Tuberculosis
see also:
Description:
Tuberculosis is known from an extreme antiquity and still represents an important medical and social problem. Annually in the world of 8 million people get sick, and 3 million - die of tuberculosis. The size of a pandemic is so big that in 1993 WHO announced tuberculosis a problem of "great danger". In recent years around the world incidence of tuberculosis increased. Main reasons for increase in incidence: the decrease in the standard of living of the population which entailed deterioration of food; the increased population shift from epidemic unsuccessful areas, reduction of scales and quality of carrying out a complex of antitubercular actions and emergence of steady strains in specific therapy. To reduce sharpness of a problem, WHO defined as the main components of the program of fight against this disease active identification of patients and immunization against tuberculosis.
Tuberculosis symptoms:
According to the existing classification of 1973 accepted at the VIII All-Union congress of phthisiatricians allocate 3 groups of the main clinical forms of tuberculosis.
* Group I. Tubercular intoxication at children and teenagers.
* Group II. Tuberculosis of a respiratory organs (primary tubercular complex, tuberculosis of intrathoracic lymph nodes, the disseminated pulmonary tuberculosis, a focal pulmonary tuberculosis, other forms).
* Group III. Tuberculosis of other bodies and systems (meningeal tuberculosis and TsNS, tuberculosis of bones and joints, tuberculosis of uric and generative organs, intestines tuberculosis, other forms).
The clinical picture of tuberculosis depends on the place of implementation of mycobacteria, a phase of pathological process, existence of complications. The disease develops slowly, can proceed long, sometimes decades.
At children and teenagers reveal primary tuberculosis arising at infection with tuberculosis mycobacteria of earlier not infected organism more often. Among all forms of primary tuberculosis tuberculosis of intrathoracic lymph nodes prevails, diagnose tubercular intoxication, primary tubercular complex, pleurisy less often, etc. Most often at tuberculosis at children lungs are surprised (85,3% among local forms of tuberculosis). Extra pulmonary forms result from hematogenous dissimination of an infection from primary center. Intoxication symptoms prevail, signs of a local inflammation are expressed less. The condition of a hyper sensitization which is shown paraspecific reactions is characteristic. The sick child is younger, the probability of development of severe local and generalized forms of tuberculosis is higher. The most frequent or severe clinical forms of tuberculosis at children are given below.
Tuberculosis reasons:
Tuberculosis in the person is caused by mycobacteria: in 92% of cases - Mycobacterium tuberculosis, in other cases - M. bovis (the look causing tuberculosis in cattle and the person). tuberculosis m - motionless thin sticks, aerobes. Kislotoustoychiva, the special technique is necessary for their coloring (according to Tsilyu-Nielsen). The activator can breed as in macrophages, and vnekletochno. Sticks are steady in external environment: on pages of books 3-4 months, in street dust - 10 days, in water - about one year, in the frozen state - decades remain. At Ural federal district and boiling perish within several minutes. Slowly grow on classical mediums - note emergence of the first colonies in 4-8 weeks.
Treatment of Tuberculosis:
Treatment is carried out by the phthisiatrician together with the pediatrician and doctors of other specialties (the urologist, the oculist, the neurologist, the orthopedist, etc.). A treatment basis - etiotropic chemotherapy. It is carried out taking into account age of the child, his anatomo-physiological features, by forms and activities of tubercular process. Special attention is paid by the organizations of the mode, to food, an exercise stress. Treatment of TB patients is performed it is long (6-18 months), step by step (a hospital-sanatorium-antitubercular clinic).
The chemotherapy is begun immediately after establishment of the diagnosis, out it is long and is continuous. Usually appoint a combination from 2 and more medicines. Antitubercular drugs classify depending on their efficiency.
* The I group (maximum efficiency) - an isoniazid and rifampicin.
* The II group (average efficiency) - streptomycin, Kanamycinum, biomycin (a florimitsina sulfate), Ethambutolum, Etioniamidum, Prothionamidum, Pyrazinamidum.
* The III group (moderate efficiency) - aminosalicylic acid (sodium para-aminosalicylate).
Medicinal antitubercular drugs possess many side effects therefore are necessary strict observance of the mode of use of drug, prevention of side effects (for example, purpose of vitamins of group B, especially B6 vitamin). It is also necessary to follow the following rules of carrying out chemotherapy.
* It is impossible to use less than two effective antitubercular drugs.
* At active process appoint three drugs (an isoniazid, rifampicin and Pyrazinamidum) within 2 months, then two drugs (an isoniazid and rifampicin) within 6 months (in pediatric practice - 4 months).
* At severe forms at any age appoint four drugs within the first 2-3 months.
* Daily reception of an isoniazid and rifampicin within 9-12 months is most effective (the positive effect is noted in 99% of cases).
* At a bend of tuberkulinovy tests at the child (even in the absence of symptoms of intoxication and local changes) carry out 3-month prevention by an isoniazid.
