Fibrous-cavernous tuberculosis: symptoms and treatment. Prevention and useful advice

Fibrous-cavernous pulmonary tuberculosis is a destructive disease, the hallmark of which is the presence of an isolated cavity in the lungs. In medicine, it was called "cavern". The disease is a stage in the progression of pulmonary tuberculosis. Often, a clinic of a similar pathology has an erased character.

Features of the disease

As a rule, fibro-cavernous tuberculosis is observed in adult patients. In childhood, primary tuberculosis manifestations are very rare.

Cavernous pathology acts as the outcome of infiltrative tuberculosis, but it happens that a disseminated, or focal, type of pathology develops.

Fibrous-cavernous form is detected in 5% of cases of tuberculosis.

Cavernous tuberculosis as a step towards the development of fibrous-cavernous pathology

A characteristic pathomorphological sign of cavernous tuberculosis is the presence of a single cavity, the absence of inflammation and fibrotic changes in the area of bronchial tubes, lymphatic vessels and nearby tissue. The disease lasts no more than 2 years.

The healing of caverns occurs with the formation of:

• Rumen;
• Tuberculosis;
• A single focus of tuberculosis;
• Sanitized cavity.

In the absence of proper therapy, the cavernous form can go to fibrous-cavernous tuberculosis, which is characterized by fibrosing of the walls of the cavern and the nearby pulmonary parenchyma. There are also multiple foci of dissemination.

Symptomatic of the disease

As a rule, fibrous-cavernous tuberculosis is localized in one lung. The development of the disease occurs for 3-4 months of ineffective therapy of another type of tuberculosis. Manifestations of the disease become particularly striking in the phase of decay.

The main symptoms of the disease can be listed:

• Asthenia;
• A decrease in appetite;
• Weak cough with phlegm;
• Expectoration of blood;
• bleeding;
• Wet rales in the cavity of decay.

After the formation of the cavern, the symptoms become meager, less pronounced and nonspecific. The patient may complain of general weakness, constant fatigue, weight loss and the presence of subfebrile temperature.

The development of a latent form of tuberculosis can be indicated by bleeding in the lungs, which develops without a cause.

Anamnesis of patients affected by fibro-cavernous tuberculosis, assumes a wavy course. The intervals between the acute period and remission can be quite long or, conversely, the acute phase can manifest itself quite often.

Fibrous-cavernous form of tuberculosis has various clinical symptoms. It is caused by the pathological process itself, as well as by concomitant complications.

There are two types of the course of the disease: limited or relatively stable, in which under the influence of chemotherapy comes the stabilization of the patient's condition and remission, which lasts for several years.

In the acute period there is a rise in temperature and development of the inflammatory process around the cavity. The temperature can reach high values if an infection of a secondary nature joins the underlying disease.

The defeat of the bronchi is accompanied by a painful nauseous cough, in which a sputum containing mucus and pus separates with difficulty.

A patient suffering from fibrous-cavernous tuberculosis, sharply loses weight. He has dry skin, which easily wrinkles. The patient's muscles are atrophied. The target of the pathological process is the shoulder belt, the back and the area between the ribs.

Patients are prone to frequent intoxication. With exacerbations of the disease, respiratory failure of 1 and 2 degrees develops. In the future, there may be an increase in the volume of the liver. There may be swelling.

When the disease progresses, larynx and intestinal lesions are noted, which leads to a weakening of the immune system. With kahesia, amyloid nephrosis and pulmonary heart disease, the prognosis of the disease is unfavorable.

Causes of the disease

Destruction can be provoked in any clinical form of tuberculosis. A provoker of development may be superinfection. Mycobacteria should be classified as pathogens. In all there are 74 names. They belong to the genus Mycobacterium. However, tuberculosis in humans is provoked by a conditionally designated type, called Mycobacterium tuberculosis.

Predisposing factors in the development of ailment are:

• Increased level of sensitization;
• A change in the reactivity of the organism;
• Diseases of internal organs;
• bad habits.

The main phases of the disease

It is accepted to distinguish the following phases of fibrous-cavernous tuberculosis:

• Infiltration. It assumes the presence of a focus of inflammation.
• The decay. In the focus of inflammation a cavity is formed, which is filled with a special form of necrotic tissue - a caseous mass. The dry contents become liquid and gradually torn off through the drainage bronchus. In its place remains a cavity. In the future, it begins to fill with air, and if there is a violation of drainage in the bronchi, it becomes liquid.
• Formation of caverns. Formation is formed by resolution of perifocal inflammation and fibrosis. The wall of the anomaly contains three layers. The inner layer is represented by a caseous mass (polygenic layer). In the middle there is a granulation shell lined with large cells of the epithelium. From the outer part of the cavity is covered with a capsule of connective tissue.
• Insemination. In this process, the dimensions of the cavity increase, and around it occurs perifocal infiltration, or seeding. The process involves the development of fresh inflammatory foci in cavernous tuberculosis. This is how the fibrous-cavernous form of the disease develops.

Frequent complications

The following complications of fibrous-cavernous tuberculosis are distinguished:

• Hemoptysis.
• Bleeding in the lung.
• Presence of percussion. It is expressed in the shortening of sound in the areas of thickened pleura and fibrosis.
• Listening to weak breathing in areas of thickening of the pleura. Also, wet wheezing and bronchial breathing are detected . Such rales are detected in the presence of large cavities. Above small formations, sounds are distinguished by a less pronounced sound.

Methods of diagnosis

How is fibro-cavernous tuberculosis diagnosed? The history of the disease at the time of diagnosis, as a rule, already contains information about a previously transmitted tuberculosis infection.

It should be noted that auscultative symptoms carry little information. Further examination by X-ray reveals the presence of ring-shaped shadows with a peripheral arrangement in the shape of an oval or a circle. After the data obtained by X-ray diffraction, differential diagnostics with a pathology such as lung abscess, peripheral cancer, bullous emphysema, pneumothorax, echinococcosis, or digested pleurisy is required.

Auxiliary diagnostic methods are laboratory and endoscopic methods.

Sputum analysis reveals a high level of MTB. At laboratory inspection the high level of allocation of bacilli is revealed. Sometimes the process becomes intense. Coral elastic fibers are also identified.

In the absence of sputum, bronchoscopy is indicated. It allows to identify the foci of inflammation in the lungs and bronchi, which prevent the closure of the cavity.

Blood test. In patients with fibro-cavernous tuberculosis there is lymphopenia and an accelerated rate of ESR up to 30-40 mm / h.

With secondary infection, there is an increase in the level of leukocytes to a value of 19 000-20 000, as well as an increase in the level of neutrophils.

There is a high protein content in the urine.

Principles of therapy

How is fibro-cavernous tuberculosis eliminated ? Treatment is conducted in a hospital in TB dispensaries.

The scheme of therapy is based on the simultaneous use of three or four drugs directed against the development of pathology. As a rule, "Izoniazid", "Etambutol", "Rifampicin" and "Streptomycin" are used. Drugs can be injected intravenously or directly into the cavity of the cavity.

Also used tuberculin therapy, respiratory gymnastics, physiotherapy procedures, laser treatment, ultrasound and inductothermy.

Conducting chemotherapy

How else can fibro-cavernous pulmonary tuberculosis be eliminated? Treatment involves chemotherapy. The procedures are assigned on an individual basis in accordance with the sensitivity indicators for medicines.

As a rule, in the presence of resistance to fixed assets against tuberculosis, therapy is conducted in accordance with the fourth regimen of chemotherapy. Treatment involves the combined use of drugs such as Kanamycin, Prothionamide, Cycloserine, PASK and Fluoroquinolone. The duration of chemotherapy is no less than 15-18 months.

Patients with the presence of fibro-cavernous tuberculosis are shown pathogenetic therapy, which is aimed at correction of various disturbed functions of the body. Metabolizing agents, as well as drugs for restoring the immune system and hormones are used.

With a favorable course of therapy, after about half a year, a positive trend is observed. There is a decrease in the release of bacilli, as well as a decrease and closure of the cavern.

Operative intervention

The healing of fibrous caverns is always very slow. If during the above-mentioned period it is not possible to achieve positive results, then fibro-cavernous pulmonary tuberculosis is eliminated through surgical intervention. In this case, a one-sided resection of the lung is indicated. The operation is also performed in a bilateral process. It also features a high degree of efficiency and allows you to maintain the patient's ability to work. The life expectancy of a sick person is significantly longer. Isolation of mycobacteria ceases.

Another type of surgical intervention is surgical collapse, involving the imposition of an artificial pneumothorax.

After treatment in hospital conditions, compulsory stay in a sanatorium, out-patient treatment with subsequent supervision in the dispensary is required.

Prognosis of the disease

In the overwhelming majority of fibrous-cavernous tuberculosis lends itself to therapy. Caverns of small size are closed and scarred. Formations with the presence of rigid walls with time are filled with caseous contents, which provokes the development of pseudotuberculoma.

The accumulation of pus, the presence of aspergillosis, the progress of tuberculosis are extremely rare.

Preventive measures

Fibrous-cavernous pulmonary tuberculosis belongs to the category of diseases caused by unfavorable social factors. Often, the primary cause is deterioration in the living standards of the population.

According to statistics, men get sick 3 times more often than women. In general, the pathology is fixed at the age of 20 to 39 years.

For the purpose of prevention, the following rules are recommended:

• Conducting appropriate preventive measures;
• Early detection of people affected by the disease;
• Allocation of funds by the state to medicines;
• Implementation of preliminary medical examinations when entering work in livestock farms;
• An increase in the area of residence for patients who have been diagnosed with tuberculosis;
• Timely delivery of vaccination to newborn babies in the first month after birth.

Conclusion

Fibrous-cavernous pulmonary tuberculosis (complications endangering the state of health) is a chronic disease. As a rule, it is provoked by cavernous tuberculosis. The disease can be of a one-sided or two-sided nature.

If previously pathology was difficult to treat, then at present medicine has a wide range of different therapeutic techniques that allow achieving a stable remission for many years. Timely therapy allows you to maintain the patient's ability to work.