Pulmonary tuberculosis - signs in the early stages, symptoms, forms, treatment in adults and prevention. Symptoms of pulmonary tuberculosis in adults and children

Tubercle foci of inflammation affecting various organs internal system human diseases are given the medical name tuberculosis. It is a chronic infection caused by the action of several species of mycobacteria of the genus Mycobacterium.

Since ancient times, it has been known to mankind under the name limpet consumption. It has extensive properties of damaging organs and tissues of the body.

Mechanism of infection

Pulmonary tuberculosis photo

The infectious agent is adapted to the external environment and is capable of long time exist outside the body, but cannot withstand the influence of sun rays and ultraviolet radiation. Capable of creating weakly virulent curved forms of strains that promote the formation of specific immunity and the body’s immunity to certain infections.

The source of the tuberculosis pathogen is an infected person. The main route of infection is respiratory, through inhalation diffuse infection released into the air with sputum. Mainly, upon contact with a person with open pulmonary tuberculosis.

Such patients, releasing bacteria through coughing, can infect many people around them over the course of a year.

With a closed form of the disease, infection can only be achieved through close and prolonged contact with the carrier. Sometimes, infection is possible when bacteria penetrate through damaged skin, or directly entering the gastrointestinal tract with contaminated products obtained from infected animals - meat and milk of livestock, eggs and poultry, or contaminated water.

But we cannot assume that the introduction of a pathogenic pathogen into the body will immediately result in tuberculosis pathology.

As a rule, the development of the disease must be preceded by certain predisposing factors, such as an unfavorable environment or a weak factor of immune and phagocytic functions. And the opinion that dangerous disease affects only people with a low socially disadvantaged status - which is fundamentally wrong.

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Stages of development of tuberculosis, early manifestations

tuberculosis - symptoms in adults photos

There are two stages in the development of the disease – primary and secondary.

Primary is the development of the disease immediately after infection. At the early stage of tuberculosis, symptoms of the primary form of the disease quite often appear in children under four years of age and in older people, which is due, in the first case, to the failure of immune functions and decreased immunity (in old people) due to age-related changes.

This infection is characterized severe course, but in most cases the patient is not contagious.

For primary pathology, the disease develops at the site of localization of mycobacteria, causing increased tissue sensitivity to them, which activates the immune system to produce antibodies that can neutralize foreign invasion.

Primary foci are most often formed in the lung tissue and nodes of the lymph system of the sternum, and in case of contact or nutritional infection - in the gastrointestinal tract and skin covering, forming inflammatory focal zones.

In parallel, the pathogen is able to move through the bloodstream and lymph, creating primary granulomatous tuberculous foci - tubercles - in the kidney, bone, articular and other tissues of the internal system. Their healing leaves behind small areas of connective tissue scar formations. But sometimes, the primary lesions progress, enlarge and disintegrate in the central part, forming a primary pulmonary cavity in the form of a cavity.

Various factors that contribute to decreased immune function ( hormone therapy, endocrine pathologies, HIV infection, etc.) provoke activation of the pathogen in infectious foci and create the prerequisites for the formation of secondary manifestations of tuberculosis.

Secondary manifestation stage tuberculosis is caused by the activation of its own pathogenic bacteria introduced during the first infection, or is a consequence of repeated infection.

It develops mainly in adult patients, forming zones of new foci and cavities (cavities), capable of merging and forming expanded pathological zones, accompanied by pronounced signs of intoxication. The symptoms of such tuberculosis in adults manifest themselves according to the location, form of the disease and the degree of damage to certain organs.

The main type of secondary tuberculosis is pulmonary.

Depending on the extent of prevalence and severity of the lesion, it manifests itself in various forms:

miliary (with millet-like tubercles throughout the lung);
disseminated (scattered) and focal;
infiltrative (with the release of inflammatory infiltrate);
cavernous, fibrous-cavernous and cirrhotic (with sclerotic changes in the parenchyma and cavities);
cavernous pneumonia and caseoma (with necrotic neoplasms.).

Some forms are manifested by pleural lesions, pyothorax and nodular sarcoidosis.

In addition to pulmonary pathology, tuberculous forts of the cranial and brain tissues, abdominal cavity, mesenteric lymph nodes, bone, articular and renal, ocular and genital structures are noted, mammary glands and skin.

The development of tuberculosis is characterized by various stages of progression, due to:

infiltration or decay;
contamination or resorption;
induration, scarring or calcification.

Depending on the possibility of isolating macobacteria, the disease can be an open form, with a positive analysis it is designated MBT (Mycobacterium tuberculosis) +) and a closed form – MBT– (negative).

Early symptoms of secondary stage tuberculosis are often mild and nonspecific, but as the disease progresses they intensify significantly. Without qualified treatment, almost a third of patients die within a few months. But sometimes the pathology takes on a protracted course or manifests itself as spontaneous regression.

Anyone can detect signs of tuberculosis. It is quite difficult to distinguish it from other pathologies, but to suspect the disease and pay attention to it Special attention and undergo timely diagnosis based on the description of tuberculosis symptoms.

The first signs of pulmonary tuberculosis in humans

The manifestation of the first signs and symptoms of tuberculosis is similar to the signs of any viral infection, which, in most cases, explains the neglect of the disease, since patients do not always start treatment on time.

A distinctive feature of the disease from all kinds of acute cold infections is its duration with progression of symptoms and deterioration of the patient’s health.

With strong immunity, symptoms of tuberculosis may begin only after the infection has spread extensively. The presented symptoms are typical for pulmonary pathology, since other types of tuberculosis lesions repeat the symptoms of common pathologies of infected organs.

Manifestation of the first symptoms of pulmonary tuberculosis are caused by the development of the process of general intoxication of the body, expressed by:

Chronic fatigue and apathy, observed before noon.
Prolonged low-grade fever, and the temperature does not exceed 37°C. Tuberculosis pathology is characterized by an increase in temperature (not higher than 38°) in the evening and at night.
Decreased appetite, nausea and obvious weight loss.
Signs of tachycardia and sharp, nagging pain in the heart (cardiomyodystrophy) are a consequence of the influence of infectious toxins on the myocardium.
Pain in the neck and head.
UPLU syndrome and night sweats.
Signs of bronchitis with prolonged cough, especially at night.
Painful breathing and the manifestation of pain when coughing, caused by the development of pathological processes in the pleural leaves and branches of the main bronchi.
Lack of air – dyspnea (shortness of breath).

In the pulmonary form, progression of the disease can cause coughing with blood or be complicated by pulmonary hemorrhage. Other forms of tuberculosis (affecting other systems and organs) occur less frequently and are diagnosed after careful differentiation from other diseases.

Signs of other types of disease

Most of the identified forms of tuberculosis pathology are a complication or consequence of the pulmonary form, manifesting themselves:

1) Damage to the pleural membrane of the lung tissue with dry inflammation of the pleural layers and exudative inflammation. Symptoms include intense chest pain caused by dry friction between the layers of the pleura. Or it may be a consequence of exudative effusion, compressing the lung tissue, as a result of which there are signs of respiratory failure in the form of shortness of breath.

2) Involvement of the respiratory organs - the larynx and pharynx - in the infectious process, with signs of difficulty swallowing and hoarseness.

3) Symptoms of tuberculosis of the lymph nodes with signs of painless enlargement of the nodes of the lymph system in the cervical and supraclavicular zone. This type of infection can also manifest itself as an independent form of the disease.

The infection can invade and develop pathological processes in any organs and systems of the body.

4) Invading the genital and urinary organs, it manifests itself:

symptom complex of urological disorders;
the presence of bloody impurities in urine;
lumbar and ovarian pain;
inability to conceive and failure of the “lunar” cycle – in women;
development of varicocele and extensive education in the scrotum - in men.

5) When the infectious focus is localized in the kidney tissue, the symptoms manifest themselves as signs of nephritis, but sometimes the disease can be asymptomatic.

6) Tuberculosis infection of the meninges develops more often in childhood and in patients with obvious signs of immunodeficiency or endocrine diseases. It is distinguished by the gradual (over one and a half, two weeks) formation of symptoms. In addition to intoxication symptoms, the initial symptoms include headaches and insomnia.

After a week has passed since the onset of the disease, meningeal signs appear - increased tone of the muscles of the back of the head, occipital and frontal pain, neurological disorders. In the second week of illness, headaches become intense and are accompanied by vomiting.

7) When tuberculosis affects the gastrointestinal tract, symptoms of alternating diarrhea with constipation, digestive disorders, intestinal discomfort and bloody inclusions in feces are added to the general signs of intoxication.

Intestinal damage can trigger the development of intestinal obstruction syndrome.

8) Tuberculosis infection of joints and bones is a rare pathology, the main contingent of patients are HIV-infected. Intervertebral discs, joints of the knees and hips are affected by pathology. When the bacteria is localized intervertebrally, destructive processes also affect adjacent vertebrae, affecting their structural tissue, causing compression and the formation of hump-shaped curvatures.

Signs of joint lesions are manifested by symptoms of arthritis; bone pathologies are accompanied by pain syndromes and a tendency to fractures.

9) Tuberculosis of the central nervous system is rare. Diagnosed in young children and HIV patients. It is characterized by the manifestation of tuberculous meningitis, or the development of tuberculoma in the brain tissue. Symptoms appear:

migraines and mental disorders;
impairment of consciousness and sensitivity;
eye pathologies;
seizures of epilepsy and loss of coordination (with the development of granulomas in the brain).

10) Tuberculosis skin pathology is characterized by the subcutaneous development of dense nodular formations, which increase as the disease progresses. The opening of the nodules is accompanied by discharge of a white cheesy mass.

For any form of tuberculosis, treatment should be started immediately, since the lack of adequate treatment for many of them is death-like.

Pulmonary tuberculosis is a primary chronic infectious disease caused by mycobacterium tuberculosis. Penetrating into tissue human body, the causative agent of tuberculosis provokes the development of local productive inflammation, leading to the appearance of small granuloma tubercles, mainly epithelioid, they become the habitat and reproduction of mycobacteria. Next, the nearest ones are affected The lymph nodes, a person acquires hypersensitivity (sensitization) to toxins secreted by the pathogen. Spreading beyond granulomas, mycobacteria affect more and more tissue areas, can move and settle in any organ system, causing secondary damage, one of which is pulmonary tuberculosis.

Pulmonary tuberculosis in its primary form often ends in self-healing, leaving small scars in the damaged tissues; secondary is either an exacerbation of uncured primary tuberculosis, or a secondary infection.

Tuberculosis infection accounts for approximately a billion people a year, 10 million people fall ill (and these are just statistics of recorded cases), and more than 2.5 million people die from this infection every year.

Pulmonary tuberculosis in adults has a clear connection with such a social factor as having a permanent job; for unemployed citizens, the risk of the disease is twice as high. There is also a gender dependence: pulmonary tuberculosis in women is observed two or three times less often (this indicator depends on the place of residence, different for countries and continents) than among the male population.

Causes of pulmonary tuberculosis

It is impossible in everyday life to create conditions that will allow one to avoid encountering the tuberculosis pathogen. But this does not mean at all that such contact will lead to illness and provoke pulmonary tuberculosis. The overwhelming number of mycobacteria entering Airways, on the skin, in digestive tract will die or be removed without having a detrimental effect. Some of them can take root in the human body, remain there for a long time, and even cause specific changes in a small area of lung tissue, but gradually the infection will fade away without developing into pulmonary tuberculosis. This happens for the reason that the body’s defense, the immune system, works in a timely and quite effective manner.

Statistics say that only five out of a hundred people develop pulmonary tuberculosis upon contact with the pathogen, another 8-10 will become carriers of the infection, while the rest are not in danger of encountering mycobacterium tuberculosis.

The reasons that increase the likelihood of disease are, in fact, those factors that weaken the body and suppress the immune system, because the weaker the defense, the easier it is for the pathogen to find a loophole in it.

A long stay in unfavorable living, sanitary, social, and environmental conditions has a detrimental effect on a person’s general condition. Living in cramped, stuffy, damp, overcrowded conditions significantly increases the risk of getting pulmonary tuberculosis; the same danger is fraught with malnutrition, poor nutrition with insufficient intake of proteins, vitamins, fatty amino acids, leading to emaciation or even exhaustion. All of the above is aggravated when a person abuses alcohol, suffers from drug addiction, or smokes a lot.

Pulmonary tuberculosis is more dangerous for people who have chronic diseases, primarily HIV infection, obstructive pulmonary pathology. It is easier for the pathogen to enter the body when there are open damaged areas of the mucous membranes, for example, with a stomach ulcer. The risk of infection increases significantly if there is close contact with a person suffering from tuberculosis; of course, this largely applies to members of his family. Another circumstance that contributes to infection is frequent hypothermia; people who do not have a permanent place of residence are especially susceptible to it. A confluence of almost all of the listed unfavorable factors is present in places of deprivation of liberty; pulmonary tuberculosis is observed in prisoners much more often than in free people.

A separate point worth mentioning is another reason - human carelessness. In many cases, the disease can be detected in the early stages, when treatment is effective and efficient, but many seek medical help only when pulmonary tuberculosis is already a fait accompli.

One of the reasons for the increased risk of disease may be refusal of vaccination (vaccination against tuberculosis). It is recommended for children of the first year of life living in areas unfavorable for tuberculosis infection. Vaccination is also indicated for all people who have household contact with a person suffering from a form of the disease that stubbornly does not respond to anti-tuberculosis therapy. Vaccination cannot prevent infection with Mycobacterium tuberculosis, but it significantly reduces the risk of developing severe forms of the disease and, accordingly, facilitates treatment.

Mycobacterium tuberculosis is extremely resistant to external influences and can remain viable for a long time even in a dried state. But if the pathogen survives in a dry room for about a year, then under the same other conditions in a humid microclimate it can retain its pathogenic abilities for up to seven years. Mycobacterium tuberculosis is resistant even to acids, but it also has weaknesses: it is afraid of substances that contain chlorine, is sensitive to sunlight, and does not like oxygen-rich air. Hence the conclusion: dry, bright rooms with good aeration, in which cleaning is carried out using disinfectants, is a fairly simple sanitary standard that prevents the spread of tuberculosis infection.

Pulmonary tuberculosis at an early stage

To understand how pulmonary tuberculosis manifests itself in the early stages, you need to understand what happens when the pathogen enters the lungs. And the following happens: mycobacterium tuberculosis settles in the bronchioles and alveoli, penetrates the lung tissue, and causes inflammatory reaction(focus of specific pneumonia). Next, they are surrounded by macrophage defenders, which, having turned into epithelioid cells, stand around the pathogen in the form of a kind of capsule and form the primary tuberculosis focus. But individual mycobacteria manage to penetrate this defense, then they move with the bloodstream to the lymph nodes, where they contact the cells of the immune defense and cause a complex of reactions that form specific cellular immunity. Inflammation occurs and is replaced by a more advanced reaction, in which macrophages also participate; it is their activity that determines whether the body’s anti-tuberculosis defense will be effective. If it does, relative immunity will develop; if it turns out to be untenable, pulmonary tuberculosis will develop.

From the moment the primary infection occurs, tuberculosis has a generalized nature, but there are no obvious signs of the disease at this stage there will be no or they will be very smoothed out, which is explained by the resistance of the human body to tuberculosis, as well as artificial immunity that has developed after vaccination. Primary pulmonary tuberculosis often ends in recovery, leaving only small scars in the tissues, often calcified. But it also happens that mycobacteria do not die, they remain in the primary foci in a “preserved” state, retaining their pathogenic abilities. If in the future, for any reason, a decrease in immunity occurs, the dormant pathogen will immediately take advantage of this, break through the protective barrier around the primary focus and begin to spread further - secondary tuberculosis will develop, one of the forms of which is pulmonary tuberculosis. From this moment, obvious, so-called clinical symptoms arise; cases of spontaneous cure of secondary tuberculosis are extremely rare.

Symptoms and signs of pulmonary tuberculosis

Early symptoms of pulmonary tuberculosis have varied, but so smooth manifestations that for a long time they may not cause significant disturbances in well-being and are quite often detected only by fluorographic examination during periodic preventive examinations or examination for a completely different disease.

Nevertheless, early symptoms pulmonary tuberculosis are present in every case of the disease, since they are caused by intoxication - an obligatory component of tuberculosis infection.

The first sign of pulmonary tuberculosis is weakness, it is especially noticeable in the morning; a person wakes up with the feeling that he has not rested at all. This may pass during the day, but even with small dynamic loads, fatigue quickly develops, which was not observed before, working ability decreases, and is observed.

Appetite begins to deteriorate until it becomes absent, and the patient gradually loses weight. Along the way, apathy develops, and interest in many activities that previously brought pleasure decreases. Pallor appears (at first periodic, then constant) of the skin, sleep is disturbed.

The temperature will make itself felt; it can remain low for a long time, within 37.5 ° C, but often has features: it appears closer to the night, accompanied by chills and excessive sweating, this helps to distinguish it from a cold and allows you to suspect the first sign of pulmonary tuberculosis .

Pulmonary tuberculosis is accompanied by a cough, initially dry, aggravated by horizontal position body, that is, predominantly at night, turning into a morning cough. With further development of the disease, the cough acquires a wet character with the release of a large amount of viscous cloudy sputum, and shortness of breath appears.

Specific inflammation in the lung tissue leads to severe congestion and high permeability of small vessels; blood elements begin to appear through their walls, which can result in hemoptysis. In advanced cases of the disease, pulmonary hemorrhages are possible. Congestion leads to pulmonary heart failure and the patient will develop swelling of the extremities; in severe cases, effusion will accumulate in the abdominal cavity - ascites.

Pulmonary tuberculosis may be accompanied by fever, which is explained by toxic irritation of the thermoregulation center. Against the background of pale skin, a feverish blush is often noted.

Painful sensations in the chest are common; they can be caused by a hacking cough, but may indicate the development of pleurisy. Often there is an asymmetrical arrangement of the ribs; on the affected side they seem to sag and fall down. Retraction of soft tissues in the supraclavicular and subclavian areas may be observed; this happens in forms of the disease accompanied by severe fibrosis of the lung tissue and involvement of the pleura in the process.

Since intoxication in tuberculosis has harmful influence throughout the entire body, then disturbances may be observed on the part of the most different organs and systems. A sick person may complain of dyspeptic symptoms; laboratory tests reveal disturbances in the functioning of the liver and kidneys.

Pulmonary tuberculosis in children gives approximately the same symptoms as pulmonary tuberculosis in adults, but due to immature immunity it can occur more rapidly, causing more severe complications.

Forms and phases of pulmonary tuberculosis

The earliest forms are manifested by the presence of:

a) primary tuberculosis complex, including the focus of specific pneumonia, mediastinum;

b) tuberculous bronchoadenitis.

According to the degree of prevalence of the pathological process, pulmonary tuberculosis is divided into many forms (there are more than a dozen of them).

Spicy miliary tuberculosis lung disease develops when an infection breaks through from a limited focus into the vascular bed. In this case, tuberculosis infection spreads very quickly not only throughout the entire pulmonary parenchyma, but also throughout various organs, in which multiple granulomas soon appear. The spleen, kidneys, and intestines are most often affected, but the infection can affect any organ and any tissue.

Hematogenous disseminated pulmonary tuberculosis is characterized by foci of infection along the arterial and venous vessels, usually in both lungs at once; this is one of the most dangerous types of the disease.

Another form - focal tuberculosis lungs - manifested by the formation of specific small lesions (no more than a centimeter in diameter), usually localized in one lung, most often tuberculosis is observed right lung.

The infiltrative form is a consequence of an exacerbation of focal changes existing in the lung.

A very severe form, difficult to treat, caseous pneumonia, is accompanied by extensive foci of necrosis, which quickly expand and lead to the formation of cavities (cavities).

The formation of persistent cavities due to the breakdown of lung tissue is characteristic of another form - cavernous pulmonary tuberculosis.

Tuberculoma is an isolated form of the disease that has a clear demarcation of the pathological focus from healthy tissue, but during exacerbation it can spread beyond the fibrous barrier.

The spread of the pathological process to the pleura leads to tuberculous pleurisy, which can take on the character of serous or purulent; more often, this form occurs as a complication.

The final stage of development of all of these forms with their progressive course is fibrous-cavernous pulmonary tuberculosis, which combines the formation of caverns, hardening of their walls and pronounced fibrosis of the pulmonary parenchyma.

Another variant of the outcome of the disease – lung cirrhosis – involves the destruction of lung tissue with fibrosis.

Pulmonary tuberculosis has three main phases. The first of them is characterized by infiltration, decay, seeding and indicates the presence of acute stages specific inflammation. The second phase is characterized by resorption and thickening, these are signs of a decrease in the activity of the tuberculosis process. The third phase, scarring and calcification, involves the healing of damage caused to the respiratory system during the course of the disease.

Disseminated pulmonary tuberculosis

This form of the disease involves the spread of tuberculosis infection through the bloodstream and lymphatic tract (more than 85% falls on the first route, less than 15% on the second); it can manifest itself as a complication of primary pulmonary tuberculosis, but much more often occurs as a secondary one. Characteristic sign– formation of multiple specific granulomas in the lung tissue; the division of disseminated tuberculosis into small-focal (granuloma size up to 0.2 cm), large-focal (foci up to 1 cm in diameter) and polymophonic-focal (mixed version) depends on their size.

The small-focal variant is acute, granulomas are localized mainly along the capillaries, are not prone to fusion, are usually surrounded by dilated alveoli (focal emphysema), and all parts of the lungs are involved in the process.

The large-focal variety of pulmonary tuberculosis has a subacute course, the pathogen spreads along the venous interlobular network, sometimes along the branches pulmonary artery, is characterized by symmetrical damage to the lungs, most often the posterior parts of the upper lobes are affected. The lesions are prone to merging and disintegrating and have the same age of occurrence.

The mixed version is always an exacerbation of subacute disseminated pulmonary tuberculosis and is chronic in nature, starting from the upper parts of the lungs and gradually descending. The outbreaks have different size, structure and shape, which is explained by the different periods of their occurrence. Reticular sclerosis, emphysema, and decay with the formation of cavities develop in the lung tissue. From this moment, the bronchogenic spread of the pathogen begins, and the symmetry of the damage to the pulmonary structures is disrupted.

Hematogenous disseminated pulmonary tuberculosis is characterized by intoxication, damage to the respiratory system and other organs. Body weight decreases more intensely than in other forms, and body thermoregulation suffers more (including for a longer period of time). But in general, the course of the disease can be extremely variable, from barely noticeable to violent.

Laboratory examination reveals significant changes in the blood: leukocytosis, increased ESR.

The onset of disseminated pulmonary tuberculosis resembles the symptoms, but soon a frequent complaint appears - shortness of breath, which is caused by pulmonary hypertension. The cough is not strong, more like coughing, the sputum is scanty and difficult to separate. The disease progresses in waves, the patient’s condition either improves or worsens again. More often than with other forms of pulmonary tuberculosis, they develop with an asthmatic component and.

The spread of disseminated pulmonary tuberculosis to other organs is manifested by corresponding symptoms. A hoarse voice and sore throat will occur with tuberculous lesions of the larynx, hematuria and severe lower back pain – with kidney damage.

Disseminated pulmonary tuberculosis in women can lead to severe infertility pain in the pelvic area, since the ovaries and the fallopian tubes. Damage to bone tissue will lead to pain in the affected area, unsteadiness of gait, weakness in the arms or legs - it all depends on the area of localization of the pathogenic focus. Most often, the larynx and organs are affected. genitourinary system And bone, but we can say that this form of tuberculosis does not spare any tissues and organs that get in its way.

Cavernous pulmonary tuberculosis

Cavernous pulmonary tuberculosis can occur as a complication of other forms of tuberculosis, has a chronic course, is characterized by the presence of cavities (cavities) in the lung tissue and massive fibrous growths around them. In addition to these changes, bronchogenic screenings are present; they can be quite old or completely fresh.

Lung damage can be unilateral or bilateral, the number of cavities varies from a single cavity to several in each lung.

Cavities due to caseous necrosis can form in other forms of the disease, but it is with cavernous pulmonary tuberculosis that fibrosis comes to the fore, the walls of the caverns acquire cartilaginous density, and the bronchi draining the cavity are affected. Due to the pronounced density of the walls of the caverns, they are very rarely cleared of contents; necrotic masses aggravate the phenomena of intoxication and contribute to further destruction of the walls, which can lead to damage to adjacent vessels and pulmonary hemorrhage. In such cases, bleeding rarely stops on its own, is difficult to respond to conservative treatment methods, and patients require surgical intervention.

The presence of screenings in the surrounding tissues further reduces the lung surface, and respiratory failure progresses.

Complaints are not much different from those with other forms of pulmonary tuberculosis, only in advanced cases they have peculiarities. Develop cachexia, rib cage takes on a barrel shape. The supraclavicular cavities sink, more on the affected side, the affected side lags behind when breathing.

When percussing the lungs, a boxy sound is heard over relatively preserved areas and a dull sound over more affected areas. Auscultation always reveals rales of various sizes, often wet. Throughout the course of the disease, patients secrete many mycobacteria in their sputum. Without treatment, cavernous pulmonary tuberculosis occurs in waves; there are periods of calm, which are followed by a new wave of exacerbation with the formation of fresh cavities, and complications develop: chronic cor pulmonale, hemoptysis, pulmonary hemorrhage. Treatment is complicated by the fact that in most cases with this form the pathogen develops drug resistance.

The diagnosis of this form is not difficult; with x-ray examination, changes in the lung tissue are clearly visible: cavities, pronounced fibrosis, compaction and shrinkage of the lung, asymmetry of the ribs, displacement of the mediastinum towards the lesion, fresh foci of contamination.

Fibrous pulmonary tuberculosis

A form of the disease in which the most pronounced manifestation is fibrosis, that is, compaction of the lung tissue with loss of its ability to perform respiratory function. Along with dense airless areas, there are foci of emphysema; their presence is combined with the preservation of signs of the active process. This form develops as a result of a long course of cavernous or disseminated pulmonary tuberculosis. In the lung tissue there may be cavities, usually deformed, in the form of cracks, there are single or multiple infiltrative foci, and dissemination phenomena. The pathological process can be one- or two-sided; fibrous tuberculosis of the right lung is more common. According to the distribution of the process, the fibrous form is divided into total and partial. In the total variant, the entire lung is involved in the process; in the partial variant, a lobe or segment is involved.

With such pronounced fibrotic changes blood circulation suffers, in combination with bronchiectasis and emphysema, pulmonary heart failure and cor pulmonale develop, which, in turn, aggravates shortness of breath, and the patient develops acrocyanosis.

This form of pulmonary tuberculosis will manifest itself depending on the phase of the process. During exacerbations, a significant and prolonged increase in body temperature occurs (up to 39°C), intoxication leads to severe weakness, night sweats, a cough with the release of viscous sputum, and shortness of breath. As activity subsides, the symptoms will be less pronounced, until you feel satisfactory.

With a long course, the nature of the sputum changes, a purulent component appears in it, often indicating the addition of a secondary infection. The further development of bronchiectasis also contributes to the accumulation and stagnation of sputum, which is released abundantly when coughing. The wheezing in the lungs becomes persistent, and the sputum becomes more viscous. Cases of hemoptysis are common, and pulmonary hemorrhages are possible, which pose a serious threat to the patient’s life. In case of bleeding, aspiration of blood from further development aspiration pneumonia.

The listed symptoms are not present in all patients; they have varying degrees expressions are combined in different ways. With the development of pulmonary heart failure, swelling of the limbs and torso, enlargement of the liver are added, and ascites may develop over time.

The course of the disease is wave-like, the symptoms either increase or decrease. The worsening of pulmonary heart failure often leads to such a significant loss of ability to work that the patient acquires the status of a disabled person. Long-term intoxication causes pronounced trophic and metabolic changes in tissues; phenomena occur in internal organs that can significantly disrupt the functions of an organ or tissue.

Fibrous pulmonary tuberculosis is an irreversible process; it is no longer possible to return lung tissue to a normal state even with the most thorough treatment, therefore, more often than with other forms, surgical intervention is required.

Diagnosis of pulmonary tuberculosis

Diagnosis of pulmonary tuberculosis is an extremely important component of mass events aimed at reducing infection, morbidity, disability, and mortality from this serious disease. It can be suspected on the basis of a number of symptoms, which, although not specific, will nevertheless push the examination in the right direction and make it possible to begin treatment in a timely manner. Identifying patients with already manifested symptoms is an important goal, but insufficient in terms of recognizing the disease at the earliest stages, since pulmonary tuberculosis (especially pulmonary tuberculosis in children) in its initial phase can be asymptomatic.

There are many schemes and complex measures aimed at identifying and treating tuberculosis infection; DOTS (Directly Observed Treatment, Short-course) is considered the most effective currently existing strategy. It includes four main conditions that will allow the disease to be diagnosed earlier and treated more successfully. The first condition is the detection of cases of the disease by the bacterioscopic method, which involves the examination of sputum smears. The second is based on mandatory bacterioscopic control during the treatment of an identified patient. Third, the mandatory availability of anti-TB drugs and their uninterrupted supply. The fourth condition is clear registration and organized reporting, which will allow assessing the results of treatment for each patient. But this strategy is more directed towards an already manifested disease, since it is based on the patient’s appeal to a doctor.

An earlier diagnosis is the Mantoux test, also known as the tuberculin test. The purpose of the test is to determine the strength of immunity to Mycobacterium tuberculosis. Injecting a tiny (0.1 ml) portion of tuberculin under the skin allows you to tell whether there are mycobacteria in the body. After a couple of days, a “button” appears at the injection site - a slight thickening of the skin with redness; the size of the skin formation depends on the number of immune cells “familiar” with the mycobacterium. The sample is assessed by the end of the third day, and only the compaction is measured, but not the area of redness - it has nothing to do with immune reactions does not have. The presence of skin infiltration is also assessed. Based on these two indicators, conclusions are drawn.

There is still no consensus on the mechanisms underlying tuberculin test. Tuberculin is not an antigen, not a toxin, but just a protein extract from heat-treated mycobacteria, so the reaction at the injection site is more likely allergic than immune, and it does not provoke the production of antibodies. However, the test quite accurately shows the presence or absence of contact with mycobacterium tuberculosis, which is its main purpose. The first Mantoux test is performed on children at one year of age.

The reason to contact a phthisiatrician is the size of a skin lump of more than 17 mm in children and more than 21 mm in adults, a sharp jump in the size of the papule compared to the previous indicator, or the presence of any pustular formations.

There are other methods for detecting Mycobacterium tuberculosis in the body, one of them is bacterioscopic. The sputum released during coughing is examined, a smear is prepared, stained, examined under a microscope; the detection of acid-fast bacilli (these will be mycobacteria) indicates infection.

The bacteriological method involves inoculating sputum on special nutrient media; if the causative agent of tuberculosis infection is present in the sputum, the growth of its colonies will be detected.

There are many similar methods, but they answer only one question: is there tuberculosis mycobacteria in the body. Other types of research can determine the form and phase of the disease.

Fluorographic examination allows one to suspect or identify focal changes in the lung tissue, to see foci of compaction, cavities, expansion of the roots of the lungs, thickening of the pleura, in such cases the patient undergoes a full x-ray examination, sputum bacterioscopy and bronchoscopy are prescribed.

Treatment of pulmonary tuberculosis

Treatment of pulmonary tuberculosis will be effective only if it involves a whole range of measures: specific and symptomatic therapy, strengthening the immune system, improving household and sanitary living conditions, establishing nutrition and routine.

The goals pursued during treatment can be divided into four main groups. The first is the elimination of manifestations of the disease and patient complaints, normalization of laboratory parameters. The second is the cessation of the release of mycobacteria from sputum; it must be persistent and long-lasting, confirmed by bacterioscopic and bacteriological methods. The third direction is a significant reduction radiological signs diseases. The fourth is restoration or at least a noticeable improvement in the functional capabilities of the respiratory system and the body as a whole, increasing working capacity.

The choice of treatment tactics is determined taking into account the general condition of the patient. The course of the disease in a severe form with severe manifestations of intoxication, high fever, and decompensation of pulmonary insufficiency requires bed rest and mandatory hospitalization. In the phase of calming down of the active specific process, a gentle regimen is indicated; treatment can be continued at home. After significant improvement in condition, they switch to a training regimen with a gradual transition to full-time work activity.

Drug treatment of pulmonary tuberculosis is a long process, taking at least four months even under the most favorable circumstances. The leading method is treatment with anti-tuberculosis drugs that have bacteriostatic and bactericidal effectiveness. The main groups of such drugs are Aminoglycosides, Rifamycins, PAS, Thiamides, Fluoroquinolones.

Pharmacotherapy must be accompanied by compliance with a number of principles. The first of them is treatment started immediately after the disease is identified, without delay until later, until better times. A complex of anti-tuberculosis drugs (at least four) is mandatory. An important condition is the duration and consistency of treatment; unauthorized breaks or refusal of one or more medications are unacceptable. Another principle is mandatory control over the treatment process, since due to the duration of treatment for pulmonary tuberculosis, patients may take medications irregularly, or even stop treatment altogether.

The listed principles are important for the reason that mycobacteria are very resistant to drug effects, quickly develop resistance to it, and are also capable of multiplying very intensively when the process is activated and spreading through the lymphatic and bloodstream. In a specific focus there may be pathogens of different populations, they will differ in metabolic activity, accordingly, it is necessary to influence them different drugs. Even with newly diagnosed pulmonary tuberculosis, the patient’s body will contain pathogens that are resistant to anti-tuberculosis drugs. All of the above explains the need for a comprehensive impact on tuberculosis infection.

There are two phases of anti-tuberculosis therapy: intensive and continuation of treatment. The intensive (initial) phase is aimed at suppressing mycobacteria with rapid reproduction, that is, with high metabolic activity, as well as preventing pathogen resistance to drugs. The continuation phase of treatment is aimed at pathogens with low metabolic activity and slow reproduction, stimulating regenerative processes in the lung tissue.

Anti-tuberculosis therapy is carried out according to approved regimens that contain the set of drugs that are most appropriate for certain forms of pulmonary tuberculosis.

The first regimen is prescribed to persons with newly diagnosed pulmonary tuberculosis, accompanied by the release of bacilli, or to patients with widespread forms of the disease without the release of mycobacteria. The course of therapy includes Isoniazid, Pyrazinamide, Rifampicin, Streptomycin in the intensive phase of treatment, lasting two months. In the continuation phase of treatment, only two drugs (Rifampicin, Isoniazid) are used for four months. If there is resistance to the listed drugs, Streptomycin is replaced with Ethambutol.

Other regimens are designed to treat tuberculosis infections with varying degrees of resistance to anti-tuberculosis therapy. In such cases, other drugs (Kanamycin, Lomefloxacin, Ofloxacin, Prothionamide, etc.) are added to the first regimen regimen; they are selected for each patient individually.

Another direction of treatment of pulmonary tuberculosis is pathogenetic therapy, it includes means to reduce the effects of intoxication and increase the body's protective capabilities. Hormonal drugs are used for those forms of the disease that are accompanied by an increased exudative reaction (infiltrative, miliary pulmonary tuberculosis, exudative pleurisy), Prednisolone is most often used. If there is a marked decrease in lymphocytes in the blood, immunomodulators are prescribed.

One type of treatment is collapse therapy; it is used for destructive forms of the disease, accompanied by the formation of thin-walled cavities. An artificial one is created, resulting in compression of the affected lung, the cavity is significantly reduced in size, which accelerates its healing. Most often, collapse therapy is used for pulmonary hemorrhages from vessels that have collapsed in the caverns.

Often, pulmonary tuberculosis requires surgical intervention; tuberculomas, single cavities, multiple cavities with pronounced fibrosis of the walls and adjacent tissues are surgically removed. TO surgical methods are used for tuberculous pleural empyema, and occasionally for necrotic lesions of the lymph nodes and severe forms of caseous pneumonia.

An important component of anti-tuberculosis treatment is diet therapy. Nutrition should be high in calories, with intensive treatment about 3000 Kcal per day, with a training regimen - 3500 Kcal per day. The diet should contain a sufficient amount of proteins, fats, carbohydrates, calcium, phosphorus, and vitamins.

At the recovery stage and for mild forms of pulmonary tuberculosis, sanatorium-resort treatment is recommended, which includes the beneficial effects of climatic factors, physical therapy, breathing exercises, diet therapy.

The effectiveness of treatment is assessed by the degree of reduction of clinical symptoms, radiological manifestations, and the absence of mycobacteria.

Pulmonary tuberculosis - which doctor will help? If you have or only suspect the development of pulmonary tuberculosis, you should immediately consult a doctor such as an infectious disease specialist.

Judging by your diet, you don’t care about your immune system or your body at all. You are very susceptible to diseases of the lungs and other organs! It's time to love yourself and start improving. It is urgent to adjust your diet, to minimize fatty, starchy, sweet and alcoholic foods. Eat more vegetables and fruits, dairy products. Feed the body by taking vitamins, drink more water (precisely purified, mineral). Strengthen your body and reduce the amount of stress in your life.

You are susceptible to moderate lung diseases.

So far it’s good, but if you don’t start taking care of her more carefully, then diseases of the lungs and other organs won’t keep you waiting (if the prerequisites haven’t already existed). And frequent colds, intestinal problems and other “delights” of life accompany weak immunity. You should think about your diet, minimize fatty, flour, sweets and alcohol. Eat more vegetables and fruits, dairy products. To nourish the body by taking vitamins, do not forget that you need to drink a lot of water (precisely purified, mineral water). Strengthen your body, reduce the amount of stress in your life, think more positively and your immune system will be strong for many years to come.

Congratulations! Keep it up!

You care about your nutrition, health and immune system. Continue in the same spirit and problems with your lungs and health in general will not bother you for many years to come. Don't forget that this is mainly due to you eating right and leading a healthy lifestyle. Eat proper and healthy food (fruits, vegetables, dairy products), do not forget to consume a large number of purified water, harden your body, think positively. Just love yourself and your body, take care of it and it will definitely reciprocate your feelings.

Pulmonary tuberculosis is an infectious lung disease that is transmitted by airborne droplets and is characterized by an inflammatory process.

The disease occurs due to the tuberculosis bacillus, it penetrates from the patient through coughing, sneezing, and dialogue.

According to generally accepted data, there are about 2 billion infected people in the world. During the year, out of 100 thousand people who become ill with tuberculosis, approximately 18 people die.

But if we take into account the total number of infected people in the world, then 25,000 people lose their lives from this disease per year. Fortunately, in recent years the number of deaths from of this disease decreased by 50%.

Incubation period

A significant amount of time elapses after a person becomes infected and before any symptoms appear. This period of time is called incubation.

For everyone it lasts a different amount of time, ranging from a quarter to a year. When incubation period ends, during this period of time the symptoms of tuberculosis can be confused with normal.

If the immune system fights bacteria that enter the respiratory tract well, then they die and the disease does not progress. Otherwise, the mycobacterium continues on its way and, being absorbed into the blood, breaks into the lungs.

An inflammatory process begins to develop there. When the incubation period ends, the first signs of tuberculosis appear. During this period, the subject is not infectious; even the Mantoux test shows a negative result. Which significantly worsens the diagnosis of identifying the disease in the early stages of development.

Signs of tuberculosis in the early stages

To identify the first signs of the disease in the early stages in adults, every mature person should take care of their health and also notice changes in the body. After all, it appears on initial stages only on fluorography.

Signs of tuberculosis in adults can be identified by the following signs:

frequent, causeless dizziness;
laziness and phlegmaticity;
sleep disturbance and excessive sweating;
anemic skin;
blush on the face;
causeless weight loss;
decreased appetite that is not associated with gastrointestinal problems;
normal body temperature, which does not exceed 37 °C.

Important! If several signs of tuberculosis appear in adults, you should consult a doctor and also take an x-ray.

Other signs of tuberculosis

As tuberculosis progresses, it becomes more visible in the following symptoms:

continuous cough with sputum;
severe shortness of breath, even with little physical activity;
strange wheezing, which can only be determined by a specialist, as it can be either wet or dry;
increased body temperature;
sparkling eyes, dull skin;
significant weight loss;
manifestation of blood in sputum;
at deep breath the appearance of chest pain.

If a person has the last two symptoms, then he is seriously ill and requires urgent hospitalization.

Temperature for tuberculosis

High temperature in tuberculosis is one of the significant symptoms of the disease. It is this reflex of the body that overtakes all other symptoms and signs of lung destruction.

This disease is characterized by both constant and variable temperature rises. Usually, the temperature rises in the morning, and on the contrary decreases closer to night. Sometimes it can reach 41 °C.

Cough due to tuberculosis

Usually the cough with tuberculosis is wet. It seems as if there is a clot in the throat and it is difficult to cough it up. This occurs because plaque accumulates in the lungs due to the inflammatory course of the disease. It prevents the lungs from circulating normally, thereby disrupting gas exchange in the bronchi.

That's why coughing is triggered, trying to clear the airways. But since there is always mucus there, this cannot be done and the cough appears again and again. The cough is most often long lasting.

In order to cough up mucus, a person strains the diaphragm, this disrupts the ventilation of the lungs and gives rise to inflammation, which makes breathing difficult. And the cough starts again. As a rule, a cough with tuberculosis occurs with the release of fluid.

Sputum is a mixture of pus and white plaque. In adults, at an early stage of development, sputum is clean and transparent, later it turns dark with the addition of blood. In the prolonged phase, the person coughs up blood with added pus. The smell of sputum is usually unpleasant and putrid.

The cough usually gets worse when lying down. Therefore, coughing fits often occur at night. This is explained by stagnation of mucus, as a person remains motionless for a long time. Resting the patient in a semi-sitting state can make the patient feel better.

Is pulmonary tuberculosis contagious?

This disease is infectious, especially considering how many people suffer from tuberculosis. It is transmitted by airborne droplets. It is not possible to insure against infection, because even insects can be the source of infection.

There are two forms of the disease: open and closed. It is believed that infection with the disease occurs only if the patient has an open form. But a closed self is also dangerous, since the transition from one form to another may not be noticeable. The symptoms of tuberculosis are very similar to a common illness or acute respiratory infection.

Over the course of a year, a person suffering from open tuberculosis can infect 15 people. That's why this disease is so common.

Stages of pulmonary tuberculosis

There are three stages:

1. Primary infection. Suppuration begins at the site where the infection occurs. In other words, local inflammation. In this case, the microbes land on the lymph nodes and signs of tuberculosis may already appear in the early stages in adults. General state the patient is good.

2. Stage hidden infection. Bacteria begin to multiply against the background of weakened immunity.

3. Recurrent tuberculosis of the adult type. Bacteria begin to infect the lungs. If they enter the bronchi, then the open form of tuberculosis begins.

Forms of tuberculosis

The forms of tuberculosis can be diverse. Therefore, further treatment or hospitalization of the patient depends on the form of inflammation.

Infiltrative tuberculosis.

This form is qualified by the fact that metamorphism takes place in the inflammation zone. The fabric is made similar to the protein mass. This includes a disease such as caseous.

Sometimes the infiltrated form goes unnoticed by humans and appears only on fluorography.

A visible indicator of this form is the release of blood from the respiratory tract with saliva, which can be confused with pneumonia.

Disseminated tuberculosis.

This form is due to the fact that infection progresses through the blood. Microbes scatter through the blood and the centers of inflammation are the upper respiratory tract. Signs begin to appear systematically, but the intoxication is severe.

Cavernous tuberculosis.

This form of tuberculosis is characterized by the appearance of emptiness that occurs in the lung tissue. Microbes enter the body through the air. It is possible to identify such a shape only with the help of an x-ray; it clearly shows a round cavity. Therapy is carried out with medication, adding immunostimulating drugs.

Fibrous tuberculosis.

The difference between this form is the origin of inversions in lung tissue. Signs of the fibrotic form are the above types of tuberculosis. There are several versions of the maturation of the disease:

Due to chemotherapy, the disease subsides, inflammation forms after a few years
times of calm are often followed by phases of deterioration
sometimes exacerbations begin to develop

Focal tuberculosis.

With this form, damage to any place is possible. It can be either the right or left lung, or both lungs. They differ in composition and size.

Symptoms of focal tuberculosis are highly elevated body temperature and severe cough. If no changes are detected in the lungs, as can be seen on fluorography, then this form is susceptible to treatment.

Open tuberculosis.

This form is the most severe and dangerous for humans. Infection occurs through airborne droplets and in an urgent case the patient must be hospitalized in a tuberculosis dispensary. A sputum smear is required to detect this form. Open tuberculosis very difficult to cure, as the bacteria become more resistant to drug treatment.

Closed tuberculosis.

This form is the exact opposite of the open form. In order to identify it, it is necessary to do a Mantoux test. Closed tuberculosis may not manifest itself for a long time. Therefore, according to generally accepted data, it is known that a third of the planet suffers from a closed form of tuberculosis.

Complications of tuberculosis

The worst complication may be death from tuberculosis. This is the case if it is not treated. There are also other consequences of the disease:

destruction of other organs occurs, for example, liver, heart, kidneys, etc.;
the disease can destroy joints, leading to bone tuberculosis;
pulmonary hemorrhage may occur - one of the most dangerous complications of tuberculosis. In this case, urgent medical attention is needed.

If a person has once suffered from tuberculosis, then he is not immune from inflammation of the disease in the future.

There is also no certainty that the child will not become infected from the mother and will be born completely healthy and without abnormalities. Often there is a frozen pregnancy or death of the baby during childbirth.

After recovery, a person may still experience headaches, discomfort in bones and joints, and weakness for some time. Most often this happens due to strong medical supplies. There may also be a disturbance in the functioning of the stomach and upset stool.

Diagnosis of tuberculosis

Diagnosis of tuberculosis includes the following steps:

the doctor listens to the patient’s complaints of shortness of breath, weight loss, and expectoration;
it is necessary to find out from the patient whether he had contact with tuberculosis patients and how long the disease lasts;
then the patient is listened to and a general examination is performed;
make a Mantoux test;
send a patient with suspected tuberculosis for an x-ray;
Then the sputum is submitted for analysis.

There are also additional screening tests for tuberculosis. One of them is bronchoscopy, which helps to look inside the lungs.

During this study, the bronchi are examined and the cellular composition is studied. What helps to find the causative agent of the disease. If it is difficult to draw a conclusion from the above diagnostics, then an analysis is done.

Treatment of tuberculosis

The first step is to eliminate severe cases of the disease and return the person to normal life.
Next, the development of bacteria and foci of manifestations is stopped with the help of medications. Therapy is carried out in a tuberculosis dispensary.
If bacteria are observed to be resistant to drugs, then drugs of stronger action are started to be administered.

As soon as the patient finds out his diagnosis, treatment should be carried out immediately. Medicines should be used in combination. It is also necessary to mentally prepare yourself for the fact that the treatment will be carried out for a long time. And do not forget that each stage of treatment must be carried out under the close supervision of specialists. If there are severe complications, then surgical intervention is necessary.

Important! Tuberculosis cannot be treated at home; all therapy is carried out only in a tuberculosis clinic, under the strict supervision of doctors.

Prevention

Prevention is a very important activity, since nowadays a large number of people suffer from tuberculosis. The most important protection may be vaccination against tuberculosis. BCG vaccination, it is done for the first time in the maternity hospital. Next, revaccination is carried out at 7 and 14 years of age. Also, do not forget to do fluorography once a year.

Thus, in order not to get tuberculosis, you need good immunity. And maintaining good immunity requires proper nutrition, exercise, a healthy lifestyle and giving up bad habits.