Pulmonary tuberculosis, which until recently provoked a huge number of deaths annually, is still considered one of the most dangerous social pathologies in our time. The prevalence of this disease correlates with the standard of living. As can be seen from statistical studies, in our country the problem has significantly intensified when the number of people who do not have a permanent place of residence increased, and at the same time many migrants appeared. According to official information from the WHO, more than two billion people are currently suffering from this disease on the planet. Up to nine million new cases are recorded annually, three times less - deaths associated with complications of the disease.
How to suspect?
Signs of pulmonary tuberculosis in adults are varied. In some patients, only the lungs suffer, while the course is latent, it is almost impossible to notice the pathology. Usually, the problem is learned from the results of a random study. Exactlyfor this reason, it is so important to undergo fluorography every year. At the federal level, such research is organized with an enviable frequency, and participation in it is free.
In other cases, early signs of pulmonary tuberculosis are similar to the common cold or flu-like. The patient feels weak, gets tired quickly, the temperature often rises, but not too high. Many note an increased separation of sweat, while the skin is pale. Symptoms worsen at night. A prolonged illness affects weight - the patient loses weight, individual groups of lymph nodes grow in size.
Typical manifestation
The most characteristic first sign of pulmonary tuberculosis is a constant cough, coughing, to which a person often does not even pay attention. In the morning and afternoon, the symptom does not manifest itself very clearly, but in the evening there is an exacerbation. Sometimes a small amount of white sputum with blood streaks is separated. This is characteristic of two forms - tuberculoma and infiltrative.
Variants are different
Sometimes the signs of pulmonary tuberculosis in the early stages differ significantly from those described above. It depends on the form of the disease: some are affected by a pronounced disease, while others have a smooth, mild pathology. The most severe option begins with a weakening of the body. Appetite disappears, a person constantly feels unwell, notes weight loss and profuse sweating at night.
Tuberculosis is characterized by sharp temperature jumps up to 40 degrees. Practically does not stop coughing, accompanied by sputum, the patient spitting blood. Even light exertion causes shortness of breath. However, as can be seen from medical statistics, all these manifestations do not mean that a person will suspect something was wrong in time and turn to a doctor.
General view
Pulmonary tuberculosis is a disease formerly popularly known as consumption. Pathology is caused by an infectious agent. The disease affects not only humans, but also many animals. At risk are cattle, pigs, chickens. The source of the problem is Koch's wand. The form that affects the lungs is the most common variety, but far from the only one. The source of the disease was named after the scientist who discovered it in 1882. Mycobacterium, identified by Robert Koch, has become the evidence base for classifying the disease as infectious. As it was revealed in the course of research, the infectious agent is characterized by increased resistance to any aggressive influences, it is not afraid of alcohol, acid, alkali. Tuberculosis can survive in the ground, snow, and the methods of destruction, identified by a German scientist, assumed the direct influence of sunlight, heat, antiseptic components containing chlorine.
Most often a person gets pulmonary tuberculosis through contact with a sick person. The infectious agent is transmitted in several ways, most often airborne. A sick person coughs, sneezes, breathes - all these processes are associated with the release of a harmful life form into the environment. He althy man,being nearby, inhales contaminated air, the infection enters the body, provoking the onset of the disease.
Alternative options
You can get pulmonary tuberculosis through contact if the skin is damaged. Wounds are literally open gates to the body. Mycobacterium easily penetrates the body of a he althy person, quickly enters the circulatory system and spreads to all internal organs. But if the skin is intact, infection by contact is impossible.
There is a variant of contracting pulmonary tuberculosis through the digestive system. This is possible if the meat of an animal with such a pathology has got into food. True, the risk of infection is high only with a high concentration of dangerous bacteria in the product. When infected in this way, the disease is most often based in the intestine. Another rare option is infection during the period of bearing a child. Even if the mother is sick, this does not mean that the child will also be born infected, but the possibility of transmission of an infectious agent exists.
Features of the disease
Even if mycobacteria has penetrated into the human body, it is not a fact that you can immediately notice signs of pulmonary tuberculosis - the probability of the disease is not one hundred percent. As medical studies have shown, Koch's wand itself is present in the body of many modern people, among them every tenth suffers from an unpleasant disease. If the immune system is strong enough, it successfully resists the infectious agent, over timedeveloping strong immunity to it.
As statistics show, to a greater extent, all forms of pulmonary tuberculosis (focal, infiltrative and others) are terrible for the strong half of humanity. The incidence rate among men is 3.2 times higher. In addition, the very course of the disease is faster than in women. The risk group includes people from the age of twenty to forty. The risk of falling ill is 42 times higher in those who are placed in colonies, places of detention (comparison was made with the general frequency of cases in our country).
How is it going?
Primary signs of pulmonary tuberculosis are provoked by an inflammatory process initiated by mycobacteria that have entered the human body. The development of the process is gradual, long. The primary form is distinguished - this is inflammation associated with infection of a person for the first time in life. The immune system does not yet contain instructions on how to deal with mycobacteria, and the infection quickly spreads throughout the body. This form is characterized by the presence of a primary focus in the tissues of the lung. This area is strictly limited. Occasionally, the course is accompanied by inflammation of the vessels through which the lymph passes.
Over time, the primary focus heals completely. In a specialized study of pulmonary tuberculosis at an early stage, tests will show a calcium-soaked hard area. In medicine, he received the name of the focus of Gon. Studies show that many people who have had a latent infection and are admitted to the hospital for a lung examination only in old age have sucheducation. After the formation of the focus of Gon, the root cause of the disease lives for a long time in the tissues of the lungs.
Two main forms of the disease
Tuberculosis is productive and exudative. In the first case, there is an increase in the volume of connective tissue. The affected lung areas seem to wrinkle. At the same time fibroblasts, epithelium, giant cells progress. The process is benign.
Exudative tuberculosis is a form in which the alveoli become a location for the accumulation of effusion formed by a variety of cells. Foci of small size degenerate into masses resembling cottage cheese in structure. Over time, they break up, which leads to the appearance of cavities. Such masses may dissolve over time.
Both variants can exist on their own or be observed in one person in parallel. If there are two forms at once, one of them dominates.
Sometimes things get worse
The latent form, in which the symptoms of pulmonary tuberculosis are practically absent, is rightly considered the easiest. Often patients do not even know that they were ill. But with a weakening of the immune system, there is a possibility of transition to a more severe stage. Most of those who seek medical help are diagnosed with secondary tuberculosis. This is a pathology, the start of which is the focus of Gon, where mycobacteria persist for a long time. Sometimes the reason is re-infection. A distinctive feature of the secondary form is the absence of a specific focus.
Symptoms in adults of diffuse pulmonary tuberculosis are associated with the formation of numerous foci of infection. The disease develops in an acute form, may proceed subacutely or be observed in a chronic form. It depends both on the state of the immune system, and on the presence of additional pathologies, the saturation of body tissues with vitamins. In the disseminated form, mycobacteria often infect bone tissue, articular, heart, and brain. Kidneys and liver suffer. Symptoms are close to flu, colds, bronchitis, pneumonia, although there are certain differences: tuberculosis does not go away with time, the situation only worsens. If the form becomes severe, the patient has respiratory failure, wheezing, continuous cough, shortness of breath. The doctor determines the damage to the brain by the tension of the occipital muscles. Sometimes symptoms of acute poisoning appear: a headache, a fever rises, the patient vomits. Possible impairment of consciousness.
Frequent option
As can be seen from statistical studies, infiltrative pulmonary tuberculosis is much more common than others. This name reflects the essence of the disease - the organic tissue is filled with inflamed cells. If you take an x-ray, you can see fuzzy inhomogeneous elements, the diameter of which exceeds a centimeter. In some patients, the infiltrative variant proceeds without any manifestations, while others note coughing, spotting, poisoning of the body. In many ways, the features of the manifestation are determined by the general condition of the body, the strength of the immune system. There is a risk of developing a form to caseous pneumonia. In the old days, such a disease was called transient consumption.
A distinctive feature of caseous pneumonia is the defeat of a lobe of the lung, sometimes more. There is a death of the tissue, which, when examined, is shown to be cheesy. Fabrics, dying, turn into granular. The body rejects such cells. The form is developing rapidly, actively progressing. At this stage of pulmonary tuberculosis, the probability of death in the first month of the course of the disease reaches 14%. On average, this way the disease develops in every tenth patient. If tuberculoma is established, tissue death occurs first within the boundaries of the connective tissue, but gradually the process expands, covering the cavity.
Cavernous tuberculosis: specifics
A distinctive feature of this form is the presence of cavities, the walls of which are formed by connective fibers. The size of such a cavity is up to 6 cm, and sometimes even more. It is known that this form appeared relatively recently, its development is associated with attempts to use various antimicrobial drugs to combat pathology. In practice, the symptoms of pulmonary tuberculosis, allowing to suspect this type of disease, are rare. The main specific danger associated with its development is the likelihood of bleeding in the tissues of the lungs due to a cavity. In addition, the course is often complicated by fungal infection.
Gradual deterioration of the patient's condition can lead to a fibrous-cavernous variety, when the lungs become a place of concentration of caverns, the walls of which are built of rather thick connectingfibers. A certain percentage of the lungs is replaced by fibrin, the bronchi are subject to deformation. The treatment of pulmonary tuberculosis of this form seems to be an extremely important social task, since it is this variety that is most dangerous for society. Only one cavern is the location of more than a thousand Koch sticks. Coughing, a person spreads them around him. The patient is at risk of bleeding into the tissues of the lung. Possible complications of a fungal nature, pneumothorax associated with impaired air exchange.
Worse than ever
The most severe stage of pulmonary tuberculosis in adults is when the disease progresses to an active growth of connective tissue covering both the lungs and the pleura. At the same time, cirrhotic - the final form is diagnosed. Patients with this diagnosis are characterized by a high percentage of death.
This variety is relatively safe for others, as it does not spread as actively as some of the previously described. But the process of treatment is frankly a difficult task. All drugs available to modern doctors hardly penetrate fibrous tissue, which makes Koch's sticks practically invulnerable to the most effective and powerful medicines.
How to detect?
The classic way to determine any form of pulmonary tuberculosis (disseminated, infiltrative, cirrhotic) is to put a special sample. This check is traditionally done annually. A protein extract obtained by using mycobacteria is used. Suchthe substance causes a peculiar reaction if it enters the infected organism. To determine the infection, it is necessary to inject a small amount of components and check the size of the seal in this place after two days. If the induration is within 5 mm, it is safe to say that the person is he althy. The result, varying within 5-10 mm, indicates the possibility of contact with patients, that is, the subject is considered to be at risk. With a 15 mm thickening (and more), the formation of an abscess can suggest infection. True, it is impossible to draw final conclusions only on the basis of the Mantoux test - there is a possibility that the result indicates a recent contact with the patient.
If the result is positive, the person should be referred for additional laboratory tests. First, sputum, bronchial washings are obtained. The event is performed under anesthesia. 20 ml of warm saline is injected into the respiratory tract and the liquid is coughed up (reflex reaction). The resulting discharge is collected in a bowl and sent for microscopic examination. This approach is not possible if a person has asthma. Excretion samples are checked by PCR or acid-resistant bacteria. The smear is stained and examined under a microscope.
Alternative options
Sometimes material for detailed examination is obtained using a bronchoscope. The doctor receives samples of internal bronchial tissues, which, under the influence of infection in tuberculosis, change in a specific way. In addition to a biopsy, it is possible to determine the fact of infection withpleural fluid examination.
Fluorography is another common, almost universal method for determining the disease. An x-ray is taken, on which inflamed foci can be seen: shadows, the size of which is less than a centimeter, and the contours are quite clear. In the presence of one focus and the absence of symptoms of a disease, a person is registered to control the condition and a second study is carried out after a while. If the results show a change in the size of the focus in a larger direction, it is necessary to first carry out a diagnosis in order to exclude oncological disease. If several foci of tuberculosis are found, it is considered confirmed, and the patient is sent to a hospital for treatment.
How to fight?
Until the last century, effective treatment of pulmonary tuberculosis was not known to mankind. Currently, quite a lot of medications of varying degrees of effectiveness have been developed. However, this does not make the problem less acute, since many patients do not even suspect infection, while others are afraid of doctors or do not want to visit the clinic. There are people who are convinced that the best treatment option is at home with self-selected means. This approach is dangerous not only for the person himself, but also for the people around him, friends and relatives, random people you meet on the streets and in stores, since it is easy to transmit the infection. Modern therapy is a long-term event that involves the simultaneous administration of several types of drugs,affecting the pathogen in different ways. Although, as can be seen from medical practice, even this approach is often not enough. For maximum effect, you will have to combine medications, gymnastics, physiotherapy, drugs that activate the immune system.
Many cases are also known when the described complex does not show the desired result, and the only way out is urgent surgical intervention, removal of the affected part or the entire lung. This is especially true when an open thick-walled cavity is detected, since scarring is too unlikely, but the risk of bleeding is high. Surgery is the only effective option even in the presence of fibrous foci that are not subject to medication. If the foci are formed by an atypical pathogen, there is a suspicion of a complication of the course by malignant neoplasms, the patient is also sent for surgery. The operation is supplemented with a complex of medicines.
How to stay he althy?
As is the case with many other pathologies, the best treatment for tuberculosis is effective prophylaxis to prevent infection. Since there is no method that allows you to 100% protect yourself from the disease, it is important to undergo checks in a timely manner to identify foci of the disease. To do this, you need to take x-rays annually and avoid contact with sick people. If tuberculosis is found in a person living in an overcrowded dwelling, measures must be taken to isolate him from his neighbors. Infants should be vaccinated as soon as age permits.such an event. Among the important social measures for the prevention of tuberculosis is the mandatory examination of all migrants arriving from areas, countries where the prevalence of pathology is high.
It was stated above that infection is possible through food. To prevent this path, it is necessary to carefully control the quality of dairy and meat products. Persons forced to work with cattle, chickens, pigs should undergo regular examinations in order to timely determine the fact of infection.
