In developed countries, the goal is to eliminate tuberculosis. It was proposed to consider tuberculosis in fact eliminated when no more than 1% of students 13-14 years old is a positive reaction to tuberculin. Now, when so much has become known about non-specific sensitivity to Tuberculin, this goal is much more difficult to determine and it is necessary to change it, indicating that no more than 1% of these students should be with a positive reaction, which is possibly related to infection with mammalian tuberculosis infection.

Now we undoubtedly have methods for the elimination of tuberculosis, but the pace of liquidation will depend on the means and effort that society is as a whole going to send it, and the numbers of people who will conduct this work. The main activities are as follows:
1) The fight against infection transmitted through the cow's milk, the method of pasteurization and the creation of tuberculin negative studs.

2) Effective treatment for disinfecting contagious or potentially infectious patients.

3) identifying all infectious or potentially contagious persons, mainly by fluorography.

4) BCG vaccination.

Success depends on: 1) the provision by prepared by clinicians, health care organizers and bacterioles and relevant opportunities, 2) reasonable use of the possibilities of mass fluorography, 3) of an effective organization in close cooperation of the preventive and therapeutic service, 4) effective public participation to attract the entire population. The brigade work method is very important for this - an individual approach leads only to partial success.

The basis of the diagnostic and therapeutic service should be the dispensary or the pulmonary branch of the general hospital. It is highly desirable that one and the same brigade worked with patients with hospitalized and outpatient. Effective notification system is important. Since the pulmonary service in most developed countries is engaged in in addition to tuberculosis, and other diseases, there are less danger of errors, if all particularly infectious cases, i.e., with radiologically explicit caverns or positive wet bacterioscopy, are hospitalized at least to abacliring sputum , installed by bacterioscopy, but preferably to negative sowing results. New cases of the disease, not similar to infectious, can be treated, continuing to work without any violations of life, but it takes a very careful observation to confidence that the treatment is carried out completely. The patient's cooperation should be provided with personal interest and the right system of medical and social services. There must be appropriate financial assistance to those with their families and their families and appropriate services for children if Mother sick.

WARNING "Resistance" of the patient. Located in home contact with patients, regardless of their age, must be examined. In many developed countries, tuberculin testing may be desirable in all ages, tuberculin negative should be vaccinated. In England, tuberculin negatives are often examined again after 6 weeks in case, if at the first sample they were in the incubation period. If the reaction remains negative, vaccination is produced. This latent period is used mainly to protect the reputation of the BCG. It is possible that without it, it is possible to do without it, and with a negative tuberculin reaction to vaccinate immediately. Tuberculin sample should be repeated 3 months after vaccination. With a sharply positive reaction, it can be suspected that this face was in the incubation period at the first sample, and a radiographic examination is necessary. Children from a touch with a negative tuberculin reaction at the beginning should not be examined x-ray, unlike tuberculin-positive. In the presence of possibilities, X-ray examination should be repeated in 3-6 months. Then, if the source of the infection is subjected to adequate treatment, there are no grounds for further surveys. If this face is from a contact with "non-controlling" patients who are not affected by adequate treatment, it should be checked after 3-6 months.

The decision on the need to examine those in contact for work is better to be made individually, depending on the probability of infectivity of the patient or data on more than one disease in the same place of work. It is very useful to keep a list of all disease notions at the place of work. If cases of the disease are numerous, all efforts should be made to organize fluorography of all working. Also, notifications should be classified at the place of residence and with a high indicator of notices in any area it is necessary to carry out activities of a local activity.

Further events. With proper treatment, most patients return to the former work if the extensive lungal damage does not lead to respiratory failure, which prevents severe physical work. Rehabilitation service, important with ineffective treatment, is now hardly required when tuberculosis.

Collective warning measures. The defense of the members of the team from tuberculosis increases with an increase in the overall economic level and social progress, with an increase in the level of sanitary enlightenment. Protective forces, in particular, increase BCG vaccination from ending school, contacts and special risk groups. Infection can be warned when monitoring milk and the corresponding detection program. The latter prevent preventive services to which great requirements are presented. Will the chemoprophylaxis place in their future, is still unknown.

Tuberculosis - The disease, with which humanity is fighting for several centuries. One of the most important steps in this struggle was made in 1882, on March 24, when R. Koh allocated in the clean culture of the causative agent of this disease - tuberculous mycobacterium. The results of his work became the key to understanding the infectious nature of pathology. As a result, opportunities have opened for high-quality diagnosis, and hence the treatment of the disease. It is to this date that the World Tuberculosis Day, celebrated since 1982, is confined.

White chamomile - a symbol associated with this day. Simple, but elegant flower is associated with healthy and pure breathing. Long before the allegations of the World Day of Combating Tuberculosis, at the junction of the 19th and 20th centuries, an event that came to the chamomile, a symbolic meaning occurred in Geneva. Young people, boys and girls went to the streets of the city to collect donations in favor of patients with terrible, especially for those times, the disease. In their hands they had shields, covered with white daisies. Later, such events acquired popularity in other cities in Europe, attracting the attention of society to the problem. The campaign with the name of the flower was carried out in Russia in 1911.

Since the day, measures to combat tuberculosis increased every year, due to which it was possible to reduce the overall global incidence on this pathology.

The first tuberculosis vaccine was developed in 1919, applied to prevent the disease in children in 1921. The first tangible successes in the treatment of pathology were noticeable during the Second World War, when streptomycin was synthesized. This discovery laid the foundation for the development of medicinal therapy, which went far ahead with time. Unfortunately, even today the recovery is sometimes quite difficult to achieve.

The World Health Organization has extended its activities on the problem of tuberculosis after the end of World War II. It is WHO belongs to the initiative to celebrate World Tuberculosis Day.

In 1993, the World Health Association invited DOTS strategy. The essence of the program in strictly observed therapy with short chemotherapy courses. It includes the principles of support from the governments of countries, early diagnosis by microscopy, uninterrupted delivery of medicines, continuously monitoring the results of treatment. DOTS also does not allow the spread of the epidemic, as it allows you to quickly identify and isolate contagious patients.

Description of the disease

The disease arises as a result of a combination of two factors: the presence of an infectious agent, which protrudes the koche stick, and the reduced resistance to the human body. The state of the immune response is the poor sanitary and hygienic conditions of residence, constant malnutrition, frequent hypothermia, excessive human told.

As for the causative agent of the disease, mycobacterium is extremely resistant to aggressive impacts of the external environment. In dust on the street, for example, bacterium is viable for 2 months. Boiling required for at least 5 minutes to disinfect things in contact with the patient's wet. Censitive bacterium to chlorine and its compounds, as well as to hydrogen peroxide.
Fortunately, contact with infection leads to infection only in 1 out of 10 cases.

Infection occurs most often with airborne droplets. During the conversation, laughter, as well as when coughing, the patient highlights the smallest particles of infected sputum, capable of twist in the room for several hours. When inhalation of such air, bacteria settle in alveoli and there are multiplied, forming an inflammatory hearth. Mycobacteria multiply slowly, but continuously, hitting all new organs through lymphatic vessels. It is also possible to infect the use of milk of patients of animals, and the intrauterine path. These paths of infection are relatively rare.

Man alert should appear characteristic symptoms of the disease: cough, not stopped by weeks, pain in the chest, a decrease in body weight without visible causes, sweating, especially at night.
The peculiarity of tuberculosis is the possibility of relapses. That is even cured, with a decrease in the protective forces of the body, he may return.

Prevention

Like any disease, tuberculosis is easier to prevent than to treat. In strengthening the prevention and awareness of the population and there is one of the main objectives of the Day of Combating Tuberculosis.

There are general prevention measures suitable not only for tuberculosis, but also for many other infectious diseases. These include such simple events as a restriction of contact with sick people, ventilating premises, ensuring a high level of natural illumination in the room, washing the hands before taking food. The strengthening of the body is also a good measure of the prevention of tuberculosis. It is advisable to be balanced food, sufficient physical exertion, outdoor walks.

As a specific prophylaxis measure, the BCG vaccine is used. It is alive, but weakened mycobacteria. For the immunization of children, the vaccination is made by 5-7 days of life. For the formation of immunity against tuberculosis, approximately 2 months is required. Repeat a vaccine in 7 and 14 years. Stressful immunity after vaccination is preserved for 7 years.

The identification of pathological changes in the early, not yet noticeable stages, also belong to the measures to combat tuberculosis. The key role here is allocated to radiation methods of research - radiography and fluorography. That is why it is better not to neglect the possibility of checking your condition, even if a person does not notice deterioration in well-being.

In service with doctors, there is a method of express diagnostics, known almost to all since childhood. The tuberculin test or manta test can demonstrate increased sensitivity to tuberculosis causative agents. Hypersensitivity may occur as a result of contact with koche stick. But there are other reasons that cause a positive reaction Mantu.

A special place is given to microbiological diagnostics. The essence of the method is to search for microorganisms in the patient's wet. The collected material is placed in conditions close to the ideal for reproduction of bacteria. The thermostat maintains the same temperature, a special nutrient medium is used. Unfortunately, for the growth of colonies, several weeks are required, and the microorganisms themselves in artificial conditions are cultivated poorly.

Results of struggle

World Tuberculosis Day is part of a large strategy aimed at reducing morbidity and mortality from this disease. In 2006, the target for 10 years to reduce the mortality from tuberculosis by 2 times worldwide. In many countries, this goal has been achieved.

Early diagnosis, fast insulation of infectious patients and timely treatment gave tangible results in the form of deaths of 43 million patients with tuberculosis and warned thousands of new infection cases.

World Tuberculosis Day plays a last role in the results obtained, because the main goal of the event is to attract the attention of each person to the problem. Any diagnosis and most advanced drugs are powerless to keep the epidemic, if humanity remains illiterate and indifferent. If at least once a year, every person will remember the problem, at the right moment it will turn to the doctor, will not neglect the methods of early diagnosis, and will save himself and his loved ones.

Moreover, the day of the fight against a socially significant disease, tuberculosis, gives a chance to take part in the help of ill, which also brings the whole world to the main goal - to get rid of tuberculosis.

7.1. The history of the development of the phthisiatric service and the basis of the ethical and legal struggle with tuberculosis in Russia

In Russia until 1917, state policy towards tuberculosis was practically absent and existed only in a charitable form. After the October Revolution (1917), the organization of the fight against tuberculosis was translated from a charitable for the state basis. When drug addresses (Ministry of Health), the RSFSR approved a section to combat tuberculosis. Gradually received the development of a new medical specialty "Phthisiatry". As a result of social transformations and extensive conducting tuberculosis measures by the end of the 30s. The past century incidence and mortality from tuberculosis in the country decreased sharply.

During the Great Patriotic War (1941-1945), the incidence of tuberculosis increased. The measures taken by the state were aimed at combating tuberculosis due to the mass evacuation of the population from the occupied territories and mobilizing into the army of phthisiators. In 1943, a government decree "On Tuberculosis Combating Events" was adopted, which provided for the deployment of new tuberculosis hospitals, night sanatoriums at enterprises, children's sanatorium gardens, forest schools.

In the post-war years, the anti-tuberculous service in the country continued to be improved. By the beginning of 1948, the number of tuberculosis institutions exceeded the pre-war level. Tuberculosis patients received not only the right to long-term free treatment, but also housing and other benefits.

Reducing the frequency of new cases of tuberculosis and mortality, lasting up to the 90s. last century, witness

twists about the theoretical and practical substantiation of methods of combating tuberculosis in the USSR.

Socio-economic changes in the early 1990s. Russia was accompanied by insufficient financing of health authorities, forced migration and worsening social protection of the population. In the aggregate, the factors called the growth of all epidemiological indicators on tuberculosis and made them the same as they were in the 60s of the last century. This once again indicates that tuberculosis is not just an infectious disease, but a complex socialobiological phenomenon associated with a decrease in living standards, military conflicts, deprivation of people of social guarantees.

At the same time, the presence of a well-organized phthisiatric service in Russia even with insufficient financing, under all adverse conditions did not give tuberculosis everywhere.

Ethical and legal foundations of the fight against tuberculosis

In the Russian Federation there are several basic regulatory documents governing the relationship between patient with tuberculosis and the state:

1. Constitution of the Russian Federation.

2. Fundamentals of the Russian Federation on the protection of the health of citizens (? 5487-1 of July 22, 1993).

3. Law of the RSFSR "On the Sanitary and Epidemiological Welfare of the Population" (1991).

4. Law of the Russian Federation "On Prevention of Tuberculosis Dissemination in the Russian Federation" of June 18, 2001? 77-FZ.

Law of the Russian Federation "On the prevention of the spread of tuberculosis in the Russian Federation"? 77 of 2001 establishes the legal framework for the implementation of public policy in the field of preventing the spread of tuberculosis in the Russian Federation in order to protect the health of citizens and ensure the sanitary and epidemiological well-being of the population.

As follows from the definitions of the law, anti-tuberculosis assistance is a combination of social, medical, sanitary and hygienic and anti-epidemic measures aimed at identifying, examination and treatment, including

mandatory examination and treatment, dispensary observation and rehabilitation of patients with tuberculosis.

The provisions of this Law apply to citizens of the Russian Federation when providing them with anti-tuberculosis assistance and apply to legal entities and individuals providing anti-tuberculous assistance in the territory of the Russian Federation. Foreign citizens and stateless persons also receive anti-tuberculosis assistance in accordance with this law.

The provision of anti-tuberculosis assistance to patients with tuberculosis is guaranteed by the state and is carried out on the basis of the principles of legality, respect for human rights and citizen, free, sharedness.

Anti-tuberculosis assistance is to citizens with their voluntary circulation or with their consent. At the same time, the dispensary observation of patients with tuberculosis is established regardless of the consent of such patients or their legal representatives.

Patients with infectious tuberculosis, repeatedly violating the sanitary and anti-epidemic regime, as well as deliberately evading the survey, on the basis of court decisions are hospitalized into specialized medical anti-tuberculosis institutions for compulsory surveys and treatment.

Heads of medical organizations and citizens involved in private medical activities are obliged to inform the relevant authorities about the patients with tuberculosis identified in the subordinate territories and each exemption from the institutions of the penitentiary system with patient with tuberculosis.

Tuberculosis patients who need anti-tuberculosis assistance are obtained in medical anti-tuberculosis organizations that have relevant licenses.

Persons under dispensary observation in connection with tuberculosis disease, when providing them with anti-tuberculosis assistance, are entitled to:

1) respectful and humane attitude;

2) obtaining information on the rights and obligations of patients with tuberculosis, about the nature of their diseases and applied methods of treatment;

3) preservation of medical mystery;

4) diagnosis and treatment;

5) Sanatorium-resort treatment;

6) Stay in medical anti-tuberculosis organizations, hospitals during the period necessary for examination and (or) treatment.

Persons under dispensary observationin connection with tuberculosis, obliged to perform:

1) Medical professionals assigned medical events;

2) the rules of the internal regulation of medical anti-tuberculosis organizations;

3) sanitary and hygienic rules mounted for tuberculosis patients in public places.

For citizens, temporarily invalidably bred due to tuberculosis disease, save place of work(position) for the period established by the legislation of the Russian Federation.

During the removal from work (positions) patients with tuberculosis public Social Insurance benefits are issuedin accordance with the legislation of the Russian Federation.

Persons under dispensary observation in connection with the disease are provided by drugs for the treatment of tuberculosis for free. Patients with infectious tuberculosis have the right to improve housing conditionsgiven the decline in epidemiological hazard for others and additional living space in accordance with the legislation of the Russian Federation.

Medical, veterinary and other workers directly involved in the provision of anti-tuberculosis assistance have the right:

1) for additional paid vacation;

2) abbreviated working week;

3) additional labor payment due to harmful working conditions (danger of infection with tuberculosis mycobacteria);

4) Providing first-priority trips for sanatorium-resort treatment in the event of tuberculosis as a result of official duties.

Violation of the legislation of the Russian Federation in the field of preventing the propagation of tuberculosis entails disciplinary, civil, legal, administrative and criminal liability in accordance with the legislation.

7.2. Anti-tuberculosis dispensaries

The activities of the anti-tuberculous (phthisiatric) service are determined by regulatory documents (orders, methodological instructions, instructions, etc.) approved by the Ministry of Health of the Russian Federation. Orders and other documents are developed on the basis of the existing laws of the Russian Federation, are documents specifying the activities of the anti-tuberculous service when providing medical care to patients with tuberculosis within the existing laws.

The anti-tuberculosis service consists of a network of state, specialized, independent medical institutions, the main task of which is the fight against tuberculosis. The headquarters of this network is the anti-tuberculous dispensary.

The anti-tuberculosis dispensary manages all therapeutic and preventive institutions that ensure the fight against tuberculosis. Dispensaries are organized by territorial principle. In small cities there is one dispensary. In major cities, one dispensary serves one or two areas with a population from 200,000 to 400,000 people. The dispensary provides therapeutic and diagnostic assistance of residents, as well as all workers and employees of enterprises, institutions, educational institutions located in the district.

The main goal of the dispensary- systematic decrease in the incidence, prevalence, infection with tuberculosis and mortality from it among the population of the service area.

To achieve this goal employees of the dispensary should study their area wellin sanitary, socio-economic, to have close contact with all therapeutic and preventive and sanitary institutions.

Each anti-tuberculous dispensary within its territory ensures the functioning of a centralized control system, which is based on two principles:

1) the unification of measures to identify, diagnose and the treatment of tuberculosis in accordance with the instructions for the organization of dispensary observation and accounting of contingents of anti-tuberculosis institutions;

2) differentiation of these measures, allowing you to develop an individual monitoring scheme of each patient in

urban and rural areas depending on the geographical and economic features, the state of communications, the features of life and other social conditions, the nature of the tuberculosis process, etc.

The main tasks of the dispensary are:

1. Organization and conduct of preventive measures.

1.1. Anti-tuberculosis BCG vaccination and revaccination.

1.2. Healing of tuberculous foci through timely and long-term hospitalization of bacyl separators.

1.3. Improving housing conditions of patients representing epidemiological danger to others.

1.4. Conducting chemoprophylaxis in the foci of tuberculosis infection.

1.5. The direction of infected children into health facilities (tuberculosis sanatoriums).

1.6. Sanitary and educational work with the population.

2. Detection of patients with early symptoms of tuberculosis disease.

3. Organization and conducting a qualified and continuity treatment of patients with tuberculosis in outpatient and stationary conditions to achieve clinical cure.

4. Dissemination of knowledge about tuberculosis among doctors and medium medical staff of therapeutic and preventive institutions of the district.

The structure of the dispensary.The dispensary must have the following compartments and offices:

1. Therapeutic departments (outpatient and clinical) for servicing adults, patients with tuberculosis.

2. Children's office in which children are serviced from 3 to 15 years.

3. Cabinet of bone-joint tuberculosis.

4. Bronchological office.

5. X-ray Cabinet.

6. Laboratories: clinical, microbiological.

7. Procedural Cabinet.

8. Dental Cabinet (in large dispensaries).

9. Fluorographic station.

10. Day tuberculosis hospital.

Emaging Surgical Helpin the Russian Federation is provided in large tuberculosis hospitals, where pulmonary surgical departments are created equipped with appropriate equipment.

With each dispensary where the hospital is available, it is recommended to organize labor workshops,in which patients with disability could be dispensed under the guidance of an instructor or acquire a new specialty corresponding to their physical condition.

Organization of medical care.There is no open reception in the dispensaries. In case of suspected tuberculosis, the patient falls into the dispensary from the district polyclinic in the direction of the therapist, the surgeon, the neuropathologist, pediatrician, school doctor or the medical doctor of health care.

Fluorographyit is a way of mass, rapid and cheap surveys of the chest organs among large groups of the population. When changes in the lungs, the fluorographic office sends patients to diagnose into a dispensary. Early disease recognition is possible only with a vigorous preventive examination of healthy people.

7.3. Dispensary groups of patients

Tuberculosis

When the patient is diagnosed with tuberculosis, it is taken by a dispensary for control:

With reversibility to clinical cure;

With irreversibility - until the end of life.

Grouping of dispensary contingentsbased on the hospitalEpidemiological principle and allows the Plotical Phtisirate doctor:

1) correctly form monitoring groups;

2) to raise them in a timely manner;

3) to determine therapeutic tactics;

4) conduct rehabilitation and preventive measures;

5) remove from dispensary observation.

The specific grouping of dispensary contingents is constantly revised and approved by the Ministry of Health of the Russian Federation.

Zero group - (0).

In the zero group, there are persons:

1) with the unspecified activity of the tuberculosis process;

2) in need of differential diagnostics, in order to establish a diagnosis of tuberculosis of any localization;

3) who need to clarify the activity of tuberculosis changes, they are credited to the zero - a - subgroup (0-A);

4) for the differential diagnosis of tuberculosis and other diseases, they are credited to the zero - b - subgroup (0-b).

First Group (I).

In the first group, patients with active forms of tuberculosis of any localization are observed. Select 2 subgroups:

first (i-a)- patients with first identified disease; first (i-b)- With the recurrence of tuberculosis. In both subgroups, patients are distinguished:

With bactering (I-A - MBT +, I-B - MBT +);

Without bacteries (I-A - MBT, I-B - MBT-).

Additionally, they allocate patients (I-B), which interrupted treatment or were not examined at the end of the course of treatment (the result of their treatment is unknown).

Second group (II).

In the second group, patients with active forms of tuberculosis of any localization with the chronic course of the disease are observed. It includes two subgroups:

second (II)- patients who, as a result of intensive treatment, a clinical cure may be reached;

second (II-b)- Patients with a far-sighted process, the seraction of which cannot be achieved by any methods and which need to be associated, symptomatic treatment and periodic (if indications) of anti-tuberculosis therapy.

Third Group (III).

In the third group (control) take into account individuals cured from tuberculosis of any localization. Fourth Group (IV).

In the fourth group, take into account persons in contact with the sources of tuberculosis infection. It is divided into two subgroups:

fourth (IV)- for persons consisting in domestic and industrial contact with the source of infection;

fourth (IV-B)- For persons who have professional contact with the source of infection.

Some Indicators and Criteria Tactics Dispensary Observation and Accounting

Tuberculosis of dubious activity.This concept is denoted by tuberculosis changes in the lungs and other organs whose activity seems to be unclear. To clarify the activity of the tuberculosis process, 0 (zero) subgroup of dispensary observation, the purpose of which consists in carrying out a complex of diagnostic measures.

The main complex of diagnostic measures is carried out within 2-3 weeks.

From the zero group, patients can be translated into the first or directed to therapeutic and preventive institutions of the shared network.

Active tuberculosis- This is a specific inflammatory process caused by MBT and determined by a complex of clinical, laboratory and radiation (radiological) features.

Patients with an active form of tuberculosis need medical, diagnostic, anti-epidemic, rehabilitation and social events.

All patients with active tuberculosis identified for the first time or with recurrent tuberculosis are credited only in the group of dispensary observation.

Chronic current of active forms of tuberculosis- long-term (more than 2 years), including wave-like (with alternating sinking and exacerbation) the course of the disease, in which clinical and radiological and bacteriological signs of the activity of the tuberculosis process persist.

Chronic current of active forms of tuberculosis arises due to late detection of disease, inadequate and non-systematic treatment, features of the body's immune state or the presence of concomitant diseases complicating the flow of tuberculosis.

Clinical cure- the disappearance of all signs of an active tuberculosis process as a result of the main course of complex treatment.

The statement of clinical cure tuberculosis and the moment of completion of the effective course of complex treatment are determined by the lack of positive dynamics of the signs of the tuberculosis process for 2-3 months.

The observation period in the I group should not exceed 24 months, including 6 months after effective surgical intervention.

Bacteridians- Patients with an active form of tuberculosis, in which in the body allocated to the external medium of the body and / or in pathological material found MBT.

From patients with extrapulic forms of tuberculosis to bacteria sedresses, individuals in which MBT is found in the separated fistula, in the urine, menstrual blood or discharge of other organs.

Patients in whom MBT are allocated during the crossing of puncture, biopsy or operational material, as bacteries are not taken into account.

In order to establish a bacterial excavation from each patient with tuberculosis before the start of treatment, the sputum (water of the bronchi) and another pathological separated at least three times by bacterioscopy and sowing should be carefully studied.

The survey is repeated in the treatment process monthly before the disappearance of MBT, which must be confirmed at least two consecutive studies (including culture) with intervals of 2-3 months.

Termination of bacteria(synonym - abaclization) - the disappearance of MBT from biological fluids and the pathological separated from the patient bodies entering the external environment. Abacillimation is confirmed by two negative consecutive bacterioscopic and culture (sowing) studies with a period of 2-3 months after the first negative analysis.

Residual posttuberculosis changes.The residual changes include dense calcined foci and focuses of various sizes, fibrous and cirrotic changes (including residual sanited cavities), pleural layers, postoperative changes in the lungs, pleura and other organs and tissues, as well as functional deviations after clinical cure.

Single (up to 3 cm), small (1 cm), dense and occasional foci, limited fibrosis (within 2 segments) are regarded as small residual changes.

All other residual changes are considered large.

Destructive tuberculosis- active shape of the tuberculosis process with the presence of the decomposition of the tissue, determined by the complex of radial research methods.

The main method of detecting destructive changes in organs and tissues is a radiation study (X-ray - overview radiographs, tomograms).

The closure (healing) of the collapse cavity is considered to be its disappearance, confirmed by methods of radiation diagnosis.

Aggravation (progression)- The emergence of new signs of an active tuberculosis process after a period of improvement or increased signs of illness to the diagnosis of clinical cure. The emergence of exacerbation testifies to ineffective treatment and requires its correction.

Recurd- The appearance of signs of active tuberculosis in persons previously undermining tuberculosis and cured from it, observed in the group III or taken from accounting in connection with recovery.

The appearance of signs of active tuberculosis in spontaneously recovered persons who have not previously registered in anti-tuberculosis institutions are regarded as a new disease.

Diagnosis formulation when you turn on or translated into a group of dispensary accounting

When you turn on the patient in the I group of dispensary accounting. Example:

1. Infiltrative tuberculosis of the upper share of the right lung (S1, S2) in the decay phase and the seeding, MBT +.

2. Tuberculous spondelite of the thoracic spine with the destruction of the vertebrae bodies TH 8-9, MBT.

3. Cavernous tuberculosis of the right kidney, MBT +.

When the patient is translated into the group II (with the chronic flow of tuberculosis), the clinical shape of tuberculosis, which takes place at the moment.

During taking into account the patient there was an infiltrate form of tuberculosis. With an unfavorable course of the disease, fibrous-cavernous pulmonary tuberculosis was formed (or a large tuberculus with a decay of or without decay) was formed. In the translated epicrise, a diagnosis of fibrous-cavernous tuberculosis of light (or tuberculle) should be specified.

When translating the patient to the control group of accounting (III), the diagnosis is formulated according to the following principle: the clinical cure of one or another form of tuberculosis (exhibit the most severe diagnosis for the period of the disease) with the presence of residual post-carcular changes (large and small), the nature and prevalence of residual changes are noted.

Examples of diagnosis formulation when transferring a patient to the control (III) group of dispensary accounting.

1. The clinical cure of the focal pulmonary tuberculosis with the presence of small residual posttuberculosis changes in the form of single small, dense foci and limited fibrosis in the upper part of the left lung.

2. Clinical cure disseminated pulmonary tuberculosis with the presence of large residual posttuberculosis changes in the form of numerous dense small foci and common fibrosis in the upper pieces of the lungs.

3. Clinical cosage of pulmonary tuberculus with the presence of large residual changes in the form of scars and pleural thickening after low resection (S1, S2) of the right lung.

In patients with extrapulmonary tuberculosis, diagnoses are formulated according to the same principle as in patients with pulmonary tuberculosis. Examples.

1. Clinical cake of tuberculous coxit on the right with a partial disruption of the joint function.

2. The clinical cure of tuberculosis is left at the left at ankylosis.

3. Clinical cure of tuberculosis drive on the right with residual changes after surgery, ankylosis of the joint.

7.4. Day tuberculosis hospital (DTS)

In order to improve medical care for patients with tuberculosis since 1993, daytime tuberculosis hospitals are organized during dispensaries.

Tasks of the day tuberculosis hospital:

1) carrying out controlled chemotherapy with patients with tuberculosis, continuing the main course of treatment;

2) control diagnostic examination;

3) Conducting anti-relaxed and preventive treatment.

DTS,in order to maintain the epidemiological regime, should be located in a separate housing or in an isolated wing, part of the main hospital building.

Patients who do not require medical observation in the evening and night time can be sent to the DTS and satisfy the following criteria.

1. Clinical indications:

1.1. First identified patients with limited forms of pulmonary tuberculosis and not distinguishing MBT;

1.2. Patients after an effective chemotherapy rate, as a result of which the cessation of the allocation of MBT or abaclision has occurred.

2. Epidemiological testimony, be sure to combine the following conditions:

2.1. Good housing conditions equal to the tuberculous hearth group III (see section 7.6);

2.2. Accommodation in a patient near the hospital (lack of negative impact on health from a trip from home and back);

2.3. Formation of a solid plant for cure, to comply with personal and social epidemiological safety measures.

7.5. Specific prevention of tuberculosis. VACCINATION. Chemoprophylaxis

In all countries of the world, such methods of specific prophylaxis of tuberculosis are used as vaccination and revaccination BCG and chemoprophylaxis.

For vaccination is used strain BCG; It is harmless, it has specificity, allergic and immunogenicity, retains residual virulence, restricted in the body of the vaccinated, while in lymph nodes. For prevention on the territory of the Russian Federation, a dry BCG vaccine is used as the most stable, capable of keeping enough to maintain the desired number of live MBT.

Duration and stability of post-specific immunity

determined by the nature of immunomorphological changes and the period of vegetation of vaccine BCG in the body of the gravity. The BCG strain is maintained in the body, vegetates in it, stimulating the development of anti-tuberculosis immunity.

2 weeks after the vaccination of the BCG strain begins to transform into L-forms. In this form, the MBT strain of BCG can be kept for a long time in the body, supporting anti-tuberculosis immunity.

The effectiveness of anti-tuberculosis vaccinations BCG is manifested in the fact that among vaccinated and revaccinated children, adolescents and adults the incidence of tuberculosis and mortality from it is lower than among the undacitated.

The duration of post-value immunity at intradermal vaccination BCG average is 5-7 years.

The method of applying the BCG vaccine and its dosage.In the territory of the Russian Federation, an intradermal method of introducing a BCG vaccine as the most efficient and economical is used.

Vaccination of BCG newborns spend on the 4th day of life without prior setting a tuberculin sample.

Revaccination of BCG or re-vaccination against tuberculosis is carried out in decreed time in the presence of a negative reaction to the manta sample with 2 those PD-L.

The first revaccination is carried out at the age of 6 (1st grade), the second - at 11 years. Subsequent revaccinations are carried out according to the testimony, with an interval of 5 years to 30 years. The technique of revaccination is the same as during vaccination.

Chemoprophylaxis

The term "chemoprophylaxis" is used to describe two different types of tuberculosis prophylactic therapy.

1. Primary prevention, when the drug is given non-infected individuals in order to prevent the development of the disease (for example, newborn on breast-in-nutrition) in contact with bacillina patients.

2. Secondary prophylaxis in which anti-tuberculosis drugs are used to prevent disease development in previously infected people in conditions of possible re-infection or tuberculosis disease.

Groups in which chemoprophylaxis

Chemoprophylaxis is carried out to prevent tuberculosis disease to the following groups of the population. It:

1) children, adolescents and adults in constant contact with tuberculosis patients;

2) Clinically healthy children, adolescents and young people under 30 years old, first infected MBT;

3) persons with sustainable hyperergic reactions to tuberculin;

4) newborns (grafted in the maternity hospital BCG vaccine), born from patients with tuberculosis mothers;

5) persons with turning of tuberculin reactions;

6) Persons having traces of previously suffered tuberculosis, in the presence of adverse factors (acute diseases, operations, injuries, pregnancy, etc.) who can cause exacerbation of tuberculosis, as well as persons previously treated from tuberculosis, with large residual changes in the lungs located in a dangerous environment;

7) Persons with traces of previously suffered tuberculosis if they have diseases that themselves can cause exacerbation of tuberculosis (diabetes mellitus, collagenosis, silicosis, sarcoidosis, ulcerative disease of the stomach, operations on the stomach, etc.).

Among those who were conducted by the chemoprophylaxis, the number of tuberculosis diseases 5-7 times less compared to the relevant groups of the population, which it was not conducted.

Preparations.For chemoprophylaxis, an isoniazide or fivazide is used for 3 months, and when the epidemic hazard is preserved, it is repeated 2 times a year to 2 months. Persons with hyperergic reactions to the Mantu sample prevention are recommended to be carried out by two drugs - isoniazide and pyrazinomide (ethambutol).

Doses.For adults and adolescents, the daily dose of isoniazid with daily reception is 0.3 g, for children - 8 mg / kg. If the intolerance of isoniazide appears, the chemoprophylaxis of fivazide can be carried out. Futivazide is prescribed by adults 0.5 g 2 times a day, children - 20 mg / kg. Both adults and children must necessarily get vitamins WB and S.

The most justified by the use of secondary chemoprophylaxis by seasonal courses (in the autumn-spring season) for 2 months per year.

7.6. Social and sanitary prevention

Tuberculosis

The basic principles of tuberculosis activities in the Russian Federation are based on the state nature of the fight against tuberculosis as a social disease. In the organization of the fight against tuberculosis, along with specialized anti-tuberculosis institutions, all therapeutic and prophylactic institutions of health authorities are involved.

The purpose of anti-tuberculosis measures:

1) to warn the infection of MBT healthy people;

2) limit and make safe contact with patients with tuberculosis in active form (especially with the bacteritor) of the surrounding healthy people in everyday life and at work.

The most important component of sanitary prevention is the conduct of social, anti-epidemic and medical measures in the focus of tuberculosis infection, i.e., in the family and the dwelling of the patient with tuberculosis - the bacteria.

Preventive measures in the focus of infection begins with a visit to its precinct phthisiaater, an epidemiologist and a precipitated medical sister of the dispensary immediately from the moment of detection of bacterial excretion or detection in light destructive tuberculosis. According to the results of the inspection of the focus of infection, the plan of recovery is drawn up.

The plan should reflect:

1) carrying out disinfection;

2) treatment of the patient;

3) the isolation of children;

4) registration in the dispensary;

5) the frequency and volume of regular surveys of all family members, carrying out chemoprophylaxis, disinfectants.

The criteria of the epidemic hazard of the heartht. ubroculous infection are:

1) the massiveness and constancy of the extraction of patients with MBT;

2) family-household conditions of the patient;

3) Behavior, general culture and sanitary literacy of the patient and those surrounding it.

Based on these criteria the foci of tuberculosis infection according to the degree of epidemic hazard is divided into three groups.In accordance with

tweys with this grouping determine the volume and maintenance of preventive measures in the focus.

The center of the group I is the most unfavorable:

1) a patient with chronic destructive tuberculosis constantly allocates MBT, lives in bad housing conditions;

2) in the patient's family there are children, teens, pregnant women;

Foci of the Group II - relatively unfavorable:

1) in a patient a scant bacterial excretion, a stable tuberculous process, lives in satisfactory housing conditions;

2) in the family of the patient only adults, there are no aggravating factors;

3) The patient and the surrounding persons do not comply with hygienic rules of behavior.

Forest III group - potentially dangerous:

1) the patient is a conditional bacteriasel;

2) in the patient's family only adults;

3) The patient and the surrounding persons perform all the necessary sanitary and hygienic measures of the prevention of tuberculosis.

Conducting preventive measures in the focus of infection

An important section of the Plan is to train the patient and members of his family sanitary and hygienic skills.

In the premises of the patient, it is necessary to carry out wet cleaning daily (current disinfection). Floor cleaninga 2% soda solution should be carried out.

When leaving a patient from the house for treatment in a hospital, in a sanatorium or, in the case of his death, the sanitary and epidemiological service is carried out by concluding disinfection.

It is very important to bring up the right skills of circulation of sputum, dishes, personal items, which practically makes it not dangerous to others.

The bacyl separator must have a whisperfor sputum collection, the contents of which are needed daily, in order to destroy the MBT, to be boiled, can be used in chlorine lime.

Patient's underwear, especially nasal scarves, towels, you need to collect in a separate bag,before washing, soak overnight in a 5% solution of chlorine and boil in 2% soda solution for 30 minutes.

The dishes are smelled separately and wipe the towel intended only for the patient.

The upper clothes of the patient with tuberculosis as often as possible are ventilated in the sun,weekly stroke the iron and disinfect at least 2 times a year in steam or steamformaline chambers. Cleaning clothes should occur outside the residential premises.

All of the above activities are placed in the concept of current disinfection, which is carried out by patient or adult family members under the guidance and control of the medical sister of the anti-tuberculous dispensary.

Events on the prevention of tuberculosis among persons working in tuberculosis institutions and in contact with tuberculosis patients

In anti-tuberculosis institutions, staff communicates with patients with tuberculosis, including with bacyl separators. This communication takes place on an outpatient reception of patients, when servicing them in a hospital and at home, where the transmission of infection with dust, contact, drip and alimentary paths is possible.

The incidence of tuberculosis of anti-tuberculosis workers is 8-10 times higher than among the entire population.

In each anti-tuberculosis institution, there are rules that have a goal of minimizing the danger of tuberculosis infection and the creation of the most favorable working conditions for staff. These rules should be strictly observed.

Individual means of protection of respiratory organs

General.Individual means of protecting the respiratory organs (respirators, gauze bandages) are used for health workers to protect against the internal distribution of MW.

The use of respirators is limited within the high risk areas, namely:

1) in boxes for patients with tuberculosis or multi-resistant tuberculosis;

2) when inducing the sputum separation or other procedures causing a cleanement;

3) in the cabinets of bronchoscopy;

4) in section halls;

5) in the cabinets of spirometry;

6) During emergency surgical interventions on potentially infectious patients with tuberculosis.

Surgical masks.There are important differences between the facial mask and the respirator. Facial masks, such as surgical (cloth or paper):

1) really ensure the prevention of the spread of microorganisms from their user (for example, a patient with tuberculosis) to other persons by retention of large particles separated near the nose and mouth;

2) Do not provide the protection of the user's body (for example, the health worker, patient, family member) from the inhalation of drip particles weighted in the air containing an infectious agent.

Means and methods of disinfection

Currently, there is a huge range of disinfectants. However, it is necessary to check their activity in the disinfection of infected MBT material.

1. Chlorine lime is a white powder containing 28.0-35.0% active chlorine.

2. Chloramin b and hb - cream powder, the content of active chlorine 27.0-28.0%. Currently, in the Russian Federation, chlorine b is not produced. As an analogue is registered for use in the territory of the Russian Federation Chloramin b firms "Bochemia" (Czech Republic).

To prepare a 5% disinfectant solution of chlorine, 500 g of chlorine in 10.0 water is dissolved.

Disinfection of personal and public facilities

Powers. Tableware (dining room) with food residues. Food residues. Washbasins, urinals, toilets, shell cranes. Patient care objects: lining vessels, urinary, tips for enema.

Disinfection methods:

1. Boil in soda solution.

2. Immersion in a vessel with a lid containing a solution of chlorine.

3. Autoclaving.

Rooms:walls, floor, doors, furniture in the ward, in medicinal offices, in public areas.

Disinfection methods:

1. The winding of the rifle dipped in activated solutions of chlorine lime chlorine.

2. Wash hot soap-soda mortar.

3. Immersion in a vessel with a lid containing a solution of chlorine.

4. Floating with chlorine lime, chloramine.

Lingerie (bedding, table, commercial, furniture covers, gauze bandages, respirators, handkerchiefs, wipes and bedding.

Disinfection methods:

1. Boil in soda solution.

2. Carrying and stroking with a hot iron.

3. Disinfection in the Dezker.

Soft furniture.Small household items, toys (metal, rubber, wooden, plastic), books, notes, paper, etc.

Disinfection methods:

1. Immersion in solutions and disinfection by modes.

2. Burning low-value items, chamber processing of valuable.

3. The cleaning of the brush moistened in one of the disinfecting solutions.

In anti-tuberculosis institutions among received patients, sanitary and educational work is systematically established. In order to protect personnel from infection, special attention should be paid to the rules of conduct, mandatory for patients.

If the patient is discharged, the rules of its behavior of the house and in public places that prevent the infection of the tuberculosis of the surrounding persons are clarified.

Health education- One of the links of the preventive work of the dispensary. In terms of anti-epidemic events,

aimed at combating tuberculosis, anti-tuberculosis propaganda should take one of the central places. Sanitary-based work must be carried out primarily among patients with tuberculosis.

Promotion of knowledge about the origin of tuberculosis, its sources, distribution is an important part of the fight against this disease. Knowledge of the methods of personal and public prevention of tuberculosis has great practical importance for the population.

Anti-tuberculosis work of institutions of the general hospital-preventive network

The prevention of tuberculosis and the detection of patients with tuberculosis among the population is a function of therapeutic and preventive institutions of the general treatment network. This work is carried out under the organizational and methodological guidance of the tuberculosis dispensary and the institution of SanEpidadzor.

The main tasks general Medical Institutions of Polyclinic Typethere are a qualified examination of the patient for tuberculosis and the timely direction of it into the anti-tuberculosis dispensary.

Common profile polyclinics carry outwhen examining patients with tuberculosis, the fulfillment of a clinical minimum: fluorography of the lungs, a sputum analysis on MBT, tuberculin sample, blood test, urine.

Events of the Sanitary System System of the Russian Federation for the Prevention and Detection of Tuberculosis

The work of the Sanitary Committee and its subdivisions for the prevention of tuberculosis in their responsibility includes:

1) conducting specific prevention, early and timely detection of tuberculosis, strengthening bacteriological services to improve the epidemiological situation on tuberculosis;

2) control over the sanitary condition of industrial enterprises, children's and adolescent institutions, for the implementation of the epidemiological regime in anti-tuberculosis institutions and foci of tuberculosis infection;

3) holding a retrospective epidemiological forecast and participation in the planning of anti-tuberculosis measures.

Need to maintain the body strength,

Victor Hugo

Tuberculosis. Phthisiatry. Robert Koh. Tuberculosis wand. Vaccination BCG. Mantoux test. Rise tuberculin samples. Dupid. Fluorography.

Tuberculosis (from Lat. Tuberculum + from Greek. Osis - Budrock + Disease) - Bugorchatka is generally an infectious disease of the entire body of a person with a predominant defeat of the respiratory system. This term was introduced by R. Laennek, who firstly described the anatomical basis for the first time - a tubercle. In case of inspection of the internal tuberculosis, the organs are visible on them characteristic tubercles. In the scientific literature, it is indicated that the tuberculosis wand can affect all organs and systems except liver.

Previously, this disease was called physhi (from Greek. Phthisis -Shopping, CHAKHOTE) or CHAKHOTOV. From here there was the name of the industry of Medicine Phthisiatry, which she gave it in 1689 by T. Martha. In Russia, they also called this disease "Thumping".

Tuberculosis for many centuries was one of the most severe infectious diseases relating to socially dangerous. In the VIII century Every seventh resident of Europe was died of him.

XIX century It was marked by the discovery of most pathogens of formidable infectious diseases and the beginning of the creation of vaccines against them. Many researchers were unsuccessful tried to find a Grozny killer - microbes of tuberculosis. It was possible to make only the German doctor Robert Koch.

It turned out that it causes this deadly alaughter a stick, very small in its size, which, as other bacteria, is impossible to simply see under the microscope. One of the most important discoveries R. Koch was that he came up with painting drugs with different colors before looking at them. To date, no researcher will study microscopic objects until they betray them.

In addition, unlike other microbes, which are rapidly divided, tuberculosis wand very slowly multiplies. In order for one division, under the most favorable conditions, it takes 14-17 hours. Therefore, bacteriological crops whose results in dysentery are ready for the 3rd day, with tuberculosis you have to wait until 3 months. Robert Kochu came to mind the thought to wait as much as long as the growth of microbes on the preparation prepared from the lungs deceased from the tuberculosis of the worker. Only on the 15th day, he discovered a colony of tuberculosis sticks.

Robert Kokh announced his opening on March 24, 1882 in Berlin at a meeting of the physiological society. Therefore, around the world, March 24 is the day of the fight against tuberculosis.

Open R. Koh Microbe called in his honor Koch's wand. It is also called mycobacterium tuberculosis - not from the word "microb", but from the word "Miko" - microscopic mushroom, because under the microscope it resembles minor mycelium cells.

Although significant successes are achieved in the prevention and treatment of tuberculosis, nevertheless, the incidence and mortality from this disease tend to increase worldwide. Every 4 seconds, one resident of the globe is infected with tuberculosis, and every 10 seconds one person dies from him.

After restructuring the 90s. The incidence and mortality from tuberculosis in Russia rose more than 2 times. The RB retains an unfavorable epidemiological situation. The incidence of tuberculosis is almost 2 times higher than in the Russian Federation as a whole, and amounted to 159.0 and 83.2 per 100 thousand people, respectively. In Buryatia, more than 200 people die from tuberculosis annually.

A similar situation with tuberculosis in the Republic of Belarus, phthisira is explained by the fact that there is a natural focus in the republic, that is, in a large horned cattle. If you drink some milk from a sick cow, to extract it with a skin or just in contact with such an animal, then an infection occurs. Tuberculosis is not an air-drip infection! A wand in the human body can get through the lungs, and through the stomach, and through the skin.

Especially dangerous in modern conditions is the so-called drug-resistant tuberculosis. Distributors of this form of the disease are asocial identities, which, taking anti-tuberculosis treatment, leave the dispensary, interrupting it. During such a "voyage", they grow a stick, sustainable to all the medicines available in the modern arsenal. To infect such a stick of law-abiding citizens, they "award" their incurable disease leading to death.

The main methods of reducing the incidence of tuberculosis, that is, its prevention, are:

Its prophylaxis with a lively weakened BCG vaccine;

Early detection of patients with pulmonary forms of tuberculosis with a fluorographic examination;

Identification of the Koche population infected ™ with the help of the Mantu sample.

The first BCG vaccine was manufactured by French scientists Microbiologist Albert Calmett and a veterinarian Camille Gen. For 13 years every 15 days, they reheated microbes from one nutrient medium to another to derive such a type that would not cause illness in the human body, but strained the immune system to develop antibodies against tuberculosis. The first vaccination from this deadly disease was made by the baby in Paris in 1921 in honor of his inventors, the anti-tuberculosis vaccine around the world is called first letters from the word "Bacillus" (from Lat. Bacillus - wand) and their names of Calmette-Geren (BCG - Bacille De Calmette et do Guerin).

In the USSR, the fight against tuberculosis was indulging in great importance. It is impressive that in the period of the Great Patriotic War, a massive vaccination of newborns BCZH began, since 1942 it became mandatory among the urban population, and since 1943 among the rural.

BCG vaccination is the only effective way to prevent tuberculosis. However, it is possible to make it only to children whose body is sterile from koche sticks. It happens in newborns and those in those who do not have time to get from the environment. The moment of hit is detected in children with the help of intradermal tuberculin sample Mantu, it is carried out by all children up to 18 years annually, starting from 12 months from birth.

BCG vaccination make a child in the maternity hospital for 3-7 days of life. After it, immunity in a child is developing only by 2 months of life, so before a two-month age, contact with tuberculosis infection is deadly dangerous. If the apartment, where the child should be discharged is a focus of infection, i.e., there lived earlier or is a sick open form of tuberculosis, then you can make a baby there only after immunity developed.

The immune response and development of immunity to tuberculosis infection is evidenced by changes arising on the left shoulder at the injection site. To one month there appears a spot, to three - papula, to six - a crust from the gun, and by the year the rutter is formed. This is the perfect response of the body to the BCG, and parents should not interfere in this process at something to lubricate the guns, to rub it, etc. It is believed that the greater the size of the scores, the better the response of the immune system.

Tuberculin is a sludge of the fragments of tuberculosis sticks. When this substance falls into the human body, an immune response arises. If the body is familiar with such genetic material, then it is very fast (in a few hours) reacts to the injection: white blood cells float to the place of injection, they begin to devour fragments of sticks and it is manifested on the skin redness and edema. If there is no voltage of immunity, that is, the body is sterile, then we do not see anything and even make it difficult to remember which hand was done by Mantu - this is called a negative breakdown.

Table 11 - Options for the body's reaction on the sample manta

Papula * - nodules (dense pillow).

Hyperemia ** - redness, its size is taken into account only in the absence of Papula.

For Mantu sample, we will try to deal with them with a table 11. It should be noted that the reaction obtained on the skin can be interpreted only under the condition that the entire previous history of the BCG and the Mantu sample in humans is known.

The ideal reaction to Tuberculin shows that the age of 1st year had a babberculus immunity for the child, and then he faded from year to year, and by 7 years the child's body came sterile and ready to revaccinate BCG (R BD).

Sometimes the immune response of the child is not developing by the year and it is not good, but not bad, since there is no tuberculosis.

Very often, after conducting the sample, Mantu the child is sent to the anti-tuberculous dispensary for further surgery and there are already a diagnosis of "Vioration of Tuberculin Sample" or "Dupification". This means that the tuberculosis wand hit the body. At the same time, the dupidation is exhibited in the case when the body is clearly sterile before increasing the immune response. With the brighteners of tuberculin samples, the immune response was injured, and then he suddenly increased. When postponing such indicators of the sample, Mantu would have turned out a steep turn - turn.

If the child is determined by a papule of 17 mm and more, and in an adult - 21 mm and more, then it means that man is sick with tuberculosis.

Thus, with the help of the Mantu sample, you can install:

The intensity of the body's immunity against tuberculosis;

Give a referral to the revaccination of BCG;

Detect the moment of contact with mycobacteria into the body;

Remove patients with tuberculosis.

The hit in the body of Koch sticks does not mean the beginning of tuberculosis. This shows the infection of the body and that now the person will have a mycobactery with him. If, at the time of the chopstick, the child's immune system suppresses a wand, then it is "preserved" and will strain immunity throughout life. And it can happen that the immune system at the time of the microbe hitting the body will not cope with it, it will begin to multiply, and this is nothing more than the beginning of tuberculosis.

How the body of the baby will behave when meeting with mycobacterium tuberculosis - it is not known to anyone. Therefore, on the recommendation of WHO in all countries, when determining the dupification in children, they are prescribed the so-called chemoprophylaxis - anti-tuberculosis drugs, for a period of 2 months only to help the children's body to overcome the wand and do not let it begin to multiply. Often, parents have questions about whether it is already necessary to take these disadvantaged medicines? Yes, it is necessary, since tuberculosis, and especially its drug-stable forms are much more dangerous. Simultaneously with anti-tuberculosis drugs, vitamins of groups A and B and calcium gluconate are prescribed - it helps to improve the tolerability of drugs.

Dupidization 3 times increases the chances of a person in the future to get sick tuberculosis, because the ward in the body under any unfavorable conditions (severe stress, poor nutrition, reduced immunity) can begin to multiply and disunity disease. Therefore, WHO is struggling to reduce the dupidity among the population to 12%.

In the newspaper "True Buryatia" for March 26, 2003, the chief physician of the Republican anti-tuberculous dispensary L.N. Slabuv in his interview said that in the Republic of Belarus by 30 years, the entire population becomes carriers of koche sticks. This figure, on the one hand, is terrible, since tuberculosis is bad, and sometimes completely incurable. On the other hand, this can not be, if only because there are people who have a mycobacterium genetically can be fixed in the body and accordingly infect them under any circumstances.

Infection with a stick of tuberculosis occurs mainly from those people whose sputum with cough, sneezing and conversation it stands out. This happens with open lung tuberculosis forms. The tuberculous focus in the body is the most real affection, and the pus consists of mycobacteria, white blood cells, broken tissues and externally reminds cottage cheese. Therefore, it is called - caseous (from Lat-Caseosis - cheese, curd) necrosis (from Greek. Necrosis - death, death) - Curl disintegration. Provided that the mouth of the pulmonary tissue breaks into the respiratory tract, the caseous mass will fall into bronchi, will annoy them, and this will lead to the splitting of infectious sputum and infection of healthy people. It is believed that every patient of the open form of tuberculosis, during the disease he has time to infect an average of 10-15 people.

With the timely detection of the tuberculosis process in the lungs using fluorography, such manifestations should not be, the GAK as a decay and bacteria are only in the launched stages of the disease. Fluorography is a study of internal organs with X-ray radiation.

If there was still a decay of the fabric and a breakthrough of the contents into bronchi, then an empty cavity remains in light - a cavern (from lat. Caverna - cave, cavity). If the breakthrough does not occur, then with the treatment of the caseous mass over the years germinates calcium salts. Such stones for all life remain in the lungs and are called calcinates.

Remember that the only protection against tuberculosis is the grafting of BCG, the prevention of the development of the tuberculous process - the head, and the most important factor in recovery from it is the early detection and clear observance of all appointments of the doctor.

Check questions and tasks

1. What is tuberculosis and which organs can he affect?

2. Tell us about the grafting of BCG.

3. Did the day of the test of Mantu apply?

4. What are the vioration of tuberculin samples and tubificin-cycling?

5. What do you know about the open forms of tuberculosis?

6. What is the fluorography apply?

7. Remember new terms and definitions that meet you when studying this topic.