Tuberculosis - Causes, Symptoms and Treatment .MF .

August 12, 2017 17:52 | Infectious Diseases

Tuberculosis - one of the oldest diseases of mankind.This is confirmed by archaeological finds: tuberculous lesion of the vertebrae was found in Egyptian mummies.The Greeks called this disease phtisis, which translates as "exhaustion", "consumption".From this word comes the modern name of science that studies tuberculosis - phthisiology;and experts studying tuberculosis, called phthisiatricians .

In XVII - XVIII centuries, the period of urbanization and dramatic development of the industry, the incidence of tuberculosis in Europe has acquired epidemic proportions.In 1650, 20% of deaths among residents of England and Wales was due to tuberculosis.

However, the reason for the disease was not known exactly until 1882, when Robert Koch discovered the causative agent of the disease - the bacterium Mycobacterium tuberculosis, which is still called Koch's wand.

In the first half of the twentieth century, the incidence of tuberculosis in developed countries began to decline, despite the absence of effecti

ve methods of treatment, which was due to improved socio-economic conditions, as well as patient isolation.However, the 80-th years of the twentieth century in developed countries has been re-registered with the rise of tuberculosis.WHO Experts attribute this to the spread of HIV, the influx of immigrants from troubled by tuberculosis countries, as well as social factors - poverty, vagrancy, drug addiction.In some places (including Russia), the situation was aggravated by a significant reduction in the control of health authorities for tuberculosis.In Russia, the rise in the incidence of tuberculosis began in 1991 and reached its maximum value - 83 persons per 100 thousand population - in 2000, since the incidence is not reduced.Currently, Russia belongs to the 22 th country with the highest incidence of tuberculosis.The causative agent of tuberculosis

tuberculosis pathogens are Mycobacterium tuberculosis.A distinctive feature of the tubercle bacillus is its special sheath, which helps the bacteria survive in extremely harsh environmental conditions, and including basic resist antimicrobial.

Furthermore, Mycobacterium tuberculosis proliferate very slowly, which is somewhat difficult to diagnose.

risk of contracting tuberculosis

The most common Mycobacterium tuberkulezaperedayutsya airborne.TB patients by coughing, sneezing, talking secrete into the surrounding air exciter composed of tiny droplets.When drying droplets formed even smaller particles, consisting of 1.2 microbial cells, these particles do not settle under gravity for a long time and are suspended in the air, into the lungs from a healthy person.

to another species of mycobacteria - Mycobacterium bovis - which can also cause tuberculosis in humans, is also characteristic of the food way of infection - through raw milk.Currently, this mode of transmission has lost its relevance.

risk of infection depends on the nature and duration of contact with the source of infection, the degree of infectiousness of the patient.The probability of infection increases many times in the presence of patients with pulmonary tuberculosis active, ie,the presence of tuberculosis in the lung cavity, as well as in lesions of the upper respiratory tract (bronchi, trachea, larynx).

In addition, the infection usually occurs in close and prolonged contact with patients - most often when a sick person is a family member.

One of the most significant risk factor - a crowd of people in poorly ventilated areas.

risk of developing tuberculosis

Once in the lungs of a healthy person, Mycobacterium tuberculosis does not always lead to disease.The risk of the disease mainly depends on individual susceptibility to Mycobacterium tuberculosis, as well as the state of the immune response.

risk of getting much depends on the age of the infected.Among infected TB incidence is highest in adolescence and young age.In women, the majority of cases occurring in the age from 25 to 34 years, at this age women suffer more often than men.

development of active tuberculosis in infected individuals contributes to a number of diseases.Leading among them is HIV infection, which resulted in suppressed immune response.The risk of tuberculosis depends on the degree of immunosuppression.HIV-infected patients is shown holding an annual Mantoux test and prevention of TB means if necessary.

In addition, the risk of developing tuberculosis is increased in chronic lung diseases, tumors, blood and other malignancies, renal failure with permanent hemodialysis, insulinpotrebnom diabetes and general exhaustion.

real risk of contracting tuberculosis often have only people with reduced immunity.

  • Younger children.
  • HIV-infected.
  • malnourished people who experience frequent exposure.
  • People living in damp, poorly heated and ventilated areas.

In addition, the risk of infection increases many times in close and prolonged contact with patients with active TB.

Pulmonary tuberculosis

The most common form of TB is pulmonary tuberculosis.Before the advent of HIV infection tuberculosis was 80% of all TB cases.Marked reduction of immunity in AIDS contributes to the formation of extrapulmonary sites of infection (both with or without pulmonary them).

lungs are the primary gateway to infection.Bacteria, passing through the respiratory tract, enter the end of the bronchi - alveoli - tiny sacs at the end of the finest bronchioles.From there, bacteria can enter the bloodstream and spread throughout the body, but this bacteria to overcome many protective barriers that may or lowered immunity, or massive infection.

TB, which develops immediately after infection, called - primary tuberculosis .It is common in children up to 4 years, which is due to insufficient formation of the immune system.Therefore, in this age of tuberculosis often he runs hard, but patients are usually not contagious.

In primary tuberculosis is usually formed the primary focus - a site easy afflicted with tuberculosis (TB granuloma).The primary focus is to heal yourself and turn into a small area of ​​scar tissue, which is sometimes found during radiography in healthy people, indicating that the previously adjourned tuberculosis.However, in some cases, the primary focus is progressing, growing in size, the central part of it breaks down and a cavity - primary pulmonary cavity.Because the primary focus of pulmonary Mycobacterium tuberculosis can enter the bloodstream and settle in various organs, forming in them TB granulomas (bumps), hence the name itself tuberculosis (tuberculum with lat -. "Hump").

Secondary tuberculosis - the result of re-infection or re-activation of an existing infection in the body.They suffer from this form of the disease mainly adults.There is formation of new lesions and cavities, which are able to merge with each other, resulting in extensive lesions and severe intoxication.Without treatment, about one third of patients die in the coming months;the remaining infection can buy protracted and may occur spontaneous subsidence of the disease.

At the beginning of disease symptoms are often mild and nonspecific, but then the symptoms are worse, leading to significant suffering.

  • Fever.
  • sweating at night.
  • Weight Loss.
  • Loss of appetite.
  • malaise, weakness.
  • Cough: dry at first, then joins the sputum, which soon becomes purulent, sometimes streaked with blood.
  • Hemoptysis.
  • With the destruction of the vessel wall may occur pulmonary hemorrhage.
  • pain in the chest, worse when breathing.
  • Shortness of breath - occurs when a massive defeat, and is a manifestation of respiratory failure

However, it also happens that the disease is asymptomatic, and the primary focus discover only years later when X-ray for another reason.

tuberculous pleurisy

extrapulmonary tuberculosis found in recent times due to the high incidence of HIV infection.Mycobacterium tuberculosis in addition to the lungs can infect virtually all tissues and organs.

tuberculous pleurisy - tuberculous lesion is membrane covering the lungs - the pleura.It occurs as a complication of pulmonary tuberculosis.

pleurisy can be dry - when the leaflets become inflamed pleura, but the liquid between the sheets does not accumulate.

A pleural effusion may occur - when between the sheets of pleura accumulated inflammatory fluid - fluid, which can compress the lung tissue and cause shortness of breath.

in tuberculous pleurisy symptoms are the same as for pulmonary tuberculosis;chest pain may be more intense, due to the friction inflamed pleura against each other;and in the presence of fluid in the pleural cavity to the fore respiratory failure.

tuberculosis upper respiratory tract

tuberculosis upper respiratory tract always a complication of pulmonary tuberculosis.

The infection process involves the pharynx, larynx.At the same time appeals to the aforementioned joins hoarseness, difficulty in swallowing.

TB lymphadenitis

TB lymphadenitis - this nodal tuberculosis.It occurs as a complication of pulmonary tuberculosis or independently of it.

Most often suffer from cervical and supraclavicular lymph nodes.Lymph nodes at the same time increased, but painless.

Tuberculosis urogenital organs

infection can affect any urinary tract and genital organs.Symptoms depend on the location of the lesion:

  • Frequent painful urination.
  • Blood in the urine.
  • pain in the abdomen and lower back.
  • Women may appear irregular menstruation, infertility.
  • Men formed mass in the scrotum, a few painful defeat at the epididymis.

However, in some cases, the disease is asymptomatic.

Tuberculosis urogenital tract respond well to treatment with anti-TB drugs.

Tuberculosis of bones and joints

Currently defeat tuberculosis of bones and joints is rare, mainly in HIV-infected patients.In most cases of tuberculosis of bones and joints suffer spinal, hip and knee joints.

With the defeat of the intervertebral joint pathological process spreads to the adjacent vertebrae, destroying the intervertebral disc, which can lead to collapse of the vertebrae and curvature of the spine formation (hump).

defeat of the hip and knee joints is expressed pain when walking, accompanied by claudication.If untreated, joint function can be lost.

Tuberculosis of the central nervous system

Tuberculosis of the central nervous system (CNS) occurs infrequently, mostly in young children and in HIV-infected.It includes a sheath of brain damage - tuberculous meningitis or tuberculoma formation in the brain substance.

When tuberculous meningitis symptoms varied:

  • Headache.
  • mental disorders.
  • Disorders of consciousness: stunned confusion.
  • sensory disturbances.
  • Violation of movement of the eyeballs.

Without treatment, TB meningitis always ends lethally.Even after effective treatment may be a neurological disorder.

Tuberculosis granuloma of the brain may show seizures, local violations of sensitivity and / or movement.

miliary tuberculosis

miliary tuberculosis called generalized form of the disease in the dissemination of the pathogen through the blood throughout the body.At the same time in various organs and tissues with small lesions - granulomas, which are lumps 1-2mm in diameter, resembling millet grain.Hence the name of this form of the disease - «milium» with Latin.- "Millet".

main manifestations consistent with the symptoms of pulmonary tuberculosis, but apart from that there are signs of a lesion of other organs: liver, spleen, eyes, meninges.

tests for tuberculosis

Mantoux

Mantoux test (tuberculin test, PPD test) - is a method for determining the intensity of immunity to the tuberculosis pathogen.

sample is introduced into the region of the inner surface of the forearm special preparation - tuberculin which is a purified product derived from Mycobacterium tuberculosis after special processing.

Why spend Mantoux test?

first vaccination against tuberculosis - BCG - is carried out in the first 3-7 days of life.However, the BCG vaccine does not always provide sufficient immunity to prevent infection.To determine whether the immunity against TB is effective, the Mantoux test is conducted annually.According to the results of the sample produce a selection of children for revaccination, held at 7 and 14-15 years.The epidemiologically disadvantaged areas with a high prevalence of TB revaccination is carried out in the 6-7, 11-12 and 16-17 years.

Additionally, the Mantoux test allows to identify infected persons and to begin timely treatment.

How is the Mantoux test?

Mantoux test is conducted annually, regardless of the results of previous trials.The middle third of the inner surface of the forearm is introduced 0,1 ml of the preparation that contains two tuberculin units (TU).After the introduction of the tuberculin formed a small hillock, which is called "a button".

Can watering Mantoux test the water?

bathe, take a shower with the Mantoux test is possible.You can not swim in the open water, so as not to infect the wound.Nor can rub this place a washcloth, as well as use any liquids and solutions: Zelenka, iodine, peroxide, it is impossible to seal the wound with plaster.You also need to make sure that the child is not combed wound.All of these can affect the result of the sample and lead to false positive results.

Evaluation

After the introduction of tuberculin in the presence of antibodies in the body against TB, at the site of the inflammatory response is generated - protective antibody fragments react with the pathogen.At the same time about 2-3 days after injection at the injection site formed a small mound of red, raised above the skin, dense to the touch, blanching with pressure.

results are assessed on day 3.To do this, make measurement of the diameter of the papules (tubercle) transparent ruler in good light.It measures not the size of redness and size of the seal.

  • negative reaction - if there is no reaction at all or reaction ukolochnaya - 0-1mm
  • reaction questionable - if there is only redness without papules or papules the size does not exceed 2-4mm
  • positive reaction - if the size of papules 5mm or more.When the amount of infiltration 5-9mm - reaction is considered mild, with size 10-14mm - medium intensity, 15-16mm - a reaction expressed
  • reaction hyperergic (excessive) - if the papule diameter greater than 17mm in children and adolescents, and 21mm in adults.And if there are any signs of severe inflammation -. Abscesses, inflammation of the surrounding lymph nodes and other

negative test indicates the absence of antibodies in the body against the tubercle bacillus.This indicates the absence of infection, as well as the lack of reaction to a previous BCG vaccination.

dubious sample is actually equal to the negative.