There are a huge number of diseases that can affect the human respiratory system. Some of them do not pose a particular threat to he alth, but there are those that are fraught with serious complications and a decrease in the patient's standard of living. One of these is tuberculous pleurisy, which we will get acquainted with in our today's article. Consider the causes of its development, varieties and recommended therapy.
What is this disease
With this pathology, the presence of an acute, chronic or recurrent inflammatory process of the pleura is characteristic. Often the disease manifests itself after infection with tuberculosis.
Tuberculosis pleurisy usually affects the serous membranes that form the pleural cavity and cover the lungs. This disease is quite serious, the fight against it has been going on for more than one millennium, but even today relapses still occur.
The danger of this pathology is that it can quickly spread among people, increasing the death rate. It is noted that quite often the disease occurs in childhood. Pleurisy of tuberculous etiology is fraught with the spread of bacteriathroughout the body, which leads to disruption of all organ systems, so the earlier the disease is diagnosed, the more effective the treatment.
Mechanism of disease progression
This pathology has two development paths:
- Exudative pleurisy of tuberculous etiology develops if the pleura is affected by toxic substances of the pathogen and tissue decay products. The pleural cavity in this case contains a small amount of bacteria. In pathogenesis, it can be noted that the body's sensitivity to pathogenic microbes increases many times, the increase occurs under the influence of the previous course of tuberculosis infection. After bacteria enter the pleura, a rapid accumulation of fluid begins.
- The second mechanism of development is inflammation of the pleura with the formation of tuberculous tubercles, which develops with a massive ingestion of bacteria from a focus in the lungs or chest lymph nodes.
How can a pathogen enter the pleural cavity
There are several ways in which a tubercle bacillus can enter the pleural cavity:
- Contact. In this case, the hit comes from foci in the lungs located under the shell.
- The lymphogenous pathway involves spread through the lymphatic vessels.
- Hematogenous spread is transport through the blood vessels.
The mechanism of the development of the disease is the inflammatory process in the pleural sheets, the accumulation of leukocytes and the penetration of fluid into the pleural cavity.
Exudatetuberculous pleurisy can be of a different nature:
- Fibrous.
- Serous.
- Bloody.
- Purulent.
If the therapy is ineffective, then over time, the serous effusion resolves, and the fibrous effusion grows with connective tissue elements and cicatricial overlays form on the surface of the pleura.
Causes of tuberculous pleurisy
Tuberculous pleurisy of the lungs refers to pathological diseases that develop on the basis of infection or insufficiency of the lungs. The etiology of pleurisy is of several types, and each has its own reasons for development.
The causes of infection are:
- Infections caused by bacteria, such as staphylococcus, a gram-negative microflora.
- The presence of viruses and parasites in the body, especially if therapy is not carried out.
- TB infection predominantly in the form of a rod.
- Fungal diseases: candidiasis, blastomycosis.
- Syphilis, typhoid and brucellosis can trigger the development of the disease.
You can also name non-infectious causes:
- If there is a development of malignant tumors in the lungs, mammary glands, ovaries.
- Pulmonary infarction.
- Pancreatitis, leukemia.
Doctors single out unknown causes that can provoke tuberculous pleurisy into a separate group:
- Injuries.
- Injuries, such as gunshots.
- Surgery.
Depending on the cause of the disease, symptoms begin to appear, but first you need to consider the varieties of the disease, they also manifest themselves in different ways.
Classification and types of pathology
If we consider the features of the pathogenesis of the disease, then tuberculous pleurisy is distinguished of the following types:
- Allergic.
- Tuberculosis of the pleura.
- Perifocal.
The first type of the disease can manifest itself against the background of a strong sensitivity of the body. A feature of this type of pleurisy is the presence of pain and the rapid accumulation of fluid. But the reverse momentum is just as fast.
In case of dissemination of a large number of small and large foci, pleural tuberculosis develops. Often this type of pathology is characterized by an extensive caseous-necrotic reaction. Tuberculous pleurisy of this type is considered the most aggravating.
Perfocal view develops if the inflammatory process from the lungs extends to the pleura. The exudate can accumulate in small or large quantities, bacteria are not always found in it, but this variety proceeds for a long time, and there are often relapses.
The pleural composition also affects the classification of the disease. Depending on this, they distinguish:
- Fibrinous or dry.
- Tuberculosis exudative pleurisy.
- Purulent.
The first pathology occurs, as a rule, in some parts of the pleura, where fibrin strands are deposited. Over time, the pleura loses its smoothness. This type of diseasefairly easy to treat if started early.
Exudative pleurisy has the opposite manifestation of the fibrous appearance. Almost immediately, fluid begins to actively stand out and accumulate in the pleural cavity. There are cases when everything starts with a dry look, which smoothly flows into an exudative one.
The purulent form is complex. The pleura is damaged as a result of a dose of MBT or a breakthrough of the subpleural focus.
If pleurisy is of tuberculous etiology, then it is divided into several more types:
- Infectious. It develops after staphylococcus, pneumococcus, tubercle bacilli enter the lungs.
- Non-infectious tuberculous pleurisy develops against the background of lung cancer, rheumatism and other pathologies.
- Idiopathic pleurisy develops for unknown reasons.
The course of the disease can vary, therefore, an acute form, subacute and chronic are distinguished. Each has its own symptoms.
Manifestation of disease
Each type of pleurisy has its own characteristics. Dry tuberculous pleurisy symptoms are as follows:
- Lymphatogenic spread of infection occurs.
- There is pain in the chest. When you inhale, it intensifies, and sneezing, coughing can also provoke it.
- The body temperature rises.
- General weakness appears as the disease progresses.
- Intoxication of the body occurs.
- Decliningappetite.
- Weight is decreasing.
The first signs do not make it possible to immediately diagnose the disease, so it is problematic to make an accurate diagnosis before the onset of pain. With the development of the disease, the pain becomes stronger, there are even cases of loss of consciousness.
The symptoms of dry pleurisy are very similar to neuralgia, so it is important to make a differential diagnosis in time. If there is dry pleurisy, then the patient tries to lie on the other side, but the pain only intensifies.
If the doctor listens from the side of pain, he will hear characteristic noises from pleural friction. It is often impossible to diagnose this type of pleurisy by blood tests.
Exudative appearance has the following symptoms:
- Shortness of breath appears.
- Weakness and malaise.
- The body temperature rises to 38-39 degrees.
- Cough.
- Dry mouth.
- Chest pain from the localization of the pathogen.
Quite often, such pleurisy has an acute course, but there are cases when the disease is asymptomatic in children or adolescents, and is detected only after an examination of the upper respiratory tract.
After the accumulation of fluid in the pleural cavity, the symptoms may decrease, only heaviness in the side remains. The amount of exudate can reach two liters. In this case, there is a headache, dizziness, the color of the skin may change in children, they become lethargic, pale and often lie on oneside.
Symptomatic of purulent pleurisy has a weak expression, the patient's condition may not change, but there is pain in the side, shortness of breath, weakness and high fever. Often the condition worsens to the point that the patient is unable to get out of bed.
Symptoms of subtypes of pleurisy
We have already found out that there are also subspecies of pleurisy, which also manifest themselves in different ways.
Perifocal has poor symptoms:
- Mild chest pain.
- A little weakness.
- Small chest noises when listening.
This subspecies of pleurisy proceeds for a long time and often with relapses, if there is an accumulation of exudate, then the signs are already more pronounced:
- The body temperature rises.
- Heavy sweating.
- Tachycardia develops.
Allergic pleurisy manifests as follows:
- The temperature rises to thirty-nine degrees.
- Tachycardia.
- Rapid accumulation of exudate.
- Shortness of breath.
- Heaviness when inhaling and pain in the side.
These symptoms can come and go quickly.
If pleural tuberculosis develops, then it is typical for it:
- The temperature can rise up to forty degrees.
- Excessive sweating.
- Pain in the side.
- Dry cough.
- Shortness of breath increases.
If this is a chronic form, then tuberculous pleurisy is typical:
- Feeling short of breath.
- The veins and lymph nodes swell in the neck.
- Blue lips.
When these signs appear, the patient must be urgently taken to the hospital. It is necessary to ensure that a person with such symptoms does not drive himself, it is better to call an ambulance if it is not possible to take him to the hospital ourselves.
Diagnosis
If there is tuberculous pleurisy, the diagnosis is difficult. To make a diagnosis, it is important for a doctor not only to know how the disease can manifest itself in various forms, but also to conduct various studies. Based on all the data, a diagnosis can be made. Diagnosis includes:
- Questioning the patient about complaints.
- Collecting information about the picture of the manifestation of the disease.
- Tuberculin testing.
- X-ray examination will detect changes in the lung tissue.
- A blood test reveals the composition of leukocytes, changes in the blood with a purulent form of pleurisy are especially pronounced.
- Urine test determines the presence of protein. If there is one, then the diagnosis is obvious.
- Bronchoscopy can detect bronchial tuberculosis, scars.
- The exudate is being examined. If the pleurisy is tuberculous, then the composition contains protein, and the glucose content is reduced.
- High levels of antibody titers in the reactions of RNHA, ELISA will indicate the presence of a tuberculosis infection.
- With the help of tomography, the etiology of pleurisy is determined.
Only after the diagnosis of "tuberculous pleurisy" is confirmed, treatmentprescribed by a qualified physician.
Therapy of disease
To cope with this disease, it is important to recognize it in time and start treatment. Many people wonder: is tuberculous pleurisy contagious or not?
This is an infectious disease, and if the sputum contains pathogens, then such a patient is a danger to others. Therapy should only be carried out in a tuberculosis dispensary.
Therapy in the first place should help stop the process of tissue destruction. To do this, appoint:
- Rifampicin.
- "Pyrazinamide".
- Ethambutol.
Duration of drug therapy is at least eight months, if pulmonary tuberculosis is also diagnosed, then the period can be increased to two years.
Specialists believe that corticosteroids, such as Prednisolone, can be effective in combating pathogens.
In order for the lungs to return to their normal shape, fluid must be pumped out to prevent the formation of stratification.
Treatment of tuberculous pleurisy is also carried out with the use of immunostimulants, such as drugs such as Levamisole, Taktivin.
If long-term drug therapy does not work, then you will have to resort to surgery.
During treatment, bed rest should be observed, and the diet should also be reviewed. It is necessary to limit the uses alt and s alty foods, drink less liquids, increase the intake of foods high in protein and vitamins.
Disease prevention
To prevent tuberculous pleurisy from returning again, treatment was not required, it is important to follow preventive measures. Tuberculosis is classified as a social disease that is directly related to the quality of life of the population. The epidemiological trouble for tuberculosis is caused by the deterioration of socio-economic conditions, the decline in the standard of living of the population, and the activity of migration processes.
For prevention purposes, the following recommendations can be recommended:
- Carry out regular preventive and anti-epidemic measures.
- As early as possible to diagnose the disease in patients and allocate drugs for therapy.
- It is mandatory to conduct medical examinations when hiring in areas that are unfavorable for animal tuberculosis.
- The state should allocate isolated living space for living with active tuberculosis, especially if they live in hostels or small families.
- Compulsory vaccination of newborns.
- Pass yearly fluorography of the lungs.
- At the first signs of illness, be sure to visit a doctor.
Compliance with these simple preventive measures will reduce the incidence of the disease, as well as help to identify it at the very first stages of development, when treatmentas efficiently as possible.
Each person is primarily responsible for his own he alth. It is not necessary to engage in self-treatment at the first signs of malaise, thereby we allow the pathogens to "strengthen their rights", and the disease begins to progress. Only a qualified doctor will make an accurate diagnosis and prescribe an effective treatment.
