The first information about tuberculosis appeared several centuries ago. Even such famous doctors as Avicenna and Hippocrates wrote about this disease in their writings. But tuberculosis began to be studied more consciously only from the 18th century, due to the fact that the cause of this disease was found.
The history of pulmonary tuberculosis began to be interested in about 5000 years ago. The ancient doctor B alters, while examining the human skeleton, found three thoracic vertebrae affected by tuberculosis.
Ancient Egypt occupies a significant niche in the study of the disease. The history of the discovery of tuberculosis is very ancient, since Egypt played a direct role in spreading knowledge about it in other countries. It was there that papyri were discovered, in which all the symptoms of the disease were described in detail. These are chills, cough, fever, fever, diarrhea and chest pain.
In Greece, tuberculosis outbreaks had a more transient form and were expressed in the form of inflammation onskin, abscesses on the lungs. When the patient coughed, the contents of the abscesses came out and cavities formed, which subsequently increased in volume. The lungs were destroyed and the patient died of fever.
In ancient times, there were many different strange rules associated with the disease. One of them, for example, is that a man could divorce his wife if she was susceptible to this lung disease (or, as it was called in those days, "consumption"). Here's the story.
The tuberculosis disease has been studied for many centuries, but only the German scientist R. Koch was able to establish the real cause of the disease. He discovered a microbacterium that caused tuberculosis. This bacterium later became known as Koch's bacillus.
If we talk about the appearance and history of tuberculosis in Russia, then we can say that it began to be thoroughly studied only at the beginning of the 20th century. Researcher Abrikosov described foci of inflammation in the lungs, which appear at the very beginning of the disease. This feature also acquired the name of the discoverer - the Abrikosov hearth.
Types of diseases
Tuberculosis can be classified according to various criteria. The most commonly used classification by species:
- Chronic tuberculosis. The disease is characterized by a mild course for the patient and the occurrence of pulmonary fibrosis. The disease manifests itself with pleurisy and general infection of the body, bronchitis and high fever.
- Focal tuberculosis. In this case, one or both lungs are completely affected. Thisthe disease can proceed imperceptibly, without any special symptoms, and quite often turns into a chronic disease.
- Infiltrative pulmonary tuberculosis. The doctor begins to fill out the medical history when symptoms of necrotic decay are detected. At first glance, the disease is invisible and can take the form of a cold.
- Fibrous-cavernous tuberculosis. One of the most dangerous types of ailments.
- Multidrug-resistant tuberculosis is considered a relatively new type in medicine. This is a pathology that is resistant to the effects of antibacterial agents and antibiotics.
Local TB
This is a form of secondary tuberculosis, the characteristic of which is manifested in the formation of foci of inflammation, each of which is not more than 10 mm in diameter. The course of the disease is asymptomatic or with little noticeable symptoms. In some patients, this form of tuberculosis may be accompanied by general weakness in the body, pain in the side and dry cough.
Studying the clinical history of focal pulmonary tuberculosis, we can conclude that it is possible to detect this disease using X-ray of the lungs, taking sputum for analysis for the presence of viruses and bronchial washings. Since this disease can occur many years after the treatment of the main tuberculosis, adults are more susceptible to the disease.
By looking at outpatient case histories for focal tuberculosis, one can classify this form of the disease according to the duration of the course. The disease may be recent (mild focal) or alreadychronic.
There can be several reasons for the onset of the disease. The most basic is direct contact with the sick person. In this case, infection is possible by airborne droplets. Or if an old disease was left untreated and progressed slowly over several years.
Until the middle of the 18th century, people thought that tuberculosis was a hereditary disease, and no one guessed that this disease could be transmitted through communication with each other. Until the 19th century, no one suspected that there was any medicine that could help the patient recover. Patients were left in special sanatoriums or houses, appointing a special diet that had no effect on the virus. Then, tests on animals only began to be carried out, which, by the way, are also susceptible to this disease and often die from it. The first vaccination against the disease was made only in 1921. Tuberculosis was treated only in monasteries, the sick were placed there.
If you carefully look at the extracts from the case history of focal tuberculosis, it becomes clear that the symptoms of the disease practically do not differ from other forms. This is an increase in temperature and sweating, weight loss and appetite.
Multidrug-resistant TB
Based on the history of multidrug-resistant tuberculosis, it is possible to identify how to correctly make this diagnosis. The patient is admitted to the institution with complaints of cough with little sputum, fever up to about 37 degrees, fatigue and weakness of the body,migraines and headaches that occur more in the evening and increased night sweats.
What you need to pay attention to when examining a patient:
- Skin. Are there pressure sores, allergic rashes or ulcers? The skin should be moderately moist and elastic. Visible mucous membranes should be of normal color, nails should be normal, and there should be no hand tremor.
- Lymph nodes should not be inflamed
- Subcutaneous fat is normally developed, no edema and veins and capillaries are not visible.
- Respiratory system. When breathing, the movement of the chest is fairly uniform, and the full volume of the lungs is involved. Additionally, no muscles are involved, breathing does not cause discomfort.
By studying the clinical history of pulmonary tuberculosis of a particular patient, it should be determined whether the lymph nodes are inflamed. For this, it is necessary to palpate them. If you feel the ribs and the spaces between the ribs, then this can bring some pain to the patient, voice trembling is pronounced.
Case history of infiltrative pulmonary tuberculosis
The following is an example of a medical history filled out by an attending physician.
Patient complaints:
- headaches;
- temperature increase to 37 degrees;
- general weakness of the body and lack of appetite;
- mild cough with little phlegm.
The condition of the patient during the examination. During the initial examination, no deviations from the normal state of the body were found. When examining the respiratory systems, it can be said that the signsinfiltrative tuberculosis will not be detected, it can only be determined by X-ray or fluorography of the lungs. The study patient, whose case was accepted for consideration, had a history of infiltrative tuberculosis of the left lung.
His x-ray showed an area of infiltration in the upper lobe of the left lung. The structure is heterogeneous, the intensity is quite low and no clearly defined boundaries are visible.
In many patients, as can be seen from some case histories of infiltrative tuberculosis of the left lung, the symptoms of the disease resemble problems with blood vessels. Between the first and further manifestations of the symptoms of the disease, there may be stages of improvement in the general condition of the body. Therefore, a person begins to think that this is just an acute respiratory disease and will not see a doctor in time.
As can be seen from the outpatient history of infiltrative tuberculosis in the decay phase, quite often the disease is accompanied by hemoptysis.
What you should pay attention to in blood tests for this disease is the indicators of monocytes and lymphocytes. Based on the outpatient charts of patients and their case histories, infiltrative tuberculosis of the left lung can sometimes be mistakenly confused with pneumonia. So the specialist should be extremely careful.
Considering different case histories of infiltrative tuberculosis of the right lung, it can be found out that during examination, the patient had pain in the chest on the right during palpation, wheezing is slightly heard, breathing is weakened. Laboratory studies showed the virus in the sputum, infiltration in the right lung and the resulting inflammatory processes that go to the root of the lung. All this makes it possible to make such a diagnosis as infiltrative tuberculosis.
Disseminated TB
Disseminated tuberculosis is a disease that is characterized by the appearance of small focal inflammations with blood or lymph flow. May be acute, chronic, or subacute.
Acute TB is mostly spread by blood only. It can be small-focal (with inflammation no more than 1-2 mm) and large-focal (inflammation diameter can reach up to 10 mm). Small-focal tuberculosis can occur as a fever, affecting the lungs, or as a manifestation of meningitis. Acute disseminated tuberculosis occurs in the form of pneumonia. The foci of inflammation are quite large and symmetrical. The progression of this disease can lead to organ tissue death.
Through the study of disseminated TB case histories, you can learn how to properly identify and treat this disease.
What to do if a patient complains of mild cough, fever, weight loss and weakness when contacting a medical facility. The doctor in this case prescribes tests, such as a CBC (general blood test), biochemistry, urethra and sputum tests (sputum is taken for the presence of viral diseases), an x-ray.
On the X-ray with this disease, infiltration in the root zone and in the right segment on the left will be clearly visible. For allslight change of varying intensity is observed.
According to the history of disseminated pulmonary tuberculosis, after several months of illness, x-rays can show the progression of foci of inflammation and changes in the structure of the roots of the lungs, for example, expansion. Adhesions may be observed on the diaphragm.
According to the records of a specialist in the history of disseminated tuberculosis, the patient is prescribed treatment with Isoniazid (20 mg per 1 kg of body weight), Para-aminosalicylic acid, 300 g per 1 kg of body weight, or Prothionamide.
Cirrhotic tuberculosis
This type of tuberculosis is characterized by the appearance of connective tissue in the pleura as a result of untreated other forms of tuberculosis. It is formed due to the untimely determination of the disease and the lack of initiation of treatment. Or the disease can be considered as a consequence of fibrous-cavernous tuberculosis. The degree of proliferation of connective tissue is divided into several categories:
- The first is called sclerosis, a process in which scar tissue spreads between the alveoli, disrupting lung tissue and causing emphysema.
- The second is called fibrosis, the process of developing connective tissue that replaces dead lung cells.
- The third is called cirrhosis, a proliferation of connective tissue that deprives the lungs of their primary function.
When studying the history of cirrhotic tuberculosis, you can see that the disease is almost asymptomatic, the sick person determines onlyshortness of breath and dry cough.
The more severe form is already present with symptoms of fibrosis and inflammation. Shortness of breath and cough are already accompanied by sputum with pus or blood. There is also tachycardia, swelling and heaviness in the hypochondrium. If the disease is not treated for a long time, then other organs begin to become inflamed.
The question arises of how to correctly diagnose the disease. The most important thing to do is to take an x-ray. If a unilateral focal inflammation has occurred in the body, then the images clearly show areas with medium and intense shading. If the disease has affected the whole lung, then the entire area will be darkened, light areas, most likely, will speak of bronchiectasis or residual caverns.
Determination of mid-lobe cirrhotic tuberculosis is possible by x-ray, if the darkened area corresponds to the volume of the wrinkled middle lobe. If pathological changes are found, then the x-ray shows a decrease in the volume of the upper sections and a decrease in transparency.
How is cirrhotic tuberculosis treated?
If TB is detected at an early stage based on the patient's medical history, then non-specific chemotherapy can be used to relieve symptoms and improve the functioning of the cardiovascular system.
If we talk about other stages of tuberculosis, then we can say that with an exacerbation of the disease, antibiotics should be administered intravenously in order to stop the spreadconnective tissue and help the body fight disease. More advanced stages are treated only surgically. If tuberculosis has affected both sides of the lungs, then it can even go as far as partial amputation.
Generalized tuberculosis
Generalized tuberculosis is the most dangerous form of manifestation of an infectious disease. It is practically untreatable. A characteristic distinguishing feature is the occurrence of focal inflammation throughout the body.
Microorganisms are scattered throughout the patient's body and affect he althy organs. As a rule, the disease is spread with the blood, so the disease is very difficult to treat.
Considering the history of the disease with generalized tuberculosis, we can say that the symptoms of the patient are the same as in other types of this disease. Just as mentioned above, they can not be categorically ignored. Only by symptoms it is very difficult for a doctor to immediately make an accurate diagnosis, since they are similar to each other.
This disease is most severely tolerated by HIV-infected people, since the body is already weakened by a terrible virus. If tuberculosis is also superimposed on top, then pathogens simply begin to kill he althy organs.
Diagnosis and treatment
As mentioned above, generalized tuberculosis is quite difficult to diagnose. It also makes it difficult to correctly establish the diagnosis and the fact that x-rays practically do not show focal inflammation, and tests for tuberculosis do not give a positive result.result.
To treat this complex form of the disease, doctors prescribe drugs that help maintain and increase immunity, increase the efficiency of the liver, and also prescribe vitamins. The complex is complemented by breathing exercises and physiotherapy.
Cavernous tuberculosis
Cavernous tuberculosis is a form of the disease, for which the hallmark is the presence of focal inflammation - caverns. This form of the disease is only an intermediate stage between diseases. Tuberculosis caverns can be divided into several types:
- Cavities that develop in areas of recent decay and are not yet completely separated from lung tissues.
- Cavities that form as two-layer walls.
- Cavities formed in the form of three-layer walls, in this case, you can correctly diagnose.
- Fibrous, which are surrounded by fibrous formations on the outside. This pathology can be described by specialists in many case histories of fibro-cavernous pulmonary tuberculosis.
- Cavities, which are cleared of caseosis and granulation, to a greater extent already appear as residual effects after the disease.
When compiling a medical history for cavernous tuberculosis, a specialist should mention that the patient went to the doctor with complaints of a strong cough that does not go away during the day. The sputum was characterized as mucous and yellow, the discharge was accompanied by shortness of breath when walking. Increased sweating, lack of appetite.
After the x-ray in the pictureit became clear that the lower lobe of the left lung was marked by the appearance of a cavity, there was a layering of the pleura against the background of many polymorphic foci of inflammation in the lower lobe. The middle and lower sections are also characterized by scattered foci and root compaction.
Treatment occurs with the help of drugs "Turbazid", "Rifampicin", "Pyrazinamide", "Ethambutol", "Isoniazid".
Skin tuberculosis
If pulmonary tuberculosis is heard everywhere, then someone may hear about skin tuberculosis for the first time. The causative agents of this disease are bacteria that enter the body through the skin. The most dangerous type of bacteria are those that cause diseases of bovine or human tuberculosis.
When infected with this disease, the first symptoms may occur only after a month. The site of infection becomes inflamed and covered with a red-brown crust, as a result, an abscess appears on this site. Children are the most susceptible to this type of tuberculosis.
The exact causes of the disease, even after researching various case histories of TB patients, are still not known. But scientists have put forward a hypothesis that those who have some problems in the body are more prone to the disease:
- Endocrine dysfunction.
- Extreme nervous excitement or disease of the nervous system.
- The problem of the functioning of the urinary system.
- Lack of light and a lot of time spent indoors.
Based on the various case histories of skin tuberculosis, it can be said that there are several types of the disease. Today, only two forms of skin tuberculosis are distinguished - it is focal and disseminated. The difference between them is in the causes and methods of treatment.
Collicative tuberculosis of the skin
This skin disease is secondary and occurs in those already suffering from tuberculosis that has affected the lymph nodes. Then the infection penetrates deep into the skin and provokes the occurrence of tissue softening and bluish edema. These manifestations occur on the neck, jaw, elbows and limbs.
Miliary ulcerative tuberculosis
This type of disease occurs against the background of tuberculosis of the liver or intestines, which is already progressing in the body, as well as the lungs. With daily excretions of the body, skin lesions also occur. At the site of the lesion, spherical inflammations appear, developing into painful bleeding ulcers.
Tuberculosis lupus
This form is the most common. It proceeds very slowly and chronically. Doctors note cases of a lifelong course of this type of disease. Most of the disease affects the face, namely the cheeks, lips and nose. It is characterized by many small smooth rashes of red-brown color, which, with the progression of the disease, begin to peel off.
In some cases, localization is possible in one place in the form of a tumor - on the nose, in the ear. Treatment may be limited to X-ray irradiation or lightening. In extreme cases, surgicalintervention.
Warty skin tuberculosis
The male part of the population, whose work is connected with the blood of animals, suffers more from this species. These could be butchers, veterinarians, slaughterhouse workers.
Feature - this is inflammation of a white color in the form of a tubercle on the fingers or on the feet. Treatment can be with drugs or radiation.
Lichenoid tuberculosis
By looking at the history of tuberculosis in a child (a group of different children), it can be revealed that lichenoid tuberculosis is a disease that affects most children.
Appears as a gray-red rash on the skin of the buttocks, face or thighs. Pain does not accompany these rashes, they are rough to the touch. They also appear as a side effect of diseases of the internal organs.
After the body is completely cured of tuberculosis, the rash disappears by itself. Very rarely, scars may remain. Treatment is exactly the same as for other forms of the disease.
Papulonecrotic tuberculosis
This form of the disease affects the skin of the entire body, face and extremities. Inflammation manifests itself in the form of small purple inflammations, densely located to each other. With the further course of the disease, inflammation can become sores.
Diagnosis of the disease occurs with the help of histological studies. Treatment occurs by treating the affected areas with ultraviolet radiation, as well as taking anti-tuberculosis drugs.
How not to get sick?
In order to protect yourself from contracting such an unpleasant disease as pulmonary tuberculosis, you should follow a few simple rules.
The first thing to remember is that you should not neglect the annual doctor's examinations, the passage of fluorography. If infection has occurred, then at least there is the possibility of treating the disease at an early stage.
When spending time in a crowded place, one should not neglect the basic rules of personal hygiene. It is recommended that you carry a clean handkerchief and antibacterial wet wipes with you at all times. In no case should you use other people's cutlery and personal belongings. It must be remembered that after shaking hands with little-known people, be sure to wash your hands.
No matter how trite it may sound, but the house also needs cleanliness. Under no circumstances should you neglect wet cleaning with antibacterial agents. It is also worth ventilating more often.
Strong immunity plays a significant role. Taking vitamins that help maintain the body, proper nutrition and the absence of bad habits can protect not only from tuberculosis, but also from many other viral diseases.
What does medicine say about safety?
Here are some recommendations:
- Annually, tests should be carried out to detect Koch's bacillus in the body. It is very easy to do, the procedure does not take much time. Everyone remembers the Mantoux vaccination from childhood. Everyone used to think thatthis very injection is the vaccine against the disease. In fact, this vaccine contains weakened cells of the virus, which work as an indicator, showing the presence of their own kind in the body.
- Based on the first advice, you should get vaccinated. To everyone's regret, no one has yet been able to create a medicine that could defeat the virus once and for all. One such vaccine can protect the body for about 3-4 years.
- And the last recommendation from doctors is to take vitamin preparations to maintain immunity.
It should be remembered that nothing should prevent visiting a doctor and a medical institution, if there are reasons for this. It is better to visit a specialist in time and undergo the necessary diagnostics, then the treatment prescribed in a timely manner will be able to bring positive results in the shortest possible time.
