Tuberculosis is an infectious disease caused by bacteria of the Mycobacterium tuberculosis complex group (M. tuberculosis and other related species) or, as they are also called, Koch's bacilli. They are very tenacious and can remain outside the body for years in almost any environment that is not exposed to direct sunlight. Tuberculosis, as a rule, affects the lungs, but sometimes other organs are also affected: the skin, joints, nervous system, etc. Not only people, but also animals can get sick with tuberculosis. The name of the disease comes from the Latin word tuberculum, which means "tubercle".
TB in brief
Pulmonary tuberculosis is a dangerous and widespread disease transmitted by airborne droplets. Its most characteristic symptoms are a cough with sputum that does not stop for a long time, hemoptysis (in advanced cases), prolonged fever, fever, lethargy, intense sweating at night.time, loss of appetite and therefore noticeable weight loss.
According to WHO, Koch's bacillus is present in the body of a third of the world's population. Usually, after mycobacteria enters the body, tuberculosis proceeds without symptoms, but in about 10% of cases (in 8-9 million people a year) it still goes into an open form. Such a patient can infect up to 15 people a year. Every year, about 3 million people die from complications of this infection in the world, including about 20 thousand in Russia.
Causes of the spread of tuberculosis
Activation of the process of infecting people with Koch sticks contribute:
- decrease in the standard of living of the population;
- intensive migration;
- increase in marginalized populations and incarceration;
- insufficient allocation of funds for treatment and preventive measures;
- medical, gender, age, social and occupational factors;
- non-compliance with the regimen, refusal of treatment or its unauthorized interruption by patients.
What are TB risk groups?
Some people are more likely to get TB than others. These are the so-called tuberculosis risk groups. This risk may be due to both biomedical and social factors.
Tuberculosis risk groups are a part of the population with a particular predisposition to the disease. Such a predisposition may be caused, for example, by certain diseases of the nontuberculousnature, unfavorable living conditions, smoking, etc.
In Russia, the risk groups for tuberculosis in adults and children are officially established by the order of the Ministry of He alth of the Russian Federation dated December 29, 2014 No. 951 “On approval of guidelines for improving the diagnosis and treatment of respiratory tuberculosis”. People in these categories need regular TB screening.
Factors that increase the risk of TB
One of the most important risk factors for developing tuberculosis is a weakened immune system. For example, TB risk groups include:
- AIDS patients and HIV carriers;
- people who have had serious chest injuries and major abdominal operations;
- patients receiving long-term corticosteroid and other therapy;
- people subject to frequent climate changes or constant overwork;
- people who have experienced severe stress;
- persons with mental illness, alcoholics, drug addicts.
An important risk factor is smoking cigarettes, smoking mixtures, hookah, cigars. Those who smoke more than 20 cigarettes a day are 2-4 times more likely to develop tuberculosis. This is due to impaired blood circulation, gas exchange and natural respiratory cleaning mechanisms that occur as a result of smoking.
Those who have a protracted course or recurrence of acute pneumonia, frequent respiratorydiseases, diabetes mellitus, history of exudative pleurisy, HNZOD, dust lung diseases.
Inadequate nutrition can also give rise to infection. Undernutrition is defined as a person's weight loss of 10% or more below normal for up to 6 months or more.
Gastritis, gastric or duodenal ulcer in 11-12% of cases contribute to the development of pulmonary tuberculosis, and over time, its likelihood increases.
Another risk factor is increased susceptibility to infection. It may be genetically determined or associated with "turns", hyperergic reactions to tuberculin in children and adolescents, as well as with the lack of vaccination with the BCG vaccine.
Other conditions for the development of tuberculosis:
- the presence of residual changes in the lungs after the cure of tuberculosis;
- contact with a person or animal with TB (family, occupational, etc.);
- imprisonment, prison work;
- puberty, advanced age, menopause;
- pregnancy and lactation (women are shown fluorography a month after childbirth).
Groups of persons to be examined
According to Order No. 951, the risk groups for tuberculosis include the following people:
- children with "turn" (first detected positive Mantoux reaction), increasing, pronounced and hyperergic sensitivity to tuberculin, positive or doubtful reaction to the test with recombinant tuberculosisallergen in standard dilution;
- persons who had pathological changes in the lungs on x-rays;
- individuals with some symptoms of tuberculosis, including those found during examination for any other disease;
- persons with chronic inflammatory diseases of the respiratory system, if exacerbations occur more than twice a year, and there is no noticeable positive dynamics during treatment for a long time;
- HIV carriers with fever, cough, excessive sweating or weight loss.
Examination of children and adolescents
Order of the Ministry of He alth separately established risk groups for tuberculosis in children. The following groups of children and adolescents need diagnostics twice a year:
- patients with diabetes, ulcers;
- with chronic non-specific respiratory or kidney diseases;
- HIV positive;
- long-term immunosuppressants.
Survey of the population to prevent the spread of tuberculosis
Regardless of the presence of TB symptoms, people at risk for TB should undergo mandatory screening. The list of these population groups and the frequency of diagnostic measures are established by the sanitary and epidemiological rules SP 3.1.2.3114-13 "Tuberculosis Prevention".
Citizens to be examined every six months
Twice a year, the following groups should undergo a fluorographic examinationpopulation:
- Conscripts.
- Staff of maternity hospitals, maternity wards.
- People who directly interact with sources of mycobacteria.
- Patients with a history of TB or with residual TB changes in their lungs (within three years of discovery).
- HIV infected.
- Patients deregistered from TB he alth facilities due to cure (within three years of deregistration).
- Patients registered with a psychiatrist or narcologist.
- Persons held in places of deprivation of liberty, as well as those released from them (within two years after release).
- Homeless faces.
Persons subject to annual screening
Survey should be done every year:
- Patients suffering from chronic non-specific diseases of the respiratory system (CHNZOD), urinary and reproductive system, digestive tract. The incidence of tuberculosis in patients with HNZOD is 10-11 times higher than in other people. These patients should not only be examined at the dispensary at least once a year, but also take sputum for analysis at least three times a year.
- Patients with diabetes. Such patients are 3 to 5 times more likely than he althy people to suffer from tuberculosis, especially if diabetes is severe or moderate.
- Persons taking cytotoxic drugs, radiation therapy, genetically engineered biologics, corticosteroids and blockersTNF-a. As a result of such treatment, human immunity is greatly reduced. Patients from this risk group for tuberculosis need to undergo not only fluorographic studies, but also chemoprophylaxis.
- Non-transportable patients. Examination of such patients is carried out using sputum analysis.
- Persons from social groups at increased risk of tuberculosis. These are refugees, internally displaced persons, citizens of other states and stateless persons, including those working in the Russian Federation, as well as people kept in organizations of social assistance and services for homeless people.
- Persons working:
- in juvenile social service organizations;
- in sanitary-resort, sports, medical and preventive, educational, he alth-improving organizations for minors;
- in nursing homes, disabled people, etc.;
- in food processing and marketing companies;
- in organizations providing consumer services to citizens;
- at water intakes, pumping stations, sewage treatment plants, reservoirs, etc.
Who is en titled to an out-of-turn inspection?
Extraordinary examinations for the diagnosis of tuberculosis in the early stages are subject to:
- patients who applied to medical institutions with suspected tuberculosis;
- patients who applied to outpatient facilities referred to a hospital, and those who are in children's inpatient medical institutions for the purpose of caring forchildren if they have not been examined within the last year;
- persons in contact with children who have changed sensitivity to tuberculin if the last examination was more than six months ago;
- citizens who arrived from other territories of Russia to live or work, if they have not been examined in the last year;
- people living in the same housing as newborns and pregnant women, if the previous examination was carried out a year or more before the day of birth;
- citizens called up or contracted for military service, if the last survey was conducted more than six months ago;
- patients newly diagnosed with HIV, patients with HIV in the third stage (with secondary manifestations) and with a low level of CD4 lymphocytes, if the last examination was carried out more than six months ago;
- applicants entering an educational institution if they have not been examined in the last year;
- citizens of other states and stateless persons who applied for a residence permit, Russian citizenship, temporary residence permit or employment in Russia;
- persons taking psychoactive drugs and not registered with a narcologist for preventive care, when detected by law enforcement officials, if there is no data on examinations for the last year;
- persons without a fixed place of residence - when applying to medical institutions or social security organizations, if there is no information about the last examination or it was carried out more thansix months ago.
Tuberculosis in an open form significantly worsens the well-being, emotional state and, as a result, the quality of human life. It requires long-term inpatient treatment, which has many unpleasant side effects. In advanced cases, not only medicines are required, but also an operation followed by a long rehabilitation period.
At the same time, the latent form of tuberculosis can be cured in 100% of cases, provided that the prescribed drugs are taken continuously. After that, the person can lead a normal life. Therefore, even people who do not belong to risk groups should regularly do fluorography in order to detect changes in the lungs at an early stage, avoid serious consequences, as well as infection of family members and colleagues. After all, contrary to popular belief, not only homeless people and prisoners suffer from tuberculosis, but also successful we althy people.
