Small and large residual changes after tuberculosis. Residual changes after pulmonary tuberculosis

Residual changes include dense calcified foci and foci of various sizes, fibrous and cirrhotic changes (including those with residual sanitized cavities), pleural stratification, postoperative changes in the lungs, pleura and other organs and tissues, as well as functional abnormalities after clinical cure. Single (up to 3) small (up to 1 cm), dense and calcified foci, limited fibrosis (within 2 segments) are regarded as small residual changes. All other residual changes are considered large.

Destructive tuberculosis

active form tuberculosis process with the presence of decay

tissue, determined by a complex of radiation methods of research.

The main method for detecting destructive changes in organs and tissues is an X-ray examination (X-ray - survey radiographs, tomograms). With tuberculosis of the genitourinary organs great importance has an ultrasound. With an active tuberculous process, X-ray examinations are carried out at least 1 time in 2 months (in I-A, 1-B and P-A subgroups) until clinical cure, in the P-B subgroup - according to indications. The closure (healing) of the decay cavity is considered to be its disappearance, confirmed by the methods of radiation diagnostics.

Aggravation (progression)

The appearance of new signs of an active tuberculous process after a period of improvement or an increase in the signs of the disease when observed in groups I and II until the diagnosis of clinical cure. In case of exacerbation (progression), patients are taken into account in the same dispensary registration groups in which observation was carried out (groups I and II). The occurrence of an exacerbation indicates ineffective treatment and requires its correction.

relapse

The appearance of signs of active tuberculosis in persons who had previously had tuberculosis and were cured of it, observed in III group or deregistered due to recovery.

The appearance of signs of active tuberculosis in spontaneously recovered persons who were not previously registered with anti-tuberculosis institutions is regarded as a new disease.

The main course of treatment of patients with tuberculosis

A complex of therapeutic measures, including an intensive phase and a continuation phase, to achieve a clinical cure for the active tuberculosis process.

The duration of the main course of treatment of a patient with tuberculosis is determined by the nature and pace of the involution of the process - the timing of the disappearance of signs of active tuberculosis or a statement of the ineffectiveness of treatment with the need to correct treatment tactics.

The main method of treatment is combined chemotherapy - the simultaneous administration of several anti-tuberculosis drugs to the patient. medicines according to standard schemes with individual correction. If indicated, apply surgical methods treatment.

Aggravating factors

Factors contributing to a decrease in immunity to tuberculosis infection, worsening of the course of tuberculosis and slowing down the cure:

medical (various non-tuberculous diseases and

pathological conditions);

social (income below the subsistence level,

professional (constant contact with sources

tuberculosis infection).

Aggravating factors are taken into account when observing patients in accounting groups, when determining the timing of treatment and carrying out preventive measures.

Formulation of the diagnosis

When registering a detected patient with active tuberculosis (group I), the diagnosis is formulated in the following sequence: clinical form of tuberculosis, localization, phase, bacterial excretion.

For example:

Infiltrative tuberculosis of the upper lobe of the right lung (S1, S2) in the phase of decay and seeding, MBT+.

Tuberculous spondylitis thoracic spine with destruction of the vertebral bodies Tb 8-9, MBT-.

Cavernous tuberculosis right kidney, MBT+.

When transferring a patient to group II (patients with chronic course tuberculosis) indicate the current clinical form of tuberculosis.

Example. At the time of registration, there was an infiltrative form of tuberculosis. With an unfavorable course of the disease, fibrous-cavernous pulmonary tuberculosis has formed (or a large tuberculoma persists with or without decay). The translation epicrisis should indicate the diagnosis of fibrous-cavernous pulmonary tuberculosis (or tuberculoma).

When a patient is transferred to the control group (III), the diagnosis is formulated according to the following principle: clinical cure of one or another form of tuberculosis (the most severe diagnosis is made for the period of the disease) with the presence of residual post-tuberculous changes (large, small) in the form (indicate the nature and prevalence of changes , nature of residual changes).

Examples:

Clinical cure of focal pulmonary tuberculosis with the presence of
small residual post-tuberculous changes in the form
single small, dense foci and limited fibrosis in
upper lobe of the left lung.

Clinical cure of disseminated pulmonary tuberculosis with

the presence of large residual post-tuberculous changes in the form of numerous dense small foci and widespread fibrosis in the upper lobes of the lungs.

Clinical cure of pulmonary tuberculoma with large
residual changes in the form of scars and pleural thickening
after minor resection (S1, S2) of the right lung.

In patients with extrapulmonary tuberculosis, diagnoses are formulated according to the same principle.

Clinical cure of tuberculous coxitis on the right with
partial dysfunction of the joint.

Clinical cure of tuberculous gonitis on the left with an outcome in
ankylosis.

Clinical cure of tuberculous gonitis on the right with
residual changes after surgery - ankylosis of the joint.

Clinical cure of cavernous tuberculosis of the right kidney.

In patients with high titers of antibodies to opportunistic flora, concomitant diseases of the gastrointestinal tract occurred (1 case of chronic cholecystitis and 1 case of gastric ulcer), while in the group of patients with low titers of antibodies to opportunistic flora, they did not met.

1. High titers of antibodies to opportunistic flora in patients with intestinal infections to Klebsiella, Escherichia, Pseudomonas aeruginosa are more common than in donors.

2. High titers of antibodies to opportunistic flora are more common in younger women and women with acute intestinal infections.

3. In patients with acute intestinal infections with high titers of antibodies to opportunistic flora, the disease often proceeded in the form of gastroenterocolitis.

4. Heat body is more common in patients with high titers of antibodies to opportunistic flora.

5. Patients with high titers of antibodies to opportunistic flora had concomitant pathology of the gastrointestinal tract (chronic cholecystitis, gastric ulcer).

LITERATURE

1. Akatov A.K. Zueva V.S. Staphylococci. - M.: Medicine, 1983. - 255 p.

2. Akhmatov N.A., Sidikova K.A. staph infection Keywords: microbiology, epidemiology, specific treatment and prevention. - Tashkent: Medicine, 1981. - 135 p.

3. Bidnenko S.I., Melnitskaya E.V., Rudenko A.V., Nazarchuk L.V. Serological diagnosis and immunological aspects of proteus infection // ZhMEI. - 1985. - No. 2. - S. 49-53.

4. Dyachenko A.G., Lipovskaya V.V., Dyachenko P.A. Features of the immune response in acute intestinal infections caused by pathogenic enterobacteria // ZhMEI. - 2001. - No. 5. - S. 108-113.

5. Kurbatova E.A., Egorova N.B., Dubova V.G. et al. Study of the reactogenicity and immunological efficacy of the Klebsiella vaccine on donors // ZhMEI. - 1990. - No. 5. - S. 53-56.

6. Degree MA, Voevodin DA, Skripnik AYu. et al. The level of serum antibodies to opportunistic microflora as a marker of the formation of secondary immunodeficiency // ZhMEI. - 2001. - No. 5. - S. 50-54.

7. Nazarchuk L.V., Maksimets A.P., Dzyuban N.F. Antipseudomonal activity of donor serum and the preparation "Immunoglobulin" // Medical business. - 1986. - No. 7. - S. 56-57.

Received 04/05/2006

UDC 616.24-002.5-036.65-02-07

CLINICAL CHARACTERISTICS AND OUTCOMES OF RECURRENT PULMONARY TUBERCULOSIS

A.A. Kholyavkin, D.Yu. Ruzanov, S.V. Butko

Gomel State medical University Gomel Regional Tuberculosis Clinical Hospital

The causes of tuberculosis relapses and the effectiveness of their treatment were analyzed in 249 patients with pulmonary tuberculosis. Relapses more often occur in people with concomitant diseases, chronic alcoholism, with residual changes after previously transferred pulmonary tuberculosis. Treatment of relapses is longer than the primary disease, does not prevent the formation of residual changes, the effectiveness of their treatment is much lower.

Key words: pulmonary tuberculosis, recurrence, causes of relapses, destruction, bacterial excretion.

THE CLINICAL CHARACTERISTIC AND OUTCOMES OF RELAPSES WITH PULMONARY TUBERCULOSIS

A.A. Kholyavkin, D.Y. Ruzanov, S.V. Butko

Gomel State Medical University Gomel Regional Tubercular Clinical Hospital

The causes of pulmonary tuberculosis recurrences and efficacy of their treatment have been analyzed for 249 patients with pulmonary tuberculosis. The recurrences arise most often secon-

dary to associated diseases, chronic alcoholism, in subjects who previously had had focal pulmonary tuberculosis. Treatment of the recurrences is longer than that of the primary foci, does not prevent residual changes, is not curative in all the cases.

Key words: pulmonary tuberculosis, relapse, reason of relapses, destruchen, allocation of bacteria.

Introduction

Improving the methods of diagnosis, treatment and prevention of tuberculosis in last years led to an improvement in its epidemiological indicators. At the same time, among the identified patients, the proportion of reactivation of pulmonary tuberculosis is quite high (4-20% or more), and there is a tendency for its relative increase. In addition, the prevalence of a process with a high frequency of decay in the lungs and bacterial excretion among patients of this category, the difficulties of diagnosis, treatment and prevention significantly affect the prevalence of tuberculosis, which maintains a high level of infection. Data on the results of dynamic monitoring of the long-term consequences of relapses of respiratory tuberculosis in modern publications are rare.

Materials and methods

To determine the causes of relapses of respiratory tuberculosis (TOD), the characteristics of their course, the effectiveness of treatment, the nature of residual changes and the state of working capacity in the long-term period, we analyzed the anamnesis data and clinical and X-ray laboratory data.

examination of 249 patients with relapses of pulmonary tuberculosis treated in the Gomel Regional Tuberculosis clinical hospital in 1991-2000 Among the observed, the proportion of men was 3 times higher than that of women (73.1 and 26.9%, respectively). At the age of 20 to 30 years there were 5.6% of patients, from 31 to 40 years - 14.5%, from 41 to 50 years - 24.9%, from 51 to 60 years - 23.7% and older 60 years - 31.3% of patients. Thus, the majority (79.9%) of patients with relapses were older than 40 years.

After clinical cure, early (up to 5 years) relapses were noted in 11.6% of patients, late ones - in 88.4%. The average time of onset of early recurrence was 4.1 years, late - 17.7 years.

Results and discussion

At the initial detection of the disease, 36.2% of patients had focal, 40.6% - infiltrative, 6.0% - disseminated tuberculosis, 6.4% - tuberculoma, 4.0% - exudative pleurisy, 2, 8% - tuberculosis of the intrathoracic lymph nodes, other forms were less common. Tuberculosis in the decay phase was detected in 28.1%, bacterial excretion - in 34.9% of patients.

Table 1

Form, phase of the process and bacterial excretion in primary disease and relapse

Clinical form tuberculosis In primary disease In relapse

Abs. % abs. %

Focal 90 36.2 26 10.4

Infiltrative 101 40.6 150 60.2

Disseminated 15 6.0 38 15.1

Caseous pneumonia - - 1 0.4

Tuberculoma 16 6.4 11 4.4

Fibrous-cavernous - - 7 2.8

Cirrhotic - - 3 1.2

Tuberculosis of intrathoracic lymph nodes 7 2.8 4 1.5

Tube. empyema - - 3 1.2

Tuberculous pleurisy 10 4.0 1 0.4

Tuberculous endobronchitis 3 1.2 5 2.0

Other forms 7 2.8 1 0.4

Total 249 100.0 249 100.0

Decay phase 140 56.2 70 28.1

Bacterial excretion 143 34.9 87 57.4

As can be seen from Table 1, TOD recurrence most often manifests itself in the form of infiltrative and disseminated forms. The focal form and tuberculoma are less common, acutely progressive and chronic forms appear. Tuberculosis in the decay phase was diagnosed in 56.2%, bacterio-excretion - in 57.4% of patients.

Thus, the course of the process in patients with relapses of TOD according to the forms of tuberculosis and the presence of destruction is less favorable than in the case of the initial detection of the disease.

The frequency of bacterial excretors with relapses of TOD increased significantly (57.4 ± 0.98%) compared with those who fell ill for the first time (34.9%, p< 0,05). Следовательно, лица, перенесшие туберкулез, являются резервом появления новых бактериовыделителей.

The study of the nature of residual changes in the lungs after the cure of the primary disease was carried out according to the generally accepted method. After the end of the main course of treatment, 18% of the examined patients had large residual changes in the lungs, 62% had minor changes, 2.9% had no residual changes in the lungs, and 9.3% of patients were discharged with a diagnosis of "condition after surgical treatment". In 81% of the observed patients, the changes were localized in the 1st, 2nd, 6th lung segments.

Most common causes(or their combination) occurrence of TOD recurrence were: concomitant diseases - 54.4%, poor material and living conditions - 41.8%, alcohol abuse and chronic alcoholism - 32.1%, shortcomings in the main course of chemotherapy and courses of antiretroviral -cidive treatment - 20.5%, stay in ICU - 18.1%, large residual changes after suffering pulmonary tuberculosis - 16.5%, contact with tuberculosis patients in humans or animals - 15.3%.

Upon admission to the hospital in 21.3% of patients with recurrent TOD, there were no symptoms of intoxication, in 62.2% they were moderately expressed, and only in 16.5% severe intoxication was observed. Hemoptysis was observed in 2.3%, pulmonary bleeding - in 0.9% of patients. Moderate inflammatory changes in the blood were observed in 32.1% of patients. At

fibrobronchoscopy performed in 129 patients, the majority (79.1%) revealed pathology: 66.7% had bilateral diffuse endobronchitis of I-II degree, 12.1% had post-tuberculous cicatricial changes.

All patients with TOD recurrence were hospitalized at the initial stage of treatment, however, 39.1% of them were in the hospital for no more than 3 months. The average duration of inpatient treatment was 84.1±3 days.

At the inpatient stage of treatment, the decay cavities were closed in 21.3%, abacillation was achieved in 39.6% of patients. The process progressed in 8.8% of patients. The absence of any dynamics was noted in 14.8% of patients.

The most common reasons for the low efficiency of treatment of patients were: the irreversibility of morphological changes due to untimely and late detection of reactivation of tuberculosis - in 62.3%, antisocial behavior and non-compliance with the treatment regimen - in 60.3%. The main reasons for premature discharge are: drunkenness and incorrect behavior - in 34.3% of cases, violation of the regimen and unauthorized departure from the hospital - in 26.9%, refusal of inpatient treatment - in 6.9%. There were 32.1% of persons who abuse alcohol, 18.1% were previously in places of detention.

An analysis of the nature of residual changes after the treatment of recurrence showed that, compared with the first identified process, large residual changes more often prevailed in relapse (16.5 and 46.7%, respectively).

In the long-term (after 2-10 years) follow-up period, after removal from the DU, 41.8% of 220 patients died, including 27.7% from the progression of the tuberculous process, 14.1% from non-tuberculous pathology ( cardiovascular diseases, stroke, chronic alcoholism, etc.). 8.4% of patients developed a chronic tuberculous process and they are observed in group II of dispensary registration (DU), 27.7% of patients were transferred to group III (A, B) of DU. 9.7% of patients were recognized as disabled due to tuberculosis, 12.4% became pensioners by age. The fate of 29 patients is unknown due to their change of residence.

Untimely and late detection of tuberculosis recurrence, asocial image

life and behavior, a more severe course of tuberculosis, the negative attitude of patients to treatment and cooperation with medical staff significantly reduces the effectiveness of therapeutic and recreational activities among these individuals and requires a change in the tactics of managing and monitoring such patients.

1. Recurrent tuberculosis of the respiratory system most often manifests itself in infiltrative and disseminated forms, characterized by the appearance of acutely progressive and chronic forms tuberculosis.

2. Concomitant diseases (54.4%), poor material and living conditions (41.8%), alcohol abuse and chronic alcoholism (32.1%) are factors contributing to the occurrence of a recurrent course of tuberculosis.

3. Treatment of patients with relapses of pulmonary tuberculosis is longer than patients with newly diagnosed disease. The cure of relapses occurs with the development of massive residual changes.

4. A differentiated system of anti-tuberculosis measures among groups at risk of re-infection with tuberculosis will make it possible to timely diagnose the activity of the process, improve the clinical structure of the disease and its prognosis.

LITERATURE

1. Ilyina T.Ya., Zhingarev A.A., Sidorenko O.A. et al. The prevalence of relapses of respiratory tuberculosis in a tense epidemiological situation // Problems of tuberculosis. - 2005. - No. 7. - S. 15-17.

2. Mishin V.Yu., Zhestkovskikh S.N. Relapses of respiratory tuberculosis // Problems of tuberculosis. - 2004. - No. 4. - S. 11-13.

3. Riekstinya V., Thorp L., Leimane V. Risk factors for early recurrence of tuberculosis in Latvia // Tuberculosis Problems. - 2005. - No. 1. - S. 43-47.

4. Standards (models of protocols) for the treatment of patients with tuberculosis. - M., 1998. - S. 10-21.

5. Brennan P. K. Tubeculosis in the context of emerging and reemerging diseases. FEMS Immunol // Med. microbiol. - 1997. - R. 263-269.

Received 05.05.2006

UDC 61 - 056. 52 - 036. 22

OBESITY EPIDEMIOLOGY

V.A. Drobyshevskaya

Gomel State Medical University

Obesity and overweight have been one of the important problems of medicine for many years. Recently, interest in it has increased significantly, due to the widespread prevalence of obesity among all age groups of the population, the low effectiveness of therapeutic measures aimed at weight loss, the discovery of new drugs for the treatment of this pathology, new advances in understanding the pathogenesis of obesity, the discovery of the hormone of adipose tissue - leptin, a group of beta-3-adrenergic receptors. Obesity is a serious problem due to the presence of such consequences as arterial hypertension, atherosclerosis, diabetes, metabolic syndrome, dyscirculatory encephalopathy. Therefore, knowledge of the epidemiology of obesity indicates the need for further work in this direction.

Key words: obesity, overweight, arterial hypertension, epidemiology, metabolic syndrome, body mass index.

EPIDEMIOLOGY OF OBESITY

V.A. Drobyshevskaya Gomel State Medical University

Obesity and excessive body have weight been leading among the medicine problems for many years. Last time the interest to this problem increased considerably being stipulated by obesity prevalence among all age population groups and low efficiency of remedial measures

Metatuberculous changes in the lungs in most cases occur after a lung disease. Most often these are the consequences of tuberculosis, although there are cases of similar consequences after other pulmonary diseases.

Changes in the lungs, as a rule, are detected by a radiologist during a routine medical examination. Metatuberculous (meta - after suffering) changes are spoken of as a radiological term, although in fact the changes can be life-threatening.

Note that the changes in question are not oncological. However, if suspicious changes are found, it is worth checking.

Tuberculosis is an infectious disease caused by an acid-fast bacterium called Koch's bacterium. Tuberculosis can affect all organs and tissues, but most often it is localized in the lungs. This disease does not go unnoticed. There are always changes that are called metatuberculous foci.

Metatuberculosis is called foci of proliferation of connective tissue or calcium deposits in the place where tuberculosis was presumably before. You can see them with a plain radiograph.

For reference. The very concept of "metatuberculosis" means that the picture seen is a residual sign of tuberculosis. In fact, connective tissue can appear as a result of any inflammation that ends in necrosis. The etiology of this inflammation is difficult to determine, therefore, not every proliferation of connective tissue can be called metatuberculosis.

AT classical understanding metatuberculosis is any change that remains after tuberculosis in its active or latent form. The remaining cases of proliferation of connective tissue in the lungs should be called pneumosclerosis or pneumofibrosis.

Metatuberculous changes in the lungs - what is it

The lungs are the “favorite organ” of Koch sticks. Mycobacterium tuberculosis are aerobes, therefore they are more often found in well-ventilated areas - the upper lobes of the lungs. Meatuberculosis foci are most often localized here.

Any residual phenomenon that occurs due to the activity of the Koch rod can be called metatuberculosis. For example, Gon's focus is a metatuberculous change that occurs after primary tuberculosis. It is localized, most often, in the upper lobes of the lungs. Any focus localized in this place should raise the suspicion of tuberculosis or its residual effects.

You can see these changes with x-rays. On the film, they look like areas of darkening (light) against the background of normal (black) lung tissue, which indicates the presence of connective tissue in the lungs.

It is possible to distinguish metatuberculous changes in the lungs from other types of pneumosclerosis using several signs:

• It is known for sure that there was tuberculosis in this place earlier;
• Localization in the upper lobes of the lungs;
• Retrospectively identified symptoms indicating past tuberculosis (cough, fever, hemoptysis);
• Other possible reasons connective tissue formation was not detected.

Types of metatuberculous changes

Like any pathological change in the lung tissue, metatuberculosis can be local and diffuse. In the first case, one or more foci are visible, small in size, clearly delimited from healthy lung tissue. Such changes occur due to focal or infiltrative tuberculosis.

diffuse changes characterized by extensive proliferation of connective tissue, due to which it is difficult to distinguish the shadow of a healthy lung. In this case, the lung decreases in size, and breathing becomes difficult.

Depending on what is in the pathological focus, there are two types of it:

• cirrhotic meatuberculosis,
• calcifications.

Cirrhotic metatuberculosis

Cirrhosis is an overgrowth of connective tissue as a result of an inflammatory process. With such metatuberculosis, connective tissue appears in areas where there used to be caseous necrosis.

Soon it fills all the areas where the lung was destroyed. It can be one or several foci, as well as an entire lobe or even the entire lung. The more pronounced cirrhosis, the more symptoms of metatuberculosis.

For reference. As a rule, foci of cirrhosis always remain after tuberculosis. varying degrees expressiveness.

Calcifications in the lungs

In this pathological condition, in the place where there used to be inflammation, calcium salts begin to be deposited. This trace element is constantly in the blood and cells of all organs, it is necessary for their normal functioning.

For reference. At the site of inflammation, the amount of calcium often increases, and after the inflammatory process subsides, salts of this element are formed. They are deposited in the form of crystals.

Often such foci are visible against the background of overgrown connective tissue, but sometimes they are found without it. On x-rays, calcifications appear as white areas, similar in density to bone.

In addition, any type of metatuberculosis can be stable or progressive. In the first case, the resulting foci are not prone to growth, they do not increase in number and size. In the second case, the pathological process tends to progress, affecting more and more areas of healthy tissue.

Symptoms of metatuberculosis

Manifestations of this pathological condition depends on how much lung tissue is affected. With the existence of one
a small focus of connective tissue or small calcifications, there may be no symptoms.

With extensive lesions, the patient develops respiratory failure and other complications that manifest themselves as follows:

• Shortness of breath that occurs on inhalation or exhalation;
• Dry cough;
• Pale skin, bluish nasolabial triangle and fingertips;
• Fingers in the form of drumsticks (with a thickening of the nail phalanges);
• Fast fatiguability, constant feeling fatigue;
• Asymmetry chest, reducing one of its halves.
• Pain in the chest (with damage to the pleura).

For reference. These symptoms develop gradually. Cough and shortness of breath can appear immediately, as soon as the connective tissue begins to compress the bronchial tree.

Asymmetry of the chest occurs in the case of the development of extensive atelectasis (collapse of the lung or part of it). Color change skin occurs when the gas exchange surface in the lungs is significantly reduced.

This also causes deformation of the fingers, but for the development of "drumsticks" several years must pass. The pain only says that pathological changes affected the pleura, there are no pain receptors in the lungs themselves.

Essence of change

During the height of tuberculosis, mycobacteria destroy lung tissue or other body structures. Such foci are called caseous necrosis. The dead lung tissue cannot regenerate, but the place where it was located does not remain empty. Connective tissue or calcifications form here, such a change is called metatuberculosis.

Important. The larger the initial focus was, the more connective tissue will remain, but it will not fully correspond to the shape and volume of the tuberculosis focus. Connective tissue tightens the lung, compresses the bronchi, blocks their lumen. In addition, it is not capable of gas exchange and it has much fewer vessels.

All this leads to respiratory failure and increased stress on the heart. Such pathological processes are observed only in patients with extensive forms of tuberculosis. If the foci are small, they are discovered by chance during the next medical examination.

Calcium salts are sometimes deposited between the connective tissue, which is clearly visible on the x-ray of the lungs. With disseminated and miliary forms of tuberculosis, calcifications can be located in the place of small foci and without connective tissue. By themselves, calcium salts do not cause any complications.

At-risk groups

Metatuberculosis can only develop in those who have had tuberculosis, because the risk groups for these diseases are the same. First of all, these are people with reduced immunity and people who often encounter aggressive strains of Koch's bacillus.

These factors weaken the body, contribute to the development of extensive changes in the lungs, which significantly affect the state of health even after the active process subsides.

Risk groups for the development of metatuberculous changes in the lungs include:

• Patients with acquired or congenital immunodeficiency;
• prison inmates;
• phthisiatricians;
• Employees of forensic laboratories;
• Often and long-term ill children and adults;
• Patients with diabetes;
• Persons who abuse alcohol;
• People with impairment eating behavior(anorexia, bulimia).

Attention. It is worth remembering that tuberculosis, as well as its consequences, can develop in any person, regardless of social status and occupation.

Treatment

Metatuberculous changes in the lungs, like any other residual effects, cannot be cured. There are no drugs that can turn the connective tissue or calcium salts into a normal lung.

Important. Only those foci that contain not only connective tissue, but also active Koch sticks are subject to treatment.

In this case, the patient can cough up mycobacteria, re-infecting himself and infecting others. In this case, surgical excision of all metatuberculous foci is indicated.

Complicated metatuberculosis is treated symptomatically. To do this, prescribe drugs that improve the blood supply to the lungs, facilitate the work of the heart, as well as expectorants, antitussives and painkillers. medicines.

For reference. The main therapy should be aimed at preventing the aggravation of the condition that has arisen, which is possible only with a change in lifestyle.

Prevention of complications in metatuberculous pathologies

Complications of metatuberculosis can be both from the lungs and from the heart. The first group includes respiratory failure, atelectasis (collapse of the lung or airlessness of the lung tissue - dangerous disease) and emphysema (hyperairiness). The second group includes heart failure, increased pressure in the pulmonary circulation and acquired heart defects.

In order to prevent the development of these conditions, it is necessary to adhere to recommendations for lifestyle changes. Most often, the patient is given the following advice:

• Quit smoking and alcohol;
• Daily walks in the fresh air;
• Compliance with the regime of work and rest, sleep and wakefulness;
• Daily performance of gymnastic exercises;
• Mastering the special breathing of yogis;
• Rational nutrition, increased intake of proteins and vitamins;
• Treatment of concomitant pathology;
• Passage of courses of sanatorium-resort treatment.

Forecast

Important. The prognosis of this pathology can be called doubtful. Metatuberculous changes in the patient's lungs will remain in any case, their reverse development is impossible.

However, it is possible to prevent the occurrence of complications or stop the process of their development. In this case, metatuberculosis can exist asymptomatically in the patient's lungs for a very long time.

With the most favorable option, small foci of metatuberculosis will not affect the patient's life in any way. In the most unfavorable - possible death due to respiratory or heart failure.

• Fibrous, fibro-focal, bullous changes
• Calcifications in the lungs and lymph nodes
• Pleuropneumosclerosis, cirrhosis
• bronchiectasis
• Condition after surgical intervention and etc.

1. Other Bodies:

• Cicatricial changes in various organs and their consequences
• Calcifications
• Condition after surgery

When characterizing the tuberculous process, one should be guided by this classification, indicating all its points. Example: Infiltrative tuberculosis of the upper lobe of the right lung in the infiltration phase, CD-, without complications.

Mycobacterium tuberculosis, morphology, types, chemical composition.

The causative agent of tuberculosis Mycobacterium tuberculosis (Mycobacterium tuberculosis, Koch's bacillus, Koch's bacillus) belongs to a large group of mycobacteria.

In the pathological material obtained from a patient with tuberculosis, mycobacterium tuberculosis has the form of slightly curved rods 1-10 µm long and 0.2-0.6 µm wide. Mycobacterium tuberculosis has a microcapsule, a cell wall, a cytoplasmic membrane, a cytoplasm with organelles, and a nucleus. The cell wall has a Gr(+) structure. They do not form a dispute, they are motionless.

The main biochemical components of mycobacteria are proteins, carbohydrates and lipids. Squirrels(tuberculoproteins) are the main carriers of antigenic properties and show specificity in DTH reactions. Carbohydrates represented mainly by peptidoglycan polysaccharides. cell wall lipids(cord factor) are responsible for the virulence of mycobacteria. Also associated with the lipid fraction acid resistance Mycobacterium tuberculosis (resistance to acids, alcohols, alkalis).

The acid resistance of Mycobacterium tuberculosis is determined by the fact that they do not stain by Gram, but for their detection, staining is used according to the method Ziel-Nielsen. In this case, mycobacteria are stained red, and everything else is blue.

Mycobacterium tuberculosis is characterized by pronounced polymorphism. There are different types of mycobacteria:

1. Common Mycobacterium tuberculosis (bacterial forms)

1. L-shapes- are mycobacteria that have lost their cell wall (usually due to long-term anti-tuberculosis chemotherapy). L-forms are characterized by a reduced level of metabolism, weakened virulence. They can long time persist in the body, inducing anti-tuberculosis immunity, and also turn back into bacterial forms.

1. Filterable Forms - ultra-small forms of mycobacteria that are not visible under a light microscope and also occur with long-term use of anti-tuberculosis drugs. The introduction of filterable and L-forms of mycobacteria to laboratory animals causes nonspecific and paraspecific inflammatory changes in their bodies.

By species (i.e. pathogenicity for various kinds animals and humans) allocate

1. Mycobacterium tuberculosis human type(m. tuberculosis) - in the vast majority of cases, they cause tuberculosis in humans
2. Mycobacteria bull type(m. bovinus) - can also cause human disease, but much less frequently (10-15% of pulmonary tuberculosis and 15-20% of extrapulmonary forms). In areas unfavorable for livestock tuberculosis, 20-30% of bacterial excretors are found to have MBT of the bovine type.
3. Atypical forms: bird type (m. avium), mouse type (m. muris), etc. In humans, they can cause lung diseases called mycobacteriosis, which are clinically and morphologically similar in many respects to tuberculosis.

3. Pathogenesis of pulmonary tuberculosis, the significance of exogenous and endogenous infection. epidemiological

Indicators.

Ways to infect a person with tuberculosis:

1. aerogenic - through the respiratory tract, occurs most often (90-95%)
2. Alimentary- through the gastrointestinal tract (less often)
3. Contact- through damaged skin and mucous membranes (rarely)
4. Transplacental - intrauterine infection of the fetus from a mother with tuberculosis through the vessels of the placenta

Tuberculosis can be:

1. Primary- Occurs when an organism first encounters a pathogen childhood. The vast majority of people in childhood are infected with Mycobacterium tuberculosis, but the disease occurs only in a few, which is determined mainly by the state of the immune system, the presence of specific post-vaccination immunity (BCG).
2. Secondary- develops in persons previously infected with MBT, against the background of relative acquired immunity. It occurs mainly in adults. There are two possible ways of developing secondary tuberculosis:

a) Endogenous activation tuberculosis as a result of reproduction of myco-
bacteria persisting in healed primary tuberculous foci
with a decrease in anti-tuberculosis immunity under the influence of unfavorable
pleasant factors.

b) Due to exogenous superinfection, usually with massive
MBT infection. This route is less common, but in recent
time, there is a tendency to increase its value due to the appearance
a large number patients with destructive forms of tuberculosis
massive bacterial shedding.

For infection and the development of tuberculosis disease, the dose of mycobacteria and the duration of contact with a patient with tuberculosis, the state immune system, as well as the effect of various adverse factors (risk factors).

To persons with increased risk of disease tuberculosis are:

1. Patients with various bronchopulmonary pathologies, atypical pneumonias, recurrent respiratory diseases, who have had exudative pleurisy.

1. Persons suffering from dust occupational diseases
2. Persons suffering from peptic ulcer of the stomach and duodenum.
3. Persons with endocrine diseases (diabetes mellitus)
4. Patients receiving hormone therapy (glucocorticoids) and other immunosuppressants

1. Persons with mental illness
2. Persons who abuse alcohol

1. Drug addicts
2. Women in the postpartum period
3. Persons held in places of deprivation of liberty
4. Persons in constant contact with TB patients
5. People with unsatisfactory social conditions of life, etc.

The epidemiological situation for tuberculosis is determined by the following most important statistical (epidemiological) indicators;

1. Infection- Percentage of the number of people who respond positively to tuberculin in relation to the number of those examined, with the exception of those with post-vaccination allergies.
2. Incidence- the number of newly diagnosed patients with active tuberculosis during the year per 100,000 population.
3. Soreness- the total number of patients with active tuberculosis registered in medical institutions at the end of the year per 100,000 people.

4. Mortality- the number of people who died from tuberculosis during the year per 100,000 population.

Meaning specific immunity(cellular and humoral) in tuberculosis

Among infectious diseases that lead to death, the most common is pulmonary tuberculosis and its extrapulmonary forms. The causative agent is Mycobacterium tuberculosis, which in the body healthy person penetrate mainly by airborne droplets.

Further, mycobacteria, if the human immune forces are weakened, begin to actively multiply and spread throughout the body, affecting internal organs. If the diagnosis of tuberculosis and the main course of treatment are not carried out in a timely manner, the complications and consequences of tuberculosis may be irreversible. Possible disability of the patient, and in severe cases, death occurs from pulmonary tuberculosis.

Post-tuberculosis changes significantly reduce the patient's quality of life. Therefore, everyone who has been touched by this terrible disease should understand what is dangerous and what causes pulmonary tuberculosis, how to survive it, know the features of tuberculosis treatment methods and signs of pathological abnormalities in case of complications.

The most common complications include chronic non-specific respiratory diseases. Often they talk about the so-called residual changes after tuberculosis. Various formations in the lung tissues, tubercles, seals that remained at the time of the patient's clinical recovery are implied. These are fibroses, scars, (calcifications) of various sizes and shapes, which can either dissolve completely over time, or lead to the development of new complications, for example, pneumothorax (more details below).

Secondary tuberculosis

Often doctors have to deal with the so-called secondary tuberculosis. That is, the focus of infection, which after the treatment was considered extinct, under the influence of certain factors becomes active again and the disease develops again. The cause of secondary tuberculosis in most cases is repeated contact with active mycobacteria, a sharp decrease in immunity due to another disease, stress, injury, and poor lifestyle.

Complications of primary tuberculosis

Atelectasis

Atelectasis occurs as a complication of tuberculous pathology if the treatment was carried out incorrectly or was not completed. Due to blockage of the bronchi, part of the lung collapses. The alveoli of the lung stick together, air does not enter the affected lung. Thus, the process of gas exchange is disturbed, symptoms of respiratory failure develop.

The severity of atelectasis directly depends on which parts of the bronchi are affected. If there is a blockage of the main bronchus, then gas exchange is disturbed throughout the whole part of the lung. If the patency of the small branches of the bronchi is disturbed, then only one segment of the lung collapses. Metatuberculous changes are detected in atelectasis with the following symptoms:

• chest pain;
• bouts of shortness of breath;
• increased heart rate with a decrease in blood pressure;
• cyanosis of the skin.

To stop further pathological changes in the tissues of the lungs, it is first necessary to restore the patency of the bronchi.

pneumosclerosis

Pneumosclerosis is one of the most severe residual changes in pulmonary tuberculosis. As a rule, it develops with advanced atelectasis: the ventilation of the segment of the affected lung is disturbed, as a result, the lung tissues are replaced by connective tissue. Pneumosclerosis is often found after surgery on the lungs, scarring of the affected tissues.

Pneumosclerosis manifests itself with the same symptoms as atelectasis. The most important thing with such a complication is to prevent secondary infection, the formation of a "cellular lung" or heart failure.

Fistulas

Fistulas as a complication of severe tuberculosis are bronchial and thoracic. The fistula is a pathological channel connecting several points of the respiratory system. How clearly the fistula will manifest itself clinically depends on its diameter and anatomical location.

The presence and severity of inflammatory processes in the pleura, as well as the "age" of the fistula. Often, such complications are formed after surgery on the bronchi or lungs. Bronchopleural fistulas may not manifest themselves at all, or make themselves felt only from time to time with bouts of dry cough with the release of a small amount of sputum.

Pneumothorax

This complication is considered more dangerous than the others, but it does not develop so often. It is usually caused by other diseases of the respiratory system, in which the pleura, the inner lining of the lungs, becomes inflamed. is formed when the integrity of the pleura is violated, resulting in a message with respiratory tract. Pneumothorax can be recognized by the following signs:

1. Sharp pain in the chest, preceded by sneezing, laughing, coughing, especially violent.
2. Dyspnea.
3. Attacks of weakness, cold sweat, rapid pulse, pallor of the face.
4. The fall blood pressure, labored, heavy breathing.

Treatment of pneumothorax is carried out in a hospital, a delay in diagnosis and proper therapy can lead to the death of the patient.