Pulmonary Tuberculosis In Adults - Symptoms, Signs, Stages And Forms Of Pulmonary Tuberculosis

2024 Author: Josephine Shorter | [email protected]. Last modified: 2024-01-07 17:49

Symptoms, signs, stages and forms of pulmonary tuberculosis in adults

Content:

• What is pulmonary tuberculosis?
• Early signs of pulmonary tuberculosis
• Other symptoms of pulmonary tuberculosis
• Is lung tuberculosis contagious or not?
• Stages of pulmonary tuberculosis
• Forms of pulmonary tuberculosis
• Complications and consequences of pulmonary tuberculosis
• Diagnosis of pulmonary tuberculosis
• How is the treatment carried out?
• Prevention of pulmonary tuberculosis

What is pulmonary tuberculosis?

Pulmonary tuberculosis is an infectious disease characterized by the appearance in the lungs of specific inflammatory changes. This disease is caused by mycobacterium tuberculosis, also called tubercle bacillus. It is transmitted through the air, by coughing, talking, sneezing.

According to the WHO, there are up to 2 billion infected people in the world. Medical sources indicate that 18 people out of 100 thousand inhabitants of Russia die from the disease in a year, it would seem that the figure is not large. However, based on the total number of people in the country, it turns out that tuberculosis will kill 25,000 people in just one calendar year. Although over the past 13 years, the mortality rate of this disease has decreased by almost 45%.

The incubation period of pulmonary tuberculosis

From the moment Koch's bacillus enters the body, and until the time a person develops the first symptoms of the disease, a certain period passes, which is called the incubation period. Each person has different time periods, but it lasts at least 3 months and no more than a year. Although the moment when the bacterium leaves the incubation stage can often be mistaken for the symptoms of ordinary SARS.

During the incubation period, the following happens: all mycobacteria that enter the respiratory tract are attacked by the immune system. If he copes well with his own functions, then they die. In this case, the disease does not develop. If for any reason the immune system fails, the mycobacterium continues its journey through the respiratory tract, is absorbed into the bloodstream and enters the lungs, starting to cause inflammation in them. At the end of the incubation period, the initial symptoms of the disease appear.

It is important that during this stage the person is not contagious to the people around him. Moreover, the Mantoux test gives negative results, which significantly complicates the diagnosis of the disease in the early stages.

Early signs of pulmonary tuberculosis

You need to be attentive to your own health and pay attention to the slightest changes in your own body in order not to miss the early signs of pulmonary tuberculosis. This is important, because the disease often does not manifest itself in any way, and can be detected only after undergoing fluorography.

The following symptoms should alert a person:

• Frequent and unmotivated dizziness.
• Apathy and lethargy.
• Sleep disturbances and excessive sweating during night rest.
• Pallor of the skin.
• Blush on the cheeks.
• Unexplained weight loss.
• Lack of appetite, not associated with gastrointestinal disease.
• Subfebrile body temperature not exceeding 37 ° C.

If one or more signs are found, it makes sense to consult a doctor and undergo not only fluorography, but also an X-ray of the lungs.

Other symptoms of pulmonary tuberculosis

At a later stage in the development of the disease, tuberculosis manifests itself more pronounced. It is characterized by the following features:

• Constant cough with and without phlegm.
• Shortness of breath, in which a person feels an acute shortage of air even after a little physical exertion.
• Wheezing, which the doctor may notice when listening. Their intensity and characteristics do not lend themselves to specific description, since they can be varied: dry and wet.
• Increased body temperature.
• Glitter in the eyes, pallor of the skin.
• Sometimes symptoms of vegetative-vascular dystonia appear.
• A sharp loss of body weight, up to 15 kg or more.
• The appearance of blood in sputum.
• The onset of pain in the sternum, both during a deep breath and at rest. This symptom appears if the process has passed to the pleura.

If the last two signs were found, then this means that the person is sick with a complex form of tuberculosis and prompt hospitalization is indicated. Often, it happens that the disease, starting in the lungs, passes through the blood to the intestines, bones and other organs.

Temperature with pulmonary tuberculosis

Hyperthermia is one of the leading signs of infection of the body with Mycobacterium tuberculosis. It is this reaction of the body that often outstrips all the main manifestations of the disease and is a clinical sign of lung damage. This disease is characterized by both constantly high thermometer readings (with acute tuberculosis and with caseous pneumonia) and subfebrile values (with focal, infiltrative and disseminated form).

Rarely, but the following type of fever occurs: a rise in temperature to low values in the morning hours and a decrease in the evening. With active, progressive forms of the disease, the temperature can reach 41 ° C.

Cough with pulmonary tuberculosis

Cough with pulmonary tuberculosis has the following features:

• The cough is moist. The person feels that there is a lump in the chest, and constantly tries to cough it up. This is due to the fact that mucus accumulates in the bronchi, as a result of the ongoing inflammatory process. It interferes with normal air circulation, disrupts gas exchange in the alveoli. Therefore, a person develops a protective reflex - a constant cough, which is designed to clear the lumen for the normal passage of air. But due to the fact that the mucus is constantly arriving, the cough occurs over and over again.
• The nature of the attacks is most often protracted. This is due to the fact that when trying to cough up mucus, the patient strains the pleura and diaphragm, which causes pressure in the lungs and impaired ventilation. This leads to the spread of inflammation and causes breathing difficulties, which means new coughing attacks.
• Tuberculosis cough most often occurs with sputum. It is a certain mixture of pus and mucus. It contains a colossal number of pathogens, which explains the prevalence of tuberculosis. At the initial stages of the development of tuberculosis, the mucus is clear and light, later it becomes rusty due to blood impurities. At the final stage, a person begins to cough up blood alone, with impurities of pus. The discharge has an unpleasant putrid odor.
• Increased coughing most often occurs when a person is lying down. Therefore, attacks often overtake the patient during the night's rest. This is due to the excessive production of mucus and its stagnation, when a person remains motionless for a long time. You may also experience chest pain and persistent coughing. Resting on high pillows can relieve the patient's condition.

Is lung tuberculosis contagious or not?

This is a very dangerous and contagious disease, especially when you consider how many people suffer from tuberculosis. The method of transmission is airborne. Not a single person can be insured against a meeting with a dangerous mycobacterium. In addition, not only people can become carriers of the disease, but also insects, for example, flies and cockroaches.

There is a belief that a person is contagious if he is a carrier of an open form of the disease. This is actually the case. Closed tuberculosis is not transmitted. But the whole danger lies in the fact that the transition of the disease from a closed form to an open one cannot always be noticed in time. Symptoms can be easily confused with a common cold when the person is already a danger to others. And in a year, a person suffering from an open form infects at least 15 people. That is why the disease is so common on the planet.

Stages of pulmonary tuberculosis

There are three stages of pulmonary tuberculosis:

1. Primary infection. The inflammation develops locally, in the area where the infection has entered. In this case, bacteria enter the lymph nodes and a primary complex is formed. As a rule, a person feels well, sometimes there are primary signs of infection.
2. Latent infection stage. If the immune system is weakened, then mycobacteria begin to multiply and spread throughout the body. Foci of tuberculosis are formed, localized in various organs.
3. Recurrent tuberculosis of an adult type. Formed foci of the disease begin to affect organs. Most often, the lungs are affected. If the cavities formed inside them break into the bronchi, a person becomes infectious to others and we can talk about an open form of the disease.

Forms of pulmonary tuberculosis

The forms of the disease can be different. The prognosis and method of treatment largely depends on the form of tuberculosis, as well as how dangerous the disease will be for others and for the carrier of Koch's bacillus.

Infiltrative pulmonary tuberculosis

This form of the disease is characterized by the fact that inflammatory changes are formed in the lungs, which are exudative in nature (that is, the processes proceed directly in the area of inflammation). In the center, caseous necrosis forms - the tissue becomes similar to a protein mass consisting of cottage cheese. The decay process is quite dynamic. Caseous pneumonia is referred to the same form of tuberculosis, but with it, necrosis is more pronounced.

Sometimes the infiltrative form proceeds inappertsely (that is, imperceptibly for the person himself) and is detected only when a person undergoes an X-ray examination. A clear symptom of this form of the disease is early hemoptysis, with a fairly satisfactory human condition. The disease often develops under the guise of pneumonia, bronchitis, prolonged flu, etc.

Disseminated pulmonary tuberculosis

This form of the disease occurs when mycobacteria are dispersed throughout the body through the blood or the lymphatic system, and sometimes both. If the spread occurs through the bloodstream, then the foci are formed in the upper parts of the lungs. If through the lymphatic system, then a large number of foci appear in the lower sections. While the generalized variant of the disseminated form is quite rare, with a predominant lesion of the lungs in almost 90% of cases.

There are many options for the course of this form of the disease, as well as clinical manifestations. The onset of tuberculosis can be both subacute and chronic. In the first case, the disease begins sluggishly, the increase in symptoms occurs gradually, but the intoxication is quite pronounced. Lesions outside the lungs are often observed. This form is characteristic both for the first stage of the development of the disease and for the second.

Cavernous pulmonary tuberculosis

The cavernous form has a number of features and is primarily characterized by the presence of a thin-walled cavity that appears on the lung tissue. Caverns begin to develop more actively when tuberculomas begin to disintegrate or with the progression of other forms of tuberculosis, more often infiltrative.

Primary infection is always latent. Bacteria most often enter the body through an aerogenic route. Catarrhal phenomena begin to appear later, when the walls around the cavity become thicker. On the X-ray image, a circular cavity is visible. Treatment takes place with several types of medications, in combination with physiotherapy and immunostimulating drugs.

Fibrous pulmonary tuberculosis

A distinctive feature of the fibrous form is the presence of a fibrous cavity, the appearance of corresponding changes in the lung tissue. In this case, the bronchi adjacent to the cavity are affected, emphysema, bronchiectasis, and pneumosclerosis often appear in the lungs.

The processes preceding the appearance of a fibrous cavity are infiltrative, tricky or disseminated forms of the disease. The number of foci can be both multiple and single, cavities appear both in one and in both lungs. There are several options for the development of the disease:

• Thanks to chemotherapy, the disease subsides, an exacerbation appears after a few years.
• Quiet periods are often followed by exacerbation periods.
• Sometimes, against the background of fibrous tuberculosis, complications begin to develop, more often with a progressive nature of the disease.

Focal pulmonary tuberculosis

This form is most often secondary. With it, few foci appear, the place of their localization is different - both one and both lungs can be affected. Symptoms are subtle. This form includes both fresh foci and old ones with a fibrous lesion. They differ in density, composition, size.

A pronounced intoxication of the body with a cough, high body temperature and other symptoms with a focal form of the disease occurs during the exacerbation phase. If the changes in the focal nature in the lungs do not show active signs, as can be seen from the X-ray examination, then tuberculosis is considered cured.

Open pulmonary tuberculosis

This form is the most dangerous. The lungs are most often affected, but other organs may also be involved. Infection occurs by inhalation of the pathogen. A patient with an open form must be isolated.

This term means that a person is infectious to others, as he releases active mycobacteria into the environment. The presence of an open form can be determined by examining a sputum smear.

Healing the open form is possible, although it is a rather complicated process. The difficulty is that bacteria are becoming resistant to many types of drugs. In addition, such people should be in long-term isolation from others.

Closed pulmonary tuberculosis

The closed form of the disease is the opposite of the open form. With it, there is no release into the external environment of mycobacteria that are infectious to the people around them.

This type of disease is much more common and may not manifest itself for a long time. Only the Mantoux test will be positive. According to some reports, a third of the world's population is infected with this form of tuberculosis.

Complications and consequences of pulmonary tuberculosis

Complications of tuberculosis are pathological processes caused by the underlying disease. If the disease is not treated, then the most formidable consequence is the death of a person.

You can also highlight the following complications:

• Other internal organs may be affected. Most often this happens when treatment is not started on time. In most cases, the liver suffers, its functioning is disrupted.
• Joints can be affected, bone tuberculosis develops, which leads to severe pain, swelling, arthritis and sometimes abscesses.
• Pulmonary bleeding is one of the formidable complications of the underlying disease. In this case, the person needs urgent medical attention.
• The immune system weakens, which makes the body vulnerable to a wide variety of infections. The patient begins to suffer more often from flu, colds, etc.
• Hemoptysis.
• Pulmonary insufficiency.
• Heart failure.
• Broncholitis, in which a calcified formation is observed in the lumen of the bronchi.
• Aspergilloma is a fungal infection of the lung tissue that can damage the wall of a blood vessel that is adjacent to the formation and cause pulmonary bleeding.
• Tuberculoma is a tumor-like formation.
• Reactivation of the tuberculosis process.
• Bronchiectasis, in which a person develops nonspecific inflammation.

A person who has once suffered from tuberculosis is not immune from its consequences in the future. So, there is no guarantee that a woman will be able to give birth to an absolutely healthy child. He may have both physical and mental disabilities. Often there is a frozen pregnancy and the death of a child during childbirth.

Sometimes, after suffering an illness, a person may suffer for some time with headaches, discomfort in muscles and joints. Most often, such a reaction is the result of treatment with potent drugs. Often it is required to restore the work of the intestines and stomach, there is a disorder of the stool.

Tuberculosis and lung cancer

The combination of tuberculosis and lung cancer has recently been encountered quite often. Recent studies show that people who have had TB are 10 times more likely to develop lung cancer. Therefore, all people suffering from tuberculosis and overstepping the age of 40 are classified as at risk for oncology.

The most susceptible to lung cancer are smokers with long experience, people with metatuberculosis syndrome and those people who have been exposed to various carcinogenic factors for a long time.

Most often, the diagnosis of lung cancer is established in people with chronic forms of tuberculosis and fibrous formations in the tissues. Another problem of such people is the difficulty of diagnosis. X-ray examination may not give a complete picture and additional methods are required - cytological and histological. If lung cancer is detected, surgery is required.

Diagnosis of pulmonary tuberculosis

Diagnosis of the disease includes instrumental, immunological and laboratory research methods and consists of several sequential stages:

• Listening to the patient's complaints, doctors pay attention to the presence of shortness of breath, general weakness, weight loss, coughing, as well as the nature of sputum.
• Collection of history of the development of the disease. In this case, it is necessary to find out whether the person had contact with patients with tuberculosis, how the disease began and how it proceeds.
• Further, a general examination is carried out, which includes observation of the skin, examination of the lymph nodes, listening to the lungs using a special device - a phonendoscope.
• If a possible presence of a disease is suspected, a Mantoux test is performed. In this case, the antigen of the causative agent of the disease is injected under the human skin, after a few days the site of administration and the immune response of the body are studied. If an infection has occurred, then the reaction will be quite pronounced: the stain is large. However, it should be understood that it is impossible to make a diagnosis only with the help of this technique, since a tuberculin test often gives false results.
• A person suspected of having tuberculosis is sent for a lung x-ray. This study allows you to see some changes in them and to suspect the presence of the disease. However, the X-ray is not able to fully confirm the diagnosis or refute it.
• Further, the patient will need to pass sputum for analysis. At least three smears are subject to examination. If pathogens are found in the sputum, and characteristic changes are visible on the X-ray, then repeated tests are performed to confirm the diagnosis. If the result is positive, the form of the disease is determined and appropriate treatment is prescribed.

Additional research methods are as follows:

• Bronchoscopy, which allows you to examine the lungs from the inside using a special device. Also, during this study, flushing is made from the alveoli and bronchi, then their cellular composition is studied and the presence of the pathogen is revealed. If required, during bronchoscopy, the affected area is taken.
• Puncture of the pleural area is done if there is tuberculous pleurisy in the lung. After its collection, a study of the composition and the presence of the corresponding mycobacteria in it is carried out.
• A biopsy of the affected area is performed to study its cellular composition. If a granuloma is found, then the diagnosis is no longer questioned.
• If diagnostics using the above methods is difficult, then PCR is used. For this, blood is taken for analysis.

How is the treatment carried out?

Treatment of the disease has specific goals:

• Elimination of clinical manifestations, as well as laboratory signs of the disease.
• Restoration of human performance. Returning him to normal life.
• Stable cessation of bacterial excretion, which must be confirmed by special studies.
• Elimination of destructive, focal and infiltrative manifestations of the disease, the absence of active signs of the disease during X-ray examination.

Treatment is carried out in a tuberculosis dispensary. The leading method is the impact on mycobacterium with the help of drugs. At the same time, one drug is not enough, as a rule, they are used in a complex consistent with a certain scheme.

Rifamycins, aminoglycazides, polypeptides, isonicotinic acid hydroside, pyrazinamide, cycloserine, thiamides, fluoroquinolones, etc. are active against mycobacteria, and they all have antibacterial and bacteriostatic properties.

If resistance of mycobacteria to drugs is observed and the treatment does not give the desired effect, then such highly effective agents as streptomycin, rifampicin, pyrazinamide, ethambutol and some others are used.

Amikacin, kanamycin, cyclolserin, PASK, etc., are considered to be in the reserve stock with doctors. When carrying out pharmacotherapy, it is important to adhere to certain principles:

• Treatment should be started as soon as the diagnosis is made.
• Medicines are not used individually, but in combination.
• The therapy is carried out for a long time.
• At each stage of treatment, medical supervision is required.

Sometimes the disease requires surgical intervention, but there are strict indications for this:

• Chemotherapy did not have the desired effect, the person shows multidrug resistance.
• The disease caused irreversible changes in the pleura, lungs, bronchi and lymph nodes.
• There are life-threatening complications from the disease.

Most often, surgical intervention is required when establishing cavernous, fibrous tuberculosis, as well as tuberculoma. Although the operation is also performed for other forms of the disease, it is somewhat less common.

In most cases, operations for tuberculosis are planned, but sometimes emergency intervention is required. This occurs in life-threatening conditions such as tension pneumothorax, profuse pulmonary hemorrhage, etc.

Contraindications are the high prevalence of the process, serious respiratory disorders, kidney and liver diseases.

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Prevention of pulmonary tuberculosis

The importance of preventive measures cannot be underestimated given the prevalence of the disease in the population. The specific method includes, first of all, vaccination. The well-known BCG vaccine, which is given to children in the hospital. It is derived from an attenuated strain of mycobacterium that causes disease. The introduction is made to develop specific immunity. This vaccine does not give a 100% guarantee that a person will not get sick, but, most likely, he will suffer mild tuberculosis. Immunity is maintained for 5 years, and then a person is revaccinated (at 7 and at 14 years old). If indicated, the vaccine should be administered before the person reaches 30 years of age, with an interval of 5 years.

It is normal for a Mantoux test to be positive for 7 years after the vaccine is administered. This indicates good immunity.

Such a screening examination method as fluorography should be performed annually. In addition to tuberculosis, it will allow you to identify other lung pathologies in the early stages.

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An important prevention method is the exclusion of contacts with patients. Naturally, it will not be possible to completely protect oneself from infection in this way, however, if there is information that a person is infected with an open form, then it is important to avoid contact with him.

Adequate nutrition, a healthy lifestyle, rejection of bad habits - all this will support the immune system and help it resist mycobacterium tuberculosis at a possible meeting with it.

The author of the article: Makarova Evgenia Vladimirovna, pulmonologist