Tuberculosis is an infectious disease caused by bacteria of the Mycobacterium tuberculosis complex group (M. tuberculosis and other related species) or, as they are also called, Koch sticks. They are very tenacious and can persist for years outside the body in almost any environment that is not exposed to direct sunlight. Tuberculosis, as a rule, affects the lungs, but sometimes affects other organs: skin, joints, nervous system, etc. Not only people, but also animals can get sick with tuberculosis. The name of the disease comes from the Latin word tuberculum, which means "tubercle".
Briefly about tuberculosis
Pulmonary tuberculosis is a dangerous and common disease, the transmission of which occurs by airborne droplets. Its most characteristic symptoms are cough with sputum, which does not stop for a long time, hemoptysis (in advanced cases), prolonged fever, fever, lethargy, intense sweating at night, decreased appetite and, therefore, noticeable weight loss.
According to WHO, Koch's stick is present in the body of a third of the world's population. Usually, after the entry of mycobacteria into the body, tuberculosis proceeds without symptoms, but in about 10% of cases (in 8-9 million people a year) it nevertheless goes into open form. Such a patient can infect up to 15 people per year. Every year, about 3 million people die from the complications of this infection in the world, including about 20 thousand in Russia.
Causes of the spread of tuberculosis
The activation of the process of infection of people with Koch sticks is facilitated by:
- decline in living standards;
- intensive migration;
- an increase in the number of marginalized segments of the population and prisoners;
- insufficient allocation of funds for medical and preventive measures;
- medical, gender and age, social and occupational factors;
- non-compliance with the regime, refusal of treatment or unauthorized interruption by patients.
What are tuberculosis risk groups?
Some people are more likely to get TB than others. These are the so-called risk groups for tuberculosis. This risk may be due to both biomedical and social factors.
Risk groups for developing tuberculosis are part of the population with a particular predisposition to the disease. Such a predisposition can be caused, for example, by some diseases of a non-tuberculosis nature, adverse living conditions, smoking, etc.
In Russia, the risk groups for tuberculosis in adults and children are officially established by order of the Ministry of Health of the Russian Federation dated December 29, 2014 No. 951 “On approval of methodological recommendations for improving the diagnosis and treatment of respiratory tuberculosis”. People in these categories require regular TB diagnosis.
Factors that increase the risk of tuberculosis
One of the most important risk factors for developing tuberculosis is a weakened immune system. For example, risk groups for tuberculosis include:
- AIDS patients and HIV carriers
- people who have suffered serious chest injuries and severe abdominal surgery;
- patients receiving long-term corticosteroid and other therapy;
- people subject to frequent changes in climate or constant overwork;
- people who have experienced severe stress;
- persons with mental illness, alcoholics, drug addicts.
An important risk factor is the smoking of cigarettes, smoking mixtures, hookah, cigars. For those who smoke more than 20 cigarettes per day, the likelihood of developing tuberculosis increases by 2-4 times. This is due to circulatory disorders, gas exchange and the natural mechanisms of cleaning the respiratory system resulting from smoking.
Those who have a prolonged course or relapse of acute pneumonia, frequent respiratory diseases, diabetes mellitus, a history of exudative pleurisy, chronic kidney disease, dust lung diseases are also at risk for tuberculosis.
Malnutrition can also give rise to infection. Nutrition is considered insufficient if a person has a decrease in body weight of 10% or more below normal in the period up to 6 months or more.
Gastritis, a stomach or duodenal ulcer in 11-12% of cases contribute to the development of pulmonary tuberculosis, and over time its likelihood increases.
Another risk factor is increased susceptibility to infection. It can be genetically determined or associated with “turns”, hyperergic reactions to tuberculin in children and adolescents, as well as the lack of vaccination with BCG vaccine.
Other prerequisites for the development of tuberculosis:
- the presence of residual changes in the lungs after curing tuberculosis;
- contact with a person or animal suffering from tuberculosis (family, professional, etc.);
- imprisonment, work in prisons;
- puberty, advanced age, menopause;
- pregnancy and lactation (women are shown fluorography a month after childbirth).
Examined Groups
According to order No. 951, the following persons are at risk for tuberculosis:
- children with a “turn” (first discovered a positive Mantoux test), increased, pronounced and hyperergic sensitivity to tuberculin, a positive or doubtful reaction to a sample with a recombinant tuberculosis allergen in standard dilution;
- persons whose pathological changes in the lungs were detected on an X-ray;
- persons with some symptoms of tuberculosis, including those found during an examination for any other disease;
- Persons with chronic inflammatory diseases of the respiratory system, if exacerbations occur more than twice a year, and there is no noticeable positive dynamics during treatment for a long time;
- HIV carriers in the presence of fever, cough, excessive sweating, or weight loss.
Examination of children and adolescents
By order of the Ministry of Health, the risk groups for tuberculosis in children were separately established. Twice a year, the following groups of children and adolescents need to be diagnosed:
- patients with diabetes, an ulcer;
- with chronic nonspecific respiratory or kidney diseases;
- HIV-infected
- taking immunosuppressants for a long time.
Survey of the population to prevent the spread of tuberculosis
Regardless of the presence of symptoms of tuberculosis, persons at risk for tuberculosis should undergo a mandatory examination. The list of these population groups and the frequency of diagnostic measures are established by the sanitary and epidemiological rules of SP 3.1.2.3114-13 "Prevention of Tuberculosis".
Citizens subject to examination once every six months
The following population groups should undergo a fluorographic examination twice a year:
- Persons serving on conscription.
- The staff of maternity hospitals, maternity wards.
- People directly interacting with sources of mycobacteria.
- Patients who have previously had tuberculosis or have residual tuberculous changes in the lungs (within three years after the detection of the disease).
- HIV infected
- Patients deregistered in TB facilities due to cure (within three years after deregistration).
- Patients registered with a psychiatrist or narcologist.
- Persons held in places of deprivation of liberty, as well as released from them (within two years after release).
- Persons homeless.
Annual Examiners
Surveys should be carried out every year:
- Patients suffering from chronic nonspecific diseases of the respiratory system (KNZOD), urinary and reproductive system, digestive tract. The incidence of tuberculosis in patients with chronic kidney disease is 10 to 11 times higher than in other people. These patients should not only undergo examination at the dispensary at least once a year, but also take sputum for analysis at least three times a year.
- Diabetes patients. Such patients are 3-5 times more likely than healthy people to suffer from tuberculosis, especially if diabetes is severe or moderate.
- Persons taking cytotoxic drugs receiving radiation therapy, genetically engineered biological products, corticosteroids and TNF-a blockers. As a result of such treatment, the human immunity is greatly reduced. Patients from this risk group for tuberculosis need to undergo not only fluorographic studies, but also chemoprophylaxis.
- Non-transportable patients. Examination of such patients is carried out using sputum analysis.
- Persons from social groups at high risk for tuberculosis. These are refugees, internally displaced persons, citizens of other states and stateless persons, including those working in the Russian Federation, as well as people held in social assistance and service organizations for homeless people.
- Persons working:
- in organizations of social services for minors;
- in sanitary-resort, sports, medical, educational, health-improving organizations for minors;
- in nursing homes, the disabled, etc .;
- in companies involved in the processing and sale of food products;
- in organizations providing household services to citizens;
- at water intakes, pumping stations, wastewater treatment plants, tanks, etc.
Who is eligible for out of turn inspection?
Extraordinary examinations for the diagnosis of tuberculosis in the early stages are subject to:
- patients who came to medical institutions with suspected tuberculosis;
- patients who applied to outpatient facilities sent to a hospital, and people who are in children's inpatient treatment facilities for the purpose of caring for children, if they have not been examined in the last year;
- persons in contact with children whose sensitivity to tuberculin has changed if the last examination was more than six months ago;
- citizens who have arrived from other territories of Russia to live or work, if they have not been examined in the last year;
- people living on the same living space with newborns and pregnant if the previous examination was carried out a year or more before the day of birth;
- citizens called up or enlisted under a military service contract if the last survey was conducted more than six months ago;
- patients who are newly diagnosed with HIV, patients with HIV in the third stage (with secondary manifestations) and with low levels of CD4 lymphocytes, if the last examination was conducted more than six months ago;
- applicants entering an educational institution if they have not been examined in the last year;
- citizens of other states and stateless persons applying for a residence permit, Russian citizenship, a temporary residence permit or work in Russia;
- persons taking psychoactive drugs and not registered with a narcologist if they are detected by law enforcement officials if there are no data on examinations over the past year;
- persons without a fixed place of residence - when applying to medical institutions or social security organizations, if there is no information about the last examination or if it was carried out more than six months ago.
Open tuberculosis significantly worsens one's well-being, emotional state, and, as a result, a person’s quality of life. It requires a long treatment in a stationary mode, which has many unpleasant side effects. In advanced cases, not only medications are required, but also an operation followed by a long rehabilitation period.
At the same time, the latent form of tuberculosis, provided that the prescribed drugs are continuously taken, is cured in 100% of cases. After that, a person can lead a normal lifestyle. Therefore, even people not belonging to risk groups should regularly do fluorography to detect changes in the lungs at an early stage, to avoid serious consequences, as well as infection of family members and colleagues. Indeed, contrary to popular belief, tuberculosis affects not only homeless people and prisoners, but also successful wealthy people.