Cirrhotic pulmonary tuberculosis is a very dangerous form of the disease, which is quite rare. The clinical picture is pronounced, mainly shortness of breath and cough develop, which are characteristic of absolutely any disease of the bronchopulmonary system.
Treatment must be carried out in specialized clinics, as this allows you to monitor the well-being of the patient and monitor the treatment. If treatment is not done in a timely manner, then irreversible changes in the lungs may occur, which often leads to the death of the patient.
Causes of the disease
The cause of cirrhotic pulmonary tuberculosis is the penetration of microscopic bacteria into the body. Pathogens are characterized by a high level of virulence, so infection can occur at any time. A lot depends on the state of human health, the presence of concomitant diseases. Environmental factors largely influence the survivability of bacteria.
In some cases, this type of pathology begins to develop after a complicated course of primary tuberculosis, when in the absence of the required treatment inflammation develops on the walls of the bronchi. There are several types of tuberculosis that contribute to the formation of a cirrhotic form, namely such as:
- chronic disseminated;
- infiltrative;
- fibro-cavernous.
Cirrhotic tuberculosis can form in various parts of the lung, which is why doctors distinguish between unilateral and bilateral lesions, as well as distinguish such forms as lobar, segmental, and also total.
Predisposing factors
With cirrhotic pulmonary tuberculosis, an initial infection occurs, that is, a sufficient number of pathogens penetrate the body. The most common transmission route is airborne, and less commonly, the disease is transmitted by alimentary, contact, or transplacental route.
Often the disease is diagnosed in people who live in adverse conditions, and it develops against the background of many other pathologies, as well as a persistent decrease in immunity. The lungs begin to secrete a lot of mucus, which should help remove the infection from the bronchi. However, when there are a lot of pathogens or the body is very weak, then inflammation begins to develop in the bronchopulmonary system, after which the infection penetrates into the lower parts of the lungs.
The causative agent of tuberculosis can penetrate the digestive system along with food, while the intestinal walls are affected by various pathologies and cannot normally protect the body. There are certain predisposing factors that significantly aggravate the course of the disease, and these include:
- diabetes;
- poor nutrition;
- ulcer;
- stress
- alcohol abuse
- addiction;
- pregnancy;
- taking immunosuppressants, hormonal drugs.
Most often, cirrhotic pulmonary tuberculosis develops in people over 60 years of age. This is due to a more active restructuring of the pulmonary parenchyma in old age. In young people, the onset of this form of the disease can occur with improper or untimely treatment of primary tuberculosis.
The main symptoms
Cirrhotic pulmonary tuberculosis is characterized by a rather slow progression, however, it leads to irreversible consequences. The main criterion for the clinical picture is the undulating course of the disease. The period of exacerbation is replaced by relief of symptoms. Intoxication manifestations of the disease gradually decrease until complete disappearance. With the localization of the inflammatory process in the upper part of the lungs, the symptoms may not be very pronounced. The patient is concerned about shortness of breath and a dry cough. With such a course of the disease, it is very important to correctly conduct timely comprehensive diagnostics.
In case of damage to the lower part of the lung, patients experience severe discomfort in the hypochondrium during coughing. In this case, sputum is expectorated, blood and purulent discharge, severe shortness of breath are observed. Various types of fibrotic changes predominate in the lung tissue, as well as a very strong inflammatory process. With a prolonged course of the disease, patients may experience signs of cirrhotic tuberculosis, such as:
- discomfort and pain in the sternum;
- sputum and mucus secretion;
- wheezing, coughing and hard breathing;
- violation of protein metabolism;
- expectoration of blood;
- cyanosis of the skin;
- pulmonary hemorrhage;
- temperature rise.
In the presence of complications, purulent bronchitis and pneumonia can also join this disease. Repeated bleeding in the lungs is also possible. Such a course of the disease can lead to suffocation and death of the patient.
Cirrhotic pulmonary tuberculosis is a rather dangerous disease, which is why complex diagnostics and thorough treatment are required.
Diagnostics and its implementation
With cirrhotic pulmonary tuberculosis, the doctor conducts a medical history carefully, as it is necessary to record even the smallest changes. Before treatment, it is necessary to perform a comprehensive diagnosis. To diagnose cirrhotic tuberculosis, you need to carry out a set of measures that complement each other. In particular, surveys such as:
- collection of medical history and initial examination;
- radiography;
- laboratory research;
- bronchoscopy.
When conducting a patient examination, a specialist, in addition to the severity of the course of the disease, should pay attention to the duration of its course. When performing a physical examination of the patient on the affected area, trembling and increased breathing can be detected with an upper lobe lesion, and also weakened with a lesion in the lower part of the lungs. Wheezing can be wet or dry.
The most effective research technique is x-ray. With cirrhotic pulmonary tuberculosis, the image can determine the presence of a lesion, since it is isolated from lung tissue. There is also a noticeable condensation of the pleura and a partial shift of the mediastinal organs to the area of pathological damage.
In addition, the doctor may prescribe laboratory tests for sputum, in which pathogens can be detected. It is worth noting that with cirrhotic lesion, a tuberculin test is not the main diagnostic method.
A sufficiently informative method of research, which allows to determine the presence of cicatricial and inflammatory stenoses, as well as purulent bronchitis, is fibrobronchoscopy. In some cases, differential diagnosis may be required. With cirrhotic tuberculosis of the lung, the doctor’s conclusion regarding the course of the disease is based on the examination. Based on this, the most suitable method of therapy is selected.
Treatment features
In the presence of the first signs of the disease, it is necessary to consult a pulmonologist or phthisiologist. Cirrhotic pulmonary tuberculosis can be treated with antibiotics and anti-TB drugs. In particular, such drugs as R-Butin, which refers to broad-spectrum antibiotics, as well as R-Tsineks, which is a combined anti-TB drug, are prescribed.
In addition, a number of expectorants and inhalations are prescribed. In order to prevent a strong proliferation of cirrhosis and complications, removal of a part of the lung can be prescribed. After surgery, it is necessary to ensure a competent nursing process. With cirrhotic pulmonary tuberculosis, this care implies a set of rehabilitation measures aimed at restoring normal breathing.
With an exacerbation of the course of the disease, tracheobronchoscopy can be prescribed. Hospitalization of the patient in a hospital of a TB institution is shown. Depending on the well-being of the patient, a specific diet of the patient and a motor regimen are prescribed.
Chemotherapy
The main method of treatment for all forms of tuberculosis is chemotherapy, which involves the use of drugs that help cope with pathogens. Therapy with anti-tuberculosis drugs should be continuous and systematic in nature, as this will achieve a lasting clinical effect. Basic chemotherapy involves the use of drugs such as:
- "Isoniazid";
- "Pyrazinamide";
- "Rifampicin";
- Ethambutol.
In the case of periodic exacerbations of the disease, a longer treatment is required, which can last for several years. In this case, you must carefully keep a history of the disease of cirrhotic pulmonary tuberculosis, as this will allow you to track the dynamics of the pathological process.
Surgical intervention
In especially severe cases of the course of the disease, surgical intervention is recommended. The main indicators for carrying out such manipulations are:
- lack of effectiveness of chemotherapy;
- resistance of tubercle bacillus to medications;
- the presence of irreversible pathological changes;
- serious complications that threaten the life of the patient.
The type and degree of surgical intervention is determined depending on the location of the lesion, as well as the level of its prevalence. In particular, such types of operations as:
- lobectomy;
- lung resection;
- pneumonectomy.
Lobectomy involves the removal of the affected area of the lung. It is carried out by open incision of the chest or by introducing into the sternum of the chamber and instruments through a small puncture. Pneumonectomy involves the complete removal of one of the lungs. After the operation, radiation therapy is prescribed. Full recovery occurs after about a year.
Resection of the lung implies a partial removal of the affected area of the lung. Sometimes several segments or lobes of this organ are removed. With extensive lesions, regional resection is indicated. The sooner the treatment is carried out, the more chances the patient has for a successful recovery.
Symptomatic therapy
Prolonged use of anti-TB drugs can cause side effects. In this case, symptomatic therapy is required. Particular attention should be paid to nutrition, as well as compliance with the treatment regimen.
It is recommended to perform gymnastics daily, engage in moderate physical labor, as well as take daily walks. The patient is shown enhanced nutrition. The diet should be high in fat and protein.
With excessive proliferation of connective tissue, hormonal preparations are indicated. These include drugs such as Dexamethasone, Prednisolone, and Hydrocortisone. If an inflammatory process is observed, then glucocorticosteroids are prescribed, since they help reduce fluid accumulation. To stimulate immunity, you need to take tuberculin and BCG vaccine.
The appointment of antioxidant drugs will also be quite appropriate. They help to accelerate the resorption of pathological foci, slow down the growth of fibrous tissue, and also help to accelerate the healing process of the formed cavities.
Emergency conditions
With the course of cirrhotic tuberculosis, serious complications may occur, which require very careful diagnosis and medical care. Emergency conditions include:
- bleeding in the lungs;
- acute pulmonary heart disease;
- spontaneous pneumothorax.
If possible, then you must regularly undergo sanitary and spa treatment in specialized institutions. Critical conditions are associated with changes in the pulmonary and bronchial structures, resulting in impaired respiratory function. With the death of a large number of capillaries and alveoli, gas exchange in the lungs significantly deteriorates.
With respiratory failure, hypertrophy of the heart muscle occurs. Over time, the myocardium is depleted, and heart failure occurs. This leads to severe circulatory disorders, which often ends in the death of the patient.
Prevention and prognosis
Prevention means avoiding contact with people with any form of tuberculosis. In case of infection, every effort should be made to prevent the subsequent progression of the disease. A patient with pulmonary tuberculosis is categorically contraindicated in hypothermia, and the patient must strictly observe all the recommendations of the doctor. An important role is played by specific prophylaxis, which implies vaccination.
With cirrhotic pulmonary tuberculosis, the prognosis largely depends on the complications arising from the course of the disease, as well as the localization of the lesion. The cause of death of the patient may be bleeding, heart and pulmonary failure and damage to internal organs.