What methods are used to diagnose tuberculosis? Detection of tuberculosis in modern conditions Methods for early detection of tuberculosis

V.Yu. Mishin

Diagnosis of tuberculosis includes several successive stages. In this case, all research methods are divided into 3 groups: mandatory diagnostic minimum (ODM), additional methods of non-invasive research (DMI-1) And invasive (DMI-2) character and, finally, optional methods (FMI).

But treatment is usually done with four different types of antibiotics taken together for two months, followed by two antibiotics for the next four months. It is very important that all four antibiotics are taken until advised by your doctor.

Sometimes these antibiotics can cause side effects. Side effects are less common in children than in adults. Feeling sick and loss of appetite antibiotics can affect the liver, but this is very rare in children. Rifampicin may turn fatty fluids into oranges, but this is harmless to the body and will disappear when the course of Rifampicin ends. Ethambutol may cause visual problems and children treated with this antibiotic may require regular eye examinations.

• This should be discussed with your doctor.
• Isoniazid and rifampicin work best on an empty stomach.

Disclaimer This information is intended to support, not replace, discussion with your doctor or healthcare professionals.

ODM includes the study of complaints, medical and life history, clinical blood and urine tests, Ziehl-Neelsen sputum microscopy of at least three samples with quantitative assessment of the massiveness of bacterial excretion, x-ray of the chest organs in frontal and lateral projections and Mantoux test with 2 TE PPD-L .

TO DMI-1 include advanced microbiological diagnostics with sputum examination by PCR and sputum culture on nutrient media with determination of MBT drug resistance to anti-tuberculosis drugs, as well as sputum culture for nonspecific microflora and fungi; in-depth radiation diagnostics using CT of the lungs and mediastinum, ultrasound for pleurisy and subpleurally located round formations; in-depth immunodiagnostics using enzyme-linked immunosorbent assay (ELISA) to detect anti-tuberculosis antibodies (AT) and antigens (AG) in the blood.

The authors of these consumer health information handouts have made significant efforts to provide accurate, current, and easy-to-use information. The Royal Children's Hospital Melbourne is not responsible for any inaccuracies, information perceived as misleading, or the success of any treatment regimen detailed in these handouts. The information contained in the handouts is updated regularly and you should therefore always check that you are referring to the most current version of the handout.

In addition to microscopy of sputum and other pathological material as a mandatory diagnostic minimum, it is possible to study using fluorescent microscopy, PCR and the bacteriological (cultural) method of inoculation on nutrient media, which are carried out in specialized laboratories of anti-tuberculosis institutions.

It is your responsibility, the user, to ensure that you have downloaded the most current version of the Consumer Information Newsletter. Most cases in children under 12 years of age are smear-negative, and smears are rarely performed in high-burden countries.

Needle examination methods for diagnosing tuberculosis

The drugs recommended for these cases are “unlabeled” for children. The incubation period, which usually lasts from 2 to 12 weeks, is the time that elapses between infection and identification of the primary lesion or a positive tuberculin skin test.

Detection of MBT allows you to establish an etiological diagnosis without much difficulty. The most difficult situation in diagnosing tuberculosis occurs in patients with clinical symptoms in the absence of sputum, and also when MBT is not detected in the sputum. In these cases, the diagnosis of pulmonary tuberculosis is largely based on radiation methods for examining the chest organs.

This transition occurs more frequently and quickly during childhood. Fever is the most easily identified systemic effect in children. The inflammation is initially localized by a nonspecific infiltrate, which can be identified radiographically. After a few days, the infection spreads to regional lymph nodes, causing them to swell disproportionately compared to the parenchymal focus. Symptoms are usually mild, including low-grade fever and cough. The cough is usually nonproductive, and mild shortness of breath is common in infants.

Focal wheezing and respiratory distress may also occur, especially in infants. The signs needed to confirm the diagnosis using chest x-ray and computed tomography are usually absent. Hilar and mediastinal adenopathy are predominant, although not always distinguishable by plain radiographs.

These methods complement the results of clinical examination of patients, while their combined analysis makes it possible to increase sensitivity and specificity, and in case of negative data from microbiological and morphological studies, they are of decisive importance. X-ray CT of the lungs is the leading diagnostic method.

Lymph nodes, usually supraclavicular or cervical, are swollen, nontender, and hard. Involvement of the cervical nodes is secondary to spread of disease from a pulmonary focus. Central nervous system involvement is quite common in children and is secondary to lymphohematogenous spread. The most common presentation in children is meningitis, primarily at the base of the brain. Clinical presentation may range from nonspecific headache without focal signs of meningitis, neck stiffness and focal signs, or even coma, hemiplegia, and signs of increased intracranial pressure.

X-ray tomographic picture of pulmonary tuberculosis differs in polymorphism both in the nature of infiltrative changes and in the localization of specific changes, and requires targeted differential diagnosis.

Specific tuberculous inflammation has a variety of radiological manifestations - from single or multiple confluent foci, round infiltrates and recissuritis to lobar tuberculous pneumonia. However, most manifestations are characterized by localization of the process in the apical [C1], posterior [C2] and upper segments of the lungs.

Nuclear shift of neutrophils in tuberculosis

The outcome of the disease depends on the severity of the symptoms. Children exhibit protein clinical manifestations, and children may present with fever, cachexia, respiratory distress, nodular changes on chest radiographs, and hepato-splenomegaly.

It is usually associated with rupture of the cavity or adjacent parenchymal focus through a bronchial fistula. Symptoms are subtle, and diagnostic evaluations are often not undertaken until the process is advanced. Vertebral disease results in bone destruction and collapse leading to the formation of a spinal column if diagnosis is delayed.

All variants of pulmonary tuberculosis are characterized not only by the presence of focal and infiltrative shadows, but also quite often by cavities, which, as a rule, are accompanied by bronchogenic contamination, which has certain patterns, which can serve as a diagnostic sign.

In the presence of a cavity in the upper lobe of the left lung, the presence of foci of contamination along the periphery and in the anterior [C3], superior lingular, inferior lingular segments, as well as the basal medial, anterior basal, lateral basal [C9] and posterior basal [C10] segments of the lower lobe of the left lung is typical .

The regions involved determine its clinical manifestations. Children usually present with fever, anorexia, weight loss, lymphadenopathy and ascites. This indicated that both tests could be used to identify infected children. Collecting specimens from children is also very difficult, especially from the youngest patients who cannot produce adequate sputum.

Current recommended treatment regimens for adults and children are essentially the same. They are based on a combination of drugs that eliminate mycobacteria through different mechanisms to prevent the emergence of resistant organisms with minimal toxicity. Isoniazid and rifampicin are the most powerful first-line bactericidal drugs.

In right-sided cavities, foci of contamination spread to the underlying parts of the upper lobe with a predominant lesion of the anterior [C3] segment, and cross-metastasis also occurs in the left lung, mainly in the upper lingular and lower lingular segments.

In clinical practice diagnostic value of the Mantoux test with 2 TE PPD-L in adult patients with radiologically detectable changes in the lungs is determined by its negative or hyperergic reaction. If the patient has a negative Mantoux reaction (puncture reaction at the injection site), changes in the lungs are more likely to be non-tuberculous processes.

In these cases, 9-12 months of therapy is recommended, and steroids in the first weeks of treatment also appear to be beneficial. The recommended dosage of first-line medications for children is given in Table 2. In these cases, one of the two medications should be interrupted.

Major authorities in the United States recommend at least three drugs for initial therapy and a duration of therapy of at least 9 months. However, the data do not support this recommendation. Of these children, 91 had a favorable outcome with a mortality rate of 12%. Treatment lasted approximately 18 months with a median of 7 drugs, including one injectable drug, for approximately 6 months.

In the presence of a hyperergic reaction (papule size 21 mm or more in diameter or vesiculonecrotic reactions regardless of the size of the papule), changes in the lungs are more likely to be tuberculous.

A positive Mantoux 2 TE PPD-L reaction with a papule size of 5 to 20 mm in diameter has no diagnostic value, since more than 70% of the adult population by the age of 30 are already infected.

The authors demonstrated that all patients were cured and adverse events occurred in two patients. The authors demonstrated that 1% of patients were treated successfully. Response to treatment was higher for studies that included injecting drugs in their regimen. Overall, 9% of patients died and 39% had side effects. These events occurred as nausea and vomiting in most cases, as well as serious events such as hearing loss, psychiatric effects, and hypothyroidism.

It has been used successfully in adults, but data in children is sparse. Adverse events included pancreatitis, peripheral neuropathy, anemia, and leukopenia. Four children were cured, while others were still receiving therapy but improving. This is only due to the assumption that pathogens are fully responsive to drugs and that patient compliance is ideal.

Currently used laboratory and immunological methods for diagnosing pulmonary tuberculosis are mainly indirect in nature and are used comprehensively to increase the significance of diagnosis verification.

In cases of doubtful activity of tuberculous changes in the lungs, exjuvantibus therapy can be used. In this case, chemotherapy is prescribed with four anti-tuberculosis drugs (isoniazid, rifampicin, pyrazinamide and ethambutol). In such cases, a repeat X-ray examination is necessary after 2 months.

This study was supported by grants from the Italian Ministry of Health. Competing Interests: The authors have declared that there are no competing interests. Principles and practice of pediatric infectious diseases. 4th edition. American Thoracic Society Diagnostic standards and classification of tuberculosis in adults and children.

Recent improvements in diagnostics

Clinical tuberculosis. 4th edition. This technology is recommended, especially in seriously ill children, when prompt diagnosis is important. Notes for recommendations 1 and 2: These recommendations also apply to gastric lavage and aspiration. . Notes for recommendations 3 and 4.

In cases of tuberculous etiology, partial or complete resorption of inflammatory changes is observed - this is the so-called delayed diagnosis. By this time, it is possible to obtain the results of sputum culture on nutrient media, done before the start of chemotherapy. Culture growth in the presence of MBT in the material is usually observed after 4-8 weeks, which confirms the diagnosis.

Thorough History

If sufficient material is available, concentration methods should be used to increase yield. A pleural biopsy is preferred. . The most common symptoms are. Weight loss or failure. Fatigue, decreased playfulness, decreased activity.

Principles of pre-sowing processing of diagnostic material

In addition to asking about weight loss or failure to thrive, it is important to look at the child's growth chart, if available. However, there are no specific shutdowns, for example. duration of symptoms have been confirmed, and accuracy will depend on context. These groups pose a major challenge to clinical diagnosis.

DMI-2 include bronchoscopy with various types of biopsies (aspiration, brush, etc.) and BAL; puncture of the pleural cavity and pleurobiopsy; transthoracic lung biopsy; thoracoscopy, mediastinoscopy and, finally, open lung biopsy with subsequent cytological, histological and microbiological studies of the obtained material.

Clinical examination

Bacteriological confirmation if possible

Appropriate samples from suspicious lesions should be obtained for microscopy and culture, although this will depend on the availability of facilities and resources. Bacteriological confirmation is especially important for children who have. Adolescents may also develop primary disease with hilar adenopathy and collapsed lesions.

Good chest radiographs are essential for proper assessment and should preferably be read by a radiologist or health care professional trained in reading them. An improved symptom-based approach for diagnosing pulmonary tuberculosis in children.

Detection of specific elements of tuberculous granuloma (caseosis, epithelioid and multinucleated cells) in a biopsy specimen allows morphological verification of pulmonary tuberculosis and timely initiation of anti-tuberculosis treatment.

FMI are very numerous and are aimed not so much at diagnosing tuberculosis, but at determining the functional state of various internal organs and metabolic processes. They examine the level of glucose in the blood, liver function, cardiovascular system, external respiration function, blood gas composition, pulmonary blood flow, etc.

Tuberculosis: a comprehensive clinical guideline. Use of diagnostic systems for the treatment of tuberculosis in children. Recommendations for contact investigation of persons with infectious tuberculosis in low- and middle-income countries. Geneva: World Health Organization. Rapid molecular diagnosis of pulmonary tuberculosis in children using nasopharyngeal samples.

Slow needle aspiration biopsy: an underappreciated diagnostic modality in pediatric mycobacterial disease. Diagnostic atlas of intrathoracic tuberculosis in children: a guide for low-income countries. Paris: International Union against Tuberculosis and Lung Disease.

The majority of cases are detected during the patient’s initial visit to general practitioners. The patient, feeling unwell, does not immediately seek help from a doctor. A low-grade fever of up to 37.5 C appears and is maintained constantly. After some time, a dry cough develops, sometimes with sputum production ( heavy smokers most often do not pay attention to it, citing their bad habit). That's when you should worry, it's time to see a doctor. Every doctor knows about the widespread prevalence of tuberculosis, therefore, when a patient presents with characteristic symptoms, he should ask the patient control questions, such as:

Every year, almost nine million people suffer from tuberculosis - many of them children. Now researchers have managed to develop a new blood test. It could significantly improve the diagnosis. Cough, slightly elevated body temperature and night sweats are the first symptoms of tuberculosis, formerly called dizziness, and are usually not particularly specific in children. It is necessary to quickly diagnose the test. "However, the diagnosis is still problematic in children," says infection researcher Christoph Geldmacher.

This may change in the future. The fact that the test provides reliable results for diagnosis in children can be demonstrated in a study conducted in Tanzania, supported by the European-African Clinical Trials Partnership initiative.

• Has the patient previously had tuberculosis?
• Did his relatives have tuberculosis?
• Has he been in contact with tuberculosis patients?
• Is the patient registered with an anti-tuberculosis institution due to hypersensitivity to tuberculin?
• Did you pass ( and when) patient fluorography of the lungs
• Whether the patient was in prison or in contact with people who were previously in prison
• Is he a migrant, homeless, living in unfavorable conditions, etc.

Communication with the patient plays a very important role in tuberculosis. From the patient’s story, you can learn some key points of the disease, for example, repeated respiratory infections he previously suffered or some signs of latent tuberculosis intoxication, which the patient indicates.
After collecting anamnesis and a thorough examination of the patient, laboratory and instrumental studies begin.

Tuberculin diagnostics
It is an important method for diagnosing tuberculosis, complementing the clinical examination of the patient. It indicates the presence of increased specific sensitivity of the body caused by the BCG vaccine or the causative agent of tuberculosis ( mycobacterium tuberculosis). To carry out a tuberculin test, tuberculin is used - a water-glycerol extract isolated from a culture of the pathogen. Tuberculin does not cause sensitization in a healthy body, and is also not capable of developing against tuberculosis. A response to tuberculin develops only in children previously sensitized by the BCG vaccine or the causative bacterium.

Mantoux test:
A small area of ​​skin on the inner surface of the forearm, namely its middle third, is treated with ethyl alcohol. The needle is inserted intradermally, parallel to the surface of the skin, with the needle cut upward. 0.1 ml of tuberculin is administered, which is one dose. At the site of tuberculin injection, a small ( diameter 7-8 mm) whitish-colored bubble in the form of a lemon peel. It is very important that the Mantoux test is performed by a specially trained nurse, since if the technique is performed incorrectly, the results become unreliable. The test results are assessed 72 hours after the test. The assessment is carried out by a doctor or a specially trained nurse. First, the forearm is examined at the site of tuberculin injection. This way you can detect the absence of external signs of a reaction, the presence of redness of the skin or the accumulation of infiltrate.

Redness of the skin should not be confused with infiltration. To do this, it is necessary to compare the thickness of the skin fold of the forearm over the healthy area, and then at the site of needle insertion. The difference is that with redness the folds remain the same thickness, but with infiltration, the fold above the site of tuberculin injection thickens. After an external examination, the diameter of the reaction is measured using a transparent ruler.

There are three types of response to tuberculin:
1. – characterized by a complete absence of skin redness and infiltration ( 0 – 1 mm).
2. Questionable reaction – redness of the skin of varying sizes or the presence of an infiltrate with a diameter of 2 – 4 mm/
3. Positive reaction – mandatory presence of infiltrate with a diameter of 5 mm or more.

In turn, positive reactions can also be divided into several types, depending on the diameter of the infiltrate:

• Weakly positive – 5 – 9 mm.
• Medium intensity – 10 – 14 mm.
• Pronounced – 15 – 16 mm.
• Hyperergic – in children and adolescents 17 mm or more, and in adults from 21 mm. Vesiculonecrotic reactions on the skin also fall into this category.
• Intensifying - a reaction accompanied by an increase in infiltrate by 6 mm or more compared to the previous sample.

Laboratory methods for detecting Mycobacterium tuberculosis
1. Sputum collection and processing: the procedure is carried out in a specially prepared room, away from unauthorized persons. The most common method is to collect material from the larynx using a swab. Mucus is collected during coughing or expectoration. The swab is placed in a special sealed container and immediately sent for microbiological examination. Materials are also collected during the study of bronchial and/or stomach lavage waters, the study of cerebrospinal fluid, pleural fluid, bronchoscopy, pleural biopsy, and lung biopsy.

2. Sputum microscopy:
It is the fastest and cheapest method for detecting Mycobacterium tuberculosis. The method is based on the ability of mycobacteria to retain their color even after treatment with various acid solutions. So, they are detected using a microscope in stained sputum smears. Along with simple microscopy, fluorescence microscopy is also used, which is based on the use of ultraviolet rays to identify mycobacteria.

Molecular genetic methods for diagnosing Mycobacterium tuberculosis 1. Polymerase chain reaction: consists of deciphering the genetic material of Mycobacterium tuberculosis. Designed to detect pathogens in sputum and recognize types of bacteria. The method has particular sensitivity and specificity.

2. Determination of pathogen drug resistance
Those strains of Mycobacterium tuberculosis on which the drug has a bacteriostatic or bactericidal effect in a minimum concentration are considered sensitive to any particular drug.
Resistant or resistant to a given drug are those strains of mycobacteria that are able to multiply when exposed to the drug in a minimum or increased concentration.

3. Serological methods for diagnosing tuberculosis
Serological methods for studying blood plasma components are based on the detection of numerous antigens related to tuberculosis, as well as a variety of immune responses caused by various forms of tuberculosis.

4. Blood analysis
Hemoglobin and red blood cells in most cases remain unchanged, except in cases accompanied by acute blood loss. An indicator indicating the presence of an active tuberculosis process is the erythrocyte sedimentation rate. Accelerated ESR is characteristic not only of fresh active tuberculosis, but also of exacerbation of a chronic process.
Other blood test parameters vary greatly depending on the nature of the lung damage.

5. Analysis of urine
In the urine analysis of a patient with pulmonary tuberculosis, there are no noticeable deviations from the norm. Changes appear only with tuberculosis and the urinary tract.

6. X-ray diagnostic methods
The most commonly used methods for diagnosing pulmonary tuberculosis are:

• Radiography
• X-ray
• 
  Fluorography
• Tomography

7. Endoscopic methods for diagnosing tuberculosis

• Tracheobronchoscopy
• Bronchoscopic lavage
• Thoracoscopy ( pleuroscopy)
• Transbronchial biopsy
• Transthoracic needle biopsy
• Pleural puncture and puncture biopsy of the pleura

All these research methods are available only in specialized medical institutions.

Timely and late detected tuberculosis
For a complete and rapid cure of tuberculosis, its timely detection is very important. Early diagnosis at the initial stages of the disease allows you to prevent its further spread, and is also the most important link in the prevention of tuberculosis infection. Tuberculosis detected in the later stages of development is very difficult to treat. In addition, such patients become epidemically dangerous to others.

To identify the disease in the early stages, it is important to diagnose and begin treatment in a timely manner. In this article we will look at what tests need to be taken to determine tuberculosis and talk about how they are carried out.

Diagnosis of tuberculosis in children and detection of the presence of infection in the lungs in adults is carried out using the bacterioscopic method. This diagnostic method involves examining sputum for the presence of an infectious agent.

Such diagnosis of tuberculosis in adults and children does not require much time, special equipment or high costs. Everything is very simple: a sputum test is taken for tuberculosis and examined under a microscope.

The process of bacterioscopic diagnosis (may be called microscopic):

1. A sputum test for tuberculosis is collected, ground and applied to a glass.
2. Press down on top with another piece of glass.
3. The test for tuberculosis is blotted with a special paper containing a substance called Fuchsin Tsilya. It allows you to show the presence of infection.
4. The study of pulmonary pathology does not end here; heating, lowering into a vessel with sulfuric acid and other steps occur.

Tuberculosis bacillus in sputum

Despite the fact that sputum testing is quite simple and such methods for diagnosing tuberculosis are easily accepted by children, the results of bacterioscopy can be ambiguous. It is necessary to take other tests for tuberculosis and conduct a number of other studies. WHO recommends undergoing this examination for preventive purposes. The average price is 570 rubles.

Ziehl-Neelsen method

This is a method of staining spores and acid-fast microorganisms, such as the bacteria that cause active tuberculosis. Mycobacterium tuberculosis is not affected by ordinary alcohol solutions of aniline dyes due to the content of cerolipids. For the Ziehl-Neelsen method, alternative heating dyes are used.

Coloring occurs as follows:

1. Snow-white filter paper is placed on top of the sputum, which is filled with Ziel carbol fuchsin.
2. The substance is heated several times over a fire until vapor appears.
3. Then it is doused with water and the paper is removed.
4. Next, the preparation is decolorized in 5% sulfuric acid.
5. They douse it with water again.
6. Stain with Leffler's blue for a few minutes.
7. Wash with water, dry, examine changes under immersion.

Criteria for tuberculosis infection: the bacilli will turn ruby ​​red, the remaining microbes will have a bluish tint.

Flotation

An analysis of saliva for tuberculosis shows that mycobacteria are unevenly distributed in it. If their content is less than 100 thousand per 1 mm, it is not always possible to determine tuberculosis in children and adults. In order to increase their concentration, they resort to the flotation method.

For diagnostics, I use gasoline, toluene or xylene to absorb microorganisms that float on the surface of a more compacted liquid.

• The preparations are prepared on fat-free glass, which are initially heated to 60 °C in an air bath.
• Droplets from the flotation ring are applied to the heated pieces of glass with a pipette, dried, and the droplets are applied there again.
• Each subsequent droplet is placed on the previous one.
• The entire ring is transferred to pieces of glass.
• Several preparations are created and Ziehl-Neelsen staining is performed.

Fluorescence microscopy

An optical method for studying tuberculosis pathogens, which are stained with fluorochromes and, as a result, begin to glow under ultraviolet light. For this examination, special devices are used, which consist of an ultraviolet-producing element and a filter system.

Many microbes do not have their own luminescence, so there are various methods for staining them to study using a special device. One of the methods is fluorochrome plating, i.e. staining with intensely diluted fluorochromes. This technique is used for bacterioscopic examination of tuberculosis pathogens.

In the reaction to antibodies, which are labeled with fluorochromes, antigens of microorganisms are detected.

Phase contrast microscopy

This is the only method of examination under a microscope that makes it possible to observe pathogenic microbes in an active state. Special phase contrast equipment is used for the examination.

When studying the sputum of those infected with tubercle bacilli, a small content of neutrophils in the deteriorating stage is revealed.

If there is no sputum or a small amount is produced, the patient is prescribed an expectorant or special inhalations that irritate the larynx. In addition, if there is no sputum, bronchial washings are examined.

Urine tests

Laboratory diagnosis of tuberculosis is necessary to confirm the diagnosis. Even if pathogenic bacteria were found in the urine, additional diagnosis of open or closed tuberculosis is necessary.

Before collecting urine, it is necessary to toilet the external genitalia, collecting the urine in a special container with a volume of 100 ml (the required amount of urine is approximately 50 ml). Before submitting urine to the laboratory, it must be stored in a cool place.

Blood tests

A clinical blood test has several research methods.

General

This test for tuberculosis can be done on adults and children. Necessary for the diagnosis of various diseases. A general blood test for pulmonary tuberculosis shows the level of leukocytes and ESR (interpretation is as follows: erythrocyte sedimentation rate).

ELISA

In this type of enzyme immunoassay test, blood is drawn to detect antibodies to tuberculosis.

If you perform this blood test for tuberculosis of the lungs and other organs, it can indicate the presence of infection. However, most often this examination is of a clarifying nature and also helps to detect latent and extrapulmonary forms.

Polymerase chain reaction

PCR diagnosis of tuberculosis is one of the most effective methods for determining the disease. Polymerase chain reaction is used to detect bacterial DNA in blood serum, urine, sputum, and spinal cord. PCR analysis with 100% accuracy indicates the presence of pathogenic bacteria in a specific organ.

The sensitivity of PCR for tuberculosis is very high. Even when other modern diagnostic methods show a negative result, this method helps to accurately identify the disease.

Quantiferon test

Quantiferon test is a laboratory blood test for the presence of tuberculosis infection. WHO recommends the use of this technique in many countries around the world. Often used as an alternative to the tuberculin test.

Be sure to read the article about it on our portal.

Tuberculin test

The Mantoux test is today an indispensable diagnostic method. It is taken annually. Children without Mantu are not accepted into kindergartens, sanatoriums, or camps. WHO recommends not to skip it.

The Mantoux test is a special injection that is administered intradermally. The vaccine contains the tuberculosis antigen - tuberculin. After its administration, the reaction is monitored to determine whether there is an infection in the body. Indicators of predisposition to the disease in the future are also identified.

Inflammation appears at the injection site, which indicates that the immune system is fighting the infection. Recently, however, a blood test for tuberculosis is increasingly being done instead of the Mantoux test, in particular the quantiferon test, which has been approved by WHO.

Differential diagnosis

Differential diagnosis of pulmonary tuberculosis helps to accurately diagnose and exclude other respiratory diseases:

• FLU and ARVI;
• Pneumonia;
• Bronchial diseases;
• Sepsis;
• Asthma;

Various samples of sputum and mucus from the larynx play a huge role in determining the disease. In addition, the gastric mucosa is examined for the presence of toxins and bronchial lavage water. Infection can also form in these organs.

Hardware diagnostic methods

Hardware diagnostic methods include:

1. Radiography;
2. Fluorography;
3. CT scan.

Prices for hardware testing for tuberculosis are approximately as follows:

• radiography - about 1200 rubles;
• price for fluorography - from 200 rubles to 500 rubles;
• for computed tomography - from 2200 rubles.

It is important to remember that examinations are necessary to make an accurate and correct diagnosis. Only after this will a specialist be able to prescribe adequate treatment that will help restore health and even save lives.

Methods for examining patients with tuberculosis

Diagnosis of different clinical forms of tuberculosis presents significant difficulties due to the similarity of clinical and radiological signs of pathologies of different etiologies (inflammatory, suppurative, systemic diseases). Epidemiological and social factors (migrants, refugees, homeless people), the presence of concomitant pathology are often not taken into account, there is an incomplete examination of the patient, poor-quality X-ray examination and incorrect interpretation of the data from this study.

Mandatory clinical minimum includes: in-depth medical history, ascertaining contacts with tuberculosis patients, objective examination of the patient, blood and urine tests, chest x-ray, tomogram of the lungs, sputum microscopy for the presence of MBT, culture of sputum, urine for MBT, determination of sensitivity to tuberculin by test Mantoux with 2TE. These methods make it possible to diagnose different clinical forms of tuberculosis in typical cases.

In difficult cases of diagnosing tuberculosis, it is necessary to conduct a bronchological examination, puncture biopsy, and diagnostic operations (mediastinoscopy, thoracoscopy, open lung biopsy). These studies make it possible to conduct cytological, histological and biological studies to verify the diagnosis; they are available in well-equipped hospitals.

With a complicated course of the disease and combined damage to a number of body systems, there is a need to study the function of respiration and circulation, the function of the liver and other organs and systems.

When collecting anamnesis, factors that contributed to the development of the disease are clarified; special attention is paid to identifying the source of tuberculosis infection. It is important to establish the presence of family (father, mother, relatives are sick with tuberculosis), residential, industrial or casual contact. In the last decade, the role of double, triple tuberculosis contacts and centers of death from tuberculosis, leading to the development of a specific disease in children, adolescents, and young people, has increased.

Animals (cattle and small livestock) suffering from tuberculosis can also be a source of infection. Eating raw cow's milk and poorly processed meat can lead to predominantly extrapulmonary forms of tuberculosis.

When diagnosing tuberculosis, it is important to establish MBT infection. In children, the development of clinical forms of primary tuberculosis occurs mainly in the first months (1-3-6 months), less often - in the first 12-18 months of infection. In adolescents, the disease develops both in the first months of infection (primary forms of tuberculosis) and 5 or more years after infection with MTB (secondary forms of tuberculosis). In adults, the development of secondary forms of tuberculosis occurs against the background of various periods of infection (10–20 years or more).

Predisposing factors to the development of tuberculosis are the presence in patients of diseases of the respiratory system (chronic bronchitis, pneumonia, bronchial asthma, frequent acute respiratory viral infections), diabetes mellitus, gastric and duodenal ulcers, neuropsychiatric disorders, as well as HIV infection. In addition, unfavorable social factors also matter: low material standards of living, alcoholism, hunger, war.

Objective examination

Examination of early-age patients, adolescents, and adults gives an idea of ​​the nature of physical development and its compliance with age standards. With timely diagnosis of tuberculosis, clear disturbances in the physical development of the patient from satisfactory living conditions are usually not observed. Late detection of tuberculosis is accompanied by either asthenia or retardation in physical development, especially in children and adolescents, which is caused by symptoms of intoxication.

The patient's skin color is moderately pale with a grayish tint and blue under the eyes. With disseminated forms of tuberculosis, there is often a blush on the skin of the face. After self-healed tuberculosis of peripheral lymph nodes, retracted star-shaped scars may be visible on the skin. The development of clinical forms of tuberculosis of the primary period in some cases is accompanied by paraspecific reactions: erythema nodosum, blepharitis, phlyctenular keratoconjunctivitis, tuberculides, arthralgia. This characterizes the activity of tuberculosis. The presence and size of the vaccination mark on the shoulder after BCG immunization are not decisive in the diagnosis of tuberculosis and the nature of its course. The scar is only confirmation of the BCG vaccination.

When examining the chest, you can notice bulging of the intercostal spaces and their expansion, lag of the chest in the act of breathing on the affected side (exudative pleurisy, complicated forms of respiratory tuberculosis).

By palpation, it is possible to establish a decrease in tissue turgur, muscle tone, and determine the number of groups and the nature of peripheral lymph nodes. In healthy children, no more than 4–5 groups of peripheral lymph nodes of size I–II are palpated; in children infected with MTB and patients with tuberculosis, from 6–7 to 9–12 groups of size II–III and III–IV are determined. These are elastically compacted, painless, round or oval lymph nodes that are not fused to the skin.

In most patients with a local form of tuberculosis of primary or secondary origin, palpation can determine persistent tension and soreness of the muscles of the shoulder girdle on the affected side (Sternberg's symptom).

Palpation of the spinous processes of the thoracic and lumbar vertebrae when determining their pain requires an x-ray of the spine. Vocal tremor when pronouncing the words “one-two-three”, “thirty-three”, determined by palpation, is weakened with exudative pleurisy, atelectasis, pneumothorax, pulmonary emphysema and increased with inflammatory, infiltrative processes in the lungs.

Percussion of the lungs with significant volumes of damage (more than 3 cm) determines the shortening of the percussion sound, which can occur with infiltration of the lung tissue, atelectasis, or effusion into the pleural cavity. Acute miliary tuberculosis, pulmonary emphysema, and large cavities are characterized by a percussion sound with a boxy tint. A significant shortening of the percussion sound is observed with exudative pleurisy.

Auscultation in limited forms of respiratory tuberculosis usually does not have distinct symptoms. With a large volume of lung damage (infiltrate with decay, pleurisy, caseous pneumonia, fibrous-cavernous tuberculosis), the breathing pattern changes (weakening, bronchial breathing, dry or moist rales). When listening to the patient, he should breathe more deeply, cough slightly at the end of the exhalation, then inhale deeply. This allows you to hear isolated small or medium bubble rales.

Active tuberculosis in patients of all ages may be accompanied by changes in the function of the cardiovascular system (tachycardia, bradycardia, functional systolic murmur over the apex of the heart, decreased or increased blood pressure), endocrine system (decreased or increased function of the thyroid gland, adrenal glands, pancreas), nervous systems (excitability, apathy, sleep disturbance, irritability).

It has been established that increased function of the thyroid gland and adrenal glands is a favorable sign, while a decrease in their function leads to a torpid, protracted course of the disease.

Instrumental and laboratory examinations

X-ray diagnostic methods occupy a leading position in the comprehensive examination of patients with respiratory pathologies of various origins. When deciphering the shadow image on the radiograph, the localization of the lesion, its characteristics, and dynamics during the treatment process are established.

Analysis of a direct plain radiograph of the chest organs begins with technical characteristics: contrast, position of the patient, symmetry of the pulmonary fields, position of the domes of the diaphragm. The x-ray is taken while the patient is inhaling. In the absence of artifacts, the surface of the radiograph should be uniformly matte. The same distances between the axis of symmetry of the radiograph and the sternoclavicular joints indicate the correct installation and position of the patient during the image. The axis of symmetry is drawn vertically through the spinous processes of the vertebrae.

The pulmonary pattern is formed by vascular shadows lying in the plane of the radiograph and in the orthograde projection. A normal pulmonary pattern has the appearance of tree-like linear shadows, the width of which gradually decreases from the center to the periphery, and is not visible beyond 2/3 of the pulmonary field. This drawing is clear throughout. In symmetrical areas of the lung fields, the same number of linear shadows is determined. Medium-sized bronchi can be in the form of ring-shaped clearings located next to the vessels. The diameter of the bronchus lumen usually corresponds to the diameter of the vessel in the orthograde projection. With a depleted pulmonary pattern, small and medium-sized vessels are not identified, and the transparency of the pulmonary fields is increased.

The roots of the lungs on the radiograph are formed by the shadow of large vessels and large bronchi. The structure of the lung root includes the head, tail, root body, and the lumen of the intermediate bronchus. The head (the confluence of the shadows of the vessels going from the upper lobe to the root) is located at the level of the anterior segment of the second rib on the right, on the left - 1.5 cm lower. The tail is the confluence of the shadows of the vessels coming from the lower and middle lobes at the level of the anterior segment of the 4th rib. The body is a vascular shadow located between the head and tail of the lung root. The width of the lung root is 15–18 mm. The intermediate and lower lobe bronchi are light stripes between the pulmonary artery and the shadow of the heart.

The median shadow on a radiograph is the shadow of an oval, obliquely located with respect to the axis of symmetry of the radiograph. It is formed by the shadow of the heart and large vessels.

On the right, the edge of the median shadow is formed by the right atrium and the ascending part of the aortic arch, on the left - the descending part of the aortic arch, the conus of the pulmonary artery, the appendage of the left atrium, and the left ventricle.

Darkening on a radiograph can be due to physiological and pathological reasons. Pathological shadows on a radiograph occur due to an increase in the density of the lung parenchyma (inflammation, tumor), disruption of bronchial obstruction, compaction of the pleura or accumulation of fluid in the pleural cavity. Dissemination in the lung tissue can be a consequence of tuberculosis, pneumonia, lymphogranulomatosis, sarcoidosis, pneumoconiosis, metastases of malignant tumors. Lobar and segmental darkening is observed in pneumonia, obstructive pneumonitis and atelectasis as a consequence of endobronchial tumors and endogenous foreign bodies. They can also be caused by forms of tuberculosis of the primary period (primary tuberculosis complex, tuberculosis of the intrathoracic lymph nodes with a complicated course).

Due to a defect in the structure of the lung tissue, clearing and cavities can form. If the clearing is limited around the perimeter by the marginal compaction of the lung tissue, then this indicates the formation of a cavity.

There are true and false cavities. True cavities are divided into emerging, fresh elastic and old fibrous, which reflects the duration of the disease and the timeliness of diagnosis.

Tomographic study most often used in the study of pathological processes in the area of ​​the roots of the lungs, mediastinum, and apexes of the lungs. This method allows you to identify decay cavities, foci, infiltrates that are not visible on radiographs. A tomographic study provides additional information about the anatomical structures of the lung root, the ability to diagnose enlarged lymph nodes, assess the condition of the bronchial lumen, their deformation, identify stenosis, and determine the angle of branching of the bronchi.

In difficult cases of diagnosing tuberculosis, computed tomography can also be used, which is prescribed for certain indications in tuberculosis or pulmonology centers.

Bronchological The study is used to clarify the diagnosis and correct the treatment of patients in tuberculosis hospitals. Bronchoscopy makes it possible to assess the condition of the bronchi and examine their contents using bacteriological, cytological, biochemical and immunological methods. With bronchial tuberculosis there can be an infiltrative, ulcerative, fistulous form. When curing a local form of tuberculosis complicated by bronchial tuberculosis, scars form in the bronchial wall. They cause deformation of the bronchial wall, can disrupt bronchial patency and lead to the development of secondary inflammatory changes. There are three degrees of bronchial stenosis: I degree – narrowing of the bronchial lumen by 1/3; II degree – by 2/3; III degree – up to the size of a narrow gap or pinhole. Bronchial stenosis can often be caused by compression of the bronchus from the outside by enlarged lymph nodes. Varying degrees of bronchial stenosis can lead to the development of either emphysema or atelectasis. Nonspecific endobronchitis usually does not cause bronchial obstruction; it is often observed in children with tuberculosis against the background of a hyperergic Mantoux reaction with 2TE.

Diagnostic bronchoalveolar lavage (BAL)– washing of small bronchi and alveoli with isotonic sodium chloride solution for diagnostic purposes. This is indicated primarily for patients with diffuse lung lesions of various origins: disseminated tuberculosis, sarcoidosis, hemosiderosis, alveolitis, histiocytosis. In a healthy non-smoking person, in the BAL fluid, alveolar macrophages are the dominant cells and make up 92%, lymphocytes - 7, neutrophils - about 1%, and bronchoalveolar epithelial cells in a small amount.

In patients with inactive forms of tuberculosis, the cell content in the BAL fluid is almost the same as in healthy individuals; with active tuberculosis, the number of neutrophils is 60% or more; with sarcoidosis – lymphocytes 60–70, neutrophils – 15–20, level of alveolar macrophages – up to 40%. In children with tuberculosis intoxication, alveolar macrophages in the BAL fluid decrease to 60%, lymphocytes increase to 20–30%.

The decisive factor in establishing the diagnosis of tuberculosis is considered identification of MBT. The main methods for detecting MBT are bacterioscopy, cultural (bacteriological) method and biological test on animals (guinea pigs). Bacteriological examination can be carried out with various materials: sputum, bronchial and gastric lavages, cerebrospinal fluid, exudates from the pleural and abdominal cavities, contents of lymph nodes, fistula discharge, urine, throat swab. Bacterioscopy is carried out by staining a smear using the Ziehl–Neelsen method; it detects mycobacteria with intense bacterial secretion (100–500 thousand MBT in 1 ml). The most sensitive is the bacteriological method, which detects MBT when there are 20–100 mycobacteria per ml. But the growth of MBT on nutrient media is slow, and a positive result is obtained 1.5–2–2.5 months after sowing. If there is no growth after 2.5 months, the culture is considered negative. In order to speed up cultural research, an automated VASTES complex has been created, which allows recording the growth of mycobacteria and determining their sensitivity to chemotherapy based on fluorescence.

Biological method– infecting guinea pigs with material from a patient (sputum, bronchial, stomach lavage, etc.) is a highly sensitive method, as it allows one to obtain a positive result if the material contains single MBT (1–3 individuals). The duration of the study is 2.5–3 months. 1 month after infection, guinea pigs' lymph nodes become enlarged and a positive test for tuberculin appears. The animal is slaughtered after 3 months and microbiological and histological examination of organs (lungs, liver, spleen) is carried out.

Serological research methods blood serum, exudate, and cerebrospinal fluid are used to identify anti-tuberculosis antibodies that confirm the specificity of the disease. An increase in the titer of phosphatidic antibodies (PHNA with phosphatidic antigen) in serum dilutions of 1: 8–1: 16 and higher (1: 32, 1: 64, 1: 128 and more) is observed in the majority of children and adults (80%), patients with active forms of tuberculosis. In case of inactive tuberculosis (phase of compaction, calcification), 15–20% of those examined have antibodies in the RNGA with phosphatidic antigen, mainly in titers of 1: 8–1: 32. Currently, in adults with active tuberculosis, specific antibodies are detected by enzyme-linked immunosorbent assay (ELISA) in 80% of cases. A study of the function of the immune system in patients with tuberculosis did not reveal immunological deficiency as the cause of the disease in most cases. On the contrary, the development of a chronic specific process and the possibility of its cure, and in children the possibility of self-healing, indicate a sufficient level of the immune system. This is confirmed by a positive Mantoux test with 2TE, normal concentrations of immunoglobulins (Ig) classes A, G, M, or increased levels of IgM and IgA at the beginning of the infiltration phase. The change in the ratio of T- and B-lymphocytes at the onset of the disease reflects the development of pathophysiological reactions of the body, observed in many inflammatory processes of various etiologies. As signs of tuberculosis activity decrease, the levels of T- and B-lymphocytes in the peripheral blood normalize.

Hemogram in children with tuberculosis has different meanings depending on age, presence of contact, form and phase of the disease. There are either normal or moderately elevated peripheral blood counts: leukocytes, neutrophils, lymphocytes, monocytes, eosinophils. In early age patients with the development of generalized forms of tuberculosis, hypochromic anemia, moderate leukocytosis or the number of leukocytes within the normal range, a shift of the leukocyte count to the left, lymphopenia, then it is replaced by lymphocytosis, increased ESR (25–45 mm/h or more), less often - in within normal values. In schoolchildren with tuberculosis, changes in the hemogram are either absent or insignificant. In adults suffering from different clinical forms of tuberculosis, the hemogram indicators are different and are most changed in disseminated, infiltrative, fibrous-cavernous forms, as well as in caseous pneumonia and complicated course of the disease. Hypochromic anemia, moderate leukocytosis, a shift in the leukocyte formula to the left, lymphopenia, monocytosis, and accelerated ESR (25–50 mm/h or more) are noted.

IN urine tests changes are often absent, but a number of patients have moderate hematuria (single fresh red blood cells) and moderate proteinuria. This is the basis for repeated bacteriological examination of urine for the presence of MBT.

A urine test for MBT should be prescribed to all MBT-infected children during the period of “turn” of the tuberculin reaction, even with normal general clinical urine tests.

Biochemical studies blood serum - proteinogram, level of sialic acids, beta lipoproteins, etc. - allow you to confirm the activity of tuberculosis infection, although these tests do not reflect the specific nature of inflammation.

In complex diagnostic cases, in recent years, the modern effective method of polymerase chain reaction (PCR) has been used, which makes it possible to detect MBT in sputum, pleural, cerebrospinal fluid, urine, and blood serum.

The use of this method is available only to large medical centers.

Detection of tuberculosis

Tuberculin diagnostics. Assessing the results of examination of a patient with suspected tuberculosis requires solving the following questions: 1) is this patient infected with MTB? 2) Who is the source of infection? 3) At what stage of infection was the disease detected? The answers to these questions are of greatest importance in establishing the diagnosis of tuberculosis in children and adolescents. Since almost all adults by the age of 30 are infected with MTB, the nature of sensitivity to tuberculin is less important for them.

The leading method for detecting MBT infection is tuberculin diagnostics, and its regular use allows timely detection of tuberculosis infection in a child or adolescent. Tuberculin diagnostics is based on the use of tuberculin, which was obtained in 1890 by R. Koch. Tuberculin is a specific allergen that is used to determine the sensitization of the human body to MBT waste products. It includes tuberculinoproteins, polysaccharides, lipid fractions and nucleic acid. The active principle is a complex of proteins and lipids. In Russia, dry purified tuberculin was obtained by M. A. Linnikova in 1939, and in 1954 its mass production began. In the Russian Federation, there are 2 forms of tuberculin release.

1. Dry purified tuberculin, produced in ampoules containing 50,000 TU (tuberculin units). It is used only in anti-tuberculosis institutions.

2. Purified tuberculin in standard dilution - a ready-to-use solution of tuberculin containing 2TE in 0.1 ml (30 doses in an ampoule).

Mass turboculin diagnostics is carried out annually from 12 months to 18 years, once a year, for children vaccinated with the BCG vaccine. For children not vaccinated with BCG, mass tuberculin diagnostics is carried out every six months from the age of 6 months.

The main tuberculin test used for mass tuberculin diagnostics is the intradermal Mantoux test with 2TE. The results are assessed during the period of maximum development of the reaction - after 48–72 hours. The reaction is considered negative in the absence of papule and hyperemia at the site of tuberculin injection (at the border of the upper and middle third of the forearm). Persons who have not been vaccinated with BCG and are not infected with MBT do not respond to tuberculin.

Tuberculin tests are a clinical expression of the phenomenon of delayed-type hypersensitivity, which develops as a result of sensitization of the human or animal body with a full-fledged antigen - virulent or weakened by the virulence of MBT (infection with MBT of a human or bovine species, immunization with the BCG vaccine).

In a patient infected with MBT or vaccinated with BCG, a papule begins to form at the site of tuberculin injection after a few hours, around which skin hyperemia is observed. The papule is a mononuclear infiltrate. With increased sensitization of the body, pronounced reactions to the administered dose of tuberculin also occur: the size of the papule is significant (15 mm or more); in the center of the papule, regardless of its size, necrosis, vesicles can form, lymphangitis and regional lymphadenitis can occur. Necrosis is never caseous. The Mantoux test with 2TE is considered positive if the papule has a diameter of 5 mm or more. Infiltrate sizes of 17 mm or more in children, 21 mm or more in adults are considered a hyperergic reaction. In addition, the appearance of additional elements on or around the papule (necrosis, vesicle, lymphangitis) for any diameter of the papule is considered a manifestation of hyperergic sensitivity to tuberculin.

Interpretation of the results of tuberculin tests is complicated by the fact that the absolute majority of children (97–98%) are vaccinated with BCG at birth and revaccinated at the prescribed time. This leads to the fact that about 60% of immunized people have questionable and positive reactions to the Mantoux test with 2TE. Differential diagnosis between post-vaccination and infectious allergies is based on the following principles:

1. The period elapsed after immunization: the first appearance of a positive Mantoux test with 2TE 2–3 years or more after the administration of the BCG vaccine, after negative tuberculin tests, indicates the occurrence of a “turn” (sharp turn) of tuberculin sensitivity due to infection (infection) MBT.

2. Increased sensitivity to tuberculin - an increase in the size of the infiltrate according to the Mantoux test with 2TE by 6 mm or more (for example, 1998 - 3 mm, 1999 - 10 mm; 1998 - 6 mm, 2000 - 12 mm ).

3. Hyperergic Mantoux tests with 2TE.

4. The presence of a monotonic positive tuberculin test for 5–7 years without a tendency to decrease sensitivity to tuberculin (for example, 7 mm – 9 mm – 6 mm – 8 mm – 10 mm – 10 mm).

The greatest difficulties in interpreting sensitivity to tuberculin arise in children of the first three years of life vaccinated with BCG. In this age group, the results of mass tuberculin diagnostics have limited diagnostic value, since the onset of MTB infection, which occurs against the background of post-vaccination allergy, is usually accompanied by the development of normergic reactions to tuberculin (infiltrate diameter - 6-8-10 mm), which is often interpreted by a pediatrician as consequence of BCG vaccination.

In doubtful cases, to clarify the nature of a positive reaction to tuberculin using the Mantoux test with 2TE, methods of individual tuberculin diagnostics should be used, which are used in an anti-tuberculosis dispensary (PTD) and a specialized hospital (use of low concentrations of tuberculin - 0.1TE; 0.01TE in the Mantoux test; performing a graduated Pirquet skin test with 100%, 25%, 5% and 1% tuberculin).

Regular use of the mass tuberculin diagnostic method makes it possible to establish the rate of MBT infection in various age groups. In the majority of children examined in kindergartens and schools, questionable and moderately positive Mantoux tests with 2TE were determined, while hyperergic tests were detected in only 0.5% of those examined. It has been established that 75% of infected MBT have an infiltrate size of 11 mm or more, but in 25% of infected people the Mantoux test with 2TE is less pronounced (the infiltrate size is from 5 to 10 mm, but questionable reactions to tuberculin are also possible). In recent years, the average papule size according to the Mantoux test with 2TE in infected MBT was 9.2 ± 0.4 mm, whereas in the 80s. XX century – 8.3 ± 0.3 mm.

Among children and adolescents with tuberculosis, variations in sensitivity to tuberculin were always observed, which were determined by the presence of contact with a patient with tuberculosis, the age of the patient, and the activity of the tuberculosis process. In young children with tuberculosis, a negative Mantoux test with 2TE occurs, according to various authors, in 2–13% of cases. In active forms of tuberculosis, sensitivity to tuberculin using the Mantoux test ranges from negative, questionable, moderately positive reactions to hyperergic. The latter occur in children and adolescents with tuberculosis in 25% of cases.

Thus, mass tuberculin diagnostics is the main method for detecting MTB infection in a child or adolescent. When examining children and adolescents based on the “turn” of the tuberculin reaction or the increase in sensitivity to tuberculin, it becomes possible to timely detect tuberculosis. In most cases, an infected child or teenager is a healthy child or teenager; only 10% of them develop tuberculosis. Therefore, every child or adolescent with a “turn” or increase in tuberculin sensitivity should be examined within 2 weeks (a chest x-ray or fluorogram in adolescents, a clinical blood test, a urine test - all tests are done in the clinic) and sent to the PTD. At the same time, all family members should be examined fluorographically, which in some cases makes it possible to identify respiratory tuberculosis in one of the relatives of the infected child. When examined at the PTD, the majority of MBT-infected patients do not show any signs of the disease (clinical or radiological). In this case, it is proposed to carry out a course of chemoprophylaxis with one tuberculostatic drug (tubazid, ftivazid) for 3 months, preferably in a tuberculosis sanatorium. During the first year of MBT infection, it is necessary to explain to parents the importance of adequate nutrition for a child or adolescent, sufficient exposure to the air, and physical exercise. It should be remembered that a child observed in the PTD for a “turn” (group VI of dispensary registration) has a medical exemption from preventive vaccinations against other infections for a period of 6 months. Timely examination and implementation of preventive measures for infection in children and adolescents increases their effectiveness and reduces the possibility of developing tuberculosis. As an analysis of case histories of children and adolescents in tuberculosis hospitals shows, in recent years only 30% of children with a “turn” of tuberculin sensitivity are examined in the first 4–6 weeks from the moment of its establishment, the rest - at a later date (6–9–18 months) . Therefore, in general, the examination of children and adolescents using tuberculin diagnostics is untimely, chemoprophylaxis courses are prescribed unreasonably late (which is no longer advisable) and the use of tuberculostatic drugs is not controlled. This reduces the effectiveness of the measures taken and contributes to the increase in the incidence of tuberculosis in children and adolescents. Mass tuberculin diagnostics remains the main method (70%) for detecting tuberculosis in children and rarely (9%) in adolescents.

It should be borne in mind that the development of tuberculosis in a child usually occurs in the first 2–6 months from the moment of the “turn” (the transition of a negative Mantoux test with 2TE to a positive one). However, the diagnosis of tuberculosis in people infected with MTB in most cases occurs 12–18 months or more from the moment the “turn” is detected, i.e., untimely.

Epidemiological method for detecting tuberculosis. The epidemiological method is applied to children and adolescents living in areas of tuberculosis infection. In the most dangerous outbreaks (groups I and II, in which patients with active tuberculosis live with constant or periodic bacterial excretion against the background of a low social and sanitary standard of living), children and adolescents are observed by a phthisiatrician once every 3–4 months. The pediatrician also monitors their health status. Any unclear, often recurrent disease or protracted clinical disease in a child or adolescent from foci of tuberculosis should raise suspicion of the possibility of a specific process. In these cases, timely diagnosis of the clinical form of tuberculosis in a child or adolescent can be achieved more quickly, especially if at the same time a TB doctor and a pediatrician carefully monitor the health status of those living in areas of infection. This is possible if the doctor of the general medical network is informed about the presence of foci of tuberculosis infection in the service area, which is achieved through constant contact in work and exchange of information between the local TB specialist and the local pediatrician. Patient management The success of treatment depends on whether the doctor is able to establish a good relationship with the patient, with in order to secure his cooperation. Achieving this is sometimes difficult, especially if you have to deal with chronically ill, sufferingBudget surveys From the book Great Soviet Encyclopedia (BY) by the author TSB

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It is important for absolutely all residents to know the symptoms and methods of diagnosing tuberculosis, as well as to have an idea of ​​treatment. The overwhelming percentage of residents believe that tuberculosis is a rare disease that affects disadvantaged people. However, it is not. The prevalence of the causative agents of this disease - mycobacteria - is currently growing and affecting new segments of the population.

Main symptoms of the disease

Testing for tuberculosis involves more than just instrumental research methods. First of all, the doctor must conduct a thorough conversation with the patient, find out his complaints, the dynamics of their development. The main symptoms necessary to determine the presence of a tuberculosis process:

• Prolonged cough: dry or with sputum;
• Blood in the sputum (hemoptysis);
• Dyspnea;
• Increased body temperature, most often to subfebrile (37 - 37.5 0 C);
• Violation of general condition: increased fatigue, followed by weakness;
• Sweating when the temperature rises.

Diseases that are taken into account when making a diagnosis

To determine the presence of tuberculosis, a number of other respiratory pathologies, the symptoms of which are similar to tuberculosis, should be taken into account:

• Pneumonia (pneumonia);
• Bronchial asthma;
• Chronic obstructive bronchitis;
• Lung neoplasm: benign or malignant.

The above is a list of only the most common diseases; in reality there are many more. That is why instrumental and laboratory diagnostics of tuberculosis play such an important role.

The importance of the Mantoux test in identifying the tuberculosis process

Tuberculosis is a dangerous disease that can remain dormant in the body for a long time. The symptoms listed above often appear in advanced cases. Therefore, to prevent untimely initiation of treatment, early diagnosis of tuberculosis is especially important.

One of the ways to determine the disease in the early stages and prevent the spread of tuberculosis is the Mantoux test. It involves the subcutaneous injection of tuberculin, which causes activation of the body's immune system and corresponding reactions on the skin. The Mantoux test is performed in schools once a year for students at the same time. The following reaction results are distinguished:

• Negative – injection mark;
• Doubtful - a spot or papule with a diameter of 2-4 mm;
• Weakly positive – diameter from 5 to 9 mm;
• Moderate result – 10-14 mm;
• Pronounced – 15 mm;
• Hyperergic – diameter greater than 17 mm for children, adolescents and adults.

The Mantoux test also gives false results. But this method is low cost, accessible and easy to implement, which is what made it so widespread in educational institutions.

What other method is used for early detection of tuberculosis?

In addition to traditional methods of diagnosing the presence of a tuberculosis process in the body, there are more highly effective, but at the same time more expensive research methods.

A diagnostic method such as Diaskintest is used. Its main difference from the already traditional Mantoux is that here, for a subcutaneous reaction, it is not a weakened tuberculosis bacillus, as in tuberculin, that is used, but a protein with the pathogen antigen.

It is also excellent that “Diaskintest” shows only an infection in an active form, and when tuberculin is administered, the detection of a positive reaction is also typical in the presence of inactive mycobacteria.

Interpretation of the results of diagnosing the tuberculosis process using Diaskintest is carried out as follows:

• Negative result – there is only an injection point or bruise up to 2 mm;
• A questionable reaction is redness of the skin;
• A positive result is 2 mm or more.

Questionable test results should alert the doctor, and the child is left under observation. If the reaction is positive, a chest X-ray and laboratory tests are performed to confirm the diagnosis.

Detecting tuberculosis using a blood test

Diagnosis of pulmonary tuberculosis using the x-ray method is considered more traditional, but it is informative only in later stages of the disease. Currently, blood is most often used as a material for early diagnosis in adults.

There are several research methods that can be used to determine the presence of a tuberculosis process:

1. General blood analysis;
2. Enzyme-linked immunosorbent assay (ELISA) of blood;
3. Polymerase chain reaction (PCR) of blood or other fluids;
4. Quantiferon test.

A general blood test is not highly specific. Its results only allow us to suspect a diagnosis. The likelihood of infection with tuberculosis is indicated by such changes in diagnostic material as an increase in the erythrocyte sedimentation rate (ESR) and an increase in the level of leukocytes (leukocytosis), mainly due to lymphocytes and monocytes. More specific methods are ELISA and PCR.

Enzyme immunoassay and PCR - modern methods of diagnosis

The essence of enzyme immunoassay is to detect specific antibodies to tuberculosis. There are two groups of antibodies in the body: IgG and IgM. Detection of the first group indicates a chronic infection or that the person has had tuberculosis in the past. If the results show an increase in IgM, acute active tuberculosis is present in the body.

The PCR method has high sensitivity. This means that PCR analysis can detect even the smallest amount of Mycobacterium tuberculosis.

Diagnosis of tuberculosis in adults using blood PCR is the most effective method for early diagnosis. It refers to molecular genetic research methods and is used to detect the DNA of Mycobacterium tuberculosis. The analysis involves the use of material such as blood, urine, cerebrospinal fluid, and lymph.

In addition to direct diagnosis, PCR is used to determine the sensitivity of mycobacteria to drugs. Traditionally, the method of inoculation on nutrient media is used for this, but this analysis has a drawback - the result takes a long time to come. PCR gives quick results. The sensitivity of tuberculosis bacilli to drugs using PCR is detected by identifying mutations in certain genes.

Instrumental diagnostic methods used in phthisiology

In our time, hardware diagnostics of pulmonary tuberculosis in adults has become more widespread compared to PCR and ELISA. These are diagnostic methods such as:

• Fluorography;
• X-ray of the chest organs;
• CT scan.

All of the above studies belong to the group of radiological methods. This means that imaging is based on the passage of X-rays through internal organs and the reflection of these rays.

Although the essence of these methods is the same, each of them has its own nuances. Fluorography is the cheapest method of hardware diagnosis of pulmonary tuberculosis. It requires less material for development and does not require special tools. The image is displayed immediately on the computer.

The fluorography method has become widespread for preventive purposes, for mass detection of tuberculosis in the early stages.

Benefits of X-rays and CT scans

X-ray is a more informative method of hardware research than fluorography. If, after fluorography, the doctor suspects the presence of tuberculosis, he should refer such patients for a survey radiography of the chest organs.

X-rays are performed in two projections: lateral and direct. This is another advantage, because in the lateral projection you can see pathology that is not visible in the direct projection due to the shadow of the heart.

But the most effective method for diagnosing the tuberculosis process in our time is computed tomography. This examination method not only makes it possible to clearly see the localization of tuberculosis, but also provides the least radiation exposure to organ systems. But this analysis has a significant drawback - its high cost. Therefore, tomography is prescribed only in controversial situations when fluorography and x-ray data do not make it possible to make an accurate diagnosis.

X-ray forms of tuberculosis

The forms of the tuberculosis process are identified so that it is possible to predict the further course of the disease, to find out whether it is a chronic or acute process, primary or secondary infection of patients. The following forms of the disease are distinguished:

• Primary tuberculosis;
• Infiltrative form;
• Focal;
• Disseminated;
• Cavernous;
• Fibrous-cavernous;
• Cirrhotic.

Primary tuberculosis occurs in children and the elderly. This form is favorable for restoring the respiratory system. It passes without significant residual effects in the lungs; the formation of foci of calcium accumulation (Gon's foci) is possible, which are visible on x-rays as bright white dots.

Features of focal, infiltrative and disseminated forms

These types of disease occur in adult patients and indicate an acute stage of the tuberculosis process. The most common is the infiltrative form, which occurs in 65% of cases. On an x-ray, it is visible as a darkening with unequal contours with a diameter of more than 1 cm. If the diameter of the shadow is smaller, such tuberculosis is called focal.

Disseminated tuberculosis is also manifested by the formation of small shadows. The main difference between these forms is that focal tuberculosis is characterized by single foci located on one side in the upper parts of the lung. They have different shapes and densities. In the disseminated type, the lesions occupy the entire surface of the respiratory system and have an almost identical round shape.

Features of cavernous, fibrous-cavernous and cirrhotic forms

These types of disease are determined by x-ray during the chronic course of the tuberculosis process. Clinically, such forms are manifested by alternating exacerbation and remission, when patients are not bothered by anything.

The picture of X-ray examination in cavernous and fibrous-cavernous tuberculous processes is similar to each other. They are characterized by the presence of cavities in the upper parts of the lungs, and the cavity in the fibrous-cavernous form has a thicker wall. This is due to the longer course of the disease and the proliferation of connective tissue around the disintegrated lung tissue. The cirrhotic form is manifested by massive darkening, occupying most of the respiratory system.

The prognosis for patients with these forms of the disease is unfavorable. They require longer treatment than acute forms. Once diagnosed, tuberculosis may require therapy for up to two years.

Methods for examining sputum to make a final diagnosis

Sputum analysis for pulmonary tuberculosis is one of the most informative and accessible methods for diagnosing tuberculosis. These methods should be used to determine the causative agents of tuberculosis - Koch bacilli. There are two main methods for examining sputum:

1. Microbiological method;
2. Sputum microscopy.

Microbiological determination of tuberculosis consists of culturing sputum on nutrient media, where the growth of mycobacteria is observed. Depending on the result of the microbiological reaction, a patient with tuberculosis may or may not excrete bacteria. The diagnosis revealed in this way helps to establish the infectiousness of patients to others. According to statistics, 70% of patients are active excretors of mycobacteria.

The main disadvantage of the microbiological diagnostic method is the duration of bacterial growth on nutrient media. This may take more than one week.

Therefore, along with culture, sputum microscopy analysis is used. This is an affordable method that does not require a lot of time and money.

What can distort the culture results and how to avoid it

The diagnostic value of growing bacteria on nutrient media depends on the correct collection of material for the reaction, its storage and transportation.

Sputum should be collected in a specially equipped room, packaged in a sterile bottle with a tight lid, made of impact-resistant material to avoid reaction with dust.

In addition, in order for the results of determining the pathogen to be as truthful as possible, a certain system should be followed:

• Collect material before the prescribed treatment;
• The examination should be done on an empty stomach in the morning;
• A minimum of 3 sputum samples must be collected;
• Sputum examination is carried out for 3 consecutive days;
• If it is not possible to immediately deliver sputum to the laboratory, it should be stored in a refrigerator at 4 degrees C for up to 2 days.

Features of collecting material for tuberculosis of extrapulmonary localization

Examination of the sputum of patients is effective only in the pulmonary form, but if tuberculosis has a different localization, it is possible to inoculate the following material on nutrient media:

• urine, sperm and prostate secretions in men, menstrual blood in women - with genitourinary tuberculosis;
• pus from bone abscesses – with bone tuberculosis;
• pus from the lymph nodes - with tuberculosis of the lymphatic system.

Taking urine is the least problematic for culture on nutrient media for genitourinary tuberculosis. Before collecting material, the external genitalia should be washed. The best results can be obtained when using a mid-morning urine sample. In women it is collected using a catheter, in men it is collected naturally.

The rules for collecting pus for analysis from bone abscesses and lymph nodes are the same. A puncture is performed using a sterile blood collection system. Analysis should be carried out immediately in the laboratory. There, using a pipette, 2-5 ml of pus is collected and mixed with 0.9% sodium chloride solution in an amount of 2-3 ml. The mixture is transferred into a bottle, shaken in a special apparatus and can be examined.

Principles of treatment and the most effective drugs

For successful treatment of Mycobacterium tuberculosis, the following principles should be adhered to:

• therapy should be started as early as possible;
• treatment should be long-term - the minimum period of therapy is 6 months and, if necessary, can be extended to several years;
• continuity - taking medications every day or intermittently - every other day, 2-3 times a week;
• complexity – 4 drugs are prescribed simultaneously;
• the correctness of therapy should be monitored by a doctor.

The most effective drugs for treating tuberculosis are presented below:

• “Isoniazid;
• "Pyrazinamide";
• "Rifampicin";
• "Ethambutol";
• "Ethionamide."

These medications are also called first-line treatment drugs. Taking these medications according to the principles listed above gives the best results and increases the chances of patients to completely get rid of mycobacteria.

Conditions complicating the course of the disease

From the previous section it is clear that one of the principles of treating tuberculosis is early initiation of therapy. Indeed, if it is not started in a timely manner, the patient’s condition worsens, and the following complications may arise:

• Pulmonary hemorrhage;
• Insufficiency of the cardiovascular system - failure of the heart and blood vessels, which leads to a decrease in the supply of oxygen to organs and a deterioration in their function;
• Spontaneous pneumothorax is a condition in which air enters the pleural space around the lungs;
• Lung atelectasis – collapse of the alveoli (breathing sacs), which leads to deterioration of the function of the respiratory system;
• Pleurisy is inflammation of the pleura (the membrane that covers the lungs).

Necessary actions to prevent tuberculosis infection

All preventive measures can be divided into two subgroups:

1. Specific;
2. Nonspecific.

Specific prevention involves vaccination. According to the National Calendar of Preventive Vaccinations, it is carried out on days 3-7 of a child’s life. Revaccination is done at 7 years of age.

Nonspecific prevention for children consists of regularly performing the Mantoux test, and for adults, undergoing fluorography once a year.

For people who have been in contact with a patient with tuberculosis or for patients in the past, chemoprophylaxis is of particular importance. The anti-tuberculosis drug "Isoniazid" is taken for 6 months.

We hope you liked the article about methods for diagnosing tuberculosis. If you know what other ways you can detect the presence of mycobacteria, tell us about it in the comments. Share this article on social networks, because tuberculosis is a dangerous disease that everyone should know about.

– 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 with 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 in the foci becomes more active 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 that make it possible to identify 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.
• Research 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).