What is a pulmonary tuberculosis: differential diagnosis and clinic
Often in medical practice revealed pulmonary tuberculosis, differential diagnosis which must be conducted with various diseases (pneumonia, atelectasis, sarcoidosis). Currently, tuberculosis is one of the biggest problems. The fact is that the Mycobacterium of tuberculosis infected about 2 billion people. This disease is of great social significance in connection with the difficulty of the treatment, the possibility of aerosol transmission mechanism, and a high mortality rate. What are the etiology, clinical features, differential diagnosis and treatment of TB infection of the lungs?
Characteristics of pulmonary tuberculosis
Tuberculosis is a chronic disease caused by mycobacteria, which can affect various organs, including the lungs. Pulmonary tuberculosis occurs most often in adults. the causative agent of this infection is very resistant to the environment. Due to its structure, mycobacteria have acquired a high resistance to many modern drugs. An infectious agent is transmitted by the following mechanisms:
The most important is the transmission of bacilli through the air when coughing. Airborne path is relevant only in case of active forms of the disease, when the bacteria found in the sputum and can be released into the environment. The vertical mechanism is rare. In the risk group of HIV-positive persons includes persons aged 20 to 40 years. Risk factors are:
- crowding groups;
- close contact with a sick person;
- the use of the same utensils with the patient;
- the presence of HIV infection;
- the use of drugs;
- the presence of chronic alcoholism;
- the presence of chronic disease of the lungs;
- total exhaustion;
- malnutrition (lack of vitamins);
- the presence of diabetes in anamnesis;
- adverse living conditions;
- stay in places of deprivation of liberty.
Clinical manifestations of tuberculosis are quite varied. They are determined by the form of the disease. The most common symptoms are:
- the increase in body temperature;
- excessive sweating at night;
- reductionof appetite;
- reduction of body weight;
- decreased performance;
- shortness of breath;
- chest pain;
- swollen lymph nodes.
Know these signs is necessary for correct diagnosis. Differential diagnosis is often based on symptoms of the disease and not just the results of laboratory and instrumental investigations. The most common complaint of patients in this situation - cough. In pulmonary tuberculosis it first dry, then with phlegm. The patient may cough for several minutes without stopping. Often coughing is allocated purulent sputum. Cough is often associated with shortness of breath, pain in the chest. In addition to coughing, you may experience hemoptysis.
Today the diagnosis of pulmonary tuberculosis involves:
- conducting tuberculin tests;
- dioscin test;
- microbiological examination of sputum or biopsy;
- implementation of x-ray light;
- General blood and urine.
Mantoux test allows to evaluate the immune status and to determine the infection. The sample result can be negative, positive and dubious. A negative result indicates the absence of the disease. Is important the differential diagnosis. For diagnosis the differential diagnosis is carried out with the following diseases: lobar pneumonia, eosinophilic pulmonary infiltrate, actinomycosis, atelectasis, lung cancer, heart attack.
Differential diagnosis of
Each TB has its own characteristics. There are the following types of pulmonary tuberculosis: primary, miliary, disseminated, infiltrative, tuberculoma. Clinical forms there is also caseous pneumonia. Very often it revealed infiltrative pulmonary tuberculosis. In the tissue of the lungs are formed, the parts of the seal. The infiltrate may occupy multiple segments or lobes of the body. It can be very difficult to distinguish from nonspecific pneumonia. The first difference is that in pneumonia the severity of the inflammatory process are significantly less, whereas in the physical examination (auscultation of the lungs) marked symptoms. In infiltrative tuberculosis, on the contrary, changes in the tissues prevail over the results of the physical examination.
Second, in tuberculosis and nonspecific pneumonia affects different segments of the lung. Tuberculosis most commonly affected1, 2 and 6 segments in pneumonia - 3, 4, 5, 7, 9, 10. Thirdly, an important place have the history data. In pneumonia there is often a indication of hypothermia or pathology of the upper respiratory tract. Infiltrative tuberculosis can be recognized on the clinic. There it was not as severe as pneumonia. Cough in tuberculosis is not so frequent, but more prolonged. Intoxication are more pronounced in pneumonia. The temperature rises slightly. In pneumonia it can reach 40 degrees. Fourth, there are differences in x-ray pattern.
In infiltrative tuberculosis detected non-uniform shadow, cavity decay, calcification, hearth Rut and petrificada in the field of roots of the lungs. Mantoux test pneumonia often happens false positive. Greater value is placed on histological examination. Pneumonia found to be neutrophils, macrophages, whereas in tuberculosis identifies epithelial cells, lymphocytes, cells of Pirogov-Langhans.
Most valuable hallmark of tuberculosis is the presence in the sputum of Mycobacterium tuberculosis.
Tuberculosis and other diseases
In some cases, tuberculosis can be mistakenly taken for eosinophilic infiltration. This condition is due to exposure to an allergen. Unlike pulmonary tuberculosis, it is characterized by:
- the increase in blood eosinophils;
- rapid regression;
- the presence of darkening with indistinct contours, which may be localized in any part of the lung.
Similar to tuberculosis for observed lumpy, the main symptom of which is chest pain. In the sputum when the disease is identified the structural elements of the (Druze) actinomycetes. Lumpy often formed subcutaneous infiltration or fistula. Differential diagnosis may occur with atelectasis. The latter differs spadenie lung tissue. Unlike tuberculosis, atelectasis of the main symptoms are shortness of breath, difficulty breathing, cyanosis. On x-ray marked decrease in the volume of the affected lung segments or an entire lobe. The shadow in this case is uniform, has a clear outline. In addition, there is a displacement of healthy tissues in the affected side.
The difference from caseous lobar pneumonia
Caseous pneumonia is one of the clinical forms of tuberculosis. It is characterized by cheesy inflammation of lung tissue. Often it is a complication of fibro-cavernous tuberculosis. You must be able to distinguish it from the focal (lobar) pneumonia. First, the sputum in lobar pneumonia brown, when cheesy - slimy-purulent. Secondly, when lobar pneumoniaauscultatory signs are more pronounced. Third, the laboratory examination in lobar pneumonia indicates the detection of pneumococci. In the urine the urobilin is detected, the cylinders of protein. In caseous pneumonia there is persistent detection of mycobacteria.
Fourth, the radiological examination in lobar pneumonia it is most often affected 1 easy. When it affects the lower lobe, whereas caseous pneumonia the process involved the upper lobe of the lung. After setting the correct diagnosis is done treatment. With this purpose used anti-TB drugs. The first row is "Isoniazid", "Rifampicin", "Pyrazinamide", "Ethambutol", "Streptomycin". Therefore, tuberculosis has a number of distinctive features, which can exclude other lung diseases.