How do you get infected with tuberculosis? Is the closed form of tuberculosis contagious? Tuberculosis is not contagious

– a disease transmitted primarily by airborne droplets. Like any other infection, it is highly contagious to others. But it all depends on what form of the disease the patient has - open or closed.

Once in the body, the tuberculosis pathogen spreads to different organs, but most often it settles in the bronchopulmonary system. In places of localization, the formation of specific tuberculous tubercles occurs. These are foci of cold inflammation, which are covered on the outside with a layer of connective tissue. It is believed that 80% of people are infected with mycobacteria. However, only a few of them get sick. So is pulmonary tuberculosis contagious or not?

There are 2 known forms of the disease:

• Closed, when the pathogen (mycobacterium tuberculosis) is inside the tubercles;
• Open, in this form, bacteria are released with tiny droplets of sputum during coughing or talking and can enter the body of a healthy person.

Is the open form contagious?

The open form of the disease is dangerous not only for the patient himself, but also for his environment. When the immune system cannot cope with the pathogen, large cavities - cavities - form in the lungs in place of the tubercles. Inside such a cavity, a cheesy tissue breakdown occurs; it is called caseous necrosis.

The phenomenon is based on the disintegration of the alveolar epithelium, while pieces of tissue of the lung and bronchial tree are released from the patient into the environment along with sputum. Is pulmonary tuberculosis contagious at this stage?

Yes. A patient with an open form of the disease is highly contagious to those people who have had close contact with him. Over the course of a day, one such person spreads billions of bacteria around him, which enter the body of a healthy person.

At the stage of decay of lung tissue, severe symptoms reminiscent of pneumonia appear. This:

• Hemoptysis;
• A hysterical cough with the release of purulent sputum;
• Chest pain;
• Temperature changes;
• Blue discoloration of the nasolabial triangle;
• Decreased skin turgor.

Most often, the infection spreads by airborne droplets, but there are also contact and nutritional modes of transmission. The tuberculosis bacillus has high “survivability” in the external environment; it remains virulent in dried sputum for 1.5 years.

Clothing, dishes, bedding, and personal hygiene items used by a sick person may contain viable tuberculosis bacteria. A person can become infected through saliva, which may be contained on a smoked cigarette. The infection is transmitted through a kiss.

Is the closed form contagious?

The infection, concentrated inside the tuberculous tubercles, remains dormant for a long time. The person does not realize that he is infected with tuberculosis. Sometimes he is bothered by weakness, a short-term dry cough, and mild chest pain. These symptoms are usually associated not with tuberculosis, but with a cold and overwork.

Mycobacteria begin to show activity under unfavorable conditions:

• After viral and infectious diseases, when the body is weakened;
• With insufficient nutrition;
• With smoking and alcoholism;
• If you have chronic lung diseases;
• For diabetes mellitus.

If a person's immunity is strong enough, he is able to control the disease. In this case, a person develops a closed form of tuberculosis.

Is a person with a dormant infection contagious or not? Until bacteria begin to be released into the environment, the patient is not a source of infection and is not contagious to his environment.

The closed form is characterized by:

• Absence of pathological changes on the radiograph;
• There are no obvious signs of illness;
• The tuberculin test shows a positive result;
• No tuberculosis bacilli are detected in sputum;
• Mycobacteria inside the body do not show activity.

Tuberculosis is not transmitted through shaking hands or using a shared toilet.

How dangerous is latent tuberculosis? It all depends on lifestyle and the state of immunity. Or the tuberculous tubercles become denser, covered with a capsule, and over time, calcifications form in their place. The infection does not spread throughout the body. In other cases, the disease progresses, then the closed form turns into open tuberculosis.

How not to get sick?

You can become infected with tuberculosis anywhere, especially where there are large crowds of people. To avoid getting sick, you need to follow simple rules:

• Wash your hands after visiting crowded places;
• Use only personal hygiene items;
• In public places, stay away from coughing people;
• Eat nutritiously; protein foods must be present in the menu;
• Undergo fluorography of the lungs annually;
• Lead a healthy lifestyle, spend more time in the fresh air, and do physical exercise;
• Do a Mantoux test as prescribed by a doctor;
• You should not smoke or drink alcohol.

Help to cope with mycobacteria:

• Sunlight, bacilli die under its influence in 2 hours;
• Boiling household items for 30 minutes;
• A quartz lamp, its radiation kills bacilli in a few minutes.

The room is ventilated daily and wet cleaned using chlorine-containing substances. Since bacilli are well preserved in dust, you need to wipe all places where it accumulates. The patient is provided with separate dishes and bed linen; these items cannot be used by other family members. When in contact with a sick person, you need to wear a mask and gloves.

If there is a threat of infection, a course of anti-tuberculosis drugs is prescribed. Preventive treatment is mandatory; it is necessary in order to stop the proliferation of bacteria that have entered the body.

Tuberculosis is considered one of the most serious pathological processes, methods of combating which have been developed over the course of more than a dozen years. It is important to have an idea of ​​how tuberculosis is transmitted, what are the factors influencing the development of the disease and what symptomatic manifestations it may be accompanied by. Let's try to understand the question of how tuberculosis can be transmitted.

Development factors

Many people are interested in how tuberculosis is transmitted from person to person? The disease tuberculosis occurs due to exposure to harmful bacteria - Koch's bacillus - on the body. The pathology is considered contagious, which requires healthy and infected people to pay special attention to their health. Infection of a healthy body occurs relatively quickly, and it is almost impossible to completely get rid of the disease. There is a special science that studies this disease. Based on the statistical data obtained, it was revealed that every third patient on the planet is infected with Koch’s bacillus, most of which are fatal.

Over the course of several decades, the study of the disease has been able to fully formulate the types of factors associated with the mechanism of transmission of tuberculosis, which can provoke the emergence and subsequent development of tuberculosis. The main virus - Koch's bacillus - is able to exist in almost any conditions. It is for this reason that the chances of overcoming it through the immune system are significantly low. However, despite the strength of their existence, bacteria have an extremely negative attitude towards exposure to direct sunlight. Since the external protection of the Koch wand is very strong, it loses the ability to actively move through internal organs and systems. In this regard, the initial period of development of the pathological process is long.

Since the disease is hidden, can manifest itself at any time and spread no less actively, it is especially important to have an idea of ​​exactly how tuberculosis is transmitted. The process of transmission from an infected organism to a healthy one can be carried out even through ordinary water, in which infection may be present. Options for infection can be varied, but measures to prevent infection always remain the same:

• avoiding being in overly crowded places;
• exclude contact with infected people, it is forbidden to even be in the same room;
• It is recommended to visit the dispensary wearing special masks, without having contact with its visitors;
• Maintain the strength of the body's immune system.

Where can you get infected with tuberculosis? The process of penetration of bacteria into the body is carried out through several options. First of all, by airborne droplets. This option is considered the most common.

Harmful bacteria enter the body through inhalation of air. Another way bacteria can enter is through food. The source of infection can be meat and dairy products from infected animals. The rarest method of infection is considered to be intrauterine.

In this case, the placenta becomes infected.

Risk of infection

How can you become infected with tuberculosis? If you come into contact with a person with tuberculosis, what is the risk of infection? Infection with tuberculosis is possible only through prolonged contact with a person who has been diagnosed with this pathology. As a rule, tuberculosis is transmitted after six months of contact. If being with a sick person was irregular and short-lived, then the chances of contracting pulmonary tuberculosis will be low. If a person has a strong immune system, then inhaling harmful bacteria (Koch bacilli) does not pose a threat to a healthy body, especially. If the contact took place on the street. Despite the active struggle of the immune system, microorganisms are able to persist in a healthy body for a short period of time, but their state is characterized as inactive. As soon as the immune system begins to weaken, a person may not eat properly or is exposed to stressful situations, microorganisms begin to actively manifest themselves, multiply and provoke the development of an active form of tuberculosis.

The routes of transmission of tuberculosis can be very diverse. How does tuberculosis become infected? After entering the body, the Koch bacillus spreads to all organs and systems of the body through the bloodstream or lymph nodes. The lungs, brain, kidneys and bone tissues are primarily affected. The age category of the patient plays an equally important role. Patients who are young or adolescent are most susceptible to the influence of the pathological process. Representatives of the weaker half of humanity are susceptible to the disease in the period from 24 to 35 years. Often, concomitant diseases can provoke an active form of tuberculosis. These include HIV infection (considered the most common phenomenon among young people). This deviation can significantly suppress the activity of the immune system. It is imperative for such patients to undergo Mantoux tests annually. Also, the development of the pathological process can be affected by lung and blood diseases, kidney failure, elevated blood sugar levels and the presence of malignant neoplasms in the body. Is tuberculosis inherited? The answer in this case is negative.

There is a so-called risk group, which includes patients most susceptible to tuberculosis. These include teenagers, those who live in damp and insufficiently heated environments, patients with poor nutrition and those who are subject to constant hypothermia.

Methods of infection

Let's look at the main routes of infection with tuberculosis. Many people are interested in the question of how does one become infected with a disease such as tuberculosis? There are several options for infecting a healthy body with Koch's wand. Let's consider the main routes of transmission of tuberculosis infection:

1. Airborne path. It is considered the most common variant of infection of a healthy body. Contact in this case is carried out with an open form of the disease. Bacteria enter the air and infect the body over several days.
2. Contact. Infection occurs through household items. The infection process occurs through mucous membranes or skin. Contact with household objects is especially dangerous. In this case, you can also become infected through a kiss.
3. Food. Most often, harmful bacteria are present in meat and milk.
4. Contactless. In this case, you can become infected with tuberculosis in a room where a sick patient had previously been for a long time. Since bacteria can remain active in the air for a long time, thorough sanitary and epidemiological treatment should be carried out before living. After disinfection, it is recommended to carry out repair work if possible.
5. Intrauterine. It is relatively rare. During the process of bearing a child, harmful bacteria can be transmitted in the womb from the mother to the child's body.

Is tuberculosis transmitted sexually? In this case, the probability of contracting tuberculosis from the patient is relatively small. Very often, infection occurs in the spring or autumn. During this period, the disease rapidly intensifies, especially if contact is made with a sick patient.

Common symptomatic signs include shortness of breath, sputum production during coughing, headaches, elevated body temperature that is difficult to reduce to normal, severe weight loss and decreased performance.

If such violations are detected, you should immediately seek help from qualified specialists.

The importance of preventive measures

It is especially important to pay attention to the prevention of tuberculosis. These events provide an opportunity to answer the question of how to avoid becoming infected with tuberculosis. What should you do to avoid getting tuberculosis? First of all, you should control the optimal ventilation of the room, which corresponds to basic sanitary standards.

Equally important is compliance with the rules of personal hygiene: you must regularly wash your hands with soap. Nutrition should be balanced and healthy, since overall health largely depends on the vitamins and microelements entering the body. Carry out wet cleaning every day using products containing chlorine. You should actively engage in sports, this will help maintain and strengthen the immune system. When diagnosing an active form of tuberculosis in a patient, it is recommended to give preference to treatment with chemotherapy and not think about whether tuberculosis is inherited.

To protect yourself from the effects of pulmonary tuberculosis, it is important to promptly prevent its occurrence, and if you suspect the presence of pathology, immediately seek help from a medical institution and start taking anti-tuberculosis drugs.

Tuberculosis is a disease caused by a special group of bacteria, namely mycobacteria, which in their DNA are at an intermediate stage between bacteria and fungi, which gives them a number of advantages, the main ones of which can be considered special vitality and the ability to reproduce by division or budding without the participation of outsiders cells in which ordinary bacteria deposit their spores.

In addition to unprecedented vitality, Mycobacterium tuberculosis has a phenomenal ability to get used to drugs and genetic memory for them, which does not allow us to completely defeat this disease.

The direct causative agents of tuberculosis include several species, and the disease itself is characteristic not only of humans, but of animals and birds. The Koch bacillus is the most dangerous for humans, and a common infection for people and humans is the BCG bacterium - on the basis of which the vaccine of the same name is prepared. The main population affected by BCG is cattle, which is why it is also called “cow” or “bovine” tuberculosis.

It is also worth noting that tuberculosis affects not only different types of living beings, but also different human organs. In addition to the well-known pulmonary tuberculosis, there is also tuberculosis of the bones, liver, skin, eyes, intestines, etc.

Contagiousness of tuberculosis. Myth or reality

Today, the pandemic of this disease has subsided a little and awareness of the danger of this infection is not as active as in the nineties and early 2000s, so many young people do not even know whether tuberculosis is contagious or not, or whether it is easy to become infected with tuberculosis.

Tuberculosis is an infectious bacterial disease that, until the beginning of the twentieth century, claimed a huge number of lives, and in Europe at one time it claimed a quarter of the population, due to which it began to be called not only consumption or dry disease, but also the white plague. To understand the level of danger of the disease, as well as its contagiousness, you need to understand the methods of its transmission.

Routes of transmission

The tuberculosis bacterium, subject to ideal conditions of 20-23 degrees Celsius, absence of ultraviolet rays and humidity, can survive for seven years without a biological carrier. In other environments, it lives a little less, however, the degree of its adaptability to unfavorable conditions is truly amazing, because even in chlorine-containing products it does not die for as long as 5-10 minutes. The only thing that can kill it almost immediately is ultraviolet radiation, which is contained in direct sunlight or produced by a special lamp.

This viability is explained by the ability of the pathogen to fall into suspended animation, in which it does not reproduce, does not provoke disease and does not require nutrition, and is also covered with a particularly strong shell, under which it is practically invulnerable. Such dormant or passive tuberculosis is found in water, air, dust, soil, in damp rooms, basements, in books, products, as well as in the blood of 30% of people, without causing harm to anyone.

Only an active form of tuberculosis bacteria can provoke the disease.

Is it possible to get infected from a patient with tuberculosis? Of course, it is possible, this is the most common way of acquiring the disease, and the infection is most often transmitted by airborne droplets, when the patient coughs, or by airborne dust - when the patient spits out sputum anywhere, it dries up and enters the lungs of others.

The method of transmitting the active form of Koch's bacillus through everyday life is less common, however, no less dangerous. Due to the fact that bacteria are transmitted through objects and common areas, this disease affects mainly families, since it is quite difficult not to become infected while living together.

Many young people are most likely concerned about the question: is tuberculosis transmitted sexually? Of course, it is transmitted, since during sexual intercourse there is an active exchange of fluids, including saliva, and people literally breathe the same air.

Also, do not forget that Koch's bacillus is quite easily transmitted from mother to child during pregnancy or during childbirth.

Considering that not only people can suffer from the disease, it would not be a bad idea to find out whether tuberculosis is contagious or not in animals. It is quite difficult to become infected with tuberculosis from an animal with good immunity, however, it is quite possible. Infection almost always occurs from cattle. Mycobacterium bovis, which, in addition to direct contact with sick cows, can be transmitted through dairy products, in which it is preserved for up to a year without heat treatment (cottage cheese, cheese, butter, etc.) or raw meat.

At what stage is tuberculosis infectious in humans?

In people, after infection, the disease can develop in an open or closed form, which differ in the ability of the patient to infect others. There is an opinion that the patient is able to infect others only with the open form, which develops in later stages of the disease, and with the closed form, the microbes sit inside.

To some extent, this is true, because at the closed stage the patient practically does not cough or secrete sputum into the surrounding space, however, given that active bacteria float freely in his blood and mucous secretions, there is still a minimal risk of infection. There are often cases when a person with the closed form also gets sick in their household, which can be explained by both a common source of infection and a slight release of the pathogen. In addition, the closed form can become open almost at any time and sometimes completely asymptomatically.

How to protect yourself and your family

It doesn’t matter whether consumption is highly contagious or not, given the widespread distribution of its causative agent, everyone should suffer from it, however, this does not happen. An effective vaccine against tuberculosis has not yet been invented, however, many people have innate immunity to this infection. It effectively prevents infection, but at the same time it must always be maintained in proper shape to avoid not only tuberculosis, but also a huge number of other problems.

To protect yourself and your loved ones from infection, you must follow basic hygiene measures: stay away from coughing people, do not share utensils or eat from the same plate, avoid untested sexual contact and do not be in the same room with sick people. When moving to a new home, it is recommended to disinfect it with an ultraviolet lamp, and also not to spend a long time in damp rooms and houses affected by fungus.

It is also advisable to avoid gatherings of large numbers of strangers, which is almost impossible with the modern pace of life, especially considering that we all use public transport.

The only effective way to prevent the disease is to take preventive diagnostics responsibly and do your best to strengthen the body by exercising, eating well, and eliminating bad habits, especially smoking, which significantly reduces the protective capacity of the lungs.

• 20.10.2018

The disease, known at the beginning of the twentieth century as consumption, which was treated with increased nutrition and stay in a warm climate, is considered fatal to this day.

Does not know the boundaries between races and countries, social strata. Anyone can get this disease, as it is caused by the tuberculosis bacillus, which is extremely resistant to external influences and is transmitted by airborne droplets, contact and food.

In contact with

Does everyone infected with tuberculosis get sick?

The widespread distribution of Mycobacterium tuberculosis in the environment creates conditions for infection of a large number of people. But infection is not a disease. The human immune system is designed to attack viruses and bacteria, and good immunity suppresses the activity of tuberculosis bacilli. Mycobacteria simply live in the human body, waiting for an opportunity to attack.

Any factor that leads to a weakening of the immune system’s defenses triggers the mechanism for the proliferation of mycobacteria, namely:

• Chronic stress;
• chronic diseases;
• metabolic diseases;
• oncological diseases;
• immunodeficiency syndrome;
• drug addiction and alcoholism.

Who gets tuberculosis and why?

Pregnant women, nursing mothers and children are at increased risk. The body's defenses in pregnant and lactating women are weakened by hormonal changes. A child's immune system is imperfect and vulnerable to attacks from bacteria of any kind; an additional risk factor for infection is the child's inability to maintain strict hygiene rules, which increases the possibility of infection.

A sick person with active pulmonary tuberculosis constantly spreads mycobacteria when coughing. A single cough leads to the dispersion of more than three thousand mycobacteria into the surrounding air. They settle on objects, mixing with dust, after which the dust is inhaled by healthy people. This explains the high rate of infection among people who spend a lot of time in poorly ventilated areas.

There is a high risk of contracting this disease:

• In a hospital ward where sick people are undergoing treatment;
• in the barracks for soldiers;
• in a prison cell, where there is a lot of crowding and there is no possibility of ventilation;
• in a school class or kindergarten group, if an adult with an active form of the disease works in the children's group;
• in the apartment where the patient lives.

Routes of infection with tuberculosis

How does bacteria enter the body?

1. The airborne route is the most common route of infection. Most often, mycobacteria enter the body through inhalation.
2. There is another way the tuberculosis bacillus enters the human body: food. Milk and meat from sick cows can become a source of bacteria.
3. Intrauterine route - occurs very rarely, only when the placenta is infected with mycobacteria during gestation or childbirth.
4. Contact is a fairly rare route, but there are cases of infection of milkmaids and butchers from sick animals; also, through contact, the conjunctiva of the eye is susceptible to the transmission of mycobacteria.

What is the risk of infection upon contact

Close contact with a patient with tuberculosis does not always lead to infection. If a patient is diagnosed with a closed form of the disease, then he does not release bacteria into the air, which means he is not contagious.

Koch's wand is well protected from external influences, since when it enters the body, it forms a dense and durable capsule around itself. It is this that allows mycobacteria to live in the human body for a long time and the immune system cannot destroy them. As long as the capsule is closed, the bacteria are not dangerous to others.

As soon as mycobacteria lose their protection, forming open wounds in the lungs, a person becomes an active spreader of tuberculosis. Casual proximity to such a carrier on a bus or subway car is not as dangerous as daily communication at work or in the family.

The risk of infection increases with the duration and proximity of interaction with the patient:

• Infection is minimal when meeting on the street or traveling in transport;
• the threat of infection is much greater if open tuberculosis is detected in a work colleague or neighbor next door. In this case, daily contact with the carrier of the infection is possible; the staircase or elevator is contaminated with mycobacteria;
• friendly communication with the patient, frequent meetings further increase the possibility of contracting tuberculosis;
• The greatest risk of infection is among people living in the same living space as the patient and having close relationships. Daily contact with a sick person, sharing meals, kissing, sexual activity - all this provokes the penetration of Koch's bacillus into the blood and lymphatic system of a healthy person.

Prevention measures

The main measure to prevent a child from getting tuberculosis is vaccination.. It contains mycobacteria that are not capable of causing the onset of the disease, but are recognized by the immune system as hostile to the body. At the same time, immunity is developed that protects the child from tuberculosis for fifteen years.

Preventive methods to prevent infection are not complicated and are accessible to anyone:

• Maintaining hygiene. The rule should be to wash your hands as often as possible, especially for residents of cities, where the likelihood of encountering a bacteria carrier is much higher;
• Thorough wet daily cleaning of the house using products containing chlorine. Mycobacteria are very sensitive to chlorine, and dust collection minimizes the risk of bacteria accumulation on the surface of the floor and objects;
• daily ventilation of the house;
• nutritious nutrition, including meat, eggs, fats and full-fat dairy products;
• Walking in the fresh air, playing sports, physical activity - these measures help strengthen the immune system.

If there is a threat of infection with tuberculosis, contact with a sick person, or a carriage of mycobacteria is detected, treatment with chemotherapy is prescribed as active prevention.

IT IS IMPORTANT TO KNOW!

IT IS IMPORTANT TO KNOW!

In the modern world, there are many diseases that pose a great danger to humanity. Open is one of them. Every year the number of cases increases, and the mortality rate from this infection reaches 2% for every 100 thousand population.

Today this infectious disease is very well studied. The microorganisms that cause this infection, their forms, routes of transmission, and methods of treatment are known. But with all the availability of information, every person may be at risk of infection with this terrible bacillus -.

Forms and routes of infection

The main distinguishing feature of open and diagnostic tests will be the release of bacteria (BC “+” or BC “-”). In the open form of tuberculosis, in addition to Koch's bacilli, mucus and specific tuberculous pus can be found in the sputum.

If we examine the discharge from the bronchi through a simple microscope, then mycobacteria will be detected only if there are a large number of them. Modern hardware diagnostics can even detect traces of mycobacteria.

In medicine, there are three forms of tuberculosis, each of which can pose a threat of infection. More details about this in the table.

All three forms include signs of the open form of tuberculosis.

and how can you get infected? Most often, infection occurs through airborne droplets. But it is not necessary to be in close contact with a sick person. The Koch bacillus, secreted when coughing, is very stable in the external environment.

It retains its vital activity in dry sputum, on the ground, and on household objects. Mycobacterium tuberculosis is resistant to acids, alkalis, and many disinfectants.

Very rarely, the disease can be transmitted through cuts and wounds (contact with a patient with tuberculosis) or through the digestive tract (this route of transmission of open tuberculosis is also dangerous).

First symptoms and risk of infection

There are a number of symptoms, by the presence of which a diagnosis is made and the disease can be determined: open form of tuberculosis. The most common symptoms are:

The most reliable information about infection can only be obtained through laboratory diagnostics. With 100% accuracy, the correct diagnosis of “open pulmonary tuberculosis” can be made by isolating mycobacteria from sputum (determining test). Bacteria are grown on special media and special staining.

The following studies also include effective diagnostic methods:

• bronchoscopy (lung tissue is collected and examined);
• endoscopic examination of other organs (as indicated);
• radiography.

It should be noted that the open form of tuberculosis is treated exclusively in specialized medical institutions - anti-tuberculosis dispensaries.

Therapy and prevention

It is very important to consult a doctor at the first sign or suspicion of tuberculosis infection. Self-medication can lead to irreversible consequences. And indiscriminate and uncontrolled use of medications will only develop mycobacteria into stable resistance to them.

Treatment periods for open forms of tuberculosis range from six months to two years. Drug therapy is selected strictly individually (consulted by the attending physician), and for the first few months the patient is in the hospital (until the active release of Koch's bacillus stops). It is strictly forbidden to interrupt the course of treatment.

There are a number of treatment regimens based on the following drugs:

• Pyrazinamide;
• Rifampicin;
• Isoniazid;
• Ethambutol.

If over the course of two to three months the selected treatment regimen does not have the desired effect, another one is selected, and the method of administering the drugs is also changed. After the course of treatment has been completed, it is necessary to conduct a laboratory and diagnostic examination for the release of Koch's bacillus into the environment.

When taking the above drugs, a number of side effects, listed in the table below, can be observed and spread to the body.

As a result, it should be concluded that only a doctor should select drug therapy and treat open tuberculosis.

The most effective open method for children today is vaccination - the first vaccination is given to the child while still in the maternity hospital.

For the adult population, vaccination is carried out according to indications. The main prevention for them is compliance with sanitary standards and improvement of working conditions. It is necessary to undergo a preventive examination every year, not to expose your health to harmful influences, and to strengthen your body.

Following simple rules will help you avoid contracting this terrible infection and will prevent it from spreading in society.

There are few Ukrainians who do not know how sad the situation with tuberculosis is in our country. Refusal of the principles of work of the phthisiatric service of the Soviet era that proved highly effective, meager funding for the industry, insufficient vaccination of the population, unfavorable environmental conditions, a decrease in the level of well-being of citizens, alcoholism and drug addiction - all these factors play into the hands of tuberculosis infection, contributing to a decrease in immune defense and an avalanche-like spread of the disease , the formation of resistant strains of bacteria that cannot be treated with standard combinations of anti-tuberculosis drugs. In the absence of real help from the state, a person is left alone with a dangerous infection, and the chances for a healthy life depend only on himself, his sanitary literacy and willpower. The most important issue that worries the average person is the risk of contracting tuberculosis in various everyday situations. How not to get sick? - let's figure it out.

In order to have a substantive conversation about the possibility of infection with tuberculosis, first of all, we will analyze the meaning of the terms infection (infection) - in relation to tuberculosis, active tuberculosis, open and closed forms of tuberculosis.

Tuberculosis- a unique infection. Entering the body with tuberculosis bacilli (Koch bacteria, Mycobacterium tuberculosis) almost always leads to infection, and very rarely to the development of an active disease. Infection (infection) with Koch's bacillus occurs once in a lifetime - usually in childhood or adolescence, at the first contact of a person with a microorganism. One or two Koch bacilli that enter the child’s respiratory tract along with inhaled air lead to infection and the development of local inflammation, however, due to the high activity of the immune system, the body quickly copes with the infection and self-healing occurs. All these processes occur completely unnoticed, have no clinical manifestations and, as a rule, do not lead to the development of active tuberculosis. Doctors learn that tuberculosis infection has occurred from the results of the next Mantoux test, which have very specific characteristics in people infected with the tuberculosis bacillus. Immunologically, the process of infection with the tuberculosis bacillus can be considered a favorable phenomenon, since, thanks to the contact with the pathogen, the human body learns to recognize tuberculosis and fight it - this is how anti-tuberculosis immunity is formed.

Despite the fact that the immune system has overcome the pathogen, a certain amount of mycobacteria remains forever in the human body (mainly in the organs of the lymphatic system) in an inactive state. The presence of “dormant” bacteria becomes the basis for the development of active tuberculosis in cases where the activity of the immune system decreases and tuberculosis bacilli escape its control. However, this does not always happen - according to statistics, the active form of tuberculosis (that is, tuberculosis with clinical manifestations, specific changes on the x-ray and in the results of laboratory tests) develops only in 1-5% of infected people. The risk of developing tuberculosis is highest in the first 2 years after the initial infection - it is during this period of time that an infected person needs to be monitored by a TB specialist and (if indicated) preventive measures. It must be said that by the age of 20-25, tuberculosis infection occurs in 90-95% of people, and most of these people (despite being infected with tuberculosis) remain healthy. That is infection with tuberculosis is not equivalent to disease!

People infected (contaminated) with tuberculosis do not have tuberculosis, do not spread the tuberculosis bacillus and therefore are not dangerous to others. Typically, a person infected with tuberculosis has a positive Mantoux test, while the results of a chest x-ray and sputum analysis do not have any deviations from the norm. Repeated contacts of an infected person with tuberculosis pathogens either have no consequences or break the immune defense and lead to the development of active tuberculosis (usually this occurs with a massive bacterial attack, contact with aggressive strains of the tuberculosis bacillus, temporary or permanent immunodeficiency).

Active tuberculosis that has developed for one reason or another can occur in two forms - open And closed. The open form of tuberculosis (bacterial excretion) is spoken of when, using bacteriological examination (culture) or microscopy, Koch bacilli are detected in the sputum, saliva and other secretions of the patient. If, upon repeated examinations, there are no bacteria in the discharge, the patient suffers from a closed form of the disease. The terms open and closed forms of tuberculosis are more often used for pulmonary tuberculosis. However, bacterial excretion is also characteristic of other types of tuberculosis - tuberculosis of the lymph nodes, tuberculosis of the reproductive system, intestinal tuberculosis, etc. The presence of bacterial excretion (BC+) is a very important indicator of the patient’s infectious danger, since tuberculosis can only be contracted from a person who releases mycobacterium tuberculosis into the environment. However, there is one nuance here: due to the insufficient power of laboratory research methods, in some patients with an open form of tuberculosis, mycobacteria cannot be detected in the sputum (and other secretions). That is, although officially non-infectious, they pose a serious danger to others. Therefore, no doctor guarantees 100% safety for people who have contact with patients with closed form of tuberculosis. It is believed that contact with such a patient has approximately a 30% probability of leading to the development of an active form of the disease; the risk of infection increases with constant, close, prolonged contact.

So, a patient with an open form of tuberculosis is certainly dangerous, a patient with a closed form is potentially dangerous.

Contact options

The risk of developing tuberculosis directly depends on the nature of contact and determines the preventive measures necessary in each specific case.

Theoretically, the lowest probability of developing the disease is during short-term contacts with a patient with tuberculosis in public transport, public places, stairwells, etc. To reduce the risk of developing active tuberculosis in such a situation, simple preventive measures help, such as a healthy lifestyle, balanced diet and regular annual examination (Mantoux test - for children and adolescents under 15 years old, chest fluorography - for adolescents over 15 years old and adults), as well as mandatory washing hands after going outside, regular cleaning and ventilation of premises.

The risk of developing active tuberculosis increases significantly with prolonged and regular contacts with a tuberculosis patient (cohabitation, regular communication at work or in free time), as well as with contacts accompanied by the exchange of biological fluids (kissing, sexual relations). Healthy people who find themselves in such a situation fall into the category of “TB contacts” and should be examined by a TB doctor as soon as possible. The purpose of a phthisiological examination is to exclude an active form of tuberculosis in a contact person and to identify indications for chemoprophylaxis with anti-tuberculosis drugs. Examination of contact persons usually includes a tuberculin test (Mantoux test), an X-ray examination of the chest organs, sputum examination for the presence of tuberculosis bacillus, and general clinical examinations of blood and urine. Contact children and adolescents are examined 4 times, adults – 2 times a year. Chemoprophylaxis is carried out in people with the highest risk of developing tuberculosis (primarily in people with immunodeficiency states, people exposed to massive exposure to aggressive strains of tuberculosis) using 1-2 anti-tuberculosis drugs prescribed in minimal dosages.

An important preventive measure aimed at reducing the risk of developing the disease is to stop contact with the bacteria-releasing agent. To do this, a patient with an open form of tuberculosis is hospitalized in a hospital; contact persons are advised to temporarily interrupt personal communication with the patient (until the mycobacterium disappears from the discharge); sometimes patients with an active form of tuberculosis (especially in the chronic course of the disease with permanent bacterial excretion) are provided with a separate living space. The patient with tuberculosis and his relatives should not consider temporary isolation as a life tragedy - in most cases, if the doctor’s recommendations are followed conscientiously, after 2 months of therapy, bacterial excretion stops and the patient ceases to be dangerous to the people around him. In situations where it is not possible to interrupt contact with a patient with an open form of tuberculosis, all contact persons are subject to long-term preventive therapy with anti-tuberculosis drugs.

Children. Children, due to the peculiarities of the immune system, are at increased risk for the development of active tuberculosis. Therefore, when a person with tuberculosis appears in a family (regardless of the form of the disease), the child’s contact with this relative must be stopped, and the child must be registered with a phthisiatrician. Contacts of tuberculosis and/or primary infected children and adolescents, after examination by a phthisiatrician and exclusion of the active form of tuberculosis, are not contagious, not dangerous to others and can attend children's institutions (kindergartens, schools) even if they receive preventive treatment with anti-tuberculosis drugs .

Pregnant. Contact with a tuberculosis patient during pregnancy leads to the development of the disease with almost the same probability as contact in a non-pregnant state. First of all, contact must be interrupted and it must be ensured that it does not recur. A pregnant woman who has been in contact with a patient with tuberculosis must carefully monitor her health and, when the first signs of pulmonary pathology appear, consult a doctor (general practitioner, phthisiatrician) for examination. In case of prolonged contact with a patient with an open form of tuberculosis, the pregnant woman is examined according to the generally accepted scheme (with the exception of x-ray examination, which is carried out using special techniques in the presence of strict indications). In most cases, chest x-rays and anti-tuberculosis medications are postponed until the postpartum period. Contact with a patient with tuberculosis is under no circumstances an indication for termination of pregnancy. If high-risk contact occurs during the planning stage of pregnancy, it is necessary to postpone conception until the danger has completely disappeared.

Prisoners. The risk of developing tuberculosis is very high when in contact with patients serving sentences in prison or former prisoners, since these people in the vast majority of cases are carriers of aggressive strains of tuberculosis that are resistant to most anti-tuberculosis drugs. Relatives visiting sick prisoners (if refusal of visits is impossible for some reason) are recommended to come to visits wearing clothes made from materials resistant to disinfectants, a scarf covering their hair, and a 4-layer gauze mask covering the mouth and nose. After visiting, clothes must be soaked in a disinfectant solution (chlorantoin, Domestos) for 2 hours. During the entire period of increased risk, the contact person must be examined twice a year at a tuberculosis dispensary. You must be prepared for the TB doctor to prescribe preventive anti-tuberculosis treatment. Contact between children and prisoners with tuberculosis is extremely undesirable.

« Contact without contact" Despite the lack of direct contact with the source of infection, people who live in an apartment (house) where a person with tuberculosis previously lived are in serious danger. Koch bacilli remain viable in the environment for a long time (they live in room dust for about a month, in books for 3 months, in dark and basement rooms for up to 4-5 months) and are quite capable of causing disease in new residents. To avoid health problems, before moving in, you need to find out whether the apartment has undergone final disinfection - treatment of the premises by the sanitary-epidemiological station. If disinfection has been carried out, you need to make cosmetic repairs and then feel free to move into your new home. If disinfection has not been carried out, living in the apartment before it is carried out is highly not recommended.

To conclude the topic, we will list situations related to tuberculosis contact in which urgent consultation with a TB specialist (or therapist) is necessary, and we will also provide recommendations for basic tuberculosis prevention.

An examination by a phthisiatrician regarding contact with a patient with tuberculosis is indicated in the following cases:

1. In case of close, prolonged contact with a bacteria excretor.
2. If there are close relatives who have had tuberculosis (indicates a possible genetic predisposition to the disease).
3. In the presence of diseases or conditions that cause a decrease in immune activity, including when undergoing therapy with hormonal or cytostatic drugs.
4. If you have bad habits (smoking, alcohol abuse, drug addiction), chronic stress.
5. If children and adolescents came into contact with the patient.

Within a year after stopping contact with a patient with active tuberculosis, it is necessary to pay attention to the following symptoms, the appearance of which should be the reason for a premature X-ray of the lungs and consultation with a phthisiatrician:

1. Long-term, causeless loss of body weight.
2. Dry cough lasting more than 3 weeks.
3. Low-grade body temperature.
4. Enlarged peripheral lymph nodes.
5. Increasing weakness, drowsiness.
6. Chest pain, hemoptysis.

To reduce the likelihood of developing tuberculosis after known or suspected contact, it is recommended:

1. Do not smoke or drink strong alcoholic drinks, beer, or low-alcohol mixtures.
2. Consume at least 150 - 200 g of foods rich in animal fats (meat, fish, eggs, milk, etc.) per day.
3. Consume enough vitamins of all groups.
4. Do not consume synthetic products (chips, fast food).
5. Stay outdoors more often and lead an active lifestyle.
6. Avoid repeated close contact with people with active tuberculosis.
7. Undergo regular preventive examination (lung fluorography).

Finally

Tuberculosis is dangerous, one cannot but agree with this, but the situation is not hopeless. Modern medicine makes it possible to fight this disease, and timely prevention helps prevent its development. Be attentive to yourself and your loved ones, lead a healthy lifestyle, do not hesitate to seek advice and help from doctors - this will increase your chances of a healthy long life. Take care of your health!

Tuberculosis– one of the oldest diseases of mankind. This is confirmed by archaeological finds: tuberculosis of the vertebrae was found in Egyptian mummies. The Greeks called this disease phtisis, which translates as “exhaustion”, “consumption”. From this word comes the modern name of the science that studies tuberculosis - phthisiology; and specialists who study tuberculosis are called phthisiatricians.

In the 17th - 18th centuries, during the period of urbanization and rapid development of industry, the incidence of tuberculosis acquired the character of an epidemic in Europe. In 1650, 20% of deaths among residents of England and Wales were due to tuberculosis.

However, the exact cause of the disease was not known until 1882, when Robert Koch discovered the causative agent of this disease - the bacterium Mycobacterium tuberculosis, which is still called Koch's bacillus.

In the first half of the twentieth century, the incidence of tuberculosis in developed countries began to decline, despite the lack of effective treatment methods, which was due to improved socio-economic living conditions, as well as the isolation of patients. However, by the 1980s, a rise in the incidence of tuberculosis was again recorded in developed countries. WHO experts explain this by the spread of HIV infection, the influx of immigrants from disadvantaged tuberculosis countries, as well as social factors - poverty, vagrancy, drug addiction. In a number of places (including Russia), the situation was aggravated by a significant reduction in the control of health authorities over tuberculosis. In Russia, the rise in the incidence of tuberculosis began in 1991 and reached its maximum value - 83 people per 100 thousand population - in 2000, since then the incidence rate has not decreased. Currently, Russia is one of the 22 countries with the highest incidence of tuberculosis.

The causative agent of tuberculosis

The causative agents of tuberculosis are Mycobacterium tuberculosis. A distinctive feature of the tuberculosis bacillus is its special shell, which helps the bacterium survive in very harsh environmental conditions, including resisting major antimicrobial drugs.

In addition, Mycobacterium tuberculosis multiplies extremely slowly, which makes diagnosis somewhat difficult.

Risk of contracting tuberculosis

Most often, Mycobacterium tuberculosis is transmitted by airborne droplets. When patients with tuberculosis cough, sneeze, or talk, they release the pathogen into the surrounding air in tiny droplets. When the droplets dry, even smaller particles are formed, consisting of 1-2 microbial cells; these particles do not settle under the influence of gravity and remain suspended in the air for a long time, from where they enter the lungs of a healthy person.

For another type of mycobacteria - Mycobacterium bovis - which can also cause tuberculosis in humans, is also characterized by a food route of infection - through raw milk. Currently, this route of transmission of infection has lost its relevance.

The risk of infection depends on the nature and duration of contact with the source of infection and the degree of infectiousness of the patient. The likelihood of infection increases many times if the patient has active pulmonary tuberculosis, i.e. in the presence of a tuberculous cavity in the lung, as well as in cases of damage to the upper respiratory tract (bronchi, trachea, larynx).

In addition, infection usually occurs through close and prolonged contact with a sick person - most often if the sick person is a family member.

One of the most significant risk factors for infection is crowding of people in poorly ventilated areas.

Risk of getting tuberculosis

When Mycobacterium tuberculosis enters the lungs of a healthy person, it does not always lead to illness. The risk of the disease depends mainly on individual sensitivity to Mycobacterium tuberculosis, as well as on the state of the immune response.

The risk of getting sick depends significantly on the age of the infected person. Among those infected, the incidence of tuberculosis is highest in adolescence and young adulthood. In women, most cases of the disease occur between the ages of 25 and 34 years; at this age, women get sick more often than men.

A number of diseases contribute to the development of active tuberculosis in infected individuals. The leading place among them is occupied by HIV infection, as a result of which the immune response is suppressed. The risk of developing tuberculosis depends on the degree of immune suppression. For patients with HIV infection, an annual Mantoux test and prophylaxis with anti-tuberculosis drugs are recommended, if necessary.

In addition, the risk of developing tuberculosis increases with chronic lung diseases, blood tumors, other malignant neoplasms, renal failure with constant hemodialysis, insulin-requiring diabetes mellitus and general exhaustion.

Most often, only people with reduced immunity have a real risk of contracting tuberculosis.

• Young children.
• HIV-infected.
• People who are undernourished and experience frequent hypothermia.
• People living in damp, poorly heated and ventilated areas.

In addition, the risk of infection increases many times over with close and prolonged contact with patients with active forms of tuberculosis.

Pulmonary tuberculosis

The most common form of tuberculosis is pulmonary tuberculosis. Before the advent of HIV infection, pulmonary tuberculosis accounted for 80% of all tuberculosis cases. A pronounced decrease in immunity in AIDS contributes to the formation of extrapulmonary foci of infection (simultaneously with or without pulmonary ones).

The lungs are the primary portal of infection. Bacteria, passing through the respiratory tract, enter the terminal parts of the bronchi - the alveoli - small sacs at the end of the thinnest bronchioles. From there, bacteria are able to enter the bloodstream and spread throughout the body, but to do this, bacteria need to overcome many protective barriers, which is possible either with a decrease in immunity or with massive infection.

Tuberculosis that develops immediately after infection is called - primary tuberculosis. It often occurs in children under 4 years of age, which is associated with insufficient development of the immune system. Therefore, at this age, tuberculosis is often severe, but patients are most often not contagious.

With primary tuberculosis, a primary focus is usually formed - an area of ​​the lung affected by tuberculosis (tuberculous granuloma). The primary lesion can heal on its own and turn into a small area of ​​scar tissue, which is sometimes found on X-rays in healthy people, indicating previous tuberculosis. However, in some cases, the primary lesion progresses, increases in size, its central part disintegrates and a cavity is formed - the primary pulmonary cavity. From the primary pulmonary focus, Mycobacterium tuberculosis can enter the bloodstream and settle in various organs, forming tuberculosis granulomas (tubercles), which is where the name tuberculosis comes from (tuberculum from Latin - “tubercle”).

Secondary tuberculosis– the result of re-infection or re-activation of an infection already existing in the body. Mostly adults suffer from this form of the disease. New lesions and cavities are formed, which can merge with each other, leading to extensive lesions and severe intoxication. Without treatment, about a third of patients die in the coming months; For others, the infection may become protracted, or the disease may spontaneously subside.

At the very beginning of the disease, symptoms are often mild and nonspecific, but then the symptoms intensify, leading to significant suffering.

• Fever.
• Sweating at night.
• Losing weight.
• Loss of appetite.
• Malaise, weakness.
• Cough: at first dry, then sputum is added, which soon becomes purulent, sometimes streaked with blood.
• Hemoptysis.
• When the vessel wall is destroyed, pulmonary hemorrhage may occur.
• Chest pain that gets worse with breathing.
• Dyspnea – occurs with massive damage and serves as a manifestation of respiratory failure

However, it also happens that the disease is asymptomatic, and the primary lesion is discovered only years later during radiography for another reason.

Tuberculous pleurisy

Extrapulmonary tuberculosis has become increasingly common in recent years due to the widespread spread of HIV infection. Mycobacterium tuberculosis, in addition to the lungs, can affect almost any organs and tissues.

Tuberculous pleurisy- This is a tuberculous lesion of the membrane covering the lungs - the pleura. Occurs as a complication of pulmonary tuberculosis.

Pleurisy can be dry - when the layers of the pleura become inflamed, but fluid does not accumulate between the leaves.

And exudative pleurisy may occur - when inflammatory fluid accumulates between the layers of the pleura - exudate, which can compress the lung tissue and cause shortness of breath.

Symptoms for tuberculous pleurisy are the same as for pulmonary tuberculosis; chest pain may be more intense due to friction of the inflamed pleura against each other; and in the presence of fluid in the pleural cavity, respiratory failure comes to the fore.

Upper respiratory tract tuberculosis is always a complication of pulmonary tuberculosis.

The pharynx and larynx are involved in the infectious process. In this case, the above-mentioned complaints are accompanied by hoarseness of voice and difficulty swallowing.

Tuberculous lymphadenitis

Tuberculous lymphadenitis- This is a tuberculous lesion of the lymph nodes. Occurs as a complication of pulmonary tuberculosis or independently of it.

The cervical and supraclavicular lymph nodes are most often affected. The lymph nodes are enlarged, but painless.

Tuberculosis of the genitourinary organs

The infection can affect any part of the urinary tract and genital organs. Symptoms depend on the location of the lesion:

• Frequent, painful urination.
• Blood in urine.
• Pain in the lower abdomen and lower back.
• Women may experience menstrual irregularities and infertility.
• In men, when the epididymis is affected, a space-occupying formation is formed in the scrotum, which is somewhat painful.

However, in some cases the disease is asymptomatic.

Tuberculosis of the genitourinary tract responds well to treatment with anti-tuberculosis drugs.

Tuberculosis of bones and joints

Currently, tuberculous lesions of bones and joints are rare, mainly among HIV-infected people. Most often, intervertebral, hip and knee joints are affected by tuberculosis of bones and joints.

When the intervertebral joint is damaged, the pathological process spreads to the adjacent vertebra, destroying the intervertebral disc, which can lead to flattening of the vertebrae and the formation of spinal curvature (hump).

Damage to the hip and knee joints causes severe pain when walking and is accompanied by lameness. If left untreated, joint function may be lost.

Tuberculosis of the central nervous system

Tuberculosis of the central nervous system (CNS) occurs infrequently, mainly in young children and in HIV-infected people. It includes damage to the lining of the brain - tuberculous meningitis or the formation of tuberculoma in the substance of the brain.

With tuberculous meningitis, the symptoms are varied:

• Headache.
• Mental disorders.
• Disturbances of consciousness: stupor, confusion.
• Sensory disturbances.
• Impaired movement of the eyeballs.

Without treatment, tuberculous meningitis is always fatal. Even after effective treatment, neurological disorders may remain.

Tuberculous granuloma of the brain can manifest as epileptic seizures, local disturbances of sensitivity and/or movement.

Miliary tuberculosis

Miliary tuberculosis is a generalized form of the disease when the pathogen spreads through the blood throughout the body. At the same time, small lesions form in various organs and tissues - granulomas, which are tubercles with a diameter of 1-2 mm, reminiscent of millet grains. Hence the name of this form of the disease – “milium” from Lat. - “millet”.

The main manifestations correspond to the symptoms of pulmonary tuberculosis, but in addition there are signs of damage to other organs: liver, spleen, eyes, meninges.

Tests for tuberculosis

Mantoux test

The Mantoux test (tuberculin test, PPD test) is a method for determining the strength of immunity to the causative agent of tuberculosis.

The test consists of introducing a special drug into the area of ​​the inner surface of the forearms - tuberculin, which is a purified product obtained from mycobacterium tuberculosis after special treatment.

Why is the Mantoux test performed?

The first vaccination against tuberculosis - the BCG vaccine - is carried out in the first 3-7 days of life. However, the BCG vaccine does not always provide sufficient immunity to prevent infection. To determine how effective immunity against tuberculosis is, the Mantoux test is performed annually. Based on the test results, children are selected for revaccination, which is carried out at 7 and 14-15 years of age. In epidemiologically unfavorable areas with a high prevalence of tuberculosis, revaccination is carried out at 6-7, 11-12 and 16-17 years of age.

In addition, the Mantoux test allows you to identify infected individuals and begin timely treatment.

How is the Mantoux test performed?

The Mantoux test is carried out annually, regardless of the results of the previous test. 0.1 ml of the drug, which contains 2 tuberculin units (TU), is injected into the middle third of the inner surface of the forearm. After the introduction of tuberculin, a small tubercle is formed, which is commonly called a “button”.

Is it possible to wet the Mantoux sample with water?

You can swim or shower with a Mantoux test. You should not swim in open water to avoid infecting the wound. You should also not rub the area with a washcloth, or use any liquids or solutions: brilliant green, iodine, peroxide, or cover the wound with a band-aid. You also need to make sure that the child does not scratch the wound. All this can affect the test result and lead to a false positive result.

Evaluation of results

After the administration of tuberculin, if there are antibodies against tuberculosis in the body, an inflammatory reaction is formed at the injection site - protective antibodies react with fragments of the pathogen. In this case, approximately 2-3 days after injection, a small red tubercle forms at the injection site, rising above the skin level, dense to the touch, turning pale when pressed.

Results are assessed on day 3. To do this, measure the diameter of the papule (tubercle) with a transparent ruler in good lighting. It is not the size of the redness that is measured, but the size of the lump.

• Negative reaction - if there is no reaction at all or a pinprick reaction - 0-1mm
• The reaction is questionable - if there is only redness without a papule or the size of the papule does not exceed 2-4mm
• The reaction is positive - if the size of the papule is 5 mm or more. With an infiltrate size of 5-9mm, the reaction is considered mild, with a size of 10-14mm, medium intensity, 15-16mm, a pronounced reaction.
• The reaction is hyperergic (excessive) - if the diameter of the papule exceeds 17 mm in children and adolescents and 21 mm in adults. And also if there are any signs of severe inflammation - pustules, inflammation of nearby lymph nodes, etc.

A negative test indicates the absence of antibodies against the tuberculosis bacillus in the body. This indicates the absence of infection, as well as the absence of a reaction to the previous BCG vaccination.

A questionable sample is actually considered negative.

A positive test may indicate infection with Mycobacterium tuberculosis or the intensity of anti-tuberculosis immunity after vaccination. Distinguishing one condition from another is not always easy.

The following evidence supports infection with a positive Mantoux test:

• The first positive reaction after negative or questionable results in previous years.
• An increase in papule by 6 mm or more compared to the previous year.
• A positive reaction with an infiltrate of 10 mm or more for 3-5 years in a row (except for some cases of an allergic reaction to tuberculin).
• Hyperergic reaction.
• The diameter of the papule is more than 12 mm 3-5 years after vaccination.
• Presence of risk factors for infection: contact with sick people tuberculosis, location in an endemic region, low socio-economic status.

What to do if the test is positive?

If the test was assessed as positive or hyperergic, and the possible influence of immunity after the vaccine was excluded, it is recommended to consult a phthisiatrician who conducts a number of additional studies to diagnose primary tuberculosis: x-ray examination of the chest organs, microbiological examination of sputum to determine Mycobacterium tuberculosis, examination of members families, etc. If after a complete examination no signs of infection are found, a positive or hyperergic test can be assessed as an allergic reaction to tuberculin. Only a TB doctor (tuberculosis specialist) has the right to make such a conclusion.

Contraindications to performing the Mantoux test:

• Skin diseases.
• Acute infectious diseases or exacerbation of chronic diseases. The test is performed one month after all symptoms of the disease disappear.
• Allergic conditions.
• Epilepsy.
• Quarantine in children's institutions. The test can be taken a month after the quarantine is lifted.

The influence of other vaccinations on the Mantoux test:

You cannot take the Mantoux test on the same day as any vaccinations, as this may affect its results. However, immediately after assessing the test results, any vaccination can be carried out.

The Mantoux test should be performed at least 4 weeks after vaccination with inactivated (killed) vaccines: against influenza, tetanus, diphtheria, etc. And 6 weeks after vaccination with live vaccines: against measles, rubella, mumps, etc.

Microbiological examination:

Microbiological examination– this is the detection of Mycobacterium tuberculosis in sputum or in biopsy samples of affected lymph nodes.

Sputum is collected in the morning; 3 sputum samples are required for testing.

X-ray examination:

Fluorography remains a reliable screening test for detecting pulmonary tuberculosis. Thanks to this study, it is possible to identify foci of active or previous tuberculosis.

If a newly detected tuberculosis focus is suspected, the patient is sent for an X-ray of the lungs, where the focus can be examined in more detail.

Treatment of tuberculosis

Treatment of active tuberculosis and tuberculosis in children is carried out in a hospital. Antibiotics are used. First-line drugs include isoniazid, rifampicin, pyrazinamide, ethambutol and streptomycin.

Isoniazid is an integral part of any course of treatment for tuberculosis (except in cases of development of resistance to isoniazid). This drug is usually prescribed orally - it is well absorbed. Taking the drug can be daily or intermittent. When taken daily, the daily dose in adults is 5 mg/kg, in children – 10-20 mg/kg. The maximum daily dose is 300 mg. When taking the drug intermittently - 2-3 times a week, the maximum daily dose is 900 mg.

Side effects of isoniazid:

• Hepatitis. The risk of developing hepatitis increases with age, as well as with concomitant alcohol abuse, concomitant use of isoniazid and rifampicin. While taking isoniazid, it is recommended to monitor the level of liver enzymes; when the first signs of the disease appear (persistent increase in ALT, AST 3-5 times higher than normal), you should stop taking the drug.
• Neuropathy. Develops in 2-20% of cases depending on the dose of the drug.
• Skin rash – 2%.
• Fever – 1.2%.
• Anemia.
• Joint pain.
• Epileptic seizures.
• Mental disorders.

Rifampicin ranks second in effectiveness against Mycobacterium tuberculosis after isoniazid. Rifampicin is prescribed 2 times a week or daily for adults 600 mg (10 mg/kg), for children - 10-20 mg/kg.

Side effects of rifampicin:

• Gastrointestinal disorders.
• Hepatitis: mainly in patients with chronic hepatitis or cirrhosis of the liver (especially against the background of alcoholism)..
• Skin rash – 0.8%.
• Hemolytic anemia – 1%.
• Decrease in platelet count.

Pyrazinamide. Used mainly for short courses of tuberculosis treatment. Side effects include a toxic effect on the liver, as well as an increase in uric acid levels in the blood. However, gout, a disease that is caused by an increase in uric acid in the blood, rarely develops when taking pyrazinamide.

Ethambutol. This drug is somewhat weaker than other first-line drugs. Therefore, it is most often used in combination with other drugs. Ethambutol is usually well tolerated. The most severe side effect is optic neuritis, which is manifested by decreased visual acuity and inability to distinguish between red and green colors. These changes are usually reversible, but vision recovery may take 6 months or more.

Streptomycin. This drug is administered intravenously or intramuscularly.

Side effects when using streptomycin occur most often - 10-20% of cases. The most severe of them are toxic effects on hearing and kidneys. The effect on the auditory and vestibular apparatus is manifested by imbalance, dizziness, tinnitus, and hearing loss.

The course of treatment for tuberculosis is usually 6 months. Evaluation of the effectiveness of treatment is carried out monthly based on the results of detection of the pathogen in the patient’s sputum. In severe forms of the disease, as well as in the presence of mycobacteria resistant to anti-tuberculosis drugs, the course of treatment can be extended to 12-18 months.

Complications of tuberculosis

• Complications of the tuberculosis process are varied:
• Pulmonary hemorrhage. It can develop when a vessel in the lungs is destroyed as a result of tuberculous inflammation. This is an acute complication that is often fatal.
• Pneumothorax is the accumulation of air in the pleural cavity, the space surrounding the lung. Occurs when an alveolus (the terminal part of the bronchial tree) or a bronchiole ruptures. Air accumulating in the pleural cavity compresses the lung, which leads to shortness of breath and difficulty breathing.
• Respiratory failure. With massive tuberculosis damage to the lungs, the volume of effectively working lungs decreases, which leads to a decrease in blood oxygen saturation. This leads to severe shortness of breath, sometimes attacks of suffocation.
• Heart failure. Usually accompanied by respiratory failure. It is caused by an increase in pressure in the vessels of the lungs, and increased work of the heart under these conditions.
• Amyloidosis of internal organs. With a long course of tuberculosis, a specific protein, amyloid, can be formed in the internal organs, which can lead to dysfunction of these organs.
• Reduction or loss of function of the affected joints.

Vaccination against tuberculosis

Currently, vaccination against tuberculosis is included in the mandatory vaccination program and is carried out with the BCG vaccine, which stands for “bacillus Calmette-Guerin” (BCG), named after the names of its creators. BCG was created in 1909 from a weakened strain of Mycobacterium bovis; and was first introduced to humans in 1921. The effectiveness of the BCG vaccine is the subject of much debate. According to various studies, it ranges from zero to 80%. However, it is known for sure that the vaccine is significantly effective in children and provides good protection against the development of severe forms of the disease. Mandatory universal vaccination against tuberculosis has not been adopted in all countries; this decision depends on the level of tuberculosis incidence in the country. In Russia, this level is so high that widespread vaccination is considered necessary and mandatory.

BCG is injected into the middle third of the shoulder; after 2-3 months, a skin reaction appears at the injection site in the form of a small (up to 1 cm) thickening. The infiltrate cannot be treated with any means, rub with a washcloth, or remove the crust that covers the wound. By 6 months, a scar has formed.

BCG vaccination is contraindicated:

• Children suffering from any form of immunodeficiency: congenital or acquired (AIDS); and also if there are people in the newborn’s family who suffer from these diseases.
• In the event that the newborn's siblings experienced complications after BCG vaccination.
• Children suffering from severe congenital diseases of the central nervous system, enzymopathies.

Vaccination is postponed:

• In case of prematurity.
• For any infectious diseases.
• In case of Rh conflict between mother and child (if the Rh factor is positive in the child and negative in the mother): if hemolytic disease of the newborn develops.

Complications after vaccination:

• Generalization of infection. Since the BCG vaccine contains live, albeit weakened, bacteria, the development of tuberculosis is possible. However, this complication is extremely rare, almost exclusively in children with undiagnosed immunodeficiency.
• Formation of an ulcer at the site of infiltration. The infiltrate begins to grow and ulcerate, i.e. an open, weeping wound surface appears. Most often this is due to improper care of the vaccination site.
• Formation of subcutaneous infiltrate. If the vaccine is administered incorrectly (injected too deeply), a “ball” forms under the skin. Subcutaneous infiltrate can break into the bloodstream and cause the spread of infection. Therefore, if you suspect this complication, you should immediately consult a doctor.
• Damage to regional lymph nodes. There is an increase in nearby lymph nodes - most often axillary ones, which are painless and range in size from a walnut to a chicken egg. If the lymph nodes are enlarged, immediate consultation with a phthisiologist is also required.
• Formation of a keloid scar. It is formed when there is a hereditary predisposition to the formation of excessive scar tissue at the site of skin damage. It is extremely rare in newborns.

Should my child be vaccinated?

This issue causes constant debate between parents and doctors. It is known that tuberculosis most often affects people of low social status or those suffering from immunodeficiency. Therefore, in many developed countries, only people in risk groups are subject to mandatory vaccination: those living in conditions of low sanitary standards, poorly nourished, and those who have a family member with tuberculosis. However, in Russia the situation is fundamentally different - the level of general incidence of tuberculosis in our country is extremely high. Therefore, any child from the most prosperous family has a much higher risk of encountering an active form of tuberculosis than, say, in the USA or European countries.

The risk of an unvaccinated child becoming infected with tuberculosis in Russia significantly exceeds the risk of any possible complications of vaccination!

Prevention against tuberculosis

Prevention is vaccination.

In already infected individuals, isoniazid has been found to be effective in preventing the development of active tuberculosis. Taking isoniazid daily for 6-12 months reduces the risk of active tuberculosis in those infected by 90% or more. In addition, taking isoniazid reduces the risk of tuberculosis among HIV-infected people.

Indications for drug prevention of tuberculosis:

• Persons in close contact with tuberculosis patients.
• Persons with a positive Mantoux test and signs of previous tuberculosis, detected by radiography or fluorography.
• Changing a negative Mantoux test in the previous year to a positive one is a “turn” of the test.
• HIV infection with a positive Mantoux test.
• Positive Mantoux test and concomitant diseases that reduce the immune response: taking corticosteroid drugs, patients with diabetes.
• Persons arriving from regions with an increased incidence of tuberculosis: prisons, psychiatric clinics, long-term care homes, as well as homeless people, with a positive Mantoux test

Every year, approximately 3 million people die from pulmonary tuberculosis around the world. That is why the question of where, when and how one can become infected with tuberculosis is very relevant. Tuberculosis is an ancient disease and very dangerous for humans. Treatment for the disease is long, unfortunately not always productive. Koch's bacillus (tuberculosis bacterium) can damage any organs, but most of the bacteria affect the lungs.

Is tuberculosis contagious? The most important question that arises in a person’s mind. For a long time it was believed that only the poor could get tuberculosis. As this erroneous opinion is clear, no one is immune from infection by bacteria; there are many places where the virus can enter the body, a street, a store, an expensive restaurant or an ordinary cafe. In a word, everything that surrounds you can be potentially dangerous. The most common method of infection is airborne droplets.

How is tuberculosis transmitted from person to person?

A person suffering from an open form of tuberculosis, sneezing, coughing or simply talking, releases a huge number of microorganisms around him. It is worth noting that Koch's wand extends approximately 12 meters from a sick person.

Methods of infection:

• Droplets of sputum that linger on the walls or floor can be activated in a healthy body, but they penetrate very easily along with the smallest particles of dust.
• The second method of infection is direct contact. By using something that belongs to a sick person, from clothes to dishes, you put yourself at risk, since tuberculosis bacteria can easily enter the body, finding a damaged area through the skin.
• Method of food contamination. Tuberculosis as a disease can affect not only humans, but also animals. By eating the meat of a sick animal, you can infect your body with Koch's bacillus. This means one thing, any type of meat must be well cooked.
• Intrauterine infection. Quite a rare occurrence. As you know, tuberculosis can be contracted by transmitting the virus from mother to fetus. Experts say infection can occur at any stage of pregnancy.
• Non-contact method of infection. Koch's bacillus retains its viability for 6 months, so there is a risk of getting sick in a room where a person with tuberculosis was located during this time.

Risk of infection

In order to minimize the possibility of turning white, it is necessary to carry out a set of sanitary and epidemiological treatment measures. But not everything is so sad, research has shown the fact. It is possible to become infected with tuberculosis only if you are in contact with the patient for a sufficiently long time. One-time contact between a healthy person and a sick person is completely safe.

The human immune system in a normal state is capable of secreting defender cells that instantly respond to the penetration of Koch's bacillus by absorbing tuberculosis microorganisms. But in some cases, a certain amount of bacteria remains in the body in an inactive state, without causing any harm to the body and human health. However, these inactive bacteria can easily become activated if the immune system weakens. After some time, the form of tuberculosis will enter the active phase, and this is already dangerous.

Harmful organisms can infect not only the lungs, but also spread through the blood and settle in the kidneys, brain, and so on. The risk of the disease largely depends only on the person himself; the largest number of patients are young people aged 18 to 30 years. Tuberculosis can also occur as a consequence of other diseases, the main one being HIV infection, which does not allow the immune system to fight various viruses.

In addition, the risk of contracting pulmonary tuberculosis increases if a person is a carrier of chronic diseases such as diabetes, kidney failure and, of course, lung disease. Such people are recommended to conduct a Mantoux test annually, which will help identify a possible Koch bacillus disease and take treatment measures.

Signs of tuberculosis in adults

You can determine whether an adult is sick based on some basic signs. The first thing you should know is that there is an open form of tuberculosis, there is a closed form, the symptoms of the disease, despite the similarity, have significant differences. Also, symptoms depend on the stage of development of the disease.

The main danger of open tuberculosis is infection during contact with a patient. The first sign is a cough; in a sick person it is paroxysmal, protracted with copious secretion of yellowish sputum; the progressive type of tuberculosis can be determined by the appearance of blood in the sputum during a cough. Sharp weight loss, and despite the fact that the person continues to eat as usual, he continues to lose weight. Periodic increase in body temperature. And increased sweating during sleep.

The closed form of tuberculosis has the following symptoms. A rare cough is sometimes also paroxysmal. In general, it proceeds without any symptoms that emphasize the disease. In order to understand whether a person is sick, it is necessary first of all to do a Mantoux test and donate blood for analysis. As soon as a doctor discovers tuberculosis in a person, he immediately prescribes treatment, which directly depends on the form of development of the disease. As already mentioned, in some cases treatment will be ineffective.

Open form of tuberculosis: how you can get infected

The source of tuberculosis infection is primarily contact with sick people. Phthisiatricians say that one person with tuberculosis can infect up to 15 healthy people with a weakened immune system over the course of a year. It is no secret that the risk group includes those people who, by chance, are forced to come into contact with a sick person.

Experts also highlight the possibility of infection through the use by a healthy person of objects that were used by the patient. There is also a risk of infection among those people who suffer from chronic lung diseases; pneumonia is often the causative agent of the disease. In order to exclude the possibility of tuberculosis, you should initially treat pneumonia correctly and strictly follow the doctor’s instructions.

Closed form of tuberculosis: can you get infected?

Today, the closed form of tuberculosis is the most common of its kind. According to the World Health Organization, 25 percent of the population on the planet suffers from the closed form, while only 7 percent experience stagnation, and the closed form becomes open. Once the Koch bacillus enters the body, it begins to affect the respiratory organs and lymphatic system. The closed form of tuberculosis is not dangerous to others, however, for a sick person this is a reason to constantly monitor its behavior in the body. To do this, you need to do a Mantoux test every year and donate blood for analysis.

Unlike the open form, the closed one does not allow bacteria to come out with the help of sputum; viruses are kept as if in a jar with a tight lid. The immune system, secreting cells, defenders intercepts every attempt of the virus. For a sick person, it is sometimes possible to experience shortness of breath and difficulty breathing, this is a reason to consult a specialist.

Incubation period of tuberculosis

The period (time period) from the moment when Mycobacterium tuberculosis (Koch bacillus) enters the body until the appearance of the primary manifestations of the disease is called the incubation period in medicine. As a rule, the incubation period lasts from 90 days to a year. The very moment of the end of this period is very difficult to identify, since the onset of the disease can easily be confused with a common cold.

The incubation period is the time when Mycobacterium tuberculosis enters the respiratory tract and is under the active influence of the body's immune system. A healthy immune system can completely destroy the Koch bacillus bacteria, in which case the disease will not develop, and some (residual) bacteria will remain inactive in the body. During the incubation period, a person does not excrete any harmful bacteria with sputum. It is worth saying that during this period of time even the Mantoux test will show a negative result.

Judging by your diet, you don’t care about your immune system or your body at all. You are very susceptible to diseases of the lungs and other organs! It's time to love yourself and start improving. It is urgent to adjust your diet, to minimize fatty, starchy, sweet and alcoholic foods. Eat more vegetables and fruits, dairy products. Feed the body by taking vitamins, drink more water (precisely purified, mineral). Strengthen your body and reduce the amount of stress in your life.