Pathogenesis of tuberculosis. Etiology of tuberculosis. Symptoms and early signs of tuberculosis

Many people have heard about tuberculosis, but few realize the real danger of this formidable disease. For many years, physicians around the world have studied the factors that contribute to the development of infection, the main signs and manifestations. During this time it was found out that the early stage of tuberculosis of the lungs and other organs can proceed in an asymptomatic manner, and the absence of treatment leads to serious complications.

Brief information about the disease

To date, the pathogenesis of tuberculosis has been studied in full. This is a dangerous and very contagious disease caused by infectious agents from the mycobacterium.

There are several types of microorganisms that provoke disease in humans. These include:

• Human, occurs most often, it accounts for 92% of all recorded cases;
• Bull, leads to the disease is much less likely, they are sick about 5%;
• Intermediate, mainly distributed in South Africa, in Russia, the disease is detected in 3% of patients;
• Mouse and avian, occurs only in persons who have immunodeficient conditions in the anamnesis.

Few people know that the respiratory anatomy of tuberculosis is not limited. The bacillus is also striking:

• bones;
• Gastrointestinal tract;
• Genitourinary system;
• brain.

Irrespective of localization, the ailment is extremely dangerous and inevitably leads to a fatal outcome in the absence of treatment.

The disease has a long incubation period. The first symptoms can appear after 3 months - 1 year after the introduction of an infectious agent.

Statistics

Medical professionals around the world are seriously concerned about the rapid spread of the disease. Russia is the 22nd in the list of countries.

Previously, the majority of those infected were persons who were serving their sentences in places of deprivation of liberty. But since the beginning of the 1990s an outbreak of the disease began, and the bacillus began to spread widely.

Every day new cases of tuberculosis were diagnosed among well-off families, most of the cases were children.

In the health care organization, this fact was associated with a decrease in the standard of living of citizens, which was observed at that time and was caused by political restructuring to the country.

For many years of the present epidemic, the specialists have implemented a set of preventive measures that allow for a little stabilization of the situation, to reduce morbidity and mortality. These included:

• Vaccination of newborns in the hospital;
• Monitoring of new infections through the Mantoux reaction (in children) and fluorography (in adults).

The rod of tuberculosis is extremely resistant to changes in the environment, therefore, it remains for a long time in a viable state in water, earth, etc. If the elementary rules of personal hygiene are not fulfilled, the risk of getting sick is quite high.

Characteristic features

At the heart of the primary pathogenesis is the penetration of the pathogen into the body. Such people do not get sick at once, accordingly, there are no complaints.

With the weakening of immunity may occur:

• Slight increase in body temperature;
• Increased heart rate;
• Strong sweating at night;
• Blush in combination with unnatural pallor of the skin;
• Weakness, dizziness;
• cough;
• Separation of sputum with an admixture of blood.

Deterioration of the general condition occurs against the background of poisoning by toxins of microbes. The larger the number, the more pronounced the symptoms.

The first signs of tuberculosis in patients with a strong immune system may be minor or nonexistent.

The most severe course and rapid progression is observed in people with health problems.

If the microorganism struck:

• Bone tissue - there is a strong pain in all joints and stiffness of movements.
• The brain - there is nausea, vomiting, severe headache and muscle pain.
• Urinary system - the patient is constantly feeling a bladder overflow. In later stages, the appearance of blood in the urine.
• Gastrointestinal tract (GIT) - there is a constant discomfort in the abdomen, nausea, scarlet veins in the stool.
• The skin - on its surface formed nodules, filled with pus, which eventually open.

Against the background of a long course of tuberculosis, an inflammatory process of the granulomatous type occurs, which can be observed in any affected organ. To detect it, modern diagnostic methods are used.

Risk groups

It has long been proven by medicine that the pathogenesis of tuberculosis directly depends on the state of the body's defense system.

No one is insured against infection, but the group at greatest risk includes persons:

• With HIV and AIDS;
• Prisoners;
• Suffering from various chronic diseases (ulcers of the digestive system, diabetes mellitus, etc.);
• Having bad habits;
• Younger age;
• Neglecting the rules of personal hygiene;
• Regularly in contact with the infected;
• During pregnancy;
• Experiencing regular stress;
• Inadequate vitamins and minerals;
• Living in environmentally unfavorable areas;
• From low-income families;
• Without a specific place of residence.

With the activation of the pathological process, the pathogenesis of tuberculosis is characterized by increased infectiousness.

Forms

The type of infection depends on the duration of treatment, the probability of infection of other people. The following phases of tuberculosis are distinguished:

1. Open. It is observed when the lungs are affected. If the sputum analysis carried out confirmed the presence of pathogens in it, the person is contagious.
2. Closed. With a negative result, the patient is not a carrier of the disease.

If the wand first got into the body speak about the primary form, in the opposite case about the secondary.

In addition, the ailment can differ in the nature of the lesion:

• Miliary;
• disseminated;
• Infiltrative;
• limited;
• cheesy;
• Fibrous-cavernous;
• Tuberculosis;
• cavernous;
• Cirrhotic;
• Tuberculous pleurisy.

The course of the disease in childhood and during pregnancy

The etiology of tuberculosis indicates that people with a weak immune system are most vulnerable to infection. Such a disorder can be congenital, but most often appears in the process of life, under the influence of various factors.

In childhood, the protective system is not completely formed, so the risk of infection increases inversely with the age of the child. That is, the younger he is, the more likely the penetration of a malicious wand.

After infection, the disease proceeds in exactly the same way as in adults, but in a more severe form. Specific differences do not.

Tuberculosis during pregnancy is not the reason for its interruption.

Transition to the active phase can be observed in the first trimester or after delivery. The rest of the time is less common. This is due to the activity of the immune system and hormonal changes in the body.

Infection of the fetus is not always observed. Basically, this is typical for the following forms:

• Fibrous-cavernous;
• Heavy destructive;
• Disseminated.

Such pathogens easily overcome the placental barrier, lead to severe disorders in the fetus.

After the diagnosis is made, the patient is under the control of a gynecologist and phthisiatrician.

The treatment begins immediately, while the drugs that have the least negative impact on the unborn child are selected.

If the disease is detected on time, the prognosis for the woman and the baby is favorable, but there are exceptions. Sometimes abortion is still recommended.

Examination

After the appearance of the first suspicious signs, patients rarely visit the doctor, but in vain. Behind the mask of harmless fatigue, not only tuberculosis, but other terrible diseases can hide.

Even a slight deterioration in well-being without signs of acute respiratory disease, but with an increased body temperature should be an occasion to visit a doctor.

The initial examination will be conducted by a therapist who will listen to all complaints, take into account the etiology of tuberculosis and give directions to general tests (blood and urine) and other necessary studies, it can be:

• Fluorography. It is held once a year, starting from the age of 15. It allows to detect pulmonary tuberculosis and other pathologies of the respiratory system. It is included in the list of mandatory examinations when applying for a job, before leaving the army, etc. If the result of fluorography is controversial, then additionally do X-rays.
• Mantoux test. Many mistakenly confuse her with vaccination. This is a special type of diagnosis of tuberculosis. It is administered to all babies aged 1 to 14-15 years, sometimes up to 17. A small needle under the skin is injected with a substance called tuberculin. It contains the products of vital activity of pathogens. After such contact, a "button" should appear. To measure the result, measure its diameter.
• Immunoenzyme analysis (ELISA). It allows to determine the presence of a microorganism in the blood at the time of the study.
• Sputum analysis according to Tsiol-Nielsen. It is administered to all patients with a prolonged cough. Sputum is stained with a special solution, which allows to determine the presence of pathogenic bacilli.
• Bacteriological sowing. It allows you to find out which wand triggered the disease. Sowing ripens about 1-2 months, but gives a very accurate result, allowing you to choose effective therapy.

In case of suspicion of tuberculosis of other organs, additionally:

• X-ray;
• MRI or CT of the affected area;
• Encephalogram, and the like.

The pathogenesis of tuberculosis has very similar features to many other diseases, such as cancer, so it is not always possible to suspect it immediately.

Treatment

The choice of therapy, mainly depends on the pathogenesis and clinic of tuberculosis. It is conducted under the supervision of phthisiatricians and takes a long period. In most cases this is 2 years, slightly less than 3-4.

The choice of a drug regimen depends on many factors. As a rule, the doctor makes such a decision on the basis of:

• Patient's condition;
• His age and sex;
• Results of the survey, and so on.

Main goals of treatment:

• Make the patient non-contagious;
• Stimulate the healing of damaged tissues;
• Restore health.

A positive result can be achieved with the help of the following drugs:

• Paraaminosalicylic acid.
• "Streptomycin".
• "Kanamycin".
• Rifampicin.
• "Ftivazide."
• "Pyrazinamide."
• "Ethionamide".

Basically, 3, 4 or 5 components are used at the same time.

It is mandatory to use chemotherapy courses, the duration and dosage of which is determined individually.

After the use of aggressive medications, the process of tissue regeneration is slow and not quite as it should, so phthisiatricians often prescribe pathogenetic treatment for the natural process of tissue repair. This includes a whole range of activities that make it possible to achieve good results. These include the reception:

• Anti-inflammatory drugs;
• Immunomodulators;
• Enzymes;
• Vitamins of group B;
• Sorbents;
• Preparations for the protection and restoration of the liver (hepatoprotectors);
• Glutamic acid;
• Anticoagulants;
• Antikinins;
• Anabolic;
• Antiallergic drugs, etc.

Operation

Most often, the initial forms of the disease do not require surgical treatment. In advanced cases without these methods can not do. When lung lesions are performed:

• Lobectomy.
• Resection.
• Bilobectomy.
• Pulmonectomy.
• Cavernectomy.
• Pneumothorax.

Taking into account the pathogenesis of extrapulmonary tuberculosis , surgical intervention can also be applied to it.

If complications arise from the infected gastrointestinal tract, a scheduled or emergency operation is planned to eliminate the consequences.

Tuberculosis of the central nervous system is treated mainly by conservative means. If they do not help, they start to remove pathological foci. These are very complex procedures that can lead to irreversible consequences.

Suppurative skin granulomas can also be operated.

The main purpose of such measures is to eliminate the consequences of the disease and, if possible, restore the work of the affected systems.

What to do in order not to get infected

Despite the desperate struggle of physicians with tuberculosis, pathology is still very common among the population, so it is not superfluous to know how to protect yourself and your loved ones:

• Vaccination. Do this vaccination at the request of parents, but do not abandon it. It allows you to develop a stable immunity against infection in your baby, which becomes the most powerful after reaching 1 year. As a result, the child does not become ill with tuberculosis or transfers it in mild form.
• Regular examination. It allows to identify the disease at an early stage, to carry out effective treatment and to prevent the infection of a large number of people. This includes Mantoux test and fluorography.

Some groups of patients show preventive courses of chemotherapy, these are:

• They have weak immunity and chronic lung diseases, gastrointestinal tract, central nervous system.
• Living in the same room with an infected person.
• Have changes in the airways against the background of the tuberculosis.
• Childhood with poor Mantoux test results.

In addition to medical activities, there are a number of recommendations that can reduce the risk of developing the disease. For this you need:

• Exercise regularly;
• To eat healthy food;
• To struggle with dependencies;
• Wash hands thoroughly before meals and after visiting public places;
• Limit contact with a sick person;
• It is good to disinfect the whiteness of the room in which the infected person is;
• Regularly take vitamins and preparations containing polyunsaturated Omega-3 acids.

All TB doctors know one small secret how to reduce the risk of contracting tuberculosis. For this it is necessary to have breakfast in the mornings and not to allow long hungry gaps during the day (especially when it is necessary to use public transport). It is believed that the bacillus has practically no chance to penetrate the body.

Complications

Negative consequences of tuberculosis are noted by individuals who are delaying a visit to a doctor and neglecting diagnosis. The launched form can threaten a person:

• Cardiac and respiratory insufficiency;
• Bleeding from the affected organs;
• The formation of ulcers, fistulas;
• Impaired kidney and liver function;
• Development of granulomas throughout the body;
• Amyloidosis;
• Pneumothorax;
• Impairment of motor function;
• Paralysis;
• Sepsis;
• Gangrene;
• Necrosis;
• Coma;
• Lethal outcome.

When complications appear, the prognosis of the disease is extremely unfavorable.

From all of the above, we can conclude that the disease provokes a variety of symptoms. The first signs of pulmonary tuberculosis can be manifested by a prolonged cough, not eliminated by mucolytic drugs. This should alert the patient and make him consult a doctor. It is worth remembering that the disease is well treatable with timely treatment, and in case of transition to a neglected form, the risk of complications that inevitably leads to painful death is high.