Tuberculosis is a specific infectious process that proceeds
in two main forms: pulmonary and extrapulmonary. The reason
The disease is Mycobacterium tuberculosis – microbe, resistant
to environmental factors and quickly mutates in the body
According to the World Health Organization, a third of the population
our planet is infected with tuberculosis. It means that
Mycobacterium is already in the human body, but the disease is still
�”Dozing”. Every year, 8-9 million diseases become acute.
form. Mortality from complications of tuberculosis reaches 3 million
person per year.
What is tuberculosis?
Tuberculosis is a contagious infectious disease, the main
caused by infection of the body with Koch sticks
(Mycobacterium tuberculosis complex). Main symptoms
tuberculosis, with its classic course – cough with sputum
(often mixed with blood), weakness, fever, significant loss
weights, night sweats and others.
The main focus of the lesion is the airways (bronchi of the lungs),
but sometimes mycobacteria cause inflammation in the lymphatic, nervous
and genitourinary system, musculoskeletal system, on the skin, or
even affect the entire body (miliary form).
The causative agent of tuberculosis is mycobacterium (Mycobacterium
tuberculosis). Onиболее распространённый путь передачи туберкулёза
– airborne. The tubercle bacillus is transmitted at
contact while talking, sneezing, singing or coughing, as well as
through household items.
The immune system of a healthy person copes with infection
killing Koch’s wand in the airways. Too massive
infection or frequent contact with the patient can cause disease
даже у здорового person In people with weakened immune systems
its cells are not able to destroy mycobacteria.
Features of mycobacterium:
- High resistance to acids, alcohols, alkalis
- It multiplies faster and prefers dark, non-ventilated,
- Cold resistance
- Direct sunlight, heat does not tolerate
- Chlorine-containing substances are detrimental.
The incubation period for tuberculosis, i.e. period from the moment
hitting Koch’s wand before the first signs of illness,
ranges from 2 to 12 weeks, on average – 6-8 weeks, sometimes a year and
Types and forms
The classification of tuberculosis is as follows:
On the localization of the disease:
Легочная форма — туберкулез легких, бронхов, плевры, трахеи
and larynx, which can occur in the following type:
- primary tuberculosis complex (tuberculosis pneumonia +
- tubercular bronchoadenitis, isolated lymphadenitis.
- Tuberculosis of the bones and joints;
- digestive system;
- genitourinary system;
- central nervous system and meninges.
The most common form of tuberculosis is pulmonary tuberculosis. Before
the emergence of HIV infection pulmonary tuberculosis accounted for 80% of all cases
tuberculosis disease. A pronounced decrease in immunity in AIDS
contributes to the formation of extrapulmonary foci of infection
- Первичный туберкулез развивается сразу после проникновения
pathogen into the bloodstream and the formation of a small granuloma, which
heals itself or transforms into a cavity. From the cavity,
filled with blood, germs are spread throughout the body with
the formation of new foci of inflammation. If untreated,
severe course of pathology a person dies.
- Secondary tuberculosis is talked about when the ill person
contracted another type of mycobacterium tuberculosis and got sick again,
or when the remission is aggravated. This situation is more
typical for adult patients. New foci form in the lungs.
inflammations, sometimes so close to each other, that caverns
merge, and there are extensive cavities with exudate. Person,
suffering from secondary pulmonary tuberculosis is very contagious for
surrounding When coughing with sputum in the air constantly stand out
In the development of tuberculosis isolated phases of infiltration, decay,
seeding, resorption, compaction, scarring and calcification.
With regard to the isolation of bacteria, an open form is distinguished (with
isolation of bacteria, MBT-positive) and closed (without isolation,
Open form of tuberculosis
Tuberculosis is considered to be open, if the patient secretes
mycobacteria with saliva, sputum, or secretions from other organs.
Bacteria are excreted when seeding or microscopy of excreta
the patient. Bacteria spread very rapidly through the air. With
conversation infection with particles of saliva spreads over a distance
70 cm, and when coughing – up to 3 meters.
With закрытой форме патологии выделение микробов отсутствует,
symptoms of the disease are vague, they resemble signs of a cold.
In this case, it is quite difficult to establish the fact of the disease.
The first signs of tuberculosis
When bacteria have all the conditions for reproduction, they are
originally affect lung tissue. Gradually enter the blood and
begin to infect the internal organs. Incubation period
продолжается до двух лет, при этом больной не заражает surrounding
With провоцирующих факторах процесс активизируется в легких,
переходит в открытую form. What are the signs of tuberculosis?
appear in this period, what is their manifestation?
The first signs of pulmonary tuberculosis are:
- Feelings of weakness, fatigue, noticeable decline
- Dyspnea, persistent low-grade fever and cough with
- Excessive perspiration, especially at night, sudden weight loss,
tachycardia, swollen lymph nodes, chest pain.
- Person, который болен туберкулезом имеет уставший вид,
pointed features, an unhealthy blush on the cheeks.
The first sign that makes one suspect that something was wrong is
an increase in the size of the lymph nodes in the armpit, supraclavicular, or
cervical groups. It is worth emphasizing that swollen lymph nodes
more often limited to only one zone. Nodes are not soldered to each other
and with the surrounding tissue, painless.
At the same time, the complete blood count is not expressed
changes characteristic of inflammation. Onоборот, в крови определяют
анемию и снижение количества лейкоцитов (лейкоцитопения).
The main cause of the development of the disease is considered the Koch microbacterium,
which, after penetration into the human body can last
time does not manifest itself. Activation of the bacteria occurs
when a person’s immune system does not have enough resources
for the destruction of the pathogen.
The peculiarity of an infectious disease is that if the immune
the system does not immediately destroy it, the pathogen lives for many years.
Incubation period при закрытой форме длится несколько лет.
Reservoir of infection and source of tuberculosis infection
are sick people (most often infection occurs upon contact
with patients with open pulmonary tuberculosis – when
tuberculosis bacteria are excreted with sputum). With этом реализуется
respiratory infection (breathing air with diffuse
A patient with active secretion of mycobacteria and severe cough
able to infect more than a dozen people during the year.
Withзнаки туберкулеза проявляются одинаково часто у людей разного
age, both in newborns and in elderly patients. Main
sources of infection tend to become
sick people as well as meat and milk from animals that are sick
tuberculosis. Onиболее часто туберкулез передается
by airborne droplets.
The risk of falling ill significantly depends on the age of the infected.
Among those infected, the incidence of tuberculosis is highest in
youthful and young age. In women, most cases
the disease occurs between the ages of 25 and 34, at this age
women get sick more often than men.
Factors contributing to the development of the disease:
- Frequent visits to public places, transportation, medical
- Reduced immunity
- Emotional overstrain,
- Onследственная предрасположенность,
- Long-term treatment with hormones, cytostatics and other
Ways of transmitting tuberculosis:
- Tuberculosis is spread from person to person by airborne
by, that is, you can get infected even without
contact with the patient, but simply being in the same room with him.
- In some cases, infection occurs through food.
products and other items that are infected with Koch sticks.
- If the causative agents of tuberculosis are ingested with food, then
tuberculosis in children and adults affects the gastrointestinal tract, and
not light as happens when inhaled by an infected
The real risk of getting tuberculosis is most often only people
with reduced immunity.
- Younger children.
- People who are undernourished, experiencing frequent
- People living in damp, poorly heated and ventilated
Besides, риск заразиться многократно увеличивается при тесном
and prolonged contact with patients with active forms of tuberculosis.
Symptoms of tuberculosis in humans
Tuberculosis can have many masks, and, as already noted,
This indicates that the manifestations of this disease may be
very different, because of what we can assume the relevance
совершенно иного diseases. The symptoms of tuberculosis are determined by
basis of the area of concentration of the pathological infectious
Clinical signs do not appear immediately, but only when
the causative agent of the disease has penetrated the bloodstream or hit most of
lungs. At first, the symptoms of tuberculosis are mild, but as
progression of the disease, they become more pronounced.
Main признаками в острый период считаются следующие
- sputum cough that lasts more than 3
- impurity in the blood in sputum;
- temperature rise to subfebrile;
- weight loss;
- increased fatigue;
- lack of appetite;
- abrupt changes moods;
- decrease in working capacity.
Manifestations of tuberculosis symptoms directly depend on where
it is in the body that mycobacteria are introduced, do
complications, as well as other factors. Tuberculosis develops
slowly enough, sometimes the illness can even last
Important! Symptom complexes requiring urgent
Symptoms of inflammatory bronchopulmonary disease:
- Coughing sputum lasting longer than 3 weeks
- Hemoptysis, pulmonary hemorrhage
- Chest pains that occur when breathing
Intoxication symptoms (manifesting longer than 3 weeks):
- excessive sweating, especially night
- Weakness, fatigue
- Weight loss
Symptoms and first signs of extrapulmonary tuberculosis
Symptoms of extrapulmonary tuberculosis depend on the location of the disease
and affected organ:
- Туберкулез органов пищеварения – характеризуется
periodic abnormal stool, bloating, pain in the area
bowel, blood in the stool, high body temperature up to 40
- Tuberculosis of the bones. This form of the disease occurs
often. In most cases, it affects male women, but
may occur in childhood. Manifested as a complication
focus of infection that is already present in the body. Initially
pathology proceeds as an isolated bone center, then
destroys surrounding tissue.
- CNS tuberculosis. Here the brain membrane is affected, i.e.
tuberculous meningitis develops, can also form
tuberculoma in the substance of the brain. Symptoms may be
most diverse, in particular, it is a headache, a violation
sensitivity, consciousness, psyche, disturbances in the movements of the eyes
- Lupus. In this form, the disease is accompanied by
the appearance of tight nodules and seals localized under the skin,
they break through the skin, releasing, thereby, the cheesy whitish
masses. However, certain deviations from the general
pictures of this form of the disease, because it can manifest
- Tuberculous meningitis. A rare form of tuberculosis,
which often occurs in children at an early age. Initially у
the child begins to change behavior, a number of symptoms
malaise, subfebrile fever. In the process of development
the child suffers from photophobia, headache, drowsiness,
seizures. Cranial nerves are later affected, coma develops.
- Туберкулез мочеполовой системы обычно сопровождается
turbid urine with the presence of blood in it, frequent and painful
urination, aching pains in the lower abdomen, bloody
secretions, painful swelling of the scrotum with exudate;
The most terrible complications of pulmonary tuberculosis are:
- pulmonary hemorrhage
- spontaneous pneumothorax (air outlet to the pleural
- pulmonary heart (specific change of the right heart,
pumping blood through the lungs).
Extrapulmonary tuberculosis has its own complications:
- renal failure
- ankylosis (complete immobility of the joints), etc.
Diagnostics туберкулеза легких – чрезвычайно важный компонент
mass activities aimed at reducing infection,
morbidity, disability, mortality from this serious
ailment. It can be suspected on the basis of a number of symptoms that
not being specific, yet push the survey in the right
direction and will provide an opportunity to take timely
- Mantoux test, she’s a tuberculin test. The purpose of the sample –
determination of immunity to mycobacterium tuberculosis.
Introduction under the skin of a tiny (0.1 ml) portion of tuberculin allows
say whether there is a mycobacterium in the body. After a couple of days in place
injection appears “button” – a slight seal of the skin with
redness, the size of the skin formation depends on the amount
immune cells, “familiar” with mycobacterium.
- Fluorographic examination of the lungs – X-ray
survey method that is conducted in adults to identify
pulmonary tuberculosis. Fluorography is also performed in adolescents
starting from 15 years. In case of illness on X-ray
focal or infiltrative changes are determined.
- Sputum analysis for mycobacteria is an important laboratory test.
method by which open or closed form is determined
To suspect tuberculosis helps complete blood count, in which
In the case of an infectious process, there is a decrease in the number
лейкоцитов и повышение СОЭ (скорость оседания
red blood cells).
The treatment is based on several rules. First, besides
chemical anti-tuberculosis drugs the patient must comply with
mode, depending on the general condition.
- If the condition is severe, then there are complications
(bleeding in the lungs), then bed rest.
- If the state of health of moderate severity, then set
limited mode: avoid stress, physical exertion.
- If the general condition improves then common
Usually the treatment lasts from 6 to 8 months. On
the duration is affected by the stage of development of the disease and the presence
associated diseases. It often takes a lot more time.
for treatment. Among other factors, the bacterium itself can affect
long term treatment. It is well resistant to different drugs,
then quickly cure tuberculosis will not succeed.
An important role in the treatment of tuberculosis is the so-called first
line of anti-tuberculosis drugs:
- Streptomycin – inhibits the synthesis of bacterial protein;
- isoniazid – inhibits the synthesis of mycolic acids;
- ethambutol inhibits the synthesis of substances produced
tubercular sticks in the lungs;
- rifampicin – stops the spread of infection to healthy
- Pyrazinamide – accelerates the recovery of the lungs
Combining these drugs, the doctor conducts the first stage of treatment.
On втором этапе назначаются следующие препараты:
- para-aminosalicylic acid; cycloserine;
Optimal treatment regimen (drugs, doses, route of administration,
multiplicity of techniques, duration) is selected taking into account the following
- infectiousness of the patient (whether he secretes mycobacteria or not);
- nature of the disease (it was first detected, or in a patient
recurrence of the disease has developed);
- the prevalence and severity of the tuberculous process;
- previously received treatment;
- drug resistance (immunity) of tuberculosis
Tuberculosis therapy is carried out according to approved regimens,
which contain that set of medicines that is most
целесообразен при тех или иных формах pulmonary tuberculosis.
In more complex cases, tuberculosis is treated by surgical
interventions. This is about the fifth part of all cases. Surgical
The treatment is applied not only in the severe stages of the disease, but also in
case of complications. Such intervention prevents
death. Lung hemorrhage can damage the entire
respiratory system, making it impossible to breathe
There are the following main types of surgery:
- resection – removal of part of an organ;
- lobectomy – removal of the lobe of the lung;
- pneumonectomy – removal of the lung;
- cavernectomy – removal of the pathological damaged area –
- pleurectomy – recovery type operative
interventions. As a result of the operation, the lung tissue is released.
from the “shell” of a thickened pleura.
When selecting patients for surgical treatment is taken into account
the length of the affected area, the phase of the tuberculous process and
functional state of organs and systems.
In the absence of treatment or non-compliance with the recommendations
mortality from tuberculosis reaches 50% of cases. Besides,
the prognosis worsens in elderly people, HIV-infected and
people with diabetes.
Properly chosen treatment for tuberculosis and the absence of interruptions
when taking anti-TB drugs can achieve
significant success in the process of recovery. Successful treatment
pulmonary tuberculosis will help reduce the number of infected
tuberculosis and prevent new cases