What is focal pulmonary tuberculosis and how can it be cured. Focal pulmonary tuberculosis

is a form of secondary tuberculosis that occurs with the development of small foci of specific inflammation. Their size does not exceed 10 mm in diameter.

It is practically asymptomatic or asymptomatic.

Most people experience minor malaise, low-grade fever, discomfort, and a dry cough.
To make a diagnosis, an X-ray of the lungs is performed and MBT is detected in sputum or bronchial washings.

Therapist: Azalia Solntseva ✓ Article checked by doctor

Focal pulmonary tuberculosis among the population

In most cases, the disease is secondary and occurs against the background of an active or latent primary condition.

Clinically manifests itself as a disease of mild or moderate severity. It often occurs asymptomatically, without objective and subjective signs.

The described form of pathology can only be detected with an X-ray or tomographic examination of the chest. Approximately half of the adult population has encapsulated lesions of the lungs or bronchial lymph nodes, while in one third of patients the lesions are firmly calcified and heal completely.

www.ncbi.nlm.nih.gov

Contagious or not to others

If the disease has developed in the lungs and it is active or untreated, it should always be assumed that mycobacteria can be transmitted to another person. The pathology can spread to others through droplets in the air produced by sneezing, coughing and contact with sputum. Therefore, you can become infected with the disease through close contact with infected people.

Outbreaks of the disease occur in closed and crowded rooms and areas.

Is focal pulmonary tuberculosis contagious or not to others? The incubation period, depending on the location, activity and size of the lesion in the lungs, can vary from two to 12 weeks. A person can remain contagious for a long time and until they have been treated for several weeks.

It should be borne in mind that some people are carriers of the infection for a very long time, but this is not visually determined. Usually this corresponds to an inactive form of the disease and microorganisms are in hibernation mode during this period. In this case, the person is not contagious to others and can lead a normal life. When such persons are identified, they are prescribed special treatment.

www.medicinenet.com

Left lung disease - features, symptoms

Literature, opera, and art have popularized the traditional symptoms and signs of pulmonary tuberculosis: cough, sputum, hemoptysis, shortness of breath, weight loss, anorexia, fever, malaise, weakness, and terminal cachexia in various combinations, not only in the descriptions of heroes, heroines, and villains, but also among artists, poets and musicians. However, none of these symptoms are characteristic of focal tuberculosis.

Currently, patients who have the full spectrum of symptoms are rare in developed countries, but doctors and health care providers often see such patients in developing countries.

Usually, with this form, nonspecific signs of intoxication and inflammation of the mediastinal lymph nodes appear. With a significant increase in these formations, symptoms of compression are noted, which manifest themselves in the form of shortness of breath and pain, both at the peak of inspiration and during local palpation. The latter is most often observed when pressure is applied in the space between the collarbone and scapula, in the area where the apex of the left lung is located.

There may be a slight increase in normal body temperature, up to 37 degrees.

Increased night sweats, which cause subjective discomfort to the patient, are not always observed and depend on the individual reaction of the body.

www.ncbi.nlm.nih.gov

Effective treatment of pathology

Standard therapy recommended by the International Union Against Tuberculosis and Lung Disease, the World Health Organization and the National Institute for Health and Clinical Excellence (NICE) consists of six months of rifampicin and isoniazid (usually given as a combination tablet), initially supplemented with 8 weeks of pyrazinamide and ethambutol.

It is important not to violate the treatment regimen, only this guarantees a positive result. A reliable drug is available that contains rifampicin, isoniazid and pyrazinamide in one medication. A tablet containing all four drugs is also available. They have the great advantage of reducing the possibility of drug resistance emerging.

Pyridoxine is indicated only in malnourished patients or in patients at risk for peripheral neuropathy. Results of susceptibility tests are usually available until the end of the two-month intensive treatment period: provided that the organisms are susceptible to rifampicin and isoniazid. If possible, therapy should be confirmed by smear and sputum culture at the final stage.

1. In developing countries, if patients have a cough that persists for more than three weeks despite broad-spectrum antibiotics, sputum should be checked for the presence of acid-fast bacilli.
2. The appearance on chest radiographs is often less specific in immunocompromised patients. Images may not reveal lesions.
3. In the absence of evidence of previous infection or BCG vaccination, strong positive Mantoux test results increase the likelihood that a person has tuberculosis, even if the sputum is negative.
4. If drug resistance is detected, the treatment regimen must be modified and expanded.
5. Cross-infection is more likely if the patient has sputum positive for acid-fast bacilli.
6. Home therapy is no more likely to result in cross-infection than hospital treatment.
7. BCG vaccination should be offered to all people at high risk of contracting tuberculosis.

www.ncbi.nlm.nih.gov

What does an x-ray show?

The site of infection can be located anywhere in the lung and has nonspecific findings, ranging from too small to detectable with nodular areas of consolidation. In most cases, the disease becomes localized and forms a granuloma (tuberculoma), which eventually calcifies and becomes visible on x-ray as a nodule.

A common symptom is concomitant mediastinal (paratracheal) lymphadenopathy. This pattern is observed in more than 90% of cases of focal tuberculosis in children, but only in 10-30% in adults. These nodes typically have low-density centers with increased edge contrast. Sometimes they can be large enough to compress adjacent airways, resulting in distal atelectasis.

Pleural effusions are observed more often in adults, visible on photographs in 30-40% of cases.

Since the patient develops an immune response, both pulmonary and nodular inflammation is stopped. Calcification of nodes is observed in 35% of cases.

Post-primary or secondary pulmonary tuberculosis occurs years later, often in conditions of decreased immune status. In most cases, it develops in the posterior segments of the upper lobes and the upper parts of the lower petals. The typical manifestation is heterogeneity of tissue structure and poorly defined linear and nodular opacity.

True focal tuberculosis accounts for only 5% of cases of primary disease and is detected as a well-defined round mass, usually located in the upper lobes. The nodes can usually be single (80%) up to 4 cm and multiple, but small. In most cases, minor lesions of the lymphatic system are observed.

radiopaedia.org

How does disease of the upper lobes of the right and left lungs manifest?

When the source of infection is located in the specified tissue area, usually no specific symptoms develop. The severity and severity of general manifestations depend on the size of the lesion in the right or left organ, which can be up to 4 cm in diameter (usually up to 10 mm), as well as on the body’s ability to suppress foreign microorganisms.

Nonspecific signs include: weakness, malaise, lack of appetite, headaches, low and intermittent fever.

Under other conditions, signs appear that allow you to indicate damage to the lungs and their apices:

1. Pain in the supraclavicular areas, as well as in the forearm area, which intensifies at the peak of inspiration or during physical exertion. It may be intermittently cramping in nature.
2. Lymphadenopathy. Usually, an increase in the cervical and axillary lymph nodes is observed, since they are closest to the source of infection and react to its presence earlier than others.
3. Fever.
4. Uneven breathing due to tuberculosis infection.
5. Night sweats.
6. Pneumonitis (may be the only symptom in older people).

www.medicinenet.com

Complications and development of primary foci of tuberculosis infection

Often, symptoms of pleurisy are the first thing that attracts the attention of a patient or doctor to a lung disease. The most common form is the dry adhesive form of the disease. The appearance of primary foci is observed.

The tubercles that affect the pleura and the exudate that connects them together form a conglomerate and thus stable adhesions are formed. It can develop in any part of the chest, but most often in the upper third of the lung. The discomfort is often painful, but can sometimes be severe. People often complain about their shoulders and discomfort in their area.

However, we should not forget that pleurisy can include the diaphragm and lead to true pathologies not only of the upper limbs, but also of the abdomen.

The acute type of pleurisy presents a completely different picture. Very high fever is often observed, sometimes above 40°C. There are other symptoms of intoxication, asthenia and very rapid exhaustion are noted. Signs of effusion soon appear, with the patient experiencing relief from severe pain.

This occurs due to decreased friction between the inflamed pleural layers. The effusion may fill only part of the cavity or all of it.

Often pleurisy, as described above, is the first sign in patients with focal pulmonary tuberculosis, and if no other cause is found, and tuberculous bacteria are not detected in the fluid and no parenchymal involvement is observed, it is best to treat these patients as for tuberculous involvement.

Purulent effusions are most often observed with pneumothorax. This is especially likely after spontaneous occurrence, when the pleural space is contaminated with air and secretions from the bronchi.

The second and most difficult process is the generalization of infection. In this case, the bacilli from the focus move to other parts of the lungs, and with weak immune defense they spread throughout the body. This can lead to tuberculosis of any organ, but most often microorganisms linger in the bone and nervous systems, causing symptoms of complications.

www.journal.chestnet.org

Small focal pulmonary tuberculosis - causes, symptoms, treatment

The pathology occurs identically in adults and children. It can begin between the ages of 2 and 10 years, but more than half of all cases manifest between 10 and 18 years of age.

Infection can develop:

• primarily after inhalation of aerosol droplets sprayed into the air after a sick person coughs or sneezes.
• secondary, as a result of activation of dormant mycobacteria.

Symptoms depend on the individual characteristics of the body and the extent of the process:

• pale skin;
• abdominal pain;
• cough and shortness of breath;
• fever;
• general discomfort, restlessness or malaise;
• chills;
• weight loss;
• sweating;
• enlarged tonsils and regional lymph nodes;
• fatigue.

The goal of therapy is to eliminate the infection with drugs that fight tuberculosis bacteria. Treatment involves a combination of several medications (usually four). Treatment continues until laboratory tests show the absence of mycobacteria in the body. You may need to take different tablets for 6 months or longer to cure small-focal TB.

www.ncbi.nlm.nih.gov
www.medlineplus.gov

Fresh subspecies - secondary form

It is a secondary pathological process. Occurs after a previous disease, which was activated after inadequate treatment or as a result of inactivity of mycobacteria. There is no difference in the clinical picture between a fresh and fibrotic focal process.

What is the difference between fresh focal tuberculosis and focal pulmonary tuberculosis? The main difference lies in the X-ray picture, where fresh tuberculosis is characterized by blurring of the focus of infection: its unclear edges and the absence of a necrotic center. X-rays will help identify the form of the disease.

The secondary form has the following symptoms:

• slight weakness, fatigue;
• fever
• increased night sweats;
• anorexia;
• weight loss;
• digestive disorders;
• amenorrhea.

Collapse

Under the influence of certain factors, focal pulmonary tuberculosis may develop. It is usually asymptomatic and rarely accompanied by mild symptoms. The most effective diagnosis is using x-ray methods. The treatment regimen usually includes taking 4 special anti-tuberculosis drugs, but in some cases surgical intervention is required.

What kind of disease is this?

Focal pulmonary tuberculosis is a disease in which several small pathological foci appear in the lungs. Usually the inflammation does not spread to the entire lungs, but only to 1-2 segments.

It is a secondary infection. In most cases, it occurs a long time after recovery from the primary disease. Therefore, people over 35 years of age are mostly affected. Pathology is observed in 15-20% of all cases of pulmonary tuberculosis. ICD 10 code is A-15.

Most often, focal tuberculosis of the upper lobe of the right lung is observed. This is due to the fact that this area is immobile, poorly oxygenated, and characterized by weak blood and lymph flow.

Is this type of tuberculosis contagious or not? Infection can occur, but only with prolonged contact with an infected person. Is it contagious to others? Yes, but only with an active form. Usually in this case, the doctor recommends treatment in a hospital.

Causes

The following routes of infection are distinguished: exogenous or endogenous. In the first case, the infection enters the human body from the outside. This may happen if:

• A person has been in contact for a long time with a patient with focal tuberculosis. For example, if there is an infected person in the family. During short conversations and other contacts, infection does not occur.
• The same dishes, personal hygiene items and clothing are used with the patient.
• In a house where there is an infected person, sanitary standards are poorly observed and cleaning is not carried out.
• After the death of a sick person, the apartment was not disinfected, but they continue to live like this. The mycobacterium that causes tuberculosis is very resistant and does not die even in an acidic environment. Therefore, without thorough disinfection and cleaning of the room, there is a chance of getting sick.

The focal form of tuberculosis is transmitted mainly through the air. After infection occurs, the sick person begins to secrete the same mycobacteria as the person from whom the infection occurred.

The disease may have another pathogenesis. In the case of endogenous development, the previously existing infection becomes active again. That is, inflammation begins in old foci of the disease. Reactivation of the infection is typical not only for the lungs, but also for the intrathoracic lymph nodes. This usually occurs as a result of decreased immunity. This can happen due to frequent stress, poor diet, and excessive use of medications.

Groups and risk factors

A number of factors contribute to the development of secondary tuberculosis. These include:

• acute and chronic pathologies of the respiratory system;
• any diseases of the body that lead to a decrease in immunity;
• taking immunosuppressants, which are necessary to artificially suppress the immune system;
• stomach ulcer, diabetes mellitus;
• presence of bad habits;
• an overly active lifestyle leading to frequent overwork.

The risk group includes people who are often in the same room with infected people - family members, employees of TB dispensaries and prisons. In addition, the disease can appear in those who have previously suffered any form of pulmonary tuberculosis.

Classification

The disease can be classified according to several criteria. Let's consider each case separately.

According to the duration of the course

Foci of tuberculosis in the lungs are divided into:

• Fresh, or soft-focal. They appear as a result of endogenous factors. That is, they arise from a previously existing primary infection, which was inactive for a long time.
• Chronic, or fibrous-focal. This pathology may result from the disintegration of fresh lesions. But often it occurs due to the resorption of other forms of primary pulmonary tuberculosis. Usually the lesions are quite large, placed in a fibrous capsule. Sometimes calcification occurs in them - the accumulation of calcium salts (lime), which enters the body with water and food. In most cases they are harmless and are residual lesions. But if the capsule ruptures, the disease may return. In this case, the boundaries of the lesion may increase several times.

Both forms of the disease must be treated urgently. Otherwise, the pathological process may spread, leading to serious complications. Fatal cases are very rare, but have still been recorded.

By phase

There are 3 main phases of focal tuberculosis. Each of them has its own characteristics and degree of danger to the body:

1. Focal tuberculosis in the infiltration phase. During it, exudate accumulates around the lesion. If the infiltrate is spherical, but without clear boundaries, then the inflammatory process is fresh. When the infiltrate is cloud-like and occupies one or more lobes of the lung, we are talking about a chronic process. In the second case, a fibrous capsule is formed, and the inside of the formation is filled with caseosis - necrotic fibers.
2. Tuberculosis in the decay phase. This phase is characteristic of the fibrous-focal form of the disease. The fibrous capsule is destroyed, and its contents enter healthy lung tissue. This condition is very dangerous for human health. If the pathology is not diagnosed in time, there is a risk of damage to several segments of the organ. The pathological process is accompanied by intoxication of the body, increased fatigue and respiratory failure.
3. The disease is in the compaction phase. With proper treatment, bacterial excretion disappears. The source of the disease begins to resolve. Caseous compaction is observed due to the deposition of calcium salts. The inflammatory response decreases. If the patient had cavities, they heal, forming scars. On x-rays you can see a lesion that has a heterogeneous structure. It is usually round with uneven contours. It must be borne in mind that this phase does not mean complete recovery. There is a positive effect, but in order to maintain it, you must continue therapy and follow the recommendations of your doctor.

It usually takes at least a year for complete recovery. Resorption of the formation lasts up to 4-5 months. X-rays indicate that the patient has recovered - the lesion has either completely disappeared or parts of fibrous tissue remain.

By size

Depending on the diameter of the lesions, they can be of three types. Small (up to 3 mm) lesions quickly resolve with adequate therapy. Medium (up to 6 mm) can develop into a fibrous-focal form. Large lesions (more than 1 cm in diameter) are difficult to resolve, and such tuberculosis is accompanied by a severe course. Treatment may require surgery.

Symptoms and signs

As a rule, the focus of tuberculosis is small, rarely exceeding 1 cm in diameter, so the pathology is often asymptomatic. The clinical picture is blurred, symptoms are mild or completely absent.

However, in some cases the following symptoms may appear:

• Intoxication of the body. The patient complains of nausea, sometimes even vomiting. The state is depressed, there is increased fatigue.
• Low-grade fever – up to 37.5 degrees. It is usually observed in the evening hours.
• Signs of vegetative-vascular dystonia rarely occur. The patient may complain of severe headaches, excessive sweating in the evening, and insomnia.

Focal tuberculosis is rarely accompanied by cough, and especially by hemoptysis. Therefore, such a disease can go unnoticed for years, becoming chronic. It is usually discovered accidentally during routine fluorography.

During certain periods, the patient's condition improves. The low-grade fever disappears and he feels well. Typically, exacerbations occur in the fall or spring.

Diagnostics

Physical methods are ineffective in diagnosing focal tuberculosis. During palpation, the doctor can detect pain, which is usually localized over the area of ​​the inflammatory process. As a rule, enlargement of the lymph nodes does not occur. Upon percussion, it is discovered that the sound above the lesion is duller. Auscultation allows you to determine that there are noises during breathing, and loud wheezing is heard during coughing.

Tests with tuberculin cause a normergic reaction - minor changes in the affected area. Only sometimes the Mantoux test or Diaskintest can cause pronounced symptoms - severe swelling and redness in the injection area, increased body temperature, and the appearance of copious sputum. Sputum and bronchoalveolar lavages are also examined.

X-ray methods are considered the most accurate in making a diagnosis. But the picture may differ depending on the type and phase of the disease. If the pathology is fresh, several large and a couple of small lesions are detected on the x-ray. The shadows have a rounded shape, their outline is poorly distinguishable.

But the chronic form of the disease is characterized by compacted foci with a homogeneous structure. Shadows may be blurry or very distinct. As a rule, their size is small - from small to medium. A distinctive diagnosis must be carried out so as not to confuse the disease with other pathological conditions of the respiratory system.

If the picture is blurry and the doctor cannot make an accurate diagnosis, test therapy is prescribed. It consists of taking anti-tuberculosis drugs for several months. The doctor notes the presence or absence of dynamics. If the lesions begin to decrease, the diagnosis of tuberculosis is confirmed.

Treatment

Treatment of focal pulmonary tuberculosis is carried out with medication and surgery. Both methods are characterized by their own characteristics.

Drug therapy

In most cases, it is carried out in a hospital setting. If the disease has a closed form, treatment at home is allowed, but subject to regular visits to the local phthisiatrician. The first stage of chemotherapy involves taking 4 anti-tuberculosis drugs - Isoniazid, Ethambutol, Pyrazinamide, Rifampicin. The dosage is determined by the doctor. As a rule, the first stage lasts approximately 2-3 months.

Then, for another six months, only two drugs are prescribed, but one of them must be Isoniazid. Once every 4 months, the patient must undergo fluorography (usually not recommended, since X-rays are dangerous to the body) to monitor the dynamics of treatment.

In general, the duration of therapy is 6-9 months. Sometimes you may need to take medications for one year. After completion of treatment, a long period of rehabilitation is required. It is advisable that the patient undergo it in an anti-tuberculosis sanatorium.

Drug therapy is usually effective for any phase of the disease and size of the lesions. But sometimes it does not work, so surgery is required.

Operations

A lobectomy or segmentectomy is performed. In the first case, a lobe of the right or left lung is removed (depending on the location of the lesion). And the second option involves removing an entire segment - several lobes, if the pathological process has spread greatly.

Resection of the entire lung does not make sense, since in most cases more gentle methods are effective. After surgery, maintenance therapy is required.

Forecast

The outcome of treatment is often favorable and ends in recovery. Fresh lesions resolve faster than chronic ones. In the second case, there is a possibility that the disease will develop into another form.

Possible complications and consequences

If fresh lesions are not detected in time, there is a possibility of chronic disease. Fibrous focal tuberculosis can lead to pneumosclerosis - the formation of numerous fibrous or calcific foci. Such patients require a longer course of chemotherapy – sometimes up to 2 years.

Prevention

For preventive purposes, it is necessary to undergo regular X-ray examinations. You should boost your immunity by eating foods rich in vitamins. You can also purchase vitamin complexes in pharmacies. This will prevent not only tuberculosis, but also other diseases. It is very important to observe hygiene measures and use separate dishes, soap, towel, comb and other items.

Thus, focal tuberculosis is easily treatable. But it is almost asymptomatic, so there are difficulties in detecting it. And the sooner you start therapy, the higher the chances of a positive outcome.

• Which doctors should you contact if you have focal pulmonary tuberculosis?

What is Focal pulmonary tuberculosis

Focal pulmonary tuberculosis accounts for about 50% of all newly diagnosed tuberculosis diseases. It can occur without subjective sensations and is detected only during a mass fluorographic examination. But upon additional examination, it is often established that patients did not attach importance to a number of symptoms of tuberculosis intoxication for a long time.

Clinically and radiographically there are two forms of focal tuberculosis: fresh soft-focal and chronic fibrous-focal. During the healing process of various forms of tuberculosis, focal changes are formed. These lesions are replaced by fibrous tissue, encapsulated, and are considered fibrotic residual lesions.

What causes focal pulmonary tuberculosis

Pathogens of tuberculosis are mycobacteria - acid-fast bacteria of the genus Mycobacterium. A total of 74 species of such mycobacteria are known. They are widely distributed in soil, water, people and animals. However, tuberculosis in humans is caused by a conditionally isolated M. tuberculosis complex, which includes Mycobacterium tuberculosis(human species), Mycobacterium bovis (bovine species), Mycobacterium africanum, Mycobacterium bovis BCG (BCG strain), Mycobacterium microti, Mycobacterium canetti. Recently, it has included Mycobacterium pinnipedii, Mycobacterium caprae, which are phylogenetically related to Mycobacterium microti and Mycobacterium bovis. The main species characteristic of Mycobacterium tuberculosis (MBT) is pathogenicity, which manifests itself in virulence. Virulence can vary significantly depending on environmental factors and manifest itself differently depending on the state of the microorganism that is subject to bacterial aggression.

Tuberculosis in humans most often occurs when infected with human and bovine species of the pathogen. Isolation of M. bovis is observed mainly in residents of rural areas, where the route of transmission is mainly nutritional. Avian tuberculosis is also noted, which occurs mainly in immunodeficient carriers.

MBTs are prokaryotes (their cytoplasm does not contain highly organized organelles of the Golgi apparatus, lysosomes). There are also no plasmids characteristic of some prokaryotes that provide genome dynamics for microorganisms.

Shape - slightly curved or straight rod 1-10 microns * 0.2-0.6 microns. The ends are slightly rounded. They are usually long and thin, but bovine pathogens are thicker and shorter.

MBT are immobile and do not form microspores or capsules.
Differentiates in a bacterial cell:
- microcapsule - a wall of 3-4 layers 200-250 nm thick, firmly connected to the cell wall, consists of polysaccharides, protects mycobacterium from the external environment, does not have antigenic properties, but exhibits serological activity;
- cell wall - limits the mycobacterium from the outside, ensures stability of cell size and shape, mechanical, osmotic and chemical protection, includes virulence factors - lipids, the phosphatide fraction of which is associated with the virulence of mycobacteria;
- homogeneous bacterial cytoplasm;
- cytoplasmic membrane - includes lipoprotein complexes, enzyme systems, forms an intracytoplasmic membrane system (mesosome);
- nuclear substance - includes chromosomes and plasmids.

Proteins (tuberculoproteins) are the main carriers of the antigenic properties of MBT and exhibit specificity in delayed-type hypersensitivity reactions. These proteins include tuberculin. The detection of antibodies in the blood serum of tuberculosis patients is associated with polysaccharides. Lipid fractions contribute to the resistance of mycobacteria to acids and alkalis.

Mycobacterium tuberculosis is an aerobe, Mycobacterium bovis and Mycobacterium africanum are aerophiles.

In organs affected by tuberculosis (lungs, lymph nodes, skin, bones, kidneys, intestines, etc.) a specific “cold” tuberculous inflammation develops, which is predominantly granulomatous in nature and leads to the formation of multiple tubercles with a tendency to disintegrate.

Pathogenesis (what happens?) during Focal pulmonary tuberculosis

Pathogenesis of focal tuberculosis different, diverse and complex. This form may be a manifestation of the primary or, more often, secondary period of tuberculosis.

Secondary focal forms arise in adults under the influence of exogenous superinfection or endogenous spread of MVT from latent, previously formed foci. Such lesions contain caseation and MVT and are located in the lymph nodes or in any organ.

During the period of exacerbation of the process, MVT from the foci spreads along the lymphatic tract and small bronchi. Most often, fresh lesions appear in the apices of the lungs. First, endobronchitis develops, then the lesion covers all the small branches of the bronchi in this zone. A cheesy necrosis of the walls of the altered bronchi occurs, followed by a transition to the lung tissue, mainly in the apical region. A small focus such as caseous, acinous or lobular pneumonia is formed.

The lymphatic network is involved in the pathological process only around the lesion. Regional lymph nodes usually do not respond to lesions in the lungs. Exudative phenomena are small and quickly give way to a productive reaction.

Hematogenous spread is characterized by a symmetrical arrangement of foci, the remains of which are located in the apical regions of the lungs.

Symptoms of focal pulmonary tuberculosis

Some patients identified using fluorography actually do not have any clinical symptoms. However, most of them react to the occurrence of low-spread focal pulmonary tuberculosis with weakness, sweating, decreased ability to work and decreased appetite. Patients complain of heat in the cheeks and palms, short-term chills and low-grade fever during the day. Sometimes there is an intermittent cough, dry or with a scanty amount of sputum, and pain in the side.

Diagnosis of focal pulmonary tuberculosis

When examining the patient, slight pain in the muscles of the shoulder girdle on the affected side is noted. Lymph nodes are not changed. In the lungs, there may be a shortening of the percussion sound only when the lesions merge. In the fresh phases of development of focal tuberculosis in the presence of infiltrative changes, when coughing, hard breathing and small, moist single wheezes are heard.
Tuberculin tests are usually moderately expressed.

There is nothing characteristic of this form of the disease in the blood, and changes in the blood depend on the phase of the disease. In mild fresh forms, blood counts are normal, in the infiltration phase the ESR is somewhat accelerated, the left shift of the formula reaches 12-15% of band forms, and slight lymphopenia.

In the chronic course of the process of focal tuberculosis, the so-called productive form is observed. Foci of small and medium size (3-6 mm), round or irregular in shape, clearly defined, of medium and sharp intensity are identified.

The radiograph reveals lesions up to 1 cm in diameter, round or irregular in shape. Their contours can be clear or blurred, the intensity is weak or medium. The lesions are single and multiple, most often located in one lung, mainly in the upper sections: in segments I, II and VI; often merge with each other. Wide linear interlacing shadows are visible around the lesions - lymphangitis.

With progression, an increase in the number of fresh lesions is determined, lymphangitis intensifies, and decay cavities appear.

Treatment of focal pulmonary tuberculosis

With modern antibacterial treatment, fresh tuberculosis lesions and lymphangitis usually resolve within 12 months. On the x-ray, you can see complete restoration of the pulmonary pattern or residual slight heaviness and small outlined lesions. Less often, after full treatment, fresh lesions do not resolve, but are encapsulated, and gross fibrosis develops at the site of lymphangitis.

Prevention of focal pulmonary tuberculosis

Tuberculosis is one of the so-called social diseases, the occurrence of which is associated with the living conditions of the population. The reasons for the epidemiological problem with tuberculosis in our country are the deterioration of socio-economic conditions, a decrease in the living standards of the population, an increase in the number of people without a fixed place of residence and occupation, and the intensification of migration processes.

Men in all regions suffer from tuberculosis 3.2 times more often than women, while the growth rate of incidence in men is 2.5 times higher than in women. The most affected are persons aged 20 - 29 and 30 - 39 years.

The morbidity rate of contingents serving sentences in penal institutions of the Ministry of Internal Affairs of Russia is 42 times higher than the Russian average.

For the purpose of prevention, the following measures are necessary:
- carrying out preventive and anti-epidemic measures adequate to the current extremely unfavorable epidemiological situation regarding tuberculosis.
- early identification of patients and allocation of funds for drug provision. This measure will also be able to reduce the incidence of illness among people who come into contact with sick people in outbreaks.
- carrying out mandatory preliminary and periodic examinations upon entry to work on livestock farms affected by bovine tuberculosis.
- increasing the allocated isolated living space for patients suffering from active tuberculosis and living in crowded apartments and dormitories.
- timely implementation (up to 30 days of life) of primary vaccination for newborn children.

If signs of tuberculosis are detected, immediate hospitalization will be required, especially if it is a focal form. People who have an open form pose a high danger to society, but the incidence can be reduced only with early diagnosis and timely treatment.

At the state level, citizens must be provided with acceptable working conditions that do not threaten their health, the same applies to visiting migrants.

What it is?

Focal pulmonary tuberculosis differs from other forms in that it has few symptoms, a benign course and no damage to the lung tissue. The cortical parts of the lungs are affected inflammations with a diameter of 8-10 mm. Here Simon's foci occur - residual effects of the main infection. When symptoms of the disease begin to appear, acute focal tuberculosis or Abrikosov's lesion may develop, which is accompanied by caseous pneumonia. The location of Abrikosov's lesions is 1 or 2 segments of the lung in the form of compactions measuring 3 cm. If both lungs are affected, then during healing, Aschoff-Bullet lesions may appear.

This manifestation of primary and secondary tuberculosis is localized during exacerbation in the bronchi, and the causative agents of the disease are mycobacteria of the genus Mycobacterium. It all starts with endobronchitis, and then the small branches of the bronchi are gradually affected. Subsequently, the walls of the altered bronchi and lung tissue undergo necrosis, What . The pathological process affects only the area around the lesion, but hematogenous spread is visible in the remains in the apex of the lungs. After healing of forms of pathology, focal shadows may appear.

Forms focal tuberculosis:

1. Soft focal.
2. Chronic fibrous-focal.

At the stage of the soft-focal form, shadows with weak contours of varying sizes and intensity are detected. The basis for a tomographic examination is pathological changes in the posterior parts of the lungs. CT scan identifies disease sites located inside the lungs. Large tissue lesions have a homogeneous structure, and the contours are unclear. Small foci of tuberculosis are visualized on the lung tissue, and the walls become thicker.

The fibrous-focal form of the pathology in the chronic form manifests itself in the form of seals and strands. Such changes can develop in different ways and have two phases - active and passive. The activity of the process can be confirmed by changes in the pleura.

The disease is characterized by an inflammatory process, which is complemented by tubercles.

Symptoms

The focal form of lung damage is divided into three phases - infiltration, decay and compaction, but the signs of the clinical picture appear differently for each of them.

The initial stage may have no symptoms, but toxins, penetrating into the bloodstream, affect different organs and tissues. The main symptoms of focal pulmonary tuberculosis:

• Fatigue;
• Sweating;
• Decreased performance;
• Poor appetite;
• Weight loss;
• Feeling of heat on the face;
• Chills and increased body temperature;
• Pain on the sides;
• Cough with sputum;
• Wheezing;
• Hard breath.

The disease can be detected by performing preventive or diagnostic fluorography, at the request of the patient. Symptoms occur in one third of patients; in the rest, the disease proceeds without symptoms. In addition to the main symptoms, intoxication with focal tuberculosis it can occur with vegetative-vascular dystonia. Wheezing is diagnosed in some patients in the decay phase during the exudative focal process.

It is the long course of focal tuberculosis that deforms the chest, despite the fact that the process is localized in one of the lungs, this can provoke delay in breathing. After surgery, the deformity may become more pronounced due to spontaneous pneumothorax.

Treatment

Focal pulmonary tuberculosis must be treated in an anti-tuberculosis hospital, and inactive tuberculosis must be treated on an outpatient basis under the supervision of a doctor. First of all, the phthisiatrician prescribes anti-tuberculosis drugs in combination with vitamins, and should have a nutritious, healthy diet.

A patient can be cured by complex treatment, a combination of antimicrobial therapy measures and the principles of proper nutrition. Stages of treatment:

1. Prescription of antibacterial therapy, including drugs - isoniazid, rifampicin, ethambutol and pyrazinamide. When using this combination for three months, you can then switch to two drugs, rifampicin and isoniazid or isoniazid with ethambutol for another three months.
2. The use of immunomodulators to activate immune processes.
3. Hepatoprotectors can protect the liver; due to the toxicity of tuberculosis drugs, they are combined with chemotherapy.
4. If the process of focal tuberculosis is pronounced, glucocorticoids are used in rare cases.
5. Therapy with vitamins A, B1 and B2.
6. Proper nutrition regimen, protein foods should predominate in the diet.
7. After treatment of a form of pulmonary tuberculosis, a visit to a sanatorium or boarding house is recommended.

Treatment of focal pulmonary tuberculosis has in most cases a positive outcome. In rare cases, with the chronic form of tuberculosis, complications in the form of pneumosclerosis, with a focus of calcification, are possible; the patient may need chemoprophylaxis.

How long is the treatment?

According to statistics, on average, after a year, a person has the opportunity to be cured if all requirements and prescriptions are met, and most importantly, correctly selected chemotherapy. Under hospital supervision and adequate treatment The recovery process lasts from 4-5 months to 11-12. In the active phase of focal tuberculosis, he is shown an anti-tuberculosis hospital, where treatment lasts up to three months, in the worst situation up to nine.

If pathology is detected at the onset of the disease, it can be treated at home under the consultation of a doctor, but subsequently hospitalization in a hospital will be required. Everything will depend on the form of tuberculosis, but in terms of time the process recovery can last from a couple of months to a year and a half. Most often, the focal form can be cured after 6 months from the moment of infection.

Treatment is divided into three stages:

• Staying in a hospital;
• Partial silt day hospital;
• Ambulatory treatment.

In an open form, the patient’s treatment lasts 3 months in a hospital under the supervision of doctors, then, when the danger is over, a transfer to a day hospital with the use of expensive drugs is possible. The time frame prescribed by the doctor for treatment is should not be interrupted, to avoid re-discovery of the disease. In severe cases with resistance to Koch's bacillus, treatment can last 2-3 years.

In case of closed form of tuberculosis, the patient must be hospitalized in a hospital, and the length of stay depends on the degree of progression of the disease.

Contagious or not?

Depending on the form and stage of the disease, its contagiousness is determined. In the early stages of the disease, tuberculosis may not be contagious through airborne contact, but can be transmitted through blood. If focal tuberculosis becomes, microbacteria can spread through blood and lymph to all organs. At this stage, the form of tuberculosis becomes open and very dangerous for others.

If a mycotic infection is detected in the lymph nodes, tuberculosis becomes infectious, and the bacilli and secretions penetrate the blood and lymph. All arguments boil down to the fact that focal pulmonary tuberculosis in most cases it is contagious to others.

The open form of tuberculosis is contagious from the initial stage, and the closed form can appear only after the process has been neglected. In both cases, you can become infected through airborne droplets, as well as through contact.

The problem with Koch's bacillus microbacteria is that it is difficult to influence it with heat, light or cold, it has very high resistance. Focal tuberculosis infection may have a latent form, but visually a person may feel lethargy and drowsiness, decreased performance and increased body temperature. In parallel with this, the person’s appetite becomes poor, and the skin turns pale.

With such signs it is not immediately possible to identify tuberculosis, symptoms are similar to common viral infections That's why people don't go to the doctor. According to statistics, about 10 people a year can be infected with tuberculosis from a person who has a closed form of the disease and does not undertake appropriate treatment.

How is it transmitted?

The most popular method of transmission of focal tuberculosis is airborne droplets, and in some places this can be metro and other public transport, shops, city libraries, etc. Under everyday conditions, you can become infected from a sick person by finishing a glass of water or finishing a cigarette, as well as by kissing.

Fact! Transmission of tuberculosis microbacteria can occur through cockroaches and flies that crawl through ventilation grilles into apartments.

Focal tuberculosis can be transmitted through initial contact with the site of infection, also from another, already sick person. In addition, the source of infection maybe an animal, which can support some strains of the virus.

How tuberculosis is transmitted from person to person:

• The airborne route is one of the most common ways when small particles of bacilli and microbes contained in expectorated sputum fly out of the lungs during conversation or coughing and reach others.
• Infected people, coughing up on the ground, can provoke transmission of bacilli by airborne dust, when a healthy person inhales particles of dust contaminated by microbes.
• The contact and household route of transmission is characterized by the penetration of tuberculosis bacilli not only through the lungs, but also through the skin, blood, and eyes.
• You may not have contact with a patient with tuberculosis, but touch his personal hygiene items, dishes, clothes, telephone or computer, thereby becoming infected from the carrier.
• It is dangerous to kiss not only on the lips, but also on the cheek, since the airborne function of transmitting microbes and the exchange of saliva is involved.
• A mother during pregnancy and intrauterine development can transmit the infection to her child through the blood.
• Poorly washed hands while eating can cause subsequent tuberculosis.

Ways of contracting tuberculosis from animals:

• In an immunodeficient state, a person can become infected with the bacilli of the disease from cattle.
• Animal bites provoke infection, and you can also become infected while cutting livestock meat.
• Eating dairy and meat products from infected animals contributes to the penetration of Mycobacterium tuberculosis into the body.

One of the fastest ways to transmit lung pathology is contact with prisoners and homeless people who are breeding grounds for infections. The greatest chance of contracting tuberculosis is to visit the places where homeless people live; damp basements are an ideal place for the development of Koch's bacillus.

Prisoners after leaving prison go to common areas, shops or supermarkets, where the chances of infecting others are as high as possible. You can become infected through contact with migrant workers, who often do not comply with sanitary and hygienic standards, while working with people.

If treatment for focal pulmonary tuberculosis is started in a timely manner, the incidence rate can be reduced. For prevention, it is necessary to undergo annual preventive examinations and fluorography, and it is also mandatory to vaccinate newborns against tuberculosis.

It is distinguished by localized changes in their tissue and a certain limitation of the lesion. In other words, the sources of the disease are located in any one segment and are very rarely able to spread over a wide area.

Focal tuberculosis is one of the most common forms of this disease.

Its primary development is observed, on average, in sixty percent of all cases of the disease.

Experts classify fibrous and soft focal tuberculosis.

The first type is characterized by the tissue scarring phase, the second by the infiltration stage.

Fibrous focal tuberculosis is formed, as a rule, as a result of incomplete compaction or resorption of a mild, hematogenously disseminated or infiltrative form of the disease. In rare cases, its occurrence is associated with the process of cavities scarring.

Mild focal tuberculosis refers to the initial stage of the disease with a limited infiltrative course.

These forms of the disease differ from each other in pathogenesis. Their common feature is the limited area of ​​the affected area. Tissue changes are presented in the form of single foci. Their diameter, as a rule, is no more than a centimeter. Foci of the disease are most often located in the upper pulmonary areas. In most cases, this form of the disease is unilateral. However, in practice, bilateral lesions were also observed.

The mild focal form is characterized by less pronounced symptoms of toxin poisoning than the infiltrative stage. In addition, in the first case, the course of the disease, if decay has not begun, is not accompanied by any extraneous sounds from the chest. X-ray examination reveals one or more small lesions inside the lungs. If the outcome is favorable, the soft areas of the lesion gradually scar or resolve. Active progression of the disease can lead to the development of cavernous or infiltrative forms.

The fibrous stage, as a rule, proceeds favorably. However, throughout the course of the disease, low-grade fever, emaciation and other toxins not expressed are noted. A distinctive feature of persons suffering from the fibrotic form is the “wrinkling” of the top of the lungs, due to which the supraclavicular and subclavian fossae are clearly visible. During the examination, moist rales may be clearly noted, which occur when excessive

One of the consequences of focal forms of tuberculosis is perifocal pleurisy. In this condition, noise occurs from friction of the pleura.

Sputum production and wheezing are caused by bronchial deformation and bronchiecstasy. These violations are confirmed during a special study. Such symptoms usually accompany the fibrotic form. In addition, its characteristic manifestation is hemoptysis.

With the development of low-grade fever against the background of a fibrous-focal form, the occurrence of wheezing and sputum production, patients are assigned to the third group in the dispensary registration. Severe respiratory disorders can cause disability in patients. Regular exacerbations of the disease require the necessary treatment. If there are no active ones, the patient is considered cured of the disease. He should undergo regular rehabilitation, as well as follow disease prevention measures and regimens.

Tuberculosis is considered a complex and very dangerous disease. However, it is treatable. A favorable outcome is guaranteed only if symptoms are noticed in a timely manner. It should be noted that parents should pay special attention to the health of their children in order to identify them in time.

The main manifestations of the disease in a child include weakness, irritability, and lack of weight gain. At the same time, the temperature may rise and the lymph nodes may enlarge.