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The first signs, symptoms, methods of diagnosis and how is tuberculosis?

Tuberculosis is one of the oldest afflictions known to mankind. In Russia it was called "ataxic disease", and later "consumption". In Ancient Greece, the disease became famous under the name of phtisis, which means "exhaustion". From this word comes the modern name of the medical industry is studying the problem of tuberculosis – TB. A doctor specializing in the treatment of tuberculosis patients, known to all as the TB.

Despite the outstanding successes of modern science in the development of diagnostic tools, prevention of epidemics and treatment of complex infections over the disease still failed. On the contrary, the problem of the incidence of this disease is becoming more acute in some States of the world. The spread of tuberculosis is directly connected with the processes of globalization and migration, for which medicine developing countries simply do not have time.

Russia is on the 22nd place in the world in terms of morbidity and mortality from tuberculosis, and it is a very sad figure. Although over the past ten years the Ministry of health has achieved impressive results in the fight against the spread of the disease, to talk about success yet. And in order to protect themselves and their loved ones, it is better to arm themselves with relevant and reliable information. In this article you will learn everything about tuberculosis: what is it, what causes it, how it is transmitted, what methods are diagnosed and treated.

The content of the article:


What is TB?

The term "tuberculosis" comes from the Latin word tuberculum ("bump") because it's like the inflammation is tuberculous granuloma. Cause this disease is Mycobacterium species Mycobacterium tuberculosis complex, i.e. directly mycobacteria tuberculosis (MBT) and its closest relatives. The most important lesion of the Airways (bronchi and lungs), but sometimes mycobacteria cause inflammation in the lymphatic, nervous and urogenital system, musculoskeletal apparatus, the skin, or even affect the entire organism as a whole (miliary form).

The invincibility of tuberculosis is due to several reasons:

  • the disease often does not manifest itself for years, and even when the inflammatory process begins, the person is not in a hurry for a doctor. Early symptoms of tuberculosis easily confused with the common cold or exhaustion. In the end, time is lost, and the patient has to undergo lengthy and complex treatment;
  • Tuberculous mycobacteria are extremely resistant to aggressive environment influence, a very long time remain alive and infect more and more people in places where no one expects to meet, and where they are impossible to get rid of any sanitary methods;
  • The causative agent of tuberculosis mutates rapidly, acquiring resistance to antibiotics. Moreover, the mutation can happen in the body of a sick person in the course of the disease. This greatly complicates and prolongs the treatment, and in the absence of success can cost a man's life. For example, only in 2008 according to the who world tuberculosis sick 9 million people and a third of them died.

The first mention of tuberculosis

Modern archaeologists have had to derive from ancient graves human remains with signs of tuberculous lesions of bones and some skeletons belong to people who lived on Earth for 3000 years BC. So it's safe to say that tuberculosis is as old as mankind and his constant sad satellite.

Although the contagious nature of the disease was proven only in the late nineteenth century, people have long realized that tuberculosis is contagious. For example, the Babylonian "Hammurabi"allowed the husband to unilaterally divorce his wife if she has signs of tuberculosis. And the ancient Indian"Laws of Manu"and even forbade men to marry such women. The Governor of Venice has issued a law requiring citizens to report all tuberculosis patients"to be."

The first scientific description of tuberculosis were written by Hippocrates. Although the famous Greek healer and was noted for a profound mind and incredible powers of observation, about the TB, he made a mistake. Hippocrates noted that this disease usually affects members of the same family, and made a false conclusion about the hereditary nature of tuberculosis.

Another famous physician, Avicenna, who lived later, had indicated in his notes the direct link between tuberculosis and pleurisy, and the fact that the emergence of the disease contributes to the unfavorable environment and low social status: the tuberculosis have poor people who are malnourished, living in filth and doing hard labor. Avicenna was convinced that the disease was contagious, but didn't know how to heal.

Inthe ancient Chronicles there is mention of tuberculosis of the lymphatic system. This disease suffered by the Kiev Prince Svyatoslav Yaroslavich in the year 1076. Treatment in those days was surgical: inflammation cut out, and place then burned. Of course, this technique did not help the healers to heal the Prince.

History of the study of tuberculosis

The epidemic disease acquired in the XVII – XVIII century, when it began active construction of cities, development of industry, trade and transport. People traveled, went to work, and simultaneously carried the deadly bacteria. In the mid-seventeenth century on the British Peninsula approximately 20% of the deaths were from tuberculosis. The situation in the rest of Old Europe was no better.

Then began the first medical research aimed at establishing the nature of tuberculosis and the search for methods of treatment. Dr. Francis Silvius, who lived in the XVII century, first discovered tuberculosis granulomas at autopsy of the deceased from tuberculosis patient, but mistook them for enlarged lymph nodes. But then M. Belli (1761-1821) delved down to the truth and realized that the bumps are a form of manifestation of the disease and the basis of further spread of the inflammation.

A follower of Dr. Bailly, the French scientist Rene Laennec (1781-1826), first coined the term "tuberculosis", and described several types of this disease. He also suggested the use of auscultation of the lungs, which served as a breakthrough in the diagnosis. Russian physician G. I. Sokol (1807-1886) was familiar with the writings Laennec and relied on them in his scientific work. The result was the book "the Doctrine of thoracic diseases,"published in 1838. It first describes the cavernous Sokolsky, disseminirovanne and infiltrative form of tuberculosis, though under other terms.

A great contribution to the solution of the nature of tuberculosis made the French ship's doctor, Jean-Antoine Willman. In 1865, during the voyage he discovered that one of the sailors sick with tuberculosis, and became the witness of how the same symptoms gradually appeared in the other members of the crew. To confirm the conjecture of the infectiousness of the disease, the doctor made infected sputum and impregnated her litter, on which they lived Guinea pigs. The animals contracted tuberculosis and died.

The German pathologist Julius Kongejma in 1879, confirmed the hypothesis of Wilmina with another experience on animals: it introduced fragments infected with tuberculosis of human lung in the eye of rabbits, after which experienced the development of tuberculous granulomas.

Howeveronly in 1882, became known for certain exactly how the deadly disease spreads and affects millions of people. German physician Robert Koch spent 17 years of his life to studying this question and finally was able to discover and consider a dangerous Mycobacterium leprae under the microscope, after stained the infected sample with methylene blue and Vesuvio. Then the doctor was able to isolate bacterial pure culture and infect experimental animals. In honor of the discoverer of Mycobacterium tuberculosis was called the"tubercle Bacillus". And the solution with the bacterial culture, called "tuberculin" is used for diagnostic purposes until now.

Forms and types of tuberculosis

More than 90% of cases the tuberculosis is localized with the lungs, but there are also bone, urogenital, skin, brain, intestinal, miliary variety of the disease, so it is customary to distinguish two forms of TB:

  • Pulmonary;
  • Extrapulmonary.

On the basis of whether the sick person for the first time, or disease after a remission has reached its active stage, there are two types of tuberculosis:

  • Primary;
  • Secondary.

Primary tuberculosis

This acute form of the disease that occurs immediately after exposure to blood pathogen. Primary TB often affects children before the age of five because their not fully formed immune system can not cope with the attack of tubercle bacilli. Although the disease runs hard and has pronounced symptoms, for others at this stage, patients are not contagious.

Formed in the lung primary lesion is a small granuloma. Further events can develop either a favorable or tragic scenario. In the first case the tuberculous granuloma self-healing. Sometimes people are not even aware of the seriousness of the problem, attributing his indisposition to fatigue and cold. Then during x-ray examination in his lungs to find "surprise" - healed granuloma.

In the second case, the granuloma increases, and it occurs inside the free cavity is filled with blood formation. Cavity of tubercle bacilli through the bloodstream are carried throughout the body, the fruit of new foci of inflammation. The primary cavity can still close and heal without treatment, but if new granulomas, followed by a new cavern, that without medical care people die.

Secondary tuberculosis

On the secondary TB say when ill have contracted another type of tuberculous mycobacteria, and again fell ill, or when remission has turned into aggravation. This situation is moretypical for adult patients. In the lungs the formation of new foci of inflammation, is sometimes so close to each other that cavities merge, and there are large cavities with exudate. About 30% of patients with secondary tuberculosis in severe form, despite the efforts of doctors, die within 2-3 months. And only in one patient of the hundreds of secondary tuberculosis also subsides spontaneously as it appeared.

A person suffering from secondary pulmonary tuberculosis, a very contagious to others. When you cough into the air constantly released bacteria. Such a patient hospitalityat and conduct long-term treatment combined with antibiotics that can last up to six months. Then another two years a person hold on the account in a TB. And only then, if x-ray examination confirms the absence of new foci of the disease, the diagnosis of "tuberculosis" is finally removed.

Global epidemiological certificate

According to the world epidemiological information:

  • The annual number of deaths tuberculosis to date, second only to AIDS.
  • For the year 2013 on planet Earth is ill with tuberculosis, 9 million people, of which half a million died. 550 thousand patients – children, of which 80 thousand were killed.
  • Almost 95% of fatal cases of tuberculosis recorded in the backward and developing countries of Africa and Asia.
  • TB is among the three most common causes of death of women of reproductive age (16-45 years).
  • A quarter of all deaths of HIV-infected patients provoked by tuberculosis.
  • According to who, about 480 thousand people fell ill with TB in 2013, was affected with MDR-TB – multidrug-resistant form of the disease virtually untreatable.
  • For the period from the beginning of the nineties of the last century-present global mortality from tuberculosis has decreased by 45%.

  • Thanks to modern methods of diagnosis, 2000 to 2013 managed to keep approximately 37 million lives worldwide.

Tuberculosis mortality in Russia

According to 2013 year, one hundred thousand cases of tuberculosis in Russia 11,3 ended in death. This is great progress in comparison with indicators of 2000: since then the incidence decreased by 30%, and mortality by approximately 33%.

The latest data on the website of the health Ministry of the Russian Federation stated that by the beginning of 2015 managed to reduce the sad statistics of another 5.5%: now 10.3 per 100 000TB end with the death of the patient. Dynamics in different regions of the country vary, the biggest success was achieved by doctors of the Central Federal district where the death rate fell by 16.4%.

In the state budget for 2015 laid 4 billion rubles for the prevention and control of tuberculosis.

Who is the causative agent of tuberculosis?

Tuberculosis mycobacteria are particularly just science 74 known types of such bacteria. The term "tubercle Bacillus"is today considered obsolete because of the sticks as a result of mutations became a great many, and they all have individual characteristics. Live mycobacteria almost everywhere: in soil, in air, in water, in the bodies of people, animals and birds. In humans, tuberculosis occurs most often result of infection with MBT (Mycobacterium tuberculosis), rarely Mycobacterium bovis (bovine type of Mycobacterium) and Mycobacterium africanum (African species).

The Bacillus Mycobacterium tuberculosis called no accident: it is a thin, 1-10 µm in length and 0.2 to 0.6 µm wide, straight or slightly curved, ends rounded, the surface of the body can be slightly grainy. The ILO is unique in that under the influence of various environmental factors it can break up into incredibly small particles, or Vice versa, to cliplets in a bizarre giant octopus, and then again to return to normal form and infect humans.

Tubercle bacilli can live long outside the body of the carrier. On the dusty sidewalk, they remain viable for 10 days, between book pages – 3 months, 5 months. MBT don't like sunlight, but can withstand temperatures up to 80 degrees Celsius for five minutes. In a dark and damp room, they feel particularly at ease. Dried bacteria after a year and a half to give the disease to a Guinea pig. And frozen – even after 30 years!

The office does not have organelles movement – neither flagella nor cilia – so they remain where they are"planted" in the media. For growth and reproduction they need a temperature of 29 to 42 degree Celsius, the best option is 37-38 degrees, that is, in the patient with human tuberculosis just perfect conditions.


The first signs of tuberculosis

At the initial stage of tuberculosis are very difficult to distinguish from banal acute respiratory infections or chronic fatigue syndrome. Man constantly feels weak, lethargic and overwhelmed. Is not desirable, the mood is depressed, the slightest stress provokes a violent reaction. In the evenings you may experience light fever, nightsleep is restless, accompanied by sweating and nightmares. The temperature is stubbornly holding at 37,5-38 degrees, there is a dry paroxysmal cough, which is particularly tormented night and early morning. The first signs of pulmonary tuberculosis can manifest themselves all together, and can individually, in any combination.

Consider the progression of the symptoms in more detail:

  • Appearance change. TB gives the face a haggard and pale appearance: features sharpened, cheeks fail, they are lit by an unnatural glow, eyes become unhealthy Shine. People quickly lose weight, and if the first stage of the disease all these symptoms are not so obvious, that patients with chronic TB are so distinctive in appearance that the diagnosis is not in doubt.

  • Temperature. A sure sign of tuberculosis not decreasing in flow during low-grade fever (37-38 degrees), which is not explained by any objective reasons. In the evening the temperature may rise up to 38.5 degrees, accompanied by chills. The patient sweats all the time, but with the help of this natural reaction the body is still unable to reduce body temperature to the physiological norm, because the infection again and again causes fever. Febrile temperature (over 39 degrees) occurs at the late stages of tuberculosis, in the presence of massive foci of inflammation in the lungs.

  • Cough. A person suffering from tuberculosis of the lungs, coughing almost constantly, but in the beginning of the disease cough is dry, comes in bouts and looks like a nervous reaction. And then, when granulomas grow to cavities and accumulates in the lungs exudate begins abundant expectoration. The cough becomes moist, and after the expectoration of people at some time in relief. It is very important to know that if you or any of your loved ones for more than three weeks in a row bothers unexplained cough that is not associated with a cold, you must immediately contact the TB specialist!

  • The hemoptysis. This dangerous symptom is almost certainly talking about infiltrative form of tuberculosis, but the diagnosis must be differentiated from malignant tumors of the lung and acute heart failure, since these diseases also are characterized by hemoptysis. In tuberculosis the blood is from the respiratory tract in a small amount after a fit of wet coughing with copious sputum. Sometimes the blood flows literally like a fountain, it shows the gap of the cavity. Patientrequires immediate surgical care to save lives.

  • The pain in his chest. Pain under the ribs or blades rarely are the first signs of tuberculosis. Usually this symptom that bothers patients at acute and chronic stages of the disease. If the pain occurs early in the disease, it is poorly expressed, more like a discomfort, and most evident only with a deep breath.

Other symptoms of tuberculosis

Symptoms of extrapulmonary TB depend on the localization of infection. Although there are such rare, let's briefly consider their main features:

  • Tuberculosis of the urinary organs. A common symptom of tuberculosis of the urinary system – blood in the urine and its muddy color. Urination is typically frequent and painful. In women, tuberculosis can cause intermenstrual bleeding, deformation of the fallopian tubes and, as a result, infertility. If the disease struck a reproductive system, then the first sign will have constant aching pain in the lower abdomen and spotting. In men, the disease may be localized in the testes, within the scrotum develops painful swelling with exudate. Tuberculosis of the urinary organs is diagnosed by urinalysis and treated with the same antibiotics as pulmonary tuberculosis.

  • Tuberculosis of joints and bones. This form of the disease in modern medical practice is extremely rare and almost always occurs in HIV-positive patients. Tuberculosis affects the knee and hip joints and the spine. Inflammation destroys the cartilage and intervertebral discs, in the result, the patient begins to limp, and on the back you may receive the hump. Over time, without proper treatment, the disease leads to complete immobility. Tuberculosis of bone is characterized by striking symptoms and severe pain, diagnosis of difficulties does not cause.

  • Tuberculosis of the CNS. Tuberculosis of the brain develops either in patients with HIV infectionor in babies with congenital tuberculosis. In other situations, it is difficult to imagine that the disease was brought to such a dangerous and advanced forms. Mycobacteria provoke tuberculous meningitis, that is inflammation of the lining of the brain. Less common are granulomas occur directly in the medulla. Bright symptoms: headaches, recoordinate, tinnitus,visual disturbances, syncope, seizures, less common mental disorders and hallucinations. Without treatment the patient dies quickly, but even modern drug therapy does not guarantee salvation.

  • Miliary tuberculosis. If mycobacteria immediately after infection spread through the bloodstream throughout the body and have not met a decent resistance from the immune system, it may be miliary tuberculosis. It is characterized by numerous lesions – mikrogranulami not more than 2 mm in diameter. X-ray of such a person looks like covered with millet. The first symptoms are the same as in pulmonary TB, with the exception of cough, which can not be observed. As the growth of granulomas in various organs they start having problems in their work. The inflammation may involve the kidneys, liver, spleen. It requires long-term antibiotic therapy.

  • Tuberculosis of the digestive tract. Even one rare form of the disease, characterized mainly for HIV-infected patients. Observed bloating, aching, constipation and diarrhea, blood in the stool, sudden weight loss, persistent low-grade fever. In severe cases, the TB can cause intestinal obstruction and massive internal bleeding. In addition to medical therapy may require surgical intervention.

  • Tuberculosis of the skin. To diagnose this form of disease is simple: under the skin of the patient around the body appear thick painful nodules that burst with scratching, and from them is the white cheesy infiltration. Treatment of skin tuberculosis produced by antibiotics in the normal way.

Can you get TB?

Sorry, to be infected with TB, and make it easier than we think. According to statistics in the world every second someone gets in your body's unwelcome guest – MBT. Pick of Mycobacterium tuberculosis in any public place, and the more you go amongst the crowd, public transport and hospitals, the higher the risk. One patient with chronic active TB per year emits about seven and a half billion bacteria and infects approximately 15people. The world health organization claims that one-third of the world's population (2 billion people) is infected with tuberculosis. Then why do we still not extinct?

The fact that the immune system of a healthy person is an impassable barrier for millions of germs and bacteria, daily bombarding our body. TB wand too, will not settle down, and the carriage, most likely, never go into a disease. But if the body is weakened and vulnerable, tenacious Mycobacterium will not fail to seize the chance for a happy future. Colds, stress, malnutrition, beriberi and other favorable for office factors can trigger the beginning of the active stage of tuberculosis.

How is tuberculosis?

Tuberculosis is transmitted in four ways:

  • Airborne path. The frequency of this method is the confident leader, about 98% of cases of tuberculosis infection occurs through airborne droplets. For the single release with cough, the patient selects in surrounding air to three thousand mycobacteria, and they are scattered in a radius of five feet. Particles of dry sputum, but remain infectious. Therefore, the greatest risks people expose themselves, for a long time in the same room with patients with open tuberculosis.
  • The contact paths. Contact way implies contamination from personal belongings, clothes, utensils, toys, towels and other household items used by the patient. Tuberculosis is transmitted through kissing and sexual contact. You can become infected directly through blood, if there are wounds or scratches. Known cases when surgeons and pathologists have acquired the disease in their patients. Do not forget that TB is transmitted to people from animals: for example, you can become infected in the care of a sick cat or dog.
  • Food way. A food way of infection are common in rural areas where people do not pass the vet on the analysis of the milk and meat of livestock. Buy your products in the market with it. If a cow suffering from tuberculosis of the udder, the milk will surely get the response. About the meat of sick cows and pigs and say nothing. Contamination of the food by the current level of agriculture development is, fortunately, extremely rare. If this happened, it affects the digestive organs.
  • Intrauterine way. If the mother is ill with pulmonary tuberculosis, it does not automatically mean that it will infect the unborn baby. However, when extensive and chronic forms, especially in combination with HIV infection, the risk of fetalof infection is very high. To diagnose TB of the newborn helps the study of the placenta – the placenta. The prognosis for such infants is poor, as immunity in the body and treatment, the child will not survive.

10 myths about tuberculosis

Myth 1: Tuberculosis – a relic of the past

This disease could be called disappearing in the 60-80s of the last century. It was hoped to forget about the bubonic plague and the "Spanish flu", but in the 90s again tuberculosis epidemic: incidence and mortality increased 2.5 times and approached the post-war indicators.

Myth 2: Tuberculosis – the problem of backward States

In some sense it is: attack overcomes Bangladesh, Indonesia, Ethiopia, Zaire, Pakistan. But Russia in this list is on the 22nd place, despite the fact that States in the world more than two hundred. So, we are hopelessly backward country.

Myth 3: Tuberculosis – lung disease

Indeed, the vast majority of cases, TB affects the lungs, but, as we said above, this disease can choose for yourself and another place in the body. Then the pathogen will be allocated into the external environment do not sputum and other body fluids (urine, semen, sweat, tears, saliva, etc.) That should be considered when contact with people with suspicious symptoms.

Myth 4: TB – a disease of the underclass

This opinion is true based on the fact that before tuberculosis was sick, mostly, prisoners, the homeless and drug addicts. Now in establishments of execution of punishments there is a strict medical control. But in the sphere of illegal migration control was no more, and the problem has become rampant. It is therefore a happy man, weakened by the stresses of the big city, you may be infected with TB in the subway or any other public place.

Myth 5: the transmission is possible only at close contact

To inhale the tubercle Bacillus, it is not necessary to stand in front of the patient when he coughs. You can randomly walk into the room where the carrier, after a few hours, or even days, and catching the infection. Another thing is that the number of simultaneously trapped in the body of pathogens plays a role. With a massive and prolonged attack the immune system really can't cope with tubercular bacteria.

Myth 6: Infection = disease

A carrier of tuberculosisis every third inhabitant of the planet Earth. And only five out of a hundred carriers of the disease becomes active phase. To happened, required a significant weakening of the immune system, for example, the result of a cold or chronic stress.

Myth 7: Tuberculosis cannot be detected at an early stage

The disease can be diagnosed with great accuracy even at a very early stage. If the carriage is determined using simple tests, then what can we say about the disease? The only problem is that patients promptly seek medical attention but instead resorted to self-medication, putting themselves at the diagnosis of "acute respiratory infections".

Myth 8: Tuberculosis is incurable

Modern antibiotics and elaborate regimens allow no reason to expect a positive outcome. Complexity are only later identified, mutated and multiresistant forms of tuberculosis. The disease will not become a sentence if at the first suspicious symptoms be in the clinic and undergo a simple survey!

Myth 9: Tuberculosis can be cured instantly with the newest medications

The reverse side of delusion. Indeed, effective antibiotic with the least side effects in the Arsenal of modern doctors are available, but they do not guarantee to cure the mutated forms of the disease, and the therapy still takes several months.

Myth 10: Children's dangerous to vaccinate against tuberculosis

Very dangerous NOT to vaccinate children against tuberculosis and NOT to undergo an annual Mantoux test. These simple measures have saved thousands of children's lives. The talk of some "progressive" parents that the problem of tuberculosis is exaggerated, and the immunity of the child is not worth the extra time to injure vaccinations, criminal.


Methods of diagnostics of tuberculosis

For the detection of tuberculosis, doctors use the following methods:

  • Tuberculin;
  • X-ray examination;
  • Bacteriological analysis;
  • Enzyme-linked immunosorbent assay.

Mantoux Test

Mass tuberculin diagnostics in children and adolescents are produced annually, since one year of age. Using a special syringe or a pistol under the skin on the hand or forearm is injected 0.1 ml of tuberculin solution, the concentration of the pathogen which is determined based on the age and weight of the child. The Mantoux test is not a vaccine against tuberculosis, and the special test, allowing to judge about the tuberculosis status of the patient. The injection sitenot to wet and RUB. Three days later the doctor or the nurse evaluates the result. To do this, with a ruler measured the diameter of the papule – swelling and redness around the point of insertion of the needle.

The results of the Mantoux test:

  • 5-15 mm is an adequate immune response. Evidence that any child was subjected to contact with the agent and dealt with him, or have been vaccinated against tuberculosis, and in this way gained strong immunity;
  • 0-2 mm in the absence of an immune response. Indicates that either the child has never encountered a pathogen, or were vaccinated a long time, and protection from tuberculosis lost. These children need to revaktsinirujut;
  • 16 mm – inadequate immune response. Indicates that either a child recently infected with TB or was a carrier, and now risks to go into an active form of the disease due to depressed immunity. Such children require consultation with TB specialist.

Fluoroscopy and radiography

Mass chest x-ray examination of the respiratory system is the primary method of early TB diagnosis among the adult population of our country. Done chest x-ray every two years and represents a simplified version of the x-ray examination. Before a person becomes fluorescent (hence the name) screen, through the body are weak x-rays, and the equipment produces a picture. It is clearly visible foci of tuberculous lesions, if any. Data in coded form are stored in a special magazine, and then processed by computer to obtain the TB statistics.

Radiography is necessary for a more detailed study of tuberculosis lesions detected on fluoroscopy. This method of diagnosis is resorted to in order to allay suspicions, if the result of chest x-ray is questionable. X-rays harmful to humans, therefore, modern diagnostic facility designed to minimize exposure. Should not refuse an x-ray, if the doctor recommends to play it safe – better to be confident in the results of the survey, when it comes to such a serious disease as tuberculosis.

Bacteriological methods

Since 1995, bacteriological examination of sputum is required when referring a patient to the clinic with complaints of cough. Abroad this diagnostic practice has existed for over forty years. That is, if you are coughing, and came to the reception to the local therapist or any other General practitioner (Laura, for example), by law you have to take the sputum and stain the smear by Ziehl-Nielsen for the detection of tubercle bacilli.Keep this in mind to be able to protect their rights in case of delayed diagnosis of tuberculosis due to the negligence of medical professionals!

Another method of bacterial culture to Listino-Jensen, is not mandatory, but helps to determine the strain of tuberculosis mycobacteria, and is therefore often used in spite of the duration. After 1-2 months, the planting Matures, and the TB doctor can know for sure what type you are infected with mycobacteria. This will depend on the choice of antibiotics and treatment regimen.

Enzyme-linked immunosorbent assay

To diagnose tuberculosis is possible and blood. For this produce enzyme immunoassay, which does not give data on the disease status (carrier, acute, chronic form). It provides information only about whether there are generally in the body of the pathogen. ELISA detects human antibodies to tuberculous mycobacteria. Obviously, this method of diagnosis is relevant only for developed countries with very low incidence. But for all its primitiveness ELISA may be useful for the diagnosis of rare forms of extrapulmonary tuberculosis.


How to treat TB?

Treatment of tuberculosis is complex and lengthy, depending on the type and severity of the disease, it continues up to two years and includes the following activities:

  • Chemotherapy;
  • Supportive medical therapy;
  • Surgical intervention (if necessary);
  • Rehabilitation in sanatorium-and-Spa institutions.

Chemotherapy

In the modern practice of TB anti-tuberculosis therapy with several antibiotics.

The three schemes of treatment:

  • Three-component;
  • Four-part;
  • Pathcomponent.

Tuberculosis treatment consists of two main phases:

  • Intense;
  • Prolonged.

The aim of the first, intensive phase is to stop the inflammatory process, preventing further destruction of tissue, resorption of infiltration and exudate, the termination of the excretion of tubercle bacilli from the body to the environment. That is, the doctors are trying to make it so that the person has ceased to be contagious. It takes, on average, from two to six months.

Prolonged treatment of tuberculosis is aimed at complete healing of pockets of inflammation, scarring of damaged tissue and restorethe patient a strong immune system. Depending on the nature and severity of the disease, therapy may continue for up to two years, and in the case of a multiresistant TB, and up to three or four years until x-ray examination can not prove the complete attenuation of the disease.

The triple treatment of tuberculosis

This scheme is also called the anti-TB first-line treatment. It was proposed in the early twentieth century, and over the years the practice has saved many lives. Although now there are more sophisticated drugs, and Mycobacterium tuberculosis has become more stable, ternary diagram is still relevant, and is sometimes used.

It consists of the following antibiotics:

  • Isoniazid;
  • Streptomycin;
  • Paraaminosalicilovaya acid (PAS).

Four-part treatment regimen of tuberculosis

As the allocation of new, mutated and resistant strains of Mycobacterium tuberculosis varied approach to the treatment of the disease. To replace first-line therapy came the DOTS strategy, which was adopted in 120 countries. She is flexible and consists of four pairs of antibiotics, so the doctor has the ability to replace and combine the drugs, achieving the most efficient treatment for a particular patient:

  • Streptomycin or kanamycin;
  • Rifampicin or rifabutin;
  • Isoniazid or ftivazid;
  • Pyrazinamide or ethionamide.

Pathcomponent treatment of tuberculosis

For the treatment of the most complex, multi-resistant forms of TB to the scheme DOTS add one of the antibiotics the second, third or fourth generation. This files most often derived fluoroquinolones – ciprofloxacin. Therapy lasts at least twenty months and is much more expensive than the standard regimens. Pathcomponent scheme has another drawback – the abundance of side effects. The body has many months to grass five potent drugs.

But sometimes even such sacrifice is not possible to achieve a pronounced therapeutic effect. In extreme cases, fluoroquinolones replace one of the outdated and highly toxic antibiotics, cycloserine, capreomycin, or other drug "reserve" series. However, in October 2012 a new hope – antibiotic bedaquiline presented at the annual Convention of MSBT. In the US, the drug is allowed to use, and the world health organization issued a statement in which they stressed their interest in obtaining data about the practical application of this antibiotic for treatment of tuberculosis.

Complementary therapytuberculosis

Complementary therapy of tuberculosis includes:

  • Immunostimulants (Galavit, xymedon, Glutoxim) help the body to fight M. tuberculosis;

  • Hepatoprotection is beneficial to protect the liver from the destructive action of antibiotics, they are prescribed for permanent control of the level of bilirubin in the blood;

  • Sorbents (acetylcysteine and reosorbilakt) are assigned to the time of cancellation of chemotherapy in the case of extremely severe side effects. After a short rest period, the treatment still has to resume;
  • B vitamins, glutamic acid and ATP to prevent peripheral neuropathy and other adverse effects CNS;
  • Methyluracil, aloe Vera, glunat, Phoebe designate at the time of TB treatment to accelerate cell regeneration;
  • Glucocorticoids – a last resort, because they have a strong immunosuppressive effect. But sometimes they are still prescribed for a short period to numb too violent manifestations of the inflammatory process with extensive and severe tuberculosis.

On topic: the Most effective recipes from tuberculosis


Surgical treatment of tuberculosis

In advanced cases may require surgical treatment of tuberculosis. Now, what techniques are used currently:

  • Artificial pneumothorax or pneumoperitoneum – compression and fixation of the lung by introducing sterile air in the pleural cavity. This technique can be called by the General term "collapse therapy". When light is fixed, cavities it gradually coalesce, in addition, stops the allocation of the causative agent of tuberculosis, and the patient ceases to infect other people;

  • Speleologia or Kaberneeme – resection of the largest cavern, not amenable to conservative treatment;
  • Valve bronchomalacia – installation of miniature valves in the mouth of the bronchi to prevent them from sticking together and normalize the breathing of patients with tuberculosis;
  • Lung resection — removal of irreversibly diseased part of the lung;
  • Lobectomy – removal of one lobe of the right or left lung;
  • Bilobectomy —removal of one lobe of the right and left lung;
  • Pneumonectomy or pneumonectomy — removal of the right or left lung entirely.

akarova Evgeniya Vladimirovna, doctor-pulmonologist