Focal pulmonary tuberculosis outpatient treatment. What is focal pulmonary tuberculosis and how can it be cured

Focal pulmonary tuberculosis is a secondary form of the disease. It develops on the basis of previously cured primary lesions. Almost half of the cases of pathology are detected in patients repeatedly. The disease is sometimes asymptomatic. Often the detection of the disease occurs during a planned diagnosis. Fluorography is able to show that those manifestations that have not been paid any attention for a long period are symptoms of the disease. There are two forms of the disease: chronic fibro-focal and soft-focal fresh. During the healing of foci, zones with fibrous tissue.

Focal pulmonary tuberculosis is a pathology that occurs in areas with unfavorable indicators and with a low level of preventive control methods. The causes of occurrence are the wrong diet and lifestyle.

With low social well-being of residents, lack of a balanced diet, increased migration, the presence of a large number of people without a permanent place of residence, and the lack of proper care in the medical field, the number of cases of tuberculosis is increasing significantly.

The disease only in rare cases develops as a primary process. Most often, pathology occurs in the presence of already existing immunity to tuberculosis. It is a secondary infection.

The progression of the disease occurs for a number of reasons:

• reactivation of the focus of infection present in the human body;
• with secondary penetration into the body of mycobacteria from the environment.

Weakened immunity causes the reversion of Koch's wand.

Contribute to this condition in humans, such as:

• chronic diseases: ulcers, diabetes, pathologies of the respiratory system;
• bad habits: alcoholism, smoking, drug addiction;
• prolonged contact with a patient who has an open form of the disease;
• wrong way of life.

The prognosis of therapy depends on the stage of pathology.

Today focal tuberculosis lungs are divided into several forms:

1. Fibrofocal. It is characterized by the formation of scars and dense foci. Inflammation is almost completely absent. During the deposition of calcifications, the tissues become very hard.
2. Fresh soft patchy. Focal tuberculosis in the infiltration phase is a fresh form. Characterized by the formation of cavities. When therapy is carried out in a timely manner, the inflammatory processes disappear almost completely. It is possible to form small areas with compaction. The remaining decayed tissues are eliminated by the draining bronchioles and lungs. However, the decay cavity remains in their place.

Acute focal tuberculosis proceeds in different ways.

Most often, secondary symptoms develop on the basis of already existing complications or pathologies. The foci are localized in the lungs. However, some of them are present in other organs. For this reason, it is sometimes difficult to establish a diagnosis.

In the stage of exacerbation of the disease, from a few foci, MBT diverge throughout the body through lymphatic system and bronchi. New foci appear first in upper lobe lung. Endobronchitis develops, and only then cheesy necrosis is formed. In the future, it spreads to the entire tissue of the lungs. This stage is characterized by the formation of a focus that has common features with pneumonia.

Various tissues and lymph nodes are gradually involved in the process of disease progression. The productive reaction is changed by minor exudative phenomena. The focus of tuberculosis is symmetrical.

The main consequences of the pathology are:

• a favorable course timely therapy and detection of the disease;
• the disease disappears, but residual fibroses and calcifications may be observed;
• when the pathology passes into a severe stage, the prognosis is unfavorable.

The clinical picture of the pathology is completely dependent on the patient's body. Tuberculosis of the upper lobe of the left lung may be in the phase of decay and compaction, infiltration.

At various stages of development, the disease has certain signs. The initial phase has no symptoms. But due to the penetration of a small amount of toxins into the blood, one can observe a slight Negative influence to organs.

Focal pulmonary tuberculosis is characterized by wave-like symptoms.

Almost all signs of pathology are absent during the remission period. With an exacerbation, the symptoms are also minor.

The main signs of the disease that you should pay attention to:

• a slight increase in temperature throughout the week;
• irritability;
• lack of appetite;
• weight loss;
• heat in the palms and cheeks;
• pain in the side;
• dry cough with little sputum;
• severe sweating during night sleep, tachycardia;
• increased weakness;
• with the collapse of lung tissue, hemoptysis is observed.

After graduation acute period symptoms become milder. However, sometimes signs of intoxication persist for some time.

Observed:

• hard breathing;
• moist rales;
• percussion sound dull.

Diagnostics and therapy

To diagnose a patient, a specialist examines, X-ray diagnostics and laboratory research. The focal form is easiest to detect with an x-ray.

On examination, the doctor may find a slight soreness in the muscles of the shoulders and arms of the patient. When the lesions merge, a percussion sound is noted. For the initial stage, many patients are characterized by the presence of moist rales in the lungs.

The Mantoux test gives a slight reaction. Depending on the phase of the disease, indicators of a biochemical study may show different data. For the initial stage, the results are within the normal range. As soon as an infiltrate occurs, there is an acceleration of ESR, a slight decrease in the number of lymphocytes.

X-ray is one of the most informative methods. Without it, it is difficult to establish the correct diagnosis.

The examination allows to detect lesions up to 1.1 cm various shapes. They can be either multiple or few. More often they are found only in one lung, in its upper part. In some cases, signs of lymphangitis are found. If there is no correct therapy, then the progression of the pathology is detected on the x-ray. It is manifested by an increase in the number of fresh foci, aggravation of lymphangitis, and the appearance of decay cavities.

Sputum examination also occupies a central place in diagnostic activities. In the absence of sputum, specialists cause it with the help of certain inhalations that cause coughing fits. In it, specialists often detect mycobacteria in small volumes, which is not a threat to others, but is significant in establishing a diagnosis. In the presence of Koch's bacillus in the sputum, it is safe to speak about the development of tuberculosis. This diagnostic method is ineffective in the presence of dense foci on the radiograph. In these patients, biochemical and other diagnostic methods are used.

With a diagnosis of focal tuberculosis, antibiotic treatment can eliminate the infection in a year. After therapy, control x-ray. At a positive result it shows a restored pulmonary pattern, no or few foci. In some cases, after treatment, fibrosis still develops, and the lesions do not disappear.

Focal pulmonary tuberculosis should be treated only comprehensively. AT without fail antibiotic therapy is carried out.

In addition, medications are prescribed to support immunity for high level. If the disease progresses against the background of taking medications, then specialists replace the ineffective drug with another one.

In the hospital, the disease is treated in the infiltration phase. The patient is receiving first-line drugs. Treatment is completed only after absolute regression of changes in the lungs. Most often, the course lasts 9 months. The dispensary provides anti-relapse treatment. In the absence of positive dynamics, surgical intervention or artificial pneumothorax is performed.

Anti-tuberculosis drugs:

• Tubazid;
• Isoniazid;
• Rifampicin;
• Streptomycin;
• Ethambutol;
• Ethionamide.

When tuberculosis is diagnosed, therapy should be started immediately, regardless of whether the patient is contagious or not during this period. In a timely manner Taken measures will prevent the development of the disease and give a favorable prognosis.

Preventive actions

Focal tuberculosis - social disease, the occurrence of which directly depends on the conditions of life.

It is for this reason that prevention shows positive results.

The main reasons for the development of pathology are:

• low standard of living;
• low-quality diet;
• weak immunity.

The percentage of morbidity depends on the level of migration processes in the region, the standard of living of people, the number of people who do not have a permanent place of residence.

According to statistics, pathological condition in most cases men are affected.

The incidence among the stronger sex is several times higher than among women.

The age group is divided into age periods from 20 to 29 and from 30 to 39 years.

The most effective preventive measures to avoid infection with tuberculosis, experts include:

1. Anti-epidemiological timely measures that would fully meet the current situation in a certain area.
2. Informing the inhabitants of the region, implementation medical examinations, which would make it possible to detect pathology at the very early stage its development and start the right therapy.
3. Timely and complete provision of patients with medications, providing them with favorable conditions for the treatment of the disease.
4. Complete restriction of contact of sick people with healthy people. Therapy should be carried out in special hospitals, which employ highly qualified medical professionals.
5. Mandatory timely medical examinations for certain groups of people. These include food workers, shops, livestock and agriculture.
6. Vaccination of newborn children.

What is focal tuberculosis and how dangerous is it for the patient's life?

Experts say that this pathology accounts for half of all detected cases of infection with the disease.

The course of the disease passes without certain symptoms. Often it is detected during fluorography. However, often, after examination by a doctor, it turns out that a person simply did not attach much importance to the visible symptoms of intoxication for quite a long time. long period. For this reason, the main condition for a quick recovery is timely diagnosis.

Focal pulmonary tuberculosis refers to small forms of tuberculosis, occurring in most cases benignly. This form of tuberculosis is currently the most common among both newly diagnosed patients and among registered patients. Among newly diagnosed patients with pulmonary tuberculosis, focal tuberculosis is observed in 60%, and among those registered in anti-tuberculosis dispensaries - in 50%.

The relative frequency of focal tuberculosis among tuberculosis patients is determined by the organization of the entire system of preventive anti-tuberculosis measures and last years increases even more only due to timely detection and effective treatment of tuberculosis.

Focal tuberculosis includes processes of various genesis and prescription, of limited extent, with a focus no more than 1 cm in diameter. As can be seen from this definition, focal tuberculosis is a collective concept, therefore, two main forms of focal tuberculosis are distinguished: soft-focal and fibro-focal tuberculosis. The need to distinguish these forms is due to their different genesis, different pathomorphological picture and potential activity, unequal inclination to reverse development.

Soft-focal tuberculosis is the beginning of secondary tuberculosis, which determines the importance of this most important form of the process for the development of subsequent forms.

In the pathogenesis of the development of focal tuberculosis, it is important to correctly understand the role of exo- and endogenous infection. AI Abrikosov attached decisive importance in the development of secondary tuberculosis to the repeated entry into the lungs of Mycobacterium tuberculosis from the environment. The significance of exogenous infection is confirmed by the more frequent incidence of tuberculosis in persons who had contact with patients with tuberculosis. Although the incidence of "contacts" (persons in contact with patients with active tuberculosis) has now significantly decreased, it is still 3-4 times higher than the general incidence of the population.

Of undeniable importance is endogenous development tuberculosis, which is confirmed by the almost constant detection in the zone of fresh tuberculous foci of older ones, which, apparently, were the source of exacerbation of the process. Old encapsulated and calcified lesions in the lungs and lymph nodes detected in 80% of patients with focal tuberculosis. The significance of endogenous infection speaks more frequent illness active tuberculosis of previously infected persons, especially those who are X-ray positive, i.e., those who have traces of a previous tuberculosis infection in the lung.

The tendency to exacerbate old foci depends on the nature and duration of the residual changes and the state of the organism's reactivity. Live, virulent Mycobacterium tuberculosis can persist in the body for a long time (directly in the foci and in the lymph nodes). Mycobacterium tuberculosis is usually not found in scar tissue.

Currently, phthisiatricians recognize the importance of both endogenous and exogenous infection. Exogenous superinfection sensitizes the body and can exacerbate endogenous infection. On a correct understanding of the role of endogenous and exogenous infection, the entire system of anti-tuberculosis measures is built: vaccination, early diagnosis and treatment of primary and secondary tuberculosis, as well as prevention of tuberculosis.

In the pathogenesis of focal tuberculosis, as well as other clinical forms process, adverse factors that reduce the body's resistance are also important: concomitant diseases, occupational hazards, adverse climatic and living conditions, excessive sun exposure, mental trauma etc.

Thus, the pathogenesis of focal tuberculosis of the secondary period is different. Focal tuberculosis can develop as a result of exogenous superinfection or endogenous spread of Mycobacterium tuberculosis from latent tuberculosis foci in the lymph nodes, bones, kidneys, more often from exacerbated old encapsulated or calcified foci in the lungs. By their origin, these pathological changes either refer to the period primary infection, or are residual changes after infiltrative processes, hematogenous disseminations or small caverns.

The initial pathological changes in secondary tuberculosis are the development of endoperibronchitis of the intralobular apical bronchus [Aprikosov AI, 1904]. This is followed by cheesy necrosis of the inflammatory changes in the walls of the bronchus. Panbronchitis develops, sometimes with blockage of the lumen of the bronchus by caseous masses, then a specific process passes to neighboring pulmonary alveoli. So there is a focus of specific caseous bronchopneumonia - Abrikosov's focus. The combination of such foci with a diameter of up to 1 cm creates a pathomorphological picture of soft-focal tuberculosis.

With tuberculous inflammation, the exudative stage is gradually replaced by a proliferative one. Fresh lesions are therefore often replaced by connective tissue and become scars. A capsule is formed around the caseous foci. Such foci are called Aschoff - Bullet foci. Morphologically, alterative and proliferative foci are distinguished, but their combination is more often observed. By size, the foci are divided into small - up to 3 mm, medium - up to 6 mm and large - 10 mm in diameter.

It has been established that certain physicochemical changes are observed in the lung during the formation of foci. In the area of ​​sedimentation of mycobacterium tuberculosis, the pH of the medium shifts to the acid side, which stimulates the activity connective tissue involved in the delimitation of the inflammatory area of ​​the lung.

The formation of limited focal changes in a person suffering from tuberculosis, and not an extensive infiltrative-pneumonic process, is possible only under conditions of a certain state of the body's reactivity, which is characterized by the absence of an increased sensitivity of the body to tuberculin and the preservation, although somewhat reduced, of relative immunity. This is evidenced by the normergic reactions to tuberculin detected in patients with focal tuberculosis and the data of biochemical studies. Patients with focal tuberculosis do not have such sharp increase the level of histamine in the blood, as in infiltrative-pneumonic tuberculosis, when there is a pronounced sensitization of the body.

The clinic of soft-focal tuberculosis is characterized by low symptoms for a certain period. However, for soft-focal tuberculosis, the predominance of general mild functional disorders from some internal organs and systems always remains typical.

Some patients have subfebrile fever, excessive sweating, disturbance of sleep and appetite, decreased ability to work.

The appearance of patients with focal tuberculosis does not allow one to suspect an incipient tuberculous process: they look healthy. However, when objective research bodies chest the symptoms of reflex sparing of the affected areas are clearly identified: a lag in the act of breathing on the diseased side of the chest, muscle tension and soreness over the affected area, weakening of inspiration. There may be a shortening of the percussion tone and, during auscultation, an increase in expiration over the affected segment, the degree of which depends on the number of foci, their fusion and involvement in the pleura process.

The leukocyte form and ESR in a significant proportion of patients with focal tuberculosis remain normal. In a number of patients, minimal changes are detected in the form of a slight shift of the leukocyte formula to the left, a moderate increase in ESR. Often there is lymphocytic leukocytosis or its combination with monocytic. An increase in the absolute content of monocytes and lymphocytes in the peripheral blood indicates a functional stress on the part of the hematopoietic system involved in anti-tuberculosis immunity, and more often this accompanies the benign course of the disease.

The detection of Mycobacterium tuberculosis depends on the phase of the process and the research methodology. In focal tuberculosis, mycobacterium tuberculosis is found mainly in the phase of lung tissue decay.

It is necessary to use the whole complex microbiological research: bacterioscopy (using enrichment methods, in particular flotation), fluorescent microscopy, cultural and biological methods. It is the last two methods for focal tuberculosis that more often make it possible to detect Mycobacterium tuberculosis. To determine mycobacterium tuberculosis, usually the washings of the bronchi or stomach are examined, since patients secrete a small amount of sputum.

Multiple cultures almost doubled the frequency of detection of Mycobacterium tuberculosis in focal form.

The complex use of laboratory methods not only increases the reliability of determining the frequency of isolation of Mycobacterium tuberculosis, but also makes it possible to judge the nature of bacilli isolation: viability, virulence and drug sensitivity of tuberculosis microbacteria, their type, which has great importance for chemotherapy.

The X-ray picture of focal tuberculosis depends on the phase, genesis and duration of the process. Newly emerging in the intact lung fresh foci on the radiograph are visible as rounded spotty shadow formations of low intensity with blurry contours, usually located in groups, more often in a limited area.

The nature of radiological changes is better detected by tomography. The role of X-ray tomography in the diagnosis of destruction is the greatest, since in this form small decay cavities (up to 1 cm in diameter) are observed, which are rarely detected during survey and even with targeted radiography. Up to 80% of such decay cavities in focal pulmonary tuberculosis are detected only with the help of a tomographic research method, therefore, for all newly diagnosed patients with focal pulmonary tuberculosis, X-ray tomography is mandatory. Otherwise, most of the small decay cavities remain undiagnosed, the treatment is ineffective, and the process progresses.

Patients with focal tuberculosis are detected mainly during mass fluorographic examinations, as well as during examination of persons who apply to the clinic for catarrh of the upper respiratory tract, asthenic conditions, vegetative neurosis and other diseases, under the "masks" of which focal tuberculosis can occur.

Differential diagnosis of focal tuberculosis should be carried out with its "masks": influenza, thyrotoxicosis, vegetative neurosis and diseases in which focal shadows are detected radiologically in the lungs - focal eosinophilic pneumonia, limited pneumosclerosis.

At differential diagnosis needs to be done in a timely manner x-ray examination, which will confirm or rule out the presence of focal changes in the lungs. In addition, it is necessary to take into account the data of the anamnesis and features clinical course diseases.

With eosinophilic focal pneumonia, an increase in the number of eosinophils in peripheral blood is detected, eosinophils are also found in sputum. Noteworthy is the rapid disappearance of clinical and radiological signs eosinophilic focal pneumonia. Eosinophilic foci of pneumonia often develop with ascariasis, since ascaris larvae go through a development cycle in the lungs and sensitize the lung tissue.

When diagnosing focal tuberculosis, it is important not only to establish the origin of the foci, but also to determine the degree of their activity.

If using the whole complex of clinical and radiological research methods it is difficult to resolve the issue of the degree of activity of focal tuberculosis in a newly diagnosed or long-term treated patient, subcutaneous administration of tuberculin (Koch's test) is used, and sometimes diagnostic therapy.

The response to subcutaneous injection of tuberculin is assessed by the size of the infiltrate. A reaction with an infiltrate diameter of at least 10 mm is considered positive. About general reaction judged by a change in the patient's well-being (the appearance of symptoms of intoxication) - an increase in body temperature, a change in the leukocyte count and ESR, biochemical changes in the blood serum. With a focal reaction, which is very rarely detected radiographically, catarrhal phenomena may occur in the lung and Mycobacterium tuberculosis may be detected in sputum or washings of the stomach, bronchi.

To carry out the above tests, within 3 days before using the Koch test, the temperature is measured every 3 hours (excluding night time), on the eve of the test, general analysis blood. On the day of the test, the blood serum is examined for the content of hyaluronidase, histamine, and protein fractions. This analysis is repeated after 48 hours, a complete blood count - after 24 and 48 hours. At the same time, sputum or washings of the stomach, bronchi are examined for Mycobacterium tuberculosis by the seeding method.

An increase in the number of leukocytes, the appearance of a shift in the leukocyte formula to the left, an increase in the number of lymphocytes, monocytes in the peripheral blood, and a decrease in the number of eosinophils, and sometimes lymphocytes, are considered characteristic of an active process. In the blood serum, there is a shift towards coarse protein fractions - a- and y-globulins. An increase in the level of hyaluronidase, histamine, serotonin and catecholamines during an active process is especially characteristic.

In the absence of reliable data indicating the activity of the tuberculosis process, the issue is resolved in the negative. In doubtful data, a 3-month diagnostic course of treatment with three main tuberculostatic drugs is advisable. In 90-95% of patients, this period is sufficient to resolve the issue of the activity of the tuberculosis process.

The course of focal tuberculosis is determined by the potential activity of the process and the method of treating patients. Soft-focal tuberculosis is characterized by pronounced activity, which requires great attention to the treatment of patients suffering from this form.

Treatment of patients with active focal pulmonary tuberculosis should be started in a hospital with three main tuberculostatic drugs against the background of a rational general hygienic regimen, as well as diet therapy. All this is carried out until a significant clinical and radiological improvement. In the future, treatment in sanatorium and outpatient conditions is possible with the use of two drugs. The duration of the course of treatment should be at least 12 months, during which intermittent chemotherapy can be carried out.

With a protracted course of focal tuberculosis, pathogenetic agents can be recommended: pyrogenal, tuberculin. With the exudative nature of inflammation, a pronounced phase of infiltration, with allergic symptoms caused by anti-tuberculosis drugs, with concomitant allergic diseases, the use of corticosteroid hormones is indicated.

The outcomes of focal tuberculosis depend on the nature of changes in the lungs at the beginning of treatment and the method of treating patients. With complex use modern methods therapy cure occurs in 95-98% of patients. Complete resorption is observed only with fresh foci (in 3-5% of patients). In most patients, in parallel with resorption, the foci are delimited with the formation of local pneumosclerosis. This is due to the sufficient resistance of the organism to tuberculosis infection and the predominance of the intermediate phase of inflammation from the very first days of the development of the disease.

In 2-7% of patients with focal tuberculosis, with a combination of a number of unfavorable factors, the disease may progress with the development of the following forms of secondary tuberculosis: infiltrates, tuberculomas, and limited fibrous-cavernous pulmonary tuberculosis. In these cases, there may be indications for surgical treatment - economical resection of the lung.

The pathogenesis of fibro-focal tuberculosis is associated with the reverse development of all forms of pulmonary tuberculosis: primary tuberculosis complex, disseminated tuberculosis, soft-focal tuberculosis, infiltrative, tuberculoma, cavernous tuberculosis.

Pathomorphologically and clinically, fibro-focal tuberculosis is characterized by a large polymorphism, depending on the prevalence and duration of the forms of the previous tuberculosis process.

Patients with fibro-focal tuberculosis may complain of weakness, increased fatigue and other functional disorders.

Complaints of cough with sputum, sometimes hemoptysis, chest pain can be explained by specific pneumosclerosis in the affected area.

An objective examination over the affected area reveals a shortening of the percussion tone, and dry rales are heard during auscultation.

Changes in blood and sputum depend on the degree of activity of both specific and non-specific inflammatory processes in the foci. In the phase of compaction in the blood, lymphocytic leukocytosis is possible. Mycobacterium tuberculosis is rarely found in sputum.

X-ray in fibro-focal tuberculosis clearly reveals the intensity, clarity of boundaries and polymorphism of foci, pronounced fibrosis and pleural changes (Fig. 28).

In the diagnosis of fibro-focal tuberculosis, the greatest difficulty is to determine the degree of activity of the process, as well as the reasons for the exacerbation of the inflammatory process in the zone of tuberculous pneumosclerosis. To answer this question, it is necessary comprehensive examination sick. There may be indications for diagnostic chemotherapy.

The course of fibro-focal tuberculosis depends on the number and condition of the foci, the methods of previous therapy, as well as the living and working conditions of the patient.

Indications for specific therapy in patients with fibro-focal tuberculosis are determined by the phase of the process. Persons with fibro-focal tuberculosis in the compaction phase in a specific antibiotic therapy dont need. Preventive treatment GINK preparations. and PAS is shown to them under complicating circumstances: when changing climatic conditions, after intercurrent diseases or surgical interventions.

Patients with fibro-focal tuberculosis in the infiltration phase need treatment with chemotherapy drugs, first in a hospital or sanatorium, and then on an outpatient basis.

With newly diagnosed fibro-focal tuberculosis of dubious activity, it is necessary to carry out therapy with three main drugs for 3-4 months, and if it is effective, continue therapy on an outpatient basis.

criterion clinical cure focal tuberculosis is the absence of clinical, functional and radiographic data on lung disease, observed within 2 years after the end of effective course treatment.

Tuberculosis is an insidious and difficult disease to treat. Diagnosed and seemingly cured in the past, it can aggravate and recur again, while appearing in new forms. One of them is focal pulmonary tuberculosis (OTB), characterized by limited area defeat. Consider its features and differences from other clinical forms.

A pathological process is characteristic of OTB, the diameter of the affected area is comparable to the orthogonal section of the lung lobule. The foci are divided into small (3-4 mm), medium (5-8 mm) and large (8-10 mm). Larger lesions are referred to as infiltrates and tuberculomas. There are two main sources of pathological changes:

This disease is considered small form tuberculosis due to the limited inflammatory process and the rare development of the collapse of the lung tissue. Among all clinical forms OTB occurs in 15-20% of cases.

Classification

There are such types of OTB as fresh and chronic. In the first case, also called soft focal, mycobacteria enter the upper lobes of the lungs (from the lymph nodes or by aerogenic route), affecting the intralobular bronchus.

In this case, caseous masses (cheesy necrosis) are formed, which are aspirated into the apical and subapical bronchi and form acinous-nodular and lobular foci. Then the inflammation goes through the lymph nodes, leading to the fact that fresh (acute) foci of tuberculosis appear in the lungs.

The exudative process (accumulation of fluid in the affected tissues and compression of nerve endings) gradually turns into a proliferative one (recovery of damaged cells), very rarely progressing into an infiltrate. It is not known for certain why the foci prefer the apical lobes, but perhaps this is somehow related to weaker blood circulation, ventilation and lymph flow in this part of the lung, as well as the vertical position of the human body.

In the absence of proper therapy, fresh OTB can become chronic (fibrofocal). Active inflammatory process stimulates the phenomena of reparation and the appearance of foci of Ashsoff-Pool (enough large fibrous capsules in segments 1 and 2 of the lung).

Reasons for development

The exogenous factor of development is most often found in areas with an unfavorable epidemiological situation. Superinfection also occurs in people living with the patient open form tuberculosis. In close contact with a bacterioexcretor, mycobacteria enter the body in large quantities.

In other cases, the most common endogenous factor. The reactivation of old foci is facilitated by a decrease in anti-tuberculosis immunity caused by such reasons:

• heavy physical exercise and injury;
• stress, exhaustion, poor diet;
• chronic diseases of the endocrine system and gastrointestinal tract;
• alcohol abuse, drug addiction;
• HIV infection;
• hormonal changes during pregnancy;
• taking immunosuppressants;
• elderly age.

Very rarely, dissemination from extrapulmonary foci can lead to the appearance of new areas of inflammation:

• bones;
• joints;
• kidneys.

It is difficult to give an unambiguous answer to the question whether focal pulmonary tuberculosis is contagious or not. According to some reports, in the early stages of the disease, OTB is non-contagious due to the density of foci and the impossibility of bacterial release. But since this disease is still infectious, and the bacteria are in the blood of the sick person anyway, there is a risk of transmitting the infection to others (about 3-10%).

In addition, the disease can pass into a disseminated (open) form, in which the infection spreads throughout the body through the blood and lymph and becomes dangerous to others.

Main symptoms

The limitation and productivity of the lesion determine the asymptomatic course of the disease in 2/3 of patients. In the remaining third, OTB is manifested by the following features:

• low-grade fever (especially in the late afternoon);
• chronic fatigue;
• loss of appetite;
• irritability;
• hyperhidrosis;
• pain in the right side;
• dry cough, sometimes with a small amount of expectorant secretion;
• the chronic form is characterized by dry rales, audible during auscultation, and chest asymmetry, accompanied by a lag during breathing.

OTB can develop over the years and proceeds in waves, sometimes aggravating, sometimes subsiding, but always with a rather blurred clinical picture without clear manifestations. The course of the disease is affected individual characteristics organism, its reactivity, the state of the immune system. The disease in its development goes through three phases:

Diagnostic measures

For successful treatment timely and accurate diagnosis diseases. The obligatory diagnostic minimum of OTB includes:

The disease under consideration must be differentiated from peripheral lung cancer, and in those rare cases when OTB is localized in the lower sections, and from focal pneumonia. The latter is characterized by a more acute course and vivid manifestations.

Treatment Methods

Depending on the phase and form, focal tuberculosis is treated with both medical preparations and procedures, as well as through surgical intervention. Treatment is carried out in an anti-tuberculosis hospital and on an outpatient basis with the participation of a phthisiatrician.

Medical therapy

This main method of treatment includes courses antibacterial drugs over a fairly long period - 9-12 months. The scheme is prescribed in accordance with the form of the disease:

Anti-tuberculosis drugs are used with caution in liver disease, and ethambutol can adversely affect the condition optic nerve therefore, when taking it, you should regularly undergo an examination by an ophthalmologist.

In the phase of compaction and the formation of calcifications, the therapy is repeated twice a year for two years after the base course.

Due to the wide spread of multidrug-resistant forms of tuberculosis in the world, the pharmaceutical industry has created a new generation of anti-TB drugs that are effective against many harmful tuberculosis strains - Bedaquiline and Delamanid. They have been approved by the FDA food products and medicines).

The purpose of physiotherapy procedures that serve as a complement to complex therapy, is to strengthen the immune system, reduce unpleasant symptoms, accelerate sputum abacillation, restore damaged tissues by improving their nutrition. The physiotherapy complex consists of three groups:

Surgical intervention

Decision on surgical intervention taken on the basis of a serious deterioration in the patient's condition: when the OTB enters the decay phase and the formation of caverns, when the foci merge into a conglomerate, with constant exacerbations of the chronic form, and also in the absence of a response to antibiotic treatment.

In these cases, the part of the lung segment affected by the focus is removed. The most commonly used method of marginal and wedge resection. After operation drug therapy should continue for at least six months.

Forecast and prevention

With appropriate treatment, as well as with proper lifestyle ( balanced diet, taking vitamin complexes) OTB has a good medical prognosis. Up to 95% of patients recover within a year.

However, it must be borne in mind that a complete biological cure for tuberculosis, unfortunately, is impossible. Mycobacteria, once in the body, remain there forever.

Therefore, preventive measures that prevent the development of the disease are so important, namely:

• timely diagnostics (mass X-ray examination of the population);
• vaccination and tuberculin tests;
• improvement of living standards and socio-economic conditions;
• allocation of isolated living space for patients in order to prevent the development of secondary forms of tuberculosis (including multidrug-resistant ones) in others.

OTB is characterized by the appearance of small inflammations in the lungs, due to infection with a superinfection or due to the reactivation of old foci. The disease, although it does not have pronounced symptoms, is still subject to mandatory treatment, since a neglected disease can lead to dissemination (open form) and extremely life-threatening fibrous-cavernous tuberculosis. In this article, methods of treatment were considered, the main of which is medication.

Focal pulmonary tuberculosis is most often diagnosed in individuals who have already encountered this pathology in the past. Difficulties in diagnosis lies in the fact that the disease may not manifest any clinical signs. The main measure to control the focal form of CD is an annual X-ray examination.

TVS of the lungs is an abbreviation that stands for pulmonary tuberculosis. This disease is also referred to as BK.

What is this disease

Focal tuberculosis is a type of this infectious disease, representing the presence of one or more tuberculous lesions in the area lung tissue. As a rule, growths are small in size.

It is most often diagnosed in patients over 30 years of age, since fibrous formations on the respiratory organ occur with enviable regularity after primary CD.

Focal pulmonary tuberculosis is transmitted in the same way as any other form of it. It all depends on the severity of the disease and whether it proceeds in a closed or open form. In some cases, a person with PWS can be contagious to others, and in others, to himself.

The danger lies in the dissemination of pathology, due to which mycobacteria are released into the blood of the sick person, and fibrous foci grow throughout the body.

Reasons for development

The disease is exclusively infectious, so you can get it only through contact with an affected human body. Focal pulmonary tuberculosis grows in those places broncho pulmonary system where Koch's bacterium lesion already existed and was cured.

Ways of transmission of infection:

• airborne - in direct contact with the peddler;
• air-dust - in the case when the infected sputum got on any surface, then dried and the air evaporated;
• contact-household way - through all objects of general use, on which infectious pathogens are present;
• contact - through saliva, sputum;
• blood transfusion - through the blood;
• placental - from mother to baby during pregnancy or childbirth.

Sometimes Koch bacteria enter the body from an infected animal to a person. For example, through milk, sour cream and other products, as well as through unwashed hands after communicating with cattle.

But if there were not several deterrent factors, all the inhabitants of the Earth would already suffer from tuberculosis. So what is the reason for the defeat by mycobacteria of only a certain group of people, mainly socially disadvantaged?

A lot depends on the strength of one's own immunity, lifestyle, the amount of infection that enters the body and related factors.

When the risk of contracting CD increases:

• immunodeficiency states (HIV, AIDS);
• unfavorable living conditions (mold, dampness);
• absence good nutrition, vitamins and minerals in food;
• tendency to smoke;
• antisocial lifestyle (alcoholism, drug addiction);
• chronic hypothermia;
• the presence in the body of infectious problems that weaken the immune system;
• regular stress;
• lack of medical care;
• uncontrolled use of antibiotics, hormonal drugs and other serious medicines;
• work in animal husbandry;
• pathology in the bronchopulmonary system.

In most patients, focal pulmonary tuberculosis is diagnosed in fibrous stage, as the person did not notice or ignored the symptoms of a sudden deterioration in health.

Symptoms

Some patients do not notice signs of focal pulmonary tuberculosis or do not attach due importance to them, although they are still present. What symptoms can be noted:

• not significant, but a daily increase in body temperature to subfebrile levels (37-37.5 degrees);
• chills;
• weakness, lethargy;
• sweat in palms;
• periodic cough without sputum production or with slight expectoration;
• causeless weight loss;
• loss of appetite;
• soreness of the shoulder girdle at the site of injury;
• women may be disturbed by regular disruptions of the menstrual cycle.

However, these complaints are not enough to put mild-focal or fibro-focal tuberculosis. To identify pathology, you should contact a phthisiatrician and pulmonologist, undergo a preventive diagnostic examination. If the patient had previously had any form of tuberculosis, it is recommended to visit a doctor every six months to a year.

Diagnostics

At the reception, the specialist collects an anamnesis of the life of the person who applied, identifies complaints, performs an examination, and then sends them to other research activities.

Diagnosis of focal tuberculosis is:

1. Inspection. Palpation reveals slight discomfort in the shoulder girdle, on the side where there is a lesion.. If there is a fusion of focal formations, there is a shortening of the percussion sound in this area. Auscultation reveals hard breathing with fine wet rales.
2. Radiography. The diagnostic method using fluorography is the most informative in relation to CD of the focal type. The picture clearly distinguishes small foci that have a diameter of not more than 1 cm. Their shape can be blurry or rounded. Their predominant accumulation is observed in upper divisions pulmonary system, most often on the one hand.
3. Laboratory research. Diagnosis of blood, sputum and swabs obtained as a result of bronchoscopy is carried out. During the endoscopic studies can be observed clinical picture endobronchitis. As a rule, tuberculin diagnostics is not effective, since no significant changes are observed during its implementation. An increase in ESR and a shift in the leukocyte formula appear only in serious condition patient.

When the specialist is not sure of the diagnosis, but there are signs of focal tuberculosis and the presence of CD exists in the anamnesis, it is recommended to prescribe anti-tuberculosis therapy for a couple of months. During this time, the dynamics in the analyzes is monitored. If she began to change in better side, it is possible to speak with confidence about the diagnosis.

Treatment

The treatment of focal pulmonary tuberculosis in an active form is carried out by a phthisiatrician in a specialized clinic. Inactive is eliminated on an outpatient basis under the constant supervision of a specialist.

On average, recovery takes about a year.. If TVS is detected at an early stage and is in a soft focal form, the probability of complete resorption of the foci is 98%. Fibrous compounds may not go away completely, but they also do not pose a danger.

Focal pulmonary tuberculosis requires the use of several anti-tuberculosis drugs (eg, Ethambutol, Isoniazid, Rifampicin, Pyrazinamide). The term of admission is about 3 months. Next, maintenance therapy is prescribed for six months, during which only 2 drugs remain.

An important step in treatment is preventive measures and recovery in a medical sanatorium. The outcome of therapy in most cases is favorable.

If the patient has developed pneumosclerosis, which is characterized by fibrous foci, chemoprophylaxis is prescribed over the next year.

Complications

Complications of focal pulmonary tuberculosis are extremely rare if the disease goes into a severe stage.. This happens due to lack of proper treatment.

Possible complications:

• hemoptysis;
• pneumothorax;
• inflammation of the pleura;
• pulmonary bleeding;
• progressive course of the disease.

To prevent similar problems with health, annual fluorography should be carried out, as well as other methods of preventing an infectious disease.

Prevention

Prevention of focal pulmonary tuberculosis is divided into 2 types: it must be observed not only by the patient himself, but also measures are taken to prevent outbreaks of CD among the population.

What should the patient do after successful therapy:

• quit smoking, drinking alcoholic beverages, drugs;
• do not overcool the body;
• timely visit a pulmonologist, phthisiatrician;
• take more walks in the fresh air;
• take vitaminized and immunostimulating complexes prescribed by a doctor;
• treat infectious inflammation in the body;
• strengthen immunity;
• engage in moderate physical activity.

What are required to do specialized centers for prevention:

• perform free diagnostics tuberculin samples, fluorography;
• carry out primary vaccination against tuberculosis in the neonatal period;
• promote early detection BC;
• carry out preventive and anti-epidemic actions in unfavorable areas with increased level incidence of tuberculosis;
• provide patients with all necessary medicines at the expense of the state;
• limit contacts of a sick person with an open form of the disease with healthy people;
• inform the public;
• realize preventive examinations at the time of hiring.

Such a set of measures on the part of the patient, as well as medical and other public institutions contributes to the reduction of morbidity in certain regions. Special attention should be given to individuals who already have a history of manifestations of latent or active form tuberculosis. In this case, the risks of infection are significantly reduced, and the standard of living will certainly grow upwards.

Judging by nutrition, you absolutely do not care about immunity and your body. You are very susceptible to diseases of the lungs and other organs! It's time to love yourself and start getting better. It is urgent to adjust your diet, to minimize fatty, floury, sweet and alcohol. Eat more vegetables and fruits, dairy products. Nourish the body by taking vitamins, drink more water(precisely purified, mineral). Harden the body and reduce the amount of stress in life.