Pulmonary tuberculosis, which recently provoked a huge number of deaths every year, is nowadays considered one of the very dangerous social pathologies. The prevalence of this disease correlates with living standards. As can be seen from statistical studies, in our country the problem intensified when the number of people without a permanent residence increased, and at the same time many migrants appeared. According to official WHO information, more than two billion people currently suffer from this disease on the planet. Up to nine million new cases are recorded annually, three times fewer deaths associated with complications of the disease.
How to suspect?
The signs of pulmonary tuberculosis in adults are diverse. In some patients, only the lungs suffer, while the course is hidden, it is almost impossible to notice the pathology. Typically, a problem is learned from a randomly conducted study. For this reason, it is so important to undergo fluorography every year. At the federal level, such a study is organized with an enviable frequency, and participation in it is free.
In other cases, signs of pulmonary tuberculosis in the early stages are similar to a common cold or resemble flu. The patient feels weak, gets tired quickly, often the temperature rises, but not too high. Many note an increased perspiration, while the skin is pale. Symptoms worsen at night. A prolonged illness affects weight - the patient loses weight, certain groups of lymph nodes grow in size.
Typical manifestation
The most characteristic first sign of pulmonary tuberculosis is a persistent cough, coughing, which a person often does not even pay attention to. In the morning and afternoon, the symptom does not manifest itself very brightly, but in the evening an exacerbation is observed. Sometimes a small volume of sputum of a white hue with blood streaks is separated. This is characteristic of two forms - it is tuberculoma and infiltrative.
Options are different
Sometimes the signs of pulmonary tuberculosis in the early stages differ significantly from those described above. It depends on the form of the disease: some are affected by a pronounced disease, while in others the pathology proceeds smoothly, gently. The most difficult option begins with weakening the body. Appetite is lost, a person constantly feels unwell, notes weight loss and profuse sweating at night.
Tuberculosis is characterized by sharp temperature jumps up to 40 degrees. The cough, accompanied by sputum separation, does not stop at all, the patient coughs up blood. Even a light load causes shortness of breath. However, as can be seen from medical statistics, all these manifestations do not yet mean that a person will suspect something is wrong and turn to a doctor.
General view
Pulmonary tuberculosis is a disease formerly known among the people as consumption. Pathology is caused by an infectious agent. The disease affects not only humans, but also many animals. At risk for cattle, pigs, chickens. The source of the problem is Koch's wand. The lung afflicting form is the most common variety, but far from the only one. The source of the disease was named after the scientist who discovered it in 1882. Mycobacterium, identified by Robert Koch, has become the evidence base for classifying the disease as infectious. As it was revealed during research, the infectious agent is characterized by increased resistance to any aggressive influences, it is not afraid of alcohol, acid, alkali. Tuberculosis can survive in the earth, in the snow, and the methods of destruction identified by the German scientist suggested a direct influence of sunlight, heat, and antiseptic components containing chlorine.
Most often, a person gets pulmonary tuberculosis in contact with a patient. An infectious agent is transmitted in several ways, most often airborne. A person with a pathology coughs, sneezes, breathes - all these processes are associated with the release of a harmful life form into the environment. A healthy person, being nearby, inhales the infected air, the infection enters the body, provoking the onset of the disease.
Alternatives
You can get pulmonary tuberculosis through contact if the skin is damaged. Wounds are literally open gates to the body. Mycobacterium easily penetrates the body of a healthy person, quickly finds itself in the circulatory system and spreads to all internal organs. But if the skin is intact, infection by contact is impossible.
There is a variant of infection with pulmonary tuberculosis through the digestive system. This is possible if the meat of an animal sick with such a pathology enters the food. True, the risk of infection is great only with a high concentration of dangerous bacteria in the product. When infected in this way, the disease is most often based in the intestine. Another rare option is infection during the period of gestation. Even if the mother is sick, this does not mean that the child will also be born infected, but the probability of transmission of an infectious agent exists.
Features of the disease
Even if mycobacteria has penetrated the human body, it is not a fact that you can immediately notice signs of pulmonary tuberculosis - the probability of the disease is not 100%. As medical studies have shown, the Koch stick itself is present in the body of many modern people, among them one in ten suffers from an unpleasant disease. If the immune system is strong enough, it successfully resists the infectious agent, eventually developing stable immunity to it.
According to statistics, to a greater extent all forms of pulmonary tuberculosis (focal, infiltrative and others) are terrible for the strong half of humanity. The incidence rate among men is 3.2 times higher. In addition, the course of the disease itself is faster than in women. The risk group includes people from twenty years old to forty years old. 42 times higher risk of getting sick in those who are placed in the colony, places of forced detention (comparison was carried out with the total frequency of cases in our country).
How is everything going?
The primary signs of pulmonary tuberculosis are provoked by an inflammatory process initiated by mycobacteria that enter the human body. The development of the process is gradual, long. The primary form is distinguished - this is inflammation associated with the infection of a person for the first time in his life. The immune system does not yet contain instructions on how to deal with mycobacteria, and infection spreads rapidly throughout the body. This form is characterized by the presence of a primary lesion in the lung tissue. This site is strictly limited. Occasionally, the course is accompanied by inflammation of the vessels along which the lymph passes.
Over time, the primary focus completely heals. In a specialized study of pulmonary tuberculosis at an early stage, tests will show a calcium-soaked solid area. In medicine, he received the name of the focus of Gon. Studies show that many people who have had a latent infection and ended up in a hospital for lung examination only in old age show such formations. After the formation of the Gon focus, the root cause of the disease for a long time lives in the tissues of the lungs.
The two main forms of the disease
Tuberculosis is productive and exudative. In the first case, an increase in the volume of connective tissue occurs. The affected pulmonary areas seem to wrinkle. At the same time, fibroblasts, epithelium, and giant cells progress. The process is among the benign.
Exudative tuberculosis is a form in which the alveoli become the location of the accumulation of effusion formed by a variety of cells. Foci of small size degenerate into masses, reminiscent of cottage cheese in structure. Over time, they decay, which leads to the appearance of caverns. Such masses can dissolve over time.
Both options can exist on their own or can be observed in one person in parallel. In the presence of two forms, one of them dominates at once.
Sometimes things get worse
The latent form, in which the symptoms of pulmonary tuberculosis are practically absent, is rightly considered the easiest. Often, patients do not even know that they were ill. But with a weakened immune system, there is a chance of a transition to a more severe stage. Most people who seek medical help are diagnosed with secondary tuberculosis. This is a pathology, the start of which is the focus of Gon, where mycobacteria persist for a long time. Sometimes the reason is re-infection. A distinctive feature of the secondary form is the absence of a specific focus.
Symptoms in adult pulmonary tuberculosis in diffuse form are associated with the formation of numerous foci of infection. The disease develops in acute form, can occur subacute or observed in a chronic form. It depends both on the state of the immune system, and on the presence of additional pathologies, and the saturation of body tissues with vitamins. With a diffuse form, mycobacteria often infect bone tissue, articular, heart, and brain. Kidneys, liver suffer. Symptoms are close to flu, colds, bronchitis, pneumonia, although there are certain differences: tuberculosis does not go away over time, the situation only worsens. If the form becomes severe, the patient has respiratory failure, wheezing, continuous coughing, shortness of breath. The doctor determines the lesion of the brain by the tension of the occipital muscles. Symptoms of acute poisoning are sometimes manifested: headache, fever, patient vomiting. Possible impaired consciousness.
Frequent option
As can be seen from statistical studies, infiltrative pulmonary tuberculosis is much more common than others. This name reflects the essence of the disease - organic tissue is filled with inflamed cells. If you take an x-ray, you can see fuzzy heterogeneous elements whose diameter exceeds a centimeter. In some patients, the infiltrative variant proceeds without any manifestations, while others note coughing, spotting, and poisoning of the body. In many ways, the features of manifestation are determined by the general condition of the body, by the strength of the immune system. There is a risk of developing the form before caseous pneumonia. In former times, such a disease was called transient consumption.
A distinctive feature of caseous pneumonia is damage to the lobe of the lung, sometimes more. The death of tissue occurs, which, when examined, appears curdled. Tissues, dying, turn into granular. The body rejects such cells. The form is rapidly developing, actively progressing. At this stage of pulmonary tuberculosis, the probability of death in the first month of the course of the disease reaches 14%. On average, every tenth patient develops a disease along this path. If tuberculoma is established, the death of the tissue occurs first within the boundaries of the connective tissue, but gradually the process expands, covering the cavity.
Cavernous tuberculosis: specifics
A distinctive feature of this form is the presence of cavities, the walls of which are formed by connecting fibers. The size of such a cavity is up to 6 cm, and sometimes even more. It is known that this form appeared relatively recently, its development is associated with attempts to use various antimicrobial drugs to combat pathology. In practice, symptoms of pulmonary tuberculosis, allowing to suspect this kind of disease, are rare. The main specific danger associated with its development is the likelihood of bleeding in the tissues of the lungs due to the cavity. In addition, the course is often complicated by fungal infection.
A gradual deterioration of the patient's condition can lead to a fibro-cavernous variety, when the lungs become the site of concentration of caverns, the walls of which are built of fairly thick connective fibers. A certain percentage of the lungs is replaced by fibrin, the bronchi are subject to deformities. The treatment of pulmonary tuberculosis of this form seems to be an extremely important social task, since it is this variety that is most dangerous for society. Just one cavern - the location of more than a thousand Koch sticks. Coughing, a person spreads them around him. The patient is at risk of bleeding in the lung tissue. Possible complications of fungal nature, pneumothorax associated with impaired air metabolism.
Worse than ever
The most severe stage of pulmonary tuberculosis in adults is the situation when the disease progresses to active proliferation of connective tissue, covering both the lungs and pleura. Diagnosed with cirrhotic - the final form. Patients with this diagnosis are characterized by a high percentage of deaths.
This variety is relatively safe for others, as it does not spread as actively as some of the previously described. But the treatment process is a frankly difficult task. All drugs available to modern doctors hardly penetrate into the fibrous tissue, which makes Koch's sticks practically invulnerable to the most effective and powerful medications.
How to identify?
The classic way to determine any form of pulmonary tuberculosis (disseminated, infiltrative, cirrhotic) is to put a special test. Such a check is traditionally done annually. Apply the protein extract obtained by the use of mycobacteria. Such a substance causes a peculiar reaction if it enters the infected body. To determine the infection, it is necessary to introduce a small amount of components and check the size of the seal in this place after two days. If the induction is within 5 mm, it is safe to say that the person is healthy. The result, varying within 5-10 mm, indicates the possibility of contact with patients, that is, the subject is classified as a risk group. With a 15-mm seal (and more), the formation of an abscess, infection can be assumed. True, only on the basis of the Mantoux test can no final conclusions be drawn - there is a chance that the result indicates recent contact with the patient.
If the result is positive, it is necessary to direct the person to additional laboratory tests. First get sputum, flushing bronchial water. The event is held under anesthesia. 20 ml of warm saline are injected into the respiratory tract and the coughing of the liquid is awaited (reflex reaction). The resulting precipitates are collected in a dish and sent for microscopic examination. This approach is not possible if a person has asthma. Examination of excretion samples is carried out by PCR or determination of bacteria resistant to acids. The smear is treated with dyes and examined under a microscope.
Alternatives
Sometimes material for a detailed study is obtained using a bronchoscope. The doctor receives samples of internal bronchial tissues, under the influence of infection in tuberculosis, changing in a specific way. In addition to a biopsy, you can determine the fact of infection in the study of pleural fluid.
Fluorography is another common, almost universal method for determining the disease. An x-ray is taken, in which inflamed foci can be seen: shadows that are less than a centimeter in size, and the contours are quite clear. In the presence of one focus and the absence of symptoms of a person’s disease, they are registered to control the condition and re-examine after a while. If the results show a change in the size of the lesion in a larger direction, it is first necessary to carry out diagnostics in order to exclude cancer. If several foci are detected, tuberculosis is considered confirmed, and the patient is sent to a hospital for treatment.
How to fight?
Until the last century, humanity did not know the effective treatment of pulmonary tuberculosis. Currently, quite a lot of medications of varying degrees of effectiveness have been developed. However, this does not make the problem less acute, since many patients do not even suspect infection, while others are afraid of doctors or do not want to visit the clinic. There are people who are convinced that the best treatment option is at home with self-selected means. This approach is dangerous not only for the person himself, but also for the people around him, friends and relatives, random people on the streets and in shops, as it is easy to transmit the infection. – , , . , , . , , , , .
Many cases are known and such when the described complex does not show the desired result, and the only way out is emergency surgery, removal of the affected part or lung as a whole. This is especially true when detecting an open thick-walled cavity, since scarring is too unlikely, but there is a high risk of bleeding. Surgery is the only effective option in the presence of fibrous lesions that are not subject to medications. If the foci are formed by an atypical pathogen, there is a suspicion of a complication of the course of malignant neoplasms, the patient is also sent for surgery. The operation is supplemented with a complex of medicines.
How to protect your health?
As with many other pathologies, with tuberculosis the best treatment is effective prophylaxis that prevents infection. Since there is no method that allows you to 100% protect yourself from the disease, it is important to undergo timely checks to identify foci of the disease. To do this, annually take fluorographic images and avoid contact with sick people. If tuberculosis is detected in a person living in an overpopulated housing, measures must be taken to isolate it from its neighbors. Infants should be vaccinated as soon as age permits such an event. Among the important social measures for the prevention of tuberculosis is the mandatory examination of all migrants arriving from areas and countries where the prevalence of pathology is high.
It was indicated above that infection is possible through food. To prevent this path, it is necessary to carefully control the quality of dairy and meat products. Persons forced to work with cattle, chickens, and pigs should undergo regular examinations in order to timely determine the fact of infection.