The symptoms and treatment of fibrous cavernous pulmonary tuberculosis
Fibro-cavernous pulmonary tuberculosis is a very dangerous form of progressive disease, the prognosis of cure which does not cause much optimism. Like every other infectious disease, this kind is a great danger both for the patient and others; the most dangerous cases of children. To have the ability to provide effective assistance to a person with fibro-cavernous pulmonary tuberculosis must be identified at the earliest stages, when the cavity is not struck a large part of the body. Only with timely start of treatment, the disease can be stopped with pharmacological therapy, otherwise inevitable surgery and heavy chemotherapy treatments.
The essence of pathology
In General, tuberculosis is a infectious disease causing a characteristic destruction of tissue exposed to acute or chronic inflammatory processes caused by the influence of pathogenic mycobacteria. In turn, fibro-cavernous tuberculosis is the final phase of destructive tuberculosis of destruction, characterized by the appearance of fibrous cavities and progression of changes in the structure of lung tissue of a fibrous nature. This pathology can be a consequence of the development of any of the forms of tuberculosis lung infiltrative, cavernous and disseminated type.
The resulting cavity has a solid capsule around which flows perifocal inflammation. Cavernous wall forms a complex multilayer system: caseous mass, layers of specific and nonspecific (fibrous structure) of granulation tissue. This fibrous formation communicates with the bronchus, which provides a bronchial contamination of lung tissue.
The development of disease and other causes of pulmonary changes: pulmonary fibrosis, emphysema, bronhoektaza. The degree of damage of the body may be different, and that makes the presence of unilateral or bilateral lesions, single or multiple cavities.
Cavernous failure can have a rounded, slit-like or irregular. In addition, there are cavities in a group of cavities. Greaseopera structure of the capsule provides strength to the cavity, causing it never has a tendency to purification. Prolonged its existence leads to damage to the vascular system, causing pulmonary hemorrhage. He fibro-cavernous tuberculosis is a long - term chronic process; but this it for leaves and small traces of numeroussmall caseous foci, small infiltrates, and rash on lung tissue. The decrease unaffected area of the lung causing respiratory disease, including respiratory failure.
Forms of the disease
Taking into account the clinical picture of the disease development there are three main types of fibrous-cavernous tuberculosis:
- Limited form - a fairly stable species, characterized by stopping the development of cavities.
- Progressive form of chronic illness with alternating periods of remission and exacerbation of the inflammatory response; cavities tend to develop in size and quantity.
- Complicated form is characterized by complications - bleeding, respiratory and heart failure, "heart lung, empyema of pleura, amyloidosis of other organs.
The symptoms of the disease
The symptoms of fibro-cavernous pulmonary tuberculosis due to General tuberculous inflammation and the development of cavities, causing complications. At the initial stage of the disease General condition of the patient is estimated as satisfactory.
The main symptoms in this period: weakness, bothersome cough, shortness of breath. Temperature often has a low grade in nature.
The extension of the lesion leads to the assessment as moderate. At this stage there are characteristic General weakness pronounced, weight loss, increased sweating, acrocyanosis. Further development of the disease causes the appearance of cachexia.
The thorax becomes barrel. On the affected side is noticeable deepening of the supraclavicular and infraclavicular depression, and the lag of the half when the respiratory cycle. Periods of exacerbation of pathology is marked with a temperature rise.
Percussion examination shows the shortening of sound in the affected area, is a strict bronchial respiration, audible wheezing wet different character.
In blood analysis indicated moderate leukocytosis, lymphopenia, increase of POPS. Further progression of the process leads to a decrease in the level of hemoglobin and erythrocytes.
The transition of the disease in a complicated form characterized by onset of symptoms of defeat of the bronchi and other complications. Manifested long heavy cough with difficult separation of thick sputum Muco-purulent.
Common complications are hemoptysis and pulmonary hemorrhage. The patient has a characteristic appearance: strong thinness, dull dry skin with many wrinkles, muscle weakness(especially the muscles of the back, shoulders and intercostal.
Diagnosis of the disease
The task of the doctor when the first signs of a correct diagnose the disease.
The fibrous-cavernous form of tuberculosis differentialsa the results of the following studies: smear microscopy and sputum culture to identify M. tuberculosis; common blood analysis (erythrocyte sedimentation rate - up to 40-45 mm/h, lymphopenia, monocytosis); urinalysis (detection of leukocytes and erythrocytes, proteinuria); rentgenoterapii to detect cavities, lesions and complications; bronchological research (fiber-optic bronchoscopy); abdominal ultrasound; koagulogramma, ECG.
Treatment of pathology
To completely cure the fibrous-cavernous stage of tuberculosis is not possible, but the treatment has specific goals: the termination of activity of the mycobacteria, the withdrawal symptoms stop development of cavities and the elimination of complications.
Treatment is a long and complex process using methods of chemotherapy, metabolic, immunological and hormonal therapy. In some cases, is assigned to surgical intervention.
Drug treatment takes into account the duration of the process and stages of its development. The first detection of the disease treatment is carried out in the first category in an intense degree. First of all, is the active phase of chemotherapy. Intense degree determines the appointment of the four anti-TB drugs - isoniazid, rifampicin, pyrazinamide and streptomycin or ethambutol. Depending on the resistivity of mycobacteria treatment lasts 3-5 months.
If fibrous-cavernous tuberculosis is accompanied by relapses, in spite of the treatment, therapy is conducted in the second category with increasing doses of the first three drugs and the application of streptomycin, and ethambutol at the same time, i.e., is assigned a complex of five drugs. The course lasts for 4-6 months. Control of efficiency of treatment is conducted on smear of sputum. Together with the chemo parallel apply methods vitamin, detoxification, jatrophas, antioxidant and symptomatic therapy.
One of the radical methods of treatment of the disease is the collapse therapy. Its essence consists in creation of artificial pneumothorax by the introduction into the chest cavity of the air mass or of artificial pneumoperitoneum by creating an air volume in the abdominal cavity. This method is implemented if, after long-term chemotherapy notobserved stop the development and closing of cavities, as well as emergency assistance when profuse pulmonary bleeding. Collapse therapy may not be carried out when specific diseases of the bronchi chronic in nature.
Closure of cavernous lesions with the fibrous structure of the walls is extremely slow. If such slow paced for clinical reasons, can not meet the doctor, perhaps surgery. In the unilateral type of lesion and satisfactory condition of the patient may be a lung resection in various volumes.