Fibro-cavernous pulmonary tuberculosis is a destructive disease, the hallmark of which is the presence of an isolated cavity in the lungs. In medicine, it was called the "cavern". The disease is a stage of progression of pulmonary tuberculosis. Often the clinic of such a pathology is worn out.
Features of the disease
As a rule, fibrocavernous tuberculosis is observed in adult patients. In childhood, primary tuberculosis manifestations are very rare.
Cavernous pathology acts as the outcome of infiltrative tuberculosis, but it happens that a disseminated, or focal, type of pathology develops.
The fibro-cavernous form is detected in 5% of cases of tuberculosis.
Cavernous tuberculosis as a step towards the development of fibro-cavernous pathology
A characteristic pathomorphological sign of cavernous tuberculosis is the presence of a single cavity, the absence of inflammation and fibrotic changes in the region of the bronchi, lymphatic vessels and nearby tissue. The disease lasts no more than 2 years.
Healing of caverns occurs with the formation of:
- scar;
- tuberculomas;
- a single focal point of tuberculosis;
- sanitized cavity.
In the absence of proper therapy, the cavernous form can turn into fibro-cavernous tuberculosis, which is characterized by fibrosing of the walls of the cavity and the nearby pulmonary parenchyma. Multiple foci of contamination are also noted.
Symptoms of the disease
As a rule, fibro-cavernous tuberculosis is localized in one lung. The development of the disease occurs for 3-4 months of ineffective therapy of another type of tuberculosis. Manifestations of the disease become especially bright in the phase of decay.
The main symptoms of the disease include:
- asthenia;
- decreased appetite;
- mild cough with sputum;
- expectoration of blood;
- bleeding;
- wet wheezing in the decay cavity.
After the formation of the cavity, the symptoms become scarce, mild and nonspecific. The patient may complain of general weakness, constant fatigue, weight loss and the presence of low-grade fever.
The development of a latent form of tuberculosis can be indicated by bleeding in the lungs, which develops for no reason.
An anamnesis of patients affected by fibro-cavernous tuberculosis suggests a wave-like course. The intervals between the acute period and remission can be quite long or, conversely, the acute phase can occur quite often.
The fibro-cavernous form of tuberculosis has various clinical symptoms. It is due to the pathological process itself, as well as related complications.
There are two types of the course of the disease: limited or relatively stable, in which, under the influence of chemotherapy, the patient's condition stabilizes and remission lasts for several years.
In the acute period, a rise in temperature and the development of the inflammatory process around the cavity are noted. The temperature can reach high levels if a secondary infection joins the underlying disease.
The defeat of the bronchi is accompanied by a painful nagging cough, in which sputum containing mucus and pus is difficult to separate.
A patient suffering from cavernous fibrosis tuberculosis dramatically loses weight. He has dry skin, which wrinkles easily. The patient's muscles undergo atrophy. The target of the pathological process is the shoulder girdle, back and the region between the ribs.
Patients are susceptible to frequent intoxication. With exacerbations of the disease, respiratory failure of 1 and 2 degrees develops. In the future, an increase in liver volume may be noted. Puffiness may appear.
With the progression of the disease, damage to the larynx and intestines is noted, which leads to a weakening of the immune system. With cachexia, amyloid nephrosis, and pulmonary heart disease, the prognosis is poor.
Causes of the disease
Destruction can be triggered by any clinical form of tuberculosis. Superinfection can act as a provocateur of development. Pathogens include mycobacteria. In total there are 74 items. They belong to the genus Mycobacterium. However, tuberculosis in humans is provoked by a conditionally isolated type, called Mycobacterium tuberculosis.
Predisposing factors for the development of the disease are:
- increased sensitization;
- a change in the reactivity of the body;
- diseases of the internal organs;
- bad habits.
The main phases of the disease
It is customary to distinguish the following phases of fibro-cavernous tuberculosis:
- Infiltration. It suggests the presence of a focus of inflammation.
- Decay. A cavity is formed in the focus of inflammation, which is filled with a special form of necrotic tissue - caseous mass. The dry contents become liquid and are gradually rejected through the draining bronchus. A cavity remains in its place. In the future, it begins to fill with air, and in case of violation of drainage in the bronchi - with liquid.
- The formation of caverns. Education is formed by the resorption of perifocal inflammation and fibrosis. The wall of the anomaly contains three layers. The inner layer is represented by caseous mass (polygenic layer). In the middle is a granulation membrane lined with large epithelial cells. From the outside, the cavity is covered with a capsule of connective tissue.
- Insemination. In this process, the dimensions of the cavity increase, and around it there is perifocal infiltration, or seeding. The process involves the development of fresh inflammatory foci with cavernous tuberculosis. So the fibro-cavernous form of the disease develops.
Frequent complications
The following complications of fibrocavernous tuberculosis are distinguished:
- Hemoptysis.
- Bleeding in the lung area.
- The presence of percussion. It is expressed in shortening the sound in areas of thickened pleura and fibrosis.
- Listening for weak breathing in places of pleural thickening. Wet wheezing and bronchial breathing are also found . Such wheezing is detected in the presence of large caverns. Sounds are less sonorous over small formations.
Diagnostic Methods
How is fibrocavernous tuberculosis diagnosed ? The medical history at the time of diagnosis, as a rule, already contains information about a previously transmitted tuberculosis infection.
It should be noted that auscultatory signs carry little information. Further examination using x-ray reveals the presence of annular shadows with a peripheral arrangement in the form of an oval or circle. After the data obtained by the method of X-ray diffraction, differential diagnosis with pathology such as lung abscess , peripheral cancer, bullous emphysema, pneumothorax, echinococcosis, or rumpled pleurisy is required.
Auxiliary diagnostic methods are laboratory and endoscopic methods.
Sputum analysis reveals a high level of MTB. A laboratory examination reveals a high level of isolation of bacilli. Sometimes the process becomes intense. Coral elastic fibers are also identified.
In the absence of sputum, bronchoscopy is indicated. It allows you to identify foci of inflammation in the lungs and bronchi that prevent the closure of the cavity.
Blood analysis. In patients with the presence of fibro-cavernous tuberculosis, lymphopenia and an accelerated ESR up to 30-40 mm / h are noted.
With secondary infection, an increase in the level of leukocytes to an indicator of 19,000-20,000, as well as an increase in the level of neutrophils, is noted.
High protein in urine is noted.
Principles of Therapy
How is fibrocavernous tuberculosis eliminated? Treatment is carried out in a hospital in TB dispensaries.
The treatment regimen is based on the simultaneous use of three or four drugs against the development of pathology. Typically, Isoniazid, Ethambutol, Rifampicin and Streptomycin are used. Drugs can be administered intravenously or directly into the cavity of the cavity.
Tuberculin therapy, respiratory gymnastics, physiotherapeutic procedures, laser treatment, ultrasound and inductothermy are also used.
Chemotherapy
How else is fibrocavernous pulmonary tuberculosis eliminated? Treatment involves chemotherapy. Procedures are prescribed individually in accordance with the indicators of sensitivity to drugs.
As a rule, in the presence of resistance to fixed assets against tuberculosis, therapy is carried out in accordance with the fourth chemotherapy regimen. Treatment involves the combined use of drugs such as Kanamycin, Protionamide, Cycloserin, PASK and Fluoroquinolone. The duration of chemotherapy is not less than 15-18 months.
Patients with fibro-cavernous tuberculosis are shown to have pathogenetic therapy, which is aimed at correcting various impaired body functions. Metabolizing agents are used, as well as drugs to restore the immune system and hormones.
With a favorable course of therapy, after about six months, a positive dynamics is observed. There is a reduction in the release of bacilli, as well as a decrease and closure of the cavity.
Surgical intervention
The healing of fibrous caverns is always extremely slow. If during the above period it is not possible to achieve positive results, then fibro-cavernous pulmonary tuberculosis is eliminated through surgical intervention. In this case, a unilateral lung resection is indicated. The operation is also carried out in a bilateral process. It also has a high degree of efficiency and allows you to save the patient's ability to work. The life expectancy of a sick person is significantly extended. The selection of mycobacteria stops.
Another type of surgical intervention is surgical collapse therapy, involving the imposition of artificial pneumothorax.
After treatment in a hospital, compulsory stay in a sanatorium is required, as well as outpatient treatment followed by observation in a dispensary.
Disease prognosis
The vast majority of fibro-cavernous tuberculosis is treatable. Small caverns are closed and scarred. Formations with the presence of rigid walls over time are again filled with caseous contents, which provokes the development of pseudotuberculoma.
The accumulation of pus, the presence of aspergillosis, the progress of tuberculosis are extremely rare.
Preventative measures
Fibro-cavernous pulmonary tuberculosis belongs to the category of diseases caused by adverse social factors. Often the root cause is a deterioration in the standard of living of the population.
According to statistics, men get sick 3 times more often than women. Basically, the pathology is fixed at the age of 20 to 39 years.
For the purpose of prevention, the following rules are recommended:
- carrying out appropriate preventive measures;
- early detection of people affected by the disease;
- government allocation of funds for medicines;
- the implementation of preliminary medical examinations upon admission to work in livestock farms;
- an increase in the living area of patients diagnosed with tuberculosis;
- timely vaccination of newborns in the first month after birth.
Conclusion
Fibro-cavernous pulmonary tuberculosis (complications pose a threat to health) is a chronic disease. As a rule, it is provoked by cavernous tuberculosis. The disease can be in the nature of both unilateral and bilateral lesions.
If previously pathology was difficult to treat, now medicine has a wide range of different therapeutic methods that can achieve stable remission for many years. Timely therapy allows you to save the patient's ability to work.