Pulmonary tuberculosis is considered a social disease, its spread is directly related to the standard of living of the population. In Russia, the incidence of tuberculosis has risen sharply with the advent of homeless people and an increase in the number of migrants.
According to WHO, there are about 2 billion people in the world who are infected with tuberculosis. Every year, 9 million get sick, and 3 million die from complications.
Pulmonary tuberculosis can occur in different ways. If the process affects only the lungs, then the disease may not manifest itself at all, and the person learns about it by chance on the basis of annual fluorography. And it can also manifest itself as an ordinary ARVI – weakness, fatigue, low-grade fever, pallor and sweating, especially at night. With tuberculosis, the patient loses weight, often his lymph nodes are enlarged. And not all nodes increase, but separate groups. Another symptom of pulmonary tuberculosis is coughing, turning into a strong cough in the evening. In some cases, for example, with infiltrative pulmonary tuberculosis or pulmonary tuberculosis, the cough will be with a small amount of white sputum, but there will be blood streaks in it.
There are also more pronounced forms of pulmonary tuberculosis, in which the disease manifests itself much stronger. Patients suffering from such forms of pulmonary tuberculosis complain of indisposition, fatigue, weakness, poor appetite, weight loss, night sweats. The temperature rises sharply to 39-40 °. They are constantly tormented by cough with sputum, hemoptysis, shortness of breath even with a little physical exertion. However, even in this state, tuberculosis is not always recognized.
Tuberculosis, which used to be called consumption, is an infectious disease. Both man and animals suffer from it, most often it is cattle, chickens, pigs. It causes Mycobacterium tuberculosis tuberculosis, which is also Koch’s wand. And pulmonary tuberculosis is one of the main forms of the disease.
Mycobacterium was diagnosed in 1882 by German physician Robert Koch. Then he proved the infectious nature of consumption. Mycobacterium was extremely resistant to external influences. It does not kill acids, alkalis and alcohols, it is perfectly preserved in the ground and in the snow. It dies only when exposed to direct sunlight, high temperatures and chlorine-containing antiseptics.
For people, the main source of the disease is people suffering from tuberculosis. There are several ways to transfer information:
Airborne droplets are the most common route of infection. A person suffering from tuberculosis releases mycobacterium into the environment through coughing, breathing and talking. Healthy people, breathing in mycobacteria, thereby infecting the body with the infection.
Contact infection is possible if a person has lesions on the skin. Through wounds, mycobacterium can penetrate into the human body, however, it cannot do this through healthy skin.
Through the digestive tract, one can become infected by eating meat infected with tuberculosis. In order for the infection to be transmitted in this way, more mycobacteria are needed. With this method of transmission, intestinal tuberculosis most often develops.
The intrauterine route of infection is rare, but cases of mother-to-child transmission are known.
True, the fact that Koch’s wand has entered the human body does not mean that he will become ill with tuberculosis. Mycobacterium tuberculosis is in the body of many, but only 10-15% of them suffer from tuberculosis. The rest is produced to her immunity.
Men suffer from tuberculosis 3.2 times more often than women. And this disease develops in them much faster. Most often they suffer at the age of 20-29 and 30-39 years. At the same time, the incidence in prisons and colonies is 42 times higher than the average in Russia.
Once in the human body, the tubercle bacillus causes inflammation. However, it does this very slowly. A disease is called primary if it developed when the infection first entered the body. At the same time, the body has not yet developed ways to combat mycobacteria, so the infection spreads quite easily throughout the body. At the same time, a primary focus of inflammation is formed – a limited portion of the inflamed lung. Inflammation of the lymphatic vessels (lymphangitis) may also develop. During the healing of the primary focus, the affected area is impregnated with calcium and hardens. This formation is called Gon focus. Such inclusions in the lungs are often found in older people who have had latent forms of tuberculosis. After the formation of such a focus, mycobacteria persist for a long time in the lungs.
In general, this form of tuberculosis is the easiest. A person may not notice it. But if the immunity is weakened, more serious forms are possible. Most often it is secondary tuberculosis, which develops from the primary focus, since the bacteria there persist for a long time, or when Koch’s sticks re-enter the body. In contrast to primary tuberculosis, in these forms there is no primary focus of inflammation.
With dissipated (diffuse) tuberculosis in the lungs, several foci of inflammation are formed. The course of this disease can be acute, subacute and chronic. It depends on many factors – immunity, concomitant chronic diseases, beriberi. Usually, in the case of a lung TB disease, the bones, joints, heart, brain, liver, and kidneys are also affected. Its symptoms are similar to the symptoms of ARVI, bronchitis or pneumonia, however, unlike these diseases, they do not go away, but increase with time. In severe forms of breathing is disturbed, the patient suffers from shortness of breath, wheezing in the chest, constantly coughing. With brain damage, he develops muscle tension in the neck. Symptoms of severe intoxication are possible – vomiting, headache, impaired consciousness, high fever.
However, the most common form of pulmonary tuberculosis is infiltrative tuberculosis. Infiltration is the filling of the tissue of an organ with inflammatory cells. At the same time on the radiograph visible heterogeneous shadows with fuzzy edges with a diameter of more than 1 cm. This form can be asymptomatic and with characteristic symptoms – cough, hemoptysis, intoxication. Its manifestations depend on the general condition of the person suffering from tuberculosis. It can also develop into caseous pneumonia, which was formerly called transient consumption.
When caseous pneumonia affects one lobe of the lung and more. This form is characterized by caseous (cheesy) necrosis, in which dying off tissues become grainy and are rejected by the body. This is an acutely progressive form of tuberculosis, mortality in the first month is about 14%, it occurs in 8-10% of cases of pulmonary tuberculosis.
In pulmonary tuberculosis, caseous necrosis is limited to a dense sheath of connective tissue. However, it gradually increases and may eventually develop into a cavity (a cavity formed in the organ due to the destruction of its tissue).
In cavernous pulmonary tuberculosis, cavities with walls of connective tissue form in the tissue of the affected organ. Cavities can reach significant sizes – 6 cm in diameter, and sometimes more. This form is relatively young, it appeared at the time when tuberculosis was started to be treated with antibacterial agents. It practically does not manifest itself, however, a cavity can cause pulmonary bleeding. Often a fungal infection joins the cavernous form of pulmonary tuberculosis.
Cavernous tuberculosis can develop into a fibro-cavernous form. At the same time, thick-walled cavities are formed in the lungs, a part of the lung is replaced by fibrous tissue, and the bronchi can be deformed. Those suffering from this form of pulmonary tuberculosis are most dangerous to others, as in one cavity they have about 1010 – 1012 mycobacteria. They excrete them into the environment when they cough. For the patient himself, this form is dangerous with pulmonary hemorrhages, the addition of a fungal infection, spontaneous pneumothorax (air accumulation in the pleural cavity, resulting in pressure changes in the chest and air exchange is disturbed).
With the growth of connective tissue in the lungs and pleura, cirrhotic pulmonary tuberculosis develops. This is the ultimate form of pulmonary tuberculosis. It often leads to the death of the patient, but not very dangerous for others. The treatment of this form is difficult, as the drugs do not penetrate the fibrous tissue well.
The main method for diagnosing tuberculosis in children and adolescents is the tuberculin test (Mantoux test). It is done once a year. To do this, use tuberculin – a protein extract, which is obtained from the culture of tubercle bacilli. It acts specifically on the infected organism, and it helps to identify the diseased. To identify the disease, a small amount of tuberculin is administered to the patient, and after 48 hours the size of induration (compaction) around the site of tuberculin injection is evaluated. If induration is less than 5 mm, then the patient is healthy. If induration is up to 10 mm, then the patient is at risk, he may have been in contact with suffering from tuberculosis. If induration is more than 15 mm or an abscess has formed at the injection site, it means that the patient most likely has tuberculosis. At the same time, it is impossible to say with certainty that a person who had induction more than 15 mm during the Mantoux test was suffering from tuberculosis. Perhaps he was just in contact with the carrier of the infection.
If the tuberculin test is positive, conduct bacteriological examination of sputum, bronchial wash water. To do this, the patient is anesthesia of the respiratory tract and injected 15-20 ml of saline, warmed to 37 °. The patient reflexively coughs up this liquid, it is collected in a sterile container and examined. However, this method is contraindicated for asthma sufferers. The presence of mycobacterium tuberculosis can be determined by the method of polymerase chain reaction (PCR) or by the method of detecting acid-resistant mycobacteria, in which the smear is stained with special acid dyes, and the mycobacterium can be detected using a microscope.
It is also possible to collect material for research using a bronchoscope. Bronchoscopy makes a biopsy of the tissue lining the bronchi. When tuberculosis occurs in them characteristic changes.
Mycobacterium tuberculosis can be detected in the pleural fluid, and lung biopsy.
Another common method for identifying people suffering from tuberculosis is fluorography. This is an x-ray method of examination that helps to see the lesions of the lungs. A lesion is a shadow in a photograph with clear contours up to 1 cm in diameter. If only one lesion is visible on fluorography and there are no symptoms of the disease, then the patient is simply observed.
If, after some time, with repeated analysis, the lesion will increase, the patient is checked for the presence of cancer. And if there are several foci, they confirm the diagnosis of “tuberculosis” and begin treatment.
Until the 20th century, tuberculosis was almost incurable. Now there are many anti-TB drugs. Still, the problem of tuberculosis is quite acute. Many patients do not know that they suffer from tuberculosis, some do not want to go to the doctor and are treated on their own. But this is dangerous, because with the wrong treatment, the easily curable form of the disease can turn into a drug-resistant form.
Treatment of pulmonary tuberculosis is prolonged. At the same time, several anti-tuberculosis drugs are used at once, affecting mycobacterium tuberculosis in different ways. But, unfortunately, even such an attack “from different sides” is not enough. We also need physiotherapy, breathing exercises and drugs that improve the immune system.
But sometimes this whole set is not enough. In these cases, pulmonary tuberculosis should be treated surgically – to remove the affected part of the lung or the entire lung. The lung is removed in the case of open cavities with thick walls, the scarring of which is impossible, with life-threatening bleeding from the cavities, in the presence of significant fibrous foci in which anti-tuberculosis drugs cannot penetrate, the presence of foci formed by atypical Koch sticks and background tuberculosis.
Surgical treatment is usually combined with medication.
To prevent tuberculosis, it is necessary to promptly detect cases of the disease. To do this, you need to regularly do x-rays. It is necessary to limit contacts with people suffering from tuberculosis. To do this, those who suffer in overcrowded apartments should be isolated from the rest of the residents. It is important to vaccinate against tuberculosis in a newborn baby in time.
It is necessary to examine migrants from countries and regions unsuccessful with tuberculosis.
One of the ways of human infection is through food. It is very important to establish close monitoring of milk and meat, as well as to regularly examine workers working with cattle.