Until the twentieth century, tuberculosis was considered to be an incurable disease. A person suffering from this ailment was doomed. Nowadays, I want to have hope that this disease is over. But this is not so. Every year, around nine million people worldwide become infected with tuberculosis, especially in underdeveloped countries. More than two million people die from it.
Infected, as a rule, by airborne droplets, and this is due to the number of harmful bacteria in the air.
The classification of tuberculosis depends on its form, clinical presentation, prevalence, and so on. We will consider this problem in more detail below.
Classification adopted in Russia
The classical clinical classification of tuberculosis according to V. A. Koshechkin and Z. A. Ivanova is based on the following indicators:
- clinical features of the disease process;
- its localization and prevalence;
- flow phases;
- development mechanisms;
- the presence of bacteriological secretions.
It consists of four sections:
- Clinical forms.
- Characterization of the disease process.
- Complications after an illness.
- Changes in the body after recovery.
This classification has been used in Russia since the thirties.
Clinical forms
The forms of clinical manifestation depend on the location of the disease and its symptoms, given the pathogenetic characteristics of the disease process. It is customary to distinguish children's intoxication with tuberculosis, tuberculosis of the respiratory system (lungs, tracheal bronchi), lymph nodes, central nervous system and membranes of the brain, intestines and peritoneum, joints and bones, organs of the genitourinary system, skin, eyes, and other organs.
The clinical classification of pulmonary tuberculosis includes such ailments as primary tuberculosis, disseminated, miliary, also focal, infiltrative, caseous pneumonia, pulmonary tuberculosis. This also includes cavernous, fibro-cavernous, cirrhotic tuberculosis, as well as empyema. Let us consider in more detail each of them, since they have special significance in phthisiology.
Primary tuberculosis
This disease occurs when infected with bacteria of previously uninfected people, in which for the first time a positive reaction to tuberculin is observed. In this case, the infection penetrates the lymph nodes and causes their inflammation. The disease may not show symptoms or, on the contrary, show acute inflammation in the lungs.
Disseminated tuberculosis
The disease is characterized by the appearance in the lungs of a large number of lesions, which appears as inflammation caused by lymphogenous microorganisms.
Disseminated tuberculosis is acute, chronic and generalized. Most patients feel worse, but a small proportion of people detect the disease only after undergoing fluorography.
Focal tuberculosis
The classification of pulmonary tuberculosis explains focal tuberculosis as a lesion of the lungs that occurred for the first time against the background of the development of other forms of this disease and is expressed in productive inflammation of the respiratory organ. There is focal tuberculosis fresh or chronic. Symptoms of this ailment may not be manifested, therefore, it is often also detected only during fluorography.
Infiltrative tuberculosis
This ailment combines processes that are several foci with inflammation, which spreads to the lobes of the lung and progresses.
Infiltrative tuberculosis is round, cloud-like, broncholobular and can manifest as lobitis (an extensive infiltration, which occupies a whole fraction). Often such tuberculosis occurs under the guise of other diseases, therefore, it is recommended to conduct fluoroscopy and analysis of the sputum of the patient.
Caseous pneumonia
The disease is characterized by the presence in the lungs of necrotic zones, which are prone to cavernization. This form of tuberculosis is the most severe, as it is characterized by an acute progressive course. It is lobar and lobular.
The disease begins acutely, intoxication of the body occurs, purulent sputum appears with impurities of blood. In the early days of the disease, diagnosis is difficult, since a negative reaction to tuberculin is detected.
Tuberculoma
The classification of forms of pulmonary tuberculosis explains tuberculoma as a disease with an asymptomatic picture and a chronic form of the course. It is stable, regressive and progressive. The disease is characterized by the presence of dense inclusions or single foci in the surrounding lung tissue.
Cavernous tuberculosis
The disease is characterized by the presence of an air cavity without inflammation in the walls and tissues of the lungs. If pronounced fibrosis with multiple foci of seeding is attached to all this, then such tuberculosis is called fibrocavernous. This process is chronic.
A limited and common form of the disease is distinguished. Cavernous tuberculosis is a consequence of the treatment of other forms of the disease and is asymptomatic.
Cirrhotic tuberculosis
The disease is characterized by massive pulmonary fibrosis, where healed and active foci, caverns are observed. Periodically, the disease worsens in the form of pneumonia and bronchi. Cirrhotic tuberculosis is limited and diffuse. The disease provokes respiratory failure and inflammatory processes in the respiratory system. Seals in the connective tissue of the lungs are observed.
Pleurisy
This disease is an acute inflammation of the pleura, having a chronic form and arising from complications of tuberculosis. Such forms are distinguished:
- dry pleurisy;
- exudative pleurisy;
- empyema.
The classification of pulmonary tuberculosis explains the aforementioned disease as inflammation, which spreads in the pleural cavity, causes intoxication and accumulation of fluid in the pleural cavity.
Characterization of the disease process
The classification of the clinical forms of tuberculosis by the characteristics of its process depends on the presence or absence of MBT (mycobacteria) in the test material taken from the patient. Here, the duration of the disease process and the location of the affected areas are taken into account. Pay attention also to the presence of seals and scarring in the affected areas.
Complications
The complications that the disease can cause are the following points:
- blood spitting;
- bleeding in the lungs;
- sudden pneumothorax;
- fistula formation;
- atelectasis;
- pulmonary, renal and heart failure;
- amyloidosis and so on.
These manifestations can accompany the disease at all stages of its development, it all depends on the patient’s immunity.
Changes after illness
After cure for tuberculosis, changes in some organs may be observed. So, it may show up:
- the presence of calcifications in the lymph nodes and lungs,
- cirrhosis
- fibrotic, dystrophic and other changes in the respiratory system.
And also the presence of scars on different organs, their calcification and so on.
Classification Turban - Gerhard
At the beginning of the last century, the classification of Turban - Gerhard was recognized, which is based on the theory of the progression of pulmonary tuberculosis. It is considered quite simple and highlights the role of the spread of the disease for the further prognosis of tuberculosis.
But over time, this theory was refuted and another classification of tuberculosis began to be used. Tubran and Gerhard believed that at first the disease affects the upper sections of the lungs (the first stage of the disease), then it goes to the middle sections (second stage), then it affects the entire organ (third stage).
Modern classification of tuberculosis
Nowadays, it is customary to use the international classification of tuberculosis, which is constantly being improved. According to her, different types of tuberculosis are indicated by code combinations consisting of letters and numbers. It was adopted in 1973 and consists of four parts (A, B, C, D).
The classification of tuberculosis corresponds to the international classification of diseases, indicated by numbers. For example, code A15-A16 refers to a disease of respiratory tuberculosis.
In some countries, the classification of tuberculosis is used, where its destructive and non-destructive forms are distinguished. In the first form, the necrotic layer increases, which can go to the layer of lung tissue. There are foci of pneumonia, changes in the bronchi. So, cavernous, cirrhotic and fibro-cavernous tuberculosis are referred to destructive forms.
Thus, tuberculosis today is a particularly dangerous disease that is transmitted from an infected person by airborne droplets. The disease has several forms and classifications. It can be acute or asymptomatic and lead to various complications and even death.