Update: October 2018
Tuberculosis is an infectious process that does not lose its
danger throughout the thousand-year history of mankind, yielding
in importance, except that the plague and cholera.
If during the period of 70-80 years Soviet medicine managed to keep
the process of morbidity and treatment under control, then with the collapse
preventive system of the Soviet public health
migration processes and more open post-Soviet
Space situation has deteriorated markedly.
Today you no longer have to reassure yourself with the thought that
Tuberculosis is a disease of asocial groups.
Incidence statistics indicate that any person who does not
depending on their wealth and nature of nutrition, having errors in
immune defense, has all chances to get tuberculosis.
With этом появилась тенденция, при которой уравнялись шансы у
poor and rich. Often young quite wealthy mothers
weakened after childbirth, apply for pulmonary problems,
which during the examination are one form or another
That is, today the incidence situation has slipped by about
to the level of the beginning of the 20th century, when the intelligent environment was sick
tuberculosis no less than urban lumpen. Today in
Worldwide, tuberculosis affects about 60 million people.
Mycobacterium tuberculosis is also called Koch sticks or
tubercle bacillus, because it looks like a wand. She is
grows slowly on solid nutrient media, but quickly forms
on the surface of the liquid membranous formations. No toxins
bacteria do not secrete, therefore the moment of infection with them can quite
go unnoticed without signs of intoxication.
As sticks multiply and accumulate in
the body, there is an allergic reaction to them with the introduction
tuberculin (positive or hypernergic Mantoux test). If a
a mycobacterium cell is eaten by a leukocyte macrophage, it may well
live inside it and then go out into the bloodstream and cause
tuberculous process. Also, similar to chlamydia, mycobacterium
turn into L-forms, which, not multiplying, exist
vegetatively inside the cells.
Mycobacterium in the environment
The infectious agent is resistant to almost all external factors.
- In the water, bacteria can live for six months
- On the pages of books – about 3 months
- With комнатной температуре при влажности больше 70% микобактерия
can live about 7 years.
- If a в пыли содержится высохшая мокрота больного, выделяющего
bacteria, they still live about 12 months.
- In street dust with ambient lighting – 2 months, in the ground –
up to six months.
- In the raw milk of sick cows, the chopsticks live for 2 weeks, in the cheese
and oil up to 12 months.
When does Koch’s wand die in the environment?
- Koch sticks are badly tolerated only ultraviolet –
germicidal lamps kill them in 2-3 minutes, and direct solar
rays in two hours.
- With кипячении в засохшей мокроте гибель микробов наступает
in half an hour, in wet – in 5 minutes.
- In six hours, you can kill the chlorine-containing bacteria.
Ways of transmitting tuberculosis
The bulk of the infected gets mycobacterium aerogenic
by people with tuberculosis.
- Either airborne from a sick person (when talking,
sneezing, coughing), or airborne dust, inhaling the pathogen along with
- Contact-household way (with common utensils, hygiene products,
bed linen, towels) also does not lose relevance.
- The food pathway, also called nutritional, is realized through
food or water infected by sick people or
animals (usually cattle). But cases are rare today
infections from sick cows: unboiled milk and dairy products
- Transplacental is also a rare route of infection.
from mother to fetus.
- Contact can infect young children who have
the penetration of mycobacteria is possible through the conjunctiva of the eyes.
Higher risk of infection from a mycobacterial person is lower
– от больного внелегочными формами tuberculosis. The longer the person
is present in the presence of mycobacteria and the higher their concentration in
the inhaled air, dust, water or food, the higher the probability
The pathogen in the body captures leukocyte macrophage. With этом
the fact of infection does not mean the development of the disease. Thanks
passive (after BCG) or one’s own immunity
only carries mycobacteria. Only when immune protection fails
inflammatory process begins to unfold.
See New TB Test – Fast and Accurate
Is tuberculosis transmitted through door handles?
Become infected with tuberculosis by grabbing the doorknob after
how it is used by the patient, it is possible only if it lies on the handle
dense layer of dust. The patient releases Koch’s bacilli and coughs
directly on the pen before you took it. AT
In other cases, this route of infection tends to zero.
It is also unlikely to be an infection during a handshake (excluding
cases when the bacillus exchanger coughed into a fist, and you,
handing with him, inhaled intensely, raising his hand to his nose
or mouth). In general, it is not bad to take the rule at least sometimes
handle common areas (including door handles)
chlorine-containing detergents. By the way, alcohol and acid on
mycobacteria do not act. In addition to bleach for disinfection can
use hydrogen peroxide.
What happens after infection?
Most often, the infection occurs in childhood, but some people
can become infected as early as adulthood. Since the main
the path of infection is aerogenic, then most often the wand falls into
lung tissue directly under the pleura. Here she causes a focus
cheesy necrosis, the size of a pinhead to cherry.
For the first time this element of inflammation was described by Prague professor Gon, in
whose honor is described and called the Gon hearth.
Since in most cases the immune response to mycobacterium
there is, the center is gradually closed, soaked with calcium salts
and turns into petrificate (small pebble). Such stones all
and are found nearby during autopsies in people who do not have tuberculosis
and dead from other causes. This confirms the high
infection with tuberculosis of the population, as well as the dependence of onset
clinical manifestations and developed disease from the immune state
protection. That is, whether the disease will develop after infection or not
depends on the state of immunity infected.
Closed tuberculosis: how is it transmitted
About closed tuberculosis, they say when there is no secretion of mycobacteria
in the external environment. At the same time, a closed form of tuberculosis becomes ill.
a person infected with any of the possible ways (most often
aerogenic or contact-household, less-food). Himself sick
cannot infect anyone until its form
diseases will not lead to destruction of the affected organ (more often
lung) and will not cause the selection of Koch sticks to the external environment with
phlegm, urine, tears.
Open tuberculosis: how is it transmitted
Infection with open tuberculosis occurs, as well as closed. With
this patient secretes mycobacterium into the external world and is dangerous for
surrounding With посевах мокроты в анализе выявляются палочки Коха.
So patients with the open form of pulmonary tuberculosis usually infect
close relatives, colleagues or acquaintances by a large number
highly virulent microbes, resulting in
development of the primary tuberculosis complex.
Problems of modern phthisiology
Having achieved quite tangible results in containing tuberculosis
in the second half of the 20th century, professionals involved in this
infection (phthisiatricians) already from the late nineties began to face
problematic, previously considered a closed question.
Patient with an open form of tuberculosis (bacillus separator) per year in
In the normal mode, it is able to infect from 15 to 20 persons, not
living with him in the same dwelling and not in contact
close. That is, in transport, in the store, in the workplace.
What was and what is now
With this in mind, during the Soviet period, phthisiatry in places of detention
wore a punitive character, the treatment of patients
was carried out necessarily and continued (if necessary, under
control of the district police officer) and after the release of the patient,
that is, at his place of residence. Patient open form
relied extra square meters to reduce the risks for those
lived with him (and these meters with a creak, not always, but
Today, no one can force a citizen to be treated in
forced from the tuberculous process. Man by
self-will can interrupt therapy when it deems necessary. Even
if tuberculosis care in prisons and
It turned out (that today is not always and not everywhere), then after he can
refuse to continue treatment.
The use of certain drugs for tuberculosis treatment
Sighing relieved after the introduction of tuberculosis
drugs that gave a high percentage of cure, TB specialists
clearly hurried. Today, most of the tools used are already
do not give such brilliant performance, in connection with the adaptation to
them causative agents of the disease.
Rifampicin – the habit of some adds five kopecks
doctors or patients to resort to anti-tuberculosis drugs for
treating other infections. So, having been treated a couple of times from
staphylococcal furunculosis rifampicin, about tuberculosis
The action of this drug can be forgotten.
Fluoroquinolones – at all corners phthisiatricians cry out to reason
pharmacological companies, insisting on maintaining fluoroquinolones in
backup antibiotics group. Fortunately, in our country they are
would strongly not recommend to use in children’s practice. None
less, very often, doctors and pharmacists recommend that
non-severe infections still susceptible to cephalosporins,
penicillins or macrolides, namely fluoroquinolones, as more
effective (and expensive) means. Commercial gain, ambition
without a hitch to cure an infection, leading to terrible
consequences of leaving a person in the future without any
The problem of resistance of mycobacteria
The sustainability issue is not limited to gradual
mycobacterium tuberculosis adaptability to known
antibiotics. Today, cases have become a reality.
a person becomes infected with an already resistant bacterium. That is not exactly
in the patient’s body, the bacterium has become resistant, and
came to him initially stable. It is this sad fact.
beds in tuberculosis hospitals, where
There are actually suicide bombers who can be helped drastically by nothing.
it is impossible, but one can only alleviate their suffering.
In addition, phthisiatricians are not rarely faced with the problem of severe
tolerability of treatment of patients with tuberculosis. Tuberculosis
drugs are very toxic and today due to mass
allergization of the population (including drug) and the presence of patients
contraindications to the use of a particular tuberculosis
treatment, the treatment is delayed and the patient’s chances of
Increasing the number of destructive forms
This is another feature of modern tuberculosis. Still
some 30-40 years ago caverns and fibrin decay of the lungs
It was impossible to show students in dispensaries or hospitals.
Today, destructive tuberculosis is not uncommon. Also worth
note that HIV-infected people in our country most often die
it is from tuberculosis.
Tuberculosis is a very insidious, difficult to diagnose disease,
since some of its forms are not rarely disguised as others
pathology (see symptoms of pulmonary tuberculosis). Especially difficult
diagnose extrapulmonary tuberculosis, symptoms
which are no different from non-specific inflammatory
processes of other organs (kidneys, joints, spine,
lymph nodes, genitals, etc.), instrumental methods
diagnostics do not indicate a tuberculous process with 100%
Accuracy, general medical network physicians are deprived of additional methods
specific diagnosis and often tuberculosis
Pediatric phthisiology also has a lot of problems.
There are a huge number of TB-infected children whose parents are
categorically refuse preventive treatment,
attending kindergartens and schools. At what point does a child with
hyperergic test Mantoux will be a detailed picture
tuberculous process, no one can say. What time is it
will take place before the appeal to the TB doctor, diagnosis and
Isolating a baby from its own kind is also a matter of chance.
The hysteria unfolded around vaccination campaigns is idiocy.
BCG has been done, is being done and will be done by all reasonable pediatricians.
children of reasonable parents (see the opinion of the cms on the BCG vaccination and its
consequences, as well as Diaskintest and Mantu – one does not replace
other). No one calls for a total vaccination of all
There are certain contraindications and certain categories.
children who should not be vaccinated in the first days after
of birth. For such children, there is a pediatric phthisiologist and an immunological
commission that give their recommendations on terms and rules
But for a healthy child, in a family which is not present at the moment
patients with tuberculosis, BCG is a real chance when faced with
tuberculosis infection, do not join the ranks of hopelessly sick,
in the worst case, getting off with a mild form of the disease. No need to rely
to the fact that in the old days no vaccinations were given to children.
- First, natural selection then worked, and only survived
the strongest with a wealthy immunity,
- Secondly, the incidence of tuberculosis among children cannot even
close to compare with the late Soviet and even the present
In conclusion: tuberculosis is a dangerous disease with several
ways of infection, completely eliminate contact with whom today
almost impossible. That is why the fight against tuberculosis should
to be primarily aimed at strengthening the immune response