A very unpleasant and deadly disease of pulmonary tuberculosis has existed on the Earth for millennia, as evidenced by archaeological excavations and numerous historical documents. In the modern world, he annually takes into the ranks of his victims about 10 million people, 25% of whom die.
The most unpleasant form of the disease is disseminated pulmonary tuberculosis, which means multi-focal, "spilled" over all the lungs. It is very easy to catch the infection, since the ways of its transmission are unusually simple, and the symptoms at the initial stages are almost invisible. In fact, each of us is at risk of getting infected every day, but, fortunately, not every organism is capable of developing tuberculosis. If a formidable diagnosis is nevertheless made, there is no need to despair, since now science has stepped so far that even disseminated pulmonary tuberculosis can be completely cured. To do this, you need not to shy away from routine examinations and scrupulously follow the appointment of a treating TB doctor. They say that knowing the strengths and weaknesses of the enemy is already a 50% victory. So let's see what tuberculosis is, where it comes from and how to deal with it.
Koch sticks
Disseminated pulmonary tuberculosis is caused by microscopic living organisms, the so-called mycobacteria. They exist on the planet for millions of years, but were discovered only in 1882 by the doctor and scientist Koch, in whose honor they were named - Koch's wands. There are 74 varieties of pathogenic mycobacteria (abbreviated ICD), 6 of which are capable of causing tuberculosis in humans and animals. They were called chopsticks because of the appearance of a really stick-like one. Some mycobacteria are perfectly even, some slightly curved, and both have a length of 1 micrometer to 10, and a width of about 0.5 microns.
A unique feature of them is the structure of their walls, or shells. Without going into details, we note that it at Koch's rods allows them to mutate an infinite number of times, defend themselves against the work of antibodies, which is killing for other parasites, and stably resist adverse environments. They even successfully use bacteriophages, the meaning of which is to protect our body from parasitic microorganisms. Being absorbed, Koch's sticks do not die, but modify macrophages so that they multiply quietly and at the same time be inaccessible to the protective systems of their host. In other words, Koch's sticks use the cellular defense of our body to invade it.
Once in the lungs of a healthy person, these parasites at first form single foci (primary tuberculosis), but then with blood and / or lymph spread to a large area of one or both of the lungs and other respiratory organs, thus disseminated pulmonary tuberculosis develops. Under certain circumstances, it can develop even after treatment for primary tuberculosis, since Koch's bacilli in an inactive form remain in the body for many years.
Infection pathways
Three types of bacteria cause human pulmonary tuberculosis - M. tuberculosis (human subspecies), M. africanum (intermediate subspecies) and M. bovis (animal subspecies). Cattle are the last to get sick, and it is transmitted to humans with unpasteurized milk.
Many people wonder if disseminated pulmonary tuberculosis is contagious or not. The answer is unequivocal: it is very contagious if it passes with the release of Koch sticks (tuberculosis bacteria).
They fall from a sick person to a healthy until unusually simple:
- they can be inhaled with air;
- with saliva (for example, when coughing, kissing);
- through the dishes used by the patient;
- through household items;
- from mother to fetus;
- when using insufficiently sterile medical instruments.
As you can see, you can get infected with tuberculosis anywhere: in transport, in public places, in educational institutions, at work, and so on.
Important: Koch's sticks are fantastically tenacious. They retain their dangerous properties outside the human body for a very long time. Here are a few examples of how many Koch sticks live in the environments that we encounter every day:
- in a dark place without sunlight - up to 7 years;
- in the dried sputum of the patient (remaining on any items) - up to 1 year;
- in the dust on the street - up to 60 days;
- on sheets of book publications - up to 3 months;
- in water - about 150 days;
- in unboiled milk - about 14 days;
- in cheese (butter) - up to a year.
Is it possible to negatively answer the question of whether disseminated pulmonary tuberculosis is contagious or not? Perhaps the Koch sticks present in the environment can be easily destroyed? Unfortunately, it’s not easy to kill these mycobacteria. Due to their unique cell wall, they practically do not suffer from sunlight, ultraviolet radiation, alcohol, acetone, acids, alkalis, many disinfectants, dihydrates, and when boiling objects with infected sputum they do not die for 5 minutes. If Koch's sticks could develop in the body of any person, tuberculosis would affect all the inhabitants of the planet Earth.
Risk groups
Even in preschool age, most babies pick up Koch's sticks, but disseminated pulmonary tuberculosis or any other develops only in weakened, painful children. Also included in the risk group:
- Persons who have been in close contact with tuberculosis patients for a long time;
- people with low immunity;
- HIV-infected;
- taking immunosuppressants;
- adolescents and middle-aged people during hormonal adjustment;
- starving;
- suffering from tuberculosis of the skin and other organs;
- suffered an infectious disease;
- ill with primary pulmonary tuberculosis and treated;
- long-term pass some physiotherapeutic procedures (for example, quartz).
Classification
Disseminated pulmonary tuberculosis can develop in the following ways:
1. With blood flow (hematogenous). In this case, both lungs are affected. Bacteria can enter the bloodstream through the affected lymph nodes, Gon foci, through the right heart and pulmonary vein.
2. With lymph (lymphogenous). In this case, one lung is affected.
3. Lymphogematogenous.
The nature of the course of the disease distinguishes disseminated pulmonary tuberculosis of the following forms:
- acute (miliary);
- subacute;
- chronic;
- generalized. They say about this type of disease when, for some reason, a breakthrough occurs in the blood vessels of the lymph node affected by mycobacteria, the structure of which has become curdled (caseous). In this case, a huge number of Koch sticks appear in the blood at the same time. Fortunately, this happens infrequently.
Acute tuberculosis
The disease begins abruptly, suddenly, the symptoms are very bright, a bit like pneumonia. The diagnosis is made on the basis of hardware examination of the lungs and microbiological sputum tests. Acute disseminated pulmonary tuberculosis is characterized by the presence in the lung tissue of many small (about a millimeter) tubercles resembling millet grain. Hence the second name - "miliary ( milae in Latin means" millet ") tuberculosis." The patient first changes the structure of the capillaries, collagen breaks down in them, and the walls become permeable, which leads to the penetration of mycobacteria from the bloodstream into the lungs. Symptoms are as follows:
- a sharp jump in temperature to 39.5-40 ° C;
- weakness, weakness, high fatigue;
- rapid pulse;
- lack of appetite;
- cyanosis of lips and fingers;
- yellowness of the skin;
- nausea before vomiting;
- headache;
- dry cough or sputum production, in which, in addition to mucus and pus, there are bloody streaks;
- shortness of breath.
Sometimes there is a pronounced toxicosis, up to loss of consciousness.
Subacute tuberculosis
It is observed when the disease spreads to large blood vessels (intralobular veins and interlobular arteries). In this case, foci of up to 1 cm in diameter are detected. They are located mainly in those segments of the lungs where there are many capillaries and lymphatic vessels. By nature, foci are proliferative, without inflammation and tumors, but they can lead to inflammatory processes in the visceral pleura.
Symptoms of the subacute form of tuberculosis can resemble many other diseases, which complicates the clinical diagnosis. Among the main ones there are:
- fatigue, weakness;
- temperature around 38 ° C;
- cough with sputum.
Chronic tuberculosis
This form of the disease is observed when the patient has not completely cured primary (fresh) tuberculosis. In such cases, mycobacteria repeatedly through the bloodstream or lymph flow from the primary foci to new segments of the lungs, as a result of which multiple foci of different sizes (from very small to rather large), of different shapes and structures appear in them. They can be calcined and completely fresh, with a bright inflammatory picture. Foci are found in both lungs. A disappointing picture is added by emphysema, fibrosis of various tissues in the lungs, pleural scars. Nevertheless, chronic disseminated pulmonary tuberculosis may not manifest itself externally, and therefore it is most often detected by fluorography. Symptoms of the chronic form of tuberculosis are as follows:
- increased fatigue;
- poor appetite;
- emaciation;
- frequent headaches;
- causeless rise in temperature (occasionally);
- cough.
Disseminated pulmonary tuberculosis: phases
It was previously believed that the first phase of infection occurs in the upper lobes of the lungs, II - in the middle, and III already reaches the lower ones. In the future, such a classification was recognized as incorrect, since the phases of the development of this disease can equally occur in any segments of the lung. To date, these phases of pulmonary tuberculosis are distinguished:
- focal;
- infiltration;
- decay;
- Office + (open form of tuberculosis);
- Office - (closed).
Disseminated pulmonary tuberculosis in the MBT + infiltration phase means the course of the disease with the release of mycobacteria into the environment. The main symptom is a cough with sputum, especially if pus and blood are present in it.
The focal phase is mainly characteristic of primary or fresh tuberculosis. It is characterized by the fact that only a couple or even one segment is affected. Moreover, the size of the outbreak is small (up to 1 cm in diameter). This phase proceeds without symptoms and is detected, as a rule, during a hardware examination of the lungs (x-ray, fluorography).
Disseminated pulmonary tuberculosis: phase of infiltration and decay
This nature of the course of the disease is obtained when it is not detected timely (the patient avoids the obligatory annual fluorography, does not go to the doctors for the first alarming symptoms, does self-medication or uses folk remedies, usually not effective enough as the main treatment). The decay phase means that the morphology of the foci in the lungs has reached the extent to which the tissues began to decay, forming real holes. Fragments of decayed tissue with a cough go out. They are sputum interspersed with pus and blood. Also, these fragments fall on segments of the lungs that are not yet susceptible to disease, as a result of which they are immediately seeded with mycobacteria. Patients diagnosed with disseminated pulmonary tuberculosis in the decay phase are a dangerous source of infection for others and are subject to mandatory hospitalization. Treatment in a hospital they have a long, up to six months. As a result, the decayed foci heal (calcify).
The infiltration phase is also observed in the progressive course of the disease, but in this case, lung tissue does not decompose. In general, an infiltrate is a site (focus) in which there is an inflammatory process. Many lymphocytes and white blood cells move to this place, and the symptomatology resembles acute pneumonia. Disseminated pulmonary tuberculosis in the infiltration phase has the following symptoms:
- a sharp increase in temperature to high levels;
- weakness, weakness;
- chest pain;
- cough;
- signs of intoxication;
- headache;
- sometimes weakening of consciousness.
Without rapid treatment, tissue disintegration begins at the site of infiltrates. The patient coughs them out or in the process of coughing moves to the second lung, where infection of former healthy tissues occurs very quickly. Tuberculosis in the phases of decay and infiltration is fraught not only with an increased risk of infection for others, but also a fatal outcome for the patient himself.
Diagnostics
It is not always easy to immediately establish disseminated pulmonary tuberculosis in a patient. Diagnosis is difficult due to the fact that the symptoms of this disease and pneumonia, acute respiratory viral infections, even metastatic cancer are very similar. When contacting a patient with a complaint of fatigue, cough, pain in the larynx, weakness, shortness of breath, the doctor must examine the skin for scars that may remain from previous paraproctitis and lymphadenitis. The symmetry of the chest is also examined (it is not there if tuberculosis develops in one lung), soreness and muscle tension in the shoulder girdle are checked. When listening to the lungs with a stethoscope, it is revealed whether there are wheezing, what is their localization and nature. Laboratory tests of sputum for the presence of mycobacteria are mandatory. In some cases, bronchial or gastric lavage water is taken for examination from patients (most often in children). In addition, laboratory tests may include:
- bronchoscopy;
- sputum microscopy;
- pleural biopsy;
- thoracoscopy;
- pleural puncture.
The most widely used and accurate are fluoroscopic examinations.
Treatment and prognosis
If the doctor has diagnosed disseminated pulmonary tuberculosis, the treatment will be long and multifaceted. The prognosis depends on the phase in which the disease is detected, and how accurately the patient complies with the instructions of the doctors. With any type of pulmonary tuberculosis in the phase of the office + the patient is hospitalized. In the hospital, they mainly carry out drug therapy (chemotherapy), which consists of anti-TB drugs, physiotherapy, and vitamins that strengthen the immune system.
Chemotherapy in newly diagnosed patients in the intensive phase of treatment is carried out with the following anti-TB drugs: Isiniazide, Rifampicin, Pyrazinamide and Ethambutol, and in the continuation phase, Isoniazid and Rifampicin or Isoniazid and Ethambutol "
In acute disseminated tuberculosis, the use of corticosteroids and immunomodulators is indicated. Most often prescribed "prednisone" (15-20 mg / day for 6-8 weeks).
The duration of treatment is up to 6 months. If within 3 months there is no tendency to improve, as well as for a number of other indications, it is possible to use surgical intervention, which consists in removing a separate pulmonary segment or the lung as a whole.
Now we are using the latest method of treating tuberculosis, called "valve bronchial block", or simply "bronchial block", which is an alternative to surgery.
Prevention
Pulmonary tuberculosis is considered a social disease, the spread of which largely depends on the quality of life of the population (living conditions, migration, serving sentences in prisons and so on). As preventive measures, especially for disseminated pulmonary tuberculosis, we can name:
- mandatory passage of fluorography;
- carrying out anti-epidemic measures;
- BCG vaccination;
- allocation of funds by the state for the treatment of tuberculosis patients;
- maintaining an active (playing sports), healthy lifestyle;
- the passage of patients with a full course of treatment of focal tuberculosis.