Bronchial tuberculosis in children symptoms. Tuberculosis of the respiratory tract and bronchi

1

The article presents modern data on bronchial tuberculosis. The features of its clinical manifestations are considered, the possibilities of its early recognition are analyzed, since the detection of bronchial tuberculosis in the early and uncomplicated phase of the disease is extremely rare. A clinical observation with revealed bronchial tuberculosis is presented, indicating the problems and significant diagnostic difficulties arising in the recognition of bronchial tuberculosis, as well as the advantages of its early detection. The reasons for under-examination of the patient at the outpatient stage have been analyzed, which led to the wrong diagnosis and inadequate therapy. For the timely recognition of bronchial tuberculosis in persons with prolonged / recurrent cough, it was proposed to search for clinical signs of local broncho-obstructive syndrome, timely include in the diagnostic process bronchoscopic examination and modern methods of diagnosing tuberculosis, among which is Diaskintest®.

bronchial tuberculosis

Diaskintest®

fibrobronchoscopy

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Tuberculosis as infection poses a serious threat to the health of the population all over the world, in connection with which it is recognized as a socially dangerous and socially significant disease (Resolutions of the Government of the Russian Federation of 13.11.2001 No. 790 and 01.12.2004 No. 715). By participating in the early detection of tuberculosis patients, doctors in the general medical network have a unique opportunity to help reduce the burden of tuberculosis, since almost half of bacillary patients who pose an epidemiological danger to others are not detected in a timely manner. Meanwhile, an unidentified and untreated patient with tuberculosis with the presence of bacilli can infect from 5 to 50 people in a year. The errors in the diagnosis of tuberculosis have remained at the same level for decades: 1950 - 35-45%, 2007 - 34-40%. The problem of early diagnosis of pulmonary tuberculosis constantly attracts the attention of specialists not only in the field of phthisiopulmonology, but also in other specialties, since a patient with bacillus excretion poses a significant epidemic danger to others, and a favorable outcome of tuberculosis is possible with its early detection and timely initiation of adequate treatment. Significant diagnostic difficulties arise in the recognition of bronchial tuberculosis, which some authors attribute to complications of pulmonary tuberculosis and intrathoracic lymph nodes. Therefore, in these situations, local manifestations of bronchial tuberculosis, as a rule, are not diagnosed in a timely manner. This article describes a clinical observation with identified bronchial tuberculosis and a review of the literature on this pathology.

Clinical observation

Patient V., 21 years old, a student, 23.04.2011 was admitted to the therapeutic department of a multidisciplinary hospital with complaints of unproductive paroxysmal cough; chest discomfort during physical activity, after a long conversation, laughter; severe difficulty in exhaling in a horizontal state, in connection with which sleep was disturbed; "Wheezing rales in the throat" in a horizontal position.

Anamnesis. In November 2010, after suffering ARVI, she noted the appearance of the listed complaints. Over the next 5 months, she repeatedly consulted a therapist, otorhinolaryngologist and pulmonologist. She was observed and treated in a polyclinic. Physical examination revealed no pathological abnormalities. In the analysis of peripheral blood, there was a transient increase in leukocytes up to 10.6 ∙ 109 / l, ESR - 10-16 mm / h, in the main indicators of biochemical blood tests - without pathological changes. On the radiograph of organs chest - no pathological changes. When studying the parameters of ventilation and bronchial resistance (March 2011), restrictive changes of the I degree, obstruction of small bronchi within the II degree were registered, the structure of the OEL was not changed, the bronchial resistance was increased to 135% of the due value. Sputum analysis for mycobacterium tuberculosis (MBT) 3-fold - negative. Fibrogastroduodenoscopy was performed to exclude gastroesophageal reflux disease - without deviations. Outpatient diagnoses - a protracted course of tracheobronchitis, then - bronchial asthma. The treatment was carried out: antibiotics (several courses), erespal, mucolytics, nebulizer therapy with lazolvan, berodual, pulmicort, seretide (800 mcg / day). There was no improvement in the patient's condition.

Upon admission to the hospital general state satisfactory. NPV - 16 / min. BP - 110/80 mm Hg. Heart rate - 82 / min. Above the anterior and posterior parts of the left half of the chest, bronchial breathing, in the clinostatic position - stenotic breathing, dry wheezing on exhalation in the clinostatic position and during the forced expiratory maneuver, which was assessed as evidence of the presence of local broncho-obstructive syndrome. Blood tests and the main indicators of biochemical blood tests at admission and in dynamics - no pathological changes. On the radiograph of the lungs: pulmonary fields without focal and infiltrative changes. Fibrobronchoscopy (FBS): the left main bronchus is deformed, severe contact bleeding, a symptom of a "dead mouth", the bronchus is subtotally obturated with exophytic growing tumor tissue like "white fish meat" (biopsy taken). In the lower lobe bronchus there is thick purulent content, aspiration was carried out and the patency of the bronchus was restored. On the right, bronchial architectonics are common. Conclusion: exophytic growing tumor of the main bronchus on the left (infiltrative-ulcerative form, complicated by purulent endobronchitis). Morphological examination of the biopsy: small fragments of necrotic tissue and small groups of cells with artifactal changes, suspicious of tumor. Spiral computed tomography of the chest cavity: the volume of the left lung is reduced due to hypoventilation. In the left main bronchus on top wall an exophytic tumor with a wide base and signs of wall invasion is located. The bronchus lumen is narrowed by more than 50%. Conclusion: tumor of the main bronchus on the left. Oncologist's consultation: tumor of the left lung, examination at an oncological dispensary is recommended.

However, given the patient's age, the duration of subjective symptoms in the absence of changes in blood tests, the second diagnostic hypothesis was bronchial tuberculosis. During bacterioscopy of a sputum smear collected after FBS, and staining according to Ziehl-Nielsen, MBT was found - more than 50 in the field of view. With a diagnosis of tuberculosis of the left main bronchus, infiltrative-ulcerative form, complicated by bronchial stenosis of the II degree and hypoventilation of the left lung, the patient was referred to an anti-tuberculosis dispensary. Morphological examination of the material taken from the edge of the ulcer of the left main bronchus, during the repeated FBS, revealed Pirogov-Langhans cells, flat-cell metaplasia against the background of necrosis foci, diffuse focal dense infiltration with neutrophils, lymphocytes, macrophages. After treatment with regimen I of chemotherapy, grade II cicatricial stenosis of the left main bronchus was formed as an outcome of bronchial tuberculosis.

The final clinical diagnosis: tuberculosis of the left main bronchus: infiltrative-ulcerative form, complicated by bronchial stenosis of the II degree and hypoventilation of the left lung.

Research results and their discussion

The peculiarities of this observation are that the diagnosis of bronchial tuberculosis was made only 5 months after the appearance of the first signs of the disease, and the decisive factor in the diagnosis was the adequate interpretation of the results of the physical examination (the presence of local broncho-obstructive syndrome), timely performed by FBS with biopsy, as well as repeated studies of sputum on the office. Under-examination of the patient at the outpatient stage was the reason misdiagnosis and inadequate therapy.

Bronchial tuberculosis is infiltrative and ulcerative. The process is characterized by predominantly productive and, less often, exudative reactions. In the wall of the bronchus under the epithelium, typical merging tuberculous tubercles are formed, and a blurred infiltrate of limited length is formed. With caseous necrosis and disintegration of the infiltrate, an ulcer forms on the mucous membrane covering it, ulcerative tuberculosis of the bronchus develops, which took place in this observation. The clinical course of bronchial tuberculosis depends on the localization of bronchial lesions - large (lobar, intermediate, main) or segmental-subsegmental bronchus. But in all cases, it is extremely rare to detect bronchial tuberculosis in the early and uncomplicated phase of the course of the disease (in less than 1% of cases), since it is often asymptomatic or the symptomatology does not differ from a prolonged or recurrent course of nonspecific bronchitis. If the infiltrate in the wall of the bronchus obstructs its lumen, expiratory dyspnea and other symptoms of impaired bronchial patency may occur. X-ray of the chest organs either does not reveal pathology, or deformation and narrowing of the bronchus is found, characteristic radiation symptoms occur when bronchial tuberculosis is complicated by hypoventilation / atelectasis of the lung lobe. According to I.P. Zhingel among the newly admitted to the therapeutic departments of the phthisiopulmonology clinic with various forms of respiratory tuberculosis in 15.8% of cases, bronchial tuberculosis was recognized as the main manifestation of respiratory tuberculosis.

These diagnostic problems have been addressed in modern algorithm diagnostics of respiratory tuberculosis. The diagnostic process should include persons with complaints suspected of tuberculosis, in particular, having a cough for more than 3 weeks. The obligatory diagnostic minimum includes a threefold examination of sputum, microscopy (from 3 samples) and culture of sputum on solid or liquid nutrient media to detect mycobacteria, PCR diagnostics, plain chest X-ray, linear tomography. If the diagnosis is not clear, additional research methods are carried out, including spiral computed tomography, fibrobronchoscopy with a complex of biopsies, including direct biopsy of the bronchial mucosa, pathological formations in them.

Early diagnosis of bronchial tuberculosis requires repeated examination of sputum on MBT by bacterioscopy and bacteriological culture in patients with protracted / recurrent bronchitis. If there is bronchial tuberculosis, then MBT will be found in 90-93% of patients with tuberculosis. Since in 26.3% of cases, bronchial tuberculosis as the leading localization of the infectious process in the lungs occurs with damage to the wall of the main, intermediate or lobar bronchus, bronchoscopy in all cases reveals a local specific lesion of the bronchial mucosa (including subsegmental and segmental bronchi). At the same time, the symptoms identified during bronchoscopy are sometimes the only reliable criteria for tuberculous lesions.

Among modern diagnostic methods, attention should be paid to Diaskintest®, which is designed for the diagnosis and differential diagnosis of tuberculosis, it allows you to determine the tuberculosis allergen - a recombinant protein produced by a genetically modified culture of E. coli. Diaskintest® - two antigens present in virulent MBT strains and absent in the BCG vaccine strain. When administered intradermally in persons with tuberculosis infection, Diaskintest® causes a specific skin reaction, which is a manifestation of delayed-type hypersensitivity. In persons vaccinated with BCG and uninfected with MBT, there is no reaction to Diaskintest®.

Difficulties in diagnosing bronchial tuberculosis are due to a number of factors, in particular, the fact that long time he has an asymptomatic course, even in the presence of ulcerative tuberculosis of the bronchus. And the most characteristic clinical symptoms tuberculosis of the bronchi, such as cough, sometimes with a painful sensation in the chest, expiratory dyspnea, and with the development of bronchial obstruction - atelectasis of a part of the lung, are nonspecific, do not fit into the picture of tuberculous lung lesions and are a manifestation of local broncho-obstructive syndrome.

In conclusion, it should be emphasized that for the timely recognition of bronchial tuberculosis in persons with prolonged / recurrent cough, it is necessary to look for clinical signs local broncho-obstructive syndrome, timely include in the diagnostic process bronchoendoscopic examination and modern methods for diagnosing tuberculosis, including Diaskintest®.

Reviewers:

Tetenev FF, Doctor of Medical Sciences, Professor, Head of the Department of Propedeutics of Internal Diseases, Siberian State Medical University, Ministry of Health of the Russian Federation, Tomsk;

Bukreeva EB, Doctor of Medical Sciences, Professor of the Department of Internal Diseases, Pediatric Faculty, Siberian State Medical University, Ministry of Health of the Russian Federation, Tomsk.

The work was received on December 10, 2014.

Bibliographic reference

Ageeva T.S., Volkova L.I., Mishustina E.L., Mishustin S.P. TUBERCULOSIS OF BRONCHES IN GENERAL MEDICAL PRACTICE // Basic research... - 2014. - No. 10-7. - S. 1265-1268;
URL: http://fundamental-research.ru/ru/article/view?id\u003d36101 (date accessed: 03/29/2020). We bring to your attention the journals published by the "Academy of Natural Sciences"

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The defeat of the respiratory system with a Koch stick is a fairly common phenomenon. Basically, everyone understands lung damage by this wording. But this is not the only organ that can be affected. There are cases when they diagnose tuberculosis of the bronchi or trachea. What is bronchial tuberculosis? What are the first signs of pathology and is this type of disease contagious?

Definition

By bronchial tuberculosis is meant damage to the wall of the organ, which is caused by the tubercle bacillus. In the future, it is possible to spread the MBC to nearby organs. There are two outcomes:

1. Breakdown of tissue, resulting in ulceration or fistula. This is characteristic of primary infection.
2. Tuberculosis of the trachea and upper respiratory tract... This outcome is characteristic of the chronic form of tuberculosis. Here usually mycobacteria have passed to the bronchi from another organ.

All people suffer, regardless of gender or age.

The reasons

Immediately, as an independent pathology, bronchial tuberculosis appears infrequently, there are isolated cases. Basically, the cause is mild tuberculosis transferred before or bronchoadenitis.

Infection occurs in the following ways:

• bronchogenic (transmission through sputum);
• contact (penetration from infected areas);
• lymphogenous (transmission through the lymphatic tract)
• hematogenous (through the blood).

Who is at risk?

The provoking factors, first of all, are the presence of MBC in other respiratory organs and in the body in general. Indirectly affects bronchial tuberculosis:

• poor living and working conditions (dampness, cold, dirt, exposure to harmful substances, etc.);
• delayed treatment various diseases (viral and bacterial etiology, especially associated with ENT organs);
• poor nutrition (the use of semi-finished products, preservatives, lack of balanced foods and vitamins);
• the presence of bad habits (tobacco smoking, alcohol abuse, drug use).

The risk group includes persons:

• previously suffering from tuberculosis or having it at the moment;
• workers veterinary clinics, TB dispensaries, morgue and meat shops;
• with weak immunity;
• carriers of HIV infection;
• diabetics;

You should also highlight those people who neglect preventive medical examinations and supporters traditional medicine... These individuals can harm themselves and others with their own hands.

First symptoms

It is possible to recognize bronchial tuberculosis by some symptoms. But, unfortunately, they are characteristic of other diseases as well, which is why it is so important to undergo a diagnostic examination.

It should also be borne in mind that certain signs are characteristic of a particular form or stage of tuberculosis.

Usually appears:

There are forms when signs are absent or barely noticeable.

It is also worth noting the symptoms that are present in tuberculosis and other pathologies.

• unreasonable rise or fall in body temperature;
• malaise;
• lethargy;
• impotence;
• apathy;
• aversion to food and refusal to eat it;
• sweating in large quantities.

If you notice the above symptoms that are not eliminated symptomatic treatment, you should seek advice from a TB dispensary to a phthisiatrician. If necessary, the doctor will examine the patient.

Types and forms

When diagnosing and before prescribing treatment, the type of pathology is determined. There are only three pathomorphological forms. It:

• infiltrative;
• ulcerative;
• fistulous or fistular.

Let's see how they are characterized.

Infiltrative form

Usually this form of bronchial tuberculosis is detected. An infiltration in the region of the upper respiratory tract is found during examination. It causes poor bronchial patency. The affected area is small, round, or elongated. It is thickened and hyperemic. In this case, the patient is not dangerous to other people. There is no MBC allocation.

Ulcerative form

A diagnostic examination shows that there is ulceration in the bronchi. The defeat occurs at the mouth of the lobar or segmental bronchi. If the inflammation is productive, then the ulcer is limited, superficial. It has a granular or smooth bottom. Also present white bloom on the edge. With exudative-necrotic inflammation, the ulcerations are deeper, bleeding. Their bottom is covered with a gray coating. In the second case, there is more bacterial excretion.

Coughing up blood immediately takes place. The release of mycobacteria with sputum is present, which suggests that a person can infect people around him.

Fistulous or fistular form

Here the bronchial wall and lymph nodes are damaged. There is a breakthrough of the lymph node into the bronchial wall - a fistula. It is funnel-shaped. If you click on it, then caseous masses of yellow or white will go.

Calcium crystals are often released from the fistulas. The latter can be located in the diseased organ, which can be seen during bronchoscopic examination. After their weakening, bronchiolitis deposits penetrate into the adjacent airways (located below). This contributes to atelectasis, cirrhosis. This form is especially dangerous. The carrier of the infection actively secretes the tubercle bacillus, so the treatment is carried out for a long time, in isolation and strictly in the TB dispensary.

Diagnostics

To identify the bacillus and clarify the place of its localization, you need to undergo an appropriate examination. If a person is already registered in a TB dispensary, then a complication of the bronchi will be seen on routine diagnostics. Another option is to detect changes in the organ on a fluorographic image. These options assume the case when there are no obvious symptoms yet. After that, a detailed study and determination of the form of the disease begins.

If there are symptoms inherent in tuberculosis (cough, hemoptysis, constant temperature, weakness), then a referral to an appointment with a phthisiatrician is given by a therapist or other specialist to whom the patient turned.

In a specialized clinic you will need to go through:

1. X-ray (if it has not been passed earlier).
2. Computed tomography. Here deformation of the organ, zones of atelectasis and hypoventilation will be revealed.
3. Bronchoscopy. Bronchostasis and stenosis are characteristic here.
4. Fibrobronchoscopy. It will provide an opportunity to clarify the type and localization of bronchial tuberculosis.

Sometimes there are no endoscopic signs of bronchial tuberculosis, but this does not mean that everything is in order. To clarify the diagnosis, they must take sputum and lavage fluid for analysis. If tuberculosis is present, then mycobacteria will be found in the biomaterial.

A tuberculin test is advisable. He usually shows a positive result, which is difficult to doubt.

In addition to all of the above, they can offer:

• ELISA diagnostics;
• biopsy;
• morphological studies of the changed zones.

Only after the full results have been obtained can the diagnosis be clearly announced. After that, the doctor is determined with the treatment.

Treatment

Can help a patient with bronchial tuberculosis drug treatment, in some cases, surgical intervention is indispensable.

Medication

To get rid of MBC, drugs are prescribed by mouth. They can be administered via a catheter, aerosolized, or given oral administration. Inhalation based on antibiotics, laser irradiation of mucous membranes are advisable.

A bronchoscopy is done, during which all caseous masses are removed. Existing granulomas are cauterized with trichloroacetic acid. The bronchial passages themselves are flushed.

From anti-tuberculosis drugs, preference is given to:

• Ftivazid;
• Streptomycin;
• PAX;
• Ethambutol;
• Rifampicin.

It should be noted that all funds are discharged in a comprehensive manner. It can be 2 or even 4 drugs. The dosage is calculated individually for each patient. In no case should the patient regulate it independently. This is fraught with serious consequences. When there is side effects, deterioration of health, you should tell the attending phthisiatrician about this. He, in turn, will decide what action to take next. Usually drugs are replaced by others. Interruption of treatment is strictly prohibited.

The duration of the therapeutic course depends on the existing form of bronchial tuberculosis. It can be three months or six months (if the form is infiltrative or ulcerative) or 10 (for fistulous). If the symptoms have disappeared, this does not mean that recovery has come. The treatment lasts as long as the doctor sees fit.

Operations

With the development of bronchoconstriction of the 2nd or 3rd degree, an operation is performed. Stenting is done, the affected tissue is removed.

After the patient takes anti-tuberculosis drugs and is under medical supervision.

After the completion of the therapeutic course, the turn of rehabilitation comes. At best, it takes place in a special sanatorium or in the appropriate home conditions.

Prognosis and complications

The prognosis of the disease is 70% satisfactory. People live, work in favorable conditions labor. 30% die due to the decay of the affected massive areas.

In case of late detection of bronchial tuberculosis, lack of treatment or in violation of the doctor's recommendations. Complications may occur in the form of:

• atelectasis;
• bronchoconstriction;
• hypoventilation;
• fistula;
• decay of tissues.

Mycobacterium often invades the trachea.

Prevention

After treatment, a person must take all measures so that a relapse does not appear. For this you need:

• undergo chemoprophylaxis for two years after recovery in the autumn and spring;
• adhere to proper nutrition, which should include all micro and macro elements, proteins, vitamins and other nutrients;
• normalize wakefulness and sleep;
• walking more in the fresh air;
• forget about bad habits (smoking and alcohol);
• leave hazardous production;
• do not overcool;
• timely treat all diseases (especially those related to the respiratory system);
• maintain an appropriate standard of living.

Output

Tuberculosis of the bronchi is a pathology in which a person can secrete MBC and infect others or be not dangerous. There are three forms of the disease. Before starting treatment, you need to determine the type of pathology and find its localization.

Bronchial tuberculosis is a disease that occurs mainly in a chronic form and affects the walls of the bronchi with Koch's tubercle bacillus. Basically, it goes not as an independent pathology, but as a complication of pulmonary tuberculosis and also affects the intrathoracic the lymph nodes... This form of the disease infects the upper respiratory tract, and tracheal damage is also possible.

There are three forms of bronchial tuberculosis:

1. Infiltrative. This is the most common type of damage to the bronchi and trachea. When examining patients in the upper respiratory tract, an infiltrate is visible, which disrupts bronchial patency. In this form, a person is not contagious, since it does not emit mycobacteria.
2. Ulcerative. When diagnosing, one can observe the presence of an ulcerative formation with a whitish bloom along the edges. The development of hemoptysis is possible. The patient is most often infectious to others, since he already secretes mycobacteria.
3. Fistulous. With this form, damage to the bronchial wall, lymph nodes appears. So-called fistulas are formed, through which calcium crystals can drain. On examination by bronchoscopy, large crystals can be seen in the bronchi. Under their weight, bronchiolitis enter the lower respiratory tract, causing atelectasis of the lungs, and later cirrhosis. With this form of tuberculosis, the patient is extremely dangerous and can infect others, as he releases bacteria.

Symptoms

It is possible to understand that a person is sick only with a thorough diagnosis of the patient. Clinical manifestations depend on the localization of the process, the form of tuberculosis and the duration of the disease. Sick people mainly complain of an excruciating cough, while they experience pain in the interscapular region and behind the sternum. The cough cannot be treated with conventional cough medicines. Viscous sputum is released in large quantities and odorless.

With ulcerative infectious tuberculosis, the patient may have blood during sputum secretion. With an infiltrative form, there is a possibility that no complaints will be observed at all. Clinical manifestations may not be noticeable or be erased.

In people with tuberculosis, all of the symptoms that occur with infectious diseases... Such as the:

• temperature increase;
• weakness;
• lack of appetite;
• fever;
• profuse sweating.

Complications may develop against the background of bronchial tuberculosis:

• stenosis of the trachea and bronchus;
• bronchiectasis;
• bronchial pneumonia.

With obstruction of a small caliber of the bronchi, the signs of bronchial tuberculosis may be similar to ordinary bronchitis, the presence of a tumor or the presence of a foreign body in the airways of the lower section. For a more accurate diagnosis, you need to pass the patient tests, make a thorough diagnosis.

Identification of infected and diagnostics

Since this disease is mainly not independent, but arises against the background of other forms of tuberculosis, almost all patients are already being treated by a phthisiatrician. The doctor must study the medical history, examine and interview the patient for the presence of other diseases, complaints, contact with persons who are sick with an open form of tuberculosis.

Rarely, a bronchial form of the disease is detected during the annual passage of the medical commission, when fluorography is done, in patients with fever and barking cough, hemoptysis. Do targeted diagnostics of the disease in the TB dispensary. The doctor prescribes:

1. X-ray and computed tomography lungs with suspected tuberculosis. In this case, destructive changes, areas of atelectasis and hypoventilation are visible.
2. Bronchography showing stenosis and bronchiectasis.
3. To determine the location and shape of the lesion - fibrobronchoscopy.
4. Examination of sputum and lavage fluid for the presence of mycobacteria.
5. A blood test for the presence of a titer of anti-tuberculosis antibodies.
6. Sometimes bronchoscopy and lung biopsy.

Treatment

Prescribe local treatment:

• drugs are injected through a catheter or sprayed with an aerosol;
• carry out inhalations with antibiotics;
• mucous membranes are irradiated with a laser;
• in severe cases, the attending physician may prescribe surgical removal of the affected area of \u200b\u200bthe lung.

After discharge, the patient undergoes rehabilitation at home, and then a spa treatment is prescribed.

The prognosis for bronchial tuberculosis patients is generally favorable, the main thing is to identify the disease in time and prescribe appropriate treatment. Moreover, you need to trust it to specialists, and not use it. folk remedies... Thus, you can avoid various complications and quickly cure tuberculosis.

Statistics

According to statistics, only two percent of the disease is acute or subacute. In ninety-eight percent of cases, it is a chronic disease. There is no data on who is more likely to get sick children or adults. Revealed only that vaccinated children two and a half times less sick than without vaccination. There is also a tendency to increase the risk of contracting bronchial tuberculosis if a person is sick with another species.

Specialist

Many doctors deal with the problem of treating bronchial tuberculosis disease. One of them is O. V. Lovacheva, a highly qualified doctor, doctor of honey. Sci., specialist in the treatment and detection of tuberculosis in the bronchi. He is a specialist in various fields. Such as phthisiology, endoscopy, pulmonology. Wrote 200 papers related to this problem. She defended her thesis for a candidate in the diagnosis of lung malformations in combination with tuberculosis. She also defended her doctoral dissertation. Has an academic title in the field of phthisiology. The general work experience as a doctor is thirty years. Teaches at the Central Research Institute to the present. Under the leadership of Olga Viktorovna, they defended twelve doctoral and candidate sciences. Teaches and prepares specialists-endoscopists in the section of bronchological research. Lobacheva has many merits and she is the secretary of the editorial committee in the journal "Tuberculosis and Lung Diseases". She personally performed thousands of operations and studies of the bronchi, used the most complex biopsy techniques and surgical manipulations. He constantly gives various reports at conferences, lectures students on phthisiology in Moscow and other cities of Russia.

Tuberculosis of the bronchi is an infectious pathology in which the bronchi are affected by mycobacterium tuberculosis. Most often, this ailment is secondary, it develops against the background of tuberculosis of the lungs and thoracic lymph nodes. A characteristic feature of this disease is numerous fistulas, ulcers and infiltrates in the respiratory organs. Quite often, this ailment is combined with tuberculosis of the trachea and larynx.

Varieties of pathology

Tuberculosis of the bronchi and other upper respiratory organs rarely occurs in isolation from pulmonary tuberculosis. All varieties of this pathology, one way or another, are associated with an external source of infection. With regard to this, the disease is classified into groups, depending on the route of infection.

1. Contact. In this case, the development of the disease is possible when the infection spreads through the affected lymph node, connective tissue or trachea, with the further penetration of mycobacteria into the bronchial tree.
2. Bronchogenic. You can become infected due to the infected phlegm secreted by the bronchi.
3. Hematogenous. Mycobacterium tuberculosis penetrate the bronchi with the bloodstream from other affected organs.
4. Lymphogenous. In this case, the bacteria are transmitted by the lymph flow, for example, from the breast lymph nodes affected by mycobacteria.

Tuberculosis of the upper respiratory tract is an order of magnitude less common than the bronchi or trachea. Most often, unvaccinated people and people with weakened immunity are sick with tuberculosis. Rational nutrition and social living conditions play an important role in the spread of infection.

Tuberculosis of the bronchi has several different forms of flow. Each of them is distinguished by its characteristic features.

• Infiltrative. In this case, the lumen of the bronchi practically does not narrow and the sputum does not contain mycobacteria. Infiltration forms on the bronchi, which can be of different sizes.
• Ulcerative. With this form of the disease, both small and large bronchi are affected by mycobacteria. Pathogen sticks are often found in sputum.
• Svishcheva. The walls of the bronchi are severely depleted and fistulas form on them. This can cause blockage of small bronchi.

With bronchial tuberculosis, diagnosis can be very difficult, since the disease proceeds without characteristic signs. It is especially difficult to recognize the infiltrative form of the disease.

Tuberculosis of the bronchial tree can lead to such serious complications as atelectasis and cirrhosis of the lung.

Clinical picture

In most cases, bronchial tuberculosis occurs in a chronic form, without any characteristic signs. Only in 2% of cases, the pathology is very acute and is accompanied by specific symptoms. The severity of the clinical picture is influenced by the form of the disease, the location of the infectious process and the degree of tissue damage.

Tuberculosis of the bronchi proceeds with a number of symptoms, according to which one can suspect the infection of the respiratory organs with mycobacterium tuberculosis.

• Intense barking cough, which is completely resistant to treatment with the usual drugs. It is noteworthy that in a horizontal position of the body, such a cough increases significantly.
• Wheezing, which is a consequence of significant narrowing of the bronchi in some forms of tuberculosis. Whistling and noise during breathing can be heard not only when listening to the patient with a stethoscope, but even at a distance.
• When coughing, a large amount of viscous phlegm is released. With ulcerative lesions of the bronchi, blood particles can be observed in the sputum. With a fistulous form of the disease, there may be inclusions of calcifications in the sputum secreted.
• With tuberculosis of the bronchi, pain and a burning sensation between the shoulder blades almost always occur. Experts say that this phenomenon is observed when the lymph nodes are affected.

When the respiratory organs are infected with mycobacteria, the symptoms characteristic of other forms of tuberculosis are not observed. The person does not lose body weight, and there is no heavy sweating, especially at night. In addition, the temperature can remain normal, not even rising to subfebrile levels.

If bronchial obstruction occurs during tracheobronchial tuberculosis, the symptoms may resemble typical bronchitis. In this case, the patient has a persistent foreign body sensation in the bronchi, and noisy breathing is observed, very reminiscent of bronchial asthma.

Even an experienced doctor is not always able to correctly diagnose the disease. To clarify the diagnosis, they resort to various examination methods.

Diagnostics

Given the peculiarities of the course of the disease, its diagnosis can be somewhat difficult. In more than half of patients, such a pathology proceeds without a pronounced clinical picture, therefore, to clarify the diagnosis, they resort to different research methods. Basically, doctors use the following methods:

• X-ray tomography. Due to this procedure, it is possible to identify damage to the bronchi and impaired ventilation of the lungs due to bronchial obstruction.
• Bronchoscopy. Thanks to this examination, it is possible to accurately determine the form of the disease and the localization of the infectious process. If necessary, a biomaterial can be taken with a bronchoscope for biopsy.
• Examination of the patient's sputum. Collect sputum in a sterile container and examine it for the presence of Koch's bacillus.
• Flush analysis. If the cough is dry, then a little isotonic is injected into the bronchiole segment. saline, which is then aspirated and examined for the presence of mycobacteria.

The most reliable diagnostic method is ELISA analysis. This test detects antibodies to mycobacteria in the blood. This research method is carried out only in conjunction with other diagnostic measures, since it can only show the presence of Koch's bacillus in the body, but does not indicate the localization of the inflammatory process.

To complete the picture, the patient is prescribed urine and blood tests. This allows you to objectively assess your overall health.

Treatment features

Even in the absence of a pronounced clinical picture, pulmonary tuberculosis must be treated. Considering that the defeat of the bronchi with Koch's bacillus is a secondary disease, it requires complex treatment using several types of antibacterial drugs.

Besides oral administration various tablets, the patient is shown and local treatment... If the infection is localized, then the patient is injected with chemotherapy drugs into the respiratory organs using a bronchoscope. With extensive damage to the respiratory organs, aerosol spraying of antimicrobial drugs is indicated.

Quite often they resort to mechanical cleansing of the bronchi from caseous masses. This manipulation is also carried out through a bronchoscope. In some cases, cauterization of the affected tissue with a laser is indicated. The indication for such a procedure is a strong narrowing of the lumen of the bronchi and scarring.

For tuberculosis, it is always prescribed complex treatment, which includes several different antibiotics, as well as vitamin preparations and immunostimulants. If the cough is very intense and painful, the following medications may be prescribed:

• Novocaine intravenously and subcutaneously, in the chest and shoulder blades.
• Treatment of the breast area with calcium chloride.
• A nicotinic acid.

From antibiotics, drugs based on streptocide and Ftivazid are prescribed. Treatment with such medicines should last at least 3 months.

It should be borne in mind that with prolonged therapy, mycobacteria become resistant to drugs of some drug groups and the effectiveness of the treatment is reduced. In this case, the treatment is adjusted.

For the entire period of treatment, the patient is placed in an anti-tuberculosis dispensary and is under constant medical supervision, since the disease can be contagious. During and after tuberculosis, the patient should eat well.

To prevent a relapse of the disease, the patient should drink antibacterial drugs twice a year, for a course of up to 3 months. This treatment regimen is indicated in the first two years after recovery.

The defeat of the bronchi by mycobacteria is often observed with tuberculosis of the lungs and trachea. This form of the disease generally proceeds without characteristic signs, so it is difficult to diagnose it. You can suspect an ailment on the basis of a strong, barking cough and pain between the shoulder blades.

Clinical course... Most patients (98%) develop bronchial tuberculosis chronically. Acute and subacute onset of the disease is rare (2%), mainly in children with asymptomatic or unrecognized primary tuberculosis, in particular, tuberculosis of the tracheo-bronchopulmonary lymph nodes. In these cases, acute or subacute specific lesions of the trachea and bronchi. simulates at first foreign body and is the cause of diagnostic errors. Tuberculosis of the bronchi, especially in the initial forms, may be asymptomatic. The main most characteristic symptoms and signs of the disease are: persistent, loud, barking, sometimes convulsive cough (as with whooping cough), often with painful sensations in the chest, which usually does not subside sometimes even with the use of large doses of drugs, and in some cases even with prolonged treatment with antibacterial drugs; persistent chest pain, often with a slight cough, with the presence of whistling, "tracheal" wheezing in a limited area of \u200b\u200bthe lungs; shortness of breath with slight exertion, not corresponding to the prevalence of the tuberculous process of the lungs, often with asthmatoid attacks and even cyanosis.

Root localization of the process in the lungs or a close connection of tuberculous changes with the root of the lungs are also typical; atelectasis of the entire lung or, more often, of individual lobes and segments; ineffective therapeutic pneumothorax or significant collapse of the lung resulting from it, which does not correspond to the amount injected into pleural cavity gas; the presence of blocked, swollen, large and giant caverns; repeated detection of mycobacterium tuberculosis in sputum in the absence of clinical and radiological changes in the lungs or the isolation of mycobacterium tuberculosis in the sputum of patients with complete collapse of the lungs; stenotic breathing with a normal larynx.

The most characteristic features of bronchial tuberculosis in children are symptoms associated with impaired bronchial patency in the presence of lobar or segmental atelectasis, especially in acute or subacute onset of the process. Much less often than in adults, children have a very strong, paroxysmal cough, accompanied by noisy labored breathing and shortness of breath. In adolescents, clinical forms of bronchial tuberculosis are also observed, very similar to those in children. According to the clinical course, bronchial tuberculosis in children and adolescents with secondary forms of pulmonary tuberculosis does not differ from bronchial tuberculosis in adults.

Changes in the bronchi in primary tuberculosis have characteristics... The affected lymph nodes exert mechanical pressure on the bronchi, with possible subsequent perforation, which causes narrowing of the bronchial lumen. Similar changes can be observed in patients of any age who suffer from primary tuberculosis, but especially often in children, whose bronchial wall is softer and more pliable than in adults.

Diagnosis tuberculosis of the bronchi is mainly established during bronchoscopy (see). However, the absence of obvious signs of bronchial tuberculosis during bronchoscopy does not exclude the assumption of a specific process in segmental, draining bronchi. It is also necessary to examine mucus, bronchial and gastric washings (especially in children) for mycobacterium tuberculosis, make a biopsy, cytological examination, super-exposed, tomographic X-ray images and bronchography. Bronchoscopy is indicated in the presence of the above-mentioned direct (subjective) symptoms and indirect (objective) signs of bronchial tuberculosis, as well as as a control study before the imposition of pneumothorax, before lung operations, if a tumor or foreign body is suspected. Diagnostic and therapeutic bronchoscopy for tuberculosis is performed, using also an optical bronchoscope, under local and general anesthesia. Bronchoscopy under anesthesia with relaxants is especially indicated for children of preschool and primary school age, adults with poor tolerance of local anesthetics, with technically difficult or unsuccessful tube insertion under local anesthesia, restless and fearful people, patients with injuries, epilepsy, deaf and mentally ill people, and also with significant deformities of the trachea and bronchi.

Differential diagnosis carried out with acute and chronic endobronchitis (nonspecific), with abscesses, bronchodilators, foreign bodies, Beck's sarcoid, silico-tuberculosis, echinococcus, scleroma, syphilis, especially tumors. In the clinical diagnosis of bronchial tuberculosis, in addition to the characteristics of the tissue reaction (mainly productive or exudative) and the form (infiltrative or ulcerative, during healing - cicatricial), it is also necessary to indicate the localization of the process according to the international nomenclature of the bronchi and lung segments. Complications can be stenosis (1, 2, 3 degrees), as well as broncho-lymphatic fistulas.

The phases of the process should be noted: decay, seeding, resorption, compaction, scarring. The graphic designation of pathological changes on the stamps (A. N. Voznesensky) of the lobes, segments of the lungs, trachea and bronchi gives a clear picture of the lesion (Fig. 4, 5, 6).

Figure: 4. Stamp diagram of the trachea, segmental bronchi, lobes and segments of the lungs. Solid line - border of lung lobes, dotted line - border of segments, Arabic numerals - segments and segmental bronchi (according to international nomenclature), Roman numerals - ribs.

Figure: 5. Stamp diagram of the tracheobronchoscopic picture of the bifurcation of the mouths of the main, lobar and segmental bronchi.

Figure: 6. Tuberculosis of the bronchi on the stamp-diagram (below - symbols of the tuberculous process). Tuberculosis of the bifurcation of the trachea, the mouths of the right and left upper lobe, trunk and lower lobe bronchi (exudative, ulcerative, progressive - the seeding phase).