Treatment of focal form of tuberculosis. Is it possible to become infected with focal tuberculosis

Tuberculosis is infectious lung disease transmitted predominantly by airborne droplets. Infection among the world's population is 1/3, but in most cases, Mycobacterium tuberculosis (Koch's bacillus) is successfully suppressed by the immune system. The disease has many forms, differing in the nature of the symptoms and the severity of the course. Focal tuberculosis is one of the most insidious types of the disease, because often a long period does not show itself.

Focal tuberculosis - definition of the disease

Focal pulmonary tuberculosis is a tuberculous lesion of a specific nature, the main features of which are the appearance of a few lesions up to 1 cm in diameter within 1-2 segments in one or both lungs.

Focal tuberculosis usually occurs in two forms:

• Soft-focal. It develops as a result of fresh infection with mycobacteria. It begins with endobronchitis in the terminal section of the bronchus, then the inflammation spreads to segments of the upper lobes of the lungs, forming one or more foci of inflammation in lung tissue;
• Fibrofocal(chronic). Occurs as a result of lymphohematogenous dissemination of Mycobacterium tuberculosis (MBT) in the body. MBT remain in the intrathoracic lymph nodes in the L-form and, against the background of a decrease in immunity, can be transformed into typical MBT through the bloodstream, lymphatic system and even through the bronchi with a specific lesion of their walls.

The fibrous-focal form of the disease is the result of incomplete resorption and compaction of soft-focal, infiltrative, acute disseminated pulmonary tuberculosis. According to the size of the lesions, small lesions are distinguished - up to 3 mm, medium - 4-6 mm, large - 7-10 mm.

Causes and how the disease is transmitted

Focal tuberculosis accounts for 10-15% of cases of the total incidence of tuberculosis and spreads, like other forms, by aerogenic means. There are several: infection is possible when in a confined space with patients with an open form - people who have passed and have the immune system failed with Koch's wand.

The chronic form can occur when a number of favorable factors appear, because if the MBT has entered the body, then even a complete cure for the disease does not guarantee their destruction forever. That is why the level of the body's defenses plays a decisive role in the causes of both primary and secondary infection.

The provoking factors in the occurrence of the disease are:

• Unfavorable social and living conditions;
• Unfavorable epidemic situation;
• Lack of specific immunization of the population;
• Treatment with immunosuppressants;
• Chronic somatic diseases(diabetes, ulcers, pneumoconiosis);
• Having bad habits.

Among rural residents, infection can occur through the alimentary route - through contaminated products, since there is a bovine species of MBT. Among the rare types of infection, the following methods of infection are known: contact (through the conjunctiva of the eye), intrauterine (from mother to fetus). Focal tuberculosis, like its other types, is contagious when open form when MBT is released from the foci of inflammation into the environment.

Symptoms

Focal tuberculosis is characterized by undulating, with periods of exacerbation and attenuation, long course. In most cases, the disease is detected during a fluorographic examination. Prior to this, the patient may be disturbed by minor signs of general malaise, weakness, excessive sweating, dry or unproductive cough.

In its development, the disease goes through several stages:

• Infiltration. When the MBT is activated in the blood and lymphatic systems, active intoxication begins, which results in a deterioration in the general condition, a decrease in appetite and weight. It is possible to increase t to subfebrile indicators, while some begin to burn palms and cheeks. Disturbed persistent cough and pain in the side;
• Decay and compaction. The lack of treatment at the first stage becomes an impetus for the development of more severe symptoms: the appearance of fine bubbling rales, breathing becomes harder, and the percussion sound becomes dull. Against the background of impaired ventilation of the lungs, tachycardia appears and increased sweating, especially at night.

A characteristic feature of focal tuberculosis is hemoptysis or the presence of traces of blood in the sputum, which may appear in the acute phase. Due to the wrinkled tops of the lungs, the supraclavicular and infraclavicular fossae are clearly visible. The disease is very easy to confuse with other respiratory diseases. inflammatory diseases, and often only X-ray allows you to establish the nature of the lesion.

Possible Complications

The mild-focal form of the disease is considered an uncomplicated type of tuberculosis and with timely treatment amenable to complete cure. However, delay in diagnosis and therapy can lead to fibrosis. focal form, followed by the formation of severe complicated forms of the disease:

• . With the progression of the focal form, lung damage is manifested by an exudative type inflammatory response and the formation of foci of caseous decay;
• Tuberculoma. A encysted caseous focus of more than 1 cm appears in the lung, most often detected by radiography. Can be used both conservatively and surgical methods treatment;
• Cavernous tuberculosis. Appears with the progression of primary forms and is characterized by the formation of caverns - persistent cavities of the decay of the lung tissue. Cavernous tuberculosis makes its carrier extremely dangerous for others, because there is a huge release of MBT into the environment.

With a delay in diagnosis and, consequently, treatment, focal tuberculosis can go into severe incurable forms, which even with intensive care can only heal, but not heal completely.

Treatment

The main method for diagnosing focal tuberculosis is radiography. It is the size, shape and degree of darkening of the foci that can characterize the severity and stage of the disease.

The undulating course of the disease makes diagnosis difficult. Therefore, the highest probability of detecting an infection is in the acute stage. Can be used bacteriological research sputum and a Mantoux test.

Medical therapy

After the diagnosis is made, initial treatment is carried out in a hospital (2-3 months), and after the patient is transferred to an outpatient drug regimen. In general, the course of treatment with timely detection takes up to 12 months.

The following groups of drugs are used for treatment:

Of particular importance in the treatment of tuberculosis of any kind is proper nutrition. In doing so, several important points must be taken into account:

Folk remedies

Treatment can also be carried out at home, as an addition to medicines or during the rehabilitation period:

Alternative treatment sometimes gives amazing results, but one should not forget about the obligatory consultation of a doctor. After all, even regular products nutrition in a certain state of health can cause its deterioration.

Prevention

The main measure to prevent childhood morbidity is, of course, timely vaccination. The first vaccination is carried out for 5-6 days absolutely healthy baby, repeated - at 7, 14 and 17 years.

For adults preventive actions come down to a few recommendations:

• Avoiding prolonged contact with an infected person;
• Compliance with the rules and regulations of personal hygiene;
• Regular fluorographic examinations;
• Constant care for the level of immunity: healthy eating, rejection of bad habits, physical education, walks in the fresh air.

Video

findings

Focal tuberculosis is the same disease as other forms of tuberculosis, and in severe open forms it is just as contagious. However, like other diseases, it can be completely cured with timely measures taken.

And the most likely way of detection is the passage of fluorography, since most often this form is asymptomatic. And the harm from a protracted illness can be much greater than from a tiny fraction of radiation exposure during the examination.

V.Yu. Mishin

Focal tuberculosis - clinical form, characterized by the presence of a few foci no larger than 1 cm, mainly of a productive nature.

Tuberculous lesions are unilateral and less commonly bilateral, localized most often in the upper lobes of the lungs, usually in the cortical regions, with a lesion volume of no more than one or two segments. At the same time, the foci are very diverse in terms of the time of occurrence, morphology and pathogenesis.

Focal tuberculosis in the structure of clinical forms of respiratory tuberculosis occurs in 15-20% of cases.

Pathogenesis and pathomorphology. Focal pulmonary tuberculosis is a clinical form related to the secondary period of tuberculosis infection. The pathogenesis of focal pulmonary tuberculosis is different.

It can occur both as a result of exogenous superinfection (new infection), and during endogenous reactivation as an exacerbation of residual changes that have formed after previously transferred tuberculosis.

With exogenous infection, fresh (soft) single foci of specific inflammation, not exceeding 1 cm in diameter, develop mainly in the bronchi of the 1 and / or 2 segments of the upper lobes of the lungs.

Morphological changes characteristic of soft-focal pulmonary tuberculosis were described in 1904 by AI Abrikosov. Describing the foci in the tops of the lungs, the scientist noted that in addition to the defeat of the parenchyma of the lung, there was a lesion of the terminal sections of the bronchial system.

A soft focus begins with endobronchitis in the terminal section of the bronchus. Then the inflammatory process spreads to the surrounding lung tissue, where areas of acinar or lobular pneumonia are formed, which are projected on the radiograph as “soft” focal shadows against the background of a mesh lung pattern.

A.I. Strukov defined such a focus as acute focal tuberculosis.

Such foci are sometimes completely absorbed or replaced by connective tissue, turning into scars, and peribronchial and perivascular sclerosis is formed along the lymphatic pathways.

However, for the most part, such foci, if not used specific treatment tend to increase and progress with the transition to infiltrative pulmonary tuberculosis.
This form is characterized by the presence of one or more foci of tuberculous inflammation in the lung tissue. They look like rounded foci of caseosis, around which there is either a zone of specific granulation tissue or a fibrous capsule. The sizes of the foci vary from 3 to 10 mm in diameter.

With endogenous reactivation, the disease occurs as a result of lymphohematogenous dissemination of MBT in the body. Their source of distribution is residual changes in the form of calcifications in the lungs (Gon's focus) or calcifications in the intrathoracic lymph nodes after primary tuberculosis, where long time can persist MBT in the form of L-forms.

With a decrease in specific immunity ( accompanying illnesses, mental trauma, overwork, malnutrition, etc.) L-forms can transform into typical MBT, which spread not only through the blood and lymphatic tracts, but sometimes through the bronchi, after a preliminary specific lesion of their wall and the formation of a glandular-bronchial fistula.

The wall of the bronchus is destroyed and specific inflammation passes to the lung tissue. At the same time, separate or grouped soft foci are formed in the lungs, which in almost 90% of cases are also concentrated in the upper lobes of the lungs.

With endogenous reactivation, a focal process in the lungs can also develop as a result of an exacerbation of already existing old foci, called fibro-focal tuberculosis.

Such foci are usually located in the apex of the lung among atelectatic fibrous tissue, surrounded by a dense fibrous capsule, contain a small amount of calcareous salts and can grow into fibrous tissue.

With exacerbation, a zone of perifocal inflammation appears around such foci. Subsequently, infiltration by lymphocytes occurs, loosening and disintegration of the capsule of the focus, in which lymphoid tubercles are formed.

Leukocytes, penetrating into the focus and acting with their proteolytic enzymes, cause the melting of caseous-necrotic masses. At the same time, the MBT, their toxins and tissue decay products spread through the expanded and inflammatory-modified lymphatic vessels, in which separate or multiple fresh foci are gradually formed.

With liquefaction and sequestration of caseous masses, small cavities such as alternative caverns appear.

There is a significant "archive" of tuberculosis in the lungs, consisting of foci different nature, under adverse conditions, it can progress and move from a focal form to an infiltrative, cavernous, disseminated form.

The reasons for the upper lobe localization of focal tuberculosis in the lung tissue are not well understood. Numerous hypotheses on this subject are rather contradictory.

While some researchers associate the formation of foci in the apex of the lung with its limited mobility, insufficient aeration and vascularization, others argue that there are better opportunities for MBT to settle and multiply due, on the contrary, to greater air intake and increased blood flow.

Along with this, it is important vertical position human body. One way or another, but the predominant localization of focal tuberculosis in the upper lobes of the lungs is generally recognized.

Clinical picture of focal tuberculosis is determined by the characteristics of the reactivity of the organism of patients who usually have no signs of hypersensitization and preserved, although reduced, immunity.

According to the current classification, the focal process may be in the phase of infiltration, decay and compaction. At different stages of development, focal tuberculosis has a different clinical expression and is characterized by different symptoms.

The development of focal tuberculosis is usually asymptomatic or oligosymptomatic. With the limited nature of pathological changes in the lung tissue, the absence of an extensive zone of perifocal inflammation around them and a pronounced tendency to decay, tuberculous bacteremia rarely occurs, and it does not enter the blood a large number of bacterial toxins, tissue decay products.

The disease in this case can proceed secretly. Such an inapperceptive, i.e., unconscious, or unnoticed, course by the patient, is noted in every third newly diagnosed patient with a focal process.

However, when the disease develops asymptomatically, it does not always remain stable and may be replaced by clinically significant symptoms.

A relatively small amount of toxins, entering the general circulation, affects various systems, organs and tissues of the body.

In 66-85% of cases with focal pulmonary tuberculosis, certain symptoms of intoxication are found, of which most often - a violation of thermoregulation in the form of subfebrile temperature, usually in the afternoon or late in the evening.

Patients note a feeling of heat, a slight and short-term chilling, followed by a slight perspiration, mainly at night or early morning, fatigue, decreased ability to work, loss of appetite, tachycardia.

Perhaps the development of various functional disorders, increased secretion and acidity of gastric juice.

This or that symptom complex in each individual case is obviously determined not only by the nature of the pathological changes in the lung tissue, but primarily by the state of the organism's reactivity and especially the state of its endocrine and nervous systems.

In some patients, symptoms of hyperthyroidism are determined: an increase thyroid gland, shiny eyes, tachycardia and other characteristic signs.

Rarely noted dull aching pain in the shoulders or interscapular space. In the early forms of the disease, by palpation, one can note a slight rigidity and soreness of the muscles of the shoulder girdle on the side of the lesion (symptoms of Vorobyov-Pottenger and Sternberg).

With percussion over the affected area, a shortening of the sound is occasionally determined. Sometimes breathing over this area is hard or with a bronchial tone, with auscultation, single wheezing rales are heard, sometimes moist single finely bubbling rales when the patient coughs.

In persons with focal pulmonary tuberculosis, bacterial excretion is poor. As a rule, it does not pose a great epidemic danger, but it has great importance to confirm the diagnosis of tuberculosis.

The presence of MBT in sputum is a reliable sign of an active tuberculous process. Even a single confirmation of bacterial excretion confirms the activity of the tuberculosis process.

At the same time, the persistent absence of MBT in sputum or washings of the stomach (bronchi) does not exclude the activity of tuberculous changes.

The activity of focal tuberculosis can also be determined using bronchoscopy if fresh or previously transferred endobronchitis is detected. In the aspirate obtained during bronchoscopic examination, or in bronchoalveolar washings, MBT can be detected.

The blood picture in the presence of an infiltration phase is characterized by a moderate left shift of neutrophils, lymphocytosis, and an increase in ESR. In the presence of a phase of resorption and compaction, the blood picture remains normal.

Dermal tuberculin reactions most often normergic. There are also immunological methods for determining the activity of the process: assessment of blast transformation of lymphocytes, inhibition of their migration, the method of rosette formation. They give encouraging results (especially in combination with tuberculin diagnostics) and make it possible to confirm the activity of the tuberculosis process in the presence of a compaction phase in a significant number of subjects.

If these methods do not help to establish the activity of the tuberculosis process, one has to resort to the so-called test therapy. Such patients undergo chemotherapy for 2-3 months and study the X-ray dynamics of the process, taking into account the subjective state, the blood picture in dynamics, etc.

X-ray picture. Focal tuberculosis in the x-ray image is characterized by a large polymorphism of manifestations.

By size, the foci are divided into small - up to 3 mm, medium - up to 6 mm and large - up to 10 mm in diameter.

Mild TB characterized by the presence of weakly contouring shadows of low intensity and different in size. The predominant location of pathological changes in the first, second and sixth segments, i.e., in the posterior sections of the lungs, predetermines the mandatory tomographic examination.

Longitudinal tomography reveals focal changes in layers 6-8 cm from the surface of the back, with damage - in layers 3-
1 cm. On CT, the lesions are located in the depths of the lung tissue, peribronchially.

The most typical is a combination of one or two large foci with a small number of small and medium ones.

Large foci usually have a homogeneous structure. The contours of the largest foci at this stage of the development of the process are fuzzy and uneven, especially in the presence of a pronounced exudative component. The density of the lung tissue in the area of ​​the foci may be slightly increased due to perifocal edema and the presence of small multiple foci; the walls of the bronchi in the area of ​​pathological changes are also thickened and clearly visible.

Fibrofocal tuberculosis manifested by the presence of dense foci, sometimes with the inclusion of lime, and fibrous changes in the form of strands. In some cases, the non-simultaneity of the appearance of focal changes in the lungs and different ways their reverse development can cause a diverse morphological picture, the so-called polymorphism.

Polymorphism is characteristic of focal tuberculosis in both the active and inactive phases of development. Sometimes, in addition to the foci, pleural changes are determined, which is an important indirect evidence of the activity of the process.

With an exacerbation of the process, along with old foci, soft foci appear, a picture of perifocal inflammation around the aggravated focus is revealed. Sometimes exacerbation is manifested by the formation of new foci in the peripheral zone of the old process. At the same time, a small-loop network of lymphatic vessels is found around old foci.

With significantly pronounced perifocal changes that have developed along the periphery of the foci in the form of broncholobular merging foci, pneumonic formations are formed.

Diagnostics. Focal pulmonary tuberculosis is more often detected during preventive examinations of the population or "risk groups" by fluorography. Wherein beam methods diagnostics, especially CT, are decisive in the diagnosis.

In cases where the diagnosis of focal tuberculosis is defined as “doubtful activity”, the appointment of anti-tuberculosis drugs (isoniazid, rifampicin, pyrazinamide, ethambutol) is indicated with an assessment of the clinical and radiological dynamics of the process in the lungs.

Differential Diagnosis carried out with focal pneumonia, peripheral benign and malignant tumors.

Treatment patients with focal pulmonary tuberculosis are more often carried out in outpatient settings according to III standard mode chemotherapy. In the intensive phase of treatment, the four main anti-TB drugs (isoniazid, rifampicin, pyrazinamide and ethambutol) are prescribed for two months, and in the continuation phase - in
within 4-6 months - isoniazid and rifampicin or isoniazid and ethambutol.

Forecast diseases with timely prescribed treatment, as a rule, are favorable with a complete clinical cure.

- This secondary disease caused by mycobacteria that entered the body earlier, as a result of primary infection. Usually the secondary process occurs against the background of a previously cured primary. Most often, the disease is found in x-ray examination as focal tuberculosis of the upper lobe right lung.

Focal pulmonary tuberculosis may be asymptomatic. AT childhood practically does not occur, it is usually diagnosed after 27-30 years.

Development and forms of the disease

So, what is focal pulmonary tuberculosis? This is a limited inflammatory process in the lungs, which is characterized by the formation of foci and has several development paths:

There are two forms of focal tuberculosis:

• soft-focal - or focal tuberculosis in the phase of infiltration;
• fibro-focal tuberculosis- occurs in the compaction phase.

In the first case, the foci easily disintegrate, forming cavities. At adequate treatment are easily absorbed, leaving small seals in the lung tissue. In the second case, the inflammatory process is practically absent, the foci degenerate into scar tissue.

Clinically, focal pulmonary tuberculosis can proceed in different ways:

In any of these forms, tuberculosis of the right lung most often occurs, less often synchronous development of the disease is possible.

The main reason for this is the decrease immune status body as a result of:

• alcohol abuse and nicotine addiction;
• poor nutrition (strict diets, vegetarianism);
• HIV infection;
• other conditions characterized by a decrease in immunity.

Also importance has a psycho-emotional state that has a strong influence on the body's susceptibility to various infections, including to. People who are chronically stressed are known to be more susceptible to adverse conditions. environment, including infections.

Another important question, which worries many, is focal tuberculosis contagious or not, and how is it transmitted? Unfortunately, the open form of this type of disease is extremely dangerous for others. Since this is a secondary form, it does not have pronounced symptoms at the beginning of development, but manifests itself when the process is already running. However, all this time a person can infect others, because mycobacteria can be transmitted both aerogenically and by contact.

Diagnostics and therapy of focal pulmonary tuberculosis

Diagnosis of focal tuberculosis is quite complicated and in some cases requires differentiation from other lung diseases. The main diagnostic methods are:

Focal pulmonary tuberculosis can rarely be diagnosed by the clinical picture, since the disease in some cases is asymptomatic. Most often, pulmonary tuberculosis is detected during a routine examination or when seeking medical help for another reason. It has been noted that among the population that did not undergo periodic medical examinations, there are more cases with advanced forms of tuberculosis than among people who are regularly examined.

Treatment of focal pulmonary tuberculosis consists in prescribing or their combination in age-specific individual dosages. Vitamin therapy is also used. Highly important point is the nutrition of the patient.

Compliance with the principles of good nutrition plays no less important role than antimicrobial therapy. Only complex application These measures make it possible to treat the patient without the development of characteristic complications and not only prevent a relapse, but cure the patient forever.

Focal pulmonary tuberculosis involves treatment at the first stage only in a hospital for 2-3 months, then the patient is transferred to ambulatory treatment. On average, with properly selected chemotherapy and good nutrition full recovery occurs after 12 months.

If signs of tuberculosis are detected, immediate hospitalization will be required, especially if it is a focal form. A high danger to society is posed by people who have an open form, but the incidence can only be reduced with early diagnosis and timely treatment.

At the state level, citizens should be provided with acceptable working conditions that do not threaten their health, the same applies to visiting migrants.

What it is?

Focal pulmonary tuberculosis differs from other forms in that it has few symptoms, a benign course and no damage to the lung tissue. The cortical regions of the lungs are affected inflammations with a diameter of 8-10 mm. Here, Simon's foci take place - the residual effects of the main infection. When the symptoms of the disease begin to appear, acute focal tuberculosis or Abrikosov's focus may develop, which is accompanied by caseous pneumonia. The location of Abrikosov's foci is 1 or 2 segments of the lung in the form of seals 3 cm in size. If both lungs are affected, then during healing, Aschoff-Bullet lesions may appear.

This manifestation of primary and secondary tuberculosis is localized during exacerbation in the bronchi, and the causative agents of the disease are mycobacteria of the genus Mycobacterium. It all starts with endobronchitis, and then gradually affects the small branches of the bronchi. Subsequently, the walls of the altered bronchi and lung tissue undergo necrosis, what . Pathological process only affects the area around the lesion, but hematogenous spread is seen in the remnants in the apex of the lungs. After healing of forms of pathology, focal shadows may occur.

Forms focal tuberculosis:

1. Soft focal.
2. Chronic fibro-focal.

At the stage of the soft focal form, shadows with weak contours are found different size and intensity. The basis for conducting a tomographic examination are pathological changes posterior sections of the lungs. CT scan reveals the sites of disease damage located inside the lungs. Large tissue lesions have a homogeneous structure, and the contours are fuzzy. Small foci of tuberculosis are visualized on the lung tissue, and the walls become thicker.

Fibrous-focal form of pathology with chronic form appears in the form of seals and strands. Such changes can develop in different ways, have two phases - active and passive. The activity of the process can be confirmed by changes in the pleura.

The disease is characterized inflammatory process, which is complemented by tubercles.

Symptoms

The focal form of lung damage is divided into three phases - infiltration, decay and compaction, but signs clinical picture appear differently for each of them.

The initial stage may not have symptoms, but toxins, penetrating into the bloodstream, affect different organs and tissues. The main symptoms of focal pulmonary tuberculosis:

• fatigue;
• sweating;
• Decreased performance;
• poor appetite;
• Slimming;
• Feeling of heat on the face;
• Chills and fever;
• Pain on the sides;
• Cough with sputum;
• wheezing;
• Hard breath.

It is possible to identify the disease during preventive fluorography or diagnostic, at the request of the patient. Symptoms occur in one third of patients, the rest of the disease proceeds without symptoms. In addition to the main symptoms of intoxication with focal tuberculosis, it can occur with vegetative-vascular dystonia. Wheezing is diagnosed in some patients in the decay phase during the exudative focal process.

It is the long course of focal tuberculosis that deforms chest, despite the fact that the process is localized in one of the lungs, this can provoke delay in breathing. After surgical intervention the deformity may become more pronounced due to spontaneous pneumothorax.

Treatment

Focal pulmonary tuberculosis must be carried out in an anti-tuberculosis hospital, and inactive - on an outpatient basis under the supervision of a doctor. First of all, the phthisiatrician prescribes anti-tuberculosis preparations in combination with vitamins, while there should be a complete healthy diet.

Complex treatment, a combination of antimicrobial therapy measures and principles, is capable of curing a patient. proper nutrition. Stages of treatment:

1. The appointment of antibacterial therapy, including drugs - isoniazid, rifampicin, ethambutol and pyrazinamide. If this combination is used for three months, then you can switch to two drugs, rifampicin and isoniazid, or isoniazid with ethambutol for another three months.
2. The use of immunomodulators to activate immune processes.
3. Hepatoprotectors are capable of protecting the liver; due to the toxicity of tuberculosis drugs, they are combined with chemotherapy.
4. If the process of focal tuberculosis is pronounced, in rare cases, glucocorticoids are used.
5. Therapy with vitamins A, B1 and B2.
6. Proper nutrition regimen, protein foods should prevail in the diet.
7. After treatment of a form of pulmonary tuberculosis, a visit to a sanatorium or boarding house is recommended.

Treatment of focal pulmonary tuberculosis has in most cases a positive outcome. In rare cases, in the chronic form of tuberculosis, complications are possible in the form of pneumosclerosis, with a focus of calcification, the patient may need chemoprophylaxis.

How much is treated?

According to statistics, on average, after a year, a person has the opportunity to recover if all the requirements and prescriptions are met, and most importantly, with properly selected chemotherapy. Under supervision in a hospital and adequate treatment the recovery process lasts from 4-5 months to 11-12. In the active phase of focal tuberculosis, he is shown an anti-tuberculosis hospital, where treatment lasts up to three months, in the worst situation up to nine.

If the pathology is detected at the beginning of the disease, it can be treated at home under the advice of a doctor, but subsequently hospitalization will be required. Everything will depend on the form of tuberculosis, but in time the process recovery can last from a couple of months to a year and a half. Most often, the focal form can be cured after 6 months from the moment of infection.

Treatment is divided into three stages:

• Stay in a hospital;
• Partial silt day hospital;
• Ambulatory treatment.

In an open form, the patient's treatment lasts 3 months in a hospital under the supervision of doctors, then, when the danger is over, transfer to a day hospital with the use of expensive drugs is possible. The terms prescribed by the doctor for treatment, should not be interrupted to avoid re-discovery of the disease. In severe cases with resistance to Koch's bacillus, treatment can last 2-3 years.

With a closed form of tuberculosis in a patient without fail hospitalized, and the length of stay depends on the degree of progression of the disease.

Infectious or not?

Depending on the form of the course and the stage of the disease, its contagiousness is determined. In the early stages of the disease, TB may not be contagious through airborne contact, but it can be transmitted through blood. If focal tuberculosis becomes, microbacteria can spread through the blood and lymph to all organs. At this stage, the form of tuberculosis becomes open and very dangerous for others.

If a mycotic infection is detected in the lymph nodes, tuberculosis becomes contagious, while bacilli and secretions penetrate the blood and lymph. All arguments boil down to the fact that focal pulmonary tuberculosis in most cases is contagious to others.

The open form of tuberculosis is contagious from the initial stage, and the closed form can appear only after the process has been neglected. In both cases, you can get infected by airborne droplets, as well as by contact.

The problem of microbacteria Koch's sticks is that it is difficult to influence heat, light or cold, it has a very high resistance. Focal tuberculosis infection may have a latent form, but visually a person may feel lethargy and drowsiness, decreased performance and increased body temperature. At the same time, a person becomes poor appetite, a skin turn pale.

With such signs, it is not immediately possible to detect tuberculosis, symptoms are similar to normal viral infections so people don't go to the doctor. According to statistics, about 10 people a year can be infected with tuberculosis from a person who has closed form disease, and not undertaking appropriate treatment.

How is it transmitted?

The most popular method of transmission of focal tuberculosis is airborne, and places for this can be metro and other public transport, shops, city libraries, etc. Under domestic conditions, you can get infected from a patient by drinking water from a glass after him or smoking cigarettes, as well as by kissing.

Fact! The transmission of tuberculosis microbacteria can occur through cockroaches and flies that crawl through ventilation grilles into the territory of apartments.

Focal tuberculosis can be transmitted through primary contact with the site of infection, also from another, already sick person. In addition, the source of infection could be an animal, which may support some strains of the virus.

How tuberculosis is transmitted from person to person:

• The airborne route is one of the most common methods when small particles bacilli and microbes contained in expectorant sputum, during a dialogue or cough, fly out of the lungs and get to others.
• Infected people, coughing up on the ground, can provoke the transmission of bacilli by airborne dust when healthy man will inhale microbial dust particles.
• The contact-household transmission route is characterized by the penetration of tuberculosis bacilli not only through the lungs, but also through the skin, blood, and eyes.
• You can not contact with a TB patient, but touch his personal hygiene items, dishes, clothes, phone or computer, thereby becoming infected from the carrier.
• It is dangerous to kiss not only on the lips, but also on the cheek, since the airborne function of transmitting microbes and saliva exchange is activated.
• A mother during pregnancy and fetal development can transmit the infection to her baby through the blood.
• Poorly washed hands while eating can cause tuberculosis later on.

Ways of infection with tuberculosis from animals:

• At immunodeficient state a person can become infected with disease bacilli from cattle.
• Animal bites provoke the penetration of infection, and you can also become infected during the cutting of livestock meat.
• Eating dairy and meat products of infected animals contributes to the penetration of Mycobacterium tuberculosis into the body.

One of quick ways transmission of lung pathology are contacts with prisoners and homeless people who are breeding grounds for infections.. The greatest likelihood of contracting tuberculosis is to visit the places where the homeless live, damp basements are an ideal place for the development of Koch's wand.

Prisoners after leaving prison go to places common use, shops or supermarkets where the chances of infecting others are as high as possible. You can become infected through contact with migrant workers, who often do not comply with sanitary and hygienic standards, while working with people.

If you start treatment of focal pulmonary tuberculosis in a timely manner, you can reduce the incidence rate. For prevention, you need to undergo annual preventive examinations and fluorography, it is also mandatory to vaccinate against tuberculosis for newborns.

Focal pulmonary tuberculosis refers to secondary manifestations of tuberculosis. This species is characterized by the fact that after illnesses respiratory system foci are found in the lungs. And not only after tuberculosis. It would seem that they should not be, since in most cases the treatment was carried out, but alas. This situation is especially complicated after tuberculosis.

- This infection, the causative agent of which is Mycobacterium tuberculosis (Koch's wand). All countries of Eastern Europe on the this moment are endemic in this disease. Pulmonary form is the most common among all forms of tuberculosis. In most cases, focal pulmonary tuberculosis is recorded.

Focal is such a specific inflammation, in which changes in the lungs according to x-ray do not exceed 1 cm. At the same time, they are larger than miliary affects, whose diameter is 2-3 mm. With focal tuberculosis, there may be several affects, but they do not tend to merge and other changes in the lungs are not detected.

Most often, focal tuberculosis affects the upper lobes of the lungs. The fact is that Koch's wand is an aerobe, it needs oxygen for growth and reproduction. Upper lobes the lungs are better ventilated than the lower ones and have a worse blood supply, which means they always have a lot of oxygen.

Here, a focus of infection occurs more often, however, mycobacteria can live even at low concentrations or total absence air, because focal tuberculosis can be found in other lobes, but less likely.

With focal tuberculosis in the lungs, Koch's bacillus that already lived there appears or is activated. She starts producing various enzymes that eat into lung tissue. Living tissues turn into white cheesy dead masses, which are called caseous necrosis. The main feature of such inflammation is its rapid delimitation from surrounding tissues.

For reference. Focal tuberculosis is a type of pathology that is characterized by a rapid change from the alterative phase of inflammation to the productive phase. Inflammation always goes through three phases: alternative, exudative and productive. With tuberculosis, the exudative phase is not expressed, because the process is specific.

This means that while the microbe is destroying lung tissue, the immune system is building a cellular barrier around it. This is the so-called specific inflammation. All cells of this barrier are located in a strictly defined order. They do not allow inflammation to increase. If the barrier is absent, more widespread infiltrative inflammation or even caseous pneumonia occurs.

In the event that the focus of caseous necrosis disintegrates, a cavity will appear in the lung. Then focal tuberculosis will become a tuberculous cavity.

If a large amount of connective tissue grows in the focus, tuberculosis becomes fibro-focal.

For reference. In general, focal pulmonary tuberculosis is one of the most favorable forms of this pathology. The loss of lung tissue is usually minimal.

Classification of focal tuberculosis

Focal pulmonary tuberculosis can be of several types. The classification is based on the number of foci, their exact localization, shape
inflammation, the size of each focus and the method of infection penetration.

By quantity, focal pulmonary tuberculosis is isolated with:

• Single hearth. In this case, there is only one effect.
• Multiple foci. In this case, there are two or more foci, but each of them has a size of 3 to 10 mm, they are not interconnected and do not merge. One of these affects may be the main one, and the others - metastatic, they are called foci-screenings.

According to the localization of the focus:

• Upper lobe;
• Middle lobe (for the right lung);
• Lower lobe.

In addition, when describing the pathology, the name of the segment in which it is located and its approximate boundaries along the intercostal spaces and conditional lines of the chest are indicated.

For example, a focus in the apical segment of the left lobe of the right lung at the level of the second rib along the midclavicular line. In this way, the exact location of the affect is indicated.

In size, the foci themselves can be:

• Medium - from 3 to 6 mm in diameter.
• Large - from 6 to 10 mm.

For reference. There are also small foci up to 3 mm, but they are typical for miliary tuberculosis. If the affect occupies more than 1 cm, it is called not a focus, but, for example, an infiltrate.

Another important characteristic of each focus is the way it occurs. According to this principle, there are:

• Primary focus. In this case, we are talking about the focus of Gon, in which the activation of mycobacteria occurred or about the affect at the first meeting with mycobacterium.
• Secondary focus. It exists regardless of the focus of Gon, it is formed when microorganisms enter from the outside.
• Hearth-screening. In this case, the lungs already have active tuberculosis with destruction, and the patient, coughing up necrotic masses with bacteria, infects himself.

According to the form of inflammation, two possible types are distinguished:

• Soft-focal (actually focal). In this case, the affect consists only of decaying tissues and inflammatory cells. This form occurs at the beginning of the tuberculosis process.
• Fibrofocal. This view is more late form. At the same time, connective tissue appears in the focus, replacing the centers of destruction and delimiting the affect from healthy lung tissue. Ultimately, the focus can completely turn into metatuberculous.

Causes

For any forms and types of tuberculosis, there is only one reason - the pathogen enters the lungs and activates it. The only etiological factor of tuberculosis is Koch's bacillus.

Focal pulmonary tuberculosis can have one of two mechanisms of development. The first is associated with the activation of the pathogen, which was already in the body and rested in the focus of Gon for a long time. The second - with the ingestion of the pathogen into the lungs.

For reference. If Koch's wand enters the lungs for the first time, tuberculosis will be primary, if it is repeated, this condition is called superinfection. Any addition of a new pathogen to an existing one is called superinfection in medicine.

The question arises why in some people mycobacterium stays in the Gon focus all their lives and does not cause disease, in others it contributes to the development of foci that are quickly cured, in others it causes extensive lung necrosis with lethal outcome. The difference lies in the factors that contribute to the development of pathology.

Factors contributing to the emergence of focal tuberculosis:

• Increased virulence of mycobacteria. This term means the aggressiveness of mycobacteria in relation to a susceptible organism and its danger to humans. An increase in virulence occurs if this strain of rods has been in the bodies of people with weakened immunity for a long time. Nothing interfered with mycobacteria, and it acquired new properties. If such a bacterium enters the body of a person with normal immunity, a tuberculous focus will occur, but the body's immune forces suppress inflammation, making it delimited.
• massive contamination. Even in a person with normal immunity, with a large microbial load, a tuberculous focus may appear. However, in healthy body this process will not spread more than 1cm.
• Short-term decrease in immunity. The reason for this may be hypothermia, overwork or acute illness. At the same time, at the time of a decrease in immunity, either mycobacteria are activated in the focus of Gon, or a focus occurs with a new ingestion of bacteria. Then immunity is restored and prevents tuberculosis from spreading further. With a constant decrease in immunity, it is not focal tuberculosis that occurs, but its more diffuse forms.
• Restoration of immunity. The opposite mechanism is at work here. A person has been reduced for a long time defensive forces resulting in infiltrative tuberculosis. Then the immunity was restored and the inflammation began to decrease, the delimitation of inflammation led to the appearance of a focus instead of an infiltrate. At the time of examination, the patient was already diagnosed with focal tuberculosis. Such a mechanism is rare.

For reference. If a mycobacterium with increased aggressiveness or a large number of Koch's sticks enters the body of a person with normal or slightly reduced immunity, focal pulmonary tuberculosis will occur. However, the immune forces of the body will prevent its spread, because the type of tuberculosis will be precisely focal.

Symptoms of focal pulmonary tuberculosis

Since the affect is very small in this disease, the symptoms may be absent or have an erased form. With multiple foci, the likelihood of an extended clinic increases. In the case of fibro-focal tuberculosis, the patient may be disturbed only by a prolonged paroxysmal cough.

Symptoms of focal pulmonary tuberculosis can be as follows:

• Increase in body temperature. It is not always observed. Sharp increase temperature for tuberculosis is not typical. More often there is unexpressed subfebrile condition up to 37.5 °C.
• Cough. It occurs if the focus is located close to large or medium bronchi. Then the patient is worried about dry cough. When the focus begins to disintegrate and its contents exit through the bronchi, the cough becomes productive with a small amount of viscous sputum.
• Symptoms of intoxication. As a rule, there is no acute pronounced intoxication with tuberculosis; it develops for a very long time. In patients with long-term tuberculosis, there is a decrease in appetite, emaciation, general exhaustion of the body, pallor of the skin, fast fatiguability.
• Hemoptysis. This feature is also characteristic only for long-term running forms tuberculosis.

Important. Very often, a focal lesion of the lungs is an accidental finding during the next fluorographic study. The patient feels completely healthy.

Diagnosis of focal tuberculosis

This diagnosis is made on the basis of an x-ray picture of the lungs and a sputum examination for acid-fast bacterium. The main thing for the doctor is to determine when there are indications for X-ray and sputum smear microscopy.

Attention. The indication for this study is a cough for more than two weeks, prolonged subfebrile body temperature of unknown origin, the presence of active tuberculosis in the past.

The x-ray image shows foci of darkening (light) ranging in size from 3 mm to 1 cm, located anywhere in the lungs, but more often in their right lobe. An increase in intrathoracic lymph nodes is observed only in primary tuberculosis.

In the event of fibrosis, connective tissue is visible in the focus, making it more clear and demarcated, and calcifications can be seen against its background. If there is destruction, the focus becomes heterogeneous, enlightenment is observed in it.

Sputum smear microscopy must be performed twice. With a focal form of tuberculosis, a smear may be negative because too few mycobacteria are isolated for a reliable diagnosis. In addition, before the onset of the decay of necrosis, the patient does not allocate Koch's sticks at all. If the cough is not productive and it is impossible to take sputum, bronchial washings are microscopically examined.

In the event that it is difficult to understand what the boundaries of the focus are and whether there is decay in it, the patient is sent for CT. It is also possible to additionally detect lymphocytosis and relative neutropenia in the blood, slight increase in ESR. Other research methods are uninformative.

For reference. Fluorography is essential for detecting lesions, but only as a screening method. With its help, you can suspect the presence of tuberculosis in people who do not have symptoms. However, the diagnosis must be confirmed by X-ray. A change in the reaction to the Mantoux test in focal tuberculosis is not typical due to the low content of bacteria in the body.

Treatment of focal pulmonary tuberculosis and prognosis

Treatment of focal tuberculosis is carried out in the same way as any other form of it. The patient is hospitalized or isolated at home. He is prescribed antibiotics according to a special scheme.

Isoniazid and rifampicin are used first, then pyrazinamide, ethambutol, and other drugs may be added.

Attention. It is important to determine the sensitivity of mycobacteria isolated from the patient to antibiotics. This allows the development of individual treatment regimens. As a rule, such therapy lasts 2-3 months. With timely treatment, the prognosis is favorable.

If a patient has fibro-focal tuberculosis, it is much more difficult to treat it. In the focus, delimited by connective tissue, the antibiotic almost does not penetrate. Such patients are recommended surgery with the removal of the focus and connective tissue around it. In this case, the prognosis is doubtful.

For reference. The outcome of a focal lung lesion is a metatuberculous focus. This is the place where there was once caseous necrosis, and now connective tissue has grown instead of the dead lung tissue. The metatuberculous focus, as a residual phenomenon of tuberculosis, with its small size, does not have any clinic.