Article for Competition "Bio / Mall / Text" : In many countries, he was considered a long time to be defeated, which remained only on the pages of the history textbook. Nevertheless, he "rebelled out of the ash" and again began to threaten people: in 2016, according to WHO statistics, there were 10.4 million patients in the world, of which about 2 million died. It was also established that about a quarter of the world's population (and this is not a little bit of 1.7 billion people) suffers the hidden form of this disease, which does not show itself until time, but at any moment it can be activated . If you played in Plague Inc. , then you remember that the best way to roll back the progress in creating medication against infection is the production of the pathogen resistance , that is, stability, to it. Real bacteria also apply as well as virtual, and the pathogen, which will be discussed, is not an exception. The shape of this disease with wide drug stability does not respond to almost all existing antibiotics, and it is already in 117 countries . Therefore, it is necessary to create a fundamentally new remedy for this known disease, whose name is - tuberculosis .
This work was published in the nomination "Free Topic" of the Bio / Mall / Text Competition -2018.
The General Sponsor of the Competition is the company "DEEM": the largest supplier of equipment, reagents and consumables for biological research and production.
The prize sponsor of the audience sympathies was made by the Genotek Medical Genetic Center.
"Book" Sponsor of the Competition - "Alpina Non-Fikshn"
Air gives us life, he also brings and illness .Aristotle
In 2008, in the monthly publication, the WHO Bulletin and the organization's website was published interview with Bridget Givel, Professor from the Pasteur Institute in Paris. She told about laboratories around the world, employed by advanced developments in the field of phthisiology, and the unpleasant features of tuberculosis. So, S. Koha's stick (Mycobacterium tuberculosis or simply MTB. ) causing this disease is very difficult to work, as it refers to slowly growing Mycobacteriums . Because of this, there are considerable money and time for experiments, and the results of research appear as small portions that progress towards the ultimate goal is the perfect medicine from tuberculosis - is very slow. The professor leads the reader to the conclusion that there are many difficulties in the fight against tuberculosis, and only joint efforts of scientists from all countries he can be defeated . The cure of humanity from the "archaic" infection has been delayed so far, and phthisiatry today is one of the advanced (and at the same time one of the most studied) directions in biomedicine.
But science is developing. Since 2008, ten years has passed since 2008, and humanity has become progressive and in the technical plan, and in terms of ownership of the necessary information. Today we are entering such a period when the framework is impossible to erase, and the seraging of humanity from infections, which led to millions of deaths, simply inevitably. So what do scientists do for this? Will new technologies help in victory over Koch's wand? And most importantly - how soon can we declare that tuberculosis is really defeated? In this we will try to figure out ... But let's start with the beginning.
A few words about tuberculosis
Koch stick, causing tuberculosis, belongs to the genus Mycobacterium. . Today, there are more than 74 types of mycobacteria, widespread in soil, water, air, among people and animals. Console " Miko. "In the title of mycobacteria translates from Latin as" wax ". It was given to these bacteria for no accident: in their cell wall (Fig. 1) contains long wax molecules - Mikolic acids . Together with huge polysaccharides Arabinogalactans Also, there are only mycobacteria, they constitute a solid shell protecting the bacterium from acids, alkalis, alcohol and other substances.
If the infection becomes active, then in 90% of cases it affects the lungs, although it can also develop in any other part of the body. General features of tuberculosis include fever, chills, loss of appetite and fatigue. Pulmonary tuberculosis is also manifested by pain in the chest and a long cougium with a wet or even with blood .
Bacteria get into the body with air-droplet. First, they will be in the lungs, where they will slowly share, and, while they are slightly, they will remain almost invisible to immunity. MTB. Do not distinguish toxins, so when infected with bright symptoms do not immediately occur. During the incubation period, which lasts from 4 to 12 weeks, Koch's wand attracts the attention of exclusively cells of congenital immunity - Phagocyt . The first to the place are neutrophils, but their ability to destroy mycobacteria is limited, and then the case is taken Macrofagi - The most ancient immune cells.
Phagocytosis occurs like this: first the cells fix mycobacteria on the membrane, then this section of the membrane is immersed in the phagocyte cytoplasm and forms Fagosoma - Bubble with bacterium. The phagaosome is then merged with lysosomes filled with enzymes that digest bacteria. If the virulence of the causative agent is low, its existence in the body ends on this. However, mycobacteria with significant virulence synthesize a lot of so-called Lipoarabinomannan (also known as Cord factor ) - Substances that prevent lysosomes to merge with the phagosomes, and the bacteria will be reconciled inside the macrophage. As a result, the infected macrophage dies, and mycobacterias are on the will. When macrophages die, enzymes damaging the nearest cells flow from them. In this case, pathology begins: the lungs are observed the foci of the disintegrating fabric, pus, inflammation and cavity. But the third option is also possible. If immunity and virulence are balanced, then bacteria remain in macrophages, and the body isolates the source of infection, forming Granuloma - Surrounded by a dense capsule ordered clusters of macrophages, T-lymphocytes and connective tissue . But inside the scarked granuloma, mycobacteria still live throughout life. It is almost impossible to remove the wand once in the body, and this is a risk of activation of tuberculosis at any stage of life with a deterioration in its conditions, aging or HIV infection. The prevalence of this type of damage is indicated by the fact that helazing granulomas are found in 97% of all deceased adults (Fig. 2) . This, partly, explains the failure to eliminate tuberculosis in the near future.
The first steps
Tuberculosis is one of the most ancient diseases. He was found even from Egyptian mummy, found by archaeologists one hundred and fifty years ago !
In ancient Greece, already knew about the existence of this disease and called it in the word phtisis (depletion ), emphasizing the sharp weakening of the patient's body. From this word subsequently the name of science about Tuberculosis - Physiology . The ancient Greek thinkers of Herodot, Isocrat and Aristotle also wrote about this disease, and its descriptions of her symptoms were found in the Middle East, in India, Egypt, Mezhdury and many other countries.
Due to the similarity of the symptoms of consumers with signs of fever and Katarov (bronchitis) Diagnosis of the disease up to the beginning of the 20th century often lagged for several months. Over time, the first view of the hippocratic appearance began to call. Most patients moved to the category of consumers, when it was already impossible to cure them, or when doctors could not understand what they were sick.
By the beginning of the XIX century, approaches to treatment have changed little since the hypocratic times. For the treatment of tuberculosis, all sorts of funds were used, however, most of them were ineffective, since the disease is very intense - it is poorly amenable to modern treatment. Blooding was used as an anti-tech procedure, and the wet was diluted with special pills made of a mixture of cardamom, sea bow and ammonia (this resin and is now included in the expectorant means). When the disease is already launched, the doctors were solved for more serious measures. Since the lungs were blamed in the hemopdes, the doctors tried to break through it and clean, putting a mirrower plaster on the back or creating an artificial ulcer ball between the ribs. It was stipulated that the means causing the smallest pain is least useful.
Doctors believed that the birth from the body would not be expelled with alone medicines and procedures. They should be combined with walks, measured lifestyle and a diet, excluding alcohol and food with a pronounced taste and smell. Seen in the air with the "animal feces", which, allegedly, kick the birth from the body, as well as visiting sanatoriums.
Since the Chakhotka was considered unsuccessful or what kind of safety technique when leaving for patients speech was not going. The dirty underwear of the patients was given in the laundry room, the chambers swept away, the dust shimmer into the air, and in moments of relief, consuming were published.
The main reasons for the disease were considered all sorts of excess, "no-marine" - both physical (increasing, alcoholism, a sedentary lifestyle, excessive overvoltage) and emotional (strong passions, anxiety, etc.) It was even believed that the Chakhotka was mainly overwhelmed with refined Creative nature, inclined to high and strong feelings, melancholy, philosophy, the rejection of low-albele, capable of experiencing real and imaginary events, - and therefore, no matter how ridiculous today, "many did not want to get rid of her at all. CHAKHOTKA also called the disease of the aristocrats.
A woman with the initial stage of the pulmonary tuberculosis is almost the ideal of the beauty of the XIX century: thin, with pale leather, a blush, brilliant expressive eyes and, of course, deeply thought. To achieve the same effect, many healthy women dripped into the eyes of Belladonnu and rubbed the skin with different means, including with arsenic, and even drank vinegar. From Chatheka dreamed of die Byron, and Chopin and Chekhov died.
Later it turned out that most of the victims of Chakhoveka are not aristocrats, but factory workers and prisoners. Then every tenth died from her in Russia. In this era, the main reasons for CHAKHETOP considered the fumes and dust of all kinds .
Everything changed after March 24, 1882, when Robert Koh (Fig. 4) announced the discovery of tuberculous sticks, or bacillos ( Bacillus. - "wand" in Latin; Do not confuse with the name of the class and the kind of completely other bacteria! - Red .) , and this discovery was taken by doctors. For the first time, the hypothesis is about the fact that the magnitude of the smallest beings is caused, in 160 years old, Benjamin Martin put forward to Koch, but then scientists did not support this thought. The discovery of Koch stimulated the search for drugs acting specifically on Koch's wand. Now March 24, on the day of the opening of Koch sticks, the World Day of Combating Tuberculosis, established WHO, is celebrated annually.
Diagnosis of tuberculosis
Soon, scientists have taken the first steps for the invention to the means of diagnosing the disease. In 1890, Koh reported the opening Tuberculina which is a glycerin extract from tuberculosis bacilli M. tuberculosis и M. bovis (The first of them causes tuberculosis in people, and the second - in animals). And then the scientists suggested that with the help of this fluid to which immunity will react, you can check the person on whether it is sick.
In 1907, the Austrian pediatrician Clemens Pirka became interested in this idea and offered to apply tuberculin on the skin, specially scratched Scarifier (This is a plate with sharp cloth, which is very often used in the blood fence from the finger). A year later, the Frenchman Charles Mantu offered to enter Tuberculin not on the , but under Skin and after three days, measure the size of the "button". As it turned out, if we enter tuberculin subcutaneously, then the test is more sensitive . Subsequently, Charles Mantu has developed a Tuberculin-based test that can be checked for infections.
These hypotheses remained unnoticed. German doctor Felix Mendel In 1908, their accounting and developed a test with the use of Tuberculina, which he called in honor of Mantu. So was introduced into practice Tuberculin test . By the way, in the English-speaking countries, it is as a sign of gratitude Mendel today is called Mendel Manta .
At first, the test was completely unreliable due to unnecessary impurities in tuberculin - the productivity of bacteria and part of the nutrient medium that caused false results. Such a tuberculin received marking ATK. (Alt Tuberculin Koch. , from German - "Old Tuberculin Koch"). American biochemist Florence Zabert decided to stop it disgrace and was engaged in the development of the method of cleaning proteins from mycobacteria, as a result of which the protein was obtained PPD. (Purified Protein Derivative , from English - "Production of purified protein"), on the basis of which it was possible to create a more reliable test. The first publication of Visibert appeared in 1934, and in 1940, this protein became an international standard .
In 1897, the doctor from Boston Francis Williams discovered that infection in the lungs is noticeable in X-ray rays, and in 1904, Russian scientist Alexei Apricot described in detail the picture of the state of patients with lungs on the radiograph (Fig. 5). In particular, in the picture, depending on the running of tuberculosis, you can see the dimming, Kaverns (cavities that remained after the collapse of the lung fabric, where the most bacteria sits) and fibrous sections. So another classic method of diagnosing tuberculosis was laid - Radiography .
Soon there was a method very similar to the previous one - fluorography . Initially, the fluoroscope tried to use for a wide variety of purposes - ranging from the search for weapons in humans (this is the very apparatus that shines luggage at airports) and ending with a shoe business. In fact, it is the same X-ray, only the image is obtained not due to the chemical processes on the film occurring when the X-rays hit, but is projected onto a special fluorescent screen, where the energy of X-ray radiation is converted into visible light (the general principle of the action of radiation diagnostics methods is shown in the figure 6). From the screen, the image is transferred to a small film or chamber. For the diagnosis of tuberculosis, the first began to use the fluorography of Brazilian pulmonologist Manuel Diaz de Abreu in 1918 .
Today, x-ray and fluorography are the main weapons in the fight against tuberculosis, although they have a lot of opponents, because they, again, have their own minuses. First, for some patients, such as pregnant women, patients in serious condition and people with open bleeding, there are contraindications. Secondly, healthy people fluorography can be made only once a year (due to the fact that X-ray radiation can cause mutations). Therefore, the chance is that tuberculosis will be diagnosed too late. And therefore scientists still look for an alternative version of the diagnosis of tuberculosis at an early stage.
Another good diagnostic option - Bacteriological analysis of sputum - Found in the middle of the last century with the development of microscopy. The essence of this method is the consideration of a specially colored smear and search in it koche sticks. If they were not found there, then the analysis is carried out several times to check the result .
Most often smear stained by Cylla Nielsen . In this case, identify the so-called Kum. — Acid resistant mycobacteria (as it is clear from the title, they do not die in acids, unlike other bacteria), to which the koche stick belongs. Bacteria are stained with different dyes (first the carbolovy fuchin cying, then methylene blue), and they are treated with acid between staining. All surviving bacteria are painted red, and others in blue. Koch sticks in the preparation look like thin wands of raspberry color, having a length of 1-10 μm, and width to 0.6 μm (Fig. 8).
If the laboratory assists in the sputum of mycobacteria in sufficient quantity, then the next stage of diagnosis becomes sowing Sample in the nutrient medium - take a separate colony in the sample, push it with a special tool and move to a Petri dish with a nutrient medium. Being placed in optimal conditions, microorganisms grow faster, which makes it possible to clarify their appearance and evaluate sensitivity to different antibiotics.
As a standard for the selection of the causative agent of the disease, it is recommended Wednesday Levsenshtein-Yensen . This is a dense egg medium on which the growth of mycobacteria is obtained on the 20-25th day after sowing . Egg Wednesday also received widespread in our country Finn-II. . It is characterized by the fact that instead of the L-Asparagin amino acid, it uses sodium glutamate, which starts the other synthesis of mycobacteria amino acids. Growth appears on this medium earlier, and the frequency of isolating bacteria is 6-8% higher.
The bacterioscopic method is extremely sensitive. In a single examination, the sensitivity is about 85%, and if the samples are examined three times, the analysis will show a sensitivity of 98%. But do not forget about these 2% ...
If bacterioscopy did not show the presence of Koch sticks, doctors believe that "it can not be", then produced Flotation . In biomedicine, this term flocked from the mining industry, where it denotes one of the methods of enrichment of minerals, in which they are treated with liquids with different density, as a result of which the desired material turns out to be on the border of their partition. In biomedicine, the case is also the same, only instead of minerals - a sample of sputum, from where bacteria are distinguished. As a result, bacteria becomes more per unit volume, and they are becoming easier to visualize. This method also received the name " Pottengera method " [eighteen].
In the 1930s, for the identification of acid-resistant mycobacteria (KUM), the method was used for the first time Fluorescent microscopy - Another method of diagnosing over the smear. As is known, all molecules are able to absorb the quanta of light and move into electronically excited states. The return of the molecule to the "ordinary" condition accompanied by the radiation of the light is called Fluorescence . Various molecules, fluorescent in varying degrees - many of them emit so little light that it is not even visible. The method was very valuable for biology due to the use of bright fluorescent orange dyes, which are added before the stroke procedure and are attached to the wax structures in the cell wall, which are characteristic only for mycobacteria. Then, this smear is studied through a special microscope, the device is shown in Figure 9. It highlights the sample with an exciting light source, which is why the dye begins to glow, and the bacteria become visible (Fig. 10). A large contrast contributes to more comfortable recognition of bacteria compared to the coloring method over Cylu-Nielsen, therefore you can explore samples with a smaller increase and, thanks to this, much faster. This method really liked many equipped with laboratories, but it did not become popular for several reasons. First, it should be remembered about the saying, invented by scientists: "Not all that is kum, which glitters." And secondly, the disadvantage is the high costs associated with the service of a special microscope. Therefore, scientists decided not to move to a new diagnostic method .
In 2008, they introduced another trial that resembles Mantu and, according to the inspector, which can replace it - Diskintest . This is an allergen, a combination of two proteins that have koche sticks, and there is no bacteria used in vaccinations from tuberculosis - Mycobacterium bovis . Therefore, after the Diskintest vaccine suffered, unlike the Mantu sample, does not show false-positive results. This difference determines the high sensitivity of the drug in comparison with tuberculin .
Treatment of tuberculosis
People understood that disruptive patches and bloodsucms were not the most effective methods of treating tuberculosis. From the beginning of the 20th century, inhalation of various improvised drugs began to apply inhalations to increase the effectiveness of treatment (in fact, they were given to the patients in the hope that at least something from this would help, but in vain) and the introduction of them directly into the lung. But the best solution was then the operation. It is thanks to attempts to tamper tuberculosis scalpel Thoracic surgery (That is, the surgery of the organs of the chest) reached his heyday, and now we can be proud of all what we know and have in the art, including for the operational treatment of other diseases.
An important weapon in the fight against tuberculosis is vaccination. In 1908, the French Albert Calmett and Camille Herne worked on the production of tuberculous chopstick cultures and the study of different nutrient media. As it turned out, on a glycerin-based medium, bile and potatoes grow wands of the smallest virulence. And then colleagues decided to find out if it is impossible to grow a weakened strain for vaccination through repeating cultivation. Two years later, they created on the basis of their scientific research Bacillus Calmetta-Geren (BCG) applied in humans to this day .
The next major milestone in the history of the fight against tuberculosis was the summer of 1943. At that time, some strange disease was spread on the bird courtyards among chickens, the source of which was supposed to be in the soil. Students under the leadership of the Professor of Soil Microbiology Zelman Vaxman  withdrew patients with chickens with bird courtyards to identify the cause of the disease. Then one of the students, Albert Shatz, found in the throat of several birds of the soil lumps, brought molding fungi, and discovered in them streptomycin . He began to thoroughly study it and, tested the impact of streptomycin on various bacteria, Shatz learned that this substance kills koche sticks, against which recently open penicillin was powerless. During clinical tests, the condition of patients whose days were considered, improved, and they went on amendment. In 1952, Waxman received the Nobel Prize for the opening of his student in physiology or medicine, and Shatz became the owner of the "legal and scientific status of the streptomycin cooper". By the way, the term "antibiotic" first suggested Waxman himself .
For the first few years, Streptomicin possessed extremely high activity: it was possible to even pour water into a bottle, where before this was a drug, and it was all the same to drink an effect. But after only 10 years, the effectiveness decreased, and now the action is negligible at all.
A completely new approach to the control of tuberculosis was created due to the efforts of the Dutch Dr. Karel Stillo, who in 1974 proposed the principles of the DOTS strategy - the diagnosis of the bacterioscopic method, therapy with special drugs, regular deliveries of these drugs and reporting systems, which allows to evaluate the results of the treatment of each patient. In 1994, this strategy recommended that WHO for use in countries for which the problem of tuberculosis is relevant. DOTS is still a fundamental treatment scheme, although modern doctors kindly modified it.
But tuberculosis and did not think to give up. In the 80s, drug-sustainable tuberculosis strains appeared - formidable superbacteries that do not react to neither rifampicin or other antibiotics. In 2006, a bacterium appeared, which does not react to almost any medicines - the causative agent of tuberculosis with wide drug resistance (Slo-TB). This bacterium is raging now in Baltic States, Russia, Ukraine and China. Today in different regions of Russia to antibiotics are resistant from 10 to 40% of strains MTB. . The drug stability in the bacteria appeared, mainly due to the frivolous appeal of irrequisite citizens with antibiotics, which, engaged in uncontrolled self-treatment, take them too often, without much need and without appointing a doctor, without observing the correct treatment schemes, which entails adaptability of bacteria To drugs and, roughly speaking, now in relation to bacteria, you can apply a well-known expression "what does not kill us - do stronger."
In 1993, WHO proclaimed the situation with the tuberculosis "global emergency health situation", and in 2006 the organization developed a global plan to "stop tuberculosis", which aims to eradicate the disease until 2015. The objectives of the organization were not achieved due to the growth of HIV-associated tuberculosis and the appearance of drug-resistant forms . And then WHO set itself a new plan - to defeat tuberculosis by 2030. We hope this problem will finally be solved.
The most modern Tactic Tactics for the first time identified pulmonary tuberculosis is as follows. First, the patient is drinking at the same time six months so-called Preparations of the first line - Therapy for tuberculosis is always combined.
- Rifampicin. Its mechanism of action is associated with the suppression of the enzyme DNA-dependent RNA polymerase, as a result of which the cell ceases to synthesize RNA and dies. Rifampicin penetrates well in the tissue and fluids of the body and is found in therapeutic concentrations in the sputum and the contents of the cavron. However, rifampicin can not drink people with HIV-positive status.
- Isoniazid . The mechanism of action is associated with the oppression of the synthesis of micoloic acids in the cell wall of the bacteria. Also, the drug is used in veterinary medicine for the treatment of skin tuberculosis in dogs and cats, but they often have the most severe side effects. In man, when it can be hepatitis. Despite this, isoniazid, due to its phenomenal activity, remains one of the strongest optics in the fight against tuberculosis.
- Pyrazinamide . The substance that has a bactericidal effect on Koch wand. It retains activity only in an acidic environment - it is precisely that it is in the foci of early tuberculosis lesions. In the course of treatment, resistance may occur very quickly, the probability of which reduces the combination with other drugs.
- Etcutol. The drug that can help in the case of the sustainability of the bacterium to the previous four. It quickly penetrates into the bacterial cell, disrupts the structure of ribosomes, the synthesis of RNA and the protein, lipid exchange, binds magnesium and copper ions, and also destroys the enzymes involved in the synthesis of the cell wall of mycobacteria, as a result of which bacteria die, and the survivors can be easily destroyed by others means. However, mycobacteria and to this drug are stable, blocking the paths of the formation of etcutol into the cell.
Together, these four means are used during the first two months, and then pyrazinamide and etumbutol will stop drinking, and only rifampicin and isoniazide take the next four months. There are even special preparations with a content of four and two antibiotics.
But under certain circumstances, tuberculosis with multiple drug resistance can develop, which is not reacting to treatment with first line drugs. In this case, the patient is prescribed Preparations of the second line - Cycloserine, Ofloxancin, Amicacin, Canamycin and other drugs. These are antibiotics, distinguished by high cost and a large number of side effects that are prescribed only in case of extreme need.
But sometimes these drugs are powerless, and then there are tuberculosis with broad drug resistance. And since it does not operate drugs first and second lines, the choice of therapy in this case is strongly limited . What to do? This question is trying to answer scientists around the world.
Know-how vs char
In search of accurate diagnostics
Over the past 2-3 years in the field of finding new, acceptable ways to diagnose tuberculosis, a lot has been done. During this time, scientists have created new diagnostic methods that are far away from simplicity and reliability.
For example, in December 2017, an international group of scientists has developed a methodology for diagnosing urine analysis tuberculosis, reminiscent of the usual pregnancy test. In this study, the main tool is a test strip of a coating based on a complex compound of copper, changing color in the presence of glycolipid Lipoarabinomannan (LAM), which is only in the cell wall of the koche sticks and need it to ensure her survival inside macrophages. This test has a high sensitivity - it shows the presence of LAM even in the earliest stages of the disease. The technique has already been tested on 48 volunteers with previously diagnosed tuberculosis, and its sensitivity exceeded 95%. When this diagnostic method goes on sale, it will be possible to check for the presence of koch sticks without leaving the house .
It is known that Tuberculosis is accompanied by a characteristic smell, and Christian Mlderuti, along with colleagues from Tanzania, suggested that it can feel specially trained animals with a sharp scent, even if the smell is very weak. He and his colleagues knew that in order to sniff out mines by the smell of explosives, the hamster rats were used, and in the experiment they decided to train the rat along the same technique, but only with the smell of bacteria. After training, rats were given to smell samples of sputum, taken from 982 children under five years. 34 of them have previously found tuberculosis, and rats diagnosed were confirmed - but along the way they found it in 57 children who were considered healthy. In the future it turned out that these 57 children had tuberculosis, too, was not to see the bacterioscopic method of Bacillus. And when after rats, the samples of sputum checked a more complex microscope, bacteria there still found. Obviously, hamster rats could help doctors to detect tuberculosis in the early stages, especially when there is no possibility to use complex and expensive diagnostic methods .
The approaches can be attributed to direct methods for the detection of mycobacterium, the essence of which consists in identifying the specific fragments of the DNA pathogen in the sample. Among the molecular biological techniques used for this, the method of polymerase chain reaction (PCR), which is based on a multiple increase in the number of copies of a specific DNA section: 20 PCR cycles lead to an increase in the original DNA a million times, which allows to visualize the results by the method of electrophoresis in agarose gel . A very high level of sensitivity (95% or more), which is the main advantage of the method, is achieved due to the fact that as a result of repeated copying, the level of a specific oligonucleotide sequence in the reactionary sample increases 106 times. PCR diagnostics of tuberculosis is based on the use of DNA sequences specific to all substitution of tuberculosis mycobacteria. Often, the primers of IS elements are used for these purposes (these are the migrating elements of the genome, which are necessary to transfer information inside the cell), for example, IS-986 or IS-6110, since these items are characteristic only for the types of mycobacteria of the tuberculosis group .
Many dozen years in medicine to determine infections apply modifications Immuno enzyme analysis (IFA) . This method is based on binding antigens with antibodies - proteins that are formed in the body in response to the invasion. Standard immunoassay occupies 3-4 hours, and fluorescent labels are usually used to visualize the associated antibodies. The problem is that it does not have enough sensitivity to work with low content of antibodies in standard immunoassay.
In the laboratory of nanostructures and nanotechnologies of IEB RAS, under the leadership of Viktor Morozov, several years ago began to develop a completely new method of immunoassay, based on electrophoresis. They have improved express immunoassay, achieving great accuracy for samples with a small concentration of the infection marker, which will allow to identify tuberculosis when the disease has not yet been manifested. To visualize the binding of antibody molecules, they used magnetic labels. In the new work, they managed to significantly improve the accuracy of the method, setting the conditions under which the number of magnetic label-related magnetic labels linearly depends on the concentration of antibody analyzed. On the cellophane membrane, scientists applied spots of secreted tuberculosis antigens and antibodies to these antigens. The resulting microchip they were placed in a self-made device for electrophoresis (flow cell, Fig. 12) and passed blood plasma through it. In order not to wait until the antibody molecules come across the microchip molecules, scientists have applied the electric field in the cell so that negatively charged antibodies are shifted from the flow toward the membrane and concentrated on the microchip. Thus, the binding of antibodies with antigens occurred very quickly - this method allows for 5-10 minutes to determine several antibodies or antigens at once. Next, the suspension of magnetic particles carrying antibodies was passed through the cell, which also fell on the microchip in literally in seconds. Samples were analyzed under a microscope, calculating with a special software, the number of magnetic particles and comparing them with positive control. A quantitative assessment in immunoassay is necessary to relate results with indicators of an uninfected person and to identify pathology .
At the next stage, the group of Viktor Morozova tried to diagnose tuberculosis, analyzing intra-libid fluid. Previously, it was not easy, but the researchers constructed a simple and cheap device with a piping filter, on which the pulmonary liquid microclux is harvested. The device was tested at the Central Research Institute of Tuberculosis: 42 patients from those who have not yet been treated, 10 minutes breathed in the device. After that, scientists with the help of the same microchip were determined whether specific biomarkers were in the assembled material. It turned out that there are no living mycobacteria in exhaled air, but there are antibodies produced in the body in response to the actively multiplying koche wand. But at the definition of antibodies to mycobacteriums in exhaled air compared with the analysis of sputum there is one minus: the accuracy of the new method is only 70%. It is not yet possible to increase this indicator due to the fact that the part of healthy people have long in contact with the patients, the same antibodies are being developed in the lungs. In the future, scientists want to solve this problem, adding an analysis of the test for another sign of infection - inflammation in the lungs, which can be determined by the presence of special proteins in the exhaled air .
In pursuit of innovative treatment
Over the past ten years, great progress has been made not only in the field of diagnosis, but also in the field of drug development from tuberculosis.
To invent a new cure for infection, you first need to find a suitable target - for example, some necessary enzyme that is greatly different in bacteria and in person (it is necessary that the molecule blocking bacterial protein does not block its human analogue) and which can be chemically Block.
In the mid-2000s, such a target for blocking was proposed - Aminoacil TRNA synthetiasis (Arsaza ). Arsaza is an enzyme that accelerates the formation of a bunch of amino acids with TRNA before embedding the latter into the synthesized protein. Arsassies ensure the correctness of further reading of information from mRNA in the synthesis of proteins on ribosomes. For each amino acid, there is its own aminoacyl-tall synthetase. At the same time, some bacterial arsas are often quite different from the eukaryotic counterparts that we are only on hand.
For tuberculosis, seekers antibiotic-inhibitor inhibitors have not yet closeed because it has not yet been obtained by three-dimensional structures of these enzymes and is not clear how to identify potential medications. However, the primary structure in some tuberculosis Arsaz, in particular Leucile TRNA synthetase (LRSAZ ) Known, like what amino acids are in the active center.
Scientists from Ukraine and Canada decided to use this information in the original way. Three-dimensional structure and accurate structure of the active center are known in another bacterial lrshasis belonging to bacteria Thermus Thermophilus. . Directly in the active center, the similarities of their amino acid sequences are 95%, while with human lsase, the similarity is minimal. Using the LRSAZ structure T. Thermophilus. as a template, researchers built a model of Lrsaz M. tuberculosis .
Now heminformatics entered the battle. Scientists took the base from 100,000 different molecules and tested them virtually for interaction with the active center of the model by several algorithms, some of which they developed themselves. It made it possible to reduce the list of candidates up to 270, so that they are then tested experimentally. Tests have shown that six molecules belonging to two different classes have strong inhibiting properties, which for simplicity labeled as "molecule 1" and "molecule 2" (Fig. 13).
Subsequently, computer models of molecules 1 and 2 were created, built into the Active Center of Lrsaza Koch sticks, with which it is possible to understand exactly how molecules interact with a pathogenic enzyme. Using these knowledge, it is possible to optimize the structure of the molecule so that it is still tightly binding to the active center of tuberculous LRsase. Thus, six analogues of molecules 1 and two analogue of the molecule 2 were synthesized, which showed excellent results when testing their effectiveness.
In addition, all molecules have been tested for inhibiting human lsase, and in all cases their activity to pathogenic protein was at least 10 times higher, which makes them safe for humans. Therefore, the found molecules are good candidates for the role of antituberculosis antibiotics .
Innovative funds against mycobacterium also includes the drug under the technical title. SQ109. . It has a unique multicomponent mechanism of action, which consists in the oppression of the transport enzyme MMPL3. participating in the synthesis of the Cord factor is the main weapon of koche sticks. In addition, SQ109 affects enzymes affecting electron transport, making it difficult to mycobacterium breathing, and also disrupts the pH gradient and the membrane potential necessary to maintain intracellular transport. The result of such a multilateral impact is the powerful oppression of the growth of mycobacteria and low drug sustainability. The drug is equally well effective as in relation to drug-sensitive bacteria, so drug-resistant strains, as well as with respect to the latent form of tuberculosis. In addition, this drug is good because it is safe and is well tolerated by patients, which is important in the case of long therapy .
Scientists from the Caroline Institute in Stockholm found out that the combination of absolutely affordable and well-studied drugs also helps the body to fight tuberculosis. These medicines stimulate the body to deal with bacteria, which reduces the risk of resistance. The complex includes phenylbutirat Used to treat disruption of metabolism and helping the body to produce "natural antibiotics" - peptides. Scientists have found out that in combination with vitamin D, the drug allows you to deal with infection. In addition to the theory, these researchers lead examples from practice: an experimental combination gave effect in the treatment of patients in a small Asian country with a population of more Russian - Bangladesh .
One of the most important discoveries in the field of treatment of tuberculosis in the XXI century is the invention Bedacilina which synthesized American scientists in 2012. Its principle of operation is based on a completely new principle, rather than in rifampicin, isoniazide, etcutol and pyrazinamide. This action (called ionophory ) Includes blocking the movement of ions through a mycobacterial membrane, which leads to exceeding the critical gradient marks of the ions necessary for the growth and survival of the bacterium. Bioelectricity that these ions create is the key to the development of energy and a whole series of other incredibly important cellular processes in the bacteria. The violation of these ion gradients is fatal for koche sticks, but before Bedaskilin appeared, there were no medicines that can do it and be safe for humans. The most promising aspect of the drug is its ability to reduce treatment for up to eight weeks, which greatly simplifies treatment. In addition, Bedacavilin is used already in some newest treatment tactics as a preparation of the first line .
A team of several scientific centers in the United States suggested simply to raise microorganisms to each other (video 1). The plan of these researchers is beautiful and simple: competing pathogens will not unite against the medication. Instead, they will begin to kill each other, and the doctors will then remain only to spend the sweep of the survivors on the "battlefield". Thus, the existing drugs, to which pathogens have already developed resistance, can again become effective. Or bacteria will be too busy with enemies to develop drug resistance.
How to push the microorganisms among themselves? To find a way, researchers spent several tests on mice. Rodents, however, were infected with malaria, rather than bacterial infection, but for bacteria there are the same laws of nature as for the other organisms. But scientists were used at once two lines of malaria plasma - amenable to the treatment of strain and resistant to existing drugs. First, animals infected with malaria sensitive to drugs, together with water, was given a nutrient substance for a parasite. Moreover, "feeding" was kept in different quantities: someone got more "fertilizers", some less. Then the mouse passed the course of therapy with the help of the same drugs. When the rodents were obtained nutrient, treatment failed in 40% of cases. Tests confirmed that this was due to the appearance of strains resistant to therapy. But when scientists have limited the volume of the nutrient solution, all the mice recovered, that is, scientists prevented the appearance of resistance.
Then the team was convinced that the positive results were caused by the competition among parasites, and not any other effect of food restriction. Scientists have infected part of mice only resistant to treatment with parasites, and another group is stable and sensitive. It turned out that when mice were infected only with sustainable strains, and the nutrient was limited, resistant parasites survived. But if animals were infected as sensitive treatment and stable strains, the number of resistant parasites did not grow. Even if they were much larger in the body of animals than usually at the initial stages when infection occurs. Apparently, there was a competition for the food between the lines of parasites, which arrived in limited quantities. In other words, natural competition is a weak place of causative agents of infections.
For pathogens of various diseases (for example, tuberculosis), it is necessary to define its "tidy slice" - then the nutrient substance for which they will begin to fight. In addition, researchers need to be able to choose the best moment in order to start this struggle .
In the following study used ethionamide - One of the second-line drugs, which is prescribed in case of failure in the treatment of classic four antibiotics. As is known, it is not active before it comes into the reaction with the bacterium and turns into an active form. This activation occurs with a special gene. ETHA which encodes an enzyme that turns ethionamide to toxin, and usually the medicine is accompanied by more special substances that stimulate the work of this gene. Scientists have previously described compounds that can stimulate activity ETHA But they do not affect strains with mutation in this gene, making them resistant to ethionamide. This time, the researchers discovered a new gene, which also turns ethionamide into an active form even when ETHA - Mutant. This gene called ETHA2. , U. MTB. Usually inactive. But scientists have found a substance, SMART-420. which surprisingly increased activity ETHA2. By making an ethionamide a real killer bacteria, and even those who have resistance to ethionamide due to mutation ETHA . Since the SMART-420 increases the efficiency of ethionamide, then it is possible to reduce its number, which means the side effects can be minimized.
Of course, there is a chance that the bacteria will have stability and to SMART-420. That this does not happen, this substance should be used with interruptions: if there will be cells with new stability in the population and there will be too few cells, so then, when the SMART-420 temporarily disappears, they will be supplied with ordinary microbes. However, how to use Smart-420, it will become clear after clinical trials that should begin very soon .
At the Retrovirus Conference and Opportunist Infections in Seattle, the authors of another interesting study from the TB Alliance association told about successful tests of two therapies of drugs at once. New methods that will make treatment easier and more efficiently, got the names BPAMZ. и BPAL - According to the abbreviated names of already famous antibiotics that have not previously tried to combine.
The first method includes the reception of four drugs (already familiar to us Bedaquilin, as well as a pretomanide, moxifloxacin and pyrazinamide) once a day. BPAMZ passed tests with the participation of 240 people in ten countries in Africa. For four months, this therapy helped to treat almost all cases of the usual disease, and for the fight against a sustainable view of the disease left for six months. Most often, the bulk of bacteria came out with a sputum during the first two months.
The second method is BPAL - combines three antibiotics (Bedalivilin, Pretomanide and Linzolid), which are accepted once a day. Of the 69 patients who were treated with this technique, in 40 cases of testing were successful: after six months of therapy, the disease retreated, and it was about the most difficult form with wide drug stability.
According to the authors of new methods, the first type of therapy has the potential of treatment to 99% of patients with different forms of tuberculosis. The remaining 1% "takes over" the second type of treatment. However, it is still necessary to carry out more large-scale tests and conduct official approval of new methods, since the Pretomanide drug is still experimental. All this can take at least three years, but the result is worth it.
Indian researchers recently found that PRANLUKAST. - The drug that is used to treat asthma can also fight with tuberculosis. It turned out that when this drug is used by itself or, even better, along with rifampicin, it treats from tuberculosis much better than combined preparations of the first line. The drug is struggling with tuberculosis bacteria so as not to harm good bacteria, and therefore does not cause side effects - he suppresses the synthesis of the enzyme Ornithinecetyltransferase (Argj. ), which is only in koche sticks and some other pathogens and not detected in humans. This enzyme is a key predecessor of arginine, which is necessary for the survival and pathogenesis of bacteria .
Also, people need new, more efficient vaccines for the prevention of tuberculosis, which are able to replace the "old woman" of BCG, which is not a universal means - because the strains of tuberculosis sticks are incredibly diverse. The only alternative vaccine that scientists can now offer now H4: IC31 . It contains recombinant protein TB10. . Scientists appreciated the safety and immunogenicity of H4: IC31 in adults in practical experience: they used a vaccine in South Africa in the conditions of the epidemic of tuberculosis, watching the grafted. As it turned out, only the overall fatigue was the most unfavorable side effect, but the vaccine had a good to print a recombinant protein in cellular memory, as a result of which, until the very end of observations, immunity coped with tuberculosis .
Very interesting to the case scholars from the medical school of Stanford University. They created a new version of the browser computer game Eterna Medicine, which will use the creative abilities of thousands of players to create a salivary to diagnose tuberculosis.
Eterna. - This is a "game with a target", which attracts users to solve puzzles associated with the folding of various RNA molecules necessary in certain studies. This project is supported by the Bill and Melinda Gates Foundation, Stanford University and National Health Institutions.
The meaning of the game is to fold the RNA thread, which will meet the condition assigned task. The player can change the sequence by placing any of the four RNA nucleotides in different positions. RNA, depending on the sequence of nucleotides, can be spontaneously bend into the myriad of all sorts of forms. And on how RNA will have, it may depend so much, including how it can bind to other RNA molecules. On this, a new test developed by scientists from Stanford is founded.
Experts intend to develop a RNA molecule, which will be the main character in a new test analyzing a blood sample. This desired molecule has already been called OpenTB. . The test "calculates" the ratio in the sample of three RNA molecules belonging to the chopstick of the koche and the patient. Two of them in large quantities can be found in the sample when a man is sick. The third type of RNA serves the threshold - if the molecules of the first two species are greater than the third, then this is a sign of infection. OpenBB will be able to contact these three molecules, and on the basis of how it happened, it is possible to conclude whether a person is sick (video 2).
Although OpenTB is a single RNA molecule, it will have three parts, each of which binds to one of the three tuberculosis-related RNA molecules. OpenTB should also take various forms depending on the proportions of three types of RNA. If a patient has many RNA molecules of the first two types (inherent in sick people), the OpenTB will form in shape 1. But if the representatives of these two types of molecules are less than the third, then the OpenB will be in form 2. Form 1 must also be able to contact Fluorescent tag, while form 2, on the contrary, should not. Therefore, molecules with form 1 will emit light, and with form 2 - no. Measuring the brightness of the glow, it can be concluded, whether a person is sick or not: if it is above some threshold, then the patient has an active tuberculosis.
Once a year and a half after the launch of the project, biologists received tens of thousands of designs, of which they chose several truly promising projects. Checking them, they synthesized RNA in the laboratory for further inspections and research. As of 2018, testing continues using real blood samples taken in patients.
If this study proves successful, it will help save millions of lives. After all, at the moment there is still no simple blood test, which can detect an active infection, and which can be passed more than once a year in order to diagnose tuberculosis at an early stage with a greater fraction of the likelihood.
The first version of the Eterna game was launched 7 years ago in order to allow ordinary people who are not related to the world of science, creating potentially useful biomolecules. Such molecules should be stable enough to function inside the cells. Over the past years, yesterday's simple gamers have ever learned this area, becoming parallel to experts in the construction of complex molecules. Moreover, some of them became even co-authors of scientific work in the field of molecular biology.
Unfortunately, despite the all the above-described work of scientists, and the active search for solving the problem of combating tuberculosis, today this disease is still not defeated. But, from all the above, we can come to the conclusion: despite the fact that Koch's wand so far successfully resists, scientists have come up with and continue to invent new funds that should become a wall guarding our health, replace the familiar to us. Do new technologies help in the fight against tuberculosis? Of course, yes. Everything suggests that scientists slowly, but rightly approaching the WHO program to eradicate tuberculosis. And when these and other tools go beyond the limits of laboratories, it will be possible to say with complete confidence: "Tuberculosis is defeated!". This is only a matter of time ...
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- Koh and all his sticks;
- T-lymphocytes: travelers and households;
- Chief "Forewoman" of Medicine: Zelman Vaxman;
- 12 methods in pictures: polymerase chain reaction;
- 12 methods in pictures: immunological technologies.
Tuberculosis is a bacterial infection that spreads through the contaminated sputum particles secreted by a sick person with coughing or sneezing. This is a heavy, but curable disease.
Tuberculosis is a common and dangerous disease. Although, thanks to the successes of modern medicine, morbidity and mortality from it significantly decreased. According to approximate estimates, about a third of the world's population is infected with tuberculosis (latent form). Of these, about 10% of the disease sooner or later goes into an active stage.
In the Russian Federation for 2012, 96,740 cases of tuberculosis were registered, the incidence of average in the country was somewhat decreased, compared with 2010-2011. The highest incidence of tuberculosis is registered on the territory of the Far Eastern, Siberian and Ural Federal Districts.
Tuberculosis is basically affecting the lungs, but it can develop in any other organ, including in the bones and nervous system. Consult a doctor if you have a cough that does not pass more than three weeks, or if blood appeared in the wet.
The development of tuberculosis is associated with a bacterium, which is called tuberculosis microbacterium. The pulmonary form of tuberculosis is the only infectious form of this disease, which is distributed, as a rule, only with prolonged contact with an infected person. For example, tuberculosis is often distributed among family members living together.
The immune system (the natural protection of the body from infections and diseases) of most healthy people kills bacteria, and symptoms do not appear. Sometimes the immune system cannot kill bacteria, but can restrain them in the body. In this case, symptoms are not observed, but bacteria are stored in the body. This is called the latent (hidden) form of tuberculosis.
There is also another independent form of tuberculosis - tuberculosis.
If the immune system can not even isolate infection, bacteria begin to spread into light or other body organs. Then, for several weeks or months, symptoms of illness can manifest. This form of tuberculosis is called active. When weakening the immune system, tuberculosis can move from the latent form to active.
As a rule, with timely treatment for medical help tuberculosis is curable completely. Most often a course of antibiotics is appointed, usually semi-annual. Several different antibiotics are used, since some forms of tuberculosis are resistant to certain antibiotics. If you have tuberculosis, resistant to medicines, treatment can take up to one and a half years.
If you were closely with a patient with tuberculosis, it is necessary to be examined to eliminate the presence of infection and you. For this, the chest radiography is usually prescribed, blood tests and skin diagnostic test Mantu.
BCG vaccination (Bacillus vaccination
Symptoms of tuberculosis
Symptoms of tuberculosis depend on the body struck infection. As a rule, the disease develops slowly. Symptoms can manifest itself in a few months and even years after infection. In some cases, the bacteria infect the body, but do not cause any symptoms. This is called the latent (hidden) form of tuberculosis. If bacterium caused the appearance of symptoms, it is called the active form of tuberculosis.
Symptoms of pulmonary shape tuberculosis
Tuberculosis infection in lungs is called a light tuberculosis. This is the most common form of tuberculosis. Symptoms of tuberculosis lungs:
- cough, which does not pass more than three weeks, while there is sporming of sputum, sometimes with blood;
- shortness of breath, at first moderate, but gradually amplifying;
- lack of appetite and weight loss;
- High temperature 38º C or higher;
- night sweating;
- Strong fatigue and fatigue;
- The pain of incomprehensible origin, which lasts more than three weeks.
Contact the therapist if you have a cough that does not pass more than three weeks, or in sputum you noticed blood.
Signs of extralegal tuberculosis
In some cases, tuberculosis can develop outside the lungs, it is called extrapulmonary tuberculosis. Extrallular tuberculosis is more common in people with a weakened immune system, especially in people with HIV. You are also more exposed to extrapulic tuberculosis, if you have previously been infected with tuberculosis, but you have no symptoms (latent tuberculosis form).
Tuberculosis can hit the following parts of your body:
- lymph nodes (tuberculosis of lymph nodes);
- bones and joints (bone tuberculosis);
- digestive system (gastrointestinal tuberculosis);
- bladder and genital organs (urinary tuberculosis);
- Nervous system (tuberculosis of the central nervous system).
These types of tuberculosis can cause additional symptoms described below.
Tuberculosis Lymph nodes
Lymph nodes are small formations that are part of the immune system. They eliminate unwanted bacteria and particles from the body. Symptoms of lymph nodes tuberculosis:
- Disabling painless swelling of lymph nodes, as a rule, in the neck, it is possible to swell any lymph nodes in the whole body;
some kindTime swollen lymph nodes can start highlighting fluid through the skin.
Symptoms of bone tuberculosis:
- bone pain;
- curvature of affected bone or joint;
- loss of sensitivity of the affected bone or joint or the impossibility of moving them;
- Weakening bone, it is easy to break.
Symptoms of gastrointestinal tuberculosis:
- abdominal pain;
- Rectal bleeding.
Symptoms of urinary tuberculosis:
- burning in urination;
- blood in the urine;
- a frequent need for urination at night;
- Pain in groin.
Tuberculosis of the central nervous system
The central nervous system consists of a head and spinal cord. Symptoms of the tuberculosis of the central nervous system:
- stiffness muscles neck;
- change behavior, for example, disorientation in space and time;
- Sigging (convulsions).
Causes of tuberculosis
Tuberculosis is caused by a bacterium, which is called tuberculosis microbacterium. The transfer of tuberculosis occurs when a person with an open form of tuberculosis of light coughs or sneezes, and another person inhales droplets scattered in the air with tuberculosis bacteria.
However, although tuberculosis is distributed in the same way as a cold or flu, it is not so inflated. As a rule, you will need to spend a long time in close contact with an infected person to get infected. For example, tuberculosis is often distributed among family members living together. But the likelihood that you get infected, sitting next to the sick tuberculosis on the bus or train, very small. Not all patients with tuberculosis are contagious. As a rule, children or people with extrapulmonary tuberculosis are not distributors of infection.
As a rule, the immune system is able to defeat bacteria that cause tuberculosis. However, in some cases, bacteria infect the body, but they do not cause any symptoms (latent form). If infection is accompanied by symptoms, they talk about active tuberculosis. Sometimes the disease passes to the active phase after a few weeks or months from infection.
Approximately 10% of people infected with tuberculosis, a few years after infection, the disease will go into an open form. This is usually due to the weakening of the immune system, for example, during the passage of chemotherapy.
Tuberculosis risk group
Anyone, but the following groups can be infected with tuberculosis:
- People living in the medium where the incidence of tuberculosis is higher than usual;
- People with such diseases as HIV or those who are more susceptible to the disease of tuberculosis due to certain circumstances.
To other factors that can increase the risk of developing the open form of tuberculosis include:
- close contact with an infected person;
- If you
everlived in the region where tuberculosis is common, traveled in this region or received guests from there;
- belonging to the ethnic group originating from the region where tuberculosis is common;
- Related immunity
due toHIV, diabetes or other diseases;
- loose immunity due to long-term reception of drugs, such as corticosteroids, chemotherapy or tumor necrosis factors (used for the treatment of some types of arthritis);
- Children's or elderly age - the immune system of children and the elderly, as a rule, weaker than in healthy adults;
- Weak health or poor nutrition due to lifestyle or other problems, such as drug use, alcohol or life abuse or life on the street;
- Accommodation in adverse conditions or with a large number of other people, for example, in prison.
Diagnosis of tuberculosis
Each type of tuberculosis requires special diagnostic methods. In case of suspicion of tuberculosis, the doctor will send you to the phthisiatra (specialist in tuberculosis) for further diagnosis and treatment.
Diagnosis of pulmonary form tuberculosis
Diagnose the pulmonary shape of tuberculosis can be difficult. As a rule, several surveys are required, including the chest X-ray, which allows you to get an image of lungs. If you have a pulmonary form of tuberculosis, a change in the appearance of your lungs should be visible in the picture, for example, the formation of scars.
Other analyzes may be required to confirm the diagnosis. For example, you can take samples of mucus and sputum for analysis under a microscope for the presence of tuberculosis bacteria. These procedures are important in order to determine what treatment will be most effective.
Examination with extrapulmonary tuberculosis
With suspected extrellular tuberculosis, several procedures will be held to confirm the diagnosis. Including the following:
- Computed tomography - A series of X-ray shots under a slightly different angles are made, which the computer collects in a detailed image of the inner structure of your body;
Magnetic resonanceTomography (MRI) - with strong magnetic fields and radio waves, a detailed image of the inner structure of your body is created;
- Ultrasound (ultrasound) - with the help of high-frequency sound waves, an image of your internal organs is created;
- blood tests;
- Analysis of urine;
- Biopsy - From the affected area, a sample of fabric is taken for research for the presence of tuberculosis.
You can also make a lumba puncture. The procedure consists in the fence of the sample of the spinal fluid from the spinal channel of the spine. The spinal fluid is a transparent liquid, the surrounding brain. After the fence, the fluid sample is investigated on the tuberculosis of the nervous system.
Screening to latent tuberculosis
According to the law, an adult is obliged to regularly undergo fluorographic examination or making X-ray. This is necessary for the early detection of the most common pulmonary form of tuberculosis. The survey must be held once every two years. For some groups of the population (doctors, teachers, food industry workers, employees
If you were in close contact with the patients with an open form of tuberculosis, you also can recommend to survey the lungs to identify possible disease in the early stages.
Sample mantu - A common test for the detection of tuberculosis. The sample lies in the introduction in the forearm substance called PPD tuberculin (tuberculin, peeled from the proteins of the medium). Tuberculin is introduced intraderially. Mantu's test is held every year to all healthy children. In adults, the manta sample is made according to special testimony (for example, with suspicion of tuberculosis).
If you have a latent tuberculosis form, your skin will be sensitive to PPD tuberculina and a red seal will appear at the injection site, as a rule, within 48-72 hours after sample setting. If you have a very strong skin reaction, you may need an x-ray of the chest to confirm or eliminate the active form of tuberculosis.
If there is no skin reaction to the manta sample, most likely you have no latent tuberculosis. However, the doctor may appoint you a repeated X-ray study of the lungs during the year, since tuberculosis is developing for a long time.
If you have vaccinated BCG (bacillos
Analysis of the secretion of gamma interferon - This is a more modern type of blood analysis on tuberculosis, which is becoming more and more common.
It can be used to diagnose the latent form of tuberculosis in cases where the results of the Mantu sample are not indicative (for example, with a frequent formulation, like
Treatment of tuberculosis
Treatment of tuberculosis depends on its type, but most often a long course of antibiotics is prescribed. Tuberculosis is a severe illness, which, if not treated, can lead to death. However, when passing a full course of treatment, death is rare. Most often, hospitalization is not required for treatment.
If you have found the active shape of the pulmonary tuberculosis (tuberculosis that struck the lungs and caused symptoms), you will be sent to the phthisiatra - a specialist for the treatment of tuberculosis.
The pulmonary form of tuberculosis is treated with a semi-annual combination of antibiotics. As a rule, the course consists of the following drugs:
- Two antibiotics: isoniazide and rifampicin, daily for six months;
- Two additional antibiotics: pyrazinamide and etcutol, daily for the first two months.
In some cases, we can be appointed with the reception of these drugs only 3 times a week if you need control over the tuberculosis process.
May go through a few weeks or months before you feel better. How many times it will take, depends on your overall health and severity of tuberculosis. After receiving drugs for two weeks, most people are no longer contagious and feel much better. However, it is very important to continue to take medicines according to the instructions of the doctor and completely under the course of treatment with antibiotics.
Admission of drugs for six months is the most effective method of complete destruction of tuberculosis bacteria. If you stop taking antibiotics until the course is completed or you will pass medicine, tuberculosis bacteria can develop antibiotic resistance. It is potentially dangerous, as it may make it difficult to treat and require longer reception of drugs.
After cure from the active tuberculosis, you will be under the dispensary observation in the phthisiatra for 3 years. Being at dispensary accounting, you need to periodically undergo a survey from a doctor. In addition, you will be told how to recognize signs of repeated tuberculosis in time, although such cases and rare. In special cases, even after the course of treatment, tuberculosis can lead to death. This may occur if the lungs are damaged too much and cannot work normally.
Empty tuberculosis can be treated with the same combination of antibiotics as its pulmonary form, however, the duration of treatment will be increased to a year. If tuberculosis affected your brain, you can register corticosteroids, for example, prednisone, which you will need to take for several weeks with your antibiotics. This will help remove the edema in the affected areas. As with a pulmonary form, it is important to take medicines strictly according to the directions of the doctor and fully complete the course of treatment.
With latent form of tuberculosis, the tuberculosis bacteria is infected, but at the same time you have no symptoms of the disease. Treatment of the latent form of tuberculosis is usually recommended to the following persons:
- under the age of 35;
- people with HIV, regardless of age;
- medical professionals, regardless of age;
- People with traces of scar tissue formed under the influence of tuberculosis, prominent X-ray, which never passed treatment.
The treatment is not recommended for a sick latent form of tuberculosis, if they are more than 35 years old (and they have no HIV, as well as they do not work in the health sector), since the risk of liver damage increases with age, and for some people the risks of treatment outweigh its advantages.
The latent form of tuberculosis is also not always treated, if there are suspicions that bacteria are resistant to medicines. In this case, regular monitoring of the state can ensure that the disease has not passed into an active form.
In some cases, the treatment of the latent form of tuberculosis can be recommended to persons who need to receive immunosuppressants. These drugs suppress the immune system (natural protection of the body from infections and diseases) and can allow tuberculosis to move from the latent form to active. These include people, for a long time receiving corticosteroids or undergoing chemotherapy.
In such cases, tuberculosis must be cured before receiving immunosuppressants.
Treatment of closed tuberculosis is either in the reception of a combination of isoniazide and rifampicin for three months, or only isoniazid for six months.
Side Effects of Tuberculosis Treatment
Rifampicin can reduce the effectiveness of some contraceptives, such as a combined oral contraceptive. During rifampicin intake, use another type of contraceptive, such as condoms. In rare cases, these antibiotics can damage the liver or eyes, which may have difficult consequences. Therefore, before the start of treatment, you need to check whether your liver works well. If you are going to take a etcutol, before the course of treatment, you also need to check your eyesight.
Please contact your specialists immediately if you have any of the following symptoms:
- nausea or vomiting;
- yellowing of the skin (jaundice) and urine darkening; temperature 38º C or higher without explicit reasons;
- tingling or numbness or feet;
- skin rash or itching;
- Changes in view, such as blurring of vision or daltonism.
To learn more about the side effects of your drugs, read information about the preparations from tuberculosis.
Tuberculosis, resistant to antibiotics
Like most bacteria, bacteria that cause tuberculosis can work out resistance to antibiotics. This means that medications will no longer be able to kill those bacteria that should. If tuberculosis has become resistant to one type of antibiotics, it is usually possible to overcome, as there are other antibiotics. However, in some cases, the following may occur:
- Tuberculosis becomes resistant to two antibiotics - this is called multiple drug resistance tuberculosis;
- Tuberculosis becomes resistant to three or more antibiotics - this is called a wide drug resistance tuberculosis.
As a rule, with both types of tuberculosis required
Preventing the spread of infection
If you were diagnosed with lung tuberculosis, you will remain infectious
- Do not go to work, to school or university, until your doctors say that it is safe;
- Always cover your mouth when you cough, sneeze or laugh;
- Always dispose of used paper scarves in a plastic package sealed;
- more often to air the room so that the room was fresh air;
- Do not sleep in one room with other people, as in a dream you can cough or sneeze without giving yourself a report in this report.
Tuberculosis prevention: BCG vaccination
Tuberculosis is a severe infectious disease affecting the lungs, but it can also affect other parts of your body, for example, bones, joints and kidneys. It can also cause meningitis. Although tuberculosis is a severe disease, with proper treatment it is possible to complete the cure from most of its forms.
BACG BACG (Bacillus
With the help of the service, you can find all the clinics where there are vaccinations.
The BCG vaccination is made on the basis of a weakened form of a bacterium, which is very similar to the pathogen of tuberculosis in humans. Since bacteria is weak, the vaccination does not cause disease, but it encourages the immune system to protect against the disease, producing strong immunity. The vaccination by 70-80% protects against the most severe forms of tuberculosis, for example, from tuberculous meningitis in children. It is less effective in preventing respiratory form of the disease (respiratory disease), more common among adults.
What doctor to contact with tuberculosis?
With the help of the service, you can find all anti-tuberculous dispensaries in the city, as well as find a good phthisiatra - a doctor who is engaged in the diagnosis, treatment and rehabilitation of tuberculosis patients.
Tuberculosis is an infectious disease that occurs due to the human koche sticks. The disease is dangerous in that it affects the organs of the respiratory system. Rightly subject to tuberculosis, leather, lymphatic, urinary, nervous, lymphatic system, as well as other organs and systems.
The immune system (the natural protection of the body from infections and diseases) of most healthy people kills bacteria, and symptoms do not appear. Sometimes the immune system cannot kill bacteria, but can restrain them in the body. In this case, the development of symptoms is not observed, but bacteria are stored in the body. This is called the latent (hidden) form of tuberculosis.
Methods of transmission of infection
Airborne-drip - through the Chihannie, the cough of the patient with an open form of the disease, and even the striking, the wand retains its pathogenicity.
Alimentary - through the digestive tract. The infection falls into the body due to bad hygiene or poorly washed and untreated food.
Contact - infection falls inside a person through the eye conjunctive, with kisses, sexual contact, through contact of contaminated items with human blood, the use of foreign hygiene items.
Types of tuberculosis
Open form - the disease is clearly expressed, the bacteria are easily detected in sputum, cartoons. The patient itself is a danger to others, as the infection is transmitted by air-droplet. Microbacteria can be detected in sputum, urine, wheel masses.
The closed form is not dangerous to others. It is characterized by the complexity of the detection of infection in sputum. Most often occurs the tuberculosis of the lungs, but this infection may also affect bones, joints, urinary system, intestines, peritoneum, brain shells, CNS, peripheral lymph nodes, leather
The first symptoms of tuberculosis
In the early stages, the disease proceeds almost asymptomatic. As it develops, the patient's condition deteriorates, but specific symptoms are not observed. Increased fatigue, weakness, sharp weight loss without visible reasons, temperature 37-38 ° C, not falling for a long time, night sweating. In children, the disease progresses faster than adults.
The pulmonary shape of tuberculosis accompanies cough. First light, eventually begins to progress. If the cough lasts more than three weeks, you need to immediately seek medical attention. Cough is first dry, parotid, especially at night and in the morning. Later, the yellow-green wet begins to stand out, and at the stage of the Kavern there is a hemlaper.
In the form of a tuberculosis, which strikes the brain and its shell, in addition to the symptoms of general intoxication, sleep disorders are observed, headaches, the intensity of which is gradually enhanced.
Who enters the risk group by the development of tuberculosis?
People with diseases such as HIV.
People with a weakened immunity, the presence of diabetes.
Children or elderly age - have a weaker immune system.
People living in adverse conditions.
People living in the regions where the incidence of tuberculosis is above average.
How is tuberculosis diagnose?
To diagnose the disease, you need to apply to the treatment on the attending therapist, who, if suspicion of tuberculosis, sent to the admission to the phthisiatra (tuberculosis specialist) for further diagnosis and treatment. Diagnostics will depend on the type of disease.
Diagnosis of pulmonary shape of tuberculosis
It is required to make an X-ray snapshot of the chest, which allows you to get an image of lungs. With the light-shaped form of tuberculosis in the picture, changes in the appearance of the lungs should be seen, for example, the formation of scars.
To confirm the diagnosis, samples of mucus and sputum are taken to analyze under a microscope for the presence of tuberculosis bacteria.
Examination with extralegal tuberculosis
Survey at latent tuberculosis
For the prevention of the disease, each person must at least once every two years undergo fluorography and make X-ray lungs.
How to treat tuberculosis?
Treatment of pathology depends on its type, but the course of antibiotics is most often appointed. Tuberculosis is a dangerous disease that requires immediate treatment. This allows a person to return to his familiar lifestyle.
Antibacterial therapy is aimed at suppressing the reproduction of the pathogen of tuberculosis.
Treatment takes place in 2 phases: several drugs are used on the first to reduce the population of microbacteria, the second phase is the supporting therapy. Antibiotics stop the reproduction of bacteria and allocating them into the environment, inflammatory process.
After taking such potent drugs, a person needs additional supporting therapy that will strengthen the body and reduce the toxic effect. For this purpose, the reception of immunostimulants is assigned (restore the liver), sorbents (remove toxic products of decay of chemotherapy) and vitamin complexes.
After receiving drugs for two weeks, most people are no longer contagious and feel much better. However, it is very important to continue to take medicines according to the instructions of the doctor and completely under the course of treatment with antibiotics.
Other Tuberculosis Methods
The goal of therapy is the elimination of tuberculous foci in the lungs with ineffective treatment, eliminating the effects of pulmonary tuberculosis, elimination of lesions of organs. All this is necessary for the prevention of the re-appearance of the disease and to eliminate the appearance of complications.
Indications for surgical intervention can be any forms of tuberculosis of respiratory organs, especially in the case of the development of complications that threaten human life.
It is used for an optimal combination of anti-tuberculosis drugs aimed at eliminating mycobacteria and to suppress their reproduction. The duration of such treatment may reach a year - it all depends on the form and stage of the development of pathology.
If it is too early to stop chemotherapy, then an exacerbation or complication of tuberculosis may occur. Therefore, it is important to follow all the recommendations of the doctor. And the doctor for its part should draw up a detailed treatment plan and adjust throughout therapy.
The patient who shows chemotherapy as a method for treating tuberculosis should be ready for the negative consequences of such an aggressive way. Often there are side effects on the effect of drugs. 2 types of adverse reactions are observed: toxic and allergic. Dysbacteriosis may also occur.
The doctor may appoint an outpatient treatment if the disease has been revealed at an early stage and there is completely no contamination for others. At the same time, it is necessary to regularly visit the attending physician and undergo diagnosis. Most often, the patient is transferred to outpatient treatment after surveillance in the hospital and passing the extensive course of therapy in the tubdype. At this time, the patient is no longer contagious.
Where to undergo diagnosis and treatment of tuberculosis?
How to treat tuberculosis of any type know in the Medunication Medical Center. We are treating the disease in Krasnoyarsk. We do not recommend engaging. For the help of an experienced doctor, contact our medical clinic.
Sign up today at a convenient time for you, and tomorrow will pass a survey. Powerful equipment for conducting CT, MRI and Ultrasound, experienced doctors who, if necessary, hold a primary inspection at home, are waiting for you to "Medunion".
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Online on our website Medyunion.ru. Fill out an electronic form by specifying your contact details, a specialization of a doctor, convenient date and time for receiving.
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Given the creation of many effective drugs that are available today for doctors, the likelihood that patient with tuberculosis can be cured. Nevertheless, it is important that the person understand the danger of infection and fully cooperated with the doctors during therapy and treatment with antibiotics. The prevention of the transition of a latent infection in an active form is equally important.
The use of antibiotics during disease
Both latent tuberculosis infection and active tuberculosis, doctors treat antibiotics. Treatment lasts at least six months, because antibiotics work only when bacteria are actively divided, and the causative agents of this infection grow very slowly. Although the latent tuberculosis infection can be treated with only one antibiotic, the active stage of the disease is treated with several antibiotics at the same time to reduce the likelihood that bacteria will develop drug resistance.
Active tuberculosis should be treated aggressively, and patients may have to begin treatment from staying in the hospital so as not to allow bacteria to spread among others. The patient drinks antibiotics, adopts additional drugs under the control of the doctor. After a few weeks, as the condition and suppression of the activity of bacteria (when the patient is no longer contagious), transition to outpatient treatment is possible.
The problem of treating tuberculosis
The greatest danger in the treatment of tuberculosis is strictly compliance with the treatment schedule. If the patient does not take antibiotics on schedule, it will give bacteria the opportunity to develop resistance to drugs, acquire aggressive properties, then tuberculosis is much more difficult to cure. Therefore, it is very important to take all medicines in accordance with the instructions under the control of the doctor. Most treatment programs require that the medical worker observes how the patient takes each dose of medication prescribed to him.
The doctor can control the patient's condition during treatment with blood tests to check the liver condition, take sputum tests to see if bacteria are sensitive to antibiotics that take the patient. Tuberculosis treatment implies and conducting chest radiography to find signs of illness.
Other localization of infection
Extrallular tuberculosis is an active form of infection in any part of the body, except for the lungs (for example, in the kidneys, spine, brain or lymph nodes). The treatment of an extrasecient tuberculosis infection is mainly the same as in the defeat of the lungs, except that infection with the brain damage or bones is treated longer.
Hidden tuberculosis infection: what medications are needed?
Treatment of latent tuberculosis infection is usually carried out by one antibiotic for nine months. The purpose of this treatment is the removal of bacteria from the body. Long therapy requires, since antibiotics work only when bacteria are actively divided, and microbes causing tuberculosis may not grow and do not multiply for a long time. This treatment is necessary to prevent the development of the active form of tuberculosis infection.
Isoniazide is the most frequently prescribed antibiotic if the patient has a hidden infection. This drug may cause damage to the liver during long-term use. Therefore, the doctor can control the liver condition through blood tests during the entire treatment period. When taking medication, paracetamol and alcohol should be avoided, as they can also cause liver damage. Symptoms of liver damage include nausea, vomiting, yellow discoloration, fever and diarrhea. Some people who have not been revealed by a positive skin test reaction take isoniazide, because they actively in contact with a person who is sick of tuberculosis, and a high probability of infection.
Some medicines taken to treat other pathologies significantly increase the risk that latent tuberculosis infection will become active. It is necessary to inform the doctor about all the preparations that the patient takes.
Active tuberculosis infection: Prevention of complications
For the treatment of active tuberculosis and prevention of complications, immediate antibiotic treatment is necessary. Since the appearance of anti-tuberculosis drugs in the 1940s, the treatment of drug-sensitive disease (tuberculosis, which is caused by bacteria sensitive to antibiotics) has become very effective with proper use and selection of dosage, course duration. Treatment no longer requires a long stay in the hospital. The patient can be partially treated at home. Finding patients in hospitals in the period of contagious is preventing the spread of bacteria among others, especially children and the elderly, future mothers. Patients take medicines until the disease ceases to be contagious. When the patient is no longer contagious, he may leave the hospital and continue to take medicine at home. Hospitalization can last from a few weeks to several months, depending on the severity of the disease and on whether the patient has the opportunity to fully be treated at home.
Since active tuberculosis slowly responds to therapy, prescribed medications must be taken every day for a long time. It may be at least six months, and sometimes more than a year. This is preventing complications and the formation of bacteria resistance to antibiotics.
In most cases, the treatment program for drug-sensitive tuberculosis involves a reception from two to four drugs. The attending physician can use sputum analysis results to determine which antibiotics are most effective. Therapy begins with one type of drug, and according to the results of the seeding and sensitivity, it is adjusted to reproduce the reproduction and activity of mycobacteria as quickly and efficiently. Treatment should not be interrupted, otherwise it will be necessary to start all over first, changing drugs. Pass the test The health of your lungs Having answered the test questions, you will learn whether one of the most common ailments of smokers - chronic obstructive lung disease (COPD).
Talked with heroine
Cured from tuberculosis
Sometimes you live an ordinary life, and then the doctor tells you: Hello, you have an open form of tuberculosis, you need to be treated.
And it turns out that the whole former lifestyle has to be changed, drinking potent drugs, perform the appointments of the doctor - and all this without any Guarantees. And in the process of treatment, see how people die.
On my own experience I can say: even the open form of cerebulosis tuberculosis. The main thing is to fulfill all the recommendations of the doctor and do not engage in amateur. Barsing fat, perhaps, acted on Koch sticks 300 years ago, but today there are more efficient and reliable treatment regimens.
This article is not about effective patterns of therapy and not about magical drugs. Tuberculosis itself is a complex disease in treating. If the first signs noticed, better consult a doctor. And if you have already diagnosed, comply with the recommendations of phthisiators, and do not try to be treated, following the advice from the Internet.
But I will tell you how to defeat the disease not only with the help of tablets, but also with the help of discipline. And about how to build communication with others with such a severe diagnosis.
How I lived to the disease
It is believed that tuberculosis is a disease common in the environment of people socially disadvantaged. Many believe that, if you do not communicate with people without a certain place of residence, to live clean, it is good to eat and pass the fluorography in a timely manner, you can not be afraid of tuberculosis.
But in life everything is not so simple. I never communicated with homeless, did not live in unsanitary conditions, and I never had medical problems. And my husband at that time worked as a doctor and at the first symptoms of any disease right here I found the right specialist and agreed about consultation.
My husband was a practicing psychoreflexotherapist, and he did not have any problems with work and clients. We lived in Kyzyl for a long time - in Bishkek. For half a year left for Yamal, then we bought a house in Volgograd and moved there.
We have never experienced special needs in money: our income level has always been above average. The role of the housewife did not suit me, so I was engaged in what I always liked, - sewed to order. My sewing machines moved from the city to the city. The income was enough to actively relax: we went around Half Siberia tourist routes, Altai, could afford to relax on the sea.
So in 2009, my husband and I were in Volgograd. It is there that my health began to deteriorate.
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How I got sick tuberculosis
The first signs appeared at the end of 2008. At that moment I did not consider them serious. But the frequent temperature, the increased fatigue was alarmed by my husband, and together with him we turned to the therapist. The therapist I did not give me a diagnosis, I wrote down the directions to those skilled in the art, among whom was a phthisiar, and I also asked to take a snapshot of the lungs.
Ultimately, none of the recommendations of the therapist for examinations at that moment I did not fulfill. Relationships with her husband worsened, and I was more involved in solving personal problems than my health. And the temperature over time ceased to disturb me, and I decided that it was an ordinary cold. At that time, I was not up to medical questions: conflicts began in the family, in the spring of 2009, I returned home, in Kyzyl, and a little later designed a divorce. The work found very quickly - settled in a tourist firm.
But the disease did not leave anywhere. I was constantly sick, although I still seemed to me that these are ordinary ARVI. During the year I constantly saw anti-happose and antipyretic drugs. And the temperature, shortness of breath, weakness and high sweating have become almost familiar to me. Even in the workplace I constantly wanted to sleep.
In the end, it was the bosses that I advised me to check for tuberculosis. In April 2009, I passed the analysis in a tubidispere and received a diagnosis: an open form of tuberculosis.
What is a tuberculosis
Before getting sick, I, of course, heard about tuberculosis, but mostly it was a standard set of information. He knew that the disease is infectious, very dangerous, but in our time it is rare and mainly among the various asocial elements. It seems Doctors learned tuberculosis to treat, but it turns out not always, and sometimes people die from him.
Details explained to me the doctors already on my own example. Causes this disease of the bacterium called Mycobacterium tuberculosis. She can hit many human organs: bones, kidneys, liver. But most often the tuberculosis is striking the lungs - it happened in my case.
This disease is distributed by air-droplet, approximately also As a coronavirus infection: a sufficiently sneezed sneeze or plow, wet drops containing tuberculosis bacteria are in the air. If you breathe them, tuberculosis bacterium enters the body. But there are more complex ways to spread infection: for example, a sputter with bacteria falls on the surface to which a healthy person touches, and then he does not wash his hands and transfers them to his throat.
Tuberculosis is a dangerous disease: he takes the tenth among the most common causes of death in the world. Every year, up to 10 million people are infected throughout the world. And 1.5 million each year die from it.
Naturally, this statistic worked me. But one thing when you know about 10 million somewhere Far, another - when you herself get a diagnosis in the hands and understand that the probability to die is 15%. Moreover, death will not be at all quiet and peaceful. Bacterry destroys the lungs, and it can cause a stranger: death will come from lack of oxygen. If The defeat in the lungs will affect the vessels, death may occur from pulmonary bleeding. And often the cause of death is pneumonia or heart failure.
That from the patient with tuberculosis requires the state and what gives
With most diseases, there are no special requirements for the patient from the state. For example, broke a person's foot - it can get a sick leave, and may not receive if he does not want himself. In such a situation, even demanding the design of the hospital is the right of a person, not a duty, and it is impossible to force it.
But with tuberculosis everything is much more difficult. It enters the official list of diseases that are dangerous to others. For example: in this list, tuberculosis is adjacent to such diseases as the plague, Siberian ulcer and Ebola fever.
I think that is why the state towards the sick asstends certain obligations. The most important thing is free treatment. I will immediately say that for the whole period of treatment I did not spend a penny on the medicine: they completely provided me in a tuberculous dispensary.
The logic of the state here is this: cheaper to cure one person, than to heal also those whom he can infect.
But in return for free treatment, duties appear in the patient with tuberculosis. The main one is to fulfill all the prescriptions of the doctor and undergo treatment in full.
If a person refuses treatment, it may be forcibly hospitalized. It happens in court. Here is an example: a woman has a discovered form of tuberculosis, and she did not want to be treated. The prosecutor's office filed a lawsuit against forced hospitalization, and his court satisfied him. And to those who will not fulfill the decision of the court, bailiff will come and will be delivered to the hospital forcibly.
But the use of compulsory measures in my plans was not included - the main task was to cure.
I still wonder how much money has spent the fund of compulsory health insurance for my treatment. Now learn this is simple: there is a special section on the portal of the State Service, where everyone can see what medical services it turned out and how much it cost each of them. Information there are available only since September 2016, and I have been cured earlier, and in my case such information is not visible to me.
My spending on anti-tuberculosis preparations made up 0 Р. I still can't even attend how much I was treated, although I suspect that it was completely expensive. And besides drugs, I was treated stationary, in a tuberculous dispensary, and for it also did not pay a penny.
And I got the following.
Paid sick-year per year. The removal from work in such a situation is completely legal. I was a source of dangerous infection, and go to work in the usual mode meant Danger colleagues and customers.
Since I was officially officially, a disability sheet was discovered. Work experience made it possible to receive full payment. The problem was that in my employment contract the wages were indicated in the amount of minimum wage. In 2009, the minimum wage was 4330 Рper month, plus a regional coefficient was added to it - 0.9. As a result, it turned out 8227 Р- I received them during the year. But if not official employment and not the policy of the OMS, I do not Received And that.
Disability pension. In the process of treatment, during the year I did not have improvements, and I received a referral to the medical and labor expert commission - VTEK. Its tasks include determining the causes of the occurrence of disability and the purpose of its degree. The Commission set me a third disability group. Payments at that time were about 5 thousand per month.
In addition to my life, the disease affected those who surrounded me. I'll say right away: I did not infect anyone. But everyone with whom I contacted, was still under the supervision of doctors, went through the hospitals and handed over. My mom, sister, boss and ex-husband - it affected everyone. But there were never conflicts about this: everyone understood everything and perceived adequately.
How I was treated in a tuberculous dispensary
Often people represent tuberculosis hospitals as a separate territory somewhere Far outside the city, where the characters are roaming from the series about the revived dead. In fact, it is not. The dispensary in which I was treated was not far from the city center and was not fenced with barbed wire from healthy people. On the first floor, the doctors guided healthy people and those who do not have signs of the disease.
And on the second and third floor there were chambers for the fallen. Separately chambers for those who have an open form, for those who have closed, and for those who have chronic tuberculosis. And even its own surgical department.
At the time of receipt, no doctor can even talk about how much inpatient treatment will last. It all depends on the results. In my case in the hospital I spent five months, as my open form of tuberculosis at last Switched to closed. This does not mean complete recovery - the bacteria did not go anywhere. But the dangers of surrounding I have no longer imagined. It was a big victory - first of all because there was no more need to constantly be in the hospital! W. Someone This period may be greater or less. In any case, one should not count on the fact that to a certain day, for example, to the new year or his birthday, it will be at home.
The schedule in the tubdypery is not very different from any other hospital: the rise at seven in the morning, breakfast is very calorie and nutritious. Good nutrition is one of the conditions of treatment. Every day, even fresh kumys were brought to us - this is a fermented milk drink from horse milk. In our region in the store it is not for sale - they make it only in the chaban parking lots.
Procedures begin with six o'clock in the morning: we were won and controlled so that we take medicine. At the post of nurse, there were always milk and water so that everyone could choose than to drink medicines. After breakfast, the procedures continue. In the free from the procedures, time can be walking in the courtyard, and the yard is also not fenced with barbed wire. The mode compared to other hospitals is quite liberal. We were even allowed to smoke in the toilets - although I suspect that it was possible because of the sympathy for our senses.
But alcohol was under the full ban. There were people who tried this ban to bypass: for example, one of the patients at night got out the window and went to the beer. Back to the second floor it was already more difficult to rise - he fell and broke his leg. He was discharged for the violation of the regime, and he continued at home already at home, but for a while: drink alcohol pills - a bad idea. Soon he returned to the dispensary in an even more severe condition.
The process of treatment is heavy. Doctors call it chemotherapy, although drugs, of course, differ from those that are treated oncological diseases. The tuberculous stick is a very resistant to the treatment of bacterium, it quickly gets used to drugs, and treatment over time ceases to give results. Therefore, it is necessary to combine various antibiotics and antibacterial agents. Doctors do it according to certain schemes so that tuberculosis bacteria does not produce such drug stability. Over time, the scheme has to change.
I will not contain the treatment and names of specific drugs here. Firstly , now I do not even remember the names of all medicines. BUT Secondly The treatment regimen should be prescribed by the doctor, and what helped one may be useless for the other.
But why I want to warn - it is from the treatment of folk remedies. I still meet the "Proven Recipes" on the Internet: for example, a mixture of aloe juice, a foiled salary and various vegetable juices, a barthy fat, pine pollen. And even I meet the reviews of the relatives of patients from the "My Studio Town Series ate Icelandic Moss and washed by vinegar - and for a year already healthy." In fact, most likely, a person did not recover - he only seems so.
The fact is that all medicines appointed with tuberculosis, the body transfers very badly. Nausea, shortness of breath, sweating, even vomiting is normal satellites of treatment. But so far it is bad to man, bacteria also has to be disadvantaged. It happens that the patient does not withstand and moves to the treatment of barcurate fat.
It may develop so that by the beginning of treatment, as it was in my case, the body was already accustomed to a tuberculous wand - a slightly elevated temperature is perceived as normal. And on the background of the tablets, from which the liver hurts and constantly sick, folk treatments are perceived as ordinary vitamin. There is a feeling that it is, the cure happened! But in fact, at this time, the tuberculous wand calmly donates the lungs and other organs. And then the person returns back to the tube, but already in a more severe condition.
But, even knowing all this, folk remedies try, probably, all sick. It also did not bypassed me. When the main task is to survive, grab it for any opportunity to treat, even ghostly. I myself tried Icelandic moss. True, the reception of medicines did not stop at the same time. The effect of this moss did not notice.
If you want to try a dog or a badger fat, it is better to refuse immediately. I myself did not try it, but I saw those who try. When the liver does not work normally due to Drugs, bad-haired fat will only worsen the general condition.
Folk remedies for tuberculosis at best will lead to loss of money, and at worst - only complicate the course of the disease. The likelihood is high that their reception instead of normal therapy will lead to death.
But what really helped me, this is the tincture of the root of chicory and the decoction of the grass of the mother. But I took them not for treatment - it does not affect the bacteria. Mother I drank like a sedative. True, I'm not sure that doctors approve of its use in order to treat nervous disorders, but he helped me. Perhaps this placebo, but he is harmless. And the root of chicory well restored the appetite, otherwise I could not eat after taking medications at all.
The treatment did not always proceed smoothly. I passed through the hemopying, and through blood transfusion. I saw how my neighbors were dying around the ward, - one of them was only 21 years old, and she entered the tube she just a month earlier me.
After five months of treatment, the result appeared: the open form moved into the closed. This means that my body stopped allocating the virus and I became safe for others.
But it did not mean that I was cured. Treatment continued, but already outpatient. From Monday to Friday, I went to the tubes every morning, received pills and droppers there, and then returned home.
Restrictions on work with outpatient treatment are not completely removed, but become softer. For those who work for hire, it all depends on the nature of the work. If by the nature of the work you need to regularly pass a physical examination, the final decision is made by doctors during the medical examination. But the seam, working at home, regular medical examinations are not required, so I did what I can best.
As it turned out, the disease is not a hindrance. I had more free time, I learned the demand for sewing products, materials and began to sew warm clothes from modern synthetics for the needs of the staff of power structures that are not satisfied with what states them, as well as for hunters and tourists. I led the sale and still leading through the Internet, but I will not give a link to my page, there is enough customers and without advertising. The demand for such products turned out to be stable, and in 2014, when the dollar rate jumped twice and the prices for imported warm clothes even increased in the Internet, for my products, buyers literally literally line up.
How I treated tuberculosis in the sanatorium
After the end of inpatient treatment, I was offered to continue it in the sanatorium. Offered options to choose from: in Altai and Bashkortostan. Geographically closer was the Altai Sanatorium "Chemal". I paid the road at my own expense, but these are actually the only costs of treatment. The path in one direction cost me about 5 thousand rubles at the prices of 2011. I drove in a ticket and therefore for staying in the sanatorium for two and a half months nothing paid anything.
The schedule in the sanatorium was little different from the graphics in the tubdype. Lifting, treatment, destination, procedures. We must walk - the sanatorium is located in the mountainous location, in Pine Bor. The climate there is such that tuberculous bacteria is difficult to carry it.
Food, as in any tuberculous institution, reinforced, high-quality and diverse.
But treatment in the sanatorium did not give the result, which I counted and attending doctors. The state continued to deteriorate: in the pictures, the area of lung damage increased. The fact that tuberculosis has moved into a closed form, secured others, but I didn't make it healthier - bacteria continued to destroy my lungs.
Consilium, who examined me before discharge from the sanatorium, decided: the only thing that can help me is to remove the affected part of the lung. To do this, I was offered to go to Novosibirsk.
I did not give up. The only thing I asked for doctors is to go home. I have already concluded that I will follow all instructions, but I needed to leave warm things at home.
As I personified at home
In Kyzyl, he turned to a tubdy scan, to his doctor, about a trip to Novosibirsk to the operation. The doctor offered to consult with our surgeons and agreed on a full-time consultation with them. The surgeon looked at my pictures that did in the sanatorium, and the decision of the Consilium did not approve. Instead of removing the affected part of the lung, he suggested another treatment scheme - imaging the lungs through the abdominal cavity.
By itself, this procedure is assigned if chemotherapy is ineffective, as in my case. Between the ribs or in the abdominal cavity, the puncture is made, and air is injected between light and ribs. Light at the same time, the blood circulation is improved in it, and the affected areas are compressed.
The procedure was carried out in the hospital, in the surgical department. But if the hospital day, after thinking the patient can go home. At that time I lived a 10-minute walk from the Tubdypancer and traveled to the house on foot. The sensations after thinking are not the most pleasant.
Much depends on the qualifications of the doctor making a prank. Once a specialist who thought me on constantly, did not turn out to be in place, he was replaced by another doctor, which, apparently, was less experienced. Something It did not go according to the plan, and the air fell under the skin. I barely got to the house on that day. Then I told the doctor all, and I no longer saw an inexperienced specialist.
The procedure included 10 pensions - one per week.
Apparently, it is imagining and gave a positive result. Repeated surveys and snapshots have shown that the situation is improved: new foci of lesion did not appear in the pictures, and the old began to gradually decrease.
Treatment on this did not end: I'm all also continued to perform the appointment of a doctor. After that, I was no longer hospitalized and did not send to the sanatorium. At first I was treated in the day hospital - I was in the ward only in the afternoon, and in the evening I left home. The last three years the treatment was exclusively outpatient.
But even outpatient treatment took place under the control of the doctor. Every morning I went to the tubdy scan, took the medicine nurse under control, and then returned home and was engaged in tailoring.
What taught me tuberculosis
With the identification of tuberculosis until the moment when it was recognized as a healthy, five years have passed. The conclusion that the disease is defeated, doctors made on the basis of the results of the tests and images: Bacteria in sputum was not detected, and in the pictures affected lung areas were calcined - the body as if cementing them with calcium salts. Even if tuberculosis bacteria remained inside these areas, they will not fall into a healthy part of the lungs.
From your disease, I made certain conclusions that concern and my financial well-being, and relations with others. And I tried to consider these conclusions when planning my future life.
The main conclusion - recurrence is possible at any time. Even if a person is recognized as clinically healthy, there are no guarantees that the disease will not return tomorrow. And therefore, even hoping for the best, you should always be prepared for the most pessimistic version of the development of events.
Costs for treatment. Indeed, the treatment of tuberculosis is completely free. The state provides ill medications, pays for expensive surveys, procedures, and, if necessary, and surgical operations.
But this does not mean that the disease will not hit the budget. The long-term disease primarily leads to a decrease in income, and it does not matter that it is not necessary to spend money on the tablets in the pharmacy.
Discipline. If you have been prescribed treatment, you need to continue the course. If the course is too heavy and you cannot transfer it, in no case do not learn the entire treatment. It is best to consult a doctor - it will help to choose a new diagram of reception of drugs or prescribe other medicines.
Work. For a whole year, I received a guide on a sheet of temporary disability. But the size of payments on the hospital depends on the size of the official salary. If contributions to the OMS Foundation pay with minimal salary, then payments will be same .
After recovery, I made the appropriate conclusions and at the first opportunity got a job with official design and white salary. Now I work as a sales representative. Taking into account my insurance experience, payments on the hospital leaf will be 100% of the average earnings. Translated for money is more than 50,000 Рper month. True, I haven't had to use the advantages of a paid hospital in a new place of work - there was no reason.
With the employment itself, no problems arose. As far as I understood, the selection of candidates is mainly based on the autobiography and questionnaires. There are no questions related to medicine and diseases. I myself tell about the suffering diseases I am not obliged, and no one asked for such questions. Break in labor activity also did not embarrass anyone. Now few of the employers can surprise the dates of records in the employment record - many work without official design.
Saving. Payments on the passage of disability go on just a year. If during this time it will be possible to defeat tuberculosis - well. If not, prescribe a pension. In my case, it was a pension on the disability of the third group. Its size in 2021 - 9311 Р. It is believed that a person can work with such disabilities. But on a personal example I can say: when the liver falls off after taking the impact dose of drugs, I constantly want to sleep and after half an hour, the man gets tired as if the sleepers unloaded the sleepers, you can not dream about full work. And the payment of any work depends on the volume and quality.
So have 100-200 thousand rubles in the occasion in case of a sudden disease - not at all extra precautions.
Prevention. Despite the fact that I officially read healthy, recurrence is possible at any time. The risk is always saved. Therefore, an important place in my life is now occupied by prevention.
Tuberculosis bacteria develop well in a weakened organism. Therefore, I strengthen health as I can. First of all, the shock doses of vitamins. I spend on them about 1500-2000 Рper month. I buy them in sports nutrition stores - it goes cheaper.
And I'm trying to gain weight. By the beginning of the disease I weighed 47 kg, now - 53 kg. The plans are to gain weight up to 56-57 kg, and believe it is not as easy as it may seem. The slender figure is perhaps good for the photo shoot, but with any serious illness, there will be only problems.
Alcohol consumption is minimized, but not fully excluded. On average, according to my approximate estimates, in the year I use 5-7 bottles Beer and approximately a bottle of wine.
But I could not quit smoking, although I tried more than once. But the hopes to get rid of this bad habit leave.
As soon as the opportunity appeared, I was given from coronavirus, and, apparently, one of the first in the city. Transferred tuberculosis is not a contraindication for such an vaccination, but pulmonary diseases for a person who has been passing with tuberculosis, will be guaranteed to give more problems than for someone who they did not hurt.
Relatives. Tuberculosis is almost impossible to transfer without relatives and close people nearby. If a person is one as finist and there are no friends, no relatives, ready to support, or no one at least Just shook out about the problems and complain about life, everything will be much more difficult. Get upset alone harder than with Someone , and worry and nervous with tuberculosis doctors do not recommend.
I actually saved my mother. She prepared my favorite dishes every day and brought me to the hospital. Constantly supported, calm down. And at certain moments, she took full care for me - when I was lying after the procedures and could not do anything. How much she was worth the nerves and health, I can't even imagine.
Without mom and her support, I most likely not would have done with a disease.
For sure also People helped me who did not know me before: my boss, her husband, colleagues. Communication with me brought only problems with me - I had to take tests, to undergo surveys. But at the same time, if I need help and support, I always received it. And no negative on their side has never been.
When I lay in a tubidisperess, I met a man with whom I now live. At first I talked with him via the Internet, we called on the phone, but I did not come about the meeting. At first I did not tell you that I was sick with tuberculosis. But when he was in the sanatorium, he called him and told everything in tears. What is already sick for many months and how it all ends - and Lessa will end - No one knows.
I expected some kind of reaction. He could hang up and simply not respond to calls and messages. But he said that now is not medieval and treat if not all, then almost everything. The main thing is the recommendations of the doctors to observe and the regime does not violate that I did.
As a result, we did not just continue communication, but now we live together, although we did not have such plans. Build plans, having a diagnosis "open form tuberculosis" is very difficult, but, as it turned out, often the situation is for the better. And if a person did not escape, knowing about my diagnosis, it means that it can also be calculated in solving simpler problems. In any case, as my experience shows, no diagnosis, even the most complicated, it is not a reason to despair. There will always be people who will support and help.
- Nobody insured from tuberculosis.
- Even such a diagnosis is not a reason to despair.
- On expensive drugs, procedures and sanatoriums do not have to spend their money, they will pay for the fund of the media. Maximum pay back to the sanatorium.
- People's methods of treating tuberculosis are a useless waste of money.
- Without the support of close people, it will be more difficult to be treated.
- No disease is a reason to stop contacts with the outside world and avoid communication.
Did you have a disease, which influenced lifestyle or attitude towards it? Share your story.
Pulmonary tuberculosis - This is an infectious pathology caused by Bacillus Koch, characterized by various clinical and morphological attitudes of pulmonary lesions. The variety forms of pulmonary tuberculosis determines the variability of symptoms. The most typical for the tuberculosis of the lungs respiratory disorders (coughing, hemoptal, shortness of breath) and symptoms of intoxication (long subfebilitation, sweating, weakness). Radiation, laboratory studies, tuberculiniyagnosis are used to confirm the diagnosis. Chemotherapy of pulmonary tuberculosis is carried out by special tuberculostatic preparations; In destructive forms, surgical treatment is shown.
Tuberculosis of the lungs is a disease of infectious etiology that occurs with the formation of specific inflammatory foci in the light of specific inflammatory foci and general-caution syndrome. The incidence of pulmonary tuberculosis has an ancient history: tuberculosis infection was also known to representatives of early civilizations. The former name of the disease "PHTISIS" is translated from the Greek denotes "Chakhotka, exhaustion", and the teaching about tuberculosis was called "phthisiatry".
To date, the pulmonary tuberculosis represents not only a biomedical, but also a serious socio-economic problem. According to WHO, every third inhabitant of the planet is infected with tuberculosis, mortality from infection exceeds 3 million people per year. Pulmonary tuberculosis is the most frequent form of tuberculosis infection. The proportion of tuberculosis of other localizations (joints, bones and spine, genital, intestines, serous shells, CNS, eye, leather) in the incidence structure is significantly lower.
Specific agents due to the infectious nature of the disease, serve mycobacterium tuberculosis (MBT). In 1882 Robert Koh first described the basic properties of the pathogen and proved its specificity, therefore bacterium received the name of his discoverer - Koch wand. Microscopically mycobacterium tuberculosis have the kind of straight or slightly curved fixed stick, 0.2-0.5 nm wide and a length of 0.8-3 nm.
A distinctive feature of the IBT is their high resistance to external influences (high and low temperatures, moisture, the effects of acids, alkalis, disinfectants). The smallest resistance of lung tuberculosis pathogens demonstrate to sunlight. For a person, the danger represent tuberculous bacteria of human and bull type; Cases of infection of the bird type of mycobacteria is extremely rare.
Ways of infection
The main path of infection with the primary tuberculosis of the lungs is aerogenic: from a patient with an open form of a person mycobacteria is distributed with mucus particles, highlighted in the environment during a conversation, sneezing, cough; Can dry and distribute with dust at considerable distances. In the respiratory pathways of a healthy person, the infection more often enters air-drip or dust.
A smaller role in infection is played by alimentary (with the use of infected products), the contact (using common hygiene and dishes) and the transplacent (intrauterine) path. The cause of secondary pulmonary tuberculosis is the re-activation of the previously transferred infection or re-infection.
However, the MBT hit in the body does not always lead to the disease. Factors, against which tuberculosis of the lungs develop especially often, are considered:
- Unfavorable social consumer conditions
- Smoking and other chemical dependencies
- Immunosuppression (HIV infection, intake of glucocorticoids, condition after organ transplantation)
- Oncological diseases, etc.
In the risk group on the development of pulmonary tuberculosis are migrants, prisoners, persons suffering from narcotic and alcohol addiction. The virulence of infection and the duration of contact with a sick person is also important.
With a decrease in local and general protection factors, mycobacteria is freely penetrated into bronchiols, and then in the alveoli, causing specific inflammation in the form of individual or multiple tuberculous tuberculos or foci of cotton necrosis. During this period, a positive reaction to Tuberculin - a turn of tuberculin sample appears. The clinical manifestations of the pulmonary tuberculosis at this stage often remain unrecognized. Small hotels can be dissipated independently, scarring or conquered, but MBT in them remains for a long time.
The "awakening" of infection in old tuberculosis foci occurs when a collision with exogenous superinfection is either under the influence of adverse endo- and exogenous factors. Secondary pulmonary tuberculosis can occur in an exudative or productive form. In the first case, peripocal inflammation develops around the initial focal; In the future, infiltrates may be decayed, melting with rejection of caseometric masses and the formation of a cavern. With productive forms of the tuberculosis process, connective tissue grows in the lungs, which leads to pulmonary fibrosis, the deformation of the bronchi, the formation of bronchiectasis.
Primary pulmonary tuberculosis is the first developed infiltration of lung tissue in individuals who do not have specific immunity. Diagnosed mainly in children's and adolescence; Less often arises from senior and elderly people who, in the past, transferred a primary infection ending with complete cure. Primary pulmonary tuberculosis can take a form:
Secondary pulmonary tuberculosis is developing with repeated contact with MBT or as a result of reactivation of infection in the primary focus. The main secondary clinical forms are presented:
Separately distinguish between coni-tuberculosis (tuberculosis, developing against the background of pneumoconiosis), tuberculosis of the upper respiratory tract, trachea, bronchi; Tuberculous pleurisy. When the MBT patient is released into the environment with sputum, the open form (VC +) of the lung tuberculosis is mentioned; In the absence of bacillos - about closed form (VK-). It is also possible periodic bacillos (VC ±).
The flow of pulmonary tuberculosis is characterized by a consistent replaceable phase of development:
- 1) infiltrative
- 2) decay and saming
- 3) rallying
- 4) seals and ordinary seals.
Light tuberculosis symptoms
Primary tuberculosis complex
The primary tuberculosis complex combines signs of specific inflammation in light and regional bronchigag. It may be asymptomatic or under mask of colds, so mass screening of children (manta) and adults (preventive fluorography) contribute to the detection of primary lung tuberculosis.
The subacute occurs more often: the patient is worried about dry cough, subfebilitation, fatigue, sweating. Under the acute manifestation of the clinic reminds nonspecific pneumonia (high fever, cough, chest pain, shortness of breath). As a result of treatment, the PTK (center of Gon) occurs. In adverse cases, casomic pneumonia can be complicated, the formation of a cavern, tuberculous pleurite, miliar tuberculosis, dissemination of mycobacteria with the defeat of the kidneys, bones, brain shells.
Tuberculosis of intragenic lymph nodes
With tuberculosis, VGU symptomatics is due to the compression of large bronchial and mediastinal organs with increased lymph nodes. For this form, a dry cough is characterized by a dry cough, an increase in cervical and axillary nodes. In early age children often arises difficult to exhale - expiratory string. The temperature is subfebrile, there may be febrile "candles".
Signs of tuberculosis intoxication include the absence of appetite, a decrease in body weight, fatigue, skin pallor, dark circles under the eyes. An extension of the venous network on the skin of the chest can indicate the venous stagnation in the chest cavity. This form is often complicated by the tuberculosis of bronchi, segmental or equity atelectasis of lungs, chronic pneumonia, exudative pleuritis. In the breakthrough of casomic masses from lymph nodes through the wall of the bronchi, pulmonary foci of tuberculosis can be formed.
Focal Light Tuberculosis
The clinical picture of the focal tuberculosis of Malosimptom. Cough is missing or rarely occurs, sometimes accompanied by the release of poor sputum, pain in the side. In rare cases, hemochkali is noted. More often, patients pay attention to the symptoms of intoxication: non-permanent subfebilitation, malaise, apathy, reduced performance. Depending on the limitations of the tuberculosis process, fresh and chronic focal tuberculosis of the lungs are distinguished.
The flow of focal tuberculosis of the lungs is relatively benign. In patients with impaired immune reactivity, the disease can progress into destructive forms of lung tuberculosis.
Infiltrative pulmonary tuberculosis
The clinical picture of the infiltrative tuberculosis of the lungs depends on the value of infiltrate and can vary from non-space of pronounced symptoms to an acute feverish state resembling flu or pneumonia. In the latter case, there is a pronounced high body temperature, inges, night sweats, general weakness. From the side of the respiratory, it is worried about cough with a wettero and streaks of blood.
In the inflammatory process with infiltrative form of the pulmonary tuberculosis, pleura is often involved, which causes the appearance of pain in the side, pleural effusion, the lag of the affected half of the chest during breathing. Complications of infiltrative tuberculosis of the lungs can be caseometric pneumonia, atelectasis of lung, pulmonary bleeding, etc.
Disseminated lung tuberculosis
It can manifest in acute (miliary), subacute and chronic form. The typhoid form of miliar tuberculosis of the lungs is distinguished by the predominance of intoxication syndrome over bronchopulmonary symptoms. It begins acutely, from the rise of temperature to 39-40 ° C, headaches, dyspeptic disorders, harsh weakness, tachycardia. When strengthening toxicosis, a violation of consciousness may occur, nonsense.
With the pulmonary form of milling tuberculosis of the lungs from the very beginning, respiratory disorders, including dry cough, shortness of breath, cyanosis, are more pronounced. In severe cases, acute cardiovascular failure is developing. Meningkeal form corresponds to the symptoms of brain shells.
The subacute flow of disseminated pulmonary tuberculosis is accompanied by moderate weakness, decrease in working capacity, deterioration of appetite, weight loss. Episodically arise the rise raises. Cough productive, not very worried about the patient. Sometimes pulmonary bleeding becomes the first sign.
Chronic disseminated pulmonary tuberculosis in the absence of aggravation asymptomane. During the outbreak of the process, the clinical picture is close to the subacute form. Disseminated lung tuberculosis is dangerous by the development of extrapulic tuberculosis, spontaneous pneumothorax, heavy pulmonary bleeding, amyloidosis of internal organs.
Cavernous and fibrous cavernous pulmonary tuberculosis
The nature of the flow of the cavernous tuberculosis process is wave-like. Inxication symptoms, hyperthermia increase in the decay phase, the cough is enhanced and the amount of sputum increases, hemochkali occurs. The tuberculosis of bronchi and nonspecific bronchitis are often joined.
Fibrozno-cavernous pulmonary tuberculosis is distinguished by the formation of a cavity with a pronounced fibrous layer and fibrous changes in the pulmonary fabric around the cavity. It flows for a long time, with periodic exacerbations of general infectilation symptoms. With frequent outbreaks, respiratory failure of II-III degree develops.
Complications associated with the destruction of pulmonary fabric are profuse pulmonary bleeding, bronchiploral fistula, purulent pleurisy. The progression of the cavernous tuberculosis of the lungs is accompanied by endocrine disorders, cachexia, amyloidosis of the kidneys, tuberculous meningitis, cardiovascular failure - in this case, the forecast becomes unfavorable.
Cyrrotic lung tuberculosis
It is the outcome of various forms of pulmonary tuberculosis with incomplete involution of a specific process and development at its place of fibrous-sclerotic changes. With pneumatic crims, bronchi is deformed, the lung is sharply reduced in size, the pleura is thickened and often occasional.
Changes occurring in the cirrotic tuberculosis of the lungs cause leading symptoms: pronounced shortness of breath, pulling chest pain, cough with purulent wet, hemoptysis. In exacerbation, signs of tuberculosis intoxication and bacillos are joined. The characteristic external sign of the pneumocyrosis is the sealing of the chest on the side of the lesion, the narrowing and the accuracy of intercostal intervals. With a progressive flow, a pulmonary heart is gradually developed. Cyrrotic changes in the lungs are irreversible.
It is an encapsulated case-plated focus that has formed in the outcome of the infiltrative, focal or dismissed process. With a stable flow, the symptoms do not occur, the formation is detected during the radiography of the lungs by chance. In the case of progressive tuberculosis, intoxication increases, subfebilitation appears, breast pain, cough with a sputum separation, possibly hemoptal. When decaying the focus of tuberculosis can be transformed into a cavernous or fibrous-cavernous pulmonary tuberculosis. Less often notes regressing the flow of tuberculos.
The diagnosis of one or another form of lung tuberculosis is exhibited by a phthisiatre physician based on the totality of clinical, radiation, laboratory and immunological data. To recognize secondary tuberculosis, detailed analysis of anamnesis is of great importance. To confirm the diagnosis is carried out:
- Radiation diagnosis. The lung radiography is a mandatory diagnostic procedure that allows you to identify the nature of changes in the pulmonary tissue (infiltrative, focal, cavernous, disseminated, etc.), determine the localization and prevalence of the pathological process. The identification of calcined foci indicates a previously transferred tuberculous process and requires clarification of data using CT or MRI of the lungs.
- Analyzes. The detection of MBT is achieved by a repeated range of sputum (including with PCR), washing waters of bronchi, pleural exudate. But by itself, the fact of the absence of bacillos is not a reason for eliminating the pulmonary tuberculosis. Modern immunological tests allow you to reveal a tuberculosis infection with almost a 100% probability. These include Quantiferon and T-spot. TB.
- Tuberculinidiagnosis. The methods of tuberculinidiagnosis include diaskin-test, cake and manta samples, however, these methods can give false results. Sometimes, to confirm the pulmonary tuberculosis, it is necessary to resort to test treatment with anti-tuberculosis drugs with an estimate of the dynamics of the X-ray picture.
According to the results of the diagnosis of pulmonary tuberculosis, the lungs are differentiated with pneumonia, sarcoidosis of the lungs, peripheral lung cancer, benign and metastatic tumors, pneumonicosis, lungs, abscess, silicosis, abnormalities of the development of lungs and vessels. Additional methods of diagnostic search may include bronchoscopy, pleural puncture, lung biopsy.
CT OGK. Kavern in the S3 top lobe of the left lung.
Treatment of lung tuberculosis
In phthisiatric practice, an integrated approach to the treatment of pulmonary tuberculosis has been formed, including drug therapy, surgery and rehabilitation activities. The treatment is carried out in stages: first in the toy, then in the sanatoriums and, finally, outpatient. Prior moments require the organization of therapeutic nutrition, physical and emotional rest.
- Anti-tuberculosis therapy. The leading role is assigned to specific chemotherapy with anti-tuberculosis drugs. For therapy of various forms of lung tuberculosis, 3, 4 and 5-thicomponent schemes are developed and used (depending on the amount of drugs used). The first line tuberculostatics (obligatory) include isoniazide and its derivatives, pyrazinamide, streptomycin, rifampicin, ethambutol; The means of the second row (optional) are aminoglycosides, fluoroquinolones, cycloserine, ethionamide, etc. Methods of administration of drugs are different: orally, intramuscularly, intravenously, endobrocyal, intravenously, inhalans. Courses of anti-tuberculosis therapy are carried out for a long time (on average 1 year and longer).
- Pathogenetic therapy. The pulmonary tuberculosis includes the reception of anti-inflammatory funds, vitamins, hepatoprotectors, infusion therapy, etc. In the case of drug resistance, intolerance of anti-tuberculosis funds, collapsotherapy is used at pulmonary bleeding.
- Surgery. With appropriate indications (destructive forms of pulmonary tuberculosis, empyema, cirrhosis, and a number of other), various operational interventions are used: cullotomy, thoracoplasty, pleuractomy, leaving of the lungs.
The prevention of pulmonary tuberculosis is an essential social problem and a priority state task. The first step on this path is the mandatory vaccination of newborns, children and adolescents. With mass surveys in preschool and school institutions, the formulation of intradermal tuberculin samples of Mantu is used. The screening of the adult population is carried out by carrying out prophylactic fluorography.