There are a huge number of diseases that can affect the human respiratory system. Some of them do not pose a particular threat to health, but there are those that are fraught with serious complications and a decrease in the patient's standard of living. One of these is tuberculous pleurisy, which we will meet in our today's article. Consider the reasons for its development, varieties and recommended therapy.
What is this disease?
With this pathology, the presence of an acute, chronic or recurrent inflammatory process of the pleura is characteristic. Often the disease manifests itself after infection of the body with tuberculosis.
Tuberculous pleurisy usually affects the serous membranes, which form the pleural cavity and cover the lungs. This disease is quite serious, the fight against it has been going on for more than one millennium, but in our days relapses still arise.
The danger of this pathology is that it can spread rapidly among people, increasing the mortality rate. It is noted that quite often the disease occurs precisely in childhood. Pleurisy of tuberculous etiology is fraught with the spread of bacteria throughout the body, which leads to disruption of all organ systems, so the earlier the disease is diagnosed, the more effective the treatment.
The mechanism of the development of the disease
This pathology has two development paths:
- Exudative pleurisy of tuberculous etiology develops if toxic substances of the causative agent of the disease and tissue breakdown products are affected by the pleura. The pleural cavity in this case contains a small number of bacteria. In pathogenesis, it can be noted that the body’s sensitivity to pathogenic microbes increases manifold, the growth occurs under the influence of the previous course of tuberculosis infection. After bacteria enter the pleura, rapid fluid accumulation begins.
- The second development mechanism is inflammation of the pleura with the formation of tuberculous tubercles; it develops when bacteria from the outbreak in the lungs or thoracic lymph nodes mass.
How can the pathogen enter the pleural cavity?
There are several ways in which tubercle bacillus can enter the pleural cavity:
- Contact. In this case, the ingestion occurs from foci in the lungs located under the shell.
- The lymphogenous pathway involves spreading through the lymphatic vessels.
- Hematogenous spread is the transport of blood vessels.
The mechanism of the development of the disease lies in the inflammatory process in the pleural sheets, the accumulation of leukocytes and the penetration of fluid into the pleural cavity.
Exudate tuberculous pleurisy can be of a different nature:
- Fibrotic.
- Serous.
- Bloody.
- Purulent.
If therapy is ineffective, then over time the serous effusion resolves, and the fibrous one grows with connective tissue elements and scar deposits form on the pleura surface.
Causes of tuberculous pleurisy
Tuberculous pleurisy of the lungs refers to pathological diseases that develop on the basis of infection or lung failure. The etiology of pleurisy is of several types, and each has its own reasons for development.
The causes of infection are:
- Infections caused by bacteria, such as staphylococcus, gram-negative microflora.
- The presence of viruses and parasites in the body, especially if therapy is not carried out.
- Tuberculosis infection is mainly in the form of a stick.
- Fungal diseases: candidiasis, blastomycosis.
- Syphilis, typhoid and brucellosis can trigger the development of the disease.
Non-infectious causes can also be mentioned:
- If there is a development of malignant tumors in the lungs, mammary glands, ovaries.
- Pulmonary infarction.
- Pancreatitis, leukemia.
Doctors single out in a separate group unknown causes that can provoke tuberculous pleurisy:
- Injuries.
- Injuries, such as gunshots.
- Surgical intervention.
Depending on the cause of the disease, the symptoms begin to appear, but first you need to consider the types of the disease, they also appear in different ways.
Classification and types of pathology
If we consider the characteristics of the pathogenesis of the disease, then tuberculous pleurisy of the following types is distinguished:
- Allergic.
- Tuberculosis of the pleura.
- Perifocal.
The first type of disease can occur against the background of a strong sensitivity of the body. A feature of this type of pleurisy is the presence of pain and rapid accumulation of fluid. But the reverse dynamics are just as fast.
In the case of dissemination of a large number of small and large foci, pleural tuberculosis develops. Often, for this type of pathology, an extensive caseous-necrotic reaction is characteristic. Tuberculous pleurisy of this type is considered the most burdensome.
A perfocal view develops if the inflammatory process from the lungs extends to the pleura. Exudate can accumulate in small or large quantities, bacteria are not always found in it, but this variety lasts a long time, and there are often relapses.
The pleural composition also affects the classification of the disease. Depending on this, there are:
- Fibrinous or dry.
- Tuberculous exudative pleurisy.
- Purulent.
The first pathology proceeds, as a rule, in some parts of the pleura, where fibrin filaments are deposited. Over time, the pleura loses its smoothness. This type of disease can be easily treated if it is started in a timely manner.
Exudative pleurisy has the opposite manifestation of fibrotic appearance. Almost immediately, fluid begins to actively stand out and accumulate in the pleural cavity. There are times when it all starts with a dry look that flows smoothly into exudative.
The purulent form is complex. There is a defeat of the pleura as a result of a dose of MBT or a breakthrough of the subpleural focus.
If pleurisy of tuberculous etiology, then it is divided into several types:
- Infectious. It develops after staphylococcus, pneumococcus, tubercle bacillus enter the lungs.
- Tuberculous non-infectious pleurisy develops against the background of lung cancer, rheumatism and other pathologies.
- Idiopathic pleurisy develops for unknown reasons.
The disease can proceed unevenly, therefore, an acute form, subacute and chronic, is distinguished. Each has its own symptoms.
Manifestation of the disease
Each type of pleurisy has its own characteristics. Dry tuberculous pleurisy symptoms has the following:
- Lymphatic infection spreads.
- There is soreness in the chest. When inhaling, it intensifies, and sneezing, coughing can also provoke it.
- Body temperature rises.
- General weakness appears during the development of the disease.
- An intoxication of the body occurs.
- Appetite decreases.
- The weight is reduced.
The first signs do not allow you to immediately diagnose the disease, therefore, before the onset of pain, an accurate diagnosis is problematic. With the development of the disease, the pain becomes stronger, there are even cases of loss of consciousness.
The symptomatology of dry pleurisy is very reminiscent of neuralgia, so it is important to conduct differential diagnosis on time. If there is dry pleurisy, then the patient tries to lie on the other side, but the pain only intensifies.
If the doctor listens from the side of the onset of pain, he will hear characteristic noises from the friction of the pleura. It is often not possible to diagnose this type of pleurisy by blood tests.
The exudative appearance has the following symptoms:
- Shortness of breath appears.
- Weakness and malaise.
- Body temperature rises to 38-39 degrees.
- Cough.
- Dry mouth.
- Chest pain from the localization of the pathogen.
Quite often, such pleurisy has an acute course, but there are cases when the disease is asymptomatic in children or adolescents, and is detected only after examination of the upper respiratory tract.
After the accumulation of fluid in the pleural cavity, the symptoms may decrease, only the heaviness in the side remains. The amount of exudate can reach two liters. In this case, a headache, dizziness appears, in children the color of the skin may change, they become lethargic, pale and often lie on one side.
Symptoms of purulent pleurisy are mild, the patient's condition may not change, but pain in the side, shortness of breath, weakness and high fever appear. Often the condition is aggravated to the point that the patient is unable to get out of bed.
Symptoms of subspecies pleurisy
We have already found out that there are also subspecies of pleurisy, which also manifest themselves in different ways.
Perifocal has scant symptoms:
- Mild chest pain.
- Slight weakness.
- When listening to small noises in the chest.
This subspecies of pleurisy proceeds for a long time and often with relapses, if exudate accumulates, then the signs are already more pronounced:
- Body temperature rises.
- Heavy sweating.
- Tachycardia develops.
Allergic pleurisy is manifested as follows:
- The temperature rises to thirty-nine degrees.
- Tachycardia.
- Rapid accumulation of exudate.
- Dyspnea.
- Heaviness when inhaling and pain in the side.
These symptoms can quickly appear and also disappear.
If pleural tuberculosis develops, then it is typical for it:
- Temperature can rise up to forty degrees.
- Excessive sweating.
- Pain in the side.
- Dry cough.
- Dyspnea intensifies.
If this is a chronic form, then tuberculous pleurisy is characterized by:
- Feeling of lack of air.
- Veins and lymph nodes swell around the neck.
- Cyanosis of the lips.
When these signs of the patient appear, it is urgent to be taken to the hospital. It is necessary to make sure that a person with such symptoms does not drive, it is better to call an ambulance if it is not possible to take him to the hospital on his own.
Establishing diagnosis
If tuberculous pleurisy occurs, diagnosis is difficult. For the diagnosis, it is important for the doctor not only to know how the disease can manifest itself in various forms, but also to conduct various studies. Based on all the data, a diagnosis can be made. Diagnostics includes:
- Interviewing the patient for complaints.
- Collection of information about the picture of the manifestation of the disease.
- Conducting tuberculin samples.
- X-ray examination will detect changes in the lung tissue.
- A blood test reveals the composition of white blood cells, changes in the blood are especially pronounced with a purulent form of pleurisy.
- A urinalysis determines the presence of protein. If there is one, then the diagnosis is obvious.
- Bronchoscopy can detect bronchial tuberculosis, scars.
- Exudate is examined. If tuberculous pleurisy, then the composition contains protein, and the glucose content is reduced.
- High rates of antibody titers in the reactions of RNGA, ELISA will indicate the presence of tuberculosis infection.
- With the help of tomography, the etiology of pleurisy is determined.
Only after the diagnosis of tuberculous pleurisy is confirmed, treatment is prescribed by a qualified doctor.
Disease therapy
To cope with this ailment, it is important to recognize it in time and start treatment. Many people ask: is tuberculous pleurisy contagious or not?
This is an infectious disease, and if pathogens are contained in sputum, then such a patient is a danger to others. Therapy should be carried out only in a tuberculosis dispensary.
Therapy should primarily contribute to ending the process of tissue destruction. To do this, appoint:
- "Rifampicin."
- "Pyrazinamide."
- Ethambutol.
The duration of drug therapy is at least eight months, if pulmonary tuberculosis is also diagnosed, then the period can be extended to two years.
Experts believe that they can be effective in the fight against pathogens of corticosteroids, such as Prednisolone.
In order for the lungs to take their normal shape, it is necessary to pump out the liquid in order to prevent the formation of stratification.
Treatment of tuberculous pleurisy is also carried out with the use of immunostimulants, for example, drugs such as Levamisole, Tactivin.
If long-term drug therapy does not give its results, then you will have to resort to surgical intervention.
During treatment, bed rest should be observed, and the diet should also be reviewed. It is necessary to limit the intake of salt and salty foods, drink less liquid, increase the intake of foods high in protein and vitamins.
Disease prevention
To prevent tuberculous pleurisy from returning, treatment was not required, it is important to observe preventive measures. Tuberculosis is a social disease that is directly related to the quality of life of the population. Epidemiological troubles in tuberculosis are caused by worsening socio-economic conditions, a decrease in the standard of living of the population, and the activity of migration processes.
For the purposes of prevention, it is recommended to adhere to the following recommendations:
- Conduct regular preventive and anti-epidemiological measures.
- As soon as possible, diagnose the disease in patients and allocate drugs for therapy.
- It is imperative to conduct medical examinations when hiring in those areas that are unfavorable for animal tuberculosis.
- The state should provide isolated living spaces for people living with active tuberculosis, especially if they live in dormitories or small families.
- Mandatory vaccination of newborns.
- Undergo fluorography of the lungs annually.
- At the first signs of the disease, you must visit a doctor.
Compliance with these simple preventive measures will reduce the frequency of the disease, and will also help to identify it at the very first stages of development, when treatment is most effective.
Each person is primarily responsible for their health. It’s not worthwhile to self-medicate at the first signs of malaise, thereby we allow pathogens to “strengthen their rights”, and the disease begins to progress. Only a qualified doctor will make an accurate diagnosis and prescribe an effective treatment.