, signs specific to meningitis develop: severe headache, vomiting without previous nausea, in young children - a fountain, the inability to tilt the head to the chest and reach it with the chin (so-called neck stiffness), hypersensitivity to stimuli of any kind ( light, sound, touch cause a sharply negative reaction in the child). In infants, a suspension symptom (Le Sage symptom) is detected when the child is raised to a vertical position. At the same time, it is held under the armpits, without lowering it onto a support. In the case of a positive symptom of Lesage, the baby's legs remain bent at the knee and hip joints.

Infants are also characterized by bulging of the large fontanel and a monotonous "brain" cry, which are formed due to increased intracranial pressure in meningitis. High temperature.

A feature of tuberculous meningitis is the predominant localization of the lesion in the area of ​​\u200b\u200bthe base of the brain, where the cranial nerve trunks emerge from it. Therefore, in the second week of the disease, the characteristic signs are the symptoms of damage to these nerves - double vision, strabismus, smoothness of the nasolabial fold, etc. High fever, vomiting, lack of appetite and intoxication lead to exhaustion of the child. In the third week of the disease, the process from the meningeal membranes passes to the substance of the brain, meningoencephalitis develops with motor disorders, convulsions, paralysis. Without treatment with specific drugs, tuberculous meningitis always ends in the death of the patient. If treatment is started on time, the child's condition gradually improves, the signs of meningitis disappear. With a late start of treatment, a complicated chronic course of the disease is often observed with the formation of dropsy of the brain (hydrocephalus), persistent paralysis of the limbs, and atrophy of the optic nerves. In such cases, full recovery is not possible.

Usually, secondary tuberculosis develops in young and middle-aged people who had a primary tuberculosis infection in childhood. MTs are reactivated from “preserved” foci, or a new infection (superinfection) occurs. The infection spreads from the focus With the blood or lymph flow, as well as through the lumen of the bronchi. Secondary tuberculosis is characterized by a variety of clinical manifestations. Currently, there is an increase in tuberculosis among the elderly and senile age, in whom the disease proceeds atypically and, accordingly, is more difficult to detect.

Secondary tuberculosis also includes forms with localization in the respiratory organs, and tuberculosis of extrapulmonary localization, for example, the genitourinary, skeletal system, etc.

Secondary tuberculosis respiratory organs includes the following forms:

Focal pulmonary tuberculosis,

disseminated pulmonary tuberculosis,

Infiltrative pulmonary tuberculosis,

caseous pneumonia,

tuberculosis of the lungs,

cavernous pulmonary tuberculosis,

Fibrous-cavernous pulmonary tuberculosis,

cirrhotic pulmonary tuberculosis,

tuberculous pleurisy,

Tuberculosis of the upper respiratory tract - larynx, trachea, bronchi.

This is one of the most common forms of secondary pulmonary tuberculosis. According to statistics, it occurs in 45-50% of all newly diagnosed patients. Focal tuberculosis develops when primary foci of tuberculosis are activated or during superinfection in an organism that is immune to MT, but negative environmental influences (malnutrition, stress, frequent acute respiratory infections, other concomitant diseases) predominate.

The predominant localization of the foci is the upper lobes of the lungs, more often the tops and the subclavian region. With fresh foci, patients most often do not complain, although almost always the phenomena of intoxication - increased fatigue, irritability, weakness - are present to one degree or another. There is no cough in the early stages of the disease, or it occurs rarely and is dry.

Subsequently, it is possible to secrete scanty mucopurulent sputum, in which MTs are usually absent or rarely detected. Wheezes in the lungs are not heard, their appearance indicates the progression of the process or the formation of cicatricial-sclerotic changes in the lungs. Tuberculin test is positive, without any special deviations.

In the general blood test, there is a relative predominance of lymphocytes, the ESR rises to 20 mm/h. On radiographs of the lungs, in the upper lobes (in the apices and subclavian regions), sometimes in other departments, isolated or merged with each other small or medium-sized foci (up to 10 mm in diameter) of irregular round or oblong shape are revealed. With the exacerbation of old foci, radiographically, a zone of perifocal inflammation can be detected around them.

It indicates the resorption of fresh lesions, its transition to a chronic form - a decrease in the size of the focus, compaction, and sometimes the formation of individual conglomerates, while cicatricial changes and pleural adhesions occur in the lung tissue. The progression of the process is characterized by enlargement of the foci, their merging with each other, in some cases, the lung tissue disintegrates with the formation of small cavities.

Disseminated pulmonary tuberculosis

Disseminated pulmonary tuberculosis is distinguished by the spread of MT with blood flow. Their source can be both newly emerged and newly activated foci of infection. Treatment of patients with chronic disseminated tuberculosis requires much more effort and is not always successful.

A variety of disseminated tuberculosis, miliary pulmonary tuberculosis, was discussed in the section on primary tuberculosis infection, since it can occur in both primary and secondary tuberculosis. In addition, there are medium-focal, large-focal, limited and widespread disseminated tuberculosis.

Forms are distinguished along the flow:

Subacute - chronic.

spicy miliary tuberculosis occurs, but with timely treatment, patients can be completely cured, despite the pronounced severity of the process.

Subacute disseminated tuberculosis is the most common form. The disease can be disguised as influenza, protracted bronchitis, focal pneumonia. The temperature is usually subfebrile, there is a cough, dry or with a small amount of sputum, in which MT can sometimes be detected. In some cases, manifestations are more characteristic of extrapulmonary localization of tuberculosis (renal, sexual, bone, etc.). Perhaps the development of signs of effusion pleurisy. Objectively, there are single small bubbling wet rales in the lungs. In the general blood test, a moderately elevated level of leukocytes is detected, ESR - from 20 to 30 mm / h. On x-rays of both lungs, mainly in their upper outer sections, scattered foci of the same type of darkening are found against the background of a coarse or finely looped mesh pattern. With timely rational therapy started, the subacute process can be cured. If the subacute form was not detected in a timely manner, the disease continues to progress slowly and gradually becomes chronic: multiple, scattered, foci of varying density and size, cicatricial changes, and emphysema are formed in the lungs. The collapse of the foci leads to the formation of individual or numerous caverns, from which MTs can spread along the lumen of the bronchi.

Chronic disseminated tuberculosis characterized by:

The appearance of shortness of breath (sometimes asthmatic in nature),

Cough with purulent sputum containing MT,

hemoptysis,

Violation of the functions of the cardiovascular system.

lowering blood pressure,

Tachycardia,

sleep disorders,

Sweating.

Objectively, there are multiple scattered dry and moist rales in the lungs. In the general analysis of blood during an exacerbation of the process, a moderately elevated level of leukocytes, monocytes, ESR is increased. In the bronchi during diagnostic bronchoscopy, specific changes are often found. An x-ray examination in the lungs reveals foci of darkening of various sizes and densities, located less symmetrically than in the subacute form, a mesh pattern, emphysema, thin-walled, so-called stamped, because of their uniformity, cavities. Due to sclerosis, the roots of the lungs are pulled up, the heart and large vessels are in a "hanging" position. Adhesions between the lungs and the pleura, pleura and diaphragm are often found.

Infiltrative pulmonary tuberculosis occurs quite often - in 25-40% of cases. This form is distinguished by an erased and almost asymptomatic course in most cases. In one half of the patients, there are no intoxication phenomena, in the other they are very insignificant: 3-4 months before the infection is detected, increased fatigue, subfebrile temperature, sweating during excitement, and unmotivated chilling are noted. The infiltrate is a focus of inflammation in the lung tissue, ranging from one lobe to an entire segment and even a lobe of the lung. With the localization of a small (round) infiltrate in the thickness of the lungs, no objective research methods, except for X-ray, can reveal it. If the infiltrate is located near the pleural surface of the lung, then weakened hard breathing can be heard over it, with involvement in the inflammatory process of the pleura - a specific pleural friction noise.

There are complaints of cough with scanty sputum and stabbing pains when breathing in the subclavian region or at the spine of the scapula.

But if the infiltrate captures a large area, for example, an entire segment of the lung (cloudy infiltrate), the clinical manifestations are intense. Patients seek help in connection with an acute deterioration in well-being.

The main complaints are:

An increase in temperature in the evening up to 38-39 °, not accompanied by chills;

The appearance (intensification) of a cough with mucopurulent sputum - quite often, MT is found in the sputum of such patients;

Periodically - stabbing pains in the chest from the side of the lesion;

Weakness,

Sweating - especially at night and early morning hours,

Cardiopalmus,

decreased appetite,

Hemoptysis and (or) pulmonary bleeding.

In patients with a decrease in temperature in the morning, working capacity is maintained, and there is also a state of euphoria, as a result of which they cannot adequately assess their condition. An objective examination in the lungs above the affected area determines weakened hard breathing, persistent moist fine bubbling rales, a pronounced lagging of half of the chest from the side of the infiltrate compared to the opposite in the act of breathing.

Infiltrative tuberculosis is detected on x-rays in the form of shadows with a diameter of more than 1 cm. Round infiltrates, occupying one or two lobes of the lung, have a diameter of 1.5-2 cm. illumination in the center. The infiltrate can also occupy an entire lobe of the lung, then the borders of the darkening pass along the interlobar groove.

Due to the collapse of infiltrates, lung caverns of irregular shape can form. With active therapy, resorption of infiltrates or their compaction with the formation of tuberculomas is possible.

Caseous pneumonia

Previously, this process was called transient consumption. Caseous (curdled) pneumonia got its name due to the development of inflammatory foci in the lungs with a predominance of tissue decay, which looks like cottage cheese crumbs. When a whole lobe of the lung is involved in it, the patient's condition is marked by severe severity. A sharp adynamia develops when a person lies in bed and is not able to get up from it. He needs outside care.

Caseous pneumonia does not develop suddenly - there is a certain stage of deterioration of health associated with the phenomena of intoxication, but the patients themselves do not associate these manifestations with the onset of severe weakness. They complain of cough with a large amount of purulent mucus sputum (up to 300-500 ml per day), aggravated in a position on a healthy side (usually MT is present in large quantities in sputum), debilitating torrential sweat at any time of the day. There is a fever with evening rises in temperature up to 39-40 ° and daily fluctuations within 2-3 °. Development of pulmonary bleeding is possible.

Also noted:

Paleness of the skin with a bluish tint,

The almost complete absence of the subcutaneous fat layer, weight loss occurred in the previous stages of the disease;

An increase in the number of respiratory movements up to 26-28 per minute in the absence of shortness of breath or a feeling of lack of air;

When listening to the lungs, it is determined that the breathing is bronchial, but very weakened,

Numerous wet rales of various sizes, which, during the period of liquefaction and rejection of caseous masses, take on a kind of “squishy” shade.

With such pronounced changes in the patient's condition in the general blood test, there is no increase in the number of leukocytes, but the ESR is sharply increased - up to 50-60 mm / h. On x-rays, an intense, but uneven darkening of the affected “lobe of the lung with multiple enlightenments (sites of decay) is revealed, the interlobar border is indistinct due to the large number of foci in the adjacent sections of the adjacent lobe of the lung. With timely therapy, a cure is possible with an outcome in massive pulmonary cirrhosis.

Tuberculoma of the lungs

It is a tuberculoma of the lungs, a focus of inflammation of a rounded shape, with a diameter of more than 2 cm, delimited from the surrounding tissue by a connective tissue capsule. The inflammatory area is represented by caseous masses and is formed when foci or infiltrates are compacted, as well as as a result of the fusion of several small foci in focal or chronic disseminated tuberculosis. Tuberculoma can remain unchanged for several years, but sometimes tissues quickly disintegrate there, and if the area near the bronchus is involved in destruction, a drained cavity (cavern) is formed, from which the infection can spread through the bronchi with the formation of new foci.

Tuberculomas are difficult to treat with anti-tuberculosis drugs. Usually the main method of treatment is surgery.

The clinical manifestations of tuberculoma depend on the stage of the process, its localization and size. In a stable condition, tuberculoma may not manifest itself in any way. With an exacerbation of the process, an increase in the size of the focus and its decay, intoxication occurs, often pronounced, complaints of coughing with mucopurulent sputum (contains MT), hemoptysis. Objectively, fine bubbling wet rales are heard over the affected area. On x-rays, dark areas are determined, more often in the upper lobes of the lungs, with a clear contour, inside which there are often interspersed calcified areas. Pleural adhesions and scars are often present. The disintegration of tuberculoma is characterized by marginal sickle-shaped or central enlightenment and the presence of an inflammatory "track" connecting the shadow with the root of the lung. When most of the caseous masses are released, a cavity is formed - a cavity with uneven internal contours.

Cavernous pulmonary tuberculosis is diagnosed in those cases when inflammatory foci in the lungs resolve, and the decay cavity remains. Often this happens under the influence of anti-tuberculosis therapy, which is easier to treat fresh foci and infiltrates, and old caverns are cleaned, their walls become not so thick, incomplete closure with scar formation does not occur.

There may not be pronounced intoxication phenomena, especially with a small size of the cavity and the absence of its connection with the draining bronchus, which happens if the bronchus does not function, is closed by a mucopurulent plug, etc. If the cavity drains through the bronchus, then sputum with caseous masses is released , which usually contains MT. In the caverns left after treatment with anti-tuberculosis drugs, there is no MT, they are thin-walled, reminiscent of cysts. Radiographically, with undrained caverns, a clear meniscus-shaped shadow of the fluid can be detected, which shifts in accordance with the position of the patient's body.

Fibrous-cavernous pulmonary tuberculosis

Fibrous-cavernous pulmonary tuberculosis develops with the progression of various forms of tuberculosis. It is distinguished by a combination of fresh foci, decay cavities (caverns) and cicatricial changes in the lung tissue. The formation of new foci and sites of decay in various parts of the lungs contributes to the spread of infection through the bronchi from old cavities and scars when the process is activated.

Fibrous-cavernous tuberculosis is observed in persons suffering from alcoholism and drug addiction, as well as those who have not been treated or have been treated ineffectively for other forms of tuberculosis.

Fibrous-cavernous tuberculosis proceeds in waves - with periods of improvement and deterioration, it is difficult to treat.

The period of exacerbation is accompanied by pronounced symptoms of intoxication, increased cough with a large amount of sputum (contains MT), the appearance of hemoptysis and pulmonary bleeding. As more and more new sections of the lung tissue are involved in the process, the conditions for gas exchange deteriorate sharply. The whole body begins to experience oxygen starvation, as a result of which (along with intoxication) dystrophic changes develop in all tissues and organs - atrophic gastritis, myocardial dystrophy, arterial hypotension, pulmonary heart failure, amyloidosis of internal organs. On x-rays, multiple cicatricial seals in the lung tissue are determined, against the background of which (mainly in the upper sections) there are cavities that have a different size and shape and clear contours.

With an exacerbation of the process against this background, fresh foci of darkening are noted in the middle and lower lobes of the lung.

Cirrhotic pulmonary tuberculosis

It is a cirrhotic pulmonary tuberculosis outcome of disseminated, infiltrative and fibrous-cavernous tuberculosis with attenuation of inflammation activity. In the lung tissue, massive cicatricial changes are formed, as a result of which the bronchi and pulmonary vessels are deformed, the mediastinal organs are displaced, and pulmonary emphysema is formed.

There are complaints about:

Severe shortness of breath - often asthmatic in nature,

Cough with mucopurulent sputum

Intermittent hemoptysis.

At the same time, various rales and bronchial breathing are heard in large quantities in the lungs. The phenomena of pulmonary heart failure gradually increase, the so-called Cor pulmonale develops with edema, ascites, and an increase in the size of the liver.

With cirrhosis on x-rays, which developed as a result of infiltrative tuberculosis, there is a massive compaction and a decrease in the volume of a lobe or the entire lung with a displacement of the trachea and mediastinal shadow towards the lesion, emphysema of the lower lobe of the same and opposite lung. Cirrhosis, formed against the background of disseminated tuberculosis, is characterized by a diffuse spread of scar tissue, the presence of scattered dense or calcified foci, uplifted roots of the lungs, and the mediastinal location of the mediastinal organs (hanging, or drip, heart). Against this background, individual or multiple cavities can be detected - residual cavities. Emphysema of lungs is sharply expressed. Cirrhotic pulmonary tuberculosis is already an irreversible process. It is characterized by a long and sluggish course, but periodically worsens. Treatment gives only a symptomatic effect.

Tuberculous pleurisy

Tuberculous pleurisy develops during the transition of inflammation from lung tissue to its membrane. An effusion is formed in the pleural cavity, which contains MT, but they cannot always be detected by laboratory methods. The empyema of the pleura is extremely difficult, which develops as a result of a breakthrough of the cavity into the pleural cavity. More often, the defeat of the pleura of a tuberculous nature occurs in children and young people.

Usually the disease develops gradually, but there may be an acute onset, as well as a latent course.

Within 2-3 weeks of the disease, patients note:

Deterioration of your well-being

Growing weakness

fatigue,

The appearance of a rare dry cough,

subfebrile temperature,

Periodic pain in the side of the tingling type.

Then the temperature rises to 38-39 °, shortness of breath appears, the cough becomes wet, pain in the side intensifies. During the examination, signs of effusion into the pleural cavity are determined. It is possible to establish the diagnosis of tuberculous pleurisy only after a pleural puncture with a study of the nature of the effusion.

Tuberculosis and its complications

The most dangerous and life-threatening complications of pulmonary tuberculosis are pulmonary hemorrhage and spontaneous pneumothorax. Hemoptysis and pulmonary bleeding in tuberculosis can be caused by many reasons.

First of all it is:

Damage to large areas of lung tissue with involvement of blood vessels in the process, especially in the foci of decay,

Chronic infection with frequent exacerbations

Liver damage during long-term treatment with toxic anti-tuberculosis drugs.

There are, in addition, a number of external factors that contribute to the occurrence of hemoptysis and pulmonary hemorrhage:

Hypothermia or overheating of the patient,

His stay in conditions of large fluctuations in atmospheric pressure and air temperature,

Sudden changes in weather, highlands,

Acute and chronic alcohol poisoning of the body.

There are hemoptysis or pulmonary bleeding single and repeated. Bleeding is divided into small, in which up to 100 ml of blood is released, medium - up to 500 ml and abundant (profuse) - more than 500 ml of blood. Hemoptysis means the presence of more or less blood in the sputum. Pulmonary bleeding (hemoptysis) should not be confused with bleeding from, for example, gums or nasopharynx. As a rule, in these cases, patients do not experience difficulty in breathing, the blood quickly turns into clots. With true hemoptysis and pulmonary bleeding, the blood is scarlet, frothy and, as a rule, does not coagulate for a very long time. First, the patient notes a sore throat, possible tightness and pain behind the sternum, and then a special, bubbling cough begins, a state of slight suffocation occurs. The appearance of the smell and salty taste of blood is typical.

Abundant pulmonary bleeding is characterized by signs of acute blood loss.

In this case, the patient is noted:

Dizziness,

sharp pallor,

frequent pulse,

Drop in blood pressure.

Hemoptysis and even pulmonary bleeding, small in volume and duration, are usually not accompanied by such phenomena.

The result of pulmonary bleeding of a large volume may be the death of a patient from asphyxia due to blockage of the respiratory tract by blood clots and the bronchospasm caused by them. Unfortunately, at the beginning of pulmonary hemorrhage, one can never predict its volume and duration, and even after it stops, no one guarantees that it will not start again. Therefore, when the first signs appear, you should call an ambulance and urgently deliver the patient to the hospital, where he can receive adequate treatment.

It is also a serious complication of pulmonary bleeding - spontaneous pneumothorax. It occurs when the lung tissue ruptures and air enters the pleural cavity. The development of pneumothorax provokes heavy physical exertion or a strong cough, as this sharply increases the pressure in the airways, which contributes to rupture. The tendency to disrupt the integrity of the lung tissue is typical for patients with long-term tuberculosis, leading to the formation of non-functioning scar tissue in place of old foci. When a spontaneous pneumothorax occurs, an infection always enters the pleural cavity along with the air, and due to the delay in identifying this complication and providing assistance to such a patient, he may develop a severely current purulent inflammation of the pleura - empyema.

A characteristic feature of the development of spontaneous pneumothorax is the suddenness of the development of symptoms - the patient can accurately indicate even the time of their appearance. Manifestations of pneumothorax can vary significantly depending on the amount of air that has entered the pleural cavity. Tension pneumothorax is especially difficult, in which air on inhalation constantly enters the pleural cavity from the lungs, and does not leave it on exhalation. Most often there are complaints of pain in the affected half of the chest, dry cough, shortness of breath, palpitations. In severe cases, pallor of the skin with a bluish tinge, cold sweat, frequent pulse, and increased blood pressure join.

The main symptom of tension pneumothorax is severe shortness of breath, then the skin acquires a grayish-bluish tint, the timbre of the voice is disturbed, and there is a feeling of fear of death. The patient is in a forced sitting position, he is restless, excited. The lagging of the affected side of the chest during breathing is clearly noticeable, the depressions of the intercostal spaces and supraclavicular fossae disappear or even swell. When trying to listen to the lungs, it is noted that there are no breath sounds on the affected side, heart sounds are weakened on the pneumothorax side. It is sometimes possible to identify it only with an X-ray examination, and with a small closed pneumothorax, objective manifestations may not be expressed.

With the secondary spread of MT throughout the body, usually with blood flow, foci of infection can form not in the lungs or not only in the lungs, but in other organs - the kidneys, organs of the reproductive system, bones, central nervous system, skin, etc. Extrapulmonary localization of the tuberculosis process characteristic mainly for socially prosperous segments of the population. In the first place among all extrapulmonary localizations of tuberculosis is currently tuberculosis of the genitourinary system. In this case, as a rule, the disease is detected in the later stages, which is facilitated by a long period of absence of clinical manifestations.

There is tuberculosis of the skeletal system in focal and destructive forms, which can have an acute or chronic course. The introduction of infection into the bone marrow from primary foci in the lungs leads to the development of tuberculous osteomyelitis. Tuberculosis of bones and joints occurs more often in children, less often in adults. With tuberculosis of bones and joints, the most dangerous is the formation of a hump, joint deformities, sequesters, that is, areas of bone necrosis, its destruction. Other extrapulmonary localizations of tuberculosis are less common.

It is possible to carry MT into the endocrine glands, liver, central nervous system, in women the uterus and fallopian tubes suffer, which leads to infertility, for men the development of tuberculous prostatitis, orchiepididymitis is typical.

Tuberculosis: diagnosis

Due to the frequent absence of complaints and specific symptoms, the diagnosis of tuberculosis in the early stages of the disease, when anti-tuberculosis drugs are most active and a complete cure can be achieved, is a problem that can be solved with the help of mass surveys of the population: children - using the Mantoux test, adults - using the method fluorography.

The main method for detecting primary tuberculosis infection in children is tuberculin diagnostics. To do this, all children, starting from 12 months, undergo an intradermal Mantoux test with 2 TU. The Mantoux test is carried out once a year or 2 times a year in areas unfavorable for tuberculosis. Tuberculin is an allergen for an organism in which Mycobacterium tuberculosis is present, therefore, if there is a positive reaction, a child or an adult is considered to be tubercular.

A positive reaction to tuberculin is considered when, after its intradermal injection, an area of ​​redness forms on the child's forearm, slightly rising above the skin surface, with a diameter of 5 mm or more. Questionable results include a reaction with a diameter of 2-4 mm and all cases when the reddened area does not rise above the skin surface. Negative results are those in which there is no redness or it corresponds to a simple prick reaction (0-1 mm) 72 hours after the administration of 2 IU. A positive Mantoux test result can be associated not only with primary tubinfection.

Recent vaccination (1-3 years ago) or revaccination with BCG vaccine can lead to the development of the so-called post-vaccination allergy, which develops 2-3 months after the introduction of BCG and persists for 2-4 years. It manifests itself as a positive result of the Mantoux test up to 10-11 mm, but gradually decreases down to 0. Post-vaccination allergy is detected by a Mantoux test with 2 TU not in all vaccinated, but only in U3 cases, while in the rest the Mantoux reaction remains negative, despite the qualitative the vaccination done. After infection with MT, the Mantoux test in children with post-vaccination allergies increases by 6 mm or more, and in children with negative reactions it becomes positive for the first time. This condition is called the turn of the tuberculin reaction and indicates the development of primary tuberculosis infection. In the case of a tuberculin reaction, the child is considered threatened by tuberculosis and should receive a prophylactic course of the anti-tuberculosis drug isoniazid in combination with vitamin B6 and calcium gluconate in age-appropriate dosages for 3 months.

Tuberculin diagnostics is quite widely used not only in children, but also in adults, when it is necessary to identify extrapulmonary tuberculosis and confirm the specific nature of the damage to such organs as the kidneys, eyes, etc. For example, in the organs of the genitourinary system, tuberculin tests make it possible to recognize the presence of an active specific process in the early terms, even without the results of urine cultures for Mycobacterium tuberculosis, and also increase the effectiveness of the latter. Tuberculin tests in adults also consist in the intradermal administration of tuberculin, followed by an assessment of the reactions that occur: the body as a whole (general), the skin at the injection site (prick) and the alleged affected organ (focal). As a provocation, tuberculin tests are used to diagnose a newly suspected tuberculous lesion of extrapulmonary localization, assess the effectiveness of a specific treatment, and control the activity of the process.

Tuberculin diagnostics is contraindicated in case of individual intolerance to tuberculin and active tuberculosis of any localization.

It includes a Mantoux test, intradermal injection of 0.1 ml of tuberculin with an assessment of the size of the papule after 72 hours without taking into account the focus of hyperemia. The terms of the maximum severity of the skin reaction correspond to the terms of the maximum reaction in the focus and the general reaction of the body to the introduction of tuberculin.

A fluorographic examination is carried out for all people over 12 years old once every 2 years, and in areas with a high incidence of tuberculosis - annually. In some cases, the diagnosis can be established only on the basis of fluorography, but more often patients are sent for further examination and either an X-ray examination or computed tomography is performed.

A complete diagnosis of pulmonary tuberculosis is impossible without high-quality radiography, which allows you to identify the type of disease, and in the study in dynamics - the degree of activity of the process. On radiographs of the lungs, the consequences of the previous tuberculous process are also visible - calcified foci, cicatricial changes and complications of the disease - cirrhosis of the lungs, emphysema, etc.

When fluorography is undesirable or it is impossible to carry it out, these are pregnant women, bedridden patients, etc., they conduct an enzyme-linked immunosorbent assay (ELISA) test, which detects antibodies to MT in the blood. The information content of ELISA is high in cases of extrapulmonary localization of tuberculosis.

Tests for tuberculosis.

Bacteriological research plays an important role. This study allows you to isolate and identify MT. The material for the study is mainly sputum with pulmonary tuberculosis and other environments with its extrapulmonary localization - urine with kidney tuberculosis, prostate secretion with prostatitis, etc.

Bacterial excretion of MT is not only a cardinal sign of infection, but also a factor in infecting others, which is important in epidemiological terms.

Importance is attached to the microscopic examination of sputum smears stained in a special way for the visual detection of MT. Without fail, sputum smear microscopy should be carried out in non-transportable patients, patients with chronic diseases of the respiratory organs and urinary system, as well as in workers of livestock farms disadvantaged by tuberculosis.

A bacteriological study is the sowing of material taken from a patient on special media - it is carried out in the conditions of specialized laboratories. MTs are characterized by slow growth, so the first colonies on classical media are formed 4-8 weeks after sowing. More selective media are now available, allowing colony growth within 2 weeks, but not all laboratories have them available.

It also takes some time to determine the sensitivity of MT to anti-tuberculosis drugs that inhibit or do not inhibit the growth of a culture when a diluted antibiotic or chemotherapeutic agent is added to it.

But if it is not possible to detect tuberculosis by bacteriological methods, that is, there is no bacteriological excretion, and the data of x-ray diagnostics are nonspecific, the entire available examination complex should be used up to a biopsy of the material obtained by bronchoscopy or other endoscopic methods.

Tuberculosis - treatment

In modern conditions, schemes have been developed for the treatment of tuberculosis, doses and combinations of drugs have been carefully verified, but tuberculosis continues to be the most urgent problem of our time. And although more than half a century has passed since the discovery of streptomycin and isoniazid, the latter remains the most active drug against MT, however, Coca's bacillus has ideally adapted to constantly changing conditions over many millennia of existence in the human body.

This is currently expressed in the emergence of resistance to anti-tuberculosis drugs (ATPs). And although now we have a sufficient arsenal of means to suppress MT, in the case of multiple resistance or multiresistance of mycobacteria, the treatment of the patient becomes many times more complicated.

Treatment of pulmonary tuberculosis with specific anti-tuberculosis drugs includes the solution of the following tasks:

Suppression of reproduction of Mycobacterium tuberculosis and prevention of their spread in the body;

Termination of bacterial excretion to avoid possible infection of healthy individuals;

Achieving a state of clinical cure with minimal functional loss and residual changes;

Prevention of disease recurrence.

But even the most powerful anti-TB drugs can only suppress the active reproduction of MT in the body, but not completely destroy them. In addition, even at bacteriostatic concentrations, many anti-tuberculosis drugs have severe side effects, due to which patients often refuse to take them. Due to the forced reduction in dosages in such patients, the concentration of drugs in the body also decreases, and MT quickly learn to exist in their presence.

There is another category of undisciplined patients who forget to take their medications, sometimes skipping several days, or cancel drugs on their own with an unsatisfactory, in their opinion, effect. Under such conditions, MTs continue to multiply. As a result, it is possible to cure such a patient only with the use of rather expensive drugs of the reserve line, since the most effective first-line drugs no longer work on them. Or tuberculosis goes into a chronic stage with the most adverse consequences for the body. And if at the same time a person continues to excrete bacteria, then he infects others precisely with his mycobacteria resistant to anti-TB drugs.

The fundamental postulate of modern phthisiology is the intake of drugs in prescribed doses and a strictly defined course. At the beginning of treatment of a patient with a newly diagnosed acute process, MTs are in the active phase, they multiply rapidly and are located predominantly extracellularly. Therefore, anti-TB drugs act on them with maximum efficiency, and under optimal conditions and strict adherence to the regimen of taking and doses of drugs, such patients are completely cured. Treatment in such cases lasts from a year to a year and a half, and, as a rule, after 3-6 months, MTs lose their activity and, for the most part, hide from PTPs inside phagocyte cells, in which it is already difficult to destroy pathogens. In addition, MTs have significant variability; they can change their shape or go into a dormant state. In the latter case, it is no longer possible to act on them. Such dormant forms of MT are subsequently a source of infection activation under unfavorable conditions for the body.

Treatment of tuberculosis in connection with such features of the behavior of mycobacteria is reasonably divided into two phases:

The phase of intensive treatment, when the patient receives the maximum of highly active anti-TB drugs,

Post-treatment phase, when for. To prevent the reactivation of dormant and intracellularly located MTs, it is necessary to use a smaller amount of anti-TB drugs. During the post-treatment phase, in addition to the latter, all kinds of therapy are used to improve the immune status of the body and increase its resistance to infection, as well as to activate the recovery processes in the affected organs.

Very often, premature discontinuation of anti-TB drugs, when the patient has a pronounced improvement in his condition and well-being, leads not only to the formation of drug resistance in MT, but also to an exacerbation of the tuberculous process. Further treatment in such cases becomes more complicated, and its duration also increases. The same applies to chronic forms of tuberculosis, in which patients spend on treatment almost the entire life span allotted to them.

It is quite achievable, a realistic goal to cure fresh tuberculosis, which requires the implementation of the doctor's recommendations and the regular intake of anti-tuberculosis drugs for 12-18 months. At the same time, the treatment of chronic forms and tuberculosis caused by drug-resistant forms of MT is a very difficult task, for which it is necessary to involve the entire reserve of drug and non-drug, including non-traditional, methods of therapy.

Distinguished from anti-tuberculosis drugs three main groups:

The most effective drugs are isoniazid and rifampicin (rifadin);

Intermediate drugs - ethambutol, streptomycin, prothionamide, ethionamide,

pyrazinamide, kanamycin, cycloserine, florimycin;

The least active drugs are PASK and Tibon.

The impact of anti-tuberculosis drugs on mycobacterium tuberculosis is diverse and consists of a violation of their metabolic processes and enzymatic activity, growth and reproduction retardation, and a decrease in aggressiveness towards the macroorganism.

Most often, in the treatment of a newly diagnosed patient with an acute tuberculous process, standardized schemes are used. Depending on the severity of the patient's condition and the activity of the disease, 3-4-5 drugs are used simultaneously. The principle of combination therapy is the cornerstone of phthisiology.

One drug (monotherapy) for the treatment of tuberculosis is not used, because MT, due to its pronounced variability, very quickly get used to its action. On the contrary, several drugs that act on MT in different directions complement each other and do not allow the pathogen to quickly develop resistance.

Usually, in forms of tuberculosis that are characterized by the collapse of the lung tissue, the formation of cavities and bacterial excretion, the scheme "isoniazid - Crifampicin + streptomycin" is used in combination with pyrazinamide and ethambutol, alternating with each other. Isoniazid is the main drug in the combination, which is prescribed to the patient throughout the course of therapy, or until resistance develops to it. Rifampicin due to the possibility of toxic effects on the liver is prescribed during the first 4 months of treatment, after which it is canceled. Streptomycin is characterized by a very rapid formation of MT resistance to it, so it is prescribed for 2 months. Pyrazinamide and ethambutol are also used throughout the course of treatment. They alternate with each other every other day. At the beginning of treatment, all anti-TB drugs are taken in a continuous course (daily), and then they switch to taking the drugs at the right dose once every few days. This is necessary in order to suppress the activity of MTs located inside the cells and prevent them from multiplying intensively again.

With such forms of tuberculosis infection as caseous pneumonia, miliary tuberculosis, tuberculous meningitis, the maximum allowable doses of anti-TB drugs (isoniazid, rifampicin, kanamycin) are used in the form of intravenous infusions. Caseous pneumonia, the mortality rate of which is 30-50%, with the ineffectiveness of such treatment within 3-6 weeks, requires the appointment of a surgical intervention - removal of the affected lung - pulmonectomy. Refusal of the operation most often causes a terminal outbreak of tuberculosis and death of the patient.

The terms of treatment for limited (benign) forms of tuberculosis can be limited to 8-9 months, the number of drugs in combination is usually 3, then 2. As a rule, this is isoniazid + streptomycin +. ethambutol (or pyrazinamide), streptomycin is canceled 2 months after the start of therapy.

In case of a disease caused by drug-resistant forms of MT, it is necessary to individually select reserve drugs that are combined with each other in the same way as the main drugs. However, it should be taken into account that, for example, such a combination as fluoroquinolones + pyrazinamide + ethambutol does not act as effectively on MT as a combination of isoniazid and rifampicin with the same pyrazinamide and ethambutol.

In this regard, the duration of the intensive phase of treatment with reserve drugs increases. The most unfavorable for patients is the development of MT resistance to the combination of isoniazid and rifampicin.

Among the drugs of the reserve series, in addition to fluoroquinolones, it should be noted cycloserine, prothionamide, ethionamide, kanamycin, florimycin, as well as a drug from the rifampicin group - rifabutin.

It is possible to detect drug resistance of MT only by a cultural method, that is, when a culture of mycobacteria is isolated from a patient, followed by testing its response to various anti-TB drugs, which in itself is a lengthy process, then treatment begins with a combination of first-line drugs.

After that, therapy is reviewed, if resistance to individual drugs is detected, they are canceled, adding at least 2 reserve funds instead.

Treatment of children with primary tuberculosis infection should be comprehensive and include measures to combat infection, increase the body's resistance, as well as the optimal regimen for the child and good nutrition. All appointments are made by a phthisiopediatrician.

Treatment is carried out in a hospital in case of a complicated primary complex, tuberculosis of the intrathoracic lymph nodes, miliary tuberculosis, tuberculous meningitis. In the polyclinic, treatment is carried out for tuberculosis intoxication, a simple primary complex,1 a "small form" of tuberculosis of the intrathoracic lymph nodes.

Antibacterial therapy is carried out using specific anti-tuberculosis drugs, which are prescribed according to the same general principles as for adult patients. However, the age of the child and the anatomical and functional features of his body are always taken into account. For example, in young children, the use of certain effective anti-TB drugs is limited by the development of side effects that are difficult to assess for a number of age reasons. A drug such as ethambutol is not prescribed for children under 3 years of age, since its side effect is a toxic effect on the optic nerve. The control of visual function in children at this age is objectively difficult. Cycloserine is generally contraindicated in children and adolescents due to side effects on the central nervous system with an already unstable psyche.

On the contrary, it should be noted that in childhood, many drugs are easier to tolerate, which in adults cause side effects due to toxic effects on the liver. As a rule, the latter in children is not yet undermined by alcohol intake and previous diseases.

Against the background of taking anti-tuberculosis drugs, other means of drug treatment are also used, which reduce inflammatory reactions and enhance immunity. Depending on the form of the disease and the severity of its course, heparin, immunomodulators, riboxin, vitamins C, E, group B, aloe, plasmol, tuberculin therapy are used. The use of glucocorticoid therapy in children and adolescents is limited exclusively to complicated forms of the disease (such as bronchial tuberculosis, bronchopulmonary lesions, meningitis, exudative pleurisy, dissemination).

Electrophoresis with absorbable agents, UHF and laser therapy are also used from physiotherapeutic effects.

In the treatment of children with tuberculosis, there are psycho-emotional difficulties associated with trauma due to separation from the family. But even when treating children on an outpatient basis (at home), there are many problems caused, for example, by their inability to swallow pills. In addition, due to the lack of special pediatric dosage forms, tablets for adults have to be divided, which leads to the destruction of their capsules or protective shells. As a result, the toxic effects of anti-TB drugs may increase.

Children and adolescents with tuberculosis should always receive long-term anti-TB drugs, which is associated with the impossibility of surgical treatment, at least during the first year after the start of anti-TB therapy. Even with the formation of tuberculoma or cavern, surgical intervention is contraindicated, since a specific inflammatory process in the intrathoracic lymph nodes can lead to a postoperative outbreak of tuberculosis with possible dissemination of infection.

Tuberculosis: Essential anti-tuberculosis drugs

Isoniazid

Isoniazid is isonicotinic acid hydrazide and is the main agent in this group of drugs, as well as the most active agent against MT. It has a pronounced bacteriostatic effect on Mycobacterium tuberculosis (stops their growth and reproduction), while it does not have such activity against other common microorganisms.

Isoniazid is well absorbed in the gastrointestinal tract when taken orally and after 1-4 hours in the blood is already at the desired concentration, which persists for another 6-24 hours. The drug is excreted from the body mostly by the kidneys.

Isoniazid is used to treat all forms and localizations of active tuberculosis in patients of all age groups. Greater effectiveness of prescribing the drug can be achieved in the treatment of "fresh", acute processes. In most cases, isoniazid is administered orally, less often - intravenously, as well as for washing cavities and fistulous passages.

It is recommended to take isoniazid after meals. For adults, the daily dose of the drug is calculated based on the proportion of 10-15 mg per kilogram of the patient's body weight. As a rule, this is 0.6-0.9 g per day. Usually, starting treatment, this dose is divided into 3 doses per day of 0.2-0.3 g, respectively, then they switch to a single dose of the entire daily dose, which is more convenient for patients and more effective. With the development of side effects, the dose is reduced to 8-5 mg / kg per day once.

In childhood, the dose of isoniazid per day is from 5 to 10 mg / kg, in severe cases - up to 15 mg / kg, but not more than 0.5 g per day.

Standardly, isoniazid is combined with PAS and streptomycin or with drugs of the second group.

Side effects when taking isoniazid are the possible occurrence of headache, dizziness, nausea, vomiting, pain in the heart, skin allergic reactions. In relation to the central nervous system, euphoria, sleep disturbances, and in rare cases, psychotic reactions may occur; damage to peripheral nerves may occur with the development of muscle atrophy and paralysis of the limbs. In some cases, the occurrence of drug-induced hepatitis. It is extremely rare for men to develop gynecomastia, and for women - menorrhagia (excessively heavy menstrual bleeding). In the presence of concomitant epilepsy, seizures may become more frequent in patients.

As a rule, to eliminate side effects, it is enough to reduce the dose of the drug or take a short break in taking it. To prevent complications from the nervous system, it is recommended to prescribe pyridoxine intramuscularly in parallel with the use of isoniazid, but 2 ml of a 2.5-5% solution 2 times a day.

Contraindications to the appointment of isoniazid are epilepsy, a tendency to convulsive seizures, poliomyelitis in the past, severe vascular atherosclerosis, severe liver and kidney dysfunction.

Ftivazid

Ftivazid also belongs to the group of isonicotinic acid hydrazide derivatives. In terms of its therapeutic properties and indications for prescribing, the drug is close to isoniazid, but it is absorbed more slowly in the digestive tract, and the blood concentration of the active substance that affects MT is lower.

Assign ftivazid orally. As a rule, the drug is well tolerated. For adults, the daily dose is usually 1-1.5 g - 0.5 g 2-3 times a day. For children, the drug is prescribed at 20-30-40 mg per kilogram of body weight per day (but not more than 1.5 g per day) in 3 divided doses.

With lupus erythematosus, ftivazide is used at a dose of 0.25-0.3 g 3-4 times a day, the course usually accounts for 40-60 g. The courses are repeated 2-3 times, with a break between them of 1 month.

Side effects when taking ftivazid are similar to those that develop when using isoniazid. To prevent and eliminate them, B vitamins (pyridoxine, thiamine) are used.

Contraindications to the appointment of ftivazid are angina pectoris, heart defects in the stage of decompensation, organic diseases of the nervous system, kidney diseases of a non-tuberculous nature, accompanied by impaired excretory function.

Saluzid, saluzid soluble

According to the properties and anti-tuberculosis activity, as well as contraindications, the drug is close to ftivazid.

Saluzid soluble is used in the form of a 5% aqueous solution, which is used to wash the fistulous passages of various localization, is injected into the caseous lymph nodes, into the genitourinary tract, cavities, in the form of inhalations - into the trachea and bronchi, is used in drops for tuberculous eye damage.

Usually the drug is used in combination with other anti-tuberculosis drugs.

Rifampicin

Rifampicin is a semi-synthetic broad-spectrum antibiotic that is active not only against MT, but also against many other microorganisms.

The drug is well absorbed in the gastrointestinal tract when taken orally. The required blood concentration is reached 2 hours after ingestion and slowly decreases over the next 8-12 hours. The drug is excreted mainly in the bile and to a lesser extent in the urine.

Rifampicin is taken orally on an empty stomach 30 minutes to 1 hour before meals. The average daily dose for adults is 0.45 g, which is taken once a day throughout the course. With exacerbations of the process in patients weighing more than 70 kg, the dose can be increased to 0.6 g per day. For children, the drug is prescribed at the rate of 8-10 mg / kg, but not more than 0.45 g per day, in 1 dose daily. In case of poor tolerance, the dose can be divided into 2-3 doses per day. The course of treatment can be 12 months or more. Usually, combinations with other anti-TB drugs are used to prevent the development of MT resistance.

Side effects of rifampicin are the relatively rare development of allergic reactions, gastrointestinal disorders, disorders of the liver and pancreas. Treatment with the drug should be carried out under close supervision and regular monitoring of liver tests and complete blood count, since with prolonged use, hematopoietic processes may be inhibited. With the development of severe side effects, the drug should be discontinued.

Rifampicin has a bright red-brown color, and at the beginning of treatment (especially) it can stain urine, sputum, tear fluid, which become reddish.

Contraindications to the appointment of rifampicin are infancy, pregnancy, hepatitis of various nature, impaired renal excretory function, hypersensitivity to the drug.

Streptomycin

Streptomycin sulfate is a broad-spectrum antibiotic that has a bactericidal effect on MT and many other microorganisms. Resistance to it develops rapidly, so it is used in combination with other anti-TB drugs (except kanamycin and florimycin) and, as a rule, in the first 2-6 months from the start of treatment.

The drug is poorly absorbed in the gastrointestinal tract and, on the contrary, well - when administered intramuscularly. It is rapidly excreted from the body, mainly in the urine. ‘

The daily dose for adults is 1 g of streptomycin, which is administered once a day. For patients over 60 years of age and with a decrease in body weight to 50 kg or less, the daily dose is reduced to 0.75 g. For children, the daily dose is calculated based on 15-20 mg per kilogram of weight, but not more than 0.5 g per day and 0.75 g per day for teenagers.

In the first few days, it is better to use streptomycin, dividing the dose into 2 doses per day. Then you should move on to a single dose, which achieves a higher concentration of the drug in the blood and tissues. In case of poor tolerance, the dose can be reduced to 0.75 g, in patients weighing less than 50 kg - up to 0.5 g. You can use the drug in the form of an aerosol for inhalation (0.2-0.25 g in 3-5 ml of distilled water ). Inhalations are performed daily or every other day, 15-20 procedures are prescribed for the course.

Side effects in the treatment of streptomycin are quite diverse: allergic reactions in the form of skin rashes, drug fever and other things, dizziness, headache, heart palpitations, diarrhea, toxic effects on the kidneys (protein and erythrocytes in urine), as well as toxic effects on the auditory nerve , and if the doses are exceeded (or the drug is poorly excreted), irreversible deafness may develop.

Therefore, in the course of treatment, regular monitoring of the function of the liver and kidneys, as well as the state of the hearing organs, and the blood count is necessary. With mild side effects, the dose of the drug can be reduced, anti-allergic drugs (tavegil, fenkarol, etc.), calcium preparations, vitamin can be prescribed. In severe side effects, streptomycin should be canceled. To prevent the toxic and allergic effects of streptomycin, calcium pantothenate is used at a dose of 0.4 g 2 times a day.

Contraindications to the appointment of streptomycin are pregnancy, liver and kidney diseases with impaired excretory function of the latter, the acute stage (first weeks) after myocardial infarction, severe forms of angina pectoris, hypertension, as well as previous neuritis of the auditory nerve.

Kanamycin

Kanamycin is a broad-spectrum antibiotic from the group of aminoglycosides. It has a bactericidal effect against many microorganisms, in addition to MT, and is used when MT is resistant to the main anti-TB drugs in various combinations (except for florimycin).

The drug is administered intramuscularly, after which it quickly enters the bloodstream and remains there in the required concentration for 8-10 hours. It is excreted mainly by the kidneys. If their function is impaired, excretion continues for more than 24 hours, which can lead to an increase in the toxic effect of kanamycin.

The daily dose of kanamycin for adults is 1 g once, for children the drug is prescribed based on 15-20 mg per kilogram of body weight, but not more than 0.5 g for children and 0.75 g for adolescents.

A solution of kanamycin in the form of an aerosol can be used for inhalation at 0.25-0.5 g per 3-5 ml of distilled water - for adults, for children, the dose for inhalation is 5 mg / kg. The course of treatment is a month (or more if necessary).

Kanamycin is a drug with a pronounced toxic effect on the auditory nerve and kidneys. It is used for constant (weekly) monitoring of the state of hearing and excretory function of the kidneys (in the form of audiometry and urinalysis). With the appearance of even a slight noise in the ears, the drug is immediately canceled. Due to difficulties in determining the state of the hearing organs, kanamycin should be prescribed to children with extreme caution.

Side effects with the introduction of kanamycin (in addition to those described above) are possible allergic reactions, abnormal liver function, paresthesia (sense of crawling, tingling, numbness of the skin).

Contraindications to the use of kanamycin are neuritis of the auditory nerve, impaired liver and kidney function (except for those caused by tuberculosis), the use of other drugs toxic to the auditory nerve and kidneys (kanamycin can be used no earlier than 12 days after their cancellation). For women during pregnancy, premature babies and children of the first month of life, the drug is prescribed only for health reasons.

Florimycin (viomycin)

Florimycin sulfate is an antibacterial agent similar in its characteristics and effect to kanamycin. It has specific activity against MT, as well as a number of other microorganisms. Belongs to group B drugs with moderate efficacy, is used in combination with other anti-TB drugs (except for streptomycin, kanamycin, monomycin, neomycin) or as a backup remedy when MT is addicted to other drugs.

Florimycin is not absorbed in the gastrointestinal tract, so it is prescribed as a solution for injection. Enter intramuscularly, deeply and slowly into the upper outer quadrant of the buttock. The daily dose for an adult is 1 g of the drug. Usually it is divided into 2 times - 0.5 g in the morning and evening, or you can enter florimycin once, 1 g each. After 6 days of daily administration, you should take a break for 1 day. If long-term treatment is necessary, the break can be 2 days or 1 day every 2-3 days of administration. Patients over 60 years of age and debilitated (weighing less than 50 kg) daily dose should be reduced to 0.5-0.75 g.

It is not recommended to prescribe the drug to children, since it is difficult to assess the degree of toxic effect of florimycin on auditory functions. However, if necessary (in case of ineffectiveness of other drugs in chronic destructive forms of tuberculosis), the dose of florimycin in children is calculated based on 0.015-0.02 (15-20 mg) per kilogram of body weight, but not more than 0.5 g in children and 0.75 g in adolescents.

When treating with florimycin, it is necessary to remember about the toxic effect of the drug on the auditory nerve, therefore, when using it in children, it is necessary to monitor the state of hearing. At the first sign of hearing loss, the drug should be discontinued.

Side effects when using florimycin may include the appearance of headaches, allergic skin reactions, toxic effects on the kidneys (protein in the urine). In patients with impaired renal excretory function, the drug may accumulate in the body, while its toxic properties are enhanced. To reduce the toxic and allergic effects of florimycin, you can combine it with the simultaneous administration of calcium pantothenate.

Contraindications to the appointment of florimycin are damage to the auditory nerve and impaired renal excretory function.

Ethionamide

It is a synthetic anti-tuberculosis drug. It is less active than tubazid and streptomycin, but in some cases it affects MTs that are resistant to these drugs.

Ethionamide is usually given orally after a meal. Adults are prescribed 0.25 g 3 times a day, with good tolerance - 4 times a day. In case of poor tolerance, patients over 60 years of age and weighing less than 50 kg are recommended to take ethionamide 0.25 g 2 times a day. Children are prescribed the drug at the rate of 0.1-0.2 g / kg, but not more than 0.75 g per day.

Side effects when prescribing ethionamide are a deterioration in appetite, the appearance of nausea, vomiting, flatulence, abdominal pain, loose stools, and weight loss. Urticaria-type rashes are possible. In rare cases, there are changes in the central nervous system - sleep disturbances, depressive disorders. In order to smooth side effects, you can use nicotinamide 0.1 g 2-3 times a day, as well as pyridoxine 1-2 ml of a 5% solution intramuscularly. For the prevention of disorders of the gastrointestinal tract, it is recommended that patients with increased acidity of gastric juice use the drug in conjunction with Almagel, Maalox and other agents that reduce the aggressiveness of the gastric environment, and in anacid or hypoacid conditions, use diluted hydrochloric acid or gastric juice.

In general, the drug should be used with caution in diseases of the gastrointestinal tract and liver.

Prothionamide

Prothionamide is similar in chemical structure to ethionamide, in terms of anti-tuberculosis activity it practically does not differ from it, but is relatively easier to tolerate. It is usually used in combination with other anti-tuberculosis drugs.

As a rule, it is prescribed for poor tolerance to ethionamide, however, the occurrence of cross-resistance of MT to drugs of this group should be taken into account and protionamide should not be used with developed resistance to ethionamide.

The drug is taken orally after meals, adults - at a dose of 0.25 g 3 times a day, with good tolerance, 0.5 g 2 times a day. Patients over 60 years of age and weighing less than 50 kg are usually prescribed 0.25 g 2 times a day. For children, the drug is recommended at a dose of 10-20 mg / kg per day.

Side effects when taking protionamide are characterized by the possible development of gastrointestinal disorders, allergic skin reactions, as well as dizziness, weakness, palpitations, paresthesia, but they are less pronounced than when using ethionamide.

The drug is not prescribed during pregnancy.

PASK (sodium para-aminosalicylate)

Para-aminosalicylic acid and its sodium salt (abbreviated as PAS) have activity in suppressing the growth of MT, however, in terms of their effectiveness, they belong to the last, third group of drugs, therefore they are used mainly in combination with other anti-TB drugs - isoniazid, rifampicin, etc. Combination therapy prevents the rapid development drug resistance of MT and enhances the action of more active drugs. Various combinations with PAS are used for tuberculosis of various forms and localizations.

When taken orally, PAS is well absorbed in the gastrointestinal tract, it is prescribed 0.5-1 hour after a meal. The drug should be washed down with milk, alkaline mineral water, 0.5% solution of baking soda. The daily dose for an adult is 9-12 g of PAS (3-4 g 3 times a day), for a child, the daily dose is calculated based on the proportion of 0.2 g per kilogram of body weight, but not more than 10 g per day, divided by 3-4 intake per day. For adult patients weighing less than 50 kg and with poor tolerance, the drug is prescribed 6 g per day. With good tolerance, it is more expedient to prescribe the entire daily dose of PAS in 1 dose, with poor tolerance, it should be divided into 2-3 doses.

Due to the need to take large amounts of the drug, patients need to choose a more acceptable version of PAS for them, since there are different dosage forms of this drug - powder, tablets, tablets soluble in the intestine, granules containing 1 part of PAS and 2 parts of sugar, injection solution . Granules, due to their composition, are easier to carry than pure PAS. 1 teaspoon contains 6 granules, which corresponds to 2 g of PAS and 4 g of sugar. So, to obtain a daily dose of 12 g, the patient should take 2 teaspoons 3 times a day.

Side effects when taking PAS are gastrointestinal disorders, allergic manifestations, and liver dysfunction. On the part of the gastrointestinal tract, there may be a decrease or lack of appetite, nausea, vomiting, abdominal pain, diarrhea or constipation. To stop them, it is usually enough to reduce the dose of the drug or stop taking it for a short time. Less commonly, these phenomena occur when the patient follows the diet (at least 3 times a day), as well as when using the drug in the form of granules or tablets that are soluble in the intestine.

Allergic reactions when taking PAS may include skin rashes like urticaria, fever, asthmatic phenomena, joint pain, and eosinophilic blood reaction. With such signs, you should stop taking the drug temporarily or completely (depending on the severity of the allergic reaction) with the obligatory use of antiallergic drugs (tavegil, phencarol, etc.), calcium chloride, ascorbic acid. With prolonged allergic reactions that are not treatable with conventional antiallergic drugs, glucocorticoid hormones are used.

During therapy, patients should regularly examine the blood and urine, as well as conduct functional liver tests. You should be aware that large doses of PAS have a depressing effect on the function of the thyroid gland, therefore, with prolonged use, goiter may form.

Contraindications to the appointment of PAS are severe damage to the kidneys and liver, amyloidosis, peptic ulcer, heart failure in the stage of decompensation, hypothyroidism. The drug should be taken with caution in patients with moderately severe diseases of the gastrointestinal tract.

Cycloserine

Cycloserine is a drug from the group of antibiotics, which is active against a number of microorganisms. However, the ability to inhibit the growth and reproduction of MT is the most significant effect of the drug. The activity of cycloserine against MT is inferior to that of streptomycin and ftivazide, but it is effective in the resistance of MT to them and PAS. Therefore, the drug is used as a reserve agent, especially in patients with chronic forms of tuberculosis, on whom previously taken drugs have ceased to have an effect, or as part of combination therapy with more active agents to prevent the development of MT resistance to them.

Cycloserine is well absorbed in the gastrointestinal tract, it is administered orally immediately before meals at a dose of 0.25 g 3 times a day for adults. Patients over 60 years of age and malnourished (weighing less than 50 kg) - 2 times a day. For children, the dose is calculated at 0.01-0.02 g per kilogram of body weight per day, but not more than 0.75 g per day. At a dose of 0.02 g / kg, the drug is prescribed for acute processes or with insufficient effectiveness of low doses.

Side effects when taking cycloserine are due to a greater degree of toxic effects on the central nervous system and consist in the possible occurrence of headache, dizziness, insomnia, or, conversely, drowsiness, anxiety, increased irritability, memory loss, damage to peripheral nerves. In some cases, more serious disorders develop - a sense of fear, hallucinations, seizures, loss of consciousness.

As a rule, to eliminate these side effects, it is necessary to reduce the dose of the drug or cancel it in case of severe violations. To prevent side effects, simultaneously with cycloserine, you can use glutamic acid 0.5 g 3-4 times a day before meals, pyridoxine 1-2 ml of a 5% solution intramuscularly. Additional use of anticonvulsant and sedative drugs, antidepressants is possible.

Contraindications to the use of cycloserine are organic diseases of the central nervous system, epilepsy, mental disorders, as well as indications of the presence of mental illness in the past. You can not take cycloserine before surgery and in the first week after it. Caution when taking the drug is necessary for people with unstable mentality and suffering from alcoholism and drug addiction, as well as patients with impaired renal function.

Ethambutol

Ethambutol has the ability to inhibit the growth of MT, while it has no effect on other microorganisms. The drug is well absorbed in the gastrointestinal tract, excreted mainly by the kidneys, and is used in combination with other anti-TB drugs in various forms and localizations of the tuberculosis process.

The drug is used for oral administration. The entire daily dose is taken once after breakfast. For adults, the dose is calculated based on 25 mg per kilogram of body weight, for children - 20-25 mg / kg, but not more than 1 g per day. In this dose, the drug is taken throughout the course of treatment. Adults can sometimes take ethambutol 2-3 times a week at a rate of 50 mg/kg. Side effects when taking ethambutol may include an increase in cough, an increase in the amount of sputum, the appearance of allergic rashes on the skin, as well as gastrointestinal disorders, depression, and decreased vision. These phenomena disappear after discontinuation of the drug. Contraindications to the use of ethambutol are cataracts, optic neuritis, inflammatory eye diseases, diabetic retinopathy, pregnancy.

Pyrazinamide

Pyrazinamide in its antituberculous activity belongs to group B drugs. Its features are good penetration into the lesion and high activity in the acidic environment of caseous necrotic masses (foci of cheesy decay), therefore it is often used in combination with other anti-TB drugs for tuberculous lymphadenitis, tuberculomas and others. conditions with the presence of extensive areas of cheesy necrosis.

The daily dose of pyrazinamide for adults is 1.5-2 g, and with good tolerance - 2.5 g. It should be taken 1 g 2 times a day after meals. Patients over 60 years of age and with a body weight of less than 50 kg, the dose should be no more than 1.5 g per day. For children, the dose is calculated on the basis of 20-30 mg per kilogram of body weight, but not more than 1.5 g per day.

Side effects when taking pyrazinamide are the development of allergic reactions - skin rashes, fever, increased levels of eosinophilic cells in the blood, as well as possible gastrointestinal disorders, decreased appetite, headaches, less often irritability and anxiety. Perhaps the toxic effect of the drug on the liver, so during the treatment it is necessary to regularly perform liver function tests. In case of any violations, the drug should be discontinued. Reducing the toxicity of pyrazinamide contributes to the simultaneous administration of methionine, vitamin B)2, lipocaine.

Contraindications to taking pyrazinamide are liver dysfunction and gout.

Thioacetazone (Tibone)

Thioacetazone (tibon) belongs to group C drugs with little activity against MT. In addition, its use is limited by its relatively high toxicity. Thioacetazone is usually prescribed in combination with other anti-TB drugs to reduce the possibility of developing drug resistance in MT. It should not be used simultaneously with ethionamide due to the development of cross-resistance of mycobacteria.

Tibon is more often used for tuberculosis of the mucous membranes, lymphadenitis, skin lesions, and the presence of fistulous passages.

For adults, the drug is prescribed in a daily dose of 0.1-0.15 g (0.05 g 2-3 times a day). It should be taken orally after meals with a glass of tea, milk, water. For patients weighing 50 kg or less, as well as those over the age of 60, the daily dose is 0.1 g. For children, the dose is calculated based on 0.5-1 mg per kilogram of body weight, but not more than 0.05 g per day.

Side effects when using tibon are characterized by the possible development of headache, nausea, loss of appetite, skin reactions. In the treatment of large doses, toxic effects on the kidneys and liver, as well as the hematopoietic system, are possible. With severe side effects, the drug is canceled. Contraindications to the appointment of tibon are violations of the liver and kidneys, diseases of the hematopoietic system.

Fluoroquinolones

Currently, fluoroquinolones such as ciprofloxacin (ciprolet, ciprobid), ofloxacin (tarivid), pefloxacin (abaktal), lomefloxacin (xenaquin) and norfloxacin (nolicin) are widely used in practice. The choice of the drug in each case should be carried out individually, taking into account the sensitivity of MT, however, ciprofloxacin and ofloxacin are most often used. Typically, fluoroquinolones are used in the complex therapy of drug-resistant forms of tuberculosis. However, due to the wide availability of fluoroquinolones and the frequent prescription of these drugs for other non-tuberculous diseases, the development of MT strains resistant to them is also possible.

The most common side effects when taking fluoroquinolones are decreased appetite, nausea, abdominal pain, vomiting, diarrhea (the development of pseudomembranous colitis is not excluded), sleep disturbances, headache, depressed mood; kidneys, lowering blood pressure, skin allergic reactions. In some cases, the development of candidiasis of the mucous membranes is observed. Most drugs have a photosensitivity effect, so you should avoid direct sunlight while taking them.

Contraindications to the use of fluoroquinolones are epilepsy, pregnancy and lactation, children and adolescents under 18 years of age, hypersensitivity to fluoroquinolones. Fluoroquinolones should be used with caution in severe atherosclerotic processes (including in patients over 60 years of age), kidney disease and convulsions of unknown origin.

During the period of use of fluoroquinolones, a sufficient amount of liquid should be taken.

Additional medical treatment

The pathogenetic therapy of a patient with tuberculosis implies the use of all means that increase the body's resistance to infection, suppress pathological inflammatory reactions, and eliminate individual manifestations of the disease.

Anti-inflammatory non-steroidal drugs (NSAIDs) are one of the commonly used groups of drugs that are used to eliminate inflammatory phenomena both in the exudative type and in the predominantly productive type of reactions. The most effective among them are diclofenac and indomethacin, which are usually administered orally after meals 3 times a day for 3-4 weeks.

Heparin also has a sufficient anti-inflammatory effect, which is used in the form of subcutaneous injections at a dose of 5000 IU / kg every other day for a course of 1.5-2 months or in the form of electrophoresis on the chest.

With the predominance of the exudative nature of inflammatory reactions and the severe course of the disease (exudative pleurisy, meningitis, infiltrative or miliary tuberculosis), patients are prescribed adrenal hormone preparations (glucocorticoids). Among them, the most widely used is prednisolone, which in its anti-inflammatory activity exceeds the natural hormone cortisol by 5 times. Prednisolone is prescribed in a dose of 5 to 20 mg per day - for adults, children - based on the calculation of 1 mg per kilogram of weight, but not more than 20 mg per day. The duration of the course depends on the patient's condition, but usually is 3-8 weeks, therefore, taking into account the increased excretion of potassium salts against the background of glucocorticoid therapy, a diet rich in potassium salts and drugs such as asparkam or panangin should be prescribed. Another feature of glucocorticoid therapy is the mandatory accounting of daily biorhythms for the release of the body's own hormones, that is, they are taken mainly in the morning. A sufficiently long course of prednisolone requires its gradual abolition (usually a scheme is used: 20 mg - 15 mg - 10 mg - 5 mg - 2.5 mg). In addition to systemic administration, glucocorticoids are also used topically (in the form of hydrocortisone aerosols) for tuberculosis of the bronchi, larynx, as well as for severe allergic phenomena associated with intolerance to anti-TB drugs.

Patients, if destructive processes are expressed in the lungs (decay of lung tissue), are prescribed drugs from the group of proteolysis inhibitors - contrykal, gordoka, which suppress the enzymatic destruction of proteins.

For the correction of disturbed metabolic processes in the body, patients are recommended to take drugs from the group of antioxidants. These include tocopherol (vitamin E) and sodium thiosulfate in the form of a 30% solution of 8-10 ml intravenously by stream or inhalation. In addition, riboxin at a dose of 0.2-0.4 g 3 times a day for a course of 30-40 days, lipoic acid 25 mg 3 times a day, cocarboxylase and ATP in the complex for a course of 20-40 days contribute to the improvement of energy metabolism. Among non-drug methods, the most widely used is the use of low-energy laser radiation.

Timely and complete vitamin therapy is important, which is prescribed simultaneously with anti-tuberculosis drugs in order to prevent and correct possible side effects. In addition, in conditions of tuberculosis intoxication, the need for vitamins increases, and their reserves in the body are rapidly depleted. It must be remembered that a patient with tuberculosis needs increased doses of vitamin C (1-1.5 g per day), vitamin B (5 mg per day), vitamin B6 (2 mg per day). Pantothenic and glutamic acids are successfully used to correct the side effects of anti-TB drugs.

Treatment after achieving a stable anti-inflammatory effect should be aimed at enhancing the recovery processes in the lung tissue. For this purpose, anabolic hormones are used, usually nerobol or retabolil, 50 mg (1 ml) once a week (4-5 injections per course), as well as biogenic stimulants - solcoseryl, vitreous, plasmol, FiBS. They are also used to reduce the formation of gross cicatricial changes in the lung tissue together with trental. From non-drug means during this period, ultrasound is used on the chest in the area of ​​​​localization of the site of damage to the lung tissue. Tuberculin therapy (treatment with tuberculin) is used with a tendency to form tuberculomas in order to stimulate regenerative processes. The initial dose is determined by intradermal titer. For medicinal purposes, a concentration is used that is 10 times less than the established one. For example, with titer No. 8, treatment begins with dilution No. 9. Tuberculin is administered subcutaneously at a dose of 0.1-0.2 ml 2-3 times a week. Depending on tolerance, the dose is gradually increased (up to 1 ml). Finish treatment with dilution No. 2 or 1. The duration of the course is 1-2 months.

Pneumothorax and pneumoperitoneum - these methods of treatment are more surgical and are used relatively rarely. Artificial pneumothorax is the introduction of air into the pleural cavity for therapeutic purposes. The positive effect of pneumothorax exposure is caused by a complex reflex mechanism, leading to the formation of relative functional rest in the affected area of ​​the lung, where the conditions of both blood supply and lymph outflow change.

Currently, the indication for the imposition of artificial pneumothorax is the preservation of a stable decay cavity and bacterial excretion in the treatment of PTP in sufficient doses for 3-4 months, mainly in infiltrative, cavernous and focal pulmonary tuberculosis. In addition, pneumothorax is also used in the development of complications such as hemoptysis and pulmonary bleeding. Treatment with artificial pneumothorax is carried out against the background of PTP therapy, which is continued for at least 10-12 months.

Pneumoperitoneum is a treatment for pulmonary tuberculosis by introducing air into the abdominal cavity. Indications for pneumoperitoneum are bilateral, mainly lower lobe, destructive processes that usually occur with disseminated and infiltrative tuberculosis, in conditions of insufficiently effective treatment of anti-TB drugs, as well as with pulmonary hemorrhage and hemoptysis.

A complication of tuberculosis is pulmonary bleeding. If a patient develops hemoptysis or pulmonary bleeding, he should be immediately hospitalized in a specialized department. Blood loss of more than 500-1000 ml requires strict bed rest in a position with a raised headboard. The patient should apply tourniquets to the limbs (shoulders and hips) for 30-40 minutes, while the pulse on the radial artery and glans should be maintained.

Drugs that increase blood clotting are administered intravenously: vikasol, fresh frozen plasma, 6% solution of aminocaproic acid, 100.0 ml drip or contrical (gordox, trasilol) at a dose of 10,000-20,000 IU in 100 ml saline solution drip. 1-2 hours after these measures, the patient should take aminocaproic acid orally, 5 ml 4-6 times a day. In total, 20-30 ml of the drug should be taken on the first day.

In order to reduce blood pressure in the pulmonary vessels, ganglion blockers are used: 1.5% gangleron 1.0-2.0 ml subcutaneously, 5% pentamine 1.0-2.0 ml subcutaneously, benzohexonium 0.1 each ml inside 3-6 times a day for 2-3 days. 10 ml of a 10% solution of calcium chloride is administered intravenously, anti-allergic drugs are used (pipolphen or diphenhydramine orally or subcutaneously), as well as ascorbic acid, 3-5 ml of a 5% solution intramuscularly.

You should not use codeine during this period, which is part of many antitussives, and other narcotic drugs, since their main effect in this case is to suppress the cough reflex. A depressant effect on the respiratory center is also possible, which causes a violation of the discharge of blood clots and sputum from the respiratory tract and threatens the development of aspiration pneumonia. If the measures taken were ineffective and the bleeding continues, the patient is shown the imposition of pneumoperitoneum or artificial pneumothorax, which lead to compression of the patient's lung and cessation of bleeding.

Surgical intervention is advisable to carry out during the period of even a temporary stop of bleeding, which reduces the risk of surgery by 10-15 times, but it is better to transfer the patient to the surgical department in advance.

In case of hemoptysis, the patient is prescribed a semi-bed rest. For 3-5 days, he is carefully monitored. Of the drugs, aminocaproic acid is usually used 5 ml orally 3-4 times a day (with a 6-8 hour interval between doses), 10% calcium chloride solution 1 tablespoon 3-4 times a day after meals, ascorbic acid 0.1 g 3-4 times a day, antiallergic drugs. Modern hemostatic agents are highly effective. With their use, hemoptysis or pulmonary bleeding stops in the vast majority of patients (95-98%).

The next complication is spontaneous pneumothorax. With the development of spontaneous pneumothorax, mandatory hospitalization of the patient in a specialized hospital is required. A satisfactory condition with a closed pneumothorax is the reason for prescribing antibiotics for the prevention of pleurisy and pleural puncture with complete removal of air and straightening of the lung. A day after the puncture, X-ray control of the degree of lung expansion is performed, and if it is insufficient, a repeated pleural puncture is performed.

Valvular and open pneumothorax require emergency intervention. Initially, a pleural puncture is performed to confirm the diagnosis, with the most complete removal of air from the pleural cavity. In this case, the patient's condition is rapidly improving. In parallel, the pleural cavity is drained, otherwise the patient's condition will soon return to its original state. If, after drainage, the expansion of the lung occurs slowly, after 3-4 days the patient is transferred to the pulmonary surgical department for surgical treatment or re-drainage. Surgical treatment should be performed within 3-7 days, when pleural empyema has not yet developed.

Nutrition for tuberculosis

Nutrition is one of the most important components of the treatment of patients with tuberculosis.

At present, taking into account the current level of knowledge, it should be noted that not so much the quantity of food as its qualitative composition plays the role of the main therapeutic factor in tuberculosis.

Tuberculosis is a social infection. Outbreaks of the disease characterize periods of wars and other social upheavals. The role of proteins in the nutrition of the population is important, a decrease in the number of which immediately leads to a significant increase in the incidence. However, protein food of animal origin - meat, milk and dairy products, eggs, fish - as an integral part of good nutrition is not only a factor in the prevention of tuberculosis, but is also necessary for its treatment. Under conditions of chronic intoxication, with fever, and especially with phenomena of lung tissue decay, the body's need for proteins increases, therefore, in the food of patients, at least half of their amount should be easily digestible animal proteins.

The goals of therapeutic nutrition for tuberculosis are:

Ensuring the physiological needs of the patient's body with good nutrition in conditions of increased protein breakdown and intense metabolism of fats and carbohydrates;

Increase resistance to infection;

Normalization of all types of metabolism, including vitamin and mineral;

Assistance in the restoration of diseased tissues of the body.

Modern views on the calorie content of food for tuberculosis patients differ from previous recommendations.

In terms of calories, fats are the most valuable food component, followed by carbohydrates. Therefore, it is easiest to increase the calorie content of food by additionally including fatty foods and easily digestible carbohydrates (sugar, honey, starch, flour products, sweets, etc.) in the diet. This is exactly what has been done in the past. If you familiarize yourself with the recommendations of traditional medicine, then there are constantly tips to use marmot and bear fat, rendered badger fat, lard and ground squirrel meat, etc., for tuberculosis. Until now, mixtures of oil and honey with various additions are used, which patients are fed by relatives.

However, an excess of fats and carbohydrates in the diet harms patients with tuberculosis in the same way as their lack. In everything you need to observe the measure or know the golden mean. In modern conditions, tuberculosis no longer leads to such exhaustion of patients as before. Moreover, patients are increasingly overweight. At the same time, you should be aware that additional fats in the diet cause stress on the enzymatic systems of the digestive tract. And excess carbohydrates lead to additional allergization of the body, which is already significant due to the presence of MT.

In general, it should be noted that patients with tuberculosis still need enhanced nutrition. Enhanced, but not excessive.

An excess of fats and carbohydrates - fatty, sweet and starchy foods, has a negative effect on the course of the disease. Food overload causes difficulties in metabolism, the body spends additional energy on digesting food, and not on fighting the disease. Therefore, the total calorie content of food should be increased, in comparison with the physiological need of a healthy person, by no more than a third. Fortified nutrition should usually be recommended during the activity of the process, and not during the period of improvement. For patients with increased body weight, enhanced nutrition, especially at the expense of fats and carbohydrates, should not be prescribed.

The patient's diet should contain at least 100-120 g of protein daily, depending on age and body weight, and at least half should be in the proportion of protein of animal origin - meat, eggs, milk, fish.

The amount of carbohydrates in the diet should be from 400 to 500 g. One of the main principles of a balanced diet should be observed here: easily digestible carbohydrates (sweets, sugar, honey), bread and flour products, as well as cereals from unprotected cereals (semolina, rice, millet) should be less than vegetables, fruits, potato dishes and cereals from protected cereals (oatmeal, buckwheat, pearl barley, wheat).

The amount of fat in the diet should not exceed the physiological norm for a patient of a particular gender, weight and age. Usually it is 80-100-120 g. It is preferable to give patients easily digestible fats of milk in the form of sour cream, cream and butter. At least one third of the total fat quota should be vegetable oils; rich in fat-soluble vitamins and polyunsaturated fatty acids.

The content of the optimal amount of minerals in food is very important. The physiological need for them, as well as for vitamins, is covered by the maximum possible consumption of vegetables and fruits. The need for calcium is usually covered by milk and dairy products, especially cottage cheese and cheese. If necessary, additional administration of potassium, patients are advised to eat dried apricots and raisins. Nuts contain many minerals. If it is impossible to cover the increased need for vitamins, especially A, C, B and group C, it is recommended to administer them additionally orally or by injection. The highest need for vitamin C exists in patients with fibrous-cavernous forms, with high fever and tissue breakdown. They need to take ascorbic acid daily at a dose of 250-300 mg. A large amount of vitamin A contains egg yolk, fish oil, and provitamin A - carrots, tomatoes, red bell peppers. To increase the content of B vitamins, liver, black bread, dishes with bran, drinks from baker's or brewer's yeast are introduced into the diet.

In uncomplicated forms of the disease, fluid is not limited. In the presence of pronounced effusion processes (pleurisy, an increase in the amount of discharge from the bronchi, meningitis), as well as in renal forms of tuberculosis, the allowable rate of free fluid should not exceed 0.8-1 liter per day. In these cases, patients are prescribed a so-called salt-free diet, when the salt content in food is reduced to 6-8 g per day. On the contrary, with diarrhea, vomiting, when the patient loses a lot of fluid, the amount of salt and water is increased.

The total calorie content of the diet (gender, weight, age), its regimen depends on the individual characteristics of the patient (with bed rest, the energy requirement is not as great as with a sparing training one. It is believed that with bed rest, a man of average weight and age needs 2700 kcal, with half-bed - 2900-3100 kcal, with load - 3500 kcal.

Dietary nutrition of patients with pulmonary tuberculosis according to the treatment table No. 11 allows the use of such products and dishes as:

Bread: wheat, gray, rye, buns;

Snacks: doctor's sausage, cheeses, cheese butter, herring and shrimp butter, low-fat and not very salty ham;

Milk and dairy products: milk, cottage cheese, calcined cottage cheese;

Fats: butter and vegetable oils, sour cream, cream;

Eggs and dishes from them: boiled eggs, omelettes, scrambled eggs (no more than 2 eggs per day);

Meat, fish: low-fat varieties;

Cereals: buckwheat and oatmeal, "Hercules";

Fruits and berries: any;’

Vegetables: any;

Vitamins: vitamin C in the form of a decoction of rose hips, B vitamins in the form of a yeast drink.

Intestinal tuberculosis, especially during the period of exacerbation, requires the appointment of food exclusively in boiled and pureed form. Spicy dishes, strong meat and fish broths and spices are completely prohibited.

With tuberculosis of the bones and joints, the diet should contain at least 120 g of protein, an increased amount of mineral salts, especially calcium salts, and vitamins.

Non-drug treatment of tuberculosis

Not the last place in the treatment of tuberculosis is occupied by non-drug methods of treatment, when more and more patients excrete forms of mycobacteria resistant to anti-TB drugs. Ideally, they should be combined with medicines to improve the quality and speed of treatment. Non-drug methods of influencing the body include climatotherapy, including aerotherapy and heliotherapy (treatment with air and the sun).

Climatotherapy includes all the beneficial effects on the human body of natural factors of a certain area with a particular climate. In the past, doctors recommended that TB patients be treated in highlands or in a combination of sea and mountain climates. Therefore, there is still a very large number of sanatoriums for sick children and adults on the southern coast of Crimea. However, with the current level of knowledge, we can say with confidence that tuberculosis is successfully treated in any climate, when patients have the opportunity of unlimited access to fresh clean air. Therefore, the main component of climatotherapy is aerotherapy. Fresh air is the main therapeutic factor for patients with lesions of the respiratory system of any nature. It has a pronounced tonic and hypnotic effect, increases appetite, activates the activity of the central nervous system and the body's natural resistance to infections.

In the conditions of local sanatoriums, aerotherapy is carried out all year round. Its possibilities are especially wide in the summer, when patients can be in natural conditions during the day and on the so-called covered verandas at night, that is, treatment with fresh air is not interrupted for a minute. The air of coniferous forest is especially useful.

In addition to fresh air in special climatic zones, solar radiation and geographical factors are also important. The following types of climates are most useful for patients with tuberculosis: mountainous (there is a foothill climate from 300 to 700 m above sea level, mid-mountain - from 700 to 1400 m above sea level, high-mountain - from 1400 to 1900 m above sea level and super-mountain - over 1900 m, but the latter is not indicated for patients), marine, flat (ordinary and steppe).

The sea climate acts on the body as a tonic and hardening factor. Features of the maritime climate are rich insolation, constant humidity, as well as sharp daily temperature fluctuations. Treatment by the sea is indicated for patients with various extrapulmonary localizations of tuberculosis, as well as for the majority of pulmonary patients with tuberculosis in the stage of regression. The maritime climate is also indicated for children with tuberculosis, especially with frequent colds. But during primary tuberculosis, one should not forget about caution, since during this period the immunity is not yet fully formed, therefore, during the first year after infection with tuberculosis, it is better to heal the child in local conditions.

The mountain climate is also characterized by rich insolation, it is characterized by pronounced air ionization, lower (compared to the plain) atmospheric pressure, sharp daily temperature fluctuations and moderate winds, has a pronounced tonic effect on the body, has a beneficial effect on the nervous, circulatory and respiratory systems, as well as for metabolic processes. Mountainous areas have a good effect on tuberculosis patients outside the stage of exacerbation, with moderately pronounced symptoms of intoxication. For patients with an acute course of the tuberculous process, especially with cardiovascular disorders, the mountain climate is contraindicated.

The plain climate has a mild and even sparing effect on patients due to moderate insolation, relatively high atmospheric pressure, and weakly expressed ionization. Treatment in these usual conditions for patients does not contribute to obtaining tonic and hardening effects. As a rule, it is used for the aftercare of various forms of pulmonary tuberculosis.

Heliotherapy (sun therapy) is also one of the components of climatotherapy. The presence of direct or scattered sunlight is the strongest irritant for the body. As a rule, heliotherapy is used to treat extrapulmonary localizations of tuberculosis (bone-articular, lymph nodes, skin). The therapeutic effect of this method is the ultraviolet rays of the solar spectrum. Due to the high intensity, heliotherapy should be used only by an experienced doctor with mandatory strict control of the radiation dose. With active pulmonary tuberculosis, sunbathing is absolutely contraindicated.

When conducting heliotherapy requires compliance with certain techniques. There is a scheme that provides for irradiation of only the anterior surfaces of the legs on the first day for 10 minutes. On the second day, the entire front surface of the legs is irradiated, but the irradiation of the legs is already 20 minutes, and the thighs - 10. On the third day, the entire front surface of the body is irradiated, while the irradiation of the legs is already 30 minutes, the thighs - 20, and the abdomen, chest and arms - 10. The next 3 days, the back surface of the body is irradiated in the same sequence. Then very gradually they move on to sunbathing for the whole body, controlling the appearance of any complaints and negative sensations in the patient. Sunbathing for children and adolescents is allowed only in the morning at an air temperature of 20-25 ° C after adaptation to aerotherapy. Heliotherapy helps to increase the body's natural resistance to tuberculosis.

Hydrotherapy (hydrotherapy) can also be used as an integral part of climatotherapy, or in local and even at home as a hardening and training method for the body, which increases resistance not only to tuberculosis, but also to other respiratory infections. Douches and other water procedures can be used at home or in a local sanatorium, which are first performed at a water temperature of 30-35 ° C (warm) with its subsequent gradual decrease (down to the temperature of tap water). After water procedures, the skin should be rubbed with a coarse terry towel. Daily water procedures have a tonic effect on the nervous system, improve well-being, sleep and appetite. Sea bathing in the conditions of climatic sanatoriums combines the healing effects of various natural factors - sea water, solar radiation and sea winds.

Koumiss therapy is currently one of the non-traditional methods of treating tuberculosis. Previously, koumiss treatment was widespread. The fresh air of the steppes, good nutrition and koumiss were in great demand by the sick. The therapeutic factors of koumiss treatment should be recognized as fresh steppe air, in itself necessary for patients with tuberculosis, as well as alcohol and lactic acid, high-grade protein and vitamins of mare's milk. In addition, a daily intake of 3 to 5 liters of koumiss added 1,500 to 2,000 calories to the diet. At the present stage, there is a trend towards the revival of koumiss therapy.

Therapeutic exercise for tuberculosis

In the treatment of tuberculosis, physiotherapy exercises are used very widely.

Therapeutic exercise aims not only to increase the adaptive capacity of the body and resistance to infection, but also to train those functions that have been impaired by the disease.

It has now been established that bed rest and generally gentle rest are indicated to patients only during the period of activation of the process and the development of threatening complications. The rest of the time, patients should maintain physical activity, which in a hospital or sanatorium is remarkably achieved by physical therapy. This method is especially useful for children, who usually find it difficult to tolerate the restrictions of the motor regime.

Physical exercises should be combined with aerotherapy, hardening, climatic treatment, and, if necessary, with anti-tuberculosis drugs. A set of exercises should be selected in each case individually, taking into account all the features of the course of the disease and the child's body.

Children at preschool age (3-6 years old) prefer the game to everything else, therefore, physiotherapy exercises for them should be carried out in a playful way. During this period, you can start learning to ski, skate, swim, it is desirable to use dance elements and simple gymnastic exercises to music. To prevent curvature of the spine, exercises for the muscles of the back and abdominals are necessary when unloading the spine, for which crawling on all fours, exercises in the initial position lying on the back and stomach are ideal.

But even at primary school age (7-10 years), when the child's motor mode is sharply limited due to the start of schooling, it is necessary to allocate more time for physical education. This age is characterized by the frequent development of "school" scoliosis in healthy children, and with tuberculous intoxication, muscle tone, as a rule, is greatly reduced. Therefore, patients need to pay great attention to exercises to strengthen the back muscles and form the correct posture. Younger schoolchildren learn well complex gymnastic exercises of a sports-applied type, sports games and dances.

Middle school age (11-14 years) is characterized by the onset of puberty and increased growth processes. In this regard, dystonia of the autonomic nervous system is often encountered, leading to various functional disorders of the cardiovascular and central nervous systems. As a result, sick children need to individually dose physical activity. Physiotherapy exercises for middle-aged schoolchildren are distinguished by a wide variety of forms, and children also take part in sports games with great pleasure.

In the choice of means and methods of physical therapy, the form of the course of tuberculosis is also important. In such forms as the primary tuberculosis complex and tuberculosis of the intrathoracic lymph nodes, physiotherapy mainly solves the problem of general body training. Depending on the age of the child, morning hygienic exercises, lessons of gymnastic exercises, outdoor and sports games, sports and applied exercises, dosed walks should be carried out.

With complications of primary tuberculosis, after suffering tuberculous meningitis or osteoarticular tuberculosis, children need special exercises that restore damaged functions, as well as exercises aimed at correcting postural defects. They must be combined with general training and breathing exercises. In the general complex, special exercises should occupy from 30 to 70-80%, they are carried out individually.

Control over the adaptation of the body to physical activity should be performed by a doctor or exercise therapy methodologist by measuring the pulse rate and respiration, blood pressure before exercise, immediately after it and 5-7 minutes later.

Treatment of tuberculosis with folk remedies

To date, phytotherapy is a method of treatment that complements the main anti-tuberculosis drugs. Many medicinal plants with various effects on the body are widely used - anti-inflammatory, expectorant, tonic, etc.

Treatment of tuberculosis with folk remedies: Recipe No. 1

Treatment of tuberculosis with folk remedies: Recipe No. 2

Aloe tree. With pulmonary tuberculosis, a mixture of the plant with honey is recommended (it is possible with honey and red wine). To do this, grind 1.5 kg of aloe (3-5 years of age) in a meat grinder, add 2.5 kg of May honey, 850 ml of Cahors. Mix everything thoroughly and put it in a dark jar for 5-7 days, after which the mixture should be taken for the first 5 days, 1 teaspoon 1 hour before meals, 1 time per day, then 1 teaspoon 3 times a day. This rate is designed for a course of treatment (2-3 months). Aloe, intended for the preparation of this mixture, do not water for 5 days.

Treatment of tuberculosis with folk remedies: Recipe No. 3

Cowberry. Berries boiled with honey are recommended for hemoptysis. .

Treatment of tuberculosis with folk remedies: Recipe No. 4

black elderberry. Preparations based on black elderberry have a diaphoretic, antipyretic, laxative and diuretic effect. The plant is used in the form of infusions, decoctions or teas. To prepare the infusion, pour 200 ml of boiling water over 20 g of dried berries, bring to a boil, leave for 1 hour, then strain. The resulting remedy is recommended to take 50 ml 3-4 times a day before meals. Infusion of flowers: pour 2 teaspoons of raw materials with 2 cups of boiling water. Keep for about 1 hour. Drink 2 tablespoons 3 times a day.

Treatment of tuberculosis with folk remedies: Recipe No. 5

Highlander bird ( knotweed) tones and improves metabolism. It is used as an infusion of herbs in a ratio of 1:10. Chopped grass, preferably fresh, put in an enamel bowl and put in a water bath for 5-10 minutes, leave for another 1-2 hours, strain and take 1 tablespoon 3-4 times a day.

Treatment of tuberculosis with folk remedies: Recipe No. 6

Burnet officinalis i is used in pulmonary tuberculosis to stop bleeding and as an anti-inflammatory agent in the form of a decoction. 1 tablespoon of finely chopped burnet roots should be poured with 1 cup of boiling water and boiled for 30 minutes, cool, strain and take 1 tablespoon 4-5 times a day before meals.

Treatment of tuberculosis with folk remedies: Recipe No. 7

Coltsfoot has an expectorant, anti-inflammatory, diaphoretic effect. Tuberculosis patients benefit from fresh juice from the leaves with the addition of sugar syrup to taste.

Treatment of tuberculosis with folk remedies: Recipe No. 8

Eucalyptus has a pronounced anti-inflammatory effect. Pour 1 tablespoon of eucalyptus leaves with 2 cups of boiling water. Insist 20 minutes. Hot infusion drink 1/3 cup 3 times a day before meals.

Treatment of tuberculosis with folk remedies: Recipe No. 9

Norway spruce. It is used as a decoction of buds and young cones. For 1 part of the raw material, 6 parts of water should be taken.

Treatment of tuberculosis with folk remedies: Recipe No. 10

Wild strawberry. Fresh ripe berries are especially useful as a source of vitamins and microelements. You can use strawberries in the form of tea from equal parts of berries and leaves. Brew 1 tablespoon of the mixture with 1 cup of boiling water, let it brew and drink like tea, 1 cup 3 times a day.

Treatment of tuberculosis with folk remedies: Recipe No. 11

walnut. Nut kernels mixed with honey are taken orally for pulmonary forms of tuberculosis, in the form of an ointment (yuglon) - for the treatment of skin tuberculosis.

Treatment of tuberculosis with folk remedies: Recipe No. 12

Common lilac. For tuberculosis, infusions and decoctions of the leaves are used. To prepare them, pour 1 tablespoon of raw materials with 1 cup of boiling water and take 1 tablespoon 3-4 times a day before meals.

Treatment of tuberculosis with folk remedies: Recipe No. 13

Scotch pine. For tuberculosis, an alcohol tincture of the kidneys is used.

Treatment of tuberculosis with folk remedies: Recipe No. 14

creeping clover(white). For tuberculosis, an aqueous infusion is used. To prepare it, you should take 1 tablespoon of clover flower heads, pour them with 1 cup of boiling water, leave for 1 hour in a sealed container and strain, then take '/4 cups 4 times a day 20 minutes before meals.

Treatment of tuberculosis with folk remedies: Recipe No. 15

Licorice naked has a pronounced anti-inflammatory and antitussive activity, alleviates the state of oxygen starvation, which is typical for pulmonary tuberculosis. Patients are advised to take 5 g of licorice root (in powder or decoction) per day for 1-1.5 months, that is, 300-450 g per course, with a repetition of treatment after 1.5 months.

Treatment of tuberculosis with folk remedies: Recipe No. 16

Plantain large has a pronounced anti-inflammatory, antimicrobial and expectorant effect. It is used in the form of infusions and decoctions of leaves, which are prepared at the rate of 1 tablespoon of raw materials per 1 cup of boiling water. Take '/4 cups 3-4 times a day before meals. In case of tuberculosis, plantain leaves are also shown fresh (juice), as well as sour, since in the absence of heat treatment, they retain more useful substances and vitamins.

Treatment of tuberculosis with folk remedies: Recipe No. 17

It should also be noted cuff flowers and leaves ordinary, which increase immunity, juniper (berries), oats, elecampane root. Golden root, lure, ginseng, Manchurian aralia, Chinese magnolia vine have a tonic effect and increase the overall resistance of the body.

Treatment of tuberculosis with folk remedies: Recipe No. 18

It also has the unique ability to activate self-healing processes. mummy, in particular healing and resorption of cicatricial changes. It is recommended to take mummy in the form of a 5% solution with aloe juice (5 g mummy per 100 ml of aloe juice), which also has absorbable properties. In addition to mummy, it is necessary to note honey with its 40 healing properties (take 1-2 tablespoons a day) and propolis (30 drops of alcohol tincture 2 times a day). The course of treatment with propolis is 1-1.5 months.

Treatment of tuberculosis with folk remedies: Recipe No. 19

radish. With pulmonary tuberculosis, catarrh of the upper respiratory tract, whooping cough, bronchitis, radish juice mixed with sugar or honey in a 1: 1 ratio helps well.

This medicine should be taken 1 tbsp. spoon 3-4 times a day, it acts as an expectorant and soothing cough remedy.

The radish has been known since ancient times. It was highly valued for its nutritional and healing properties.

potassium). Grated raw radish and its fresh juice excite appetite, help to remove excess fluid from the body.

Radish should not be used for gastric and duodenal ulcers, gastritis with high acidity, praises of the large intestine, diseases of the pancreas, kidneys, gout.

Treatment of tuberculosis with folk remedies: Recipe No. 20

Cucumber. Seeds of yellowed cucumbers are used for tumors of the spleen, anemia, pulmonary tuberculosis. To do this, the seeds are dried, crushed and taken as a powder, 1/2 teaspoon 3 times a day, washed down with water.

With a strong cough with wheezing, the chest is smeared with goat fat or turpentine and steamed lashes of cucumbers are applied along with marigold flowers. At the same time, they drink a mixture of cucumber juice with honey in a ratio of 1: 1, 2 tbsp. spoons 2-3 times a day

Treatment of tuberculosis with folk remedies: Recipe No. 21

Kumys- the invention of nomadic tribes, one of the most ancient drinks known on earth. Doctors define its healing properties in three capacious words: nourishes, strengthens, renews. Kumis is an effective remedy for the treatment and prevention of various forms of tuberculosis.

This fermented milk product contains enzymes, microelements, vitamins A, C, vitamins of groups B, D, E, as well as wine alcohol, lactic acid, carbon dioxide. Depending on the content of lactic acid and alcohol, as well as the aging time, koumiss is divided into weak, medium and strong.

Kumis treatment is contraindicated in case of exacerbation of tuberculosis and peptic ulcer, gastritis with high acidity of gastric juice, certain diseases of the kidneys, liver and cardiovascular system, increased thyroid function (hyperthyroidism), lung abscess, with increased excitability of the central nervous system, cardiovascular insufficiency.

Treatment of tuberculosis with folk remedies: Recipe No. 22

Here is a remedy that is used not only to fight tuberculosis, but also to maintain weakened patients, prevent atherosclerosis and oncological diseases.

Mix 1 glass of juice of carrots, beets, horseradish (grate 1 glass of horseradish roots, pour 200 ml of vodka for a day, and then squeeze the juice). Combine this mixture with 2 cups of walnuts and raisins, minced, add 1 cup of honey and 2 finely chopped lemons.

Mix all the ingredients, transfer to a container with a tight-fitting lid. Store in refrigerator.

The first 2 days, eat 1 teaspoon, then 1 tbsp. spoon 3 times a day one hour before meals or 2 hours after it. The course is 2 months, the treatment can be repeated after a 20-day break.

Every third inhabitant of the planet is a carrier of the bacterium that causes tuberculosis. Approximately 10% of carriers of the disease become ill. Tuberculosis is the second leading cause of death after AIDS.

Tuberculosis: what is it?

The name of the disease was given by the Latin word for tubercle - tuberculum. Painful granulomas - sites of lung damage - look like tubercles.
The disease is caused by numerous bacteria of the species Mycobacterium tuberculosis complex.

In more than 90% of cases, the bacterium affects the lungs. Rare 8-9% are affected by the organs of the lymphatic, nervous and genitourinary systems, bones, skin or the whole body (miliary form of the disease).

When the pathogen enters the body, a small granuloma forms in the lungs. A healthy body with good immunity copes with the disease itself, the granuloma heals after symptoms similar to SARS and overwork. It is possible to detect a healed granuloma only later - through an X-ray examination.

The body, weakened by disease, stress, diet or overwork, is not able to give an adequate immune response to the invasion of Mycobacterium tuberculosis.

The granuloma begins to grow, forming a cavity inside itself - a cavity - filled with blood. From the cavity, blood inhabited by pathogenic bacteria enters the general circulation and creates new granulomas. The body can still cope with one granuloma, but as soon as there are several of them, without medical help, the person will soon die.

Cavities grow in the lungs, close cavities merge and form large cavities filled with disease-causing fluids. In the chest cavity, fluid appears between the lungs and the sternum. A patient with active tuberculosis is highly contagious.

Patients who fall ill with active tuberculosis for the second time die in 30% of cases, despite treatment.

Tuberculosis: when did it appear

The ill-fated disease has haunted mankind almost from the appearance of the species. Archaeologists have unearthed 3,000-year-old skeletons containing bone lesions consistent with tuberculosis.

Fatal consumption in Rus' - what kind of disease? This was the name of pulmonary tuberculosis, which for many centuries was a death sentence for the patient. They tried to treat consumption in Rus' back in the 11th century by cutting out and cauterizing tuberculous cavities in the lungs.

In ancient Greece, the disease was called phtisis - exhaustion. From the Greek name of the disease comes the name "phthisiology" - a branch of medicine that deals with the treatment and prevention of tuberculosis.

Even ancient healers, including Hippocrates and Avicenna, tried to fight the disease. We can say that the struggle of doctors with tuberculosis lasted for thousands of years. Tuberculosis was defeated only in the 20th century, when antibiotics came to the aid of doctors - the only drugs that can fight Mycobacterium tuberculosis.

Tuberculosis: how does infection occur

98% of infections occur by airborne droplets.

A patient with an active form of tuberculosis, when coughing, sneezing, releases bacteria and can infect up to 15 people a year. Also, the causative agents of the disease are excreted with sweat, urine, saliva and other physiological fluids of the patient.

Science has more than 70 types of mycobacteria - the causative agents of tuberculosis. Mycobacteria live everywhere: in soil, water, air, in the bodies of birds, animals and people.
In addition, the tubercle bacillus can break into tiny particles or cling to a huge octopus, while retaining its dangerous properties.

Mycobacteria are amazingly viable in all conditions. They live in street dust for 10 days, on the pages of books - 3 months, in water - 5 months.

The dried bacteria caused disease in a guinea pig six months later. Frozen bacteria are dangerous even after 30 years!

The most favorable environment for mycobacteria: moist warm environment with a temperature of 29-42 °C. At a temperature of 37-38 ° C, mycobacteria multiply intensively, so the human body is an ideal habitat for tubercle bacilli.

Tuberculosis bacillus is constantly evolving and adapting to environmental conditions. Mycobacteria also adapt to drugs, so new, stronger drugs have to be developed to fight the disease.

There are cases when the patient abandoned the treatment he had begun - in this case, the tubercle bacillus in the body became resistant to drugs, and it became impossible to cure the patient.

Tuberculosis: the first symptoms

Diagnosing tuberculosis is easy with simple medical tests. Regular examination has saved the lives of millions of people, because the earlier treatment is started, the more favorable the prognosis.

How does tuberculosis manifest itself?

• Dry cough - more than 2 weeks.
• Weight loss.
• Sweating during sleep. In addition, sleep becomes restless.
• Loss of appetite.
• Constant subfebrile temperature 37-37.5 °C.
• Chronic weakness, fatigue.

As the disease progresses, secondary symptoms of the disease appear.

• The cough becomes excruciating, with the release of a large amount of sputum. After an attack, the patient feels a temporary improvement. One of the tell-tale signs of TB is bloody sputum, or just the discharge of blood from the throat when coughing.
• There is pain in the chest, especially when taking a deep breath.
• Under the skin, more in the region of the legs, there are nodules of a red-brown hue, painful when touched.

Tuberculosis: diagnosis

There are simple medical tests to diagnose TB.

Mantoux test

Tuberculin solution inoculation is injected under the skin of a child older than 1 year or a teenager. After 3 days, a reddish spot appears at the vaccination site, which is used to judge the adequacy of the body's immune response to the pathogen. With a normal reaction of the body, the spot takes on sizes of 5-15 mm.

Fluorography

Under weak x-rays, a chest x-ray is taken. It clearly reflects all tuberculous granulomas.

Radiography

It is carried out to study the existing foci of tuberculosis.

Sputum examination

The patient may require a sputum test for the presence of tuberculous mycobacteria if he has been coughing for a long time.

ELISA blood test

Allows you to determine the presence of the causative agent of the disease in the body. The analysis is relevant for the detection of extrapulmonary forms of tuberculosis.

Tuberculosis: treatment

Tuberculosis treatment is carried out only permanently under the supervision of a phthisiatrician.

The standard course of treatment lasts six months - during this period, the body, supported by intensive treatment, completely gets rid of the disease.

For the period of treatment, a person completely drops out of active life, since the treatment is very intensive.

The main treatment is antibacterial, aimed at the destruction of tuberculosis mycobacteria that affected the body.

Tuberculosis: extrapulmonary forms

Such forms of tuberculosis are extremely rare, they are treated according to the same schemes as pulmonary tuberculosis.

Damage to the urinary organs

Diagnosed by urinalysis. The main symptom is the cloudy color of urine and the presence of blood in it. Urination is frequent and painful. Women have bleeding, aching pains in the lower abdomen. In men, painful swelling in the scrotum.

Damage to joints and bones

This form of the disease is characteristic of HIV-infected people. Tuberculosis bacillus affects the knees, spine and hip joints. The result is lameness, sometimes a hump.

Damage to the central nervous system

It occurs in HIV-infected and infants with a congenital form of tuberculosis. Mycobacterium infects the lining of the brain. Symptoms: severe headaches, fainting, convulsions, impaired hearing and vision. The disease is practically incurable.

miliary lesion

Microgranulomas - up to 2 mm in diameter - are scattered throughout the body. The inflammatory process occurs in addition to the lungs in the kidneys, liver and spleen and requires long-term treatment.

Digestive tract injury

This form of tuberculosis is typical for HIV-infected people. The abdomen swells, pain, diarrhea and constipation appear, blood is released with feces. In addition to conventional treatment, surgery is often required.

Skin lesion

The entire body of the patient is covered with subcutaneous dense painful nodules. They break through when pressed, white curdled contents are released from them.

A simple medical examination can detect tuberculosis in the early stages of lung damage, when it can be cured relatively easily. This is especially important for children, debilitated and elderly people whose body can hardly cope with the disease.

Tuberculosis is an infectious disease caused by different types of mycobacteria (the most common is Koch's bacillus). The disease usually affects lung tissue, rarely affecting other organs. Mycobacterium tuberculosis is transmitted by airborne droplets when the patient coughs, sneezes and talks. After infection with tuberculosis, the disease often proceeds in a latent form (tuberculosis), but sometimes it becomes active.

The causative agent is Mycobacterium tuberculosis. Tuberculosis in humans can be caused by Mycobacterium tuberculosis, Mycobacterium bovis, Mycobacterium africanum, Mycobacterium bovis BCG, Mycobacterium microti, Mycobacterium canettii, Mycobacterium caprae, Mycobacterium pinnipedii. There are such ways of transmission of tuberculosis infection:

• Airborne (most common): Bacteria are released into the air when a person with active illness coughs, sneezes, or talks. The infection enters the lungs of a healthy person.
• Alimentary: penetration of bacteria with food.
• Contact: with direct contact. Usually infection occurs through the mucous membrane.
• Intrauterine infection: the possibility of infection of the fetus in utero has been established.

Types of disease: classification of tuberculosis

There are pulmonary and non-pulmonary forms of tuberculosis. Phases of the tuberculous process: infiltration, decay, seeding; resorption, compaction, scarring, calcification.

More than 90% of cases account for the pulmonary form of tuberculosis. Damage to the genitourinary organs, brain, bones, intestines and other organs is also possible.

Depending on whether a person fell ill with tuberculosis for the first time or not, primary and secondary tuberculosis are distinguished.

• primary tuberculosis is an acute form of the disease that begins to manifest itself after the pathogen enters the bloodstream. Often, primary tuberculosis occurs in children under 5 years of age. This is because the immune system is not yet fully formed in children, which is not able to cope with mycobacteria. Despite the fact that the disease in this period is difficult, it is not dangerous to others. At the beginning, with primary tuberculosis, a small granuloma forms in the lungs. This is the primary lesion of the lungs, which, in the event of a favorable outcome, can heal itself. So, the patient may not suspect that he actually had tuberculosis, attributing his well-being to a cold. However, after another x-ray, it turns out that he has a healed granuloma in his lungs. The development of a bad scenario involves an increase in the granuloma with the formation of a cavity in which tubercle bacilli accumulate. Mycobacteria are released into the blood, where they are carried throughout the body.
• secondary tuberculosis. This form of the disease occurs when a person has already had tuberculosis once, but he became infected with another type of mycobacteria. Or secondary tuberculosis can proceed in the form of an exacerbation of the remission of the disease. Secondary tuberculosis is much more severe than primary. New lesions form in the lungs. In some cases, they are located very close to each other, which merge, forming extensive cavities. Approximately 30% of patients with secondary tuberculosis die within 2-3 months after the onset of the disease.

Symptoms of tuberculosis: how the disease manifests itself

At the beginning of the disease, tuberculosis is quite difficult to distinguish from ordinary acute respiratory infections. The patient has constant weakness and "brokenness". In the evening, there is a slight chill, and sleep is accompanied by sweating, and sometimes nightmares.

Body temperature in the initial stage of tuberculosis is kept at 37.5 - 38 degrees. The patient has a dry cough that worsens in the morning. Note that all of the above symptoms may appear simultaneously or all together.

And now let's take a closer look at the main symptoms of tuberculosis:

• Change in appearance. In tuberculosis, the face becomes pale and haggard. The cheeks seem to sink, and the facial features are sharpened. The patient is rapidly losing weight. At the initial stage of the disease, these symptoms are not very noticeable, however, in the chronic form of tuberculosis, the change in appearance is so pronounced that the doctor, with a high degree of probability, can make a preliminary diagnosis only by appearance.
• Heat. Subfebrile temperature (37-38 degrees), which does not subside within a month, is a characteristic sign of tuberculosis. In the evening, body temperature may rise slightly - up to 38.3 - 38.5 degrees. Despite the fact that the patient sweats all the time, the body temperature does not subside, since the infection constantly provokes the development of a feverish state. In the later stages of tuberculosis, a febrile temperature may appear, reaching 39-40 degrees and above.
• Cough. With tuberculosis, the patient coughs almost constantly. At the beginning of the disease, the cough is usually dry and intermittent. However, with the progression of the disease, when cavities form in the lungs, the cough intensifies and is accompanied by copious sputum production. If a person is worried about coughing for more than three weeks, then this is a reason to contact a phthisiatrician!
• Hemoptysis. This is a rather dangerous symptom, indicating an infiltrative form of the disease. In this case, the diagnosis must be differentiated from a lung tumor and acute heart failure, since hemoptysis is also characteristic of these diseases. In severe cases, blood may spurt, indicating a rupture of the cavity. In this case, the patient requires urgent surgical intervention.
• Chest pain. As a rule, pain in the chest and in the area of ​​​​the shoulder blades disturbs patients with both acute and chronic forms of tuberculosis. If pains are observed at the beginning of the disease, then they are mild and look like discomfort. The pain gets worse when you take a deep breath.

Patient's actions in case of tuberculosis

At the slightest suspicion of illness, you should contact your family doctor. Protracted cough, which is not stopped by conventional antitussive drugs, should alert a person. You should consult a doctor and undergo all the necessary examinations for the presence / absence of tuberculosis.

Diagnosis of tuberculosis

To detect tuberculosis, fluorography (or computed tomography) is performed. With a productive cough, a sputum sample is taken for examination to determine the pathogen, as well as its sensitivity to antibiotics. Sometimes a bronchoscopy is done. If you suspect the presence of non-pulmonary forms of tuberculosis, tissue samples of these organs are examined.

Children under 18 years of age undergo the Mantoux reaction annually. A positive Mantoux test indicates infection with tuberculosis bacilli.

The basis of tuberculosis therapy is multicomponent anti-tuberculosis chemotherapy. There are several treatment regimens:

The three-component scheme of therapy includes the use of isoniazid, streptomycin, para-aminosalicylic acid (PAS). This classical scheme, however, is not currently used due to the high toxicity of PAS, the impossibility of prolonged use of streptomycin.

Quadruple regimen: isoniazid, rifampicin (or rifabutin), ethambutol, pyrazinamide.

Five-component scheme: A fluoroquinolone derivative (ciprofloxacin) is added to the four-component scheme. In the treatment of drug-resistant forms of tuberculosis, drugs of the second, third and next generations of this group are included.

With insufficient effectiveness of 4-5-component chemotherapy regimens, second-line (reserve) chemotherapy drugs (capreomycin, cycloserine), which are quite toxic to humans, are used.

Much attention is paid to the quality, varied nutrition of patients, correction of hypovitaminosis, leukopenia, anemia. TB patients suffering from alcohol or drug addiction undergo detoxification before starting chemotherapy.

In the presence of HIV infection in combination with tuberculosis, specific anti-HIV therapy is used in parallel with anti-tuberculosis therapy, and the use of rifampicin is also contraindicated in such patients.

In some cases, glucocorticoids may be prescribed. The main indications for their appointment are severe inflammation, severe intoxication. Glucocorticoid preparations are prescribed for a short period of time and in minimal doses, which is associated with their immunosuppressive effect.

An important role in the treatment of tuberculosis is played by sanatorium treatment. Improving the oxygenation of the lungs when inhaling the rarefied air of mountain resorts helps to reduce the reproduction and growth of mycobacteria. For the same purpose, hyperbaric oxygen therapy is used.

In advanced cases, surgical methods of treatment are used: the imposition of an artificial pneumothorax, drainage of a cavity or empyema of the pleura, removal of the affected lung or its lobe, and others.

Complications of tuberculosis

Complications of tuberculosis include hemoptysis or pulmonary bleeding, pulmonary heart failure, spontaneous pneumothorax, atelectasis, renal failure, bronchial, thoracic fistulas.

The main prevention of tuberculosis is the BCG vaccine (Bacillus Calmette-Guerin). Vaccination is carried out in accordance with the calendar of preventive vaccinations. The first vaccination is carried out in the hospital in the first 3-7 days of a newborn's life. At the age of 7 and 14, in the absence of contraindications, a negative Mantoux reaction, revaccination is carried out.

The entire adult population, in order to detect tuberculosis in the early stages, must undergo a fluorographic examination at least once a year.

Tuberculosis is a severe infectious disease that is widespread in humans and animals. The causative agent of the disease is pathogenic bacteria of the Mycobacterium tuberculosis complex family. In most cases, the disease affects the lung tissue, but sometimes the pathogenic flora settles on the mucous organs of the digestive, genitourinary and other systems of the human body. The disease is asymptomatic and may not manifest itself for a long period of time. The only sign of tuberculosis at an early stage is a periodic dry cough that does not lead to sputum discharge and irritates the larynx.

There are many factors that can contribute to the development of infection, and all of them are associated with a steady decrease in immunity. This may be poor nutrition, unfavorable environmental and epidemiological conditions in the place of residence, bad habits. Smokers are especially susceptible to tuberculosis, since the lungs, weakened by constant exposure to toxic substances, are easily affected by mycobacteria that cause tuberculosis infection. Mortality from the disease is very high - more than 3 million people a year - therefore, all newborns in the first day after birth are given a prophylactic BCG vaccination.

The causative agent of tuberculosis infection are mycobacteria (Koch's wand). In total, there are more than 70 species, but six of them are especially dangerous for humans, including strains of the human and bovine species. Koch's wand is resistant to high and low temperatures, can exist for a long time in an acidic environment. This type of bacteria can be completely destroyed only by boiling, as they retain their viability even at 60-70 °.

Mycobacteria are not afraid of freezing - at temperatures from 0° to -50° they can safely exist for several decades. On the surface of fabrics, building materials and other objects, the pathogen can be in an active state for up to 30-45 days, so it is necessary to carry out a complete disinfection of the room if there was a person diagnosed with tuberculosis in it.

Note! The probability of the spread of tuberculosis infection in children's groups is especially high. To control the epidemiological situation in preschool and general educational institutions, children undergo an annual Mantoux test (tuberculin test) - an immunological study that allows detecting antibodies to mycobacteria and suspecting tuberculosis infection. Parents have the right to refuse this examination, but it is important to understand in making the decision that most TB deaths occur in childhood.

How can you get infected?

In the vast majority of cases, tuberculosis infection occurs by airborne droplets, when a person inhales air containing mycobacterium tuberculosis infection. They are distinguished by carriers of the active form of the disease, in which the foci of infection are located on the mucous membranes of the respiratory system. They can enter the environment during conversation, sneezing, singing, coughing. The risk of infection increases during epidemics of respiratory diseases, when the body is weakened by the fight against viruses and anaerobic microorganisms that enter it.

Much less common are other ways of transmitting Koch's wand, for example:

• hospital;
• contact;
• alimentary (through the organs of the digestive tract).

Infection by contact is slightly less common than infection by airborne droplets, but is also quite common among residents of large settlements. The likelihood of transmission through the skin is very low, so shaking hands and other forms of skin-to-skin contact are generally not considered potentially dangerous. Much more often, bacteria enter the body of a healthy person through the mucous membranes. This can be the oral cavity (during a kiss), the mucous membrane of the eyes (conjunctiva), rarely the genitals. If the pathology affects the visual system, the patient begins to show signs of a purulent-inflammatory process.

The hospital route involves infection during a visit to the phthisiology department in anti-tuberculosis dispensaries. It has been proven that employees of such institutions are 5-7 times more likely to get tuberculosis infection compared to nurses, doctors and nurses of other institutions.

Important! Newborns can become infected with Koch's bacillus while moving through the mother's birth canal or during fetal development, since mycobacteria are able to penetrate the placental membrane. To prevent this from happening, it is recommended that all women do lung fluorography at the planning stage. A specialized study of salivary secretion and sputum discharge, which is carried out in private laboratories, will help to identify the disease during pregnancy.

Classic signs of tuberculosis infection

The most important symptom present at any stage of pulmonary tuberculosis is a dry cough. In primary TB infection, the cough may be mild to moderate and not irritate the throat or cause pain. After the pathology enters the active stage, the intensity of the cough will increase much. Such a cough often resembles a smoker's cough: a person constantly wants to cough up, but this does not bring relief, since sputum is not removed from the lungs.

It is very important to distinguish cough in tuberculosis from similar symptoms in other diseases of the respiratory system (pneumonia, laryngitis, tracheitis). With laryngitis, the cough is barking, wheezing, accompanied by unpleasant sensations in the epiglottis and at the location of the speech apparatus (vocal cords). Cough with bronchitis and pneumonia differs from tuberculosis cough in its duration: with pulmonary tuberculosis, a dry cough can last several weeks, with no other symptoms usually present.

After about 2-3 weeks, the nature of the cough changes, although it is still unproductive. At this stage, the cough is characterized by the following symptoms:

• high intensity;
• a constant course (with pneumonia, the cough is often paroxysmal);
• a small amount of sputum;
• drops of blood appearing in the sputum during coughing.

Such a cough is accompanied by other signs, by which it is already possible to suspect the presence of a pathological process in the bronchi and alveolar tissue that makes up the alveoli - small sacs that have access to the alveolar passage of the trachea and are involved in cellular gas exchange. A person becomes weak, drowsy, he develops apathy, a mild form of depressive disorder may begin. Body temperature during the active stage of the disease rises to 38 ° (in rare cases, it may remain within the lower limits of subfebrile condition).

At this stage, behavioral changes can also be noted: increased anxiety, aggression towards others, irritability appear. Mood can change frequently during the day - this sign, combined with a persistent cough and temperature fluctuations, almost always indicates some form of tuberculosis.

Another typical symptom of the disease is excessive sweating at night. Sweating in some cases can be so profuse that the patient has to get up and change clothes. If at the moment a person is not sick with colds, such a symptom should be a reason to see a doctor.

Important! With any form of tuberculosis (even with a latent or latent form), the patient is rapidly losing weight. There are cases when the weight loss was 60 kg in 5-6 months. If a person does not adhere to dietary nutrition and has not recently increased physical activity and has not taken drugs for weight correction, you should consult a specialist if the decrease in body weight exceeded 4-5 kg ​​per month.

Severe infection: signs and symptoms

In the severe course of the disease, characteristic symptoms can also be noticed, which are usually ignored if they are of mild or moderate intensity. One of them is pain in the sternum, which most often appears in the form of severe burning or pain. The pain may radiate to the area between the shoulder blades, collarbone, forearm. Irradiation to the leg, thigh and upper limbs is almost never encountered - this makes it possible to differentiate tuberculosis infection with heart disease and epigastric pathologies.

Painful sensations are accompanied by a dry cough, which irritates the mucous membranes of the larynx and causes severe pain when swallowing, which many mistake for a symptom of a cold. Such a cough is almost always accompanied by hemoptysis and requires immediate medical attention.

In severe tuberculosis, a person has a high temperature (39 ° -40 ° and above), the activity of the sweat glands increases during a long rest (mainly at night), the timbre of the voice changes. At this stage, there are difficulties with breathing, the patient is tormented by severe shortness of breath. Body temperature can rise abruptly during the day.

Note! The listed symptoms refer to the pulmonary form of the disease. In some cases, the disease can affect other organs and systems. In each case, the clinical picture of pathologists can differ significantly, so it is not worth doing self-diagnosis and, moreover, refusing treatment.

Signs of tuberculosis in extrapulmonary localization of the focus of infection

If the pathogen from the mucous membranes of the lung tissue enters the systemic circulation, the disease can affect not only the lungs, but also other organs. Most often, the digestive tract suffers. The focus of infection can be in different parts of the intestine, esophagus, stomach. It is almost impossible to distinguish it from other diseases of the digestive system, since the disease has no specific symptoms and “disguises” itself as other pathologies: gastritis, ulcerative lesions, duodenitis, etc.

Signs of infection in the gastrointestinal tract include:

• systematic violation of the stool (chronic constipation or diarrhea);
• painful sensations in the intestinal area that appear after eating, when passing gases or during bowel movements;
• blood in feces;
• bloating;
• body temperature above 40°.

It is possible to recognize the disease only with the help of special examination methods, including laboratory and instrumental methods.

Another difficult-to-diagnose tuberculosis infection is a lesion of the genitourinary system. Koch's wand can multiply on the mucous membranes of the bladder, kidneys (renal glomeruli and glomeruli), urethra. The patient may complain of frequent urge to empty the bladder (often false), painful urination. The body temperature at this localization of the pathological process is always high, the urine becomes cloudy, may contain sediment or streaks of blood and mucus.

Note! Similar symptoms in urogenital tuberculosis are always accompanied by pelvic pain and shooting pains in the lower back.

Damage to the musculoskeletal tissue

It is almost impossible to distinguish tuberculosis of bones and joints from deforming arthritis without special diagnostics. Even an experienced doctor cannot suspect a pathology, since the only symptom, even in the active stage, may be pain, pain when walking, stiffness of muscles and joints in the morning. If the clinical picture is supplemented by symptoms of intoxication, headache, fever, the diagnosis of tuberculosis will be easier.

If the brain is affected: how to recognize?

Tuberculosis of the brain is a very rare pathology, and in most countries there is not enough experience in the management and treatment of such patients. A distinctive feature of this type of tuberculosis is a long course and development. In some cases, the infection can take years to develop, leading to irreversible changes in the functioning of the brain and nervous system. With this localization, a person usually experiences difficulties in communicating with others, he often has inexplicable neuroses, and suicidal intentions may appear. Chronic insomnia is a constant symptom.

After the disease passes from the latent stage to the active form, other signs can be noticed, for example:

• an increase in the muscles located on the back of the neck;
• severe headache when bending forward;
• pain when stretching the spine.

Important! Tuberculosis of the brain is a deadly pathology that requires the fastest detection and timely treatment. If this is not done, the risk of mortality will be very high - more than 87%.

What methods are used for diagnosis?

Various methods of instrumental and laboratory diagnostics, listed in the table below, can be used to detect tuberculosis infection. The expediency of their appointment, as well as the volume of diagnostic measures, is determined by the attending physician, based on the symptoms present.

Video - Why is tuberculosis dangerous?

If a person is diagnosed with tuberculosis, he will be hospitalized in a tuberculosis dispensary. Treatment necessarily includes antibiotic therapy, but only a doctor should prescribe it, since most mycobacteria are resistant to various types of antibiotics.

Tuberculosis is a disease with a high percentage of deaths, so its prevention, diagnosis and treatment must be taken very seriously. Vaccination is currently considered the only protection against infection. Parents of young children need to be especially responsible, because by refusing to be vaccinated, they expose their child to the risk of infection with a deadly disease.

Video - Educational film "TB: Questions and Answers"

Video - Types of tuberculosis on x-ray

Tuberculosis is an infectious disease that is characterized by the formation of foci of specific inflammation in the affected tissues, and causes a pronounced general reaction of the entire body of the patient. Tuberculosis affects the lungs, lymphatic system, bones, joints, urinary organs, skin, eyes, and the human nervous system. If appropriate treatment is not performed, the disease progresses and leads to a fatal outcome.

In many economically developed countries, including Russia, morbidity and mortality from tuberculosis has recently decreased significantly. Epidemiological shifts are especially pronounced among children and women, among men they are still less noticeable, especially for older men. But, despite this positive trend, tuberculosis has been and remains a common disease.

The causative agent of tuberculosis- Mycobacterium tuberculosis (MT), or Koch's wand, most often it is a kind of human type, less often bovine, avian occurs in exceptional cases. Mycobacterium tuberculosis, unlike other microbes, is extremely tenacious: it feels great in the ground, in the snow, and is resistant to alcohol, acids and alkalis. It dies only with prolonged exposure to sunlight, at high temperatures and when treated with chlorine-containing substances.

The route of infection with tuberculosis, as a rule, is aerogenic: when inhaled, sprayed droplets of sputum of a sick person containing Koch's bacillus enter the lungs with air. There is a chance of getting infected by eating meat, milk, eggs of sick birds or domestic animals. In such cases, microbes enter the lungs either from the pharyngeal tonsils or from the intestines through the blood vessels and lymphatic pathways. In the vast majority of patients, for the first time in sputum, Mycobacterium tuberculosis is detected, which is sensitive to anti-TB drugs, but in 5-10% of patients they can be resistant to various methods of treatment. The resistance of the microbe to medicines in such cases is explained by the fact that the infection occurred through contact with a sick person who is ineffectively treated with specific medicines, since the strains of Mycobacterium tuberculosis secreted by such patients, as a rule, become resistant to the effects.

The main forms and classification of the disease

1. Open and closed tuberculosis
Tuberculosis is an infectious disease, but the patient may not be contagious at all stages of the development of the disease, in addition, the ability to spread the disease depends on the treatment measures taken. These features distinguish tuberculosis from other infectious diseases, such as hepatitis B and C and others. If tuberculosis is open, this means that the patient can infect others, as it releases microbes that are the causative agents of the disease. Most often, the term "open tuberculosis" is used when talking about pulmonary tuberculosis, when microbes are released into the environment when coughing and expectorating sputum. Still open tuberculosis is called CD+ (or TB+). This means that the bacteria that cause tuberculosis were detected by microscopic examination of the sputum of a sick person (TB - tuberculosis bacillus, BC - Koch's bacillus). This is one of the methods for diagnosing a disease.

There is an opposite BK+ form of tuberculosis BK- (or TB-), in which the patient is not contagious, since he does not release bacteria into the environment. The term "closed tuberculosis" itself is rarely used in medical practice, more often they talk about its equivalents BK- (or TB -).

2. Pulmonary tuberculosis and extrapulmonary tuberculosis. Tuberculosis of internal organs.
If the infectious process occurs in the lungs of a person, then they speak of pulmonary tuberculosis. The vast majority of cases of tuberculosis are pulmonary tuberculosis. However, damage to other internal organs is not excluded. The infection can affect bones, joints, human skin. Depending on the localization of the focus of the disease in tuberculosis, one can distinguish the following forms of the disease:
Intestinal tuberculosis is an inflammatory lesion of the intestinal walls, mesentery, lymph nodes surrounding the intestine. Intestinal tuberculosis can occur due to the consumption of foods that are infected with tuberculosis pathogens (for example, it can be cow's milk).
Tuberculosis of the nervous system and meninges (tuberculous meningitis) is one of the most dangerous and serious diseases. It usually develops when the infection spreads from the patient's lungs, so tuberculous meningitis is called a complication of pulmonary tuberculosis.
Tuberculosis of the bones and joints is a common form of tuberculosis. The vertebrae and large tubular bones of the skeleton (shin bones, thigh bones, etc.) are most susceptible to it. Tuberculosis of the bones or joints is the result of the spread of infection from some other affected organ.
Tuberculosis of the skin - can be the result of the spread of the disease from some other focus inside the body, but also develop as a result of direct contact of the patient's skin with pathogens.
Tuberculosis of the urinary system and genital organs. The kidneys are especially susceptible to it. Usually both kidneys are affected at once. The inflammatory process that causes the infection can lead to the loss of these organs, gradually destroying them.

Against the background of tuberculous lesions of the kidneys, tuberculosis of the ureters, urethra and bladder may occur. Infection of the bladder and other organs of the genitourinary system causes their deformation, which leads to violations of sexual function and the process of excretion of urine.

In men, tuberculosis of the genital organs also affects the prostate gland, testicles, and vas deferens.

Tuberculosis of the genital organs in women can be localized in the uterine cavity, in the ovaries and fallopian tubes.

The timeliness of detection of such forms of the disease is affected by the fact that the infection for a long time may not show any symptoms or impersonate other diseases.

3. Primary and secondary tuberculosis.
The most important clinical significance is the division of tuberculosis into primary and secondary. Primary tuberculosis occurs when the disease develops as a result of the first contact of a person with a microbacterium that causes tuberculosis. In this case, the patient's body is not yet familiar with the infection. In primary tuberculosis, the inflammatory process ends with the formation of petrified foci. In them, microbes can “doze off” for a long time. Under certain conditions, for example, if immunity is reduced, the infection can become active again, then a new episode of the disease begins. Cases of a repeated episode of the disease are usually called secondary tuberculosis, when the body is already familiar with the infection. Secondary tuberculosis proceeds differently than it happens when a person fell ill for the first time.

4. Infiltrative, caseous, miliary tuberculosis.
Pulmonary tuberculosis can be infiltrative, caseous and miliary:
Infiltrative tuberculosis is the initial stage of the development of the inflammatory process in tuberculosis. Another name for it is tuberculosis pneumonia. The lung tissue in infiltrative tuberculosis is filled with bacteria involved in the inflammatory response and cells of the immune system. If the immune defense is weakened, and the infection develops aggressively, the lung tissue covered by inflammation dies, and in their place a cavity is formed, which is filled with pus. Infiltrative inflammatory process most often develops in primary tuberculosis.
Miliary tuberculosis is a diffuse lesion of the entire lung area. With miliary tuberculosis, there are multiple small foci of inflammation in the lungs, in size and shape they resemble millet, which gave the name to this type of disease (from Latin milium - millet).
Cavernous tuberculosis is characterized by the formation of a massive area of ​​destruction in the lung tissue. With this form of tuberculosis, a cavity is formed inside the lung, which is called a cavity (from Latin cavernum - a cave). The dimensions of the cavity can be significant and reach several centimeters in diameter. Cavernous and miliary forms of the disease develop with secondary pulmonary tuberculosis.

Tuberculosis symptoms

The signs of tuberculosis are:
cough (dry or with sputum, blood may appear in the sputum)
dyspnea
consistently elevated body temperature (not higher than 38C)
sweating at night
headache
lack of appetite
weight loss.

Patients are characterized by irritability, mood swings, decreased performance. Only a few of these symptoms may appear, and not necessarily coughing will be among them. Therefore, even in the presence of the most seemingly innocuous signs, it is necessary to consult a doctor so that if tuberculosis is detected, treatment can be started in a timely manner.

Diagnostics

The Mantoux test is the simplest and most common way to test for tuberculosis. Already 72 hours after the Mantoux test, it can be seen whether a tuberculosis infection is present in the human body. However, the accuracy of this method is very low.

Microscopic examination of smears also does not give a result with absolute accuracy, because Mycobacterium tuberculosis can be easily confused with bacteria of other species and the diagnosis is incorrect.

It helps to diagnose this dangerous disease by sowing bacteria, but the causative agents of the disease may not "grow", so a negative diagnosis may be false.

In the absence of a more accurate method, the fluorographic method and the medical examination will most often be changed during the examination for tuberculosis.

In the conditions of a specialized clinic, it is possible to determine the titer of antibodies to tuberculosis. This technique allows you to determine whether there is immunity to tuberculosis in the patient's body, and to find out whether the vaccination was effective. The percentage of reliability of the method compared to others is high - about 75%.

The most modern method is the polymerase chain reaction (PCR). This is a DNA diagnostic method, using which the patient's sputum is taken for analysis. The result will be known in 3 days, its reliability is very high - 95-100%.

Tuberculosis treatment

It is impossible to take up the treatment of tuberculosis on your own. If medication is not controlled by a doctor, Mycobacterium tuberculosis develops resistance to anti-TB drugs. It becomes much more difficult to treat this disease after uncontrolled self-medication.

If a patient has tuberculosis for the first time, it can be cured, but only if the treatment is organized correctly. For treatment, several anti-tuberculosis drugs are used simultaneously, which continue to be taken for a long time. The patient usually takes 4-5 medications daily for six months. These drugs act on Koch's wand in different ways, therefore, only if they are used together, it is possible to achieve success in destroying Koch's wand.

For a reliable cure, only anti-tuberculosis drugs are not enough. Physiotherapeutic methods of treatment, breathing exercises are also used, drugs that increase immunity are prescribed.

After completion of the course of treatment, the patient is again tested. If, according to their results, tuberculosis is still detected, it means that the infectious lesion has taken a drug-resistant form.

Treatment for this form of tuberculosis can take years. Surgical methods in the treatment of tuberculosis are used very rarely, since their effectiveness in this disease is very low.

Proper nutrition plays a very important role in the treatment of this disease. The diet of the patient must necessarily include dishes from meat and fish, fruits, vegetables. Smoking and alcoholic beverages are strictly prohibited. Products should be rich in vitamins, in addition, it is good if they excite the feeling of hunger, since a patient with tuberculosis often has no appetite. It can be fish oil, rosehip infusion, kefir, yogurt.

If adequate treatment is not available, mortality from tuberculosis reaches 50% within one to two years. In the remaining 50% of patients, the disease changes into a chronic form.

Prevention of tuberculosis

Tuberculosis is called a disease of unsanitary conditions and poverty. To avoid infection with this dangerous disease, it is important to maintain immunity, since a strong immune system is able to defeat the pathogen that has entered the body, the disease on its own. To do this, nutrition must be of high quality and varied, the body must receive a sufficient amount of vitamins, it is important to play sports, and often be in the fresh air.

Infection occurs by inhalation of microscopic droplets of sputum or saliva of the patient. The likelihood of infection depends on the amount of bacteria that have entered the lungs. With a long stay in the room where the patient is located, the risk of infection increases dramatically. Therefore, ventilation is very important, because in the absence of it, bacteria remain in the air longer.