The first information about tuberculosis appeared several centuries ago. Even such famous doctors as Avicenna and Hippocrates wrote about this disease in their writings. But more consciously, tuberculosis began to be studied only from the 18th century, due to the fact that the cause of this disease was found.
The history of pulmonary tuberculosis began to be interested in about 5,000 years ago. The ancient doctor Balters, when examining the human skeleton, found three thoracic vertebrae affected by tuberculosis.
A significant niche in the study of the disease is Ancient Egypt. The history of the discovery of the disease tuberculosis is very ancient, since Egypt played a direct role in spreading knowledge about it in other countries. It was there that papyrus was discovered, which described in detail all the symptoms of the disease. This is chills, cough, fever, fever, diarrhea, and chest pain.
In Greece, outbreaks of tuberculosis had a more transient form and were expressed as inflammation on the skin, abscesses on the lungs. When the patient cleared his throat, the contents of the abscesses came out and cavities formed, which subsequently increased in volume. The lungs were destroyed, and the patient died from a fever.
In ancient times, there were many different strange rules associated with the disease. One of them, for example, is that a man could divorce his wife if she was exposed to this lung disease (or, as it was called, “consumption” in those days). Here is a story.
Tuberculosis has been studied for many centuries, but only the German scientist R. Koch was able to establish the real cause of the disease. He discovered the microbacterium that caused tuberculosis. This bacterium later became known as Koch's bacillus.
If we talk about the emergence and history of tuberculosis in Russia, then we can say that they began to study it thoroughly only at the beginning of the 20th century. Researcher Abrikosov described foci of inflammation in the lungs that appear at the very beginning of the disease. This sign also acquired the name of the discoverer - the hearth of Abrikosov.
Types of disease
Tuberculosis can be classified according to various criteria. The most commonly used classification is by type:
- Chronic tuberculosis The disease is characterized by a mild course for the patient and the occurrence of pulmonary fibrosis. The disease manifests itself as pleurisy and general infection of the body, bronchitis and high fever.
- Focal tuberculosis. In this case, completely one or both lungs are affected. This ailment can proceed unnoticed, without special symptoms and quite often turns into a chronic disease.
- Infiltrative pulmonary tuberculosis. The doctor begins to fill out the medical history when symptoms of necrotic decay are detected. At first glance, the disease is invisible and can occur in the form of a cold.
- Fibro-cavernous tuberculosis. One of the most dangerous types of ailments.
- Multidrug-resistant tuberculosis is considered a relatively new type in medicine. This is a pathology that is resistant to the effects of antibacterial agents and antibiotics.
Focal tuberculosis
This form of secondary tuberculosis, the characteristic of which is manifested in the formation of foci of inflammation, each of which is no more than 10 mm in diameter. The course of the disease occurs asymptomatically or with little noticeable symptoms. In some patients, this form of tuberculosis may be accompanied by general weakness in the body, pain in the side and a dry cough.
Studying the clinical history of the disease focal pulmonary tuberculosis, it can be concluded that this disease can be detected using x-ray of the lungs, taking sputum for analysis for viruses and bronchial swabs. Since this disease can occur many years after the treatment of basic tuberculosis, adults are more susceptible to the disease.
By looking at outpatient medical history of focal tuberculosis, you can classify this form of the disease according to the time course. The disease can be recent (mild focal) or already chronic.
There may be several causes of the disease. The most basic is direct contact with the sick. In this case, infection is possible by airborne droplets. Or if the old disease was not treated and progressed slowly over several years.
Until the mid-18th century, people thought that tuberculosis is a hereditary disease, and no one knew that this disease could be transmitted by communicating with each other. Until the 19th century, no one suspected that there was any medicine that could help the patient recover. Patients were left in special sanatoriums or homes, prescribing a special diet that did not affect the virus. Then, tests were just begun on animals, which, by the way, are also susceptible to this disease and often die from it. The first vaccination against the disease was done only in 1921. Tuberculosis was treated only in monasteries, patients were placed there.
If you carefully look at the extracts from the history of the disease with focal tuberculosis, it becomes clear that the symptoms of the disease practically do not differ from other forms. This is an increase in temperature and sweating, weight loss and appetite.
Multidrug resistant tuberculosis
Based on the medical history of multidrug-resistant tuberculosis, it is possible to identify how to correctly make this diagnosis. The patient is admitted to the institution with complaints of cough with low sputum production, fever up to about 37 degrees, fatigue and weakness of the body, migraines and headaches that occur more in the evening, and increased night sweats.
What you need to pay attention to when examining a patient:
- The skin. Are there pressure sores, allergic rashes, or ulcers? The skin should be moderately moist and supple. Visible mucous membranes should be normal in color, normal toenails, and no hand tremors.
- Lymph nodes should not be inflamed
- Subcutaneous fat is normally developed, there are no edemas and veins and capillaries are not visible.
- Respiratory system. When breathing, the movement of the chest is fairly uniform, and the full volume of the lungs is involved. Additionally, no muscles are involved, breathing does not cause discomfort.
Studying the clinical history of pulmonary tuberculosis of a particular patient, it should be determined whether the lymph nodes are inflamed. For this, it is necessary to palpate them. If you feel the ribs and the spaces between the ribs, then this can bring some pain to the patient, a trembling voice is expressed.
Medical history for infiltrative pulmonary tuberculosis
Below is an example of a medical history that the attending physician fills.
Patient Complaints:
- headache;
- temperature increase to 37 degrees;
- general weakness of the body and lack of appetite;
- mild cough with a small amount of sputum.
The condition of the patient upon examination. At the initial examination, no deviations from the normal state of the body were found. When examining the respiratory systems, it can be said that signs of infiltrative tuberculosis will not be detected, it can only be determined by x-ray or fluorography of the lungs. The studied patient, whose case was accepted for consideration, had a history of infiltrative tuberculosis of the left lung in the medical history.
On his roentgenogram, an infiltration site was found in the upper lobe of the left lung. The structure is heterogeneous, the intensity is quite low and no clearly defined boundaries are visible.
In many patients, as can be seen from some case histories of infiltrative tuberculosis of the left lung, the symptoms of the disease resemble vascular problems. Between the first and further manifestations of the symptoms of the disease, there may be stages of improving the general condition of the body. Therefore, a person begins to think that this is just an acute respiratory disease and will not go to the doctor in time.
As can be seen from the outpatient history of the disease of infiltrative tuberculosis in the decay phase, quite often the disease is accompanied by hemoptysis.
What you should pay attention to in blood tests for such a disease are indicators of monocytes and lymphocytes. Judging by the outpatient records of patients and their medical histories, infiltrative tuberculosis of the left lung can sometimes be mistaken for pneumonia. So the specialist should be extremely careful.
Considering different medical histories of infiltrative tuberculosis of the right lung, it can be found out that upon examination the patient showed pain in the chest on the right during palpation, wheezing is heard slightly, breathing is weakened. Laboratory studies have shown the virus in sputum, infiltration in the right lung and the resulting inflammatory processes that go to the root of the lung. This all makes it possible to make such a diagnosis as infiltrative tuberculosis.
Disseminated tuberculosis
Disseminated tuberculosis is a disease that is characterized by the appearance of small focal inflammations with the flow of blood or lymph. It can occur acutely, chronicly or subacutely.
Acute tuberculosis is more spread only through the blood. It can be small focal (with inflammation no more than 1-2 mm) and large focal (the diameter of the inflammation can reach up to 10 mm). Small focal tuberculosis can occur as a fever, affecting the lungs, or as a manifestation of meningitis. Acute disseminated tuberculosis occurs in the form of pneumonia. The foci of inflammation are quite large and symmetrical. The progression of this disease can lead to necrosis of the tissues of the organ.
By studying the medical histories of disseminated tuberculosis, you can learn how to properly approach the definition and treatment of this disease.
What should I do if a patient complains of a mild cough, fever, weight loss and weakness when contacting a medical institution. In this case, the doctor prescribes tests, such as a UAC (general blood test), biochemistry, tests of the urethra and sputum (sputum is taken for the presence of viral diseases), an x-ray.
On x-rays with this disease, infiltration in the root zone and in the right segment on the left will be clearly visible. In all the lungs, a change of varying intensity is observed.
According to the medical history of disseminated pulmonary tuberculosis, after several months of an ailment, an x-ray can show the progression of foci of inflammation and a change in the structure of the roots of the lungs, for example, expansion. Adhesions may be observed on the diaphragm.
As the specialist’s records in the history of disseminated tuberculosis indicate, the patient is prescribed treatment with Isoniazid (20 mg per 1 kg of body weight), Paraaminosalicylic acid 300 g per 1 kg of body weight or Protionamide.
Cirrhotic tuberculosis
This type of tuberculosis is characterized by the appearance of connective tissue in the pleura as a result of untreated other forms of tuberculosis. It is formed due to untimely determination of the disease and the lack of initiation of treatment. Or the disease can be considered as a consequence of fibro-tricky tuberculosis. The degree of proliferation of connective tissue is divided into several categories:
- The first is called sclerosis - a process in which scar tissue spreads between the alveoli, disrupting the lung tissue and provoking lung emphysema.
- The second is called fibrosis, a process of development of connective tissue that replaces dead lung cells.
- The third is called cirrhosis - the spread of connective tissue, depriving the lungs of their primary function.
When studying the medical history of cirrhotic tuberculosis, you can see that the disease is almost asymptomatic, the patient determines only the occurrence of shortness of breath and dry cough.
A more severe form is already occurring with symptoms of fibrosis and inflammation. Dyspnea and cough are already accompanied by sputum production with pus or blood. There is also tachycardia, swelling and heaviness in the hypochondrium. If the disease is not treated for quite some time, then other organs begin to become inflamed.
The question is how to properly diagnose the disease. The most important thing you need to do is to take an x-ray. If a one-sided focal inflammation occurred in the body, then the areas with medium and intense shading are clearly visible in the pictures. If the disease affects the whole lung, then the entire area will be darkened, light areas will most likely speak of bronchiectasis or residual caverns.
The determination of the median lobe cirrhotic tuberculosis is possible by x-ray, if the darkened area corresponds to the volume of the shrunken middle lobe. If pathological changes are detected, then an X-ray shows a decrease in the volumes of the upper sections and a decrease in transparency.
How is cirrhotic tuberculosis treated?
If, based on the patient’s medical history, tuberculosis was detected at the initial stage, then non-specific chemotherapy can be used for treatment to relieve symptoms and improve the functioning of the cardiovascular system.
If we talk about other stages of tuberculosis, then we can say that with an exacerbation of the disease, antibiotics should be administered intravenously in order to stop the spread of connective tissue and give help to the body in the fight against the disease. More advanced stages are treated only in a surgical manner. If tuberculosis affects both sides of the lungs, then it can even lead to partial amputation.
Generalized tuberculosis
Generalized tuberculosis is the most dangerous form of manifestation of an infectious disease. It is practically untreatable. A characteristic distinguishing feature is the occurrence of focal inflammation throughout the body.
Microorganisms are scattered throughout the patient's body and affect healthy organs. As a rule, the disease spreads with blood, so the disease is very difficult to treat.
Considering the history of the disease with generalized tuberculosis, we can say that the symptoms of the patient are the same as with other types of this disease. Just as mentioned above, they absolutely can not be ignored. It’s very difficult for a doctor to make an accurate diagnosis immediately, only because of the symptoms, since they are similar to each other.
The disease is most severely transmitted by HIV-infected people, since the body is already weakened by a terrible virus. If tuberculosis is also superimposed on top, then pathogens simply begin to kill healthy organs.
Diagnosis and treatment
As mentioned above, generalized tuberculosis is rather difficult to diagnose. It also interferes with the correct diagnosis and the fact that x-rays practically do not show focal inflammation, and tests for tuberculosis do not give a positive result.
To treat this complex form of the disease, doctors prescribe drugs that help maintain and enhance immunity, increase the efficiency of the liver, and also prescribe vitamins. The complex is supplemented by breathing exercises and physiotherapy.
Cavernous tuberculosis
Cavernous tuberculosis is a form of the disease for which a distinctive feature is the presence of focal inflammations - caverns. This form of the disease is only an intermediate stage between diseases. Tuberculosis caverns can be divided into several types:
- Cavities that develop in places of recent disintegration and are still completely separate from lung tissue.
- Cavities that form as two-layer walls.
- Cavities formed in the form of three-layer walls, in this case, you can accurately make the correct diagnosis.
- Fibrous, which are surrounded on the outside by fibrous formations. This pathology can be described by specialists in many case histories of fibro-cavernous pulmonary tuberculosis.
- Cavities that are cleansed of caseosis and granulation, to a greater extent, are already manifested as residual effects after the disease.
When compiling a case history of cavernous tuberculosis, the specialist should mention that the patient went to the doctor with complaints of a strong cough that did not go away during the day. Sputum was characterized as mucous and yellow, discharge was accompanied by shortness of breath when walking. Increased sweating, lack of appetite.
After an X-ray, the image showed that the lower lobe of the left lung is marked by the appearance of a cavity, the pleura was stratified against the background of many polymorphic foci of inflammation in the lower lobe. The middle and lower sections are also characterized by scattered foci and root compaction.
The treatment takes place with the help of drugs "Turbazid", "Rifampicin", "Pyrazinamide", "Ethambutol", "Isoniazid".
Lupus
If pulmonary tuberculosis is heard everywhere, then someone can hear about skin tuberculosis for the first time. The causative agents of this disease are bacteria that penetrate the body through the skin. The most dangerous bacteria are those that cause bovine or human tuberculosis.
When infected with this disease, the first symptoms can occur only after a month. The infection site becomes inflamed and becomes covered with a red-brown crust, as a result, an abscess arises at this place. The most susceptible to this type of tuberculosis are children.
The exact causes of the disease, even after studying various case histories of tuberculosis patients, are still not known. But scientists hypothesized that those who have some problems in the body are more prone to the disease:
- Dysfunction of the endocrine system.
- Extreme nervous agitation or diseases of the nervous system.
- The problem of the functioning of the urinary system.
- Lack of light and a lot of time spent in a damp room.
Based on a different history of skin tuberculosis disease, we can say that there are several types of diseases. Today, only two forms of skin tuberculosis are distinguished - these are focal and disseminated. The difference between them in the causes and methods of treatment.
Collicative tuberculosis of the skin
This skin disease is secondary and manifests itself in those who already suffer from tuberculosis that affects the lymph nodes. Then the infection penetrates deep into the skin and provokes the occurrence of softening of the tissue and bluish edema. These manifestations occur on the neck, jaw, elbows and limbs.
Miliary ulcer tuberculosis
This type of disease occurs against the background of already progressing tuberculosis of the liver or intestines, as well as lungs. With daily excretions of the body, skin damage also occurs. Spherical inflammation appears at the site of the lesion, developing into painful bleeding ulcers.
Lupus tuberculosis
This form is the most common. It proceeds very slowly and chronically. Doctors have noted cases of a lifelong course of this type of disease. Most of the disease affects the face, namely the cheeks, lips and nose. It is characterized by many small smooth rashes of red-brown color, which with the progression of the disease begin to peel off.
In some cases, localization is possible in one place in the form of a tumor - on the nose, in the ear. Treatment may be limited to x-ray or lightening. In extreme cases, surgical intervention may be necessary.
Warty skin tuberculosis
The male part of the population, whose work is connected with the blood of animals, suffers from this species to a greater extent. It can be butchers, veterinarians working in slaughterhouses.
A feature is inflammation of a white color in the form of a tubercle on the fingers or feet. Treatment may be with drugs or radiation.
Lichenoid tuberculosis
Looking at the case history of tuberculosis in a child (groups of different children), it can be revealed that lichenoid tuberculosis is a disease that affects most children.
Appears as a rash of gray-red tint on the skin of the buttocks, face or hips. Pain does not accompany these rashes, they are rough to the touch. They also appear as a side effect of a disease of internal organs.
After the body is completely cured of tuberculosis, the rashes disappear by themselves. Scars may remain very rare. Treatment is absolutely the same as with other forms of the disease.
Papulonecrotic tuberculosis
This form of the disease affects the skin of the whole body, face and limbs. Inflammation manifests itself in the form of small violet inflammations, densely located to each other. With the further course of the disease, inflammation can become sores.
Diagnosis of the disease occurs with the help of histological studies. Treatment occurs by treating the affected areas with ultraviolet radiation, as well as taking anti-TB drugs.
How not to get sick?
In order to protect yourself from becoming infected with such an unpleasant disease as pulmonary tuberculosis, you should follow a few simple rules.
The first thing to remember is that you should not neglect the annual examinations at the doctor, the passage of fluorography. If infection has occurred, then at least there is the possibility of treating the disease at an early stage.
Spending time in a place of large crowds, one should not neglect the basic rules of personal hygiene. It is recommended that you always carry a clean handkerchief and antibacterial wet wipes. In no case should you use someone else's cutlery and personal items. It must be remembered that after shaking hands with little-known people, you must wash your hands.
No matter how trite it may sound, but the house also needs cleanliness. Wet cleaning with antibacterial agents should never be neglected. It is also worth more often to arrange airing.
Strong immunity plays a significant role. The adoption of vitamins that help maintain the body, proper nutrition and the absence of bad habits can protect not only from tuberculosis, but also from many other viral diseases.
What does medicine say about safety?
Here are some suggestions:
- Annually, tests should be performed to detect Koch's bacillus in the body. This is very simple, the procedure does not take much time. Everyone remembers the Mantoux vaccine from childhood. Previously, everyone thought that this same injection is a vaccine against the disease. In fact, this vaccine contains weakened virus cells that work as an indicator, showing the presence in the body of their own kind.
- Based on the first advice, you should get vaccinated. Unfortunately, no one has yet been able to create a medicine that could once and for all defeat the virus. One such vaccine can protect the body for about 3-4 years.
- And the last recommendation from doctors is the adoption of vitamin preparations to maintain immunity.
It should be remembered that nothing should prevent a visit to a doctor and medical institution, if there are reasons for this. It is better to visit a specialist on time and undergo the necessary diagnostics, then the treatment prescribed in a timely manner can bring positive results in the shortest possible time.