Tuberculosis: Symptoms and Treatment
Tuberculosis is a fairly common infectious disease, provoked by a tubercle bacillus. Tuberculosis, whose symptoms are associated with lung damage, can also damage the eyes, skin, bones and joints, the organs of the genitourinary system, and often it flows, masking for other diseases such as colds or pneumonia. It also happens that symptoms may not be present as such.
Tuberculosis can be primary or secondary. Primary tuberculosis develops immediately after infection has occurred. Often, it is diagnosed in young patients, before the age of 4, this is due to the fact that the immune system they have not yet fully formed. The peculiarity of the course of the disease in this case is that the tuberculosis is in rather severe form, and often the patients for the surrounding people are not infectious.
Primary tuberculosis is accompanied by the formation of a primary focus, that is, a site in the lung that is affected by tuberculosis — a tuberculous granuloma. Such a site can later heal independently, after which, in the region of its past location, there remains a focus of scar tissue. In some cases, it is detected during an X-ray study, and in healthy patients, and this «find» indicates that tuberculosis was previously transferred.
Meanwhile, in other cases, everything is not so «smooth», because the granuloma progresses, increasing in size, after which its central part is subject to decay, thus forming a cavity, this is the primary pulmonary cavern. Mycobacteria, appearing outside the primary focus, can be found in the bloodstream, settling at the same time in various organs, this leads to the formation of «tubercles» in them, that is, all the same tuberculous granulomas, which is why tuberculosis is called (from Latin Tuberculum translates as «bugorok»).
As for the secondary form of the disease, here it can be stated that secondary tuberculosis is the result of a newly transferred infection or reactivation (re-activation) of an infection already present in the body. Basically, in this form, the disease occurs in adults. With it new caverns and foci are formed, such formations tend to merge with each other, so that the lesion can become very extensive, and intoxication — pronounced. Approximately one third of patients without treatment of the disease in this form die within the next months, others can carry it in a protracted form, it is also possible for spontaneous subsidence of secondary tuberculosis.
Infection with tuberculosis occurs in various ways. It can be an airborne path of infection (during a conversation, when sneezing or when the patient coughs), the air-dust path (with dust in the body of a healthy person, sputum elements get into the patient), the contact path (the infection enters the body through mucous and damaged areas On the skin), as well as the food pathway (infection occurs in the body of a healthy person through cattle-infected food (meat, milk, sour cream, cheese, etc.).
Mycobacterium tuberculosis, which provokes the disease (tubercle bacillus), is characterized by the fact that they are based on a special type of membrane, due to which bacteria can survive even in rather harsh environmental conditions. The same applies to the effects of antimicrobial agents, which they can successfully withstand. Mycobacteria multiply very slowly, this is one of the reasons that make diagnostics difficult.
The risk of infection is determined by the nature and duration of contact of a healthy person with the source of infection, as well as the degree of human infectiousness, this spreading infection. At times the probability of infection of a healthy person increases if a person has a tuberculosis in the active form of the lesion, that is, if the lungs form tuberculous cavities, and the upper respiratory tract is affected, and this is the larynx, trachea, bronchi.
As the most significant factor that determines the risk of infection, the places of congestion of a large number of people are indicated in conditions of insufficiently ventilated premises.
Meanwhile, Mycobacterium tuberculosis does not always cause the development of this disease, mainly the risk of its development is determined by individual sensitivity to the impact of mycobacteria, as well as the characteristics of the immune response. Age also plays an important role in considering the risk of developing this disease. So, the highest it becomes for patients of youth and young age. Tuberculosis in women is most often observed within the age interval of 25-34 years, with women at this time becoming ill more often than men.
A number of concomitant diseases can provoke the possibility of developing an active form of tuberculosis. As a leading disease, HIV infection is considered, in which the immune response is suppressed. In case of HIV infection, patients are monitored by annual Mantoux test, in addition, prophylaxis with antituberculous drugs is envisaged.
increased risk of contracting tuberculosis contribute to chronic lung disease with lesions, tumors of blood or other type of malignant disease, renal failure, hemodialysis accompanied systematic, insulin dependent diabetes mellitus, and cachexia organism.
Thus, we can summarize that the special risk for contracting TB opportunities come mostly only people who have lowered immunity. These include: HIV-infected patients, the children of group of young people living in a damp, not enough ventilated and heated rooms, as well as people, are often confronted with hypothermia and malnourished. It plays a role in smoking risk of developing tuberculosis, especially if a person smokes from one pack a day — in this case, the probability of developing the disease increases by 2-4 times. And, of course, at times the risk of infection increases with prolonged close contact with patients who have an active form of tuberculosis.
Forms of tuberculosis
In most cases, the organs of the respiratory system (in particular, the lungs and the bronchi) are affected by tuberculosis, as well as the organs of the genitourinary system. Bone-joint forms of this disease most often occur with the defeat of the pelvic bones and spine. Based on the areas affected by tuberculosis, the disease is divided into two main groups, respectively, pulmonary tuberculosis, and extrapulmonary tuberculosis.
Lung tuberculosis can manifest itself in various forms. In particular, this is the primary tuberculosis complex and tubercular bronchoadenitis. Depending on the degree of proliferation, pulmonary tuberculosis can manifest itself in one of the following forms: disseminated tuberculosis, tuberculosis latent (hidden), infiltrative tuberculosis, miliary tuberculosis, limited (or focal) tuberculosis, tuberkuloma, caseous pneumonia, cirrhotic tuberculosis and fibrocavernous tuberculosis . Significantly less often diagnosed tuberculosis of the trachea, tuberculosis of the larynx and tuberculosis of the pleura.
With regard to extrapulmonary tuberculosis, it can affect any organ in the human body. Distinguish the following varieties of this form of tuberculosis: Tuberculosis of the digestive system (mainly the defeat to be the cecum and distal part of the small intestine), tuberculosis of the meninges and central nervous system (the defeat to be the brain and spinal cord, the hard shell of the brain — in this case we are talking about Such a disease as tuberculous meningitis), tuberculosis of the skin, tuberculosis of joints and bones, eye tuberculosis.
Tuberculosis of the lung: symptoms
Tuberculosis can have many masks, and, as already noted, indicates this that the manifestations of this disease can be very different, because of what we can assume the relevance of a completely different disease. Symptoms of tuberculosis are determined on the basis of the area of concentration of the pathological infectious process. Naturally, tuberculosis of the lungs, and, for example, tuberculosis of the skin, will manifest itself differently in its symptoms and in the features of the course.
Again, the individual characteristics of a particular organism already play their role. Such features are also called constitutional, they determine how susceptible the organism will be to the influencing infection, to some extent these features affect the types and rates of development of the actual infectious process, as well as the susceptibility of the organism to the treatment of the disease and its prognosis.
Let’s move on to the symptoms, and start with their common species. With a limited form of tuberculosis, patients have increased fatigue and weakness, which is especially pronounced in the morning. In addition to this, overall performance is reduced. Tuberculosis in children in general condition is characterized by the fact that they have declining academic performance, they lose appetite, sleep is bad. Massive forms of tuberculosis, as well as the spread of infection throughout the body, can lead to an even greater aggravation of the general condition of the patient.
External changes in tuberculosis are accompanied by weight loss, the patients become drained, noticeably thinner. There is a sharpness of facial features, pale skin, blush on the pale skin. With chronic tuberculosis, patients become emaciated.
Temperature. Limited forms of tuberculosis are accompanied by a slight but prolonged rise in temperature, mainly in the range of 37.5-38 degrees. The temperature rises in the evening and at night, with sweating at night, combined with chills. It is important to distinguish the temperature of tuberculosis from the temperature that accompanies other diseases. So, with usual ARI, with bronchitis or with pneumonia, the temperature can be even higher than indicated, but it passes quickly enough, without sweating nightly. High temperature with tuberculosis accompanies only its massive forms.
Cough. This symptom is for pulmonary tuberculosis permanent. The onset of the disease is accompanied by perseverance and dryness of the cough, its aggravation is observed at night and in the morning. Further development of the disease can be accompanied by a «wet» cough, at which sputum is released. When tuberculosis cough manifests itself in chronic form, that is, it is constant. Given this, the fact that a cough for 3 weeks or more should be alerted, this requires a compulsory visit to the doctor. Such diseases as ARI, again, bronchitis or pneumonia, can similarly be accompanied by the appearance of a cough, but the difference from coughing with tuberculosis is that it is not so long, it has a slightly different character and it lends itself to the influence of therapy addressed to it (tablets, Syrups, etc.).
Hemoplegia. This symptom is a rather important manifestation of tuberculosis. Here, we are most likely talking about its infiltrative form, although the possibility of manifesting another form of tuberculosis with this symptom is not ruled out. Basically, hemoptysis is manifested after an attack of cough has passed, with a sputum a certain amount of fresh blood is expectorated. Also, pulmonary tuberculosis can be accompanied by the development of a condition such as pulmonary hemorrhage, yet this symptom is called «blood by the throat». Such a condition is not only serious, but also dangerous for the life of a sick person, medical care is required immediately. Hemoptysis, manifested in tuberculosis, must be differentiated from diseases such as heart failure or lung cancer, in which there is also a symptom of hemoptysis.
Chest pain. This pain increases during breathing.
Often, tuberculosis occurs without symptoms, in which case the primary focus is detected by chance, with an x-ray that is not related to the release of the disease.
Extrapulmonary tuberculosis: symptoms
As already indicated, tuberculosis can affect other organs besides the lungs. In this case, they speak of extrapulmonary form. Symptoms depend on where the disease is localized.
Tuberculosis of the urogenital system. Symptomatic in this case depends on where the infection is located, in particular, the following manifestations: blood in the urine, painful and frequent urination, back pain, lower abdominal pain, infertility and impaired cycle in women . When the organs of the male genitourinary system are affected, if the epididymis is affected, a new type of volumetric type is formed in the scrotum, painful when palpated. As with tuberculosis in general, the disease can take place in this form without any symptoms. In addition, the effect of antituberculosis drugs in this case determines a sufficient degree of effectiveness when applied.
Tuberculosis of bones and joints. Symptoms that indicate this disease, are now detected infrequently, as, indeed, the disease itself. HIV-infected patients are most often affected here. Knee, hip and intervertebral joints are mostly affected. If the intervertebral joint is affected, the pathological process also captures the adjacent vertebra, which causes the intervertebral disc to collapse, which in turn can cause the vertebra to flatten as the spine develops before the hump appears. If knee or hip joints are affected, walking may show intense soreness, which also causes lameness. If this form of the disease is not treated, then one can face such a development of the pathological process, in which the function of the joint is completely lost.
Central tuberculosis. The defeat of the central nervous system in tuberculosis is rarely detected, mainly again in patients with HIV, as well as in young children. Here the brain envelop is affected, that is, tuberculous meningitis develops, and tuberculoma can also form in the substance of the brain. Symptomatology can be very different, in particular it is a headache, a violation of sensitivity, consciousness, psyche, violations in the movements of eyeballs, etc. The lack of treatment of tuberculous meningitis leads to death, if treatment is performed and there is a certain efficiency from it, then, to Unfortunately, it is still completed for the patient by certain neurological disorders in varying degrees of their manifestation. With tubercular granuloma of the brain, symptoms such as epileptic seizures, sensitivity disorders, and movement disorders can be noted.
Miliary tuberculosis. With this form of tuberculosis, it is about spreading the infection throughout the body through the blood. It is also accompanied by the formation of small foci in tissues and in organs, that is, already marked with granules in the form of tubercles about 1-2 mm in diameter (they are similar to millet grains). The symptomatology of this disease is similar to the symptomatology of the lungs, although in addition there are symptoms that indicate the damage to certain organs (eyes, spleen, liver, brain envelopes, etc.).
Tuberculosis of the digestive system. The main symptomatology in this case is reduced to the appearance of diarrhea and constipation, there is pain in the abdomen, bloating. The temperature manifests itself in a long-term manner, an admixture of blood is found in the fecal masses. Sometimes there is a symptom such as an intestinal obstruction.
Tuberculosis of the skin. In this form the disease is accompanied by the appearance of dense nodules and seals localized under the skin, they break through the skin, thus freeing the curdled whitish masses. At the same time, certain deviations from the general picture on this form of the disease are allowed, therefore it can manifest itself in different ways.
As the main method of diagnosing tuberculosis, an x-ray study is used. It is important to understand the difference between the methods used in this type of research. Such a method as fluorography is relevant only as a mass type of the method of examination, as part of its conduct, it is investigated whether there are changes in the lungs that are similar to tuberculosis. Survey radiography is characterized by a greater degree of accuracy, in particular, it is an overview of the radiography of the thoracic region.
With even greater accuracy, results are obtained with simple tomography, and, finally, the most informative method is computed tomography. An important role is played by sputum analysis performed in laboratory settings. With its help it is possible to identify the pathogen, and also to determine on the basis of the result, the patient is dangerous to the environment or is not dangerous.
A special role is assigned to the methods of tuberculin diagnostics, and here the Mantoux reaction also applies. If there is a suspicion that the patient has an extrapulmonary form of tuberculosis, additional studies are required, specific options are considered depending on the alleged localization of the pathological process caused by tuberculosis.
Treatment of tuberculosis is carried out exclusively in conditions of TB dispensaries. Depending on which form of the disease is relevant, it is determined whether the outpatient needs treatment or whether it is stationary, other factors, such as the general condition of the patient, the absence / presence of bacilli, etc., are also taken into account here.
All patients who have tuberculosis for the first time are hospitalized. The treatment used is of a combined nature, that is, several types of anti-tuberculosis drugs are used. Also, the treatment of tuberculosis is lengthy, at least it takes 6 months. How successful the treatment will be depends on the patient himself, and in particular on how the medical recommendations will be implemented. If the doses of drugs decrease and the time of their intake decreases, then the treatment becomes ineffective, moreover, because of this, the causative agent of the disease acquires even greater stability in therapy.
It is important to note that any kind of treatment, including methods of traditional medicine from tuberculosis, phytotherapy, etc. — all this is only an auxiliary solution in the fight against the disease, but not the main one. There are no substitutions for anti-tuberculosis drugs. Sometimes the treatment of tuberculosis is carried out surgically, improve the effectiveness of treatment, and prevent the exacerbation of tuberculosis allows sanitation.
If TB is suspected, it is necessary to contact the TB specialist (the main specialist specializing in tuberculosis), and you can also start by visiting the attending therapist (or pediatrician — respectively, if the child is involved).