Nutrition for tuberculosis. Nutrition for pulmonary tuberculosis

"Milk is an excellent nutritional product. It is well digestible and contains all the substances necessary for the body (proteins, fats, carbohydrates, salts, vitamins). Since ancient times, milk has been considered useful product for patients with tuberculosis.

However, the opinion of old authors who believed that the patient should drink several liters of milk a day is not substantiated in any way. You should not drink more than 2-3 glasses of milk per day, as taking excessive amounts of liquid increases the load on the heart and kidneys.

Raw milk can be contaminated and contain germs of infectious diseases. Therefore, milk should be boiled. But at the same time, in order to avoid the destruction of vitamins, you need to follow some rules: quickly bring to a boil, boil for no more than 1-2 minutes in a closed pan. Pasteurized bottled milk can be consumed without boiling as it does not contain germs.

Healthy milk products are yogurt, varenets and kefir. During the preparation of kefir, the protein contained in milk coagulates into small flakes and is more easily absorbed by the intestines. The lactic acid and carbon dioxide present in kefir give it a pleasant sour taste."

Where to treat tuberculosis abroad?

University Hospital Heidelberg– a recognized leader in the treatment of diseases for almost all medical specialties. The clinic includes 43 specialized clinics and departments with a capacity of 1,900 beds.

Medical Center "Assuta" is a leading private medical center in the country. Every year, approximately 85 thousand operations are performed in Assuta clinics, 235 thousand. diagnostic examinations, 650 thousand outpatient examinations.

University Hospital Freiburg provides its clients with medical care high class. The diagnostic and treatment methods used by the Clinic staff are based on the most latest achievements Sciences.

University Hospital Zurich– one of the largest and most significant medical centers in Europe, widely known for its considerable achievements in the field of medical practice and scientific research.

Johns Hopkins Hospital– a multidisciplinary medical institution that provides patients with both therapeutic and surgical care. This institution is one of the greatest medical institutions in the world.

University Hospital Munich is multidisciplinary medical institution and offers its services in almost all areas of medicine. Works closely with many well-known clinics in the USA and Europe.

Mayo Clinic- public multidisciplinary clinics and research institutes and laboratories. They are a delivery system medical care, which is carried out at the most modern level.

Wellington Clinic- multidisciplinary private clinic Great Britain, one of the largest in the country. Due to High Quality service and efficiency of methods, this clinic was able to gain an excellent reputation.

University Hospital Dusseldorf– a multidisciplinary clinic offering a wide range of diagnostic and treatment services. The clinic has a huge range of diagnostic and therapeutic capabilities.

Chaim Sheba Medical Center is the largest medical institution in the country and the leading medical center in the Middle East. The center has 150 departments and clinics and over 1,000 medical specialists at its disposal.

University Hospital Saarland is multidisciplinary and offers diagnostics and treatment of a whole range of the most common diseases at the highest level.

GENERAL CHARACTERISTICS

Tuberculosis is predominantly chronic infection, in which the lungs are most often affected. Tuberculosis of the larynx, intestines, kidneys, bones and joints, and skin is less common. With tuberculosis, changes in the affected organs, intoxication of the body are possible, metabolism and the functioning of various organs and systems, in particular the digestive organs, are disrupted.

The nutritional regimen is based on the nature and extent of damage to the organ, the general condition of the body, and complications from other organs. The calorie content of the diet depends on the characteristics of the course of the disease, body weight and concomitant diseases. For exacerbation of tuberculosis and bed rest, 2500–2600 kcal per day is sufficient. With semi-bed rest – 2700 kcal; when the exacerbation subsides – 3000–3400 kcal. For chronic pulmonary tuberculosis, especially in humans young, a high-calorie diet of 3600 kcal is recommended. Eating more calories is not healthy. A rapid and large increase in body weight may not improve, but rather worsen the patient's condition.

OBJECTIVES OF THERAPEUTIC NUTRITION

Main tasks therapeutic nutrition for pulmonary tuberculosis are:

1. Providing the body with adequate nutrition in conditions of protein breakdown, deterioration of fat and carbohydrate metabolism, and increased consumption of vitamins and minerals.

2. Increasing the body's resistance to infection and intoxication.

3. Promoting normalization of metabolism.

4. Promoting the restoration of tissues affected by tuberculosis infection.

To accomplish these tasks, it is necessary to introduce an increased amount of protein with food (at least 120–140 g), the consumption of which is increased in patients with tuberculosis. Easily digestible protein products(milk, fish, eggs, meat). The amount of fat is recommended within physiological norm(100–120 g). Fats should be easily digestible, rich in vitamin A ( butter, cream, sour cream), about a third - in the form of vegetable fat.

The amount of carbohydrates is within the physiological norm (450–500 g). In cases where there is a violation of tuberculosis carbohydrate metabolism, allergization of the body (allergic diathesis, bronchial asthma, chronic eczema), excess body weight, patients need to limit carbohydrate intake to 300–400 g, mainly due to easily digestible ones (sugar, honey, jam, syrup, etc.).

With an exacerbation of the tuberculosis process, an increased release of mineral salts (calcium, potassium, phosphorus, sodium chloride) may be observed, so foods rich in them are introduced (milk, cheese, cottage cheese, eggs, figs, dried apricots, raisins, meat and fish products, nuts, etc.).

With exudative pleurisy, transudate, tuberculous meningitis, if there is an increase in secretions into the bronchi, kidney damage leading to edema, a hyposodium diet is prescribed, i.e. food is prepared without adding table salt. This diet helps to increase diuresis, resorption of fluid accumulated in the cavities, and subsidence of the inflammatory process. The liquid is administered in an amount of 900-1000 ml. In case of large blood loss, repeated vomiting, diarrhea, excessive sweating, the amount of table salt is increased to 20 g.

Patients with tuberculosis develop vitamin deficiency (especially ascorbic acid, vitamins A and group B). Consuming sufficient amounts of ascorbic acid increases bactericidal properties blood serum, increases the formation of antibodies, reduces intoxication. The need for vitamin C is especially high in patients with fibro-cavernous process, at high temperatures and tissue breakdown. Products recommended in this case sufficient quantity vegetables and fruits, and also need to periodically take up to 300 mg of ascorbic acid per day.

Patients with tuberculosis of the lungs, larynx, intestines and skin also need increased quantity vitamin A – about 5 mg. To meet the need for vitamin A, dairy products are recommended, fish fat, egg yolk, as well as products containing carotene - carrots, tomatoes, apricots, red peppers, etc.

Particular attention should be paid to providing patients with B vitamins. They are directly related to protein metabolism, the need for which is increased in this group of patients. It is necessary to include foods rich in B vitamins into the diet - fresh vegetables, meat, dishes made from bran, brewer's or baker's yeast.

Calorie intake – 2500–3600 kcal.

BASIC PRINCIPLES OF THERAPEUTIC NUTRITION

1. The diet should be varied, taking into account the development of the tuberculosis process and the general condition of the body.

2. Strict modes and limited nutrition can only be assigned to short term(for complications and exacerbations of the disease).

3. At all stages of treatment, nutrition should be differentiated.

It is necessary to adhere to the basic principles of quality and quantitative construction diet depending on the nature and stage of the tuberculosis process, the state of the digestive organs, the presence of complications and concomitant diseases.

There are several therapeutic nutrition options available for people with tuberculosis.

SOME HEALTH FOOD OPTIONS

First food option.

It is prescribed to patients with reduced reactivity of the body, general hypotension, low-grade fever, with a sluggish course of the disease.

The chemical composition of this diet: proteins 140 g, fats 100 g, carbohydrates 400 g, limiting easily digestible ones.

Calorie content 2700–3000 kcal. Content of ascorbic acid up to 350 mg, vitamin B1 5 g.

Cooking is normal.

Second option.

It is prescribed to patients with increased nervous excitability, low body weight, elevated temperature - up to 30 degrees, without signs of increased tissue breakdown, during the period of attenuation of the process of tuberculosis of the lungs, bones and joints.

Chemical composition of the diet: proteins 110–120 g, fats up to 120 g, carbohydrates 500–550 g. Ascorbic acid content up to 300 mg.

Cooking is normal.

Meals are fractional - 5 times a day.

Third food option.

This option is prescribed during the period of exacerbation of the process with pronounced tissue breakdown, significant inflammatory phenomena occurring with high temperature and exhaustion. In these cases, there is usually increased protein breakdown.

Chemical composition of the diet: proteins 120–140 g, fats 100 g, carbohydrates 400–500 g.

Calorie content 3000–3500 kcal.

Introduction required excess quantity ascorbic acid. The remaining vitamins are recommended within the physiological norm. Calcium up to 2 mg per day. Table salt 8 g. It is advisable to consume a large number of different drinks, raw juices, vegetables and fruits, rich mineral salts and vitamins.

During the period of exacerbation of the disease, appetite often decreases, disorders of the gastrointestinal tract often occur, which must be taken into account when composing the diet.

Culinary processing: all food is prepared pureed.

The diet is split, every 2–3 hours.

NUTRITION FOR PATIENTS WITH TUBERCULOSIS WITH ACCOMPANYING DISORDERS OF THE DIGESTIVE ORGANS

Patients with tuberculosis often experience accompanying illnesses from the digestive organs. Chronic gastritis and colitis often occur in connection with the use of anti-tuberculosis drugs. Gastritis is usually with low acidity. In this case, split meals are recommended with the obligatory exclusion of coarse plant fiber from the diet. Vegetables and fruits are given only in boiled and pureed forms; tough varieties of meat are also given in pureed or minced forms.

If the activity of the liver and biliary system is impaired, foods that cause irritation are excluded from the diet. Prohibited fatty varieties meat and fish, fried dishes, pastry, smoked meats, canned food, marinades, strong tea and coffee.

SAMPLE ONE-DAY MENU FOR TUBERCULOSIS

First option

First breakfast: curd pudding, buckwheat porridge with milk, tea.

Second breakfast: calcined cottage cheese, fruit mousse.

Lunch: broth with dumplings, fried steak with vegetables, apple compote without sugar.

Afternoon snack: soft-boiled egg (1 piece), rosehip decoction.

Dinner: boiled fish, baked with potatoes, carrot puree, tea with lemon without sugar.

It's a disease infectious nature, which is provoked by Koch bacilli or tuberculosis bacilli. Tuberculosis bacteria are very resistant to external factors. They can for a long time survive in soil, humid environments, on contaminated surfaces and are even resistant to disinfectants (for example, the tuberculin bacillus survives on the pages of books for about 4 months).

Methods of penetration of mycobacteria and the causes of tuberculosis

People with weak immune systems are most prone to tuberculosis disease. Most often, infection occurs through airborne droplets, at the moment when the patient coughs, sneezes, speaks, sings, laughs. When communicating healthy person the patient is at high risk of contracting tuberculosis. After all, a person involuntarily inhales and at the same time draws in Koch sticks. Also, tuberculosis can be infected through direct contact: during a kiss, through the use of objects that the patient had previously used.

It is worth noting that mycobacteria of this disease cannot develop outside a living organism, but they retain their abilities for a long time. You can also get sick through eating food from animals with tuberculosis (through milk, meat).

Most often, tuberculosis affects people who have low body resistance to various infections and who have immunodeficiency. People who eat poorly, live in poor conditions, abuse alcohol, and take drugs are also at risk.

Tuberculosis can be caused by taking hormonal drugs, such as the use of corticosteroids, which are used to treat bronchial asthma and other diseases.

Forms of tuberculosis

Tuberculosis should be divided into 2 main forms: pulmonary And extrapulmonary tuberculosis . It is according to these 2 types that it is worth considering the manifestations of the disease.

Tuberculosis may be closed And open form . In the presence of an open form, Koch's bacillus is released with the patient's sputum, which can be easily detected during a routine analysis. A patient with this form of tuberculosis is dangerous to others. As for the closed form, it is difficult to identify. It can only be detected during sowing, when the stick sprouts there.

Symptoms of pulmonary tuberculosis

Pulmonary tuberculosis is the most common type of this disease. It can be distinguished by several characteristics.

Let's start with the main symptoms. Adult patients experience increased fatigue, low performance, constant malaise and weakness in the morning time. In children, pulmonary tuberculosis can manifest itself as bad sleep, decreased appetite, low concentration and difficulties in completing the school curriculum.

As for the general appearance of patients, they are thin, quickly lose weight, pale, and their facial features become sharper.

Next sign- This temperature. Body temperature rises slightly, to 37.5 or 38 degrees Celsius. The temperature fluctuates in the evening or at night, while the person feels very chilly, there is increased secretion sweat. This is the main difference between tuberculosis and bronchitis, pneumonia, and acute respiratory infections. With these listed diseases, the temperature rises sharply to high mark and can also fall rapidly. With tuberculosis, the temperature lasts for long period time.

Presence of cough– unchanging and main symptom pulmonary tuberculosis. In the initial period of the disease, the cough is dry and persistent, mainly disturbing patients at night or in the morning. As the disease progresses, the cough becomes moist, accompanied by big amount sputum. During the pulmonary form of tuberculosis, the cough does not stop. Naturally, with others inflammatory processes There is also a cough, but it is not as long as with tuberculosis.

Spitting blood. This is the most important symptom pulmonary tuberculosis. Blood appears in sputum after severe attacks cough. At neglected form tuberculosis may cause bleeding in the lungs or, as they say, bleeding from the throat. This condition is very life-threatening for the patient, and therefore requires immediate attention to medical professionals.

Depending on the severity and location of the lung lesions, there are: focal, disseminated, miliary, infiltrative, cavernous, cirrhotic, fibrous-cavernous tuberculosis, caseous pneumonia and tuberculoma.

Symptoms of extrapulmonary tuberculosis

The tuberculosis bacillus can affect not only the lungs, but also all other organs. With this type of course it is difficult to determine tuberculosis, because in this case there are many accompanying symptoms, which can be confused with other diseases of individual organs.

Tuberculosis is classified as:

• joints, bones and spine– with this type of tuberculosis, patients note severe pain in the affected areas, limited movement, the presence of pathological, specific fractures;
• brain– such tuberculosis develops within 2 weeks, and most often develops in people with low level immunity (in HIV-infected and diabetic patients). During the first week, the patient's temperature rises, sleep is disturbed, and frequent outbursts of anger and irritability occur. In the second week, severe headaches occur and vomiting occurs. Meninges irritated during the first week. Brain damage manifests itself as tight neck muscles, pain in the back with straightened legs, while pressing the head to the chest, tilting the head in a lying position. Nervous system disorders are observed.
• digestive organs– with this type of tuberculosis, constipation or distress occurs, severe pain in the abdomen, bloating, and there may be intestinal obstruction and bloody discharge in the feces;
• genitourinary system – the tuberculosis bacillus mainly affects the kidneys, while the patient’s temperature rises, his back hurts, and urination occurs along with blood discharge. May also be affected urethra, ureters and bladder. In such cases, urinary retention occurs.
• skin– with this type of tuberculosis, nodules and lumps appear under the skin, which over time increase in size and rupture the skin, releasing a white thick liquid.

Useful foods for tuberculosis

For effective disposal against mycobacteria must be adhered to therapeutic diet, which is aimed at increasing immunity, normalizing weight, appetite, sleep, regenerating damaged tissues and restoring metabolic processes and impaired functions of one or another organ.

Nutrition is prescribed depending on the site of infection, metabolic processes, the weight of the patient, and also, depending on the stage, the form of tuberculosis.

Depending on the patient’s regimen, he is prescribed food with a certain calorie content for each kilogram of weight. For completely bedridden patients, 35 kcal should fall per kilogram; for patients who spend about 6 hours in bed and have short walks 40 kcal required; for active patients (3 hours of lying down during the day plus training and plus participation in the labor process), food should have 45 kcal; but for workers who work from 3-6 hours a day with a break of 2 hours (during working hours) they will already need 50 kcal per 1 kg of body weight. This increased calorie content is explained by the high energy consumption that is lost due to constant feverish conditions.

Due to the fact that with tuberculosis there is an increased breakdown of protein, food must compensate for its deficiency. During normal course disease, per 1 kilogram of body weight you need one and a half grams of protein, and during the period of exacerbation of the disease, protein consumption should reach up to two and a half grams of protein. It should be noted that half of it must be of animal origin. It is better to replenish protein by consuming milk, cottage cheese, fish, meat, and eggs.

To improve the metabolism of the amino acids tryptophan, arginine and phenylalanine, you need to eat foods with these amino acids: feta cheese, hard cheese, cottage cheese, pork and beef liver, chicken, turkey, mushrooms (dried white), squid, soy, cocoa, peas, chum salmon caviar. These amino acids have antibiotic properties.

In addition, the body needs to be saturated with essential fatty acids(you need to eat vegetable fats and butter), vitamins A, B, C, E, calcium (you can get it by eating cottage cheese, cabbage, legumes, lettuce, raisins), phosphorus, magnesium and iron.

With tuberculosis of the digestive tract, the patient needs to eat pureed light soups, weak broths, steamed dishes, porridges, pureed vegetables (pumpkin, carrots, zucchini, potatoes), jelly, jelly, rosehip decoction, juices, non-acidic cottage cheese and non-sharp cheese, cutlets , steamed meatballs.

When the nasopharynx and larynx are affected by the tuberculosis bacillus, it is important that all food is in liquid, ground, mushy form. Uncool is good for consumption mashed potatoes, tea or coffee with milk, just milk, milk porridges, frozen broths and strained jelly.

If joints and bones are affected by tuberculosis, it is necessary to replenish the body with calcium, phosphorus and fish oil.

When spitting blood, you need to equalize water-salt balance, drink jelly, fruit drinks, jelly, tomato juice, water with lemon juice, eat liquid semolina porridge.

In general, patients should eat in a calm, pleasant environment, always in a ventilated room. Meals should be fractional, the number of meals up to 5 times.

In the nutrition of patients with tuberculosis, the diet of table No. 11 is taken as the basis.

Traditional medicine

• In a saucepan with hot milk, add a tablespoon of internal fat of goose, pig and Indian black tea, add 250 grams of dried currants and raspberries, 2 glasses of vodka, a large handful of aloe leaves. Cook for two hours with the lid closed over low heat. After cooking is complete, leave the broth to infuse for an hour, then filter it and add half a liter of honey (it is better to take linden honey, but under no circumstances should you boil it - it will lose its beneficial features and turns into poison). Take one tablespoon of this decoction three times a day before meals (20-30 minutes).
• For tuberculosis, you need to eat pig fat with tea. To do this, grate 200 grams of lard and 3 green apples, place in a bowl and simmer over low heat. At this point you need to beat until white 12

Many doctors predict a new wave of tuberculosis in the near future - the fourth in a row. Doctors have known about the survivability of mycobacteria, or Koch's bacillus, for a long time. Today, not only our country, but the whole world, even the prosperous United States, faces the danger of a tuberculosis epidemic. The tuberculosis outbreak in New York in the early nineties is an example of this...

FOURTH COMING

When antibiotics appeared, many therapists were confident that tuberculosis would soon be defeated. But the harder the mycobacterium was beaten, the more it increased its pathogenicity and, having passed through several weakened and undertreated patients, it transformed beyond recognition. This is how completely new forms (strains) of the tuberculosis pathogen appeared, resistant to certain anti-tuberculosis drugs: some are not sensitive to streptomycin, others to rifampicin, others to several at once medicines- so-called multidrug-resistant. These are the most dangerous strains.

Mycobacterium tuberculosis has truly enormous adaptive capabilities.

Of course, science does not stand still. Thanks to molecular genetic research, there is hope for the creation of completely new means of protection against tuberculosis, for example, immunomodulators.

But for now, tuberculosis is still insidious. Unfortunately, it is difficult and expensive to survey the entire population. Fluorography is very informative: with its help it is possible to identify almost 50–55% of patients. However, the method has disadvantages: in addition to the danger of radiation (although devices have appeared where it is reduced by 100 times), it is a very expensive pleasure: to identify one person infected with tuberculosis, you need to spend about 25 thousand rubles.

In addition, there are cases when, without surgery, it is difficult to understand the truth of the tuberculosis disease. There are so-called pulmonary tuberculomas, which were first studied in our country: having a single focus or even a conglomerate of lesions, a person may not complain of cough, fever, and only sometimes feel weak. There is still a debate about the diagnosis of tuberculoma. It has been proven that among these formations, 20% are lung cancer, 20–25% are progressive tuberculosis. The remaining formations can remain unchanged for years, becoming more active only in old age, when the immune defense “gives up.”

6 QUESTIONS ABOUT TUBERCULOSIS

Can you get tuberculosis through cow's milk?

Approximately one in ten cases of the disease is presented extrapulmonary forms tuberculosis. Mycobacteria can affect any organ human body except hair and nails. Most often, she chooses buds, masquerading as traditional kidney diseases, for example, pyelonephritis. According to statistics, every fourth infertility is associated with damage to the genital area by mycobacterium. They often strike the joints and spine. Phthisiologists-ophthalmologists believe that half of those who are blind for an unknown reason have lost their sight due to ocular tuberculosis.

According to statistics, every fourth infertility is associated with damage to the genital area by mycobacterium.

Extrapulmonary forms of tuberculosis are indeed often contracted through food, especially through the milk of sick cows or goats. So be sure to boil fresh milk. Keep in mind that mycobacteria also thrive in cheese and butter.
The traditional source of tuberculosis infection is also the meat of sick cows, sheep, and chickens. Today, about fifty domestic and wild animals, twenty-five species of birds are known from which one can catch tuberculosis. Boil or fry meat purchased second-hand thoroughly.

Chickens with tuberculosis lay infected eggs. By appearance It is impossible to distinguish them from normal ones. So the most sensible thing is to buy products only in stores or official markets, where they undergo special control.

What to do if, with severe tuberculosis, one lung is completely affected?

Very few medical institutions provide such phthisiosurgical care - for example, in surgical department Central Research Institute of Tuberculosis. Such patients have a lack of oxygen in the blood, a weight loss of 20–50%, and it is clear that the operation is associated with high risk. The effectiveness of such operations is 68–82%, depending on the severity of tuberculosis. Without surgical intervention Unfortunately, about a third of patients die after 7–8 years. Therefore, the sooner you go to the operating table, the greater the chance of defeating tuberculosis.

Who gets tuberculosis more often?

Of course, consumption is least likely to come to a prosperous home, where people have the opportunity to take care of their health, eat well, look to the future without fear - their the immune system crashes much less often. Among the carriers of tuberculosis there are a lot of homeless people, migrants, former prisoners, socially maladjusted individuals - alcoholics, drug addicts.

There is also a hereditary predisposition to consumption: people from the Caucasus, from Central Asia suffer from it much more often than natives of the middle zone.

And, of course, those who, by virtue of their profession, come into contact with a large number people, as well as relatives of tuberculosis patients. Especially the elderly.

How do you get infected with tuberculosis?

The pathogen is transmitted by airborne droplets- through sputum, which is sprayed when coughing, talking, laughing, or, when dried, enters the body, as we have already said, with dust. Symptoms of tuberculosis are cough with sputum, sweating, weight loss, fever, weakness, shortness of breath for more than a month. All these manifestations are serious reason consult a doctor. Remember: recently onset tuberculosis responds well to treatment.

Be sure to undergo fluorography once a year.

Those traveling to the countries of Asia and Africa need to know that tuberculosis is especially rampant in Somalia and India. But in China, for example, everything is fine. And most exact method recognition of tuberculosis - examination of sputum using the bacterioscopic method.

Is the tuberculosis vaccine effective against the disease, and should children have it?

In our country BCG vaccine It is done to all children on the 4th–7th day after birth, at 6–7 years old and 14–15. With the exception of those for whom it is contraindicated, these are approximately 0.5%. BCG saves you from fatal forms of tuberculosis: tuberculous meningitis, cavernous pneumonia and others.

In the USA, children who are in contact with tuberculosis patients are vaccinated with the same vaccine. Many experts believe that BCG is also a preventive measure against cancer. It is used to treat some forms of cancer.

Every year, schools and kindergartens conduct biological testing for tuberculosis. active drug tuberculin - Mantoux test. Parents should know that in many children the skin at the site of tuberculin injection turns red not due to the disease, but due to BCG vaccination. An individual approach is required here, and a competent specialist will correctly “read” the Mantoux test.

Contraindications for the Mantoux test - allergic manifestations, skin diseases, epilepsy, acute infectious diseases and chronic during exacerbation.

Is it dangerous to live in an apartment where a person with tuberculosis once lived?

In an apartment where a patient with tuberculosis lived, especially if he did not comply hygiene requirements, the causative agent of the disease can persist for a long time. But it can be dealt with. Effective way treat the room - preferably before and after renovation - disinfectant, for example, a chloramine solution. You can do this yourself, or you can invite specialists from the regional sanitary and epidemiological station. It's good if this apartment is on the sunny side. sunlight harmful to mycobacteria.

Tuberculosis(Tuberculosis) is an infectious, predominantly chronic disease of many species of agricultural and wild animals, including fur-bearing animals and poultry, characterized by the formation of various organs specific nodules - tubercles, prone to cheesy disintegration.

Pathogen – microorganism of the genus Mycobacterium. There are three main types of the causative agent of tuberculosis: 1) M. tuberculosis (human species); 2) M. bovis (bovine species); 3) M. avium (avian). In terms of morphology and cultural properties, they are largely similar to each other; These are thin, straight, often slightly curved rods 0.8–5.5 µm long, located singly or in groups in smears. Branched, filamentous and coccus-like forms of the microbe are also found. The microbial cell membrane contains fatty wax-like substances, and granularity is noted in the protoplasm.

Mycobacteria are strict aerobes, nonmotile, do not form spores or capsules, acid-alcohol-resistant; are stained bright red using the Beale–Neelsen method, and other microflora are stained blue.

To grow the tuberculosis pathogen, glycerin MPA, MPB, potatoes, egg and synthetic media are used. Cultures grow slowly: human mycobacteria - 20 - 30 days, bovine mycobacteria - 20 - 60, avian - 11 - 15 days. If there is no growth, it is recommended to keep the crops in a thermostat for 3 months.

Pathogenicity of certain types of tuberculosis pathogen for various types animals and humans are not the same. The species of the causative agent of tuberculosis is determined by the characteristics of their growth on artificial nutrient media and by performing a bioassay on guinea pigs, rabbits and chickens.

Sustainability. Mycobacteria are very resistant to various environmental factors and chemicals. This property is explained by the presence of fatty wax substances in the microbial cell. The causative agent of tuberculosis remains viable in manure for 7 months, in dried cow feces for up to a year, in soil for more than two years, in river water for up to 2 months; in meat, frozen and stored in the refrigerator - up to a year, in salted meat - 45 - 60 days, in butter - up to 45, in cheese -. 45 – 100, in milk – up to 10 days. Pasture areas where animals with tuberculosis were grazed remain infected throughout summer period(V.N. Kislenko, 1972).

Heating milk to 70 C kills the tuberculosis pathogen in 10 minutes, and boiling it kills it in 3-5 minutes. The best disinfectants are an alkaline 3% solution of formaldehyde (exposure 1 hour), a suspension of bleach containing 5% active chlorine, a 10% solution of iodine monochloride and a 20% suspension of freshly slaked lime, applied by three times whitewashing with an interval of 1 hour

In addition to the pathogenic mycobacteria of the three named types of the causative agent of tuberculosis (pathogenic mycobacteria), the genus Mycobacterium contains large group atypical mycobacteria. Based on morphological characteristics, they are difficult to distinguish from the causative agent of tuberculosis; they are often represented by coarser, thicker, non-granular rods of different lengths. Atypical mycobacteria are widespread in nature, and many of them are saprophytes. Once in the body of animals, atypical mycobacteria are able to multiply in it, and create short-term sensitization of the body to tuberculin for mammals.

Epizootological data. Many species of domestic and wild animals are susceptible to tuberculosis, including game animals and birds (more than 55 species of mammals and about 25 species of birds). Most often this disease is recorded in large cattle, pigs, minks and chickens; less often - in goats, dogs, ducks and geese; very rarely - in sheep, horses and cats. Monkeys are highly susceptible to tuberculosis. Among wild ungulates, deer are more often affected. Humans also suffer from tuberculosis.

Source The causative agent of the infection is animals with tuberculosis, from whose body the pathogen is excreted in milk, feces, nasal discharge, and sometimes with sperm. When cows are infected with any type of tuberculosis pathogen, mycobacteria are always excreted in the milk.

Transmission factors for the causative agent of tuberculosis can be feed, water, pastures, bedding, manure, etc., contaminated with secretions of sick animals. Young animals are mainly infected through milk and skim milk obtained from sick animals. Intrauterine infection of calves is possible. Animals can become infected with the human species through contact with people with tuberculosis.

The route of infection is predominantly alimentary, but aerogenic is not excluded, especially when patients are kept together with healthy people in closed, poorly ventilated, damp rooms. Tuberculosis spreads relatively slowly among animals. This is explained by the length of the incubation period of the disease (up to 45 days). Inadequate feeding, unsatisfactory living conditions (overcrowding, dampness) and other unfavorable factors reduce the overall resistance of the animal's body and contribute to the rapid spread of the disease. There is no definite seasonality in the manifestation of the epizootic process in tuberculosis. However, in cattle it is more often recorded during the stall period.

Pathogenesis. The causative agent of tuberculosis, having entered the body through digestive tract with food or inhaled air, penetrates the lungs or other organs. At the site of its localization, an inflammatory process develops, manifested by cellular proliferation and exudation; There is an accumulation of multinucleated giant and epithelioid cells surrounded by a dense layer of lymphoid cells. The exudate accumulated between the cells coagulates, forming a network of fibrin, and an avascular tuberculous nodule is formed - tubercle. It initially has a grayish color and a round shape; its size is from the head of a pin to the size of a lentil grain. Soon the nodule is surrounded by a connective tissue capsule. The tissue inside the encapsulated nodule, due to the lack of influx of nutrients and under the influence of pathogen toxins, dies and turns into a dry crumbly mass resembling cottage cheese (caseosis). In a benign course of the disease, the primary focus undergoes calcification, a dense connective tissue capsule forms around it, and further development of the infectious process stops. In an organism with reduced resistance, the process of encapsulation of the pathogen in the primary focus is weakly expressed. Due to insufficient regeneration of connective tissue, the walls of the tuberculous nodule melt, and mycobacteria enter healthy tissue, which leads to the formation of many small, translucent nodules (biliary tuberculosis). Small tubercles can merge with each other, forming large tuberculous foci. Mycobacteria from tuberculosis foci can enter the blood, which leads to the generalization of the process and the development of tuberculosis foci of different sizes in various organs (liver, spleen, kidneys, etc.). With a long course of the disease, large tuberculosis foci and cavities can form in the lungs, sometimes reaching the size of a fist. A dense connective tissue capsule grows around them. Tuberculous cavities can communicate with the lumen of the bronchi. In such cases, their contents liquefy and are released when coughing with sputum.

Course and symptoms. Tuberculosis usually occurs chronically, and often without clearly visible signs. A positive reaction to tuberculin in animals occurs on the 14th – 40th day after their infection (incubation period). Most animals with tuberculosis are no different from healthy ones in appearance and general condition, especially at the onset of the disease. Sick animals are identified mainly by allergic and serological testing; tuberculosis lesions are usually detected only during post-mortem examination of organs. As a result of systematic planned studies of livestock (tuberculinization), it is possible to identify the disease in initial stage. The appearance of clinically pronounced forms of tuberculosis indicates a long course of the disease. Based on the location of the pathological process, pulmonary and intestinal form tuberculosis; There are also lesions of the udder and serous integument (pearl oyster), the genital form and generalized tuberculosis. It is conventionally accepted to distinguish between open (active) tuberculosis, when the causative agent of the disease is released into the external environment with milk, feces, sputum when coughing, and closed (latent) in the presence of encapsulated foci without the release of the pathogen into the external environment. If the intestines, mammary gland, or uterus are affected, the process is always considered open.

In cattle, tuberculosis most often affects the lungs. If they are severely affected, a slight increase in body temperature is observed, rare, but coughing; with a protracted course of the disease, the cough becomes weak, silent, but painful. Expectoration is almost not observed in livestock; the bronchial mucus released during coughing is swallowed or excreted through the nose. In sick animals, shortness of breath, decreased appetite, fatness and productivity are noted. Visible mucous membranes are anemic. Auscultation of the lungs reveals wheezing, and percussion reveals areas of dullness. Intestinal damage, which is accompanied by diarrhea, is accompanied by rapid exhaustion and increasing weakness of the sick animal.

Breast lesion The gland is characterized by an enlargement of the suprauterine lymph nodes, which become dense, lumpy, and inactive. In the affected lobes of the udder, compacted painless foci are felt; with significant damage, the configuration of the affected lobe changes. When milking, watery milk mixed with blood or curdled mass is released. In case of damage to the genital organs In cows, increased sexual heat and barrenness are noted, and in bulls, orchitis. In generalized tuberculosis, superficially located lymph nodes (submandibular, prescapular, knee fold, suprauterine) are inactive. Tuberculosis in pigs is asymptomatic. Sometimes an increase in the submandibular and retropharyngeal lymph nodes is observed. Abscesses may appear in the affected nodes, after opening which a purulent-curdled mass is released. With extensive lung damage, coughing, vomiting, and difficulty breathing occur. Tuberculosis in birds occurs chronically, with unclear clinical signs. The generalized form is accompanied by lethargy, decreased egg production, and exhaustion (atrophy of the pectoral muscles). When the intestines are damaged, diarrhea is observed; liver - icteric staining of the mucous membranes and skin. Lameness and tumor-like formations on the plantar surface of the extremities are sometimes noted.

Among fur-bearing animals(foxes, minks, nutrias) tuberculosis most often affects young animals. Patients experience weakness and progressive exhaustion, with pulmonary form– cough, shortness of breath. Damage to the intestines is accompanied by diarrhea, and the liver is accompanied by icteric staining of the mucous membranes. Foxes sometimes develop long-lasting ulcers on their skin.

Pathological changes. Characteristic of tuberculosis is the presence in different organs and tissues of the animal of specific nodules (tubercles) the size of a millet grain to chicken egg and more. Tuberculous foci are surrounded by a connective tissue capsule, their contents resemble a dry, crumbly, curdled mass (caseous necrosis). With prolonged illness, tuberculous nodules can become calcified. In ruminants, tuberculosis lesions are most often found in the lungs and lymph nodes of the chest cavity. In the lungs, dense, reddish-grayish lesions are found; on section they are shiny, sebaceous (no necrosis), often with caseosis in the center; sometimes the lesions have purulent foci. Occasionally, caverns of various sizes are found (cows, goats). Lymph nodes are most often affected. They are enlarged, dense, lumpy, with caseous tissue disintegration in the center of the node. When the serous integument is affected, multiple (pearl oyster) dense, shiny tuberculous nodules, reaching the size of a hazelnut, are found on the pleura and peritoneum. The intestinal form of tuberculosis is manifested by round ulcers with roller-shaped edges on the mucous membrane of the jejunum and ileum.

Diagnosis. It is placed on the basis of an analysis of epizootic data, clinical signs and the results of allergic, serological (RSC with tuberculosis antigen), pathological, histological, bacteriological and biological studies. The clinical method for diagnosing tuberculosis is of limited value, since the clinical signs of the disease in animals are not typical enough, and at the onset of the disease they are not present at all.

The main method of intravital diagnosis of tuberculosis is an allergic study. For the study, tuberculin (allergen) is used - a sterile filtrate of killed cultures of the causative agent of tuberculosis. We prepare two types of tuberculin: dry purified tuberculin (DPT) for mammals and dry purified tuberculin (DPT) for birds.

Dry purified tuberculin for mammals (protein purified derivative - PPD) consists of freeze-dried precipitated proteins of the cultural filtrate of the causative agent of bovine tuberculosis, grown on a synthetic nutrient medium. It is used for allergic diagnosis of tuberculosis in all mammals.

Dry purified tuberculin (DPT) for birds is similar in appearance and manufacturing technology to DPT for mammals. It is prepared from the cultural filtrate of the causative agent of avian tuberculosis and is used to diagnose tuberculosis in birds and pigs.

Tuberculinization methods. The main method of intravital diagnosis of tuberculosis in animals is allergic testing. tuberculin test. In horses, an eye examination method (ophthalmic test) is used. In some cases, in cattle it is placed simultaneously with intradermal. As an additional method for diagnosing tuberculosis in cattle, a simultaneous allergy test is used, which is carried out simultaneously with purified tuberculin for mammals and a purified complex allergen from atypical mycobacteria (CAM).

Animals are tested for tuberculosis from 2 months of age; breeding stock of cattle, buffaloes and camels - regardless of the period of pregnancy; sheep, goats, pigs, deer (deer), horses and donkeys - no earlier than a month after birth.

Place of injection. With the intradermal method of research, tuberculin is administered to: cattle, buffalos, zebu, deer (deer) in the middle third of the neck; For breeding bulls, it is allowed to inject into the skin of the subcaudal fold, for pigs - in the area of ​​the outer surface of the auricle at a distance of 2 cm from its base (on one side of the auricle, PPD for mammals is injected, on the other, PPD for birds). For pigs aged 2–6 months, it is better to inject tuberculin into the skin of the lumbar region, moving away from the spine by 5–8 cm (tuberculin for mammals is injected on one side, for birds on the other), using a needleless injector of the IBV-01 brand. . For goats, sheep, dogs, monkeys, fur-bearing animals (except minks), tuberculin is injected into the area of ​​the inner thigh; mink – intrapalpebrally into the upper eyelid; camels - in the skin abdominal wall in the groin area at the level of the ischial tuberosity; kuram—in the beard; for turkeys - in the submandibular earring; for geese, ducks - in the submandibular fold; pheasants, peacocks, parrots, pigeons, cranes, herons, storks, flamingos - in the area of ​​the outer surface of the lower leg, 1 - 2 cm above the ankle joint. The fur at the site of tuberculin injection is cut (feathers are plucked), the skin is treated with 70% alcohol.

Accounting and evaluation of reaction . In cattle, buffaloes, zebu, camels and deer, they are carried out 72 hours after administration of the drug; for goats, sheep, pigs, dogs, monkeys, fur-bearing animals - after 48; in birds – after 30–36 hours. Local reaction for tuberculin administration can be assessed as positive or negative.

The reaction is considered positive if a diffuse (without clear boundaries with the surrounding tissue), doughy consistency, painful inflammatory swelling is formed at the site of tuberculin injection, accompanied by hyperemia and an increase in local temperature. In some animals, the reaction manifests itself in the form of a dense, painless, clearly contoured swelling.

Cattle, buffalo, zebu, camels and deer are considered responsive to tuberculin if the above changes are present at the site of tuberculin injection and a thickening of the skin fold of 3 mm or more compared with the thickness of the fold of unchanged skin near the site of tuberculin injection.

Sire bulls tuberculinized in the subcaudal fold are considered to react when an inflammatory swelling forms at the site of tuberculin injection and the skin fold thickens by 2 mm or more.

In goats, sheep, pigs, dogs, monkeys, fur-bearing animals and birds, the reaction is considered positive when a swelling forms at the site of tuberculin injection, and in minks - when the eyelid is swollen.

Tuberculinization by the eye method is carried out twice with an interval of 5–6 days. Tuberculin (3 – 5 drops) is applied with an eye dropper to the conjunctiva lower eyelid or on the cornea of ​​the eye (with a retracted lower eyelid). The reaction is taken into account after the first administration after 6, 9, 12 and 24 hours, after the second - after 3, 6, 9 and 12 hours.

It is considered positive if mucopurulent or purulent secretion occurs from the inner corner of the eye, accompanied by hyperemia and swelling of the conjunctiva.

Allergic testing for animal tuberculosis is allowed to be carried out only by veterinary specialists who have completed a special training course, are proficient in the technique of administering diagnostic drugs and have experience in assessing allergic reactions.

The diagnosis of tuberculosis is considered established: when a culture of the tuberculosis pathogen is isolated or when a positive result of a biological test is obtained. In cattle, in addition, the diagnosis is considered established when pathological changes typical of tuberculosis are detected in the organs or tissues of animals.

When positive results of allergic tests for tuberculosis are obtained, the diagnosis of the disease is carried out by slaughtering 3–5 animals with the most pronounced reactions to tuberculin and examining internal organs, bones and lymph nodes. In the absence of typical changes for tuberculosis, pieces of organs and lymph nodes are selected and sent to a veterinary laboratory for bacteriological examination.

All livestock of the herd, including previously reacting animals, are tested with a simultaneous test with tuberculin for mammals and the KAM allergen. In herds, on farms, in populated areas where the disease has already been established, animals that react to tuberculin are recognized as having tuberculosis.

Immunity. In tuberculosis, it is non-sterile, remaining as long as mycobacteria are in the body. For specific prevention of tuberculosis in young cattle and minks, the dry BCG vaccine (1921 Calmette and Gern), used in medicine, is used. Clinically healthy animals are vaccinated with it.

Prevention and control measures. Measures to combat tuberculosis include the protection of healthy farms from the introduction of the infectious agent from the outside, systematic research in order to timely identify sick animals, the improvement of farms unfavorable for tuberculosis by slaughtering sick animals, the isolated rearing of healthy young animals and the implementation of a set of veterinary, sanitary and organizational and economic measures, aimed at protecting healthy livestock and destroying the causative agent of tuberculosis in the external environment; protecting people from tuberculosis infection.

In order to timely identify animals with tuberculosis and monitor the welfare of farms with regard to this disease, routine diagnostic tests of animals for tuberculosis are carried out annually. Cows, heifers and young cattle from 2 months of age, stud bulls, sows, boars, camels intended for sale for breeding purposes are examined.

Twice a year, cattle from breeding farms and farms supplying animals for stocking livestock complexes, milk and dairy products directly to children's and medical institutions, rest homes or trading network, as well as farms geographically bordering areas unfavorable for tuberculosis. Cattle belonging to citizens living on the territory of these farms are examined simultaneously with the farm livestock.

On breeding pig farms and in reproductive farms, sows are examined before weaning piglets, and boars - 2 times a year. In other farms, sows, boars and, if necessary, young animals from 2 months of age are examined once a year. Monitoring the well-being of poultry and fur farms for tuberculosis is mainly carried out through inspection and pathological examination of dead and killed animals and birds, as well as allergic method. Horses, mules, donkeys and sheep are tested for tuberculosis on farms affected by this disease.

If tuberculosis occurs, the farm (farm) is declared unsafe, quarantine is established and a calendar plan of measures to eliminate the disease is drawn up.

In farms affected by tuberculosis in livestock, buffaloes and reacting animals, they are immediately isolated and slaughtered within 15 days. Young animals born from sick animals are fattened in isolated conditions and sent for slaughter. The remaining animals (not responding to tuberculin) of the unfavorable farm are tested for tuberculosis every 60 days until two negative results are obtained in a row for the group, after which two more control studies are carried out with an interval of 3 months. If negative results are obtained and there are no other indications for tuberculosis, this group of animals is considered healthy.

Calves born from animals from a dysfunctional farm that do not respond to tuberculin are raised in isolation and fed with the milk of healthy cows or neutralized milk (skim milk) of their mothers. At 2 months of age they are examined for tuberculosis using the intradermal method.

Calves that react positively to tuberculin are isolated and after fattening they are slaughtered. Non-responders are examined 2 more times with an interval of 60 days, then after 3 months. Upon receipt for the entire group negative result they are recognized as healthy and used for production purposes only within the farm.

The improvement of farms with significant livestock affected by tuberculosis (more than 25% of animals) is carried out by slaughtering unfavorable livestock.

The success of the fight against tuberculosis largely depends on the activities of farm managers, who are called upon to provide the necessary assistance to veterinary specialists in conducting diagnostic studies, disinfection work, implement a set of preventive measures aimed at creating a high sanitary culture in livestock farming, increasing the natural resistance of the animal body, and equipping veterinary facilities - sanitary purposes, strictly comply with the requirements of the instructions for combating the disease.

In areas disadvantaged by tuberculosis, it is recommended to create special groups(teams) of veterinary specialists to carry out work on mass testing of animals for tuberculosis.

Under the terms of quarantine, it is prohibited to keep animals sick with tuberculosis in herds and in common livestock buildings, as well as the organization of any kind of temporary and permanent concentration points and isolation farms for keeping such animals on farms. In areas unfavorable for tuberculosis in cattle, it is not allowed to create off-farm complexes, farms and other enterprises for raising heifers. In all farms in such areas, on-farm farms (departments, teams, plots) should be organized for the isolated rearing of young animals.

Livestock purchased by farms or consumer cooperation organizations from the population living in the territory of farms (settlements) unfavorable for tuberculosis are subject to immediate delivery for slaughter without fattening and fattening (in transit), regardless of weight standards.

It is prohibited to export undisinfected milk obtained from cows of a dysfunctional farm, farm, herd in a populated area, to milk processing plants, for sale in markets, or for use online. catering etc. Such milk is subject to primary processing directly on the affected farm (on the farm) for the entire time until the disease is completely eliminated and quarantine is lifted. At the same time, milk obtained from cows with clinical manifestations of tuberculosis is prohibited from being used for food purposes and as animal feed. It is disinfected by adding 5% formaldehyde or another disinfectant to the milk. Given this, sick cows should not be milked. Milk from cows that react to tuberculosis during testing is disinfected by processing it into ghee - raw or by boiling.

Dairy products from non-responsive cows of a dysfunctional herd are disinfected at a temperature of 90 C for 5 minutes or at a temperature of 85 C for 30 minutes.

Dairy enterprises must release skim milk to farms only after it has been disinfected by pasteurization or heat treatment with live steam.

In specialized complexes, on farms for raising heifers (heifers), when a disease is detected in young animals of the technological (age) group in which patients are identified, all heifers of this group are slaughtered within 30 days, the rest of the animal population of the complex, farm - within 6 days. months (no more). Insemination of heifers is prohibited. During the period of recovery, the introduction of heifers from supplying farms into the complex, onto the farm, is stopped, and in the future, recruiting them as off-farm enterprises for raising heifers with new livestock is not allowed.

At beef production complexes and other fattening farms, when tuberculosis is diagnosed, all animals in the disadvantaged group are branded with the letter “T” and slaughtered within 15 days. The remaining livestock is examined every 60 days for tuberculosis using the allergic method or the issue of selling all the animals of the complex (farm) for meat is decided.

When infection of cattle with the causative agent of avian tuberculosis or atypical mycobacteria is established, and also when animals that react to tuberculin are detected in a free herd (on a farm), but tuberculosis has not been established in them by previous studies, the herd (farm) is considered free from tuberculosis.