is an infectious disease caused by Mycobacterium tuberculosis. During the development of the disease, it appears cell allergy , specific granulomas in a number of organs and tissues, as well as a polymorphic clinical picture.

Tuberculosis has been known since ancient times. And at the moment its spread is a very serious problem from a medical and social point of view. According to statistics, every year about eight million people in the world suffer from tuberculosis, while three million patients die. The incidence has increased in recent years. Experts name several reasons that led to this situation. This is a general decline in people's living standards, which negatively affects the quality of nutrition; deterioration in quality and reduction in the number of activities aimed at combating tuberculosis; as well as the emergence of new ones that exhibit high resistance to specific therapy.

Causes of tuberculosis

Tuberculosis occurs as a result of exposure to the human body mycobacteria . According to statistics, in approximately 92% of cases the disease is caused by bacteria Mycobacterium tuberculosis , in other cases it occurs under the influence M. bovis . A characteristic feature of the causative agent of tuberculosis is the shape of the rod. This bacterium is aerobic organism . The most optimal temperature for its existence is +38 °C. It grows well on media that contain eggs, potatoes, milk, and glycerin. The causative agent of tuberculosis exhibits high resistance to the action of various factors; it does not die when exposed to alcohols, acids, and alkalis. However, under direct sunlight and ultraviolet rays, tuberculosis pathogens die within a few minutes. At a temperature of 70 °C, death occurs within 30 minutes, and during the boiling process, the pathogen dies within five minutes. A number of agents used for disinfection also have a detrimental effect on it: 5% solution, 5% carbolic acid solution, 2% bleach solution.

Signs of tuberculosis appear equally often in people of different ages, both in newborns and elderly patients. The main sources of infection spread, as a rule, are sick people, as well as meat and milk from animals that are sick with tuberculosis. Tuberculosis is most often transmitted by airborne droplets. In more rare cases, alimentary transmission is possible. There is also the possibility of infection through the transplacental route, when the infection is transmitted to the fetus from a pregnant woman. Factors contributing to the transmission of infection include prolonged contact with a carrier of bacteria, existence in unsatisfactory social and living conditions, poor nutrition, and disruptions in the functioning of the immune system. Contagiousness is not high and directly depends on the state of the body’s defenses. For the spread of tuberculosis, seasonality and frequency do not matter.

Certain groups of the population are most often at risk of contracting tuberculosis. Carriers may be the first to develop tuberculosis -infections and people suffering from other illnesses that weaken the human immune system. There is also a high risk of infection among those who have close contact with tuberculosis patients, people who do not undergo medical examination on time, drug addicts, alcoholics, and people without permanent residence. There is also a risk of infection among citizens who have visited countries where there is a high concentration of active cases of this disease.

Despite the fact that tuberculosis is not usually classified as highly contagious diseases, up to fifty percent of people who have close contact with bacteria-transmitters become infected. However, infection with tuberculosis does not mean that the disease will develop. The manifest form of tuberculosis appears only in 5-15% of cases; in other cases of infection, people develop non-sterile immunity.

Most often, the source of infection cannot be determined. Another feature of tuberculosis in children: the younger the infected child, the higher the risk of developing tuberculosis.

Development of tuberculosis

Pulmonary tuberculosis And extrapulmonary tuberculosis develops in three stages. First of all, a person becomes infected, then a primary focus of the disease develops in a certain organ, after which the disease progresses, and the person develops new symptoms of tuberculosis.

After infection, the pathogen gradually penetrates the lymphatic and blood vessels and spreads throughout the human body. Four to eight weeks after infection, a person already has positive tuberculin tests.

The main feature of tuberculosis infection is the possibility of maintaining a life-capable pathogen in the primary focus. It can remain in a viable state for many years, and in some cases, until the end of a person’s life. In turn, after a significant decrease in immunity due to a number of diseases, the lesions can enter the active stage, and the person shows signs of tuberculosis.

Symptoms of tuberculosis

The manifestations of tuberculosis symptoms directly depend on where exactly mycobacteria are introduced into the body, whether complications occur, as well as on other factors. Tuberculosis develops quite slowly, sometimes the disease can last even decades.

Symptoms of tuberculosis do not appear in people who develop latent tuberculosis . Therefore, they do not spread the disease. In patients active form of tuberculosis Symptoms depend on where the infection develops - in the lungs or in other parts of the body. Pulmonary tuberculosis manifests itself gradually in humans and can develop over several weeks or even months. In this case, a person may notice the appearance of several symptoms of the disease, but may not even be aware of its development. With this form of tuberculosis, one of the main signs of the disease is a cough, in which thick mucus, sometimes mixed with blood, is coughed up. This cough continues for more than two weeks. In addition, signs of pulmonary tuberculosis are chills and,. A person constantly feels weakened and tired, he loses his appetite, and accordingly, body weight quickly decreases. In addition, the patient is bothered by severe and painful sensations in the chest.

Tuberculosis in children and adolescents most often manifests itself in its primary form and develops after infection with tuberculosis bacteria in an organism that was not previously infected. The most common form of primary tuberculosis occurs tuberculosis of intrathoracic lymph nodes . During the development of tuberculosis, the patient's lungs are most often affected. At the same time, extrapulmonary forms of the disease manifest themselves as a consequence of hematogenous dissemination of tuberculosis infection from the primary focus. In this case, the patient has predominantly symptoms of intoxication of the body, and signs of a local inflammatory process are expressed to a much lesser extent.

Moreover, the younger the child’s age, the higher the risk of severe local and generalized forms of the disease.

Forms of tuberculosis

The most common forms of tuberculosis in children and adults are:

Tuberculosis intoxication . This form most often occurs in adolescents and children. As a rule, the disease occurs in preschool children, as well as in primary schoolchildren. The disease is characterized by irritability, fatigue, problems with appetite and sleep. During the examination, the specialist pays attention to pale skin, weight loss, and micropolyadenia. Sometimes with this form of the disease it is possible to manifest inflammation of the conjunctiva and cornea, etc. When diagnosing in this case, the most important thing is to detect the variation of tuberculin tests. The process of infection development can continue for years, in waves. Sometimes it is possible to heal on your own and develop immunity.

Primary tuberculosis complex . This form of tuberculosis is asymptomatic until complications begin to develop. It can only be detected during an X-ray examination. However, as complications of the disease, the development of pneumonia, etc. is possible. If the course of the disease is favorable, then the patient exhibits calcification of the caseous focus in the lungs and lymph nodes. If the course is complicated, then hematogenous dissemination, lymphogenous dissemination, and a cavity may develop.

Tuberculous bronchadenitis . This form of the disease is also called tuberculosis of intrathoracic lymph nodes . This is the most common local form of primary tuberculosis in children. Due to the enlargement of the lymph nodes, the tracheobronchial tree is compressed. If the patient has severe bronchadenitis, then the manifestations of the disease will be a hoarse voice, whooping cough, and the presence of signs of acute or chronic intoxication. As the disease develops, the lymph nodes enlarge, the venous network under the skin of the chest expands, etc. To confirm the diagnosis, X-ray examination and bronchoscopy are necessary. As a complication of this condition, bronchial patency may be impaired and pleurisy , bronchial tuberculosis. If the course of the disease is favorable, then the patient exhibits calcification of the lymph nodes. If the course is complicated, hematogenous dissemination, lymphogenous dissemination, and a cavity may develop.

Disseminated pulmonary tuberculosis . The disease occurs as a consequence of extensive hematogenous spread of tuberculosis infection. The onset of the disease, as a rule, is febrile fever, after which manifestations of intoxication occur very quickly. The person complains of shortness of breath. Diagnosis of pulmonary tuberculosis is carried out using radiography. At the same time, sputum examination often does not bring results due to the absence of mycobacteria there. The diagnosis is also confirmed by transbronchial . Complications of this condition may include anemia , cardiopulmonary failure , hematogenous screenings to various organs, etc.

Tuberculosis of the urinary and genital organs . Today, this form of extrapulmonary tuberculosis is the most widespread. This disease is also defined as kidney tuberculosis , because these are the organs that are most often affected in this case. The signs of kidney tuberculosis are similar to the symptoms of nonspecific inflammation of the urinary system. The diagnosis is established by examining bacteriological urine culture, modified tuberculin tests, blood tests and other studies of the urinary tract and kidneys. As a complication of renal tuberculosis, stricture of the ureters and cavernous renal tuberculosis can develop. If treatment is carried out on time, the outcome of the disease will be favorable. In case of inadequate therapy, it is possible to develop pyonephrosis and, as a consequence, with renal tuberculosis, the kidney is removed.

Tuberculosis of bones and joints . Very often, tuberculosis of bones and joints affects children at an early age. With bone tuberculosis, the middle parts of the spine are most often affected. Due to erosion of the anterior surface of the vertebral bodies, they gradually fall off, and as a result, pronounced without scoliosis . With bone tuberculosis, the patient complains of a noticeable limitation of mobility, pain, and swelling of the parts of the spine that were affected. If tuberculosis of bones and joints progresses, then the pathological process moves to the underlying parts of the spine. Tuberculosis most often affects the knee and hip joints. A feature of tuberculosis of bones and joints is that the manifestation of destruction of bone and cartilage tissue is expressed later. Consequently, during an X-ray examination, changes in the spine and joints may not be detected. Therefore, during diagnosis it is important to identify the primary source of infection. As a result of this disease, the patient often develops a hump, contracture of the affected joint, and, as a result, early disability.

Tuberculous meningitis . A rare form of tuberculosis that often occurs in children at an early age. Initially, the child’s behavior begins to change, a number of symptoms of general malaise and low-grade fever appear. As the disease develops, the child suffers from photophobia, headaches, and seizures. Later, the cranial nerves are affected, developing . Complications of tuberculous meningitis include hypertensive-hydrocephalic syndrome and cerebral edema. If this disease is not treated, death is inevitable.

Lupus . The disease occurs as a result of the penetration of tuberculous mycobacteria into the skin. Skin tuberculosis almost always manifests itself as a secondary endogenous disease. As a rule, the pathogen enters the skin from foci of tuberculosis through the lymphohematogenous route. Infection very rarely penetrates through skin lesions. Skin tuberculosis may have focal And disseminated forms. Diagnosis of skin tuberculosis is carried out by studying anamnesis, conducting tuberculin tests, isolating tuberculous mycobacteria and other studies that are prescribed on an individual basis. There are also types of tuberculosis that affect other organs.

Diagnosis of tuberculosis

To carry out quality diagnosis of active pulmonary tuberculosis, the specialist first examines the patient’s medical history and conducts a physical examination. Diagnosis of tuberculosis involves a careful examination of the symptoms - the presence of cough, fever, fatigue, etc. Sputum culture studies are also performed. In this case, an accurate diagnosis of tuberculosis is carried out precisely by studying the results of such a study. To select the most effective drugs for treating tuberculosis, a test on bacteria should be performed.

In addition, if tuberculosis is suspected, a chest x-ray is performed. Such a test is prescribed if the tuberculin skin test is positive, or there is an ambiguous reaction to such a test, and also if the patient has symptoms of active tuberculosis.

If a latent pulmonary form of tuberculosis is suspected, its presence is indicated by tuberculin skin test. Also, the diagnosis of tuberculosis in this case involves a special blood test.

To establish a diagnosis of extrapulmonary tuberculosis, it is necessary to conduct a number of tests and studies. Depending on the specific situation, the diagnosis of tuberculosis may include a biopsy, urine culture, cerebrospinal fluid examination, MRI, and computed tomography.

Also, in the process of diagnosing pulmonary and extrapulmonary tuberculosis, a test for the presence of HIV infection and an analysis for hepatitis .

A number of additional tests are carried out already during treatment of tuberculosis.

In addition, regular screening for the presence of the disease is recommended for those categories of people who have an increased risk of contracting tuberculosis.

Early detection of tuberculosis in children is based on studying the level of specific sensitization that develops as a consequence of infection with mycobacteria. To do this, tuberculin tests are performed - intradermal Mantoux samples . A standard solution is injected into the inner surface of the forearm. A few days later, hyperemia with a papule in the center appears at the site where tuberculin was injected. The Mantoux reaction is determined by the size of the papule. The Mantoux reaction is performed on children aged 1 to 18 years annually. If the Mantoux test is positive, the child must be examined by a phthisiatrician.

Treatment of tuberculosis

Treatment of tuberculosis is carried out by a TB doctor together with doctors of other specialties. The main method of treating tuberculosis today is etiotropic chemotherapy. When carrying out such therapy, the age of the patient, the form of the disease, and the activity of the process must be taken into account. When treating tuberculosis, it is very important to pay attention to proper diet, physical activity, and lifestyle in general. Treatment of tuberculosis is a very long process and therefore requires patience. So, all stages of treatment of the disease can take about 18 months.

Surgical treatment methods are used mainly for patients with osteoarticular tuberculosis, as well as for patients with renal tuberculosis. In addition, treatment of tuberculosis involves the use of a number of measures that strengthen the body's defenses.

Doctors

Medicines

Prevention of tuberculosis

Prevention of tuberculosis involves, first of all, protection from infection with the active form of the disease. To do this, it is undesirable to stay in close quarters for a long time with people suffering from active tuberculosis. To prevent tuberculosis, people in crowded areas should wear protective face masks and follow all hygiene rules. We must not allow the latent form of the disease to become active. Prevention of tuberculosis in children involves protection against infection. To do this, everyone who works in children's institutions should be regularly examined.

Prevention of tuberculosis in children requires mandatory vaccinations , as well as chemoprophylaxis of the disease.

In addition, in order to prevent tuberculosis, mass examinations of the population are carried out through fluorography. Early detection of signs of tuberculosis allows you to start treatment at the initial stages and make it as effective as possible.

It is equally important to take all measures to strengthen the immune system. In this case, a healthy lifestyle, proper and regular nutrition, complete cessation of smoking, drugs, and alcohol abuse are important.

Diet, nutrition for tuberculosis

List of sources

• Perelman M.I. Phthisiology: national guidelines. - M.: GEOTAR-Media, 2007.
• Vizel A.A., Guryleva M.E. Tuberculosis. M.: GEOTAR-Medicine, 1999.
• Vishnevsky B.I., Otten T.F., Narvskaya ON., Vishnevskaya E.B. // Guide to pulmonary and extrapulmonary tuberculosis / Ed. Yu.N. Levasheva, Yu.M. Repina. St. Petersburg, 2006.
• Lectures on phthisiopulmonology / V.Yu. Mishin [and others]. - M.: Medical Information Agency LLC, 2006.

Despite the development of treatment and diagnostic methods, in the 21st century tuberculosis remains one of the most common and dangerous diseases. According to statistics, it kills 3 million people per year. The insidiousness of the disease is manifested in the fact that months and sometimes years pass from the moment of infection to the transition to the acute form. To notice the problem in the early stages, you need to know the signs of tuberculosis in adults and listen to the signals that the body gives.

Causes of the disease

The cause of the disease is the entry into the human body of a pathogenic bacterium - Koch's bacillus. This microorganism can live in the human body for a long time without manifesting itself in any way. Its activation and reproduction begin when the immune system fails.

Factors that provoke the development of the disease include the following:

• drug use;
• bad habits (smoking, alcoholism);
• metabolic disorders;
• unbalanced diet;
• constant stress;
• predisposition to respiratory diseases;
• unsatisfactory sanitary and hygienic living conditions.

The period when the Koch bacillus lives in the body, but does not manifest itself in any way, is called incubation. During this time, bacteria are constantly attacked by immune forces. If they cope with their tasks well, the microorganisms die and the person remains healthy.

If the immune system fails, then approximately three months after the bacteria enters the body, the incubation period ends. The first symptoms of the disease appear, which will be similar to the signs of a common ARVI.

As the disease progresses, the clinical picture becomes more vivid. Shortness of breath appears with tuberculosis and other syndromes that make it possible to suspect something is wrong. Often it is cough and breathing problems, elements of blood among the sputum that frighten the patient and force him to go to the doctor for examination.

First signs

How does pulmonary tuberculosis manifest itself in the initial stages of development? At first, the infected person does not notice any changes in the body. Gradually, Koch bacilli begin to actively multiply in the tissues of the lungs, provoking an inflammatory process.

The first characteristic symptoms appear:

• weakness, lethargy, depression;
• weight loss;
• increased sweating at night;
• deterioration in the quality of night sleep;
• causeless dizziness;
• paleness of the skin, the appearance of a permanent blush on the cheeks;
• loss of appetite.

In the early stages, there is a constant temperature, coughing up blood, and other characteristic symptoms of the disease. These signs appear later when bacteria enter the blood.

As a rule, the first symptoms of the disease do not cause a person to worry or want to see a doctor. This wastes precious time during which the disease progresses into dangerous forms. As a rule, patients come for examination when additional, more “eloquent” signs appear.

How to detect tuberculosis at the initial stage? It is necessary to pay attention to such characteristic signs as periodic causeless increases in temperature, increased fatigue, and mood swings. If any of these factors bother you for three weeks or more, you need to visit a therapist. You should not explain the loss of strength by workload at work or failures on the personal front: this way you allow the illness to progress and develop into dangerous forms.

How to detect tuberculosis in late stages?

So how can you identify it? Tuberculosis symptoms become more pronounced when Koch bacilli have entered the blood and the disease has affected a significant part of the lungs. The further the disease progresses, the more striking signs it manifests itself.

These include the following:

• persistent cough;
• shortness of breath, which gradually increases after infection with tuberculosis, occurs even with minor physical activity;

• wheezing, noted by the doctor when listening (dry or wet);
• hemoptysis due to tuberculosis;
• chest pain that occurs with deep breaths or at rest;
• elevated body temperature: up to 37 degrees or more;
• painful shine in the eyes, pallor, blush on the cheeks.

The temperature with tuberculosis usually rises at night. Fever occurs, the thermometer can show up to 38 degrees.

Symptoms of pulmonary tuberculosis in adults, which appeared in the early stages, persist. This is a decrease in appetite, sudden unmotivated weight loss (15 kg or more), weakness, increased fatigue, and apathy. The patient notes increased irritability, his performance decreases.

What is a cough like with tuberculosis? There are three key characteristics:

• Dry cough, which bothers the patient mainly in the morning and at night.
• Expectoration of wet sputum.
• The cough does not go away for three weeks or more, despite the self-medication methods used.

A characteristic sign of tuberculosis infection is hemoptysis. It occurs when the disease affects the lungs and damages blood vessels. When the patient coughs, a small amount of fresh blood is released along with the sputum. If its amount per day exceeds 50 ml, pulmonary hemorrhage occurs.

Stages of disease development

Signs of pulmonary tuberculosis vary depending on the stage of development of the disease. Doctors distinguish four stages of its progression:

1. Primary lesion
   Koch's bacillus enters the human body for the first time. This stage is typical for newborns and people with weakened immune systems. There are no pronounced symptoms, but vague signs of intoxication appear. Body temperature stays at 37 degrees or more for a long time.
2. Latent tuberculosis
   The symptoms of the closed form of tuberculosis are mild, they are similar to the manifestations of ARVI or a cold. The patient's body actively fights the infection and suppresses it. A person is not contagious. During the period of development of closed tuberculosis, periodic slight increases in temperature, increased fatigue, and apathy are possible.
3. Active disease
   In the open form of tuberculosis, the symptoms appear in full force: a person is bothered by a cough, hemoptysis that occurs when bleeding in the bronchi, fever, weakness, loss of appetite, etc. This stage is dangerous for others: the patient becomes a carrier of infection, he is able to infect other people.
4. Relapse of tuberculosis (secondary disease)
   Under unfavorable conditions, a previously cured disease is reborn. Bacteria “awaken” in old lesions or a new infection occurs. The disease occurs in an open form. There are signs of intoxication of the body and bronchopulmonary manifestations. Treatment of recurrent tuberculosis requires long-term and powerful effects.

For the primary form of the disease to transform into an open one, the pathogen must spend more than two years in the human body. For its reproduction there must be provoking factors. If they are absent and the immune system works well, the Koch bacillus dies a few days or weeks after entering the respiratory system.

Video

Video - how to identify tuberculosis?

Symptoms of the extrapulmonary form of the disease

The disease can affect not only the lungs, so special attention should be paid to the signs of tuberculosis in the extrapulmonary form. Symptoms depend on the organ in which the pathogen has settled. The following options exist:

Brain damage

This form of the disease can most often develop in childhood or in an adult suffering from diabetes or HIV infection.

The main symptoms of the problem are:

• headaches localized in the frontal and occipital lobes;
• decreased performance;
• apathy;
• deterioration in sleep quality, frequent nightmares;
• decreased appetite.

Sweating in tuberculosis, which occurs at night, is another characteristic sign of disease progression. As the disease progresses, dangerous symptoms appear - nausea and vomiting, tension in the neck muscles, specific body postures, distortion of facial expressions, squint, etc.

If the symptoms and treatment of the disease are determined in a timely manner, the prognosis for the patient is favorable. This is achieved thanks to new generation anti-tuberculosis drugs.

Gastrointestinal lesions

The patient feels pain in the digestive organs, decreased appetite, nausea, constant fatigue, lethargy, and increased sweating at night. If the disease has affected the intestines, there is a false urge to defecate, stool disorders, and blood in the stool. If Koch's bacillus is localized in the stomach area, constant thirst, belching appears, and the person suddenly loses weight. The temperature during tuberculosis in the gastrointestinal tract can rise to 40 degrees.

Damage to joints and bones

This is a rare form of the disease, the symptoms of which are similar to the manifestations of arthritis and arthrosis. The patient experiences pain during physical activity, and the range of motion of the affected limbs is limited.

Skin lesions

This is an infectious process that affects the dermis, epidermis and fatty tissue.

Its characteristic manifestations include the following:

• the appearance of rashes;
• excessive dry skin;
• frequent manifestations of allergies;
• decreased immunity;
• fatigue, lethargy of the patient.

In the initial stages, it is possible to develop tuberculosis without fever, then it rises to 37-38 degrees.

Damage to the genitourinary organs

Koch's bacillus is localized in the kidneys or bladder. Patients feel constant fatigue, apathy, complain of poor sleep, loss of appetite. Aching pain occurs in the lumbar region, urination becomes difficult or, conversely, too frequent, and is accompanied by unpleasant sensations.

According to statistics, extrapulmonary forms of tuberculosis account for 10% of all cases of infection. However, their development has dangerous consequences, including death. Therefore, it is important to listen to what signals your body is giving and consult a doctor in time.

Methods for diagnosing tuberculosis

Anyone can become infected with a dangerous disease, regardless of age and social status. Recognizing latent tuberculosis, the pulmonary or extrapulmonary form of the disease, is not easy, because the symptoms are similar to those of other pathologies. Diagnosis requires special studies.

Initially, the patient comes to see the doctor and expresses complaints. Cough with pulmonary tuberculosis that does not go away for more than 3 weeks, weight loss, shortness of breath, and decreased performance deserve special attention. The doctor finds out whether the person had the opportunity to become infected with tuberculosis from someone from his immediate environment, whether there is a relapse of tuberculosis or whether the infection occurred initially.

Based on the examination data, no conclusions can be drawn; one can only suspect the disease. For an intermediate examination for tuberculosis in adults, an x-ray is recommended, which will show whether there are foci of infection and how they are localized.

The Mantoux test is recommended for examining children.. This is an easy and safe method of exposure that does not lead to irradiation of the body. Tuberculin is injected into the child's forearm and the results are taken after three days. If the test gives a positive result, there are grounds for further diagnosis.

X-rays and Mantoux are not the basis for making a final diagnosis. More research is needed.

These include tests:

• sputum;
• blood;
• urine.

Having received the results of all examinations and comparing with them the characteristic symptoms of pulmonary tuberculosis in women and men, the doctor makes an accurate diagnosis. Its task is to determine the resistance of the pathogen to certain medications and prescribe effective methods of therapeutic intervention.

Open tuberculosis is a disease that is dangerous not only for the patient himself, but also for the people around him.

If not properly treated, it can be fatal. Modern methods of therapy make it possible to cope with a serious illness; the most important thing is to consult a doctor in time and follow all his recommendations and instructions.

Tuberculosis is one of the most common chronic infectious diseases. The pathology is caused by mycobacteria - Koch bacilli. The most famous is pulmonary tuberculosis, but a similar disorder can also develop in bone tissue, kidneys, joints and other organs. Tuberculosis usually affects the lungs, less often affecting other organs and systems. The disease has a sluggish course: years or even decades often pass from the moment of infection to the onset of clinical symptoms. Some people have been carriers of Koch's bacillus all their lives and do not know about it. However, in every tenth patient the pathology takes an active form and leads to the development of severe health problems.

Phthisiology, that is, the section of clinical medicine that studies the mechanisms of transmission and development of tuberculosis, identifies four main transmission routes of this pathology: airborne, contact-household, nutritional and transplacental.

Attention! Only people with an open form of tuberculosis are potential sources of infection.

Prerequisites for the development of tuberculosis

Anamnesis	Prerequisites for the development of pathology	Non-specific prerequisites
Hereditary predisposition	Contact with infected persons, childhood tuberculosis of the lungs, bronchi or larynx	Frequent colds, bronchial asthma
Past diseases	Particular viral or bacterial lesions of the respiratory tract, pneumonia	Severe long-term operations, chronic disorders of the gastrointestinal tract
Living in unfavorable conditions	Accommodation in the Far North	Not installed
Working in adverse conditions	Work in tuberculosis clinics, in factories producing asbestos, silicon, toxic substances	Night shift work, overwork, stress

Airborne infection

Airborne transmission of Koch bacillus is the most common method of infection. More than 95% of patients with pulmonary tuberculosis were infected in this way. Such a high contagiousness of the disease in this case is due to the following factors:

1. When a patient with open form of tuberculosis coughs and sneezes, he spreads Koch bacilli at a distance of about 1-2 m around himself.
2. During one coughing attack, the patient releases an average of 3 to 5 thousand mycobacteria into the environment.
3. Infectious agents isolated in sputum dry out but remain viable for several months or even years.
4. Epithelial membranes are the most vulnerable to the effects of bacteria and viruses. Entering the human body during inhalation, mycobacteria quickly penetrate the mucous membranes.
5. When breathing, sticks containing air masses can enter directly into the lungs.

Attention! Pulmonary tuberculosis is the most common form of the disease. It is observed in the vast majority of patients.

Contact and household infection

In case of contact infection, the pathogen enters the human body as a result of using common hygiene products or household items with the patient. Also, in rare cases, pathology develops after unprotected sexual intercourse with an infected person, kissing, or contact of infected blood with the skin and epithelium of a healthy person. In order for a pathogen to be able to penetrate the human body through contact, the presence of accompanying factors is necessary:

1. A weakened human immune system, including chronic illness, HIV or AIDS, autoimmune disorders, recent severe infections or surgery.
2. The presence of damage to the skin or epithelial membranes: wounds, scratches, ulcerations, etc.
3. Prolonged contact with an infected person: caring for him, prolonged stay in a common room, sexual contact, etc.

Attention! Women are more susceptible to infection by pathogenic microorganisms during coitus than men. This is due to the larger area of ​​the mucous membranes of the female genital tract.

Food contamination

Cases of nutritional or food contamination with Koch's bacillus are quite rare. The source of infection in this case is pigs and cattle, whose milk or meat is consumed. To avoid the pathogen entering the body, you need to follow a number of recommendations:

1. Before purchasing meat products, ask the seller for a quality certificate.
2. Thoroughly boil or fry meat products.
3. Boil milk purchased at markets or farmers' fairs before use.

Attention! You should not buy meat and milk if you are not sure of the quality of the products. In addition to Koch's bacilli, they may contain actinomycetes, helminth larvae and other pathogens of various pathologies.

Transplacental infection

With transplacental infection, pathogenic bacteria enter the child's body through the placenta during embryonic development. This route of infection occurs in extremely rare cases. If tuberculosis pathogens are nevertheless transmitted to the fetus, then the likelihood of normal development of the embryo is extremely low.

Attention! When planning pregnancy, women suffering from tuberculosis must undergo a course of therapy aimed at neutralizing mycobacteria in the body and restoring health.

First signs

Clinical symptoms of tuberculosis appear only after mycobacteria spread through the bloodstream throughout the body and begin to actively infect healthy tissues.

The first signs of pathology often resemble manifestations of an acute viral or bacterial infection. Patients complain of drowsiness, fatigue, and weakness. Low-grade fever is often observed, the patient’s body temperature rises to 37.2-38°C.

Gradually, the patient's condition worsens so much that he loses his appetite and his body weight quickly decreases. The skin of people suffering from tuberculosis becomes pale, dry and thin, with a feverish blush appearing on the cheeks.

Attention! A characteristic symptom of tuberculosis is night fever. In the evening hours the patient complains of chills, headache, and sleep disturbances.

When the lung tissue is destroyed, a dry barking cough occurs, which manifests itself at night or in the morning after waking up. Depending on the type of pathology, other manifestations of the disease arise over time.

Video - The most dangerous symptoms of tuberculosis

Symptoms of pulmonary tuberculosis

Damage to lung tissue is the most common type of tuberculosis. The disease is manifested by a characteristic cough and disruption of the respiratory system.

In patients with pulmonary tuberculosis the following are noted: symptoms:

1. Cough. Initially, attacks of dry cough occur only in the morning and at night, but soon the patient’s condition worsens. Cough occurs at any time of the day, and the attack can last from several minutes to half an hour or more. As the pathology progresses, sputum begins to be produced when coughing. At first it is transparent and liquid, over time it becomes mucous, containing bloody inclusions and clots. Attention! A long-lasting cough, accompanied by attacks of fever, is one of the most characteristic signs of tuberculosis.
2. Chest pain. The destruction of lung tissue leads to discomfort in the chest area. At the beginning of the disease, they bother the patient only after physical activity or when trying to take a deep breath. After some time, pain in the hypochondrium begins to occur even at rest and sharply intensifies during coughing.
3. Lymphadenopathy. In the initial stages of development of the pathology, enlarged lymph nodes are noted in the armpits, neck and abdomen. As tuberculosis progresses, this symptom takes on a generalized form.

Symptoms of tuberculosis of bones and joints

With this form of tuberculosis, the pathological process affects the human musculoskeletal system. Under the influence of mycobacteria, bone and cartilage tissue is destroyed. Granulomas form in the vertebrae, knee and elbow joints. This is an infiltrate filled with purulent exudate.

As the disease progresses, the following pathological signs are noted: symptoms:

1. Feeling of heaviness and discomfort in the spine and joints. This symptom appears in the earliest stages of tuberculosis. Unpleasant sensations increase with physical activity and decrease at rest.
2. Acute pain in affected bones and joints. Tissue destruction and damage to nerve endings causes intense pain. If the pathological process is localized in the spine, then the patient develops a characteristic posture: a hunched back and raised shoulders. This position partially reduces the pressure on the affected area.
3. General health disorder. Patients with tuberculosis complain of sudden mood swings, headaches, memory impairment and decreased performance. They are worried about constant drowsiness, and insomnia often occurs at night.
4. Muscle atrophy. Granuloma causes destruction of both bone and muscle tissue surrounding the affected area. Impaired mobility of joints and bones leads to muscle hypotonicity and the development of atrophy.
5. Fistula formation. The granuloma fills with pus and increases in size. The skin over it becomes hyperemic, inflamed and swollen. In most cases, a fistula forms in the area of ​​the destroyed joint or bone, from which a grayish liquid purulent exudate is released.

Attention! The formation of a fistula is an extremely dangerous condition for the patient, since at this stage there is a high probability of bacteria spreading throughout the body or the addition of a secondary infectious process.

Symptoms of kidney tuberculosis

This pathology is manifested by both local and general signs of the development of the infectious process. Kidney tuberculosis initially manifests itself as subtle clinical symptoms: discomfort in the lower back, chills, dysuria - a violation of the urination process.

Over time, the patient develops intense pain in the lower back. They are aching or cutting in nature. The disturbance in well-being in this case is caused by the growth of granuloma in the kidney tissue. The pain syndrome is usually paroxysmal in nature and clinically resembles renal colic.

General symptoms of intoxication develop both due to the rapid proliferation of mycobacteria and against the background of impaired excretion of urine from the body. The patient complains of weakness, sweating, and bad breath. Since the kidneys stop filtering urine normally, the patient may experience swelling, which leads to weight gain and makes diagnosis difficult.

Symptoms of dermal tuberculosis

Skin tuberculosis is a whole group of various pathologies that develop as a result of the action of mycobacteria. All these diseases have a number of similar symptoms:

• vesicular rash on the skin;
• chills and low-grade fever;
• positive reaction with the Mantoux test;
• itching, painful swelling of the skin;
• weight loss.

Tuberculosis is a pathological condition caused by damage to body tissues by mycobacteria. The inflammatory process in this case can be localized in any human organs and tissues. Without timely treatment, the disease can lead to the death of the patient. Therefore, if you identify any alarming symptoms, you should definitely seek advice from a specialist.

– a chronic infection caused by the bacteria Mycobacterium tuberculosis complex. When affected by tuberculous mycobacteria, the respiratory organs most often suffer; in addition, tuberculosis of bones and joints, genitourinary organs, eyes, and peripheral lymph nodes occurs. Diagnosis of tuberculosis consists of conducting a tuberculin test, X-ray examination of the lungs, detection of Mycobacterium tuberculosis in sputum, bronchial swabs, skin discharge, and additional instrumental examination of organs affected by tuberculosis. Treatment of tuberculosis is a complex and long-term systemic antibiotic therapy. Surgical treatment is performed according to indications.

ICD-10

A15-A19

General information

– a chronic infection caused by the bacteria Mycobacterium tuberculosis complex. When affected by tuberculous mycobacteria, the respiratory organs most often suffer; in addition, tuberculosis of bones and joints, genitourinary organs, eyes, and peripheral lymph nodes occurs. Most often, infection occurs by airborne droplets, less often by contact or nutrition.

Causes of tuberculosis

Characteristics of the pathogen

Mycobacterium tuberculosis complex is a group of bacterial species that can cause tuberculosis in humans. The most common pathogen is Mycobacterium tuberculosis (obsolete - Koch's bacillus), which is a gram-positive, acid-fast bacilli of the family of actinomycetes, a genus of mycobacteria. In rare cases, tuberculosis is caused by other members of this genus. Endotoxins and exotoxins are not isolated.

Mycobacteria are extremely resistant to environmental influences, persist for a long time outside the body, but die under the influence of direct sunlight and ultraviolet irradiation. They can form low-virulent L-forms, which, when present in the body, help form specific immunity without developing the disease.

Mechanism of infection

The reservoir of infection and the source of infection with tuberculosis are sick people (most often, infection occurs through contact with patients with open pulmonary tuberculosis - when tuberculosis bacteria are excreted in the sputum). In this case, the respiratory route of infection is realized (inhalation of air with scattered bacteria). A patient with active secretion of mycobacteria and a severe cough can infect more than a dozen people over the course of a year.

Infection from carriers with scant bacterial excretion and a closed form of tuberculosis is possible only through close, constant contacts. Sometimes infection occurs through nutrition (bacteria enter the digestive tract) or contact (through damage to the skin). The source of infection can be sick cattle and poultry. Tuberculosis is transmitted through milk, eggs, and when animal feces enter water sources. The entry of tuberculosis bacteria into the body does not always cause the development of infection. Tuberculosis is a disease often associated with unfavorable living conditions, decreased immunity, and decreased protective properties of the body.

Pathogenesis

During tuberculosis, primary and secondary stages are distinguished. Primary tuberculosis develops in the zone of introduction of the pathogen and is characterized by high tissue sensitivity to it. In the first days after infection, the immune system is activated, producing specific antibodies to destroy the pathogen. Most often, in the lungs and intrathoracic lymph nodes, and in the case of alimentary or contact infection, in the gastrointestinal tract and skin, a focus of inflammation is formed. In this case, bacteria can disperse with the blood and lymph flow throughout the body and form primary foci in other organs (kidneys, bones, joints).

Soon the primary lesion heals, and the body acquires stable anti-tuberculosis immunity. However, with a decrease in immune properties (in adolescence or old age, with a weakened body, immunodeficiency syndrome, hormonal therapy, diabetes, etc.), infection intensifies in the foci and secondary tuberculosis develops.

Classification

Tuberculosis is divided into primary and secondary. Primary, in turn, can be prelocal (tuberculosis intoxication in children and adolescents) and localized (primary tuberculosis complex, which is a focus at the site of infection, and tuberculosis of the intrathoracic lymph nodes).

Secondary tuberculosis differs in localization into pulmonary and non-pulmonary forms. Pulmonary tuberculosis, depending on the prevalence and degree of damage, can be miliary, disseminated, focal, infiltrative, cavernous, fibrous-cavernous, cirrhotic. Caseous pneumonia and tuberculoma are also distinguished. Tuberculous pleurisy, pleural empyema and sarcoidosis are identified as separate forms.

Outside the lungs there is tuberculosis of the brain and spinal cord and meninges, tuberculosis of the intestines, peritoneum, mesenteric lymph nodes, bones, joints, kidneys, genitals, mammary glands, skin and subcutaneous tissue, eyes. Sometimes there is damage to other organs. In the development of tuberculosis, the phases of infiltration, decay, seeding, resorption, compaction, scarring and calcification are distinguished. With regard to the isolation of bacteria, there is an open form (with the isolation of bacteria, MBT-positive) and a closed form (without isolation, MBT-negative).

Symptoms of tuberculosis

Due to the numerous clinical forms, tuberculosis can manifest itself with a wide variety of symptom complexes. The course of the disease is chronic, usually begins gradually (it can be asymptomatic for a long time). Over time, symptoms of general intoxication appear - hyperthermia, tachycardia, weakness, decreased performance, loss of appetite and weight loss, sweating. As the infection progresses and spreads throughout the body, intoxication can be quite intense. Patients significantly lose body weight, facial features become sharper, and a painful blush appears. The body temperature does not rise above subfebrile levels, but lasts for a long time. Fever occurs only in case of massive lesions.

• Pulmonary tuberculosis is usually accompanied by a cough (initially dry), worsening at night and in the morning. The existence of a persistent cough for more than three weeks is an alarming symptom, and in such cases you should definitely consult a doctor. As the disease progresses, hemoptysis may occur. Pulmonary tuberculosis can be complicated by a life-threatening condition - pulmonary hemorrhage.

Tuberculosis of other organs and systems occurs much less frequently and is detected, as a rule, after excluding other pathologies.

• Tuberculosis of the meninges and brain. It develops gradually over 1-2 weeks, most often in children and people with immunodeficiency, in patients with diabetes. Initially, in addition to symptoms of intoxication, sleep disorders and headaches appear; from the second week of the disease, vomiting occurs, and the headache becomes intense and persistent. By the end of the first week, meningeal symptoms (stiff neck, Kernig and Brudzinski symptoms), and neurological disorders are noted.
• Tuberculosis of the digestive tract is characterized by a combination of general intoxication with stool disorders (constipation alternating with diarrhea), symptoms of dyspepsia, abdominal pain, and sometimes bloody impurities in the stool. Intestinal tuberculosis can contribute to the development of obstruction.
• Tuberculosis of bones, joints and spine. With tuberculosis of the joints, symptoms of arthritis are noted (pain in the affected joints, limited mobility). When bones are affected, they are sore and prone to fractures.
• Tuberculosis of the genitourinary system. When the source of infection is localized in the kidneys, patients note symptoms of nephritis, back pain, and possibly blood in the urine. Quite rarely, tuberculosis of the urinary tract can develop, in which case the manifestations will be dysuria (impaired urination), pain when urinating. Tuberculosis of the genital organs (genital tuberculosis) can cause infertility.
• Skin tuberculosis is characterized by the appearance of dense nodules under the skin, which, as they progress, enlarge and burst into the skin with the release of white cheesy masses.

Complications

Diagnostics

Diagnosis of pulmonary tuberculosis

Since tuberculosis is often asymptomatic at first, preventive examinations play a significant role in its diagnosis. In the diagnosis of pulmonary tuberculosis the following are used:

• Screening methods. Adults annually need to undergo fluorography of the chest organs, children - a Mantoux test (a tuberculin diagnostic technique that reveals the degree of infection of the body with the tuberculosis bacillus and tissue reactivity). As an alternative to the tuberculin test and the Diaskin test, laboratory methods have been proposed to detect latent and active tubinfection: T-SPOT test and Quantiferon test.
• Topical radiodiagnosis. The main method for diagnosing tuberculosis is chest radiography. In this case, foci of infection can be detected both in the lungs and in other organs and tissues. If necessary, perform a CT scan of the lungs.
• Study of biological media. To determine the pathogen, culture of sputum, bronchial and stomach lavage water, separated from skin formations, is performed. If it is impossible to inoculate the bacterium from biological materials, we can talk about the ICD-negative form.
• Biopsy. In some cases, to clarify the diagnosis, bronchoscopy with biopsy and lymph node biopsy are performed.

Diagnosis of extrapulmonary tuberculosis

Data from laboratory tests are nonspecific and indicate inflammation, intoxication, and sometimes (proteinuria, blood in the stool) can indicate the localization of the lesion. However, a comprehensive study of the body’s condition in tuberculosis is important when choosing treatment tactics.

If an extrapulmonary form of tuberculosis is suspected, they often resort to a more in-depth tuberculin diagnosis than Mantoux - the Koch test. Diagnosis of tuberculous meningitis or encephalitis is often carried out by neurologists. The patient is examined using rheoencephalography, EEG, CT or MRI of the brain. To isolate the pathogen from the cerebrospinal fluid, a lumbar puncture is performed.

With the development of tuberculosis of the digestive organs, consultation with a gastroenterologist, ultrasound of the abdominal organs, and coprogram are necessary. Tuberculosis of the musculoskeletal system requires appropriate X-ray examinations, CT scan of the spine, and arthroscopy of the affected joint. Additional examination methods for tuberculosis of the genitourinary system include ultrasound of the kidneys and bladder. Patients with suspected cutaneous tuberculosis need to consult a dermatologist.

Treatment of tuberculosis

Treatment of tuberculosis is aimed at healing lesions and eliminating symptoms. Advanced tuberculosis is much less treatable than timely detected tuberculosis, even with a more severe course (destructive forms). Treatment of tuberculosis takes a year or more and is complex (combines drug therapy and physiotherapy). Initially, treatment is carried out in a tuberculosis clinic until the release of microorganisms stops. After which the patients are discharged to continue outpatient treatment. Patients who have undergone tuberculosis therapy are recommended to undergo treatment in specialized sanatoriums and dispensaries.

Surgical treatment is indicated in cases where conservative therapy is not sufficient to achieve a cure (cavernous form of pulmonary tuberculosis, various complications). The most common surgical treatment for tuberculosis is partial resection of the lung with excision of the affected segments. Surgical collapse therapy is also used. Patients suffering from tuberculosis are prescribed a special high-calorie diet (table No. 11), rich in easily digestible protein, vitamins C and B.

Bed rest is prescribed only for patients with a high degree of lung destruction and severe hemoptysis. In other cases, patients are recommended to take walks, exercise therapy, and vigorous physical activity.

Forecast

Currently, in most cases, with timely detection and compliance with the necessary treatment measures, the prognosis is favorable - healing of tuberculosis foci occurs and clinical signs subside, which can be considered clinical recovery. After treatment, scars, areas of fibrosis, and encapsulated lesions containing bacteria in a dormant state may remain at the site of the lesions. If the body's condition worsens, the disease may recur, so after clinical cure, patients are monitored by a phthisiatrician and undergo regular examinations. After suffering and curing tuberculosis, the tuberculin test remains positive.

In the absence of treatment or non-compliance with recommendations, mortality from tuberculosis reaches 50% of cases. In addition, the prognosis worsens in the elderly, HIV-infected people and people with diabetes.

Prevention

Preventive measures carried out by specialized anti-tuberculosis medical institutions together with general medical institutions include preventive examinations of citizens (mandatory annual fluorography), identification of patients suffering from open forms of tuberculosis, their isolation, examination of contact persons, and specific prevention of tuberculosis.

Specific prevention (vaccination) is aimed at the formation of anti-tuberculosis immunity, including the administration of the BCG vaccine or preventive chemical agents. In persons vaccinated with BCG, tuberculosis occurs in milder, benign forms and is easier to treat. Immunity is usually formed 2 months after vaccination and wanes after 5-7 years. Chemoprophylaxis measures are used among persons with an increased risk of infection: persons in contact with tuberculosis patients with a negative tuberculin test (primary chemoprophylaxis) and infected persons (secondary).