At the moment, several societies are threatening modern society at once, which threaten to turn into pandemics. These are diseases such as HIV, hepatitis B and C, and, of course, tuberculosis. A high percentage of mortality and disabling consequences do not leave a person a chance to fight the disease, and if we take into account that the diagnosis depends on the patients themselves, their trust in the doctor and the desire to be treated, then we have, to put it mildly, an unpleasant picture.
Definition
Caseous pneumonia is a form of pulmonary tuberculosis. It is more malignant than ordinary pneumonia caused by coccal flora. And it is characterized by the predominance of necrotic processes in the lungs with the formation of curd masses instead of normal pulmonary parenchyma. Over time, they undergo lysis, and large cavities remain in their place. Subsequently, they can both scar, which reduces the airiness of the lungs and, accordingly, the amount of incoming oxygen, and expand, pushing the organ parenchyma to the periphery. This process also negatively affects gas exchange and leads to the progression of exogenous hypoxia.
Classification
Depending on the area of the damaged tissue, caseous pneumonia is divided into three subtypes:
- Lobar. An independent form that captures the entire share. Since the volume of damaged and necrotic tissue is large, a severe intoxication symptom predominates in patients. As a result, the lung melts, and caverns form.
- Lobular form, or lobulitis. This is a complication of existing tuberculosis. Unlike the previous one, it affects several lobes, causing severe poisoning by tissue decomposition products.
- Acinous. It is considered as a complication of miliary (loose) tuberculosis. Despite the fact that the acinus is the smallest part of the lung, the disease is extremely difficult to carry, since it is usually not single sites that are affected, but the entire organ parenchyma.
Epidemiology
As noted above, tuberculosis is complicated by this type of disease, as caseous pneumonia. The history of the disease goes back more than one hundred years, and during this time people could not come up with a treatment. The antibiotics that patients are taking now will become irrelevant in ten to twenty years, because the pathogen will have time to develop resistance to this chemical effect.
The disease develops rapidly, the first symptoms appear quite quickly after infection. The toxins that bacteria produce negatively affect the immune system, weakening it. The main contingent prone to caseous pneumonia are socially disadvantaged people. And not only because of the lack of basic hygiene, poor nutrition and living conditions, but also because of the refusal to treat the main pathology.
Disease development
Due to the rapid division and growth of mycobacterium tuberculosis in the lungs, general and local immunity is suppressed. Microorganisms produce enzymes that have toxic effects on cellular immunity, triggering the apoptosis process (programmed cell death). Thus, after the accumulation of a certain critical mass of bacteria, a malfunction in the protective mechanisms of the human body begins. A significant prevalence of the pathogen in the internal organs and toxicity of drugs lead to a decrease in the function of the liver, adrenal glands, degeneration of the heart muscle and damage to the nervous system.
Locally, against the background of a decrease in immunity, necrotic processes are observed in the pulmonary parenchyma, multiple foci of inflammation with curdled masses inside. Gradually, they dissolve with the body’s own enzymes, and caverns (cavities) appear in their place.
Symptoms
The clinical course of caseous pneumonia may have several scenarios:
- Pneumonic, i.e. similar to classical pneumonia - high fever (up to forty degrees), chills, wet cough, chest pain, severe shortness of breath.
- Flu-like - catarrhal phenomena (runny nose, lacrimation, laryngeal edema) prevail over intoxication. There is a slight temperature, there may be a cough.
- Sepsis - a very high temperature (up to forty-forty one degrees), intoxication, migraine, cough.
Initially, no alarming symptoms are observed. Light dry cough, fever at night, loss of appetite. They can last long enough until the cough turns from dry to wet, and a viscous greenish sputum appears. At this point, the temperature is already dropping, and respiratory failure, on the contrary, is increasing. The doctor may suspect that the patient has caseous pneumonia. Symptoms are nonspecific, but in conjunction with analyzes and a history of life, the diagnosis becomes clear.
Diagnostics
In addition to collecting an anamnesis of the disease and an anamnesis of life, the doctor must carefully examine the person, possibly palpate his lymph nodes, listen to his breath. But in order to accurately verify that his assumptions are correct, the doctor sends the patient to laboratory and instrumental studies:
- X-ray of the chest. Phthisiatricians found characteristic signs that are inherent in a disease such as caseous pneumonia. The photo of the lung image presented above allows you to see the multiple foci of melting organ tissue.
- Mantoux test, or diaskintest. A simple and relatively quick way to detect the presence of tuberculosis immunity. But he does not give a one hundred percent guarantee of the development of the disease, and can be either false positive or false negative.
- Sputum microscopy. The patient is asked to collect sputum for three days in a sterile jar. Then it is taken to a laboratory where it is placed in a special Levenshtein-Jensen medium containing many nutrients necessary for bacterial growth. And only after a week will it be known whether a person secrets a Koch wand or not.
- It is mandatory to carry out standard analyzes for the clinical diagnosis: a general analysis of blood, urine, blood biochemistry, blood sugar, feces on an egg-list.
Differential diagnosis
First of all, the doctor needs to make sure that the patient really has caseous pneumonia. Differential diagnosis in this case helps to exclude diseases that are clinically very similar to the pathology we are considering. And in the first row is the usual croupous, or pleuropneumonia. Their only difference will be the nature of the necrotic masses and the pathogen. The remaining parameters are similar.
A second assumption may be pulmonary infarction. But it is enough to make an angiogram to exclude this scenario. In addition, the patient should have a history of either trauma or atherosclerosis, or the introduction of air and / or oily solutions into the bloodstream.
The third disease to compare is lung gangrene. In the process of developing this pathology, there is fever, severe intoxication, but there will be no cough and sputum.
Treatment
Once diagnosed with caseous pneumonia, treatment is started immediately. A person is transferred to a special TB hospital, where it is possible to observe a suitable bed rest and diet.
First, the doctor deals with the relief of an acute condition, whether it is toxic shock or respiratory failure. For this, the patient is given infusions of sorbents and diuretics, plasmapheresis is performed. Then comes the turn of active therapy, when antibiotics, antihypoxants, anticoagulants, hormones, interferon enter the battle. Specific therapy involves the use of antibiotic regimens designed specifically for mycobacterium tuberculosis.
Forecast
Caseous pneumonia is quite difficult to treat, so the consequences for life and health will most likely be irreversible. It is even possible complete destruction of the lung, which inevitably leads to respiratory failure.
The recommendations that TB doctors give to people with an identified Koch wand are that you should not start the disease. It is necessary to start treatment on time and go through it completely, but due to the low socialization of patients, as well as their living conditions, caseous pneumonia remains a frequent complication of tuberculosis. This is an epidemic that doctors today are practically unable to cope with.