Infiltrative pulmonary tuberculosis. Infiltrative pulmonary tuberculosis in the decay phase, contagious or not

The site is a medical portal for online consultations of pediatric and adult doctors of all specialties. You can ask a question on the topic "decay of the lungs in tuberculosis" and get it for free online consultation doctor

Questions and answers on: lung collapse in tuberculosis

2014-04-03 15:26:20

Natalya asks:

Hello. Six months ago I underwent fluorography and it showed calcifications. Ten days ago I gave birth to a daughter. The day before giving birth, I caught a very bad cold. I was admitted to the maternity hospital with a fever and a cough with phlegm. After giving birth, I had a fluorography scan of my cold lungs, the pictures turned out bad, the next day I was given an x-ray, and they diagnosed me with tuberculosis. in the garden of decay. Can x-rays be wrong or can doctors in this case? Now I'm at the dispensary, taking prescribed pills. I gave a sputum sample, but the analysis does not reveal any signs, there are no rods in the sputum analysis. Tell me, can this happen with tuberculosis in the decay stage? Although there were no symptoms during pregnancy.

Answers Strizh Vera Alexandrovna:

2011-04-04 06:07:36

Olga asks:

Hello, dear doctors!
Please tell me whether a doctor can diagnose infiltrative pulmonary tuberculosis with the following examination:
Result of an extensive x-ray: On the left in the upper lobe, a limited infiltrate is determined with the presence of a vague decay cavity against its background. The roots are compacted. The diaphragm is smooth.
Conclusion: limited infiltrate in the upper lobe of the left lung with partial rarefaction.
The mantoux reaction is negative, tests for acid-fast mycobacteria (AFB) are not detected, MBT is negative.
During the X-ray, my father was ill acute bronchitis(lingering). Could this be pneumonia?

Answers Gordeev Nikolay Pavlovich:

Hello Olga. The question is posed correctly. Yes, it could be pneumonia. And with the collapse. And in the upper lobe. Any doctor needs to evaluate all data in a comprehensive manner. Incl. and disease clinic. If clinical manifestations no, your father feels like a healthy person, then the image data can be interpreted as 80% tuberculosis. If you don't trust your doctor, you can switch to another one. After all, the quality of therapy also depends on the degree of trust in the doctor. Good health to you.

2010-04-27 15:13:35

Ekaterina asks:

Hello! I have been undergoing treatment since May 2009, at first they put me in group 0, and from September 1, 2009 I was registered with the tuberculosis dispensary and assigned to group 1A.. CT scans were performed 5 times at different times.
On May 8, 2009, they gave a diagnosis of tuberculoma of the upper lobe of the left lung.
On August 25, 2009, a CT scan showed a developing cavity in the upper lobe of the left lung.
On November 2, 2009, a CT scan again showed tuberculoma of the upper lobe of the left lung.
March 16, 2010 wrote on the site of the previously described formation is determined cavity formation with walls of uneven thickness up to 0.3 mm, dimensions 17x14 mm, without contents, the adjacent parietal pleura is pulled towards the formation. The parenchyma of both lungs in other parts of the usual airiness of the fields of pathological densitometry does not contain. The bronchial tree is visualized down to the subsegments, the bronchi are of normal diameter, not deformed, the orifices are free, their lumen and patency are preserved throughout. The sinuses are free.
The trachea is of normal shape and size, the carina is sharp. Vascular structures of the upper mediastinum with clear contours, normal diameter, walls without visible calcifications. The heart is located normally, the dimensions are not changed. Mediastinal lymph nodes are not enlarged. The mediastinal tissue is not changed.
In conclusion, they wrote a periodically draining cavitary formation of the upper lobe of the left lung
On April 13, I had a CT scan again. Subpleurally, the previously described oval-shaped cavitary formation, 16x12x14 mm in size, remains, with the presence of contents with a density of up to 7 units N (in comparison with the study of 03/16/10, the contents increased in volume) and a single calcification that was not previously determined. In other parts, everything is normal.
The conclusion was that there was a cavitary formation in the upper lobe of the left lung.
At the same time, after almost a year of treatment, I still have not shown any signs - no sputum, no cough, no fever, no sweat either.
And when I talked to the radiologist, I asked him if it was a cavity or maybe an abscess? He told me neither this nor that, that it was just a cavity formation.
But the most interesting thing is when I came to my local TB doctor, she referred me for a consultation with surgeons and gave me a referral, in which she wrote infiltrative tuberculosis in the decay phase. I still don’t understand where she got this from, if she didn’t even look at the pictures and there was no commission at which they decided to send me for a consultation, she wrote based on their radiologist’s conclusions.
I have a question for you:
Can you tell what kind of cavity formation this is? And what form of tuberculosis does it refer to?

Answers Telnov Ivan Sergeevich:

Good afternoon It is difficult to answer your question without seeing the pictures themselves, but in all likelihood you have fibrocavernous tuberculosis. I recommend having a bronchoscopy.

2010-04-11 22:57:39

Indira asks:

Hello! I have tuberculosis. Conclusion - fibroatelectasis of the upper lobe right lung; infiltrative tuberculosis in the phase of decay and seeding. There is a process in the bronchi as well. I am currently on treatment (sixth month), the dynamics are positive. It is possible and most likely that you will have to undergo surgery. Is it possible to avoid surgery or is it better to go for it? Is there a negative side to this, i.e. pros and WHAT are the cons? After how many months is it better to have surgery?

Answers Gordeev Nikolay Pavlovich:

Hello Indira. The timing of the operation is always determined individually; if planned, then usually after stabilization of the process has been achieved and/or bacterial excretion has ceased. But it’s better not to wait too long. The biggest plus is recovery. And the disadvantages are the same as with any other operation. It’s easier because it’s easy paired organ and after resection, the parts quickly compensate for the deficiency and the person feels completely healthy. Good health to you.

2014-07-18 11:16:41

Svetlana asks:

Hello, please explain my diagnosis, during a routine fluorography on December 13, 2013, focal fibrous changes were found in the image in the lobes of the right lung, and they sent me a description for a tomogram: on direct tomograms of the right. lung (sections 6,7,8,9) very fibrotic changes in the right are determined. the tops of the decay cavities were not found. on the right in the lobe there is a pleuroapipelous commissure, a fibrous scar. There is no data for active tuberculosis. when they took the fluorography for 2012, the doctor said that changes were already visible then, but no one told me about this. I passed the commission and no problems arose until the next year. I want to understand whether I have tuberculosis or not, now I’m pregnant and worried about my unborn child. Please explain what my diagnosis means.

Answers Veremeenko Ruslan Anatolievich:

Hello Svetlana! At the moment there is no active tuberculosis process (taking into account the statute of limitations of 2012). Focal changes (i.e., Gon's lesions) will remain in the lung; it is dense tissue and does not dissolve.

2014-07-01 09:52:42

Irina asks:

Good evening. Please tell me, my husband is diagnosed with infiltrative tuberculosis of the left lung S6 in the decay stage of MBT (+) MDR.GDU2A, treatment is in the intensive phase according to regimen 4, there is resistance to capreomycin, streomycin, isoniazid, rifampicin, kanamycin. Moderate impairment of bronchial obstruction. Widespread obstruction. Vegetative-vascular dystonia. Suffered from bilateral pneumonia. With these diseases, can there be no pulmonary-heart failure and with the help of what kind of examination is it determined? Doctors write that the heart and aorta are normal after performing only an ECG. Is this enough or is it necessary to carry out some other examination for a more accurate diagnosis. Thanks for the answer

Answers Gordeev Nikolay Pavlovich:

Hello Irina. Deficiency is determined both clinically and during use instrumental methods(ECG. spirography, stress tests). For him now, the main thing is to treat the underlying process. Good health to you.

2014-06-30 16:37:25

Irina asks:

Good evening. Please tell me, my husband is diagnosed with infiltrative tuberculosis of the left lung S6 in the decay stage of MBT (+) MDR.GDU2A, treatment is in the intensive phase according to regimen 4, there is resistance to capreomycin, streomycin, isoniazid, rifampicin, kanamycin. Moderate impairment of bronchial obstruction. Widespread obstruction. Vegetative-vascular dystonia. Suffered from bilateral pneumonia. With these diseases, can there be no pulmonary heart failure and with the help of some examination it can be determined. And what are the chances of being cured in specialized clinics? Thanks for the answer

Answers Gordeev Nikolay Pavlovich:

Hello Irina. Yes, at moderate violation bronchial patency, even despite other pathology, the body can be compensated and there may not be insufficiency. You did not indicate your husband's age. This matters too. And failure is determined both clinically and using instrumental methods (ECG, spirography, stress tests). If the patient is careful in treatment, then the chances of achieving a cure are high. But you must initially clearly understand that it will not be possible to completely cure the process. Only achieve permanent remission with large residual changes. Good health to you.

Infiltrative tuberculosis in the decay phase is serious illness, which is distinguished by its rapid development.

As a result of this form of tuberculosis, general intoxication, occurring in the body, as well as signs respiratory failure. Important: as a result of this condition, the patient experiences internal decay and disruption of tissue structure, as well as pathological necrosis of the alveoli, which poses a serious threat to the patient’s body and health.

More than 70% of people suffering from tuberculosis suffer from this form of the disease, which is classified as a socially dangerous disease. People aged 20-40 years are most susceptible to it - most often these are dysfunctional individuals, such as alcoholics, drug addicts and smokers. Also high risk become infected with pathology in people with chronic diseases that were caused by infection of the body.

Unlike other forms of the disease, infiltrative tuberculosis is much more common these days and is also well treated, so the mortality rate from it is approximately 1% of the total. total mortality with inflammation of the lung cavity.

Infiltrative tuberculosis is caused by mycobacteria, which are capable of for a long time live in the human body and the environment. How long can Koch's bacillus exist in the environment? On average, this mycobacterium lives about 30 days in the air and several years in the human body in an inactive state.

These mycobacteria are distinguished by the following features:

• They have a strong protective shell and no core;
• the sizes of Koch rods vary from 1 to 10 microns;
• have the shape of a straight stick;
• cannot form disputes;
• unable to move;
• do not produce toxins;
• they contain a rare protein – tuberculin.

Most often, infection with the infiltrative form of tuberculosis occurs through the air. Transplacental, contact, and fecal-oral or food method infection.

It is worth considering that even if mycobacteria penetrate the respiratory system, infiltrative tuberculosis may not develop further, due to the fact that the infection is resisted by the body's defenses in the form of mucus. A person is also protected by immunity, which does not allow dangerous myrobacteria to enter the body and does not allow them to multiply in organs and systems.

A sick person will be a danger to others if he has tuberculosis in the open stage. In this case, in lung tissue Infiltrates are actively formed, which initially have a diameter of 3 cm and then increase.

Infiltrative tuberculosis has the most different reasons occurrence, and the decisive factor in this case is the weakening of the entire organism.

Predisposing factors to the development of the disease are:

• HIV infection;
• smoking;
• diabetes;
• drugs;
• stress;
• alcohol;
• prolonged contact with the patient;
• nonspecific lung pathology;
• frequent stressful situations.

Important: incubation period The disease often lasts for several years, but with the slightest weakening of the immune system, hypothermia and poor nutrition, the Koch bacillus can quickly become active and begin to multiply in the lung cavity.

Clinical signs pneumonia caused by Koch's bacillus resembles severe degree pneumonia. As a result of inflammation, the infection quickly spreads into the lung cavity, affecting healthy cells and tissues. Infiltrative tuberculosis can quickly destroy lung tissue, which leads to toxins entering the human blood. It causes the skin to turn blue, general weakness, shortness of breath and a number of others unpleasant symptoms, life-threatening.

Forms and symptoms

Prolonged treatment of pulmonary tuberculosis often leads to the development of a disseminated stage, in which the infection actively spreads throughout internal organs. Doctors nowadays distinguish some types of infiltrative pulmonary tuberculosis, which occur in the decay phase.

These include:

1. Lobular. In this form, foci of pneumonia grow together into one large conglomerate.
2. Round. The infiltrate is characterized by smooth outlines, the size of which is 3-6 cm. When a path appears to the main part of the lung, it becomes clear that mycobacteria begin to actively search for new, more suitable foci of contamination.
3. Cloud-shaped. The contours of the inflammation are unclear and very blurred.
4. Periocissuritis. The source of the disease is in upper parts lungs, the outline of which is indistinct and very blurred.
5. Lobit. With this form of the disease, damage to the entire lung cavity is observed, in which numerous and very large cavities of tissue decay are formed.

All of the above types of infiltrative tuberculosis characterize the presence of infiltrate in the pulmonary cavity, and also show bronchogenic contamination.

All types of infiltrates can be divided into small (no more than 2 cm), medium (no more than 4 cm) and large (4-6 cm). The size of common lesions may exceed the indicators. Most often, the focus of contamination and decay develops in one lobe of the lung, while the second remains completely healthy.

Infiltrative pulmonary tuberculosis is expressed by some symptoms that cannot be called characteristic of this disease:

• pain in the thoracic region, which can be overcome by treatment for 1-2 months;
• weakness of the body;
• lack of sleep;
• pain and feeling of muscle tightness;
• feeling of heartbeat;
• cough;
• wheezing while talking;
• increased sweating.

Treatment of lung pathology

Treatment of pneumonia in the seeding phase with modern fast-acting drugs allows short term normalize the patient’s condition, since thanks to medications, the unpleasant symptoms of the disease quickly disappear. It is worth remembering that infiltrative pulmonary tuberculosis relieves the patient of chest pain only after 1-2 months complex treatment. However, it should not be violated so as not to aggravate the course of the disease.

Important: correct treatment allows you to normalize general state the patient, as well as stop the development of bacteria dangerous to health.

With morphological changes that occur in the lung cavity, treatment of the disease is very difficult, since this state is caused by the resorption of foci of inflammation, which leads to the formation of a “bag”, which quickly develops into tuberculomas. In this case, the main treatment is surgery.

How long does it take to treat pathology in the seeding phase? Current drugs can give a positive result in the treatment of the lung cavity in 1-6 months.

It is important to note that these drugs can be divided into 3 groups according to their mode of action on the body:

• the first stops the proliferation of bacteria;
• the second removes them from the body;
• the third is endowed with a restorative effect that heals damaged lung tissue.

On average, treatment in this way is carried out quickly, since each drug is endowed with unique composition, which in a short time has a negative effect on bacteria, suppressing their reproduction in the body.

If the treatment does not benefit the patient, the doctor transfers him to a hospital, where the dissemination of mycobacteria is suppressed, as well as the restoration of the lung cavity.

Tuberculosis is classified into secondary and primary. In the secondary form of the disease, there are several different types. One of them is infiltrative tuberculosis, which occurs most often in patients. It may occur in different parts. This may be infiltrative tuberculosis of the right or left lung, as well as their lobes. Therefore, you need to know how to diagnose it in order to start treatment on time and prevent consequences. Main question, many people are concerned about whether infiltrative tuberculosis is contagious or not.

What is infiltrative tuberculosis? This is a form of pulmonary tuberculosis that is found in secondary stage. At this stage, lung damage occurs, as well as the formation of infiltrates. Infiltrate is an accumulation in tissues various organs cellular debris mixed with blood and lymph fluid. In this disease, accumulation occurs in the alveoli of the lung. In any case, you need to understand that the development of tuberculosis in a severe, open form is possible only with bad work protective forces body. If there are not enough antibodies that can kill Koch's mycobacterium, then they turn into active phase, begin to multiply and destroy the lungs and neighboring organs.

1. How independent disease after the pathogen enters the body.
2. In case of progression of focal tuberculosis.

It is important to note that this type of disease is dangerous for others because it is contagious and the bacteria are transmitted by airborne droplets. This should be taken into account by the patient himself, as well as his relatives and friends. At the same time, the primary tuberculosis complex does not infect others, and infiltrative tuberculosis is an open form.

Infiltrative pulmonary tuberculosis is common, but few people know what it is. This is a form that is dangerous and contagious. It is characterized by the appearance of infiltration in the alveoli of the lung.

Take a free online TB test

Time limit: 0

0 out of 17 tasks completed

Information

Test loading...

results

Time is over

• Congratulations! The likelihood that you will develop tuberculosis is close to zero.

  But don’t forget to also take care of your body and undergo regular medical examinations and you won’t be afraid of any disease!
  We also recommend that you read the article on.

• There is reason to think.

  It is impossible to say with certainty that you have tuberculosis, but there is such a possibility; if it is not Koch bacilli, then there is clearly something wrong with your health. We recommend that you undergo a medical examination immediately. We also recommend that you read the article on detecting tuberculosis in the early stages.

• Contact a specialist urgently!

  The likelihood that you are affected by Koch bacilli is very high, but it is not possible to make a diagnosis remotely. You should immediately contact a qualified specialist and undergo a medical examination! We also strongly recommend that you read the article on detecting tuberculosis in the early stages.

1. With answer
2. With a viewing mark

Task 1 of 17

1 .

1. Task 2 of 17

   2 .

2. Task 3 of 17

   3 .

   Do you carefully observe personal hygiene (shower, hands before eating and after walking, etc.)?

3. Task 4 of 17

   4 .

   Do you take care of your immunity?

4. Task 5 of 17

   5 .

   Have any of your relatives or family members had tuberculosis?

5. Task 6 of 17

   6 .

   Do you live or work in an unfavorable environment (gas, smoke, chemical emissions from enterprises)?

6. Task 7 of 17

   7 .

   How often are you in damp, dusty or moldy environments?

7. Task 8 of 17

   8 .

   How old are you?

8. Task 9 of 17

   9 .

   What gender are you?

9. Task 10 of 17

   10 .

   Have you experienced Lately feeling very tired for no particular reason?

10. Task 11 of 17

    11 .

    Have you been feeling physically or mentally unwell lately?

11. Task 12 of 17

    12 .

    Have you noticed a weak appetite lately?

12. Task 13 of 17

    13 .

    Have you recently noticed a sharp decline in your healthy, plentiful diet?

13. Task 14 of 17

    14 .

    Have you recently felt an increase in body temperature? long time?

14. Task 15 of 17

    15 .

    Are you having trouble sleeping lately?

15. Task 16 of 17

    16 .

    Have you noticed yourself lately? increased sweating?

16. Task 17 of 17

    17 .

    Have you noticed yourself looking unhealthy lately?

The causes of this form of the disease, like all others, are a special bacterium that causes tuberculosis. The etiology of the pathology is infectious. In order for a person to become infected, several types of bacteria must be present in the body at the same time. There are extrapulmonary forms of the disease, for example, renal tuberculosis or pulmonary tuberculosis. In total, science knows about 74 types of Mycobacterium tuberculosis. The danger of this microorganism is that it is very tenacious and easily adaptable. At the same time, the bacterium is capable of modification under the influence of external factors. But, in addition to the main causes of pulmonary tuberculosis, there are risk factors that increase the chances of developing pathology after infection.

Any of these conditions provokes a decrease in immunity, which leads to the activation of bacteria in the body and the development of the clinical picture. Once infected, a person does not necessarily become ill. Our immunity is quite capable of defeating the pathogen, but if the body’s defense is weak, then the bacteria begins to multiply and become active.

Weak immunity is what provokes the causes of infiltrative pulmonary tuberculosis to reproduce and develop. As a result, the patient can earn not only focal tuberculosis, but also infiltrative, with great complications.

The mechanism of development of the infiltrative form of the disease occurs in several stages.

1. After the bacteria enters the lungs, foci are formed with a diameter of no more than 3 cm. At this moment, the doctor diagnoses infiltrative tuberculosis of the upper lobe of the right or left lung. This phase can last up to five weeks.
2. Infiltrates appear, which can increase in size and also move to other parts of the lung. Lung tissue changes color, as well as volume and density. This phase is easily diagnosed with x-rays. Infiltrative pulmonary tuberculosis may differ in the contours of the lesions, but it is always noticeable on the image.
3. Next, the lung tissue collapses. It becomes difficult for a person to breathe if tuberculosis is in the decay stage. All the signs are clear and the patient is admitted to the hospital most often during the decay phase.

If left untreated, infiltrative pulmonary tuberculosis can lead to the formation of caseous cavities and caseous pneumonia. Then there is the collapse of the lungs in tuberculosis.

The initial stage of focally infiltrative tuberculosis is considered to be the infiltration phase, when infiltrates are just formed, which can be detected on x-ray in the form of foci whitish in color. You should also pay attention to the seeding phase, which is characterized by the formation of small foci near the infiltrate. The outbreaks are small, but there are many of them.

All forms, regardless of the reason for their appearance and clinical form, go through several phases of development. This may be disseminated pulmonary tuberculosis or infiltrative pulmonary tuberculosis, but there is still a phase of infiltration, decay and seeding.

Symptoms of the disease

In order to prevent the development of infiltrative tuberculosis in the decay phase, it is necessary to pay attention to the symptoms and signs of the disease as early as possible. They may differ at different stages. Most often, the infiltrative form of tuberculosis manifests itself in acute form.

1. Pain in the chest or shoulder blade area. Localization pain depends on the location of the lesion. For example, when diagnosed with infiltrative tuberculosis of the upper lobe of the left lung, the pain may be localized in the upper left.
2. Cough. Most often dry. If there is sputum discharge, it is not at all large quantities.
3. Temperature. An increase can be observed up to 41 degrees.
4. Decreased appetite and sudden weight loss.
5. Sweating, especially at night.
6. Aching bones, as well as weakness.
7. Tachycardia.

When moving to the cavernous stage, the symptoms intensify, the cough becomes sputum, sometimes pus appears in the sputum, and severe shortness of breath and profuse sweating occur. For some types of infiltrative tuberculosis, treatment may be delayed, since the course of the disease is asymptomatic or its gradual development.

Frequent cough, even dry should be a reason for urgent appeal to the doctor. If a person suddenly begins to lose weight, and often sweats at night, then it is advisable to remember the last time you had fluorography. Remember that infiltrative pulmonary tuberculosis in the last phase of decay is much more difficult to treat.

Doctors also divide infiltrative tuberculosis into several types. This is necessary to identify the correct treatment strategy.

The types of pathology are well defined by x-ray. The doctor can determine the specific type of disease and prescribe adequate treatment. Depending on the phase and type, treatment prognoses also differ.

Types of infiltrative tuberculosis differ in the quantity, quality and form of the resulting infiltrate. Therefore, when a patient approaches, the doctor first performs a full diagnosis.

In order to prevent tuberculosis from collapsing the lungs, it is imperative to diagnose the pathology in time.

1. Biochemical analysis blood, which will show the presence of inflammation in the body. In addition, the laboratory can examine the patient's urine and feces.
2. Examining and listening to the patient. This way the doctor can identify specific wheezing.
3. X-ray. If a patient is suspected of having tuberculosis, mandatory sent for an X-ray examination of the lungs. In the picture you can see infiltrates and determine the specific type of tuberculosis.
4. Taking sputum for examination and detection of Mycobacterium tuberculosis. In this case, it is possible to forcefully induce sputum using special aerosol agents.
5. MRI is prescribed to clarify the diagnosis and study the functioning of neighboring organs.

Many patients discover tuberculosis after visiting a doctor for suspected pneumonia or bronchial disease. Diagnostic measures It should be carried out immediately after the first suspicion of the presence of a pathogen is detected. Separately, it is worth noting differential diagnosis. It can occur against the background of focal tuberculosis, as well as lung cancer, echinococcus, lung cysts and even syphilis. After treatment, it is mandatory to carry out repeated diagnostics, and every six months additional examinations for control.

Diagnosing tuberculosis is important stage in order to get rid of this pathology without waiting for complications.

There are several types of treatment for infiltrative tuberculosis. Each of them has its own advantages and disadvantages. Most effective treatment is selected by the attending TB doctor who supervises the patient.

It is necessary to realize that treatment of tuberculosis in this form is very difficult. Typically, for infiltrates to heal and resolve, it takes at least 10 months. And then you may need therapy to counteract relapses, which is carried out at a dispensary under the supervision of a specialist. The most important thing is to strictly follow all doctor’s orders and lead a healthy lifestyle.

Most often, anti-tuberculosis drugs are used in treatment, but they must be taken in a hospital, following the therapy prescribed by the doctor. Treatment takes a long time. IN as a last resort surgical intervention is used.

Doctors' forecast

Since the disease is very complex, it is necessary to understand that the prognosis cannot be 100%. Very high risk of complications. It all depends on the time of contacting the doctor and on compliance with the prescribed therapy.

• favorable prognosis means complete resorption of the infiltrate, as well as resorption with residual fibrous elements;
• an unfavorable outcome means transition to fibrous-cavernous tuberculosis, as well as death from intoxication.

In any case, it is necessary to start treatment as early as possible. In addition, it is important to raise social level life, improve nutrition, and quit all bad habits. If you completely follow all the doctor’s recommendations, the outcome will definitely be positive.

The prognosis of doctors in the presence of infiltrates depends on the stage at which the disease is detected, as well as on the conscientiousness of the therapy.

In order not to get sick or worsen your condition, you must follow preventive measures. One of them is early diagnosis. Therefore, you need to undergo routine fluorography every year.

1. Healthy image life.
2. Proper nutrition.
3. Taking vitamins.
4. Strengthening the immune system.
5. Treatment for everyone colds.
6. Vaccination of newborns, as well as adolescents up to 14 years of age.
7. Annual tuberculin test for adolescents.

It is important to understand that anyone who has a weak immune system or communicates with sick people and animals can get tuberculosis. If there is a patient in your environment, then you need to be especially careful about hygiene, otherwise you can progress the disease to cavernous pulmonary tuberculosis.

Since infiltrative pulmonary tuberculosis does not always occur independently, it is important to diagnose all abnormalities in the body. To do this, you need to undergo fluorography annually and, if you have suspicious symptoms, consult a doctor.

Consumption, as tuberculosis was once called, kills every year for centuries great amount lives. However, not everyone understands that the disease affects not only alcoholics and drug addicts, but also people with chronic diseases. Therefore, it is important to diagnose and begin treatment in time to prevent the latent form of tuberculosis from turning into an infiltrative or cavernous form, which will lead to the collapse of the lungs. At the same time, it is important to understand that the disease can stop, and the infiltrates will resolve, forming scars; the main thing is to comply with therapy, which can take more than one year. In addition, do not neglect fluorography.

Quiz: How susceptible are you to tuberculosis?

Time limit: 0

Navigation (job numbers only)

0 out of 14 tasks completed

Information

This test will show you how susceptible you are to tuberculosis.

You have already taken the test before. You can't start it again.

Test loading...

You must log in or register in order to begin the test.

You must complete the following tests to start this one:

results

Time is over

• Congratulations! Are you OK.

  The probability of getting tuberculosis in your case is no more than 5%. You are a completely healthy person. Continue to monitor your immunity in the same way and no diseases will bother you.

• There is reason to think.

  Everything is not so bad for you; in your case, the probability of getting tuberculosis is about 20%. We recommend that you take better care of your immunity, living conditions and personal hygiene, and you should also try to minimize the amount of stress.

• The situation clearly requires intervention.

  In your case, everything is not as good as we would like. Probability infectious lesion Koha sticks account for about 50%. You should immediately contact a specialist if you experience first symptoms of tuberculosis! It is also better to monitor your immunity, living conditions and personal hygiene, and you should also try to minimize the amount of stress.

• It's time to sound the alarm!

  The probability of infection with Koch sticks in your case is about 70%! You need to consult a specialist if any unpleasant symptoms appear, such as fatigue, weak appetite, or a slight increase in body temperature, because all of this may turn out to be symptoms of tuberculosis! We also highly recommend that you undergo a lung examination and do a medical test for tuberculosis. In addition, you need to take better care of your immunity, living conditions and personal hygiene, and you should also try to minimize the amount of stress.

1. With answer
2. With a viewing mark

Task 1 of 14

1 .

Does your lifestyle involve heavy physical activity?

1. Task 2 of 14

   2 .

   How often do you take a tuberculosis test (eg Mantoux)?

The rapid progression of pathology as a result of damage by mycobacteria leads to the destruction of tissue, in place of which cavities form. This form of the disease is called infiltrative pulmonary tuberculosis in the decay phase. This stage of the inflammatory process is of the perifocal type, which is accompanied by hypersensitivity and pathological changes in the functions of the endocrine system. With absence adequate treatment the infection spreads through the bloodstream to other organs. The therapeutic course is quite long, the prognosis is favorable in case of timely measures, when MTB (Mycobacterium tuberculosis) does not have time to develop resistance to all groups of drugs.

Etiology

The basis for the development of the disseminated form is endogenous or exogenous infection. Reactivation occurs with progression in the foci of old or newly formed areas in which an exudative process occurs. With repeated massive penetration of the mbt, hyperergy occurs - acute reaction the body to the influence of the provoking pathogen. The risk group includes people suffering from the following pathologies and conditions:

• Patients who have previously had Mtb infection
• For alcohol and drug addiction
• People leading an antisocial lifestyle
• For diabetes
• For serious chronic diseases respiratory system
• In people with HIV infection.

Pathogenesis

The body's defense systems are in mucociliary clearance, when a specific secretion is produced that glues the invading mtb. Subsequently, the pathogen is eliminated. If immunity, due to a number of reasons, does not have time to form, bacteria begin to accumulate in areas with the most developed microcirculation channel - in the lungs and lymph nodes. At the same time, its population increases significantly.

At the site of formation of extensive Mtb colonies, a phagocytotic process develops with the participation of macrophages. But the pathogen creates virulence factors that contribute to the destruction of lysosomal compounds. As a result, bacteria continue to multiply, but also extracellularly.

In the case of macrophage deactivation, the phagocytotic process is ineffective, so the growth of Mtb colonies is not controlled. Cells are not able to cover such a volume of damage, and massive death occurs. Many mediators and proteolytics are released, which leads to tissue destruction. At this time, a nutrient environment is created that promotes the life of the mbt.

Inflammation becomes widespread, the walls of blood vessels become permeable, due to which protein, plasma, and leukocyte compounds form granulomas in the tissues. Necrosis begins in these formations and caseosis occurs. Infiltration intensifies, individual foci merge into large areas.

The progression of the pathology consists of three stages: infiltration, decay, contamination, which indicates an active stage. Moreover, some patients may experience one of the phases, while others may experience two or three. Each has its own symptoms that help to correctly diagnose and prescribe treatment.

The main feature is the exudative process. Infiltrative tuberculosis of the upper lobe of the right lung or the left part of the system is characterized by the formation of fluid in the alveolar lumens. This secretion consists of protein fibrin and dead epithelial cells. Complications include pneumonia with damage to lobar areas and the formation of cavernous cavities.

Phthisiatricians subdivide several types of pathology with accelerated seeding:

• Tuberculosis of the right or left lung with a cloud-type infiltrate is characterized by a rapid process of decay and the appearance of new cavities. The idea of ​​blurry shadows is noted on the radiograph.
• A lesion with clear boundaries, which is localized in the subclavian zone and has light areas in the center - a round infiltrate.
• Blackout irregular shape in the form of a combination of several localizations, it has a characteristic spot of decay in the middle - this is the lobular stage.
• Triangular shadow with sharp end, facing the root and limited by a groove along the lower edge - the periscisuritic stage of decay.
• Extensive contamination and damage with large areas of infiltrates merging into common cavities, occupying an entire lobe of the left or right lung, is a lobar form.

All species, without exception, have common feature– presence of infiltrate and contamination of the bronchogenic type. The difficulty lies in the fact that the pathology, up to a certain point, has symptoms characteristic of pneumonia, influenza, and respiratory infections. Therefore, tuberculosis in the decay stage is recognized by x-ray examination.

Clinical picture

The disease develops from 14 to 120 days. Signs vary depending on the degree of development:

Infiltration phase

With this form there are still no destructive changes, but there is an inflammatory process accompanied by exudation. Symptoms are expressed in the following manifestations:

• Weakness, fatigue
• Decreased appetite
• Chest pain
• Dry cough with moist wheezing
• Pyoderma
• Muscle strain
• The sound of pleural tissue rubbing.

Decay phase

Melting of the epithelial layer begins with caseous necrotic formations. The disintegrated masses are rejected and excreted through the bronchi by air. Pneumonogenic cavities characterize the degree of decay. If the lymph nodes are involved, a breakthrough of caseous secretion occurs through the resulting fistulas. Clinical picture next:

• Cough with wheezing different intensity and sputum
• Hemoptysis
• Constant shortness of breath
• Feeling of pressure in the chest
• Increased sweating
• Temperature fluctuations from low-grade to very high
• Sleep disturbance
• Cyanosis of the oral mucosa
• Reduced skin turgor.

Seed phase

Often, tissue breakdown leads to the spread of mbt to unaffected organs. They enter healthy areas of the lung along with sputum during coughing. To all characteristic symptoms signs of severe intoxication are added. First, the disease spreads to nearby areas, then moves further.

The lesions have irregular shapes, the transition of the inflammatory process occurs through the alveolar ducts and bronchioles. This stage of tuberculosis is also called open.

Diagnostics

When examining a patient, the doctor collects data about his condition and finds out information about the primary infection. Auscultation and percussion are necessary to assess breathing and the characteristics of wheezing; they are more pronounced in the lobar form.

The most effective way Determination of any form of tuberculosis is a tuberculin test. This technique is designed to determine the reaction immune system the body on the MBT, which significantly helps in treatment. Upon receipt positive result The following tests and analyzes are carried out:

• X-ray in 3 projections
• Tomographic examination
• Bronchoscopy for sputum analysis
• Biochemical test to determine the level of leukocyte elements.

Treatment methods

When tuberculosis is detected in the decay phase, therapy is carried out in a hospital setting. Tactics are aimed at resolving infiltrates, closing cavities and negative result tuberculin test. Anti-tuberculosis drugs for chemotherapy are prescribed in combination to avoid the development of resistance. There is a principle of three groups, which involves the use of the following antibiotics:

First scheme

The course of treatment includes two medications. The first of them is isoniazid, a compound that can inhibit the production of mycolic acid, which is building material for the walls of the mbt. The agent has a bactericidal effect on pathogens in the reproduction stage and a bacteriostatic effect on the pathogen in the resting phase. The dosage is 5-10 mg/kg body weight. The duration of treatment for children is two months, for adults – 6-12 months.

The second drug of the regimen is Rifampicin, which belongs to the group of broad-spectrum antibiotics. It disrupts the production of ribonucleic elements directly in the bacterial cell. Creates a maximum concentration in the blood 2 hours after administration and maintains it throughout the day. Average daily dose is 0.45 g, but during the tissue breakdown phase it can reach 0.6 g/kg body weight. The total duration of treatment is 12 months.

Second scheme

The technique is aimed at preventing contamination and involves the use of 4 drugs. The first is Ethambutol, which destroys pathogens that have developed resistance to Isoniazid. His active substance penetrates the cells of the pathogen, disrupts cellular metabolism, but only in strains that are in the reproduction stage. It is prescribed at a dose of 25 mg/kg body weight for two months, the total duration of treatment is 6-12 months.

The second medication of the regimen is Prothionamide, which stops the production of protein elements in the structure of mycobacteria. Works against both intracellular and extracellular pathogens. Affects strains in the dormant stage, reproduction and atypical forms. Adults are prescribed 0.5 – 1 g, divided into 3 doses per day, children – 20 mg/kg body weight.

The third in the group is Pyrazinamide, which penetrates well into tuberculosis foci. Most active in acidic environment, can work bacteriostatically and bactericidally. Daily dosage – 1.5-2 g.

Another drug included in the treatment regimen is Streptomycin. This is one of the first aminoglycoside antibiotics to be used in the treatment of tuberculosis. Inhibits the protein synthesis of the pathogen, due to which the division of bacteria is suppressed and their development stops. The dosage is 0.5-1 g per day. Only if all 4 drugs are used can the resistance of the strain be blocked.

Third scheme

Prescribed in case of ineffectiveness of other treatment methods. Para-aminosalicylic acid has a low potential for developing resistance. The composition displaces the molecules of benzoic elements of folic acid, due to which a replicator disruption occurs in the structures of the ribonucleic compounds of Mtb. The average dose is 10-12 g per day, divided into several doses. For the treatment of children, 200 mg/kg body weight per day is required. Long-term therapy is required for 6 to 12 months.

The second drug in the group is Tibon (thioacetazone), which has the ability to prevent the proliferation of mycobacteria. It prevents the resistance of pathogens, is effective in the presence of fistulas or involvement in pathological process lymph nodes The product is considered toxic and is therefore rarely used. It is also used in the first and second schemes if necessary. The dosage starts with 0.01 g twice a day, gradually increasing to 0.5 g over 6 months.

• Methyluracil stimulates protective factors on cellular level, helps tissues regenerate. Dosage – 0.5 g 4-6 times a day.
• Etimizole belongs to the group of analeptic drugs. It stimulates respiratory centers, increases the level of corticosteroids in the blood. Used for complications - atelectasis, impaired ventilation and gas exchange of the lungs. Effective for bronchiolar contamination. Prescribed in an amount of 0.1 g three times a day.
• – an immunostimulant that activates the action of macrophages and leukocyte compounds. The dosage is 150 mg per day, divided into 3 doses.
• – a liposaccharide with interferonogenic properties. It improves recovery processes, increases the effectiveness of chemotherapy treatment. The maximum therapeutic dose per day is 1000 units.
• – hormonal agent, which has an anti-inflammatory, anti-exudative effect. Hinders development state of shock And allergic reactions. Helps with diffuse lesions connective tissue. For treatment, 20-30 mg per day is used.

Prevention and prognosis

A favorable outcome of treatment of the pathology is the resorption of the infiltrate. At the same time, fibrous and focal tissue changes remain. With a worse prognosis, tuberculoma may form and caseous pneumonia may develop. For a patient with increasing intoxication, the risk of death is quite high, but with modern therapeutic methods such an outcome is extremely rare.

For the purpose of prevention, the following measures are taken:

• Timely vaccination
• Isolation of patients with developing pathology
• Mandatory pre-employment examination
• Early identification of people at risk
• Carrying out anti-epidemic measures.

People who lead a healthy and fulfilling lifestyle are less susceptible to developing tuberculosis. Normal nutrition plays an important role, refusal bad habits, hardening, staying in the fresh air, physical exercise and playing sports. To maintain the body's immune strength, it is necessary to compensate for vitamin deficiencies.

The main nosological forms of infectious destruction of the lungs are abscess and gangrene of the lung. Lung abscess - purulent melting of lung tissue, delimited from healthy lung pyogenic membrane in the form of a layer of scarring granulation tissue. Lung gangrene is extensive necrosis and ichorous decay of lung tissue.

Frequency. The disease occurs 3-5 times more often than in the general population, among middle-aged men, mainly among alcoholics.

Causes of infectious destruction of the lungs

The causative agents are most often pyogenic bacteria. Among the anaerobes are bacteroides, fusobacteria, and anaerobic gram-negative cocci. From aerobes - Staphylococcus aureus, streptococcus, coli, Klebsiella, enterobacteria, legionella, actinomycetes, etc. Risk factors include alcoholism, neurological disorders (disorders cerebral circulation, swallowing, myasthenia gravis, epilepsy), general anesthesia, operations on the esophagus and stomach, prolonged vomiting, tumors and foreign bodies in the bronchi, gastroesophageal reflux disease, diabetes mellitus, immunodeficiency states.

The pathogen penetrates into the lung tissue more often bronchogenically (aspiration of oropharyngeal contents, obstruction respiratory tract, bronchopneumonia), less often - hematogenously, lymphogenously or after injury (including closed - bruise, concussion, chest compression).

Pathomorphology. A lung abscess is characterized by inflammatory infiltration with the formation of a round cavity, limited from the surrounding tissue by fibrous and granulation tissue. With gangrene of the lung, widespread necrosis is detected with multiple cavities of irregular shape, passing without clear boundaries into the surrounding edematous and leukocyte-infiltrated lung tissue.

Classification. Abscesses can be purulent and gangrenous (an intermediate form between an abscess and widespread gangrene of the lung), acute and chronic (duration of the disease is more than 2 months), primary and secondary (septic embolism or rupture of pleural empyema into the lung), unilateral and bilateral, single and multiple , peripheral and central (root).

Symptoms and causes of infectious lung destruction

During a lung abscess there are 2 periods: before the breakthrough of pus into the bronchus, when heat with chills, heavy sweats, dry cough. Over the affected area, vocal tremor is enhanced, percussion sound is dull, vesicular breathing is weakened, often heard bronchial breathing, dry or moist wheezing. After the breakthrough of pus into the bronchus, a coughing attack with big amount often foul-smelling sputum (exits “a mouthful”), the temperature drops, and overall health improves significantly. The intensity and extent of dullness of percussion sound decrease, and a tympanic tint may appear. Auscultation reveals moist rales of various sizes and bronchial (or its version - amphoric) breathing. In the chronic course of the abscess, symptoms of intoxication (fever, chills, weakness, sweating, shortness of breath) persist, cough with moderate amount foul-smelling sputum. The terminal phalanges take the shape of " drumsticks”, and the nails are “watch glasses”, signs of right ventricular failure are noted.

For gangrene lung symptoms intoxication is more pronounced, there is no appetite, the sputum is putrid in nature and is discharged in large quantities. On auscultation, vesicular breathing is weakened, bronchial breathing and moist rales can be heard.

Diagnosis of infectious lung destruction

Data laboratory examination Neutrophilic leukocytosis with a shift to the left, increased ESR, and dysproteinemia are detected. In severe cases, anemia and proteinuria are noted. When standing, sputum forms two or three layers.

When microscopy it is determined a large number of leukocytes and elastic fibers.

Complications and infectious destruction of the lungs - pleural empyema, pyopneumothorax, sepsis, hemoptysis and pulmonary hemorrhage, respiratory distress syndrome adults.

Diagnosis is based on medical history, clinical, radiological and laboratory examination. To confirm the diagnosis you can use computed tomography(allows you to accurately determine the localization and extent of the process, assess the involvement of the pleura) and bronchoscopy (helps to isolate the pathogen and sanitize the airways).

Forecast. With lung abscesses, transition to chronic form is observed in 10-15% of patients, and mortality from complications reaches 10%. Widespread gangrene of the lung leads to fatal outcome in 40% of cases.

Treatment and prevention of infectious destruction of the lungs

basis conservative treatment is antibiotic therapy, which is carried out for a long time (for uncomplicated course - up to two months), in optimal doses, bactericidal drugs, preferably intravenously. The choice of drug is determined by the nature of the isolated microflora and its sensitivity to antibacterial agents. Until culture results are obtained, antibacterial, symptomatic and detoxification therapy is carried out according to general principles(see Mon treatment). In order to improve the drainage function of the bronchi, therapeutic bronchoscopy is indicated. IN necessary cases(presence of complications, abscess large sizes or him chronic course, ineffectiveness of antibiotic therapy) surgical treatment is performed.

Prevention. As part of prevention, 3 months after discharge from the hospital, the patient is examined by a pulmonologist at the place of residence and a chest x-ray is performed.