Tuberculosis - The First Signs, Symptoms, Diagnostic Methods And How Is Tuberculosis Transmitted?

2024 Author: Josephine Shorter | [email protected]. Last modified: 2023-12-16 21:43

First signs, symptoms, diagnostic methods and how is tuberculosis transmitted?

Tuberculosis is one of the oldest plagues known to mankind. In Russia it was called "dryness", and later - "consumption". In ancient Greece, the disease became famous under the name phtisis, which means "exhaustion." From this word comes the modern name of the medical industry that studies the problem of tuberculosis - phthisiology. And a doctor who specializes in the treatment of tuberculosis patients is known to everyone as a phthisiatrician.

Despite the outstanding advances in modern science in the development of diagnostic tools, prevention of epidemics and treatment of complex infections, tuberculosis has not yet been defeated. On the contrary, the problem of the incidence of this disease is becoming more acute in some countries of the world. The spread of tuberculosis is directly related to the processes of globalization and migration, which the medicine of developing countries simply cannot keep up with.

Russia is in 22nd place in the world in terms of morbidity and mortality from tuberculosis, and this is a very sad figure. Although over the past ten years the Ministry of Health has managed to achieve impressive results in the fight against the spread of the disease, it is still too early to talk about success. And in order to protect yourself and your loved ones, it is better to arm yourself with relevant and reliable information. From this article you will learn absolutely everything about tuberculosis: what it is, what it is caused by, how it is transmitted, what methods it is diagnosed and treated with.

Content:

• What is tuberculosis?
• The first signs of tuberculosis
• Other symptoms of tuberculosis
• Can you get tuberculosis?
• 10 myths about tuberculosis
• Diagnostic methods for tuberculosis
• How is tuberculosis treated?
• Surgical treatments for tuberculosis

What is tuberculosis?

The term "tuberculosis" comes from the Latin word tuberculum ("tubercle"), because the foci of inflammation - tuberculous granulomas - are similar to it. This disease is caused by mycobacterium species Mycobacterium tuberculosis complex, that is, directly by mycobacteria tuberculosis (MBT) and its closest relatives. The most important focus of damage is the respiratory tract (bronchi, lungs), but sometimes mycobacteria cause inflammation in the lymphatic, nervous and genitourinary systems, musculoskeletal system, on the skin, or even affect the entire body (miliary form).

The invincibility of tuberculosis is explained by several reasons:

• The causative agent of the disease often does not manifest itself for years, and even when the inflammatory process begins, a person does not rush to see a doctor. The early symptoms of TB can be easily confused with the common cold or overwork. As a result, the time is lost, and the patient has to undergo a long, complex treatment;
• Mycobacterium tuberculosis is extremely resistant to the aggressive influence of the external environment, they remain in a viable state for a very long time and infect more and more people in places where no one expects to meet them, and where it is impossible to get rid of them by any sanitary and hygienic methods;

• The causative agent of tuberculosis mutates rapidly, acquiring resistance to antibiotics. Moreover, the mutation can occur already in the body of a sick person in the course of the disease. This greatly complicates and prolongs the treatment, and in the absence of success, it can cost a person his life. For example, in 2008 alone, according to WHO, 9 million people fell ill with tuberculosis in the world, and a third of them died.

The first mention of tuberculosis

Modern archaeologists more than once had to extract human remains from ancient burials with signs of tuberculous damage to the bones, moreover, some skeletons belong to people who lived on Earth 3000 years before our era. Therefore, we can confidently assert that tuberculosis is the same age as humanity and its constant sad companion.

Although the contagious nature of this disease was proved only at the end of the nineteenth century, people very long ago guessed that tuberculosis was contagious. For example, the Babylonian Laws of Hammurabi allowed a husband to unilaterally divorce his wife if she showed signs of tuberculosis. And the ancient Indian "Laws of Manu" completely forbade men to marry such women. The ruler of Venice issued a law instructing the townspeople to report all tuberculosis patients "where they should."

The first scientific descriptions of tuberculosis belong to the pen of Hippocrates. Although the famous Greek healer was distinguished by a deep mind and incredible observation, he was wrong about tuberculosis. Hippocrates noticed that members of one family usually suffer from this disease, and made a false conclusion about the hereditary nature of tuberculosis.

Another well-known healer, Avicenna, who lived later, pointed out in his notes a direct connection between tuberculosis and pleurisy, as well as the fact that an unfavorable environment and low social status contribute to the onset of the disease: poor people who eat poorly live in filth and do hard labor. Avicenna was convinced that the disease was contagious, but did not know how to cure it.

In the ancient Russian annals there are references to tuberculosis of the lymphatic system. The Kiev prince Svyatoslav Yaroslavich suffered from this disease in 1076. Treatment in those days was surgical: the foci of inflammation were excised, and the places were then cauterized. Of course, this technique did not help the healers to heal the prince.

History of tuberculosis research

The disease acquired the character of an epidemic in the 17th - 18th centuries, when the active construction of cities, the development of industry, trade and transport began. People traveled, went to work, and along the way carried deadly bacteria. In the mid-seventeenth century, in the British Peninsula alone, roughly 20% of deaths were due to tuberculosis. The situation in the rest of Old Europe was no better.

At the same time, the first medical research began, aimed at establishing the nature of tuberculosis and finding treatment methods. Dr. Francis Sylvius, who lived in the 17th century, first discovered tuberculous granulomas during the autopsy of a patient who died from consumption, but mistakenly took them for enlarged lymph nodes. However, then M. Baillie (1761-1821) looked for the truth and realized that tubercles are a form of manifestation of the disease and the basis for the further spread of inflammation.

A follower of Dr. Baillie, the French scientist Rene Laennec (1781-1826), first coined the term "tuberculosis", and also described several types of this disease. He also suggested using auscultation of the lungs, which was a breakthrough in diagnosis. Russian doctor G. I. Sokolsky (1807-1886) was familiar with Laenneck's works and relied on them in his scientific work. The result was the book "Teaching about chest diseases", which was published in 1838. In it, Sokolsky for the first time describes the cavernous, infiltrative and disseminated forms of tuberculosis, albeit under different terms.

A great contribution to the unraveling of the nature of tuberculosis was made by the French ship's doctor Jean-Antoine Vilmain. In 1865, while sailing, he discovered that one of the sailors was sick with tuberculosis, and witnessed how the same symptoms gradually appeared in other crew members. To confirm the suspicion about the infectiousness of the disease, the doctor collected the infected phlegm and soaked it on the litter on which the guinea pigs lived. The animals contracted tuberculosis and died.

The German pathologist Julius Kongheim in 1879 confirmed Wilman's hypothesis with the help of another experiment on animals: he injected fragments of a human lung infected with tuberculosis into the eye chamber of rabbits, after which he observed the development of tuberculous granulomas there.

However, it was only in 1882 that it became known for certain exactly how the fatal disease spreads and affects millions of people. German physician Robert Koch devoted 17 years of his life to studying this issue, and was finally able to detect and examine the dangerous mycobacterium under a microscope, after staining an infected sample with methylene blue and vesuvine. Then the doctor was able to isolate a pure bacterial culture and infect experimental animals with it. In honor of the discoverer, mycobacterium tuberculosis was named "Koch's bacillus". A solution with a bacterial culture, called "tuberculin", is still used for diagnostic purposes.

Forms and types of tuberculosis

In more than 90% of cases, tuberculosis is localized from the lungs, but there are also bone, genitourinary, skin, cerebral, intestinal, miliary varieties of the disease, therefore, it is customary to distinguish two forms of tuberculosis:

• Pulmonary;
• Extrapulmonary.

Based on whether a person fell ill for the first time, or the disease after remission has again passed into the active stage, two types of tuberculosis are distinguished:

• Primary;
• Secondary.

Primary tuberculosis

This is an acute form of the disease that occurs immediately after the pathogen enters the bloodstream. Children under the age of five often suffer from primary tuberculosis, because their not fully formed immune system cannot cope with the attack of mycobacterium tuberculosis. Although the disease is difficult and has pronounced symptoms, at this stage, patients are not contagious to others.

In the lungs, a primary lesion is formed - a small granuloma. Further events can develop either according to a favorable or sad scenario. In the first case, the tuberculous granuloma heals on its own. Sometimes a person does not even realize the seriousness of the problem, attributing his discomfort to fatigue and a cold. Then, during an X-ray examination, a "surprise" will be found in his lungs - a healed granuloma.

In the second case, the granuloma increases, and a free cavity appears inside it, filling with blood - a cavity. From the cavity, mycobacterium tuberculosis spread through the bloodstream through the body, producing new foci of inflammation. The primary cavity can still close and grow together without treatment, but if new granulomas appear, and new cavities behind them, then the person will die without medical assistance.

Secondary tuberculosis

Secondary tuberculosis is said to be when a person who has recovered contracted another type of mycobacterium tuberculosis and fell ill again, or when remission turned into an exacerbation. This situation is more typical for adult patients. New foci of inflammation are formed in the lungs, sometimes so close to each other that the cavities merge, and large cavities with exudate appear. About 30% of patients with severe secondary tuberculosis, despite the efforts of doctors, die within 2-3 months. And only in one patient out of a hundred, secondary tuberculosis subsides as spontaneously as it arose.

A person suffering from secondary pulmonary tuberculosis is very contagious to others. When you cough up phlegm, bacteria are constantly released into the air. Such a patient is hospitalized and undergo long-term treatment with combined antibiotics, which can last up to six months. Then, for another two years, the person is kept registered with a phthisiatrician. And only then, if the X-ray examination confirms the absence of new foci of the disease, the diagnosis of "tuberculosis" is finally removed.

World Epidemiological Reference

According to the world epidemiological report:

• By the number of deaths annually, tuberculosis is second only to AIDS.
• In 2013, 9 million people fell ill with tuberculosis on planet Earth, of which one and a half million died. 550 thousand sick - children, of which 80 thousand died.
• Nearly 95% of TB deaths occur in lagging and developing countries in Africa and Asia.
• Tuberculosis is one of the three most common causes of death in women of reproductive age (16-45 years).
• A quarter of all deaths of HIV-infected patients are caused by tuberculosis.
• According to the WHO, about 480 thousand people who fell ill with tuberculosis in 2013 were affected by MDR-TB, a multi-drug resistant form of the disease that is virtually untreatable.
• From the early 1990s to the present, the global death rate from tuberculosis has decreased by 45%.
• Thanks to modern diagnostic methods, from 2000 to 2013, approximately 37 million lives were saved around the world.

Mortality from tuberculosis in Russia

As of 2013, 11.3 of one hundred thousand cases of tuberculosis in Russia were fatal. This is a great improvement compared to the figures for 2000: since then, the incidence has decreased by 30%, mortality - by about 33%.

The latest data on the website of the Ministry of Health and Social Development of the Russian Federation says that by the beginning of 2015 it was possible to reduce the sad statistics by another 5.5%: now 10.3 out of 100,000 cases of tuberculosis end in the death of the patient. The dynamics in different regions of the country is not the same; the doctors of the Central Federal District have achieved the greatest success - there the mortality rate fell by 16.4%.

The state budget of Russia for 2015 has allocated 4 billion rubles for the prevention and control of tuberculosis.

Who is the causative agent of tuberculosis?

Tuberculosis is caused by special mycobacteria; in total, 74 types of such bacteria are known to science. The term "Koch's bacillus" is considered obsolete today, since there are a great many rods as a result of mutations, and they all have individual characteristics. Mycobacteria live almost everywhere: in the soil, in the air, in water, in the bodies of people, animals and birds. In humans, tuberculosis occurs, most often as a result of infection with MBT (Mycobacterium tuberculosis), less often - Mycobacterium bovis (a bovine species of mycobacteria) and Mycobacterium africanum (an African species).

Mycobacterium tuberculosis was called a stick for a reason: it is thin, 1-10 microns in length and 0.2-0.6 microns in width, straight or slightly curved, rounded ends, the body surface may be slightly granular. The MBT is unique in that under the influence of various environmental factors, it can break up into incredibly small particles, or vice versa, stick together into bizarre giant octopuses, and then return to its normal form and infect people.

Mycobacterium tuberculosis live for a long time outside the host organism. On a dusty sidewalk, they remain viable for 10 days, between book pages - 3 months, in water - 5 months. MBT do not like sunlight, but they can withstand heating to 80 ° C Celsius for five minutes. In a dark and damp room, they feel especially at ease. Dried bacteria can infect a guinea pig with tuberculosis after a year and a half. And frozen - even after 30 years!

The MBT do not have organelles of movement - neither flagella nor cilia - therefore they remain where the carrier "landed" them. For growth and reproduction, they need a temperature of 29 to 42 ° C Celsius, the best option is 37-38 ° C, that is, the body of a person suffering from tuberculosis is simply ideal conditions.

The first signs of tuberculosis

At the initial stage, tuberculosis is very difficult to distinguish from a banal acute respiratory disease or chronic fatigue syndrome. A person constantly feels weak, drowsy and overwhelmed. I don't feel like eating, my mood is depressed, the slightest stress provokes a violent reaction. In the evenings, there may be a slight chill, restless night sleep, accompanied by sweating and nightmares. The temperature stubbornly stays at around 37.5-38 ° C, a dry paroxysmal cough appears, which is especially painful at night and in the early morning. The first signs of pulmonary tuberculosis may appear all together, or they may appear separately, in arbitrary combinations.

Let's consider the progression of symptoms in more detail:

• Changes in appearance. Tuberculosis gives the face a haggard, pale appearance: the features sharpen, the cheeks fall through, an unnatural blush burns on them, the eyes acquire an unhealthy shine. A person quickly loses weight, and if at the first stage of the disease all these signs are not yet so obvious, then patients with chronic tuberculosis have such a characteristic appearance that the diagnosis is beyond doubt.
• Temperature. A sure sign of tuberculosis is subfebrile body temperature (37-38 ° C) that does not subside for a month or more, which cannot be explained by any objective reasons. In the evening, the temperature can rise to 38.5 ° C and be accompanied by chills. The patient sweats all the time, but with the help of this natural reaction, the body still fails to lower the body temperature to the physiological norm, because the infection provokes fever again and again. Febrile temperature (over 39 ° C) occurs already in the late stages of tuberculosis, in the presence of massive foci of inflammation in the lungs.
• Cough. A person suffering from pulmonary tuberculosis coughs almost constantly, however, at the beginning of the disease, the cough is dry, rolls in attacks and looks like a nervous reaction. And then, when the granulomas grow to cavities, and exudate accumulates in the lungs, profuse sputum secretion begins. The cough becomes moist, and after coughing up, the person feels relief for a while. It is very important to know: if you or someone close to you for more than three weeks in a row is worried about an unexplained cough that is not associated with a cold, you should urgently see a phthisiatrician!
• Hemoptysis. Such a dangerous symptom almost certainly speaks of an infiltrative form of tuberculosis, but the diagnosis must be differentiated from a malignant tumor of the lung and acute heart failure, since hemoptysis is also characteristic of these diseases. In tuberculosis, small amounts of blood are released from the respiratory tract immediately after an attack of wet cough with copious sputum. Sometimes blood literally pours out in a fountain, this indicates a rupture of the cavity. The patient needs urgent surgery to save his life.
• Chest pain. Pain under the ribs or behind the shoulder blades is rarely the first sign of tuberculosis. Usually this symptom worries patients in the acute and chronic stages of the disease. If pain is observed at the onset of the disease, then it is mild, more like discomfort, and appears brighter only with a deep breath.

Other symptoms of tuberculosis

Symptoms of extrapulmonary forms of tuberculosis depend on the site of infection. Although these forms are rare, let's take a quick look at their main features:

• Tuberculosis of the genitourinary organs. A common symptom of tuberculosis of the genitourinary system is blood in the urine and its cloudy color. Urination is usually rapid and painful. In women, tuberculosis can cause intermenstrual bleeding, deformities of the fallopian tubes and, as a result, infertility. If the ailment has affected the reproductive system, then the first sign will be constant aching pains in the lower abdomen and spotting. In men, the disease can be localized in the testicles, then painful swelling with exudate develops inside the scrotum. Tuberculosis of the genitourinary organs is diagnosed by urine analysis and is treated with the same antibiotics as pulmonary tuberculosis.
• Tuberculosis of joints and bones. This form of the disease in modern medical practice is extremely rare, and is almost always observed in HIV-positive patients. Tuberculosis affects the knee, hip joints and spine. The inflammation destroys the cartilage tissue and intervertebral discs, as a result, the patient begins to limp, and a hump may appear on the back. Over time, in the absence of proper treatment, the disease leads to complete immobility. Bone tuberculosis is characterized by vivid symptoms and severe pain; diagnosis does not cause difficulties.
• Tuberculosis of the central nervous system. Brain tuberculosis develops either in patients with HIV infection or in babies with congenital tuberculosis. In other situations, it is difficult to imagine that the disease was brought to such a dangerous and neglected form. Mycobacteria provoke tuberculous meningitis, that is, inflammation of the lining of the brain. Less commonly, granulomas may occur directly in the medulla. Symptoms are vivid: headaches, discoordination, tinnitus, visual disturbances, fainting, convulsions, less often mental disorders and hallucinations. Without treatment, the patient dies quickly, but even modern drug therapy does not guarantee salvation.
• Miliary tuberculosis. If the mycobacteria immediately after infection spread through the bloodstream throughout the body and did not meet a worthy resistance from the immune system, miliary tuberculosis may occur. It is characterized by numerous lesions - microgranulomas no more than 2 mm in diameter. An X-ray of such a person looks like he is covered with millet. The first symptoms are the same as for pulmonary tuberculosis, with the exception of cough, which may not be observed. As the granulomas grow in various organs, problems begin in their work. Inflammation can involve the kidneys, liver, and spleen. Long-term antibiotic therapy is required.
• Tuberculosis of the digestive tract. Another rare form of the disease, typical mainly for HIV-infected patients. There is bloating, aching pains, constipation and diarrhea, blood in the stool, sudden weight loss, persistent low-grade fever. In severe cases, tuberculosis can cause intestinal obstruction and massive internal bleeding. In addition to drug therapy, surgery may be required.
• Lupus. It is not difficult to diagnose this form of the disease: dense painful nodules appear throughout the body under the patient's skin, which break through when scratching, and a white, cheesy infiltrate is released from them. Treatment of skin tuberculosis is carried out with antibiotics according to the standard scheme.

Can you get tuberculosis?

Unfortunately, it is possible to contract tuberculosis, and it is easier to do than we think. According to statistics, every second in the world, someone acquires an unwanted guest in his body - the Office. You can pick up mycobacterium tuberculosis in any public place, and the more often you are in a crowd of people, in public transport and in medical institutions, the higher the risk. One patient with chronic open tuberculosis releases about seven and a half billion bacteria into the air every year and infects about 15 people. The World Health Organization claims that a third of the world's population (about 2 billion people) are infected with tuberculosis. Then why are we still not extinct?

The fact is that the immunity of a healthy person is an impenetrable barrier for the millions of microbes and bacteria that bombard our body every day. The tubercle bacillus will also not be allowed to take root, and the carrier, most likely, will never turn into a disease. But if the body is weakened and vulnerable, the tenacious mycobacterium will not fail to seize the chance for a happy future. Colds, stress, malnutrition, vitamin deficiency and other factors favorable for the office can trigger the onset of the active stage of tuberculosis.

How is tuberculosis transmitted?

Tuberculosis is transmitted in four ways:

• Airborne droplets. In terms of frequency, this method is confidently leading - about 98% of cases of tuberculosis infection occur by airborne droplets. For one emission when coughing, the patient releases up to three thousand mycobacteria into the surrounding air, moreover, they scatter within a radius of one and a half meters. The phlegm particles dry out but remain infectious. Therefore, people who spend a long time in the same room with patients with an open form of tuberculosis put themselves at the greatest risk.
• Contact ways. The contact route involves infection from personal belongings, clothing, dishes, toys, towels and other household items that the patient uses. Tuberculosis is spread through kissing and sexual contact. You can also get infected directly through the blood if there are wounds or scratches. There are cases when surgeons and pathologists acquired the disease from their patients. Do not forget that tuberculosis is transmitted to humans from animals: for example, you can get infected while caring for a sick cat or dog.
• Food route. The foodborne method of infection is typical for rural areas, where people do not take milk and meat of livestock to the veterinarian for analysis. You can also buy contaminated products from the market. If a cow is sick with udder tuberculosis, mycobacteria will definitely get into the milk. There is nothing to say about the meat of sick cows and pigs. Fortunately, foodborne contamination is extremely rare at the current level of agricultural development. If this does happen, tuberculosis affects the digestive system.
• Intrauterine route. If a mother is sick with pulmonary tuberculosis, this does not automatically mean that she will infect the unborn baby. However, with extensive and chronic forms, especially in combination with HIV infection, the risk of intrauterine infection is very high. Diagnosis of tuberculosis of newborns helps the study of the placenta - the placenta. The prognosis for such babies is unfavorable, since there is no immunity in the body, and the child will not stand the treatment.

10 myths about tuberculosis

Myth 1: TB is a thing of the past

This disease could well be called disappearing in the 60-80s of the last century. They hoped to forget about it, as about the bubonic plague or "Spanish flu", but in the 90s tuberculosis again took on the character of an epidemic: morbidity and mortality increased 2.5 times and approached the post-war rates.

Myth 2: Tuberculosis is a problem for backward states

In a sense, this is true: the attack prevails over Bangladesh, Indonesia, Ethiopia, Zaire, Pakistan. But Russia is in 22nd place on this list, despite the fact that there are more than two hundred states in the world. It turns out that we are a hopelessly backward country.

Myth 3: Tuberculosis is a lung disease

Indeed, in the overwhelming majority of cases, tuberculosis affects the lungs, but, as we described above, this ailment can choose another place for itself in the body. Then the pathogen will be released into the external environment not with sputum, but with other physiological fluids (urine, semen, sweat, tears, saliva, etc.). This should be taken into account when contacting people with suspicious symptoms.

Myth 4: TB is a disease of the lower strata of society

This opinion is justifiably based on the fact that in the past, mainly prisoners, homeless people and drug addicts were ill with tuberculosis. Now there is strict medical control in penal institutions. But in the field of illegal migration, there is no more control, and the problem has become alarming. Therefore, a well-to-do person, weakened by the stresses of a big city, can contract tuberculosis in the subway or any other public place.

Myth 5: Infection is possible only through close contact

To inhale a tubercle bacillus, you do not have to stand in front of the patient when he coughs. You can accidentally enter the room where the carrier was, after a few hours or even days, and pick up an infection. Another thing is that the number of pathogens that entered the body at a time plays a role. With a massive and prolonged attack, the immune system may indeed be unable to cope with tuberculosis bacteria.

Myth 6: Infection = disease

Every third inhabitant of the planet Earth is a carrier of tuberculosis. And only in five out of a hundred carriers the disease goes into an active stage. For such a misfortune to happen, a significant weakening of the immune system is required, for example, as a result of a long cold or chronic stress.

Myth 7: Tuberculosis cannot be detected early

The disease can be diagnosed with great accuracy even at the earliest stage. If carriage is determined using simple tests, then what can we say about the disease? The only problem is that patients do not consult a doctor in a timely manner, but instead resort to self-medication, diagnosing themselves with acute respiratory infections.

Myth 8: TB is incurable

Modern antibiotics and carefully thought out treatment regimens make it possible to count on a positive outcome. The only difficulty is presented by late detected, mutated and multi-resistant forms of tuberculosis. The disease will not become a sentence if, at the first suspicious symptoms, you go to the clinic and undergo a simple examination!

Myth 9: Tuberculosis is instantly cured with the latest drugs

The other side of delusion. Indeed, effective antibiotics with a minimum of side effects are in the arsenal of modern phthisiatricians, but they do not guarantee a cure for mutated forms of the disease, and therapy still takes several months.

Myth 10: It is dangerous to vaccinate children against tuberculosis

It is very dangerous NOT to vaccinate children against tuberculosis and to NOT have the annual Mantoux test. These simple measures have saved thousands of children's lives. The talks of some "advanced" parents that the problem of tuberculosis is exaggerated and that the child's immunity should not be traumatized by vaccinations once again is simply criminal.

Diagnostic methods for tuberculosis

To detect tuberculosis, doctors use the following methods:

• Tuberculin diagnostics;
• X-ray examination;
• Bacteriological analysis;
• Linked immunosorbent assay.

Mantoux test

Mass tuberculin diagnostics of children and adolescents is carried out annually, starting from the age of one. Using a special syringe or pistol, 0.1 ml of tuberculin solution is injected under the skin on the hand or forearm, the concentration of the pathogen in which is determined based on the age and weight of the child. The Mantoux test is not a vaccination against tuberculosis, but a special test that makes it possible to judge the patient's tuberculosis status. Do not wet or rub the injection site. After three days, the doctor or nurse evaluates the result. To do this, using a ruler, the diameter of the papule is measured - swelling and redness around the point of needle insertion.

Mantoux test results:

• 5-15 mm is an adequate immune response. Indicates that either the child was exposed to the pathogen and coped with it, or was vaccinated against tuberculosis, and in this way acquired strong immunity;
• 0-2 mm - no immune response. Indicates that either the child has never encountered the pathogen at all, or was vaccinated for a long time, and protection against tuberculosis has been lost. Such children need to be revaccinated;
• 16 mm or more - inadequate immune response. Indicates that either the child recently contracted tuberculosis, or was a carrier, and now runs the risk of becoming an active form of the disease under the influence of a decrease in immunity. Such children require consultation with a phthisiatrician.

Fluorography and radiography

Mass fluorography of the respiratory system is the main method for early diagnosis of tuberculosis in the adult population of our country. Fluorography is done every two years and is a simplified version of an X-ray examination. A person stands in front of a fluorescent (hence the name) screen, weak X-rays pass through the body, and the equipment takes a photograph. It clearly shows foci of tuberculous lesions, if any. The encoded data is entered into a special log and then processed by a computer to obtain phthisiatric statistics.

Radiography is necessary for a more detailed study of tuberculosis foci found on fluorography. This diagnostic method is also used in order to dispel suspicions if the result of fluorography is doubtful. X-rays are harmful to humans, which is why modern diagnostic equipment is designed to minimize radiation exposure. You should not give up the X-ray if the doctor recommends playing it safe - it is better to be confident in the test results when it comes to such a serious disease as tuberculosis.

Bacteriological methods

Since 1995, bacteriological examination of sputum has been mandatory when a patient applies to a polyclinic with complaints of cough. Abroad, this diagnostic practice has existed for over forty years. That is, if you cough and come to see your GP or any other general practitioner (ENT, for example), according to the law, you must take a sputum test and stain a Ziehl-Nielsen smear to identify mycobacterium tuberculosis. Consider this in order to be able to protect your rights in the event of an untimely diagnosis of tuberculosis due to the negligence of medical workers!

Another technique, bacterial culture according to Levstein-Jensen, is not mandatory, but it helps to determine the strain of mycobacterium tuberculosis, therefore it is often used, despite the duration. After 1-2 months, the sowing ripens, and the phthisiatrician can find out for sure which type of mycobacterium you are infected with. The choice of antibiotics and treatment regimen will depend on this.

Linked immunosorbent assay

Tuberculosis can also be diagnosed by blood. To do this, an enzyme immunoassay is performed, which does not provide data on the status of the disease (carriage, acute, chronic form). It provides information only about whether the pathogen is present at all in the body. ELISA detects antibodies to tuberculous mycobacteria in humans. Obviously, this diagnostic method is relevant only for developed countries with an extremely low incidence rate. But for all its primitiveness, ELISA can be useful for diagnosing rare, extrapulmonary forms of tuberculosis.

How is tuberculosis treated?

Treatment of tuberculosis is complex and lengthy, depending on the type and severity of the disease, it lasts up to two years and includes the following measures:

• Chemotherapy;
• Supportive drug therapy;
• Surgical interventions (if necessary);
• Rehabilitation in health resorts.

Chemotherapy

In modern phthisiatric practice, anti-tuberculosis therapy is used with the participation of several types of antibiotics.

At the moment, three treatment regimens are relevant:

• Three-component;
• Four-component;
• Five-component.

Tuberculosis treatment consists of two main phases:

• Intense;
• Prolonged.

The purpose of the first, intensive phase is to stop the inflammatory process, prevent further tissue destruction, resorb infiltrate and exudate, and stop the elimination of tuberculous mycobacteria from the body into the environment. That is, doctors are trying to make a person stop being contagious. This takes, on average, two to six months.

Prolonged treatment of tuberculosis is aimed at complete healing of inflammatory foci, scarring of damaged tissues and restoration of strong immunity in the patient. Depending on the nature and severity of the disease, therapy can last up to two years, and in the case of multidrug-resistant tuberculosis, up to three to four years, until an X-ray examination proves complete attenuation of the disease.

Three-component treatment regimen for tuberculosis

This regimen is also called first-line anti-tuberculosis therapy. It was proposed in the early twentieth century, and has saved many lives over the years. Although better drugs already exist and mycobacterium tuberculosis has become more resistant, the three-component regimen is still relevant and sometimes used.

It consists of the following antibiotics:

• Isoniazid;
• Streptomycin;
• Paraaminosalicylic acid (PASK).

Four-way tuberculosis treatment regimen

With the isolation of new, mutated and resistant strains of mycobacterium tuberculosis, the approach to the treatment of the disease also changed. The first line therapy was replaced by the DOTS strategy, which was adopted in 120 countries around the world. It is flexible and consists of four pairs of antibiotics, so the doctor has the ability to replace and combine drugs, achieving the most effective treatment for a particular patient:

• Streptomycin or kanamycin;
• Rifampicin or rifabutin;
• Isoniazid or ftivazid;
• Pyrazinamide or ethionamide.

5-way tuberculosis treatment regimen

For the treatment of particularly complex, multi-drug resistant forms of tuberculosis, one of the second, third or fourth generation antibiotics is added to the DOTS regimen. The most common fluoroquinolone derivative is ciprofloxacin. The therapy lasts at least twenty months and is much more expensive than the standard treatment regimen. The five-component scheme has another significant drawback - an abundance of side effects. The body has to poison itself for many months with five potent drugs.

But sometimes even such victims fail to achieve a pronounced therapeutic effect. In extreme cases, fluoroquinolones are replaced with one of the outdated and highly toxic antibiotics - cycloserine, capreomycin or another "reserve" drug. However, in October 2012, new hope emerged - the antibiotic bedaquiline, presented at the annual meeting of the IBC. In the United States, the drug was approved for use, and the World Health Organization issued a statement in which it emphasized its interest in obtaining data on the practice of using this antibiotic for the treatment of tuberculosis.

Complementary therapy for tuberculosis

Complementary therapy for tuberculosis includes:

• Immunostimulants (galavit, xymedon, glutoxim) help the body fight mycobacterium tuberculosis;
• Hepatoprotectors are necessary to protect the liver from the destructive effects of antibiotics; they are prescribed with constant monitoring of the level of bilirubin in the blood;
• Sorbents (acetylcysteine and rheosorbilact) are prescribed at the time of withdrawal of chemotherapy in case of extremely severe side effects. After a short rest period, treatment still has to be resumed;
• B vitamins, glutamic acid and ATP are needed to prevent peripheral neuropathy and other undesirable effects from the central nervous system;
• Methyluracil, aloe vera, glunate, FiBS are prescribed during the treatment of tuberculosis to accelerate the processes of cell regeneration;
• Glucocorticoids are a last resort because they have strong immunosuppressive effects. But sometimes they are still prescribed for a short time in order to drown out too violent manifestations of the inflammatory process in case of extensive and severe tuberculosis.

On the subject: The most effective recipes for tuberculosis

Surgical treatments for tuberculosis

In advanced cases, surgical treatment of tuberculosis may be required. These are the techniques currently in use:

• Artificial pneumothorax or pneumoperitoneum - compression and fixation of the lung by introducing sterile air into the pleural cavity. This technique can be called the general term "collapse therapy". When the lung is fixed, the cavities in it gradually grow together, in addition, the excretion of the causative agent of tuberculosis stops, and the patient stops infecting other people;
• Speleotomy or cavernoectomy - resection of the largest cavities that are not amenable to conservative treatment;
• Valve bronchial blocking - installation of miniature valves in the mouth of the bronchi to prevent their adhesion and normalize breathing in patients with tuberculosis;
• Lung resection - removal of an irreversibly affected part of the lung;
• Lung lobectomy - removal of one lobe of the right or left lung;
• Bilobectomy - removal of one lobe of the right and left lungs;
• Pneumonectomy, or pulmonectomy, is the removal of the entire right or left lung.

The author of the article: Makarova Evgenia Vladimirovna, pulmonologist