A very unpleasant and deadly disease, pulmonary tuberculosis has existed on Earth for millennia, as evidenced by archaeological excavations and multiple historical documents. In the modern world, he annually takes in the ranks of his victims about 10 million people, 25% of whom die.
The most unpleasant form of the disease is disseminated pulmonary tuberculosis, which means multifocal, "spilled" throughout the lungs. It is very easy to catch an infection, since the ways of its transmission are unusually simple, and the symptoms in the initial stages are almost invisible. In fact, each of us is at risk of becoming infected every day, but, fortunately, not every body can develop tuberculosis. If, nevertheless, a formidable diagnosis has been made, there is no need to despair, since now science has stepped so far that it is quite possible to completely cure even disseminated pulmonary tuberculosis. Maybe. To do this, you must not shy away from preventive examinations and scrupulously fulfill the appointments of the attending phthisiatrician. They say that knowing the strengths and weaknesses of the enemy is already 50% of victory. So let's figure out what tuberculosis is, where it comes from and how to deal with it.
Koch sticks
Disseminated pulmonary tuberculosis is caused by microscopic living organisms, the so-called mycobacteria. They exist on the planet for millions of years, but were discovered only in 1882 by the doctor and scientist Koch, after whom they were named so - Koch's sticks. In total, there are 74 varieties of pathogenic mycobacteria (abbreviated ICD), 6 of which are capable of causing tuberculosis in humans and animals. They were called sticks because of their appearance, really stick-shaped. Some mycobacteria are perfectly straight, some are slightly curved, and both are between 1 micrometer and 10 micrometers long and about 0.5 micrometers wide.
The unique feature of them is the structure of their walls, or shells. Without going into details, we note that in Koch's rods it allows them to mutate an infinite number of times, to defend themselves against the work of antibodies that are deadly for other parasites, and to staunchly resist unfavorable environments. They successfully use even bacteriophages, the meaning of which is to protect our body from parasitic microorganisms. Being absorbed, Koch's rods do not die, but modify macrophages so that they quietly multiply and at the same time be inaccessible to the defense systems of theirowner. In other words, Koch's sticks use our body's cellular defenses to infiltrate it.
Once in the lungs of a he althy person, these parasites first form single foci (primary tuberculosis), but then spread with blood and / or lymph to a large area of one or both lungs and other respiratory organs at once, thus developing disseminated pulmonary tuberculosis. Under certain circumstances, it can develop even after treated primary tuberculosis, since Koch's bacilli in an inactive form remain in the body for many years.
Routes of infection
Pulmonary tuberculosis in humans is caused by three types of bacteria - M. tuberculosis (human subspecies), M. africanum (intermediate subspecies) and M. bovis (animal subspecies). The latter is more often ill in cattle, and it is transmitted to humans with unpasteurized milk.
Many are interested in whether disseminated pulmonary tuberculosis is contagious or not. The answer is unequivocal: it is very contagious if it passes with the release of Koch's bacilli (tuberculous bacteria).
They get from a sick person to a he althy person is unusually simple:
- they can be inhaled with air;
- with saliva (for example, when coughing, kissing);
- through the dishes used by the patient;
- through household items;
- from mother to fetus;
- when using insufficiently sterile medical instruments.
As you can see, you can get TB anywhere: in transport, in public placesuse, in educational institutions, at work and so on.
Important: Koch sticks are fantastically tenacious. They retain their dangerous properties outside the human body for a very long time. Here are a few examples of how long Koch sticks live in the environments we encounter every day:
- in a dark place without sunlight - up to 7 years;
- in dried sputum of the patient (remaining on any objects) - up to 1 year;
- in the dust on the street - up to 60 days;
- on sheets of printed publications - up to 3 months;
- in water - about 150 days;
- in unboiled milk - approximately 14 days;
- in cheese (butter) - up to a year.
Is it possible to answer negatively the question of whether disseminated pulmonary tuberculosis is contagious or not? Perhaps Koch's sticks present in the environment are easily destroyed? Unfortunately, these mycobacteria are not easy to kill. Due to their unique cell wall, they practically do not suffer from sunlight, ultraviolet radiation, alcohol, acetone, acids, alkalis, many disinfectants, dihydrates, and when objects with infected sputum are boiled, they do not die for as long as 5 minutes. If Koch's sticks could develop in the body of any person, all the inhabitants of the planet Earth would suffer from tuberculosis.
Risk groups
Even at preschool age, most kids pick up Koch's sticks, but disseminated pulmonary tuberculosis or any other develops only in weakened, sickly children. Also at risk are:
- persons who are in close quarters for a long timecontact with tuberculosis patients;
- people with low immunity;
- HIV positive;
- taking immunosuppressants;
- teenagers and middle-aged people in the period of hormonal adjustment;
- starving;
- suffering from tuberculosis of the skin and other organs;
- survivors of infectious diseases;
- those with primary pulmonary tuberculosis and treated;
- some long-term physiotherapy treatments (eg quartz).
Classification
Disseminated pulmonary tuberculosis can develop in the following ways:
1. With blood flow (hematogenous). In this case, both lungs are affected. Bacteria can enter the bloodstream through the affected lymph nodes, Gon's foci, through the right side of the heart and the pulmonary vein.
2. With lymph (lymphogenic). In this case, one lung is affected.
3. Lymphohematogenous.
According to the nature of the course of the disease, disseminated pulmonary tuberculosis is distinguished in the following forms:
- acute (miliary);
- subacute;
- chronic;
- generalized. This type of disease is said to occur when, for some reason, the contents of a lymph node affected by mycobacteria break through into the blood vessels, the structure of which has become curdled (caseous). In this case, a huge number of Koch sticks appear in the blood at the same time. Fortunately, this does not happen often.
Acute tuberculosis
Diseasebegins abruptly, suddenly, the symptoms are very bright, a bit like pneumonia. The diagnosis is established on the basis of a hardware examination of the lungs and microbiological sputum tests. Acute disseminated pulmonary tuberculosis is characterized by the presence in the lung tissue of many small (about a millimeter) tubercles resembling millet grains. Hence the second name - "miliary (milae in Latin means "millet") tuberculosis." In a patient, the structure of capillaries first changes, collagen is destroyed in them, and the walls become easily permeable, which leads to the penetration of mycobacteria from the bloodstream into the lungs. The symptoms are as follows:
- a sharp jump in temperature to 39, 5-40 °C;
- weakness, weakness, high fatigue;
- rapid pulse;
- lack of appetite;
- cyanosis of lips and fingers;
- yellowness of the skin;
- nausea to vomiting;
- headache;
- cough dry or with sputum, in which, in addition to mucus and pus, there are bloody streaks;
- shortness of breath.
Sometimes there is a pronounced toxicosis, up to loss of consciousness.
Subacute tuberculosis
It occurs when the disease spreads to large blood vessels (intralobular veins and interlobular arteries). In this case, foci up to 1 cm in diameter are detected. They are located mainly in those segments of the lungs, where there are many capillaries and lymphatic vessels. Bynature foci are proliferative, without inflammation and tumors, but they can lead to inflammatory processes in the visceral pleura.
Subacute TB symptoms can resemble many other diseases, making it difficult to make a clinical diagnosis. Among the main ones are the following:
- fatigue, weakness;
- temperature around 38 °C;
- cough with sputum production.
Chronic tuberculosis
This form of the disease occurs when the patient has not completely cured primary (fresh) tuberculosis. In such cases, mycobacteria repeatedly enter new segments of the lungs with the help of blood or lymph flow, resulting in multiple foci of different sizes (from very small to fairly large), different shapes and structures. They can be calcified and very fresh, with a bright inflammatory picture. Foci are found in both lungs. A disappointing picture is added by emphysema, fibrosis of various tissues in the lungs, and pleural scars. Nevertheless, chronic disseminated pulmonary tuberculosis may not manifest itself outwardly, and therefore it is most often detected by fluorography. Symptoms of a chronic form of tuberculosis are:
- increased fatigue;
- poor appetite;
- weight loss;
- frequent headaches;
- causeless rise in temperature (occasionally);
- cough.
Disseminated tuberculosislung: phase
Earlier it was believed that phase I of infection occurs in the upper lobes of the lungs, II - in the middle, and III already reaches the lower ones. In the future, such a classification was recognized as incorrect, since the phases of the development of this disease can equally occur in any segments of the lung. To date, the following phases of pulmonary tuberculosis are distinguished:
- focal;
- infiltration;
- breakup;
- MBT+ (open form of tuberculosis);
- MBT- (closed).
Disseminated pulmonary tuberculosis in the MBT+ infiltration phase means the course of the disease with the release of mycobacteria into the environment. The main symptom is a cough with sputum production, especially if it contains pus and blood.
The focal phase is mainly characteristic of primary or fresh tuberculosis. It is characterized by the fact that only a couple or even one segment is affected. In this case, the dimensions of the focus are small (up to 1 cm in diameter). This phase proceeds without symptoms and is detected, as a rule, during a hardware examination of the lungs (X-ray, fluorography).
Disseminated pulmonary tuberculosis: phase of infiltration and decay
This nature of the course of the disease is obtained when it is not detected in time (the patient evades the mandatory annual fluorography, does not go to the doctor at the first alarming symptoms, self-medicates or uses folk remedies, as a rule, not effective enough as the main treatment). The decay phase means that the morphology of the lesions in the lungs has reached a degree at whichtissues began to disintegrate, forming real holes. Fragments of decayed tissues come out with a cough. They are sputum interspersed with pus and blood. Also, these fragments fall on segments of the lungs that are not yet susceptible to disease, as a result of which there is an instant seeding of mycobacteria. Patients diagnosed with disseminated pulmonary tuberculosis in the decay phase are a dangerous source of infection for others and are subject to mandatory hospitalization. They will have to stay in the hospital for a long time, up to six months. As a result, the decayed lesions heal (calcify).
The phase of infiltration is also observed in the progressive course of the disease, but in this case, the collapse of lung tissue does not occur. In general, an infiltrate is a site (center) in which there is an inflammatory process. A lot of lymphocytes and leukocytes move to such a place, and the symptoms resemble acute pneumonia. Disseminated pulmonary tuberculosis in the infiltration phase has the following symptoms:
- a sharp increase in temperature to high levels;
- weakness, weakness;
- chest pain;
- cough;
- signs of intoxication;
- headache;
- sometimes weakening of consciousness.
Without prompt treatment, tissue breakdown begins at the site of the infiltrates. The patient coughs them out or, in the process of coughing, moves them to the second lung, where infection of the former he althy tissues occurs very quickly. Tuberculosis in the phases of decay and infiltration is fraught not only with an increased risk of infection for others, but alsofatal for the patient himself.
Diagnosis
It is not always easy to immediately establish disseminated pulmonary tuberculosis in a patient. Diagnosis is difficult due to the fact that the symptoms of this disease and pneumonia, SARS, even metastatic cancer are very similar. When a patient goes to the clinic with complaints of fatigue, cough, pain in the larynx, weakness, shortness of breath, the doctor is obliged to examine the skin for the presence of scars that may remain from previous paraproctitis, lymphadenitis. The symmetry of the chest is also examined (it is not there if tuberculosis develops in one lung), soreness and muscle tension in the shoulder girdle are checked. When listening to the lungs with a stethoscope, it is revealed whether there are wheezing, what are their localization and nature. It is mandatory to perform laboratory tests of sputum for the presence of mycobacteria in it. In some cases, bronchial or gastric lavages are taken from patients for examination (most often in children). In addition, lab tests may include:
- bronchoscopy;
- sputum microscopy;
- pleural biopsy;
- thoracoscopy;
- pleural puncture.
The most widely used and accurate are fluoroscopic studies.
Treatment and prognosis
If the doctor diagnosed "disseminated pulmonary tuberculosis", the treatment will be long andmultifaceted. The prognosis depends on the phase in which the disease was detected, and how accurately the patient follows the instructions of the doctors. For any type of pulmonary tuberculosis in the MBT+ phase, the patient is hospitalized. In the hospital, they mainly carry out drug therapy (chemotherapy), consisting of anti-tuberculosis drugs, physiotherapy, and vitamins that strengthen the immune system.
Chemotherapy in newly diagnosed patients in the intensive phase of treatment is carried out with the following anti-tuberculosis drugs: "Isiniazid", "Rifampicin", "Pyrazinamide" and "Ethambutol", and in the continuation phase of treatment - "Isoniazid" and "Rifampicin" or " Isoniazid" and "Ethambutol".
In acute disseminated tuberculosis, the use of corticosteroids and immunomodulators is indicated. The most commonly prescribed is "Prednisolone" (15-20 mg / day for 6-8 weeks).
Duration of treatment - up to 6 months. If within 3 months there is no tendency to improve, as well as for a number of other indications, it is possible to use surgical intervention, which consists in the removal of a separate lung segment or the lung as a whole.
The latest TB treatment called "valvular bronchoplasty" or simply "bronchoblock" is now being used as an alternative to surgery.
Prevention
Pulmonary tuberculosis is considered a social disease, the spread of which largely depends on the quality of life of the population (living conditions, migration,serving sentences in prisons, etc.). As preventive measures, especially for disseminated pulmonary tuberculosis, one can name:
- obligatory fluorography;
- carrying out anti-epidemic measures;
- BCG vaccination;
- state allocation of funds for the treatment of patients with tuberculosis;
- maintaining an active (sports), he althy lifestyle;
- patients undergoing a full course of treatment for focal tuberculosis.
