What is the danger of infiltrative pulmonary tuberculosis: what is it and how to treat it
Few know why there is infiltrative pulmonary tuberculosis, what is it, and what methods of treatment of this disease exist. Tuberculosis is one of the most intractable diseases of the lungs. Mycobacterium tuberculosis are a few billion people. The disease is widespread in all countries. There are the following types of pulmonary tuberculosis: primary complex, tuberculosis of intrathoracic lymph nodes, infiltrative, miliary, focal tuberculoma and destructive forms (cavernous, cirrhotic). What is the etiology, clinic and treatment of this disease?
Features of infiltrative tuberculosis
Infiltrative tuberculosis is the most frequently diagnosed form of the disease. It accounts for 70% of all cases of this disease. From this disease more often affects adults aged 20 to 40 years. Unlike other species of tuberculosis is most easily. Mortality from this form of the disease is about 1% of the total pulmonary tuberculosis. The causative agent of infection is Mycobacterium tuberculosis. These microorganisms can survive for long periods in the environment.
These microorganisms have the following features:
- do not contain nuclei;
- belong to true bacteria;
- have rod-shaped form;
- their sizes range from 1 to 10 microns;
- actively grow and multiply in the presence of oxygen and at a temperature of 37-42º;
- not capable of movement;
- not able to form spores and capsules).
- are composed of specific protein tuberculin;
- do not produce toxins.
A person infected in most cases through the air. Possible contact mechanisms of transmission, fecal-oral (food) and transplacental. In a healthy person, even when hit in the upper respiratory tract of mycobacteria disease may not develop. Contribute to this protective force in the form of mucus and ciliated epithelium. It is important that the condition of the cells of the immune system. A sick person can be contagious if there is an open form of tuberculosis. In this form of pulmonary tuberculosis in lung tissues formed infiltrates. First, they have a diameter of about 3 cm, then they can grow.
Varieties of the disease
There are several forms of infiltrative tuberculosis:
- cloud -;
The basis for this separation are radiological signs, including the amount of infiltration. The cloud-form of tuberculosis is characterized by fuzzy contours of the shadows on x-ray. It often occurs when the formation of fresh cavities. Round infiltration looks on the radiograph as rounded, homogeneous structure shadow. In most cases the infiltration is detected in the subclavian region. When lobyte tuberculous focus is very large. It captures an entire lobe of the lung. All infiltrates are divided into small, medium and large. Small have a magnitude of 1 to 2 cm, medium 2-4 cm, large - up to 6 cm Often revealed common foci. They exceed 6 cm In most cases the lesion is limited to the lobes of the lung. Complication of infiltrative tuberculosis is a caseous pneumonia.
Causes of infiltrative tuberculosis are different. The main triggering factor is the weakening of the body. Predisposing factors of the disease are:
- the presence of diabetes;
- HIV infection;
- drug addiction;
- the living together with the sick person;
- poor socio-economic conditions;
- the presence of nonspecific lung pathology;
- professional pathology.
Human infection is usually through the air. Together with particles of saliva bacilli penetrate into the respiratory tract of susceptible organism. It is important that the incubation period for this disease can take years. The risk group includes prisoners, refugees, migrants, people from disadvantaged families, HIV infected, homeless, drug addicts. Infection is possible in a domestic environment. Equally important in the activation of mycobacteria and the appearance of symptoms of the disease is hypothermia, poor nutrition (lack of vitamins, animal protein), strain.
Symptoms in the presence of infiltrative tuberculosis are different. The main manifestations of the disease are:
- the increase in body temperature;
- sweating at night;
- productive cough;
- chest pain;
- the feeling of palpitations;
- sleep disturbance;
- pain in the muscles.
If the infiltration is large, the symptoms will be more pronounced. In the presence of Lobito or regional infiltration marked by acute onset with fever up to 38-38,5°. Morethan half of patients have a gradual onset of the disease. Every fourth TB patient flows hidden. In contrast to focal tuberculosis, infiltrative cough is not painful. It is less pronounced. Hemoptysis is rare. Objective signs of the disease are: the auscultation of rales, dullness of percussion sound.
Infiltrative tuberculosis of the upper lobe of the right lung or any other localization in the absence of therapeutic measures may lead to complications. The latter include the development of caseous pneumonia, the accumulation of air in the pleural cavity, pleurisy, meningitis, heart failure, pulmonary hemorrhage. With the development of caseous pneumonia there is a strong fever, there is shortness of breath and cough.
Directly to the treatment of infiltrative tuberculosis of the lungs is required to make an accurate diagnosis, excluding other diseases. Diagnosis includes:
- collection of anamnesis of disease and anamnesis of life of the patient;
- percussion and auscultation of the lungs;
- the measurement of body temperature and pressure;
- external inspection;
- General and biochemical blood analysis;
- the conduct of a Mantoux test and Diaskintest;
- x-ray examination of the lungs;
- the examination of the sputum for the presence of mycobacteria.
- the bronchoscopy.
In some cases, PCR is carried out. With it you can detect the presence of antigens in the blood. The results of tuberculin tests in most cases positive. Today Diaskintest is more reliable and informative method of diagnosis. Final diagnosis is made after isolation of mycobacteria. Can be used for this patient's sputum or material obtained during the bronchoscopy. Equally important is a differential diagnosis. You want to exclude diseases such as focal tuberculosis, nonspecific pneumonia, lung cancer, hydatid disease, Hodgkin's disease.
If revealed infiltrative tuberculosis of the upper lobe of the left lung, treatment should be aimed at the suppression of mycobacteria. To date, mycobacteria are resistant to drugs. For this treatment, it is preferable to use 4 or 5 anti-tuberculosis medicines.
The first-line drugs include the following: "Rifampicin", "Streptomycin", "Ethambutol", "Pyrazinamide", "Isoniazid".
Often the treatment lasts about six months. Treatment is stopped only after positive results of x-rayresearch (resorption of infiltration).
In the treatment of infiltrative pulmonary tuberculosis is necessary to consider the possibility of infection of others. To avoid this, the therapy should be carried out in TB dispensaries. Most often they are located on the outskirts of the city. Important place in the treatment is increasing immunity. This requires a complete, fortified food, quitting Smoking, the application of Immunostimulants. Frequently given corticosteroids. The disappearance of symptoms does not mean recovery. Even after a full course of therapy mycobacteria can remain in the tissues. To avoid relapse is recommended to repeat the course of medication, but on an outpatient basis.
Thus, infiltrative tuberculosis is of great social importance. If untreated, the prognosis may be unfavorable.