How to bury people with tuberculosis. Infectious danger of a dead body. Stephen Kemp, USA

If a person died of tuberculosis (open form), see?

Tuberculosis is transmitted airborne - by drip, the pathogen (Koch bacillus) is very stable in the external environment, but a number of factors are necessary for infection, otherwise everyone would have gotten sick. We see Koch's wand every day, in the same transport, in a store, just on the street, but not everyone gets sick. Imagine how much there is in tuberculosis dispensaries, but the medical staff working there are not sick. It is also important that a person has a vaccination against tuberculosis; everyone definitely received it in childhood, but some people have no reaction (no scar), negative reaction Mantoux, in this case it must be repeated in any of the clinics.

Infection with tuberculosis is possible due to the following factors:

Weakened immunity (hence people who are sick are at much greater risk of infection)
It is necessary to eat frequently (at least 3 times a day), this will also protect against infection.
Old people and children are at greater risk of infection due to their immune system. In the former it is already weakened, in the latter it is not yet fully formed.
It is imperative to wash your hands with soap before eating.

Following from the above, at the funeral young man The following recommendations should be followed:

Small children should not be taken to funerals
It is advisable for people who have a cold or are prone to frequent illnesses not to go, or to stay at a decent distance from the body of the deceased.
Be sure to eat before the funeral
Don't kiss the body of the deceased
Be sure to wash your hands before eating.
After the funeral, be sure to immediately remove clothing and wash at 90% temperature.

I think it's better not to come close to him. My ex-husband also died of tuberculosis. My son and I went to say goodbye and the doctor who was present at the funeral advised the child not to come close to the coffin. The tuberculosis bacillus is the most tenacious infection.

yes, you should be wary - the causative agent of tuberculosis is the Koch bacillus - it is very stable in the external environment... it would be advisable for you to thoroughly disinfect the entire room and get tested for tuberculosis at a tuberculosis clinic... you can take an x-ray of the lungs...

It’s still not leprosy or syphilis, it won’t stick instantly, follow the rules of hygiene and take care of your health. I got tuberculosis as a child, also contracted from a living carrier, but we communicated constantly and the disease manifested itself after pneumonia.

You can get infected, but if you kiss him on the lips, or somehow the saliva of the deceased gets on you, because tuberculosis is transmitted by airborne droplets, in other words, through saliva, so just do not touch the body of the deceased, do not drink from the container from which the deceased drank, in general, wherever you could avoid the saliva of the deceased and everything will be fine

PS the tuberculosis bacillus lives for a very long time, it’s worth getting rid of everything that the shrunken person used

I think you should stay away, and if possible, not go to the funeral or to his house. This is actually all very serious. I can advise his relatives to disinfect the premises. You can contact the city disinfection station.

In general, the relatives of the deceased would have to cremate the body so as not to endanger the participants in the mourning procedure. But if you have already decided to bury in a coffin, I would not touch the body, especially kiss it, and it is better not to attend the funeral dinner, especially if it is held at home and not in a cafe.

EXPERIENCE OF NOVOSIBIRSK CREMATORIUM

The articles of our foreign colleagues reflect the aesthetic moments of funerals - the demonstration of a dead body at ceremonies. In our practice controversial situations, described above, were practically non-existent. On the contrary, most funeral customers want to see the face of their deceased. It is a long-standing Russian tradition to spend the last moments at the coffin, and our specialists who prepare the deceased for funerals are highly qualified and will make the farewell at the coffin as safe and aesthetically pleasing as possible. The thanatopractitioners of the Novosibirsk crematorium professionally perform sanitary and hygienic preparation, embalming, create a beautiful face of the deceased for farewell, and special cases carry out high-quality facial reconstruction after an accident or other traumatic fatal situations.
Saying goodbye to the body at a closed coffin in a crematorium at the request of customers is a rare exception. For example, when, according to cultural traditions, the family of the deceased does not need to look at the dead body, or in situations where the body is so disfigured that relatives do not want to see their loved one in this state, but prefer to remember him alive.
The Novosibirsk crematorium has established a sanitary regime for farewell ceremonies, according to which there are cases in which the coffin is prohibited from opening.
Unfortunately, in the Russian Federation there are no sanitary and hygienic rules regulating the actions of funeral servants and employees of funeral homes when delivering the deceased to their home or to the funeral hall of a funeral home or crematorium. IN Russian legislation you can find documents regulating the procedure for examining corpses, autopsies and forensic medical examinations, instructions for the anti-epidemic regime of pathology departments. They contain information about the mandatory use of precautionary measures when receiving, examining and storing corpses that are suspected of having particularly dangerous infectious diseases (DID).
For example, there are “Instructions for organizing work and observing the anti-epidemic regime by pathological departments and forensic medical examination bureaus in cases of suspicion or detection of particularly dangerous infections" dated December 12, 1978? It prescribes an algorithm for working with corpses that have shown signs of acute infectious diseases, when during work more attention is paid to protective equipment, rules for collecting and storing corpse material and disinfection of premises, up to the involvement of teams of sanitary-epidemiological or disinfection stations when the disease is epidemic or endemic in nature and emergency safety measures are taken. The same instructions also contain special rules for preparing a corpse for delivery and burial.
Let me note that this is an algorithm for special infectious regimes, although today the question is controversial as to how dangerous modern infections and viruses that were not a global health problem when they were created this instruction(1978). We are primarily interested in what hygienic safety measures should be observed by funeral servants, relatives receiving the dead in the morgue for burial in ordinary cases, when during their lifetime they had tuberculosis, pneumonia, hepatitis, AIDS, etc. If a dead body can conceal themselves an infectious threat in the morgue, why didn’t any of the legislators pay attention to the infectious safety of funerals? This is where the reason for the occurrence of typical occupational (nosocomial) diseases of mortuary and funeral workers who do not observe personal hygiene and sanitary safety measures lies.

SANITARY RULES AND STANDARDS SANPIN 2.1.1279-03
INSTRUCTIONS
on the organization of work and compliance with the anti-epidemic regime by pathological and anatomical departments and the forensic medical examination bureau in cases of suspicion or detection of particularly dangerous infections (extractions)
II. Corpse toilet
Upon completion of the autopsy, the chest and abdominal cavity it is necessary to insert gauze, cotton wool or rags moistened with a disinfectant solution, add dry bleach or chloramine. The corpse is carefully stitched up in the usual way, wiped with a disinfectant solution, dressed in accordance with the requests of relatives, wrapped in a sheet soaked in a disinfectant solution, and placed in a coffin, on the bottom of which a layer of bleach 10 cm thick is poured. The inside of the coffin is lined with medical oilcloth. The seams of the upholstery should be on the side walls of the coffin and applied from top to bottom to prevent liquid leakage. The same amount of bleach is poured on top of the corpse. The coffin lid is nailed down. When buried without a coffin, the corpse is washed with a disinfectant solution and, in accordance with national customs, wrapped in cloth or felt, which must be soaked in a disinfectant solution.
V. Tactics in case of accidental discovery of particularly dangerous objects at autopsy infectious diseases, when an “accident” occurs during an autopsy and during the exhumation of a corpse
If the suspicion that the patient’s death resulted from a particularly dangerous infectious disease arose during the autopsy, measures are taken to prevent infection of personnel and the possible spread of infection into the environment.
All autopsies performed in the hall are temporarily suspended. The suspicious corpse is covered with a sheet not soaked in disinfectants. Close windows and vents. Stop the flow wash water V sewer network, the latter are collected in containers with disinfectant solutions placed under the sectional table.
Those present at the autopsy, with the exception of those who performed the autopsy, are removed to adjacent rooms without the right to leave the morgue. It is prohibited to enter the sectional room without protective clothing.
The head of the department or chief physician is notified of any suspicion that has arisen. medical institution or his deputy and local health authorities (according to subordination), who call consultants from anti-plague institutions or departments of especially dangerous infections of sanitary and epidemiological stations.
VI. Transportation and burial of corpses
A specialist autopsying a corpse that has raised suspicion of a particularly dangerous infection determines whether there was any contact of infectious material with the skin of exposed parts of the body and mucous membranes. If there is a suspicion that infectious material has entered the mucous membranes, the latter are immediately treated with a solution of antibiotics appropriate for the infection.
General management and responsibility for proper transportation, burial of corpses, and subsequent disinfection are assigned to the sanitary and epidemiological service of the region, district, city.
In cases where the diagnosis of a particularly dangerous infectious disease is beyond doubt, the corpse is not given to relatives and is buried in compliance with the requirements of the anti-epidemic regime.
If the diagnosis is in doubt and requires bacteriological confirmation, you can do two things:
1. Without waiting for results bacteriological research, bury the corpse in accordance with the requirements of the anti-epidemic regime, without releasing it to relatives.
2. Delay the burial until the results of the bacteriological examination are obtained, ensuring complete isolation of the corpse and its safety. At negative result bacteriological examination - release the corpse for normal burial, if positive result- bury the corpse in accordance with the requirements of the anti-epidemic regime.
To dig graves, transport, and bury the corpse, a burial group is assembled, including at least 3-5 people with the participation of workers from disinfection stations, disinfection departments, anti-plague institutions, and departments of especially dangerous infections of sanitary and epidemiological stations. The group is carefully instructed on the procedure for carrying out work, the features of burial, the rules for using a protective suit, and strict adherence to personal preventive measures.
Persons transporting a corpse to the burial site, if plague, anthrax are suspected, pulmonary form sapas wear a type I anti-plague suit; if cholera, smallpox, melioidosis and other forms of glanders are suspected - a type II anti-plague suit.
The corpse is usually transported to the burial site in a coffin. IN exceptional cases When there is no coffin, it is possible to transport the corpse wrapped in medical oilcloth (a bag made from it).
Transportation of corpses to the burial site is carried out using any type of transport that can be easily disinfected. The most convenient are ambulance vehicles of the UAZ-452 “A” type.
Burial is carried out in a coffin on common cemeteries. Burial without a coffin is permitted in exceptional cases. When buried without a coffin, the corpse, dressed in accordance with national customs, must be wrapped in a sheet generously moistened with a disinfectant solution. The presence of relatives at the burial is possible, provided there is no contact with the corpse.
For burial, a grave is dug 2 m long, 1 m wide, 2 m deep, and a 10 cm thick layer of bleach is poured onto the bottom. Bleach is poured onto the coffin, lowered into the grave, in a layer of 10-15 cm. The grave is covered with earth.
If the autopsy was carried out at the edge of the grave, the first to be dumped is the soil from which the autopsy mound was made, mixed with bleach.
To carry out all burial work, in addition to protective clothing, it is necessary to have shovels, ropes, a hydraulic remote control, buckets (2 pcs.), canisters or flasks with water, dry bleach, Lysol, chloramine, oilcloth bags for transporting protective clothing soaked in disinfectant solutions .
At the end of the burial, tools, protective clothing, transport, etc. disinfected on site in the prescribed manner. Persons who took part in the burial are subject to medical supervision for the period of incubation.

Sanitary rules of the Novosibirsk crematorium
At the beginning of our activities, we did not have practical skills, but we assumed that when working with corpses it was necessary to observe a special sanitary regime in addition to the mandatory treatment of premises with disinfectants and bactericidal UV installations. We consulted with employees of morgues and funeral homes, observed their work in Russia and abroad. We concluded for ourselves that we shouldn’t wait for Russia’s chief orderlies to think about the problem of funeral safety and the fact that viruses and bacteria are rapidly evolving. The Novosibirsk crematorium developed sanitary rules for the enterprise, on the basis of which our managers engaged in order acceptance services explain to their clients why they will have to say goodbye at a closed coffin. There are those who do not agree with our rules and demand to show a legislative justification. Even with the diagnosis of the deceased “Open form of tuberculosis,” they say with notes of complaint: “We looked after him for a year and did not become infected...”. In such cases, we have to prove that we have no right to risk the health of funeral servants, thanatopractors, masters of ceremonies, and other visitors to the crematorium.
From the first days of the crematorium’s operation, we developed a productive relationship with the chief sanitary doctor of the Novosibirsk region (now the head of the Rospotrebnadzor Office for the Novosibirsk region) Valery Nikolaevich Mikheev, who allowed us to call him for consultations at any time of the day if necessary. There were several such cases. For example, the crematorium workers were alarmed and did not know how to organize a farewell ceremony for relatives arriving from China with a passenger on a transcontinental flight who had died of bird flu. After consultations with V.N. Mikheev, the crematorium workers showed will, literacy and tact in carrying out the ritual.
Another such case was associated with the funeral of an HIV-infected deceased, when relatives insisted that the farewell must be with an open coffin. On the face of the deceased there was an extensive disintegrating tumor and weeping deep wound. And although, according to V.?N. Mikheeva, AIDS does not fly through the air, it was strongly recommended that relatives be denied farewell with an open coffin. Admittedly, in most cases, a tactful and firm warning about the potential danger of an infected person dead body for those who say goodbye, they perceive it with understanding.

FROM THE ORDER OF OPERATIONS OF THE NOVOSIBIRSK CREMATORIUM
2.8. Sanitary and hygienic requirements.
2.8.1. If the deceased had tuberculosis, pediculosis, viral diseases, putrefactive changes or a strong cadaveric odor, in order to ensure sanitary and hygienic safety, the farewell ceremony should be held near a closed coffin.

INTERNATIONAL SOCIETY FOR INFECTIOUS DISEASES (ISID)
In 2002, the International Society for infectious diseases(ISID) has released the second updated edition of the Guide to infection control in the hospital." 49 authors from 13 countries took part in the preparation of the manual, translated into many languages of the world. The book examines the significance and epidemiology of nosocomial infections, as well as the basic principles of infection control in health care institutions. The Russian translation of the publication was released in 2003. It was a long-awaited treatise, about which Professor L. S. Strachunsky, President of the Interregional Association for Clinical Microbiology and Antimicrobial Chemotherapy of Russia (IACMAC), scientific editor translation writes in the preface: “Despite the significant progress of medicine, the problem of nosocomial infections (NI) remains one of the most pressing. The increase in the incidence of NI is associated with an increase in the frequency of invasive procedures, the spread of multidrug-resistant bacteria, and changes in the structure of the patient population. Official statistics indicates that in developed countries, NI develop in 5-10% of hospitalized patients and lead to increased hospitalization, mortality and treatment costs. In Russia, about 60 thousand cases of NI are registered annually, although their estimated number is 2.5 million.

Nosocomial infection is any clinically recognizable infectious disease that develops in a patient as a result of his seeking treatment or stay in a hospital, as well as any infectious disease of a hospital employee that develops as a result of his work in this institution, regardless of the time of onset of symptoms (after or while in hospital). In our case, we mean morgues, funeral homes and crematoria.

Adhering to the principles of infection control is critical to solving the problem of NI. In this regard, the International Society of Infectious Diseases (ISID) has issued Guidelines for Infection Control in Hospitals. It is addressed to a wide range of specialists and will be useful in their daily work not only for medical workers, but also for specialists in the funeral industry.
This book has a separate section that reveals many of our previous theoretical assumptions and thanks to which we only strengthened our tough position in ensuring the sanitary regime in the Novosibirsk crematorium. Let me give you an example.
From the "Guide to Infection Control in Hospitals"
Chapter 42. Infectious hazards of cadaveric material (T.D. Healing, P. Hoffman, S.E. J. Young)
Key Point: Cadaveric material may pose a hazard to personnel handling it. None of the microorganisms that caused mass deaths in the past (causative agents of plague, cholera, typhoid fever, tuberculosis, anthrax, smallpox), cannot survive for a long time in buried corpses. The corpses of recently deceased people may be infected by various types, including those representing serious danger for others, pathogens that include mycobacteria, streptococci, enteropathogens, microorganisms that cause transmissible spongiform encephalopathies (for example, Creutzfeldt-Jakob disease), hepatitis B and C viruses, HIV, hemorrhagic fever viruses and, possibly, pathogens of meningitis and sepsis (especially meningococcal etiology).

TUBERCULOSIS
Tuberculosis microbacteria are resistant to environmental factors and can survive in soil, water, manure and other objects for several months and years.
The tuberculosis bacillus is most often transmitted by airborne droplets. Not only cough and sputum are dangerous, but also dust. In humid places without access to the sun, the causative agent of tuberculosis lives for months. Rarely, tuberculosis is acquired through food (milk or meat), water (if water bodies are contaminated with wastewater from tuberculosis hospitals or farms with sick livestock) or in utero. Sometimes tuberculosis becomes infected through wounds on the skin of people who dissect corpses or cut up meat carcasses.
The corpses of animals that died from tuberculosis and the affected organs of forcedly killed animals under certain conditions can also be factors in the transmission of the pathogen. In bodies and affected organs, Mycobacterium tuberculosis can survive for 2 months. up to 2 years. Rotting and decomposition of corpses has little effect on the causative agent of tuberculosis. Untimely removal of corpses and damaged organs of killed animals leads to contamination of the soil, pastures, and water bodies.

Known Facts
Corpses cremated to skeletal remains are not dangerous.
Remains of soft tissue from a corpse may pose an infectious hazard.
Theoretically, the possible danger of old corpses is associated with the anthrax pathogen, which can form resistant unfavorable factors disputes. However, it is unlikely; Moreover, people have low susceptibility to this type of infection.
The causative agents of most infections leading to fatal outcome, cannot survive for a long time after the death of the host organism.
Controversial issues
It was believed that the smallpox virus was able to survive in buried corpses. There is currently no convincing evidence for this theory. However, if the fact of infection of a corpse with smallpox cannot be ruled out, its exhumation should be carried out by persons vaccinated against this infection and with a pronounced post-vaccination scar. Vaccination against smallpox should not be specifically given to persons who will work with such a corpse. Development risk adverse reactions associated with vaccination significantly exceeds the theoretical risk of infection with a virus preserved in a corpse.
Practical recommendations
Table 42.1 When working with old and recently deceased cadavers, regardless of the type of pathogen theoretically present, the risk of infection can be significantly reduced by following these recommendations:
- Cover skin lesions and cut wounds waterproof bandages.
- Carefully handle any damage that occurs when working with cadaveric material.
- Observe the rules of personal hygiene.
- Use protective clothing (Table 42.1).
In most cases, sick patients pose a much greater danger than corpses, including people who have died from infectious diseases. In a living organism, the pathogen can multiply and be easily transmitted from person to person. In this regard, the patient can act as a source of infection for a long time. After the death of the host organism, most pathogens stop reproducing and quickly die.
Corpses of recently deceased people
Table 42.2 The range of diseases and microorganisms that can pose a danger to humans varies in different parts world, and includes tuberculosis, streptococcal infections, gastrointestinal infections, Creutzfeldt-Jakob disease (CJD), viral hepatitis, HIV infection, various viral infections(especially viral hemorrhagic fevers such as Lassa fever and Ebola) and possibly meningitis and sepsis (especially meningococcal etiology) (Table 42.2). Recently there were reports of two cases of tuberculosis infection during embalming of corpses. As with older cadavers, the use of appropriate protective clothing can significantly reduce the risk of infection, but for some infections additional precautions are recommended.

*Hygienic preparation - washing and grooming the body to improve the appearance of the corpse (an alternative to embalming);
package - placing the corpse in a plastic bag; inspection - the possibility of examining the body, touching it and having relatives stay near it before the burial procedure; embalming - introduction chemical substances, slowing down the process of decomposition of a corpse. Cosmetic preparation of the body of the deceased may be performed to improve the appearance of the corpse.

Most people rarely encounter the bodies of the dead, but in some life situations, in particular, during funeral rituals, one has to deal with the corpses of relatives or friends. Other people, due to their work, have to constantly come into contact with corpses, exposing themselves to the risk of infection. These include doctors (especially pathologists), nurses, funeral home workers, forensic pathologists, embalmers, funeral directors, clergy, emergency medical services personnel, and other individuals routinely involved in preparing bodies for burial and conducting funeral activities.

MEASURES TO REDUCE THE RISK OF INFECTION
Sectional events
Sectional events should be planned in such a way as to minimize the risk of infection of medical personnel working in them. It is mandatory to have an adequate ventilation system, running water and good sewerage.
Staff must wash their hands after each procedure and before eating (or before smoking).
The premises should be treated daily with phenol-containing disinfectants.
Instruments must be processed in a washing and disinfection chamber, autoclaved or immersed in a phenol-containing disinfectant solution for 20 minutes. There are several reasons why phenol-containing disinfectants are preferred over preparations containing hypochlorites.
Hypochlorite is corrosive and can cause damage to metal surfaces and tools. When using hypochlorite, chlorine gas is released, so when processing large areas the concentration of chlorine in the air may exceed permissible values.
In sections and rooms for embalming corpses, formaldehyde is often present. During chemical reaction Between hypochlorite and formaldehyde a strong carcinogen is formed - bis (chloromethyl) ether.

All instruments used for embalming and preparing the body for burial should be washed in hot water with detergent and disinfect, preferably by boiling for a short time (5 minutes), or immersing in a phenol-containing disinfectant solution for 20 minutes. To remove blood stains and splashes of any other body fluids, phenol-containing disinfectants should be used. To protect your hands from contact with blood or other body fluids, you must use disposable gloves. At the same time, latex gloves containing natural rubber, which can provide protection only for a short period - no more than 15 minutes, are categorically not recommended in thanatopractice. The most effective gloves for thanatopractice are nitrile gloves, widely used in European thanatoriums.
Always wash your hands thoroughly after finishing work.

Preparing corpses for burial
In many countries, especially those with hot climates, burial or other disposal procedures are carried out within 24 hours of death (for practical or religious reasons). In such situations, some pathogenic microorganisms may remain viable, therefore the wearing of appropriate protective clothing and/or good personal hygiene by persons handling corpses is extremely important.
Embalming can be one of the ways to temporarily preserve a corpse by reducing the activity of microorganisms and slowing down decomposition processes. Embalming corpses after accidents or autopsies is more complex procedure. Bodies may be severely damaged and pose a particularly high risk of infection due to the presence of damaged bones, bone fragments or bone fragments accidentally left in the body sharp objects, for example, needles. Cosmetic work on a damaged corpse is also dangerous.
In most cases, simple hygienic preparation of the corpse is sufficient, which, as a rule, is carried out by relatives of the deceased or church leaders. Typically this procedure involves washing the face and hands, dressing the corpse, combing the body's hair, and possibly trimming nails and shaving. With absence high risk infection acceptable and effective measure safety is the use of gloves and regular protective clothing.
In some cases where the cause of death is a highly contagious disease, such as Ebola or hepatitis B, even routine hygienic preparation of the corpse may not be safe. The list of such infections is given in Table 42.2.
Service staff emergency care The main infectious hazard for emergency personnel is blood. The risk of infection can be significantly reduced by preventing contact with blood through the use of gloves, face and eye protection, and, if necessary, protective clothing.
Corpses that have undergone decomposition, and especially bodies that have been in water for a certain period of time, pose a lower infectious risk. In such cases, the most likely detection will be microorganisms of the corpse's own flora and bacteria living in the water or living in the environment. Appropriate protective clothing should be worn to protect personnel handling such cadaveric material. In all cases, the bodies of the deceased should be transported to the mortuary in waterproof plastic bags or temporary fiberglass coffins. All cadaveric fluids are dangerous for personnel - blood, urine, any discharge from a corpse. Burial of corpses
Each society has its own traditions for burying corpses. These traditions should be respected as much as possible, although in some situations, such as deaths from highly contagious infections such as Ebola, cremation is the only safe procedure.
Sometimes, during natural or man-made disasters, it is not possible to follow normal burial procedures. Under these circumstances, the disposal of human remains must be done in a manner that does not expose an already stressed population to additional risk. Ideally, bodies should be cremated, but if this procedure is not possible, burying the corpses at least one meter deep (out of the reach of scavengers and pests) may be an acceptable alternative. Religious and social practices should be observed whenever possible. Disposal sites should be selected to avoid the risk of contamination of water sources.
I believe this excerpt from the Hospital Infection Control Guidelines is understandable and accessible form opens the eyes of any practicing funeral director or thanatopractor to unsafe working conditions. Therefore, these excerpts can be considered postulates and guidelines for action, although in our ranks there are still many who believe that “maybe it will blow away” and do not think about what the microcosm of bacteria and viruses inhabiting a dead body may turn out to be. I believe that hygienic factors play no less important role in the decision - to say goodbye at a closed or open coffin - than ethical and family motives.

Sergey YAKUSHIN, licensed thanatopraxist of the British Institute of Embalmers, London, German Institute of Thanatopraxy, Frankfurt

Laura asks:

Hello! Please tell me, my husband’s brother served 8 years in prison, came out, took pictures, and is now in prison. outpatient treatment at the tuberculosis dispensary, they prescribed him pizin, corsil and multivitamins, I’m very afraid for my 9-year-old child, since we go to visit his grandmother, and the patient lives with her in the village, we communicate from December 2012 to March 2013, 4 times in total 2 days. Tell me, is there a possibility of infection and what should I do? I called his doctor, she won’t say, citing confidentiality!

Answers:

Hello! Your spouse's brother is most likely sick closed form tuberculosis, and therefore does not pose a threat of infection to its environment. If you have contact with your husband's brother, there is no risk of infection for you and your child, because With the closed form of tuberculosis, there is no bacterial release into the environment. Be healthy!

Natalya asks:

Hello! My husband had an operation a year ago - pulmonary resection to remove tuberculoma in segments s1 and s2. It is already working, group 3 (clinical cure). What is the likelihood that the disease will return? His chest in the area of the suture hurts, he coughs (he is a long-time smoker and cannot quit), his body temperature does not rise.

Answers Gordeev Nikolay Pavlovich:

Hello, Natalia. With such a small surgical process, somewhere around 5-10%. He needs to regularly (1st year - 2 times, then 1 time/year) undergo laboratory and x-ray monitoring at the dispensary; eat enough (animal proteins at least 250g/day); beware of colds and, of course, don't smoke. Good health to you.

Daria asks:

Hello! My husband has disseminated tuberculosis right lung with decay (small, so the doctor said) The active phase of treatment lasted 4 months, the husband is diligently treated and feels well. Now there is an improvement in the image and he was transferred to the continuation phase of therapy for 3 months. During the entire period of treatment, the bacterium was not detected even once, neither in a smear nor in cultures. active phase treatment, my husband did not live with his family; when we saw each other, he was wearing a mask. All the children and I were examined, everyone is healthy. Is it possible for us to live together now, observing basic precautions?

Lyudmila asks:

Hello.
My mother-in-law was diagnosed with open tuberculosis. My husband stayed with her for 3 days (slept in the same room, ate together). He was given Mantoux, but he drank alcohol and it showed 19 mm. Fluorography is good. We have a small child, can he infect him? Can he visit his mother in the hospital and what precautions need to be taken?
Thank you in advance for your answer!

Natalya asks:

Hello. After being referred by a phthisiologist for a CT scan, my husband was diagnosed with infiltrative tuberculosis. Please tell me whether this form is cured permanently or is it lifelong. What threatens me and our children, 9 and 17 years old. What can I do to prevent them from getting infected?

Answers Strizh Vera Alexandrovna:

Natalia!
Tuberculosis is a curable disease. However, there are cases of infection with drug-resistant mycobacteria, which are difficult to treat. If the husband is treated as an inpatient, this significantly reduces the risk of tuberculosis in family members. You and your children need to take prophylactic anti-tuberculosis drugs

Natalya asks:

Good afternoon Tell me, please, a person with the initial stage (about 2 months) of a closed form of tuberculosis, who has been treated in a hospital for a month today, to what extent can he remain infectious? Is close contact with him dangerous?

Maria asks:

Is it possible to become infected with tuberculosis from a deceased person if he had open tuberculosis?

Answers Medical consultant of the website portal:

Hello Maria! Because the tuberculosis infection transmitted by airborne droplets, and a dead person does not breathe, does not cough or sneeze, it is quite difficult to get sick after ordinary contact with him (for example, as a result of attending a funeral). With close contact with the deceased, the development of the disease is possible. Take care of your health!

Sergey asks:

Hello! Is there a risk of getting infected in a TB clinic? I went there for a certificate and took a number in the wardrobe, and touched something else there. Even sick people could take numbers. Isn't it scary? After all, I then took on some personal things (phone, for example). Could bacteria remain on them? Or are there so few of them to infect an adult? I myself do not drink, do not smoke, I drive healthy image life. But I’ve been terribly afraid of the tuberculosis clinic since childhood). Is it possible to become infected through objects like this?

Manshuk asks:

Good afternoon Want to buy a private house in a village where a woman with an open form of tuberculosis lived for 40 years. Please tell me whether it is possible to buy this house and whether it is necessary to disinfect it? Help me please!

Answers Medical consultant of the website portal:

Hello, Manshuk! You need to contact the local sanitary and epidemiological station and agree on the final disinfection of the house. This will rid the house of the tuberculosis pathogen as much as possible. If there is an opportunity to buy another house, it is better to refuse to buy a house where a person with tuberculosis lived. Take care of your health!

007_fix asks:

Good afternoon Please tell me I am dating a young man who suffered from open tuberculosis. He has been treated since 2005... Every year he does fluorography to check the condition of his lungs good seams became smaller... While discussing the topic of tuberculosis, it turned out that my relatives did not have tuberculosis... I can continue to communicate and meet with this person... even if I want to give birth to a child from him, there is a possibility that the child may be born with this defect, if The young man does not have a congenital disease... Thanks in advance..

Answers Gordeev Nikolay Pavlovich:

Hello, 007_fix. If your young man has been cured of tuberculosis, is examined regularly (1-2 times a year), and during all this time he has not had a relapse, then he is considered a practically healthy (for tuberculosis) person. This disease is acquired and is not inherited. So you hold the cards, so to speak. Good health to you.

Lilia asks:

There was a woman living with my mother, today we found out that she has tuberculosis, she doesn’t say what extent, she hides it. I have two children, the youngest is 2.5 months old, without the BCG vaccine, but we didn’t go to see my mother often and didn’t have contact with the sick woman. Do my children have a risk of getting infected?

Ekaterina asks:

Hello!
I recently found out that my boyfriend is sick with tuberculosis, BC+, but the latest cultures do not show growth of MBT. However, BC+ is not being removed, and they say that it will not be removed for another year. He has been treated with isoniazid and other drugs since February 2008, they say that there are positive dynamics, that is, it seems that his office is sensitive to this drug. But in April or May we had contact with kisses, then from July 2008 too. Now I am taking a course of chemoprophylaxis with the same isoniazid. And I had a question: could it be that since he was treated, and during the course of treatment we had such close contacts, then my BMTs are now resistant and it is useless to prevent them with isoniazid?

Tuberculosis is an infectious process that has not lost its danger throughout the thousand-year history of mankind, second in importance only to plague and cholera.

If in the period 70-80 years Soviet medicine managed to keep the process of morbidity and treatment under control, then with the collapse of the preventive system of Soviet healthcare, the intensification of migration processes and the greater openness of the post-Soviet space, the situation noticeably worsened.

Today we no longer have to reassure ourselves with the thought that tuberculosis is a disease of antisocial segments of the population. Morbidity statistics show that any person, regardless of his income and nutritional status, with deficiencies in his immune defense, has every chance of contracting tuberculosis.

At the same time, a trend emerged in which the chances of the poor and the rich were equalized. Quite often, young, well-to-do mothers, weakened after childbirth, come to see us about pulmonary problems, which, upon examination, turn out to be one or another form of tuberculosis.

That is, today the morbidity situation has dropped to approximately the level of the beginning of the 20th century, when the intelligentsia suffered from tuberculosis no less often than the urban lumpen. Today, about 60 million people in the world are affected by tuberculosis.

Pathogen

Mycobacterium tuberculosis is also called Koch's bacillus or tubercle bacillus because it looks like a bacillus. It grows slowly on solid nutrient media, but quickly forms filmy formations on the surface of the liquid. The bacteria do not produce any toxins, so the moment of infection by them may well pass unnoticed without signs of intoxication.

As the rods multiply and accumulate in the body, allergic reaction on them with the introduction of tuberculin (positive or hyperergic Mantoux test). If a mycobacterial cell is eaten by a leukocyte-macrophage, then it may well live inside it, and then enter the bloodstream and cause the tuberculosis process. Also, similar to chlamydia, mycobacteria transform into L-forms, which, without reproducing, exist vegetatively inside cells.

Mycobacteria in the external environment

The infectious agent is resistant to almost all environmental factors:

Bacteria can live in water for six months
On the pages of books - about 3 months
At room temperature and humidity greater than 70%, mycobacteria can live for about 7 years.
If the dust contains the dried sputum of the patient, which produces bacteria, then they live for about 12 months.
In street dust with diffused lighting - 2 months, in the ground - up to six months.
In raw milk of sick cows, the sticks live for 2 weeks, in cheese and butter for up to 12 months.

When does Koch's bacillus die in the external environment?

Koch's bacilli only tolerate ultraviolet light poorly - bactericidal lamps kill them in 2-3 minutes, and direct sunlight in two hours.
When boiling in dried sputum, the death of microbes occurs after half an hour, in wet sputum - after 5 minutes.
Bacteria can be killed with chlorine-containing disinfectants within six hours.

Routes of transmission of tuberculosis

The majority of those infected receive mycobacteria aerogenously from people with tuberculosis.

Either by airborne droplets from a sick person (when talking, sneezing, coughing), or by airborne dust, inhaling the pathogen along with dust.
Contact-household path (with shared utensils, hygiene products, bed linen, towels) also remains relevant.
The food route, also called the nutritional route, is realized through food or water infected with sick people or animals (usually cattle). But today, cases of infection from sick cows are rare: unboiled milk and home-produced dairy products.
Rare routes of infection also include transplacental from mother to fetus.
Small children can become infected through contact; penetration of mycobacteria through the conjunctiva of the eyes is possible.

The risk of becoming infected is higher from a person secreting mycobacteria, and lower - from a patient with extrapulmonary forms of tuberculosis. How longer person is in the presence of mycobacteria and the higher their concentration in inhaled air, dust, water or food, the higher the likelihood of infection.

The pathogen in the body is captured by a leukocyte-macrophage. However, the fact of infection does not mean the development of the disease. Thanks to passive (after BCG) or own immunity, a person only carries mycobacteria within himself. Only when there is a failure in the immune defense does the inflammatory process begin to unfold.

Is tuberculosis transmitted through door handles?

You can become infected with tuberculosis by grabbing a doorknob after a patient has used it only if there is a dense layer of dust on the handle. The patient is excreting Koch's bacilli and coughed directly onto the handle before you picked it up. In other cases, this route of infection tends to zero.

It is also unlikely that you will become infected by shaking hands (except in cases where the bacilli excretor coughed into your fist, and you, having handled it, inhaled intensely, bringing your hand to your nose or mouth). In general, it’s a good idea to at least occasionally treat common areas (including door handles) with chlorine-containing products. detergents. By the way, alcohol and acids have no effect on mycobacteria. In addition to bleach, you can use hydrogen peroxide for disinfection.

What happens after infection?

Most often, infection occurs during childhood, but some people can become infected as adults. Since the main route of infection is aerogenic, the stick most often ends up in lung tissue directly under the pleura. Here it causes a focus of curdled necrosis, the size of a pinhead to a cherry. This element of inflammation was first described by the Prague professor Ghosn, in whose honor what was described was called Ghosn's focus.

Since in most cases there is an immune response to the mycobacterium, the lesion gradually closes, becomes saturated with calcium salts and turns into petrificate (small pebble). Such stones are often found during autopsies in people who did not have tuberculosis and died from other causes. This confirms the high incidence of tuberculosis in the population, as well as the dependence of the onset clinical manifestations and full-blown illness from the condition immune defense. That is, whether the disease develops after infection or not depends on the state of immunity of the infected person.

Closed tuberculosis: how is it transmitted

Closed tuberculosis is said to be when there is no isolation of mycobacteria during external environment. In this case, a person becomes ill with a closed form of tuberculosis who becomes infected with any of possible ways(most often aerogenic or household contact, less often food). The patient himself will not be able to infect anyone until his form of the disease leads to the destruction of the affected organ (usually the lung) and causes the release of Koch bacilli into the external environment with sputum, urine, and tears.

Open tuberculosis: how is it transmitted

Infection with open tuberculosis occurs in the same way as closed tuberculosis. At the same time, the patient releases mycobacteria into the outside world and is dangerous to others. When sputum is cultured, Koch's bacilli are detected in the analysis. Thus, patients with open form of pulmonary tuberculosis usually infect close relatives, colleagues or acquaintances big amount microbes with high virulence, resulting in the development of the primary tuberculosis complex.

Problems of modern phthisiology

Having achieved quite tangible results in curbing tuberculosis in the second half of the 20th century, specialists dealing with this infection (phthisiatricians) already from the late nineties began to face problems that were previously considered a closed issue.

A patient with an open form of tuberculosis (bacillus shedding) per year in the very normal mode capable of infecting from 15 to 20 people who do not live with him in the same living space and are not in close contact. That is, in transport, in a store, in the workplace.

What was and what is now

Taking this into account in Soviet period phthisiology in places of detention was of a forced-punitive nature; treatment of patients was mandatory and continued (if necessary, under the control of a local police officer) even after the release of the patient, that is, at his place of residence. A patient with an open form was entitled to extra square meters to reduce the risks for those who lived with him (and these meters were not always given out with difficulty).

Today, no one can force a citizen to undergo compulsory treatment for tuberculosis. A person can, of his own free will, interrupt therapy whenever he sees fit. Even if the patient was provided with TB care in places of deprivation of liberty (which today is not always and not everywhere), then after that he may refuse to continue treatment.

Using some TB drugs to treat other diseases

Sighing with relief after the introduction of anti-tuberculosis drugs, which provided a high percentage of cure rates, TB specialists were clearly in a hurry. Today, most of the drugs used no longer give such brilliant results, due to the adaptation of pathogens to them.

Rifampicin - the habit of some doctors or patients to resort to anti-tuberculosis drugs to treat other infections adds its two cents. So, having been treated a couple of times for staphylococcal furunculosis with rifampicin, you can forget about the anti-tuberculosis effect of this drug.

Fluoroquinolones - at all corners, phthisiatricians appeal to the wisdom of pharmacological companies, insisting on maintaining fluoroquinolones in the group of reserve antibiotics. Fortunately, in our country they are at least strongly discouraged from being used in pediatric practice. However, quite often doctors and pharmacists recommend fluoroquinolones for the most mild infections that are still sensitive to cephalosporins, penicillins or macrolides, as more effective (and expensive) drugs. Commercial gain, the desire to cure an infection without a hitch, leads to dire consequences, leaving a person without any chances in the future.

The problem of mycobacterial resistance

The problem of resistance is not limited to the gradual adaptation of Mycobacterium tuberculosis to known antibiotics. Today, cases where a person becomes infected with an already resistant bacterium have become a reality. That is, not exactly in the body of this patient the bacterium has acquired resistance, and has already arrived at it initially resistant. It is this sad fact that explains the beds in anti-tuberculosis hospitals, on which there are actually death row prisoners, for whom nothing can be fundamentally helped, but only to alleviate their suffering.

In addition, TB specialists are often faced with the problem of severe tolerability of treatment in patients with tuberculosis. Anti-tuberculosis drugs are very toxic and today, due to the massive allergization of the population (including drugs) and the presence of contraindications in patients to the use of one or another anti-tuberculosis drug, the course of treatment is delayed and the patient’s chances of a full recovery are reduced.

Increase in the number of destructive forms

This is another feature modern tuberculosis. Just 30-40 years ago, cavities and fibrinous decomposition of the lungs were impossible to show to students in dispensaries or hospitals. Today destructive tuberculosis is not uncommon. It is also worth noting that HIV-infected people in our country most often die from tuberculosis.

Difficulties in diagnosis

Tuberculosis is a very insidious, difficult to diagnose disease, since some of its forms are often disguised as other pathologies (see). Extrapulmonary forms of tuberculosis are especially difficult to diagnose, the symptoms of which are no different from nonspecific inflammatory processes in other organs (kidneys, joints, spine, The lymph nodes, genitals, etc.), instrumental methods diagnostics do not indicate the tuberculosis process with 100% accuracy, doctors in the general medical network are deprived additional methods specific diagnosis and often tuberculosis alertness.

Pediatric phthisiology also has a lot of problems

There is a huge number of tubi-infected children, whose parents categorically refuse preventive treatment, attending kindergartens and schools. At what point a child with a hyperergic Mantoux test will develop a detailed picture of the tuberculosis process, no one can say. How long it will take before turning to a TB doctor, making a diagnosis and isolating the baby from his own kind is also a matter of chance.

BCG vaccinations

The hysteria surrounding vaccination campaigns is idiocy. BCG has been, is being done and will be done by all reasonable pediatricians to children of reasonable parents (see the opinion of a candidate of medical sciences on the BCG vaccination and its consequences, as well as on Diaskintest and Mantoux - one does not replace the other). No one is calling for universal vaccination of all newborns indiscriminately.

There are certain contraindications and certain categories of children who should not be vaccinated in the first days after birth. For such children, there is a pediatric phthisiatrician and an immunological commission, which give their recommendations on the timing and rules of vaccinations.

But for a healthy child whose family does not have this moment patients with tuberculosis, BCG is a real chance, when faced with a tuberculosis infection, not to join the ranks of the hopelessly ill, getting off in the worst case mild form diseases. There is no need to rely on the fact that in the old days no vaccinations were given to children.

Firstly, then natural selection worked, and only the strongest with strong immunity survived,
Secondly, the incidence of tuberculosis among children cannot be even closely compared with the late Soviet and even present times.

In conclusion: tuberculosis is a dangerous disease with several routes of infection, and today it is almost impossible to completely eliminate contact with them. That is why the fight against tuberculosis should be aimed primarily at strengthening the body’s immune response.