Tuberculosis of lungs disseminated: symptoms and treatment

A very unpleasant and deadly disease of pulmonary tuberculosis exists on the Millennium Earth, as evidenced by archeological excavations and multiple historical documents. In the modern world, it annually takes in the ranks of its victims about 10 million people, 25% of whom die.

The most unpleasant form of the disease is pulmonary tuberculosis disseminated, which means multifocal, "diffuse" in all lungs. It is very easy to catch an infection, because the ways of its transmission are unusually simple, and the symptoms at the initial stages are almost invisible. In fact, every one of us is at risk of contracting the virus every day, but, fortunately, not every TB organism can develop. If you still have a terrible diagnosis, do not despair, because now science has gone so far as to completely cure even disseminated pulmonary tuberculosis is quite possible. For this it is necessary not to shy away from preventive examinations and scrupulously fulfill the appointments of the treating phthisiatrician. They say that knowing the strengths and weaknesses of the enemy is already 50% of the victory. So let's figure out what TB is, where it comes from and how to fight it.

Kokh sticks

Disseminated tuberculosis of the lungs cause microscopic living organisms, the so-called mycobacteria. They exist on the planet for millions of years, but were discovered only in 1882 by the physician and scientist Koch, in honor of which they were named - Kokh sticks. In total, pathogenic mycobacteria (abbreviated ICD), there are 74 varieties, 6 of which are capable of causing tuberculosis in humans and animals. Chopsticks were named because of the appearance, really rod-like. Some mycobacteria are ideally even, some slightly curved, both of which have a length of 1 micrometer to 10 and a width of about 0.5 microns.

A unique feature of them is the structure of their walls, or shells. Without going into details, we note that it allows Koch's rods to allow them to mutate an infinite number of times, defend themselves against the killer parasites for the work of antibodies, and steadfastly resist unfavorable environments. They successfully use even bacteriophages, the meaning of which is to protect our body from parasitic microorganisms. Being absorbed, Koch's rods do not perish, but modify the macrophages so that they can multiply easily in them and at the same time be inaccessible to the protective systems of their host. In other words, Koch's rods use the cellular defense of our body for implantation into it.

Once in the lungs of a healthy person, these parasites first form single foci (primary tuberculosis), but afterwards with blood and / or lymph spread to a large area of one or both lungs and other respiratory organs, thus developing pulmonary tuberculosis disseminated. Under certain circumstances, it can develop even after the primary tuberculosis treatment, since Koch's sticks remain in the body for many years in an inactive form.

Ways of infection

Tuberculosis of the lungs in humans is caused by three types of bacteria - M. tuberculosis (human subspecies), M. africanum (subspecies in between) and M. bovis (animal subspecies). The latter is more often sick with cattle, and the person is passed on with unpasteurized milk.

Many are wondering whether disseminated pulmonary tuberculosis is contagious or not. The answer is unequivocal: it is very contagious if it passes with the allocation of Koch's rods (tuberculosis bacteria).

They fall from a sick person to healthy so far unusually simple:

- they can be inhaled with air;

- with saliva (for example, when coughing, kissing);

- through the dishes that the patient used;

- through household items;

- from the mother to the fetus;

- when using not enough sterile medical instruments.

As you can see, you can get tuberculosis anywhere: in transport, in public places, in educational institutions, at work, and so on.

Important: Koch's sticks are fantastically tenacious. They retain their dangerous properties outside the human body for a very long time. Here are a few examples of how many Koch sticks live in the environments that we encounter every day:

- in a dark place without sunlight - up to 7 years;

- in the dried up sputum of the patient (remaining on any subjects) - up to 1 year;

- in the dust on the street - up to 60 days;

- on the pages of printed books - up to 3 months;

- in water - about 150 days;

- in unboiled milk - about 14 days;

- in cheese (butter) - up to a year.

Is it possible to negatively answer the question whether disseminated pulmonary tuberculosis is contagious or not? Perhaps, Koch's rods, present in the environment, are easily amenable to destruction? Unfortunately, these mycobacteria kill quite uneasy. Due to their unique cell wall, they practically do not suffer from sunlight, ultraviolet, alcohol, acetone, acids, alkalis, many disinfectants, dihydrates, and for boiling objects with infected sputum they do not die for 5 minutes. If Koch's rods could develop in the body of any person, all inhabitants of planet Earth would be sick with tuberculosis.

Risk groups

Even at preschool age, most babies pick up Koch's rods, but pulmonary tuberculosis is disseminated or any other develops only in weakened, sickly children. Also to the risk group are:

- persons who have been in close contact with tuberculosis patients for a long time;

- people with low immunity;

- HIV-infected;

- taking immunosuppressants;

- adolescents and middle-aged people in the period of hormonal adjustment;

- The starving;

- Skin and other organs suffering from tuberculosis;

- transferred infectious diseases;

- patients with primary pulmonary tuberculosis and treated;

- long-term passing some physiotherapeutic procedures (for example, quartz).

Classification

Tuberculosis of lungs disseminated can develop in the following ways:

1. With the bloodstream (hematogenous). In this case both lungs are affected. To get into the blood, bacteria can through the affected lymph nodes, foci of Gon, through the right heart and pulmonary veins.

2. With lymph (lymphogenous). In this case one lung is affected.

3. Lymphohematogenous.

By the nature of the disease, pulmonary tuberculosis is disseminated in the following forms:

- Acute (miliary);

- subacute;

- chronic;

Generalized. About this form of the disease is said, when for some reason in the blood vessels there is a breakthrough of the contents of the affected lymph node, the structure of which became cheesy (caseous). In this case, in the blood at the same time is a huge number of sticks Koch. Fortunately, this happens infrequently.

Acute form of tuberculosis

The disease begins abruptly, suddenly, the symptoms are very bright, a bit like pneumonia. The diagnosis is established on the basis of a hardware study of lung and microbiological sputum analysis. Acute disseminated tuberculosis of the lungs is characterized by the presence in the lung tissue of many small (about a millimeter) tubercles reminiscent of millet grain. Hence the second name is "miliary ( milae in Latin means" millet ") tuberculosis." The patient first changes the structure of the capillaries, collagen breaks down in them, and the walls become easily permeable, which leads to the penetration of mycobacteria from the bloodstream into the lungs. Symptoms are the following:

- a sharp temperature jump to the marks of 39.5-40 ° C;

- weakness, weakness, high fatigue;

- rapid pulse;

- lack of appetite;

- cyanosis of the lips and fingers;

- icterus of the skin;

- nausea before vomiting;

- headache;

- cough dry or with sputum, in which, in addition to mucus and pus there are bloody streaks;

- shortness of breath.

Sometimes there is a pronounced toxicosis, right up to loss of consciousness.

Subacute form of tuberculosis

It is observed when the disease spreads to large blood vessels (intra-lobular veins and interlobular arteries). In this case, foci are found up to 1 cm in diameter. They are located mainly in those segments of the lung where there are many capillaries and lymphatic vessels. By nature foci proliferative, without inflammation and tumors, but they can lead to inflammatory processes in the visceral leaf of the pleura.

Symptoms of subacute tuberculosis can resemble many other diseases, which complicates the setting of a clinical diagnosis. Among the main ones are:

- Fast fatigue, weakness;

- temperature around 38 ° C;

- cough with sputum discharge.

Chronic tuberculosis

This form of the disease is observed when the patient has not completely cured primary (fresh) tuberculosis. In such cases, mycobacteria repeatedly enter the new segments of the lungs with the help of blood flow or lymph flow, resulting in multiple foci of different sizes (from very small to fairly large), of different shapes and structures. They can be calcified and completely fresh, with a bright inflammatory picture. Foci are found in both lungs. A disappointing picture is added with emphysema, fibrosis of various tissues in the lungs, pleural scarring. Nevertheless, chronic disseminated pulmonary tuberculosis can not externally manifest itself in any way, in connection with which it is most often found in fluorography. Symptomatic of the chronic form of tuberculosis is this:

- increased fatigue;

- poor appetite;

- emaciation;

- frequent headaches;

- unreasonable rise in temperature (incidentally);

- cough.

Disseminated lung tuberculosis: phases

It used to be that the first phase of infection occurs in the upper lobes of the lungs, II - in the middle lobes, and III already reaches the lower lobes. In the future, this classification was recognized as incorrect, since the phases of development of this disease can equally occur in any segments of the lung. To date, there are such phases of pulmonary tuberculosis:

- focal;

- infiltration;

- decay;

- MBT + (open form of tuberculosis);

- MBT- (closed).

Disseminated pulmonary tuberculosis in the phase of infiltration of MBT + means the course of the disease with the release of mycobacteria into the environment. The main symptom is a cough with sputum, especially if there is pus and blood in it.

The focal phase is mainly characteristic of primary or fresh tuberculosis. It is characterized by the fact that only a couple or even one segment is affected. In this case, the size of the focus is small (up to 1 cm in diameter). This phase passes without symptoms and is detected, as a rule, with a hardware examination of the lungs (x-rays, fluorography).

Disseminated pulmonary tuberculosis: phase of infiltration and decay

Such a course of the disease is obtained if it is not detected in time (the patient shies away from the obligatory yearly performance of fluorography, does not consult the doctors at the first alarming symptoms, is engaged in self-treatment or uses folk remedies, usually not effective enough as the main treatment). The phase of decay means that the morphology of the foci in the lungs has reached a degree at which tissues began to disintegrate, forming the most real holes. Fragments of disintegrated tissues with a cough come out. They are sputum with impurities of pus and blood. These fragments also fall on segments of the lungs that are not yet susceptible to disease, as a result of which instantaneous contamination with mycobacteria occurs. Patients diagnosed with disseminated pulmonary tuberculosis in the phase of disintegration are a dangerous source of infection for others and are subject to mandatory hospitalization. Treatment in the hospital they have a long, up to six months. As a result, the destroyed foci heal (calcify).

The phase of infiltration is also observed in the progressing course of the disease, but in this case, the disintegration of lung tissue does not occur. In general, infiltration is a site (focus) in which there is an inflammatory process. To this place moves a lot of lymphocytes and leukocytes, and the symptomatology resembles acute pneumonia. Disseminated pulmonary tuberculosis in the phase of infiltration has the following symptoms:

- a sharp rise in temperature to high marks;

- weakness, weakness;

- Pain in the chest;

- cough;

- signs of intoxication;

- headache;

- sometimes weakening of consciousness.

Without the rapidly begun treatment, the tissue decay begins at the site of infiltrates. The patient coughs them out or in the process of coughing moves to the second lung, where the infection of the former healthy tissues is very quickly. Tuberculosis in the phases of decay and infiltration is fraught with not only an increased risk of infection for others, but also a fatal outcome for the patient himself.

Diagnostics

It is not always easy to immediately determine the patient's disseminated pulmonary tuberculosis. Diagnosis is difficult because the symptoms of this disease and pneumonia, ARVI, even metastatic cancer are very similar. When a patient visits a clinic complaining of fatigue, coughing, pain in the larynx, weakness, dyspnea, the doctor is obliged to inspect the skin for the presence of scars, which can remain from a previous paraproctitis, lymphadenitis. Also, the symmetry of the chest is examined (it is not present, if tuberculosis develops in one lung), the soreness and muscle tension in the humeral girdle is checked. When listening to the lungs, the stethoscope reveals whether there are wheezing, what are their localization and character. Laboratory studies of sputum for the presence of mycobacteria are mandatory. In some cases, patients are rushed to examine bronchial or gastric water (most often in children). In addition, laboratory studies may include:

- Bronchoscopy;

- microscopy of sputum;

- pleural biopsy;

- thoracoscopy;

- pleural puncture.

The most widely used and accurate are X-ray examinations.

Treatment and prognosis

If the doctor diagnosed "disseminated pulmonary tuberculosis", the treatment will be long and multifaceted. The prognosis depends on which phase the disease is diagnosed in and how accurately the patient complies with the prescriptions of the doctors. For any type of pulmonary tuberculosis in the phase of MBT + the patient is hospitalized. In the hospital, mainly conducted drug therapy (chemotherapy), consisting of anti-tuberculosis drugs, physiotherapy, vitamins that strengthen immunity.

Chemotherapy for newly diagnosed patients in the intensive phase of treatment is carried out with the following anti-tuberculosis drugs: Isiniazide, Rifampicin, Pyrazinamide and Etambutol, and in the continuation phase, Isoniazid and Rifampicin or Isoniazid and Etambutol ".

In acute disseminated tuberculosis, the use of corticosteroids and immunomodulators is indicated. Most often, prescribe "Prednisolone" (15-20 mg / day for 6-8 weeks).

Duration of treatment - up to 6 months. If within 3 months there is no tendency to improve, as well as for a number of other indications, surgical intervention consisting in the removal of a single pulmonary segment or lung as a whole is possible.

Now the newest method of treatment of tuberculosis, called "valve bronchial blocking", or simply "bronhoblokatsiya", which is an alternative to a surgical operation, is used.

Prevention

Tuberculosis of the lungs is considered a social disease, the distribution of which largely depends on the quality of life of the population (living conditions, migration, serving sentences in prisons, etc.). As preventive measures, especially for disseminated pulmonary tuberculosis, we can name:

- obligatory passage of fluorography;

- carrying out anti-epidemic measures;

- BCG vaccination;

- allocation by the state of means for treatment of patients with tuberculosis;

- conducting active (playing sports), a healthy lifestyle;

- the passage of patients full course of treatment for focal tuberculosis.