Tuberculosis

  
Medical College №7 
Department of Health City of Moscow  
 
 

 

 

 

"Tuberculosis".

 

 

 

 

Author: Zadorozhnaya C.A

 

State educational institution

 

secondary vocational education

Tuberculosis - a chronic disease characterized by systemic lesions, severe complications and high mortality, etc.

Exciter

 

Pathogen opened by Robert Koch in 1882, now known as mycobacterium. Mycobacterium is a curved rod, with rounded, curved edges, covered with a waxy shell.

Types of mycobacteria:

• Humanine
• Bovine
•   Avian.

Most often the disease causes of human-like mycobacterium.

Mycobacteria long time stored in the external environment and in dairy products. Very sensitive to sunlight (dies within a 1.5-2h).

Pathogenesis

 

•   From the entrance gate of the disease is limfogematogennaya dissemination throughout the body, concentrating in the development of lymphatic tissue inflammation mikrospetsificheskogo - this zone caseation surrounded by a zone of perifocal reaction. Also, there is reactive inflammation and the development of immune-allergic inflammation. The hearth is exposed resorption caseation or encapsulation with subsequent calcification. Inside are preserved Mycobacterium tuberculosis and, under certain conditions is possible to output.
• The next step - the formation of a primary tuberculous complex, it can be detected with modern diagnostic methods. Exodus - resorption, encapsulation.

 

Tuberculosis infection

 

The main source of tuberculosis infection is a sick child at age 10 and older. Sometimes become a source of sick animals or birds. The mechanism of transmission of tuberculosis and the most common route of infection - aerogenic (in air). While breathing in the human respiratory tract mucus droplets fall and dust containing mycobacteria.

There are other possible modes of transmission, namely:

- nutritional (of food, mainly milk and meat of sick animals)

- contact-household (through care and household items - towels, toothbrushes)

- contact (via broken skin)

Major role in the occurrence of tuberculosis in children has decreased immunity, as well as the following factors:- неблагоприятные условия жизни

- adverse climatic conditions (humidity)

-supercooling

- immunosuppression

- frequent upper respiratory tract infection

Seasonality of tuberculosis, as well as for other infectious diseases, is not typical.

Risk Groups

 

• People of no fixed abode
• Prisoners
• Addicts, prostitutes, alcoholics
• migrants (military families, refugees, builders, etc.).
• People serving prison camp.
• Members of lone-parent families.
• The clergy and the faithful.
• Health-care workers.

The clinical picture

 

The incubation period of 3-12 weeks.

The disease develops slowly and can last a long time, sometimes decades.

It depends on:

• Places of introduction of Mycobacterium;
• The phases of the pathological process;
• Presence of complications.

 

 

Children and adolescents often reveal the primary disease that occurs during infection with Mycobacterium tuberculosis previously uninfected body. Among all forms of primary tuberculosis prevalent tuberculosis of intrathoracic lymph nodes, less commonly diagnosed tuberculous intoxication and primary tuberculous complex, pleurisy, etc. Most children with tuberculosis in lungs (85.3% of local forms of tuberculosis). Extrapulmonary forms occur as a result of hematogenous dissemination of infection from the primary tumor. The predominant symptoms of intoxication, signs of local inflammation are less pronounced. Characteristically gipersensibilizatsii state, manifested paraspetsificheskimi reactions. The younger the child is sick, the higher the probability of severe local and generalized forms of tuberculosis.

Tuberculous  intoxication  in  children and adolescents

 

The clinic of tuberculosis intoxication distinguish two periods - the early and chronic.  
 

Early tuberculous intoxication

 

 

• Symptoms of early tuberculous intoxication manifested in:
• disequilibrium of the nervous system (irritability, excitability, lowering of attention, sleep disorders and headaches);
• loss of appetite;
• pale skin;
• intermittent (small) low-grade fever;
• some external swelling of lymph nodes.

In lean children it is easy to test the enlarged liver and spleen.

May be indigestion: relief of bowel or constipation

 

 

Erythema nodosum (erythema)

 

 

Her appearance is preceded by high fever, a few days after that, mostly on the front of the leg, there are dense infiltrates, hot to the touch, very painful, red, with tsianoticheskim shade. Most often, erythema occurs in preschool and primary school children, being allergic, paraspetsificheskoy reaction, rather than tuberculous lesions of the skin.

Chronic tuberculous intoxication in children and adolescents.

 

In chronic tuberculous intoxication characteristic features are:

 

 

•  lag in the development of the child;
• pallor;
• mikropoliadeniya (6.9 palpable enlarged lymph nodes of groups - from stones to elastic consistency);

 

In contrast to early tuberculous intoxication, chronic intoxication symptoms are all the brighter and more firmly hold:

 

• Sharply decreased appetite;
•  Reduction of turgor in all tissues, skin, subcutaneous tissue;
•  there is a slight intermittent fever, varying from 37 * with up to 37.5 * C.

The reaction of a sick child to the noisy games, hobbies, communication with children changed dramatically. Typically, children get tired quickly, and tend to retire, that is not peculiar to childhood, often laid to sleep early. School children are scattered.

 

Diagnosis of tuberculosis intoxication in children.

 

The diagnosis of tuberculosis intoxication is set on the basis of:

• data tubirkulinodiagnostiki(positive, growing in the process of observation and hyperergic reaction to tuberculin)
• clinical signs of disease (in the absence of local manifestations, defined radiographic studies and other methods),
• after testing in the specialized TB institutions.

Primary tuberculous complex

 

Asymptomatic (before the onset of complications) and can be detected only by radiological examination. In these cases reveal the plot shadowing in the lung, enlarged lymph nodes of the root and their relation to "track", formed by the shadow of the vessels and bronchi.

Symptoms

Symptoms of intoxication: low-grade fever, deterioration of general condition, loss of appetite, decrease in body weight, weakness or stimulation of the nervous system. Sometimes there sweating, poor sleep;

• bitonal cough, that is, cough of two tones (called bronchial compression increased in the amount of lymph nodes containing caseous masses);
• rapidly increases the volume of the bifurcation of the lymph nodes, and the accumulation in them and extensive perifocal kazeoza reactions may occur phenomena asthma (young children);
• On the radiograph: increase in the shadow of light in all leads.

 

 

Tuberculous bronhoadenit

The outcome of tuberculous bronhoadenita.

 

Under the influence of the treatment process is resumed after 6-18 months. Often develops calcification of lymph nodes, in which the bacilli can persist and cause aggravation.

Treatment  

 

• In the initial phase: intensive therapy (2 months); The second phase: 4-6 months
• Preparations: rimfampitsin; entambutol;
• Insulation exposed to smear-positive patients;
• Proper organization of the regime: widespread use of air and light; alternation of rest and motion, high power (exceeding the age norm of 10% -15%);
• Kymyz treatment.

Prophylaxis

 

• Specific: BCG vaccination, at the site of injection forms a scar;
• Chemoprophylaxis: carried out to children who are in contact with TB patients and children with "bends" tuberculin tests;
• Nonspecific: health-building activities aimed at strengthening the body resistance (sports, zakalianie).