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Specialization phthisiatrician

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Despite the rather narrow specialization of the phthisiatrician, his organs are not only the lungs, because the causative agent of infection, the Koch wand, can affect not only these organs, but many others. And this is without any exaggeration, because there is not a single component in the human body that is not susceptible to the harmful effects of tuberculosis - from the bones and joints to the urogenital system.

The competence of the doctor also includes the treatment and diagnosis of leprosy, which is popularly called leprosy and sarcoidosis. But the key point of the activity is still the elucidation of the causes and mechanisms of the development of pathological processes in the lungs, as well as a set of measures - from preventive to rehabilitation - and the necessary diagnostic procedures in the fight against lung disease.

Health problems as a signal to visit a specialist

The answer to the question that the TB doctor treats is understandable. The next aspect that is important to find out is when exactly to talk to him. Given the fact that tuberculosis is an insidious disease and does not manifest itself immediately after infection, and if it does, it is far from what most people imagine, you need to pay attention to the following symptoms.

  1. A lingering cough that lasts for three weeks or more. Expectorant discharge in the form of sputum and mucus are possible, in advanced cases hemoptysis.
  2. Pain between the shoulder blades that is not associated with vertebral problems.
  3. Discomfort when swallowing, as with quinsy, hoarseness in the voice, breathing problems.
  4. Rapid weight loss with the usual way of life.
  5. Fatigue, which is observed constantly and even with small loads, a feeling of weakness and malaise.
  6. Positive Mantoux reaction in a child.
  7. Sweating, especially in the dark, is a reluctance, a periodic increase in temperature.

Analyzes and diagnostic methods

If you are sent to undergo a phthisiatrician, it is recommended to undergo a chest X-ray just before his visit, and to the representatives of the weaker sex visit a gynecologist. The remaining important tests and studies, if necessary, will be prescribed by the TB doctor himself.

Among the most likely options may be:

  • standard tuberculin test,
  • sputum examination for germs,
  • microbiological culture (sputum, pus, cerebrospinal fluid, etc.,
  • sowing on a special environment Levenshteyn-Jensen,
  • liver test,
  • eye examinations, especially when taking ethambutol and hearing when taking streptomycin,
  • urine culture to eliminate the likelihood of renal tuberculosis.

If you are sent to undergo any examinations for serious reasons, you must take the results of tests and studies with you, because the first thing that a TB specialist does during the initial consultation is that it evaluates and presents a complete picture of the patient's condition. TB specialist also deals with:

  • results of fluorography and microbiological diagnostics,
  • diagnosis of extrapulmonary tuberculosis,
  • methods of computer and magnetic resonance imaging.

What else does the doctor do and does he always work independently?

Phthisiatrician can be found in tuberculosis dispensaries, specialized hospitals and specialized sanatoriums. In these institutions, he skillfully treats, consults on issues related to the timely detection and prevention of a dangerous disease.

Unfortunately, in advanced cases of tuberculosis it is not always possible to cure successfully with the main methods of modern phthisiology. Serious pathological changes in the lung tissues and bronchi can usually be excluded only by surgery. In this case, the specialist redirects the patient to a colleague — a local surgeon.

Thus, the key activities of the phthisiologist are as follows:

  • prevention of epidemics and the spread of infectious lung disease called tuberculosis,
  • the provision of tuberculosis care, explanatory work among the masses,
  • solving genetic, immunological and immunomorphological issues of an infectious nature,
  • study of biochemical processes in the etiology of tuberculosis,
  • the adoption of therapeutic measures with the subsequent introduction of new technologies in therapeutic techniques.

Where does the TB doctor take and how is the reception?

Of course, it all depends on who needs to be cured - a child or an adult. The pediatrician is located in the outpatient clinic for babies, but, most often, a specialist of this profile can be found in a TB dispensary or any other specialized institution.

If you are sent to a reception, do not be afraid of him. The doctor will carefully examine the data of current research, listen to complaints, ask about lifestyle and diseases already suffered. Based on the full picture, the specialist may prescribe additional examinations, tests, and then treatment.

For a child, receiving a phthisiatrician is obligatory upon future visits to a kindergarten or school.

Pediatric phthisiatry: features and nuances

The pediatrician detects tuberculosis, communicates to people how to prevent the disease, and treats tiny patients. In a young child, probably only the initial primary infection, that is, not the disease itself, as such, but the penetration of mycobacterium tuberculosis into the body. Of course, if the pediatrician, on the basis of the results of the Mantoux test, sent the child to the tuberculosis specialist, it means that he had a weighty reason for this. However, ahead of time, parents should not panic. The pediatric doctor must take a small patient within a few days of the test of Mantoux’s reaction, paying particular attention to the color and size of the puncture site. Do not be afraid of the annual test, it helps to identify risks at an early stage and subsequently avoid the development of the disease.

At a medical consultation, you may need an extract from the outpatient card of the child with all the necessary information, in particular, about BCG vaccination, urinalysis and blood tests, and in the presence of X-ray examination. In some cases, you may need pictures of relatives of a small patient.

Difficulties and advantages of the profession

A physician such as a phthisiologist, whether childish or adult, in the course of his professional activities, constantly encounters one of the most dangerous infections of our time. He regularly, every day, has to carefully take care of protective equipment and immunity in general, because the risk of getting sick with an illness that the doctor constantly treats is too high. The main danger lies in the fact that the treatment of doctors for tuberculosis in most cases is more difficult than that of ordinary people due to the enormous amount of contact with patients infected with the microbacterium tuberculosis. In addition, the profession requires a high intellectual level. A good doctor should be attentive, careful, conscientious, and, importantly, able to sympathize with patients.

But, despite all the shortcomings and risks to health, this medical specialization has its own advantages. This is, first of all, a good salary due to additional cash compensation, which are paid for “harm”. The representatives of this part of medicine themselves speak of their work as a special path. And not just because over the years, Koch's wand has gained “immunity” to medicines, but also because their patients are complex people and are not always interested in the positive results of the treatment that the TB doctor performs. What kind of doctor is this? Able to persuade and help psychologically.

Diseases that phthisiologist treats

This doctor deals with pathologies of the pulmonary system and other organs affected by the causative agent of tuberculosis. The specialist knows everything about the prevention, diagnosis and treatment of serious diseases:

  • leprosy (leprosy),
  • extrapulmonary tuberculosis (bones, intestines, eyes, kidneys, reproductive system),
  • open-form tuberculosis (pulmonary),
  • external tuberculosis (mucous membranes, skin, lymph nodes),
  • lung sarcoidosis
  • adrenal tuberculosis (Addison's disease),
  • tuberculous meningitis.

Most often, the TB doctor deals with tuberculosis in all its manifestations. This disease is caused by Koch sticks, which belongs to the group of mycobacteria. The main modes of transmission are airborne and domestic. The lungs are usually affected as the pathogen enters through the respiratory system.

Due to the different localization of primary and secondary foci, related professions appeared, whose specialists have a narrower competence. These are doctors:

  • phthisiology,
  • phthisiatricians and gynecologists, etc.

They can cure not only the disease, but also relieve the complications that have appeared.

Symptoms that go to a doctor

The specialist who has suspected the disease will issue a referral for examination from a phthisiatrician doctor. Usually, it is prescribed by the therapist after receiving the results of fluorography. Since children do not have an annual survey, pediatricians send them to a phthisiatrician consultation with a positive Mantoux test. This is a subcutaneous allergy test that is performed by purified tuberculin. When the size of the papules above the norm, the child is sent to the TB doctor.

Patients are able to notice some symptoms of the disease on their own and consult a doctor without a referral:

  • pain and heaviness when breathing
  • persistent cough for more than three weeks
  • drastic weight loss
  • lack of appetite,
  • the presence of blood in the sputum,
  • weakness,
  • night sweats,
  • long feeling of indisposition,
  • low-grade fever for a month.

Tuberculosis can last for a long time without symptoms. In this case, the person spreads the disease and infects others. To minimize infection with tuberculosis from hidden carriers, an annual x-ray study of the adult population is conducted.

Diagnostic methods

The doctor makes a diagnosis based on physical examination methods and laboratory diagnostic data. The first group includes:

  • General examination of the patient (the presence of exhaustion, the lag of the sick half of the chest in the act of breathing, characteristic skin changes).
  • Palpation of the chest.
  • Percussion of the lungs, kidneys (carried out by tapping movements of the finger of the right hand on the finger of the left, leaning against the place of projection of the diseased organ).
  • Auscultation of the lungs (allows you to determine the open form of tuberculosis, lung sarcoidosis).

An important step in the diagnosis is the doctor’s medical history of the patient’s life and complaints. Tuberculosis often develops with some disposing factors (being in a cool, damp room for a long time, contact with a carrier).

If the phthisiatrician has suspicions of the disease, he prescribes a further examination. This is the delivery of biomaterial to the laboratory for the following tests:

  • KLA (complete blood count).
  • Bacteriological urine culture.
  • Microbiological examination of urine, sputum, pus, bronchial wash water.
  • Hepatic tests.
  • PCR (polymerase chain reaction).
  • Biopsy of material from the affected organ.
  • Quantiferon test.

Also, the doctor prescribes an x-ray examination of the chest to the patient, eye diagnostics using ethambutol is performed. Children are given Mantoux or Diaskintest tests.

If there is a suspicion of damage to the brain or bones, the TB doctor often prescribes computed tomography, magnetic resonance imaging, taking cerebrospinal fluid, and taking blood to detect the causative agent. All these methods allow you to identify the disease, its localization and start treatment.

Pediatric phthisiatry

Patients who have not reached the age of 18 attend a pediatric TB specialist. To this doctor send children with a positive reaction to the Mantoux test or Diaskintest.

In kindergartens and schools for the preliminary diagnosis of tuberculin test is used. A purified allergen from a pathogen is injected under the skin. A papule forms at the injection site. According to its size, it is judged whether the child has contact with the pathogen. If the reaction is positive, the direction to the pediatric TB specialist is written out.

This method refers to a preliminary survey. He does not report the disease and cannot be diagnosed. But the Mantoux test allows you to determine the risk group. Often the body produces a positive reaction to tuberculin if the child has allergies or recent BCG vaccination.

At the reception of a phthisiatrician, such children are offered to undergo a quantiferonic test. To do this, carry out the collection of venous blood. The test is highly accurate, as it is carried out on specific pathogens. After him, the TB doctor indicates the presence or absence of the disease.

Early diagnosis in childhood is very important, since the child's body is not strong enough for a long course of the disease. In babies, the disease is faster, complications occur more often, and cleansing the body of the drugs takes longer. Therefore, it is important to learn about the diagnosis in the early stages and start treatment on time.

What kind of doctor is a phthisiologist?

Phthisiology is a field of medicine that deals with a narrow spectrum of issues that relate to the laws governing the development and course of the pathology caused by Koch sticks or mycobacteria. This disease is called tuberculosis.

A TB doctor is a doctor who works with people who suffer from a prolonged cough, which can eventually develop into hemoptysis. The doctor is engaged in the diagnosis, treatment, prevention and restoration of health of people exposed to the corresponding pathogen.

In addition to tuberculosis, which is traditionally accompanied by cough, slight fluctuations in temperature and other specific symptoms, the TB doctor works with patients for leprosy (leprosy) and sarcoidosis. However, the number of patients in this group is ten times inferior to the pathology caused by Koch's wand.

The prevalence of tuberculosis in the post-Soviet countries explains the relevance of such a narrow specialty of doctors. Most regional centers have tubal dispensaries that assist people with various forms of the disease.

Fact! In 2014, after analyzing the results of statistical data, the World Health Organization announced an epidemic of tuberculosis in Russia, Ukraine and Belarus, which threatens the safety of the population of the whole of Europe. This fact indicates the relevance of the issue of early detection, treatment and prevention of the further spread of pathology.

What does a TB doctor treat? What organs?

75-80% of the non-medical population knows that tuberculosis affects the lungs. Accordingly, the TB doctor only deals with the treatment of the mentioned organ. However, tuberculosis causes not only cough and other symptoms associated with impaired lung function.

Koch's wand can affect almost any structure of the human body.

Most often, mycobacteria invade the following organs:

  1. joints, spine,
  2. uterus, ovaries,
  3. kidneys, bladder,
  4. brain,
  5. adrenal glands
  6. peritoneum and others.

Despite the variety of target organs, the predominant number of patients (80-85%) suffer from pulmonary tuberculosis, due to the peculiarities of the spread of the pathogen and the development of pathology. The defeat of other structures is secondary and is caused by the migration of mycobacteria with blood or lymph flow.

What diseases does the TB doctor treat?

Phthisiatry is a science primarily concerned with establishing patterns of development, distribution and elimination of the consequences of the effect of mycobacteria on the body. In addition, doctors help patients suffering from sarcoidosis and leprosy.

However, people with symptoms resembling tuberculosis (coughing, general intoxication) often come to the TB doctor. In the course of treatment, the corresponding diagnosis is not confirmed, but the patient remains under the supervision of a doctor. The clinical picture of tuberculosis can resemble severe pneumonia, abscesses in the lungs (sluggishly flowing) and other pathologies.

Symptoms that are addressed to a TB doctor?

Tuberculosis in people not related to medicine is associated with hemoptysis. The described symptom occurs with severe lung damage, when there is a rupture of blood vessels with blood penetration into the sputum.

However, in 75% of cases, a phthisiatrician doctor meets with the following signs of the disease:

  • Dry and unproductive cough. Patients do not associate the symptom with the influence of external factors. Cough occurs spontaneously, does not cause the patient much discomfort,
  • General weakness. Symptom occurs due to intoxication. Patients do not pay attention to him, writing off feeling unwell on overwork at work, changes in the weather. Because of this, the moment of going to the doctor is delayed,
  • Night sweats. A characteristic sign that should alert any person. Если утром человек обнаруживает под головой мокрую подушку, тогда обязательно нужно консультироваться у врача для раннего выявления потенциальной проблемы,
  • Колебания температуры тела. Для туберкулеза типичным остается эпизодический подъем показателей на градуснике до значений 37,2-37,8о,
  • Discomfort when swallowing and hoarseness, accompanying cough,
  • Fast weight loss (up to 10 kg in 2-3 months).

The appearance of relevant signs indicates a possible infection of the body with mycobacteria. A phthisiatrician doctor is engaged in establishing the cause of the described symptoms with the selection of adequate treatment. Tuberculosis can be overcome completely. The main thing - time to ask for help.

When and who sends to the TB doctor?

Phthisiatry is a narrow specialization. Patients with ordinary cough or shortness of breath just do not send to the appropriate doctor. Referral for consultation should be justified by the presence of characteristic symptoms or data of laboratory, instrumental methods of examination.

Traditionally, therapists and pulmonologists refer patients to the TB doctor. However, sometimes during open surgeries in the chest or abdominal cavity, surgeons detect the presence of an infiltrate, which may be evidence of a tuberculous process in peripheral organs and tissues. In a similar situation, after completion of the intervention, the patient is examined by a phthisiologist.

Do I need preparation for inspection?

Before contacting the doctor described, no specialized training is required. It is recommended to pre-make a radiograph or x-ray. In the absence of these images, the doctor will still send the patient to the x-ray room. After consultation, the doctor assesses the patient’s health condition and prescribes additional examinations.

How is the reception at the TB doctor?

Reception at the phthisiatrician practically does not differ from traditional communication with the doctor.

The algorithm of the doctor’s work can be represented by the sequence of the following steps:

  • familiarity with the patient (during the initial examination), the analysis of complaints of a person
  • collection of anamnesis. Particular attention is paid to establishing the presence of contact with potential patients for tuberculosis,
  • assessment of symptoms. Analyzes the nature of cough, shortness of breath, sweating and other signs,
  • appointment of additional tests and examinations,
  • selection of trial therapy. It is not always possible to treat all patients by the same scheme. Correction of the means used is carried out after clarifying the features of the course of a particular clinical case.

Auscultation, percussion and palpation are used to evaluate lung function during the examination of a patient. To clarify the data of basic research methods, instrumental and laboratory methods are assigned.

What tests can a phthisiologist take?

To verify the underlying cause of characteristic symptoms (sweating, prolonged cough, fluctuations in body temperature), the doctor uses auxiliary diagnostic methods.

When examining patients with tuberculosis apply:

  1. X-ray and fluorography,
  2. general laboratory blood and urine tests,
  3. sputum culture to detect mycobacterial colonies,
  4. microscopic examination of sputum,
  5. tuberculin test (Mantoux).

If necessary, the doctor uses other procedures that allow a comprehensive assessment of the condition of the human body.

Are there any differences between a pediatric phthisiologist and an adult?

It is considered to be that a phthisiologist is a doctor who treats adult patients. However, tuberculosis does not select victims by age. Mycobacterium can attack any unprotected organism. In the case of children, the pathology often proceeds softer, which is associated with the onset of the development of the problem. However, the progression of tuberculosis at an early age faces unpleasant consequences.

Pediatric TB specialist is a doctor who treats both newborns and those of school and adolescence. Sometimes children suffer from tuberculosis since birth. The reason is intrauterine infection of the fetus during pregnancy of the mother. With timely selection of adequate treatment, the prognosis for the patient is favorable.

Is it possible to call a TB doctor at home?

A TB doctor is a doctor who does not treat a common cough or cold. The call to the house of the doctor working in the state clinic is not provided. When seeking help from private clinics, the possibility of on-site diagnosis with the selection of basic treatment is not excluded. It all depends on the particular work of a particular medical institution.

The reason for the inappropriateness of going to the doctor at home remains an increase in the risk of infecting the doctor upon contact with the patient. In addition, for high-quality diagnosis requires specialized tests that can be performed only in a medical institution.

Are there any differences between a phthisiologist and a pulmonologist?

Pulmonologist and phthisiologist - specialties that intersect with each other. In both cases, doctors work with people suffering from cough, fluctuations in body temperature, and general weakness.

The fundamental difference is the causes of these symptoms. The TB specialist is a narrower concept aimed at working with a separate contingent of patients requiring long (up to 6-12 months) and aggressive treatment. The cause of tuberculosis is mycobacterium.

Pulmonologist patients suffer from diseases caused by organic and functional changes in the respiratory system.

Conclusion

The TB specialist is a focused pulmonologist who works in conditions of high risk of contracting a dangerous disease. A doctor helps patients with tuberculosis. For verification of the diagnosis and selection of adequate treatment, the doctor requires the use of specialized tests and diagnostic techniques that are available only in appropriately equipped medical institutions. In the event of a prolonged cough occurring against the background of weight loss, fluctuations in temperature and night sweats, you should definitely consult a doctor.

General information

Phthisiology is a narrow section of medicine that focuses on the study of only one infectious disease, tuberculosis.

Due to the prevalence of this socially dependent disease and the high mortality rate in the past, the science of tuberculosis was identified in a separate clinical section. Initially, tuberculosis was classified as incurable diseases, so this section was called “phthisiology” (from Greek phthisis - death, exhaustion). It is the exhaustion of the disease that gave the second name to tuberculosis - “consumption” (from the word “wither”).

Currently, in most cases, the term “phthisiology” is used (the Greek phthisis was supplemented with the end of iatreia (treatment)), which underlines the possibility of treating the disease.

The TB specialist is a specialist with higher medical education, who additionally received an education in the specialty "Phthisiology".

The tasks of this specialist include:

  • organization of preventive measures (includes education of patients and those who are in contact with them),
  • identification of patients using objective diagnostic methods and differential diagnosis (includes the appointment of laboratory tests, the interpretation of radiographs and tomography, determination of indications for bronchoscopy and biopsy),
  • rendering the necessary emergency assistance
  • determination of the form and phase of tuberculosis, identification of complications,
  • appointment of complex therapy or timely referral for surgery,
  • determining the nature of residual changes and assessing the risk of their reactivation after clinical cure,
  • identification of associated diseases and tactics of treatment of these diseases,
  • solution of the patient's ability to work.

TB physicians work in outpatient clinics (infectious diseases or TB departments), in hospitals (TB departments in infectious or multidisciplinary medical institutions), tuberculosis dispensaries and sanatoriums.

The spread of tuberculosis throughout the world is unequal (the main number of patients is detected in developing countries), but due to the use of immunosuppressive drugs and other immune suppressing factors, the number of patients in developed countries is growing every year.

Since the disease in the initial stages is asymptomatic or latent, adults are much less likely to go to doctors for help, and a large number of patients are children.

Due to the resistance of the pathogen and the variety of ways of spreading tuberculosis, childbirth in pregnant women with this disease is carried out in specialized maternity hospitals or in insulators of ordinary maternity hospitals, and the conversion of tuberculosis facilities and building their territory is strictly prohibited.

Types of doctors

Since tuberculosis is capable of affecting not only the lungs, but also other organs of the human body, phthisiatricians have a narrower specialization.

TB specialist may be:

  • phthisiologist-pulmonologist (phthisiopulmonologist) - a specialist who treats pulmonary tuberculosis and other diseases of the bronchopulmonary system,
  • phthisiology-gynecologist (phthiology-gynecologist) - a specialist who treats women with genital tuberculosis lesions,
  • a urology phthisiologist (phthisology specialist) - a doctor who treats tuberculosis of the kidneys of the urinary tract and genitals in men,
  • a phthisiology surgeon - a specialist who treats tuberculosis with the help of surgical methods (in the Russian Federation, thoracic surgeons perform surgical treatment of pulmonary tuberculosis in the direction of TB doctors),
  • ENT specialist (phthysiootolaryngologist) - a doctor who treats tuberculosis lesions of the ear, nose, larynx and pharynx,
  • tuberculosis dermatologist (phthisodermatologist) - a specialist who deals with skin manifestations of tuberculosis,
  • by an orthopedic phthisiologist (phthisio-orthopedist) - by a doctor, whose field of activity includes lesions of joints and bones arising from tuberculosis,
  • a phthisiologist-oculist (phthisiooculist) - a specialist who treats tuberculosis eye damage,
  • pediatric TB doctor (phthisiopediatrist) - a doctor who diagnoses and treats tuberculosis in children.

In addition, the TB doctor may be an infectious diseases specialist, as tuberculosis is an infectious disease.

What organs does the TB doctor treat

Since tuberculosis can affect any tissue and organs of a person with the exception of nails and hair, the TB specialist treats:

  • lungs (most often affected)
  • the kidneys,
  • adrenal glands
  • liver
  • bones,
  • joints,
  • organs of vision
  • intestines
  • genitourinary system
  • ENT organs
  • skin, etc.

What diseases are treated phthisiologist

TB specialist treats tuberculosis. The causative agent of this infectious disease is mycobacterium tuberculosis - unicellular microorganisms without highly organized organelles, which due to the characteristics of the genome are capable of mutations. These slightly curved or straight Koch sticks do not emit toxins, so when they enter the body, there are usually no bright clinical symptoms.

Mycobacterium tuberculosis is stable in the environment and even when they are absorbed by macrophages for a long time remain viable, so the disease can develop several years after infection.

Depending on the mode of transmission, tuberculosis can occur in:

  • pulmonary form (primary lung lesions and forms of the disease that have spread to the pleura, larynx and trachea),
  • extrapulmonary form (affecting any organ).

Pulmonary tuberculosis

Since most Mycobacterium tuberculosis is spread by airborne droplets, a TB doctor most often faces pulmonary forms of the disease.

A TB specialist pulmonologist treats:

  • Primary tuberculosis complex, which develops during primary infection and most often detected in children. When infected in the alveoli, single or multiple lesions are formed, granulomatous inflammation develops, and then the pathological process affects the regional lymph nodes and vessels of the lung root. It can occur in an acute and subacute form, has no specific symptoms, therefore it is often diagnosed as pneumonia or other respiratory diseases. Above the lesion, changes characteristic of pneumonia are detected, febrile or subfebrile temperature, mycobacteria are almost not present in sputum.
  • Tuberculous bronchoadenitis - lesions of the lymph nodes located at the root of the lung with minimal changes in the lung tissue. The clinical picture varies from asymptomatic to severe intoxication, which is accompanied by a dry, sometimes paroxysmal cough.
  • Acute miliary tuberculosis. This small focal hematogenous form of the disease occurs when an infection breaks out of the lesion into the bloodstream. With the generalization of the pathological process, small prosiform tubercles are formed in the lungs, the lesion affects other tissues and organs. Manifested severe intoxication and acute onset of the disease.
  • Disseminated pulmonary tuberculosis, in which large lesions form in the lungs along the vascular branches, signs of intoxication and symptoms of bronchopulmonary diseases are observed. They reveal an acute, subacute or chronic form in which other organs and systems are affected.
  • Focal pulmonary tuberculosis, in which small lesions are formed in the lung tissue, localized in a limited area. The clinical picture is erased (the disease is asymptomatic or with minor disorders of the functions of the internal organs).
  • Infiltrative pneumonic pulmonary tuberculosis, which develops when chronic processes are exacerbated or when a new lesion is formed. The clinical picture resembles pneumonia, bronchitis, or prolonged flu.
  • Pulmonary tuberculoma, in which an encapsulated rounded caseous lesion more than 1 cm in diameter is formed in the lung tissue. The clinical picture is weak, there may be a dry cough and pain in the chest.
  • Caseous pneumonia is a severe form of tuberculosis, in which caseous changes replace normal lung tissue. Observed rapidly developing caseous necrosis, the tendency to melt tissue and the formation of cavities. Affection affects a whole lobe of the lung or the whole lung. It is manifested by high temperature (from 39 degrees), loss of body weight, hemoptysis (possibly pulmonary hemorrhage), and death is often observed.
  • Cavernous pulmonary tuberculosis, which is characterized by undulating course, scanty clinical picture and the formation in the lung tissue of an isolated area (cavity) with the preservation of normal surrounding tissue.
  • Fibrous-cavernous pulmonary tuberculosis is a chronic pathology in which fibrous caverns are present in the lung tissue and tissue changes occur around them. It has a wave-like character, with an exacerbation there is a cough with sputum and hemoptysis. This form is the most common cause of death for tuberculosis patients.
  • Tuberculous pleurisy, which can be dry and exudative, serous, purulent and sometimes hemorrhagic. It develops as an independent disease or as a complication of pulmonary tuberculosis, manifests signs of intoxication, fever, chest pain, the appearance of shortness of breath.
  • Cirrhotic tuberculosis - a wave-like pathology in which coarse connective tissue grows in the lungs and pleura and foci appear in the healed state and active form. Respiratory failure and other symptoms are observed during the exacerbation.

Also, a TB specialist-pulmonologist treats tuberculosis of the bronchi, trachea and larynx, which are rarely independent forms of the disease. Tuberculosis of the bronchi and trachea can occur in the infiltrative, ulcerative and fistulous forms, manifested by irritation of the tracheobronchial tract. Throat tuberculosis is manifested by hoarseness and pain when swallowing.

Extrapulmonary tuberculosis

Extrapulmonary forms of tuberculosis are a complication of pulmonary tuberculosis or are spread by alimentary and contact means.

TB specialist treats tuberculosis:

  • Cerebral membranes and the central nervous system, which are manifested by headaches, drowsiness, nausea and vomiting, stiff neck, pyramidal and cerebellar symptoms (seizures and impaired consciousness are possible).
  • Intestines, in which there are subfebrile, weight loss, vomiting, diarrhea and abdominal pain (signs of appendicitis or intestinal obstruction may be present).
  • Lymph nodes. Lesions affect predominantly supraclavicular and cervical anterior and posterior nodes, which become hard, increase in size, but do not hurt and further soften, forming fistulae.
  • Bones and joints. Most often, the lesions are detected in the elderly, accompanied by pain, swelling and restriction of movement in the joints.
  • Urinary system, in which there are mild local symptoms (frequent urination, pelvic pain, menstrual disorders, etc.).
  • Eye. Over a long period of asymptomatic disease with time manifested "fog" before the eyes, a feeling of heaviness in the orbital area, a progressive decrease in visual acuity, photophobia and tearing.

Также фтизиатр лечит редко встречающиеся поражения брюшины (туберкулезный перитонит), туберкулез лор-органов, кожи, сердца, печени и других органов.

Когда необходимо обращаться к фтизиатру

Консультация фтизиатра необходима лицам, у которых:

  • был контакт с человеком, больным туберкулезом,
  • при туберкулиновой пробе получен положительный ответ,
  • x-ray showed foci of darkening,
  • there are symptoms characteristic of tuberculosis.

The disease can occur in an asymptomatic form, which can be detected using fluorography.

Tuberculosis can manifest itself:

  • increased fatigue, which increases in the evening, as well as general weakness,
  • loss of body weight in the absence of objective reasons
  • loss of appetite
  • painful sensations in the sternum,
  • dry, sometimes paroxysmal cough or cough, in which translucent frothy sputum is separated (in certain forms of the disease, blood appears in the sputum),
  • sweating that appears at night,
  • periodically increasing temperature
  • shortness of breath that occurs during exercise,
  • hoarseness or pain when swallowing.

Stages of consultation

Consultation with a TB specialist includes:

  • examination of the patient’s complaints and the history of the disease (the doctor specifies how long the patient’s disturbing symptoms have appeared, whether the patient has had contact with patients with tuberculosis, etc.),
  • examination, during which the doctor examines the skin, palpates the lymph nodes and listens to the patient's lungs,
  • purpose of additional research
  • determining the form of the disease and the choice of treatment methods.

Diagnostics

To make a diagnosis, a phthisiologist uses:

  • The results of the Mantoux test (skin tuberculin test), through which you can identify the disease at an early stage. The presence of the pathogen in the body is determined by the size of the papule appearing at the injection site.
  • Sowing of biomaterials that are associated with a lesion (sputum obtained from the bronchi of the flush water, discharge of ulcers or urine) using the method of fluoroscopy in ultraviolet color. The phlegm can immediately be taken from the patient, or he brings the sputum collected in the morning for analysis within 2 hours after collecting the material.
  • Hepatic tests to investigate liver function.
  • Eye examination, including ophthalmoscopy, visometry, tonometry, cytological examination of biopsy, biomicroscopy.
  • CT and MRI scans that allow detection of lesions in the lungs and other organs.

For screening studies, fluorography is used - a rapidly performing type of X-ray, carrying a minimum radiation load on the body.

Methods of treating tuberculosis depend on the form of the disease, but the general treatment regimen includes:

  • the use of more than three drugs at the stage of intensive care, and later more than two drugs to which mycobacteria are susceptible, identified in a particular patient,
  • determination of liver enzymes, creatinine, bilirubin, urea, etc. before the use of drugs (anti-TB drugs affect the function of the liver),
  • conducting research on the presence of immunosuppressive conditions,
  • monitoring of side effects and interactions of used drugs.

The treatment regimen for new cases usually includes rifampicin, isoniazid, pyrazinamide, and ethambutol for 2 months.

If every new case of tuberculosis is detected, the sanitary and epidemiological station will be notified of this.

Therapy in persons who are in serious condition, begins immediately (until the results of microbiological studies).

Authorities dealt with by TB

First of all, as already indicated, these include the lungs. However, tuberculosis affects any tissue and organs in the body. In other words, there is no such body that could bypass this disease. Accordingly, damage is allowed for bones and joints, for meninges and skin, for eyes and lymph nodes, for intestines and peritoneum, kidneys and adrenal glands, as well as for organs of the urogenital system and for bone and joint organs.

Depending on what area was affected by mycobacteria, their subsequent discharge from the sick person will occur through sputum, urine, feces, menstrual flow, semen, tears, breast milk, fistula, ulcers, etc.

TB specialist: symptoms that should be treated

Reception of a phthisiatrician, as already noted, can be prescribed by any other doctor with the onset of appropriate symptoms. Pediatric TB specialist is necessary if the Mantoux reaction is positive (children). So, select the main symptoms that require consultation phthisiatrician:

  • pain in the chest,
  • prolonged manifestation of cough (3 weeks or more)
  • presence of expectorant secretions (sputum, mucus),
  • loss of appetite,
  • unreasonable weight loss
  • hemoptysis,
  • excessive sweating, especially at night,
  • weakness, prolonged indisposition, exhaustion,
  • periodically elevated temperature.

Often, patients for whom the active form of tuberculosis is relevant do not experience any severe symptoms. Because of this, no treatment measures are taken, because such patients simply do not know that they have the disease. However, they are dangerous for their surroundings, acting as distributors of infection.

TB specialist: diagnostic methods

To visit this specialist requires some preparation, and it concerns in particular the necessary for the conduct of diagnostic methods. So, before visiting a phthisiologist, you may need a radiography of the chest area, as well as the results of a general blood test. The TB doctor himself may subsequently schedule the following additional examinations:

  • tuberculin skin test (known as the Mantoux reaction) - it allows you to understand whether a patient is infected,
  • microbiological seeding of one or another type of material (pus, sputum, urine, discharge of ulcers or fistulas, washing water from the stomach, bronchi, etc.),
  • examination of sputum separated during cough for the presence of germs in it,
  • liver test,
  • eye exam (especially if ethambutol is used),
  • urine culture (diagnosis of renal tuberculosis).

All these are specific diagnostic methods. There are also basic general methods. In particular, this is the already noted X-ray examination of the chest area (i.e. fluorography), CT scan, MRI, a study for the diagnosis of cerebrospinal fluid, the diagnosis of extrapulmonary tuberculosis, etc.

The reception itself is based on familiarizing the doctor with the available data on past examinations of the patient. He also clarifies what complaints the patient is concerned about, learns about the peculiarities of lifestyle and the diseases that he had previously suffered. Already on the basis of a general reception, an individual decision will be made regarding the necessary diagnostic methods.

General Tuberculosis Information

Tuberculosis, in view of the characteristics that cause infection of patients, is considered to be a disease of unsanitary conditions and poverty. To rule out this disease, it is important to provide normal support for your own immunity. If the immune system is in a normal state, then it will be able to cope with a Koch wand when it is ingested.

In general, the advice of a phthisiatrician will not determine anything new for the reader. The basis for strengthening the immune system is a varied and high-quality food. It is also important to take vitamins, not bad, if there is an opportunity for sports, hardening. What is remarkable, the leading role in the development of tuberculosis is given to prisons, and, in particular, to the conditions in them, in connection with which it is possible to draw parallels with the conditions in “ordinary life”.

Quite often, the treatment of tuberculosis is carried out in the wrong way, in addition, patients often do not know about their disease, because of what it is rapidly spreading. Getting into the air environment, the Koch wand for a long period of time can maintain its own viability - up to 10 days, which is quite a lot when it comes to falling into ordinary street dust. At the same time, if the Koch wand turns out to be in conditions without sunlight, then its viability increases to a greater degree, reaching several months.

Infection with tuberculosis occurs only by inhalation of air containing sputum and microscopic droplets of saliva from a sick person. Depending on the number of microorganisms trapped in the lungs, it is determined whether infection will occur or not, whether the body is able to suppress them or not. With a long stay in one room with a sick person, the risk of infection increases many times, and it is on this principle that this disease thrives in prisons. The more poorly ventilated the premises are, the longer the disease-causing organisms will be in the air.

Infection with tuberculosis in the street during a normal handshake is not possible. At the same time, in rooms where the air is practically stationary, the risk of infection, even with tactile contact, increases.

In addition, infection with tuberculosis occurs when eating milk from animals infected with tuberculosis (cows, for example). The same applies to preventing the purchase of milk, meat and dairy products in the locations of "spontaneous" markets (places not intended for trade, in which goods are not subject to sanitary and epidemiological control). As you know, the purchase of this type of goods will be done at your own risk, and no one can guarantee their safety.

As a basic recommendation for disease control, the need for systematic X-ray scans can be indicated; children should be given a Mantoux test every year.

What is a TB doctor?

This is a specialty of a doctor with a higher medical education who studies various measures for the prevention, diagnosis and treatment of all possible forms of tuberculosis. Such a specialist is competent in matters of the causes of development, mechanisms of infection transmission of tuberculosis, the course of pathological processes. It carries out preventive, epidemiological, therapeutic and rehabilitation measures, as well as the necessary diagnostic procedures.

When should I go to a TB doctor?

A phthisiatrician should be contacted by contact with a patient with tuberculosis, with a positive response from a tuberculin test, if suspicious symptoms appear that suggest the presence of the disease.

Adults, unfortunately, for a long time may not pay attention to the signs of the disease. Their pathology is discovered by chance, during the passage of a planned x-ray examination. However, the TB doctor recommends that you seek his advice if you have the following symptoms:

  • fatigue, growing by the evening,
  • poor appetite
  • unnatural sweating, independent of the time of day,
  • unexpected and significant weight loss
  • interscapular pain,
  • persistent bouts of cough, dry or with translucent foamy sputum, in advanced cases of hemoptysis, cough increases when trying to take a deep breath, after a shout or a long conversation,
  • increasing hoarseness and pain when swallowing, heavy breathing,
  • cyclical temperature increase.

In addition, a phthisiatrician may be contacted for consultation and interpretation of a radiological image of the lungs.

What tests need to pass when referring to a TB doctor?

Immediately before visiting a TB specialist, it is recommended to undergo a chest X-ray. Women should visit a gynecologist. Other necessary analyzes and studies, if necessary, will be assigned by the actual TB specialist.

If you have already undergone any examinations for reasons related to the suspicion of a tuberculosis infection, take the results of tests and studies with you so that the doctor can evaluate them and present a complete picture of your condition.

What diagnostic methods does a TB doctor use?

Laboratory diagnostic methods used by the phthisiologist include bacteriological and bacterioscopic analyzes, biological and allergic reactions. Sometimes it is possible to use serological studies.

For microscopy, bacteriology or biological samples, use materials that are directly related to the localization of the tuberculous focus. It may be particles of pus, urine samples, salivary and cerebrospinal fluid, fecal discharge collected in a special container.

  • Homogenization procedure: the daily amount of sputum discharged by the patient is taken into a container, the same amount of 1% caustic soda solution is added, sealed and strongly shaken for 10-15 minutes. The resulting mixture is processed in a centrifuge, then a more dense layer is neutralized by adding 2 drops of 10% hydrochloric or 30% acetic acid. The drug is used in the form of smears and stains on Zil-Nielsen.
  • Flotation procedure: in the same way prepared and shaken up daily volume of sputum is kept for half an hour in a water bath at a temperature of 55 ° C. After that, add 1-2 ml of benzene (or gasoline) and shake again. The resulting mixture should be defended at a temperature of 22-24 ° C: at this time, the particles of benzene rise to the top, capturing the microbial flora. This layer is separated and placed on a piece of glass slide, which is put on additional glass, heated to 60 ° C. The material is applied in several layers and subjected to fixation and coloring on the Zil-Nielsen.
  • Bacteriology: a successful technique that is actively used when bacterioscopy was negative. Two volume doses of 6% sulfuric acid are added to the material taken, shaken for about 10 minutes. After that, the mixture is treated in a centrifuge in special containers, the more dense lower layer is separated and subjected to its neutralization reaction using 3% caustic soda. If stool particles are examined, they are treated with 4% caustic soda, the material is immersed in a thermostat, treated and the dense layer is treated with 8% hydrochloric acid. Subsequently, the drug can be sown on special media.

Such investigational drugs, such as, for example, a sample of cerebrospinal cerebrospinal fluid, particles of purulent discharge, blood elements are not pre-processed. They are applied to nutrient media and kept in a thermostat for 2 months. The first colonies can be found already after 10-30 days.

  • Investigation of deep growth: seeding of secretions is carried out in a container with citrated blood. A week later, the medium is placed in a centrifuge and a smear is made from a dense lower layer.
  • Allergological method is used to detect the actual mycobacterial tuberculosis. Produce a tuberculin injection, which can confirm the presence of infection, but does not represent the characteristics of the process itself. Such methods include intracutaneous Mantoux test and Pirke skin reaction.
  • Serological testing is a process of the reaction of the Bardé-Jangu complement. Used infrequently.

Fluorescence microscopy is considered the most modern and fastest method used by phthisiologists. The material is subjected to staining with auromin at the rate of 1: 1000. After that, remove the color with hydrochloric alcohol and again stained with magenta. As a result, tuberculosis bacilli will glow with a light green shade against a darker background.

What does a TB doctor do?

Tuberculosis clinics, hospitals, TB clinics, specialized sanatoriums - these are the places where a TB doctor works. In such institutions, you can get his advice or assistance related to the timely detection, treatment and implementation of preventive measures that reduce the risk of tuberculosis.

Unfortunately, the presence of significant and numerous cavernous tuberculosis formations, the advanced stage of tuberculosis is not always successfully treated with the help of phthisiology. Such pathological changes in the lung tissues and bronchi are usually cured exclusively by surgery. In such cases, the patient may be referred by a TB specialist to a thoracic surgeon.

To summarize the main activities of the phthisiatrician:

  • prevention of epidemics and the spread of tuberculosis infection,
  • providing anti-tuberculosis care, conducting explanatory work among the population,
  • genetic, immunological and immunomorphological issues of tuberculosis infection,
  • biochemical processes in the etiology of tuberculosis,
  • carrying out therapeutic measures, the introduction of new technologies in therapeutic methods for tuberculosis.

Phthisiatrician Doctor Advice

In order for TB to bypass you and your family, listen to the recommendations of the TB specialist:

  • consult a doctor if you suffer from regular cough, intrathoracic pain, increased sweating and difficulty breathing,
  • If you have had contact with a tuberculosis patient, consult a doctor about prevention and testing,
  • You have regular medical check-ups every two years (in educational institutions and at work, at your place of work) with the obligatory X-ray examination,
  • Some categories of the population should be examined up to 2 times a year. К таким категориям относятся действующие военнослужащие, медработники родильного отделения, люди, постоянно контактирующие с туберкулезными больными, пациенты, переболевшие туберкулезом, больные СПИДом, бывшие заключенные,
  • ведите здоровый образ жизни, закаляйтесь, питайтесь здоровой сбалансированной пищей,
  • воздерживайтесь от курения и употребления спиртных напитков,
  • regularly ventilate the production and domestic premises, follow the rules of public and personal hygiene,
  • timely treat acute and chronic pathologies in the body,
  • refrain from buying dairy products that have not been tested by the sanitary epidemiological station. Such products can be obtained from a cow with tuberculosis.

The TB doctor is a very interesting, necessary and sought-after medical specialty. This doctor bears a great responsibility for the health and full life of people. He is doing everything possible to prevent the development of an epidemic of tuberculosis - one of the most ancient infections, which is a danger at the present time.

Tuberculosis

Tuberculosis is a chronic infectious disease that occurs when a person is infected with mycobacterium tuberculosis. Mycobacterium tuberculosis causes the formation of specific areas of inflammation in the body. The site of inflammation has the form of tubercles, which are scientifically called granulomas. Granulomas contain many immune cells (some doctors believe that tuberculosis triggers autoimmune reactions in the body).

The TB doctor treats the following forms of tuberculosis:

  • tubercular intoxication in children and adolescents,
  • pulmonary form
  • extrapulmonary form.

Extrapulmonary tuberculosis includes:

  • tuberculosis of the bronchi, trachea,
  • tuberculosis of the upper respiratory tract, nasal cavity, mouth and pharynx,
  • tuberculosis of the meninges and the central nervous system,
  • intestinal tuberculosis,
  • peritoneal tuberculosis (tuberculous peritonitis),
  • lymph node tuberculosis (intrathoracic, mesenteric and peripheral),
  • tuberculosis of bones and joints,
  • urinary and genital tuberculosis,
  • eye tuberculosis,
  • lupus,
  • heart tuberculosis,
  • liver tuberculosis.

If the tuberculosis infection spreads through the body with blood (disseminated tuberculosis), then in the organs are formed small bumps. This condition is called miliary tuberculosis.

Sarcoidosis is a disease that, like tuberculosis, leads to the formation of granulomas in the internal organs and, above all, in the lungs. The cause of sarcoidosis is still not well established. Opinions of various researchers agree that sarcoidosis is an autoimmune disease, but it is not yet known what exactly triggers autoimmune reactions. It is assumed that sarcoidosis is caused by very small or atypical forms of mycobacterium tuberculosis. Some doctors believe that sarcoidosis can occur under the influence of the herpes virus (including Epstein-Barr virus).

Sarcoid granulomas are similar to tuberculosis, so when they are found the patient is sent for a comprehensive examination to rule out tuberculosis. In addition, sarcoidosis also affects the lymph nodes and other organs (sarcoidosis can affect any organ).

The following forms of sarcoidosis exist:

  • pulmonary sarcoidosis
  • lymphatic sarcoidosis,
  • skin sarcoidosis,
  • sarcoidosis of other organs and systems (heart, kidney, liver, nervous system and others).

The main difference between sarcoidosis and tuberculosis is that treatment, which is effective for tuberculosis, does not help with sarcoidosis. In addition, patients receiving treatment for sarcoidosis are at risk of developing tuberculosis (drugs inhibit the body's immune system and defenses). This requires the appointment of anti-TB drugs as prevention. Sarcoidosis is treated in tuberculosis dispensaries.

Leprosy or leprosy is a low-contagious chronic infectious disease that is caused by mycobacterium leprosy (Hansen's wand). This mycobacterium has genetic similarities with bovine mycobacteria (mycobacterium bovis), which in 15% of cases also causes the development of tuberculosis (man becomes infected by animal). Lepra is common in Africa, so it is called African tuberculosis.

Due to the similarity of mycobacterium leprosy and bovine mycobacterium (of which the BCG vaccine consists) skin tests to detect tuberculosis (Mantoux testmay be false positive.

In one form of leprosy, tuberculous granulomas are formed on the skin, i.e. tubercles that resemble tuberculosis (“Oidny” - similar). This is another similarity with tuberculosis.

The treatment of patients with leprosy is carried out in special isolated hospitals, which are called leprosariums. Such doctors as dermatologists, immunologists, infectious disease specialists are engaged in leprosy.

What are the symptoms of a TB doctor?

Patients with tuberculosis do not immediately get to a phthisiatrician, as the disease is characterized by a variety of atypical symptoms. The symptoms of tuberculosis are virtually indistinguishable from the symptoms with which people turn to other specialists, which is why it is called the “great masking specialist.” Even exhaustion (ftisis), which gave the name of the specialty phthisiatrician, can not be regarded as a clear sign of tuberculosis. If symptoms of tuberculosis occur, patients can turn to different specialists, depending on which organ suffers. That is why the suspicion of tuberculosis, as a rule, arises not from the patients themselves, but from their attending physicians - therapists, pulmonologists, cardiologists, gynecologists and other specialists. Alert against tuberculosis is “laid down” in a doctor of any specialty due to its prevalence and danger (yet it is an infectious disease).

Symptoms of tuberculosis are considered together, especially if pulmonary complaints are combined with extrapulmonary.

Symptoms that should be referred to a TB doctor

Symptom

Mechanism of occurrence

What studies produce to identify the cause of the symptom?

When does this symptom appear?

Weakness, fatigue, poor appetite

Symptoms are caused by acute or chronic intoxication of the body.

  • fluorography,
  • radiography of the lungs
  • ultrasound procedure (Ultrasound),
  • complete blood count and urinalysis,
  • blood chemistry,
  • tests for the detection of mycobacterium tuberculosis,
  • immunological blood test.
  • tubercular intoxication in children and adolescents,
  • pulmonary tuberculosis,
  • extrapulmonary tuberculosis,
  • sarcoidosis.

Weight loss

Loss of body weight is observed with a long-existing chronic intoxication, damage to many organs, which depletes the reserves of the human body.

Fever

Intoxication in the body produces substances that affect the center of thermoregulation in the body. The response of the thermoregulation center is manifested by increased sweating.

Excessive sweating

Cough and sputum

Cough appears against the background of the inflammatory process in the lungs or bronchi, and also if the bronchi are compressed by enlarged lymph nodes.

Phlegm is released when inflammation or destruction of lung tissue, as well as irritation of the bronchial mucosa.

  • radiography of the lungs
  • general blood and urine analysis
  • blood chemistry,
  • tests for the detection of mycobacterium tuberculosis (in the sputum),
  • CT scan (CT),
  • bronchoscopy and bronchography,
  • radionuclide study of the lungs,
  • thoracoscopy
  • mediastinoscopy,
  • pleural puncture,
  • biopsy (tissue sampling),
  • immunological blood test.
  • pulmonary tuberculosis,
  • bronchial tuberculosis,
  • tuberculosis of the intrathoracic lymph nodes,
  • sarcoidosis.

Dyspnea

Dyspnea occurs due to a decrease in the respiratory surface of the lungs, impaired bronchial patency, as well as restriction of chest movement. In addition, shortness of breath appears when toxins are exposed to the center of respiration and the heart does not work properly.

  • radiography of the chest and spine
  • electrocardiography (ECG),
  • Ultrasound,
  • pulse oximetry,
  • spirometry
  • general blood and urine analysis
  • blood chemistry,
  • tests for the detection of mycobacterium tuberculosis (sputum analysis),
  • CT scan (CT),
  • bronchoscopy and bronchography,
  • radionuclide study of the lungs,
  • thoracoscopy
  • mediastinoscopy,
  • pleural puncture,
  • biopsy,
  • immunological blood test.
  • pulmonary tuberculosis,
  • tuberculous bronchitis,
  • tuberculosis of bones and joints,
  • sarcoidosis.

Chest pain

Chest pain is associated with irritation of the sensory nerve endings of the pleura (shell around the lungs) or overstressing the muscles of the chest with a long cough. Less commonly, pain is associated with irritation of the nerve endings of the around-the-heart bag (pericardium) or the formation of granulomas in the bones of the spine.

  • radiography of the lungs
  • electrocardiography (ECG),
  • Ultrasound,
  • pulse oximetry,
  • spirometry
  • general blood and urine analysis
  • blood chemistry,
  • tests for the detection of mycobacterium tuberculosis (in sputum and biopsy material),
  • CT scan (CT),
  • bronchoscopy and bronchography,
  • radionuclide study of the lungs,
  • thoracoscopy
  • mediastinoscopy,
  • pleural puncture,
  • biopsy,
  • immunological blood test.
  • pulmonary tuberculosis,
  • tubercular intoxication in children and adolescents,
  • tuberculosis of bones and joints,
  • heart tuberculosis,
  • sarcoidosis.

Abdominal pain

Abdominal pain is caused by peritoneal irritation (shell covering organs and abdominal wall) or stretching the walls of the abdominal organs.

  • Ultrasound,
  • radiopaque examination of the intestines, uterus and fallopian tubes,
  • colonoscopy
  • laparoscopy,
  • general blood and urine analysis
  • blood chemistry,
  • punctures and biopsy,
  • tests for the detection of mycobacterium tuberculosis (in biopsy material, mucus from the cervix or menstrual blood),
  • immunological blood test.
  • female genital tuberculosis,
  • tuberculous peritonitis,
  • liver tuberculosis,
  • tuberculosis of mesenteric glands,
  • intestinal tuberculosis,
  • sarcoidosis.

Low back pain

Low back pain associated with the presence of an obstacle to the flow of urine and stretching of the renal pelvis.

  • Ultrasound,
  • radiopaque examination of the kidneys,
  • Magnetic resonance imaging (MRI),
  • biopsy,
  • general blood and urine analysis
  • blood chemistry,
  • tests for the detection of mycobacterium tuberculosis (in urine and biopsy material),
  • immunological blood test.
  • kidney tuberculosis.

Pain in bones and joints

Bone pain and pain in the joints are caused by the formation of granulomas in them, which are surrounded by an area of ​​inflammation. If the granulomas merge, then the destruction of the tissues of the joints and bones occurs.

  • radiography of the chest, spine, bones and joints,
  • MRI,
  • biopsy,
  • tests for the detection of mycobacterium tuberculosis (obtained by biopsy material),
  • general blood and urine analysis
  • blood chemistry,
  • immunological blood test.
  • tubercular intoxication in children and adolescents,
  • tuberculosis of bones and joints,
  • sarcoidosis.

Hemoptysis

Hemoptysis (coughing up blood) occurs when the destruction of the blood vessels of the bronchi and lungs. In some cases, the affected upper respiratory tract may bleed.

  • radiography of the lungs
  • bronchoscopy and bronchography,
  • CT scan
  • radionuclide study of the lungs,
  • thoracoscopy
  • mediastinoscopy,
  • pleural puncture,
  • biopsy,
  • analysis for the detection of mycobacterium tuberculosis (in bloody sputum and biopsy material or puncture),
  • general blood and urine analysis
  • blood chemistry,
  • immunological blood test.
  • pulmonary tuberculosis,
  • laryngeal tuberculosis,
  • oral tuberculosis,
  • sarcoidosis.

Menstrual dysfunction or sterility

Menstrual dysfunction is associated with the destruction of the mucous membrane of the uterus and ovarian tissue, and infertility, among other things, due to adhesions in the abdominal cavity or in the lumen of the fallopian tubes.

  • Ultrasound,
  • x-ray contrast study of female genital organs,
  • laparoscopy,
  • biopsy,
  • tests for the detection of mycobacterium tuberculosis (in mucus from the cervix, menstrual blood and biopsy material),
  • general blood and urine analysis
  • blood chemistry,
  • immunological blood test.
  • female genital tuberculosis,
  • tuberculosis of the peritoneum.

Urinary Disorders

Urination may be disrupted by the formation of granulomas in the renal tissue or urinary congestion in the urinary tract.

  • Ultrasound,
  • X-ray examination of the kidneys
  • CT scan
  • MRI,
  • laparoscopy,
  • general blood and urine analysis
  • blood chemistry,
  • biopsy,
  • analysis for the detection of mycobacterium tuberculosis (in urine, semen, prostate secretion and biopsy material),
  • immunological blood test.
  • tuberculosis of the urinary system,
  • male genital tuberculosis,
  • sarcoidosis.

Chair disorders

The defeat of the mesentery causes a disorder in the organs with which it is associated (mesentery fixes the small intestine to the back of the abdomen).

  • Ultrasound,
  • CT scan
  • laparoscopy,
  • radiopaque examination of the intestines,
  • colonoscopy
  • biopsy,
  • tests for the detection of mycobacterium tuberculosis (in biopsy material),
  • general and biochemical blood test,
  • immunological blood test.
  • tuberculosis of mesenteric glands,
  • tuberculous peritonitis,
  • intestinal tuberculosis.

Nausea, vomiting

Nausea and vomiting can occur as a result of intoxication of the body, with damage to the meninges or irritation of the walls of the digestive organs.

  • radiography of the lungs
  • Ultrasound,
  • MRI,
  • CT scan
  • radiopaque examination of the intestines,
  • colonoscopy
  • laparoscopy,
  • lumbar puncture,
  • biopsy,
  • tests for the detection of mycobacterium tuberculosis (in cerebrospinal fluid or biopsy material),
  • general blood and urine analysis
  • blood chemistry,
  • immunological blood test.
  • tubercular intoxication in children and adolescents,
  • intestinal tuberculosis,
  • tuberculous peritonitis,
  • tuberculous meningitis.

Skin rash

scars and ulcers

Skin rash is associated with either an allergic reaction from the small vessels (vasculitis), or with the formation of granulomas in the skin.

  • skin biopsy
  • tests for the detection of mycobacterium tuberculosis (in scraping or biopsy material),
  • Diaskintest,
  • T-spot test
  • Kveim's test,
  • general and biochemical blood test.
  • tubercular intoxication in children and adolescents,
  • lupus,
  • sarcoidosis
  • leprosy.

Round dense painless formation on the neck under the jaw, in the armpits and groin

Round dense formations are lymph nodes, which increase during the inflammatory process in the body.

  • Ultrasound,
  • biopsy,
  • analysis for the detection of mycobacterium tuberculosis (in biopsy material),
  • immunological blood test.
  • peripheral lymph node tuberculosis,
  • sarcoidosis.

Headache

(in combination with other symptoms)

Headache occurs as a result of damage to the meninges or intoxication of the body.

  • radiography of the lungs
  • spirometry
  • pulse oximetry,
  • MRI,
  • lumbar puncture,
  • analysis for the detection of mycobacterium tuberculosis (in the cerebrospinal fluid),
  • T-spot test
  • general and biochemical blood test,
  • immunological blood test.
  • tubercular intoxication in children and adolescents,
  • tuberculous meningitis,
  • sarcoidosis.

Photophobia and tearing

(in combination with other symptoms)

Photophobia and lacrimation are associated with lesions of the iris and / or choroid.

  • ophthalmologic examination (eye biomicroscopy),
  • immunological blood test.
  • eye tuberculosis,
  • sarcoidosis.

Hoarseness and sore throat

The voice becomes hoarse if the tuberculous process affects the vocal cords. Sore throat due to lesion of the epiglottis, which covers the larynx during swallowing.

  • bronchoscopy
  • analysis for the detection of mycobacterium tuberculosis (obtained during the bronchoscopy material),
  • immunological blood test.
  • laryngeal tuberculosis.

Pale face with blush

Pale complexion due to chronic intoxication and anemia (a decrease in the number of red blood cells and hemoglobin in the blood). Blush is associated with a decrease in the tone of small vessels and their expansion against the background of oxygen starvation.

  • fluorography,
  • radiography of the lungs
  • Ultrasound,
  • general blood and urine analysis
  • blood chemistry,
  • tests for the detection of mycobacterium tuberculosis,
  • immunological blood test.
  • pulmonary tuberculosis.

Blueness of lips, fingers and toes

(acrocyanosis)

The blueness of the lips, fingers and toes is associated with slower blood flow in these parts.

  • pulmonary tuberculosis,
  • sarcoidosis.

What research does a TB doctor do?

The TB doctor conducts research in people with complaints that may be caused by tuberculosis and in patients who undergo preventive examinations. The fact is that tuberculosis is often found in people who, in principle, have no special complaints. It is these patients that are the most dangerous, because even in the absence of serious illness, they do not cease to be a source of infection. The amount of research conducted by a phthisiologist depends on the place of work. The main instrumental diagnostic methods are carried out in tubal dispensaries.

Instrumental studies prescribed by the phthisiologist

Instrumental study

What reveals?

How is it done?

Fluorography

  • pulmonary tuberculosis.

Fluorography is a type of X-ray study that is used as a mass prophylactic radiation diagnostic method. After irradiation of the human chest, the resulting image is photographed on a 100x100 mm film (less x-ray image).

X-ray of the lungs, spine and joints

  • pulmonary tuberculosis,
  • tuberculosis of the joints and bones,
  • tuberculosis of intrathoracic lymph nodes,
  • sarcoidosis.

X-ray is a radiation method that allows you to take a snapshot of the desired organ in different projections. The projection depends on how the person is standing in front of the X-ray screen. If the screen is located in front of the chest (or spine and bone) - this is the front position, if the back - back, and if the right or left - side.

Bronchography and Bronchoscopy

  • bronchial tuberculosis,
  • laryngeal tuberculosis,
  • tuberculosis of the intrathoracic lymph nodes,
  • sarcoidosis.

Bronchoscopy is performed using a bronchoscope, that is, a probe that is equipped with a light source and an optical or video system. A bronchoscope is inserted through the nose or mouth and carried to the bronchus, examining its mucosa. During bronchoscopy, you can also examine the larynx, trachea, as well as take a piece of the areas that are affected. Bronchography is a radiopaque examination of the bronchi. Contrast is introduced using a catheter or a bronchoscope, followed by a series of x-rays.

Radiocontrast study of the intestines, urinary and genital organs

  • intestinal tuberculosis,
  • urinary tract tuberculosis
  • genital tuberculosis.

For a contrast study of the intestine, a patient is given a barium suspension to drink, or this suspension is injected with an enema (irrigoscopy). If you need to examine the urinary organs, then the contrast agent (urografin) is administered intravenously (intravenous urography). When examining the uterus and fallopian tubes, contrast is introduced through the vagina (hysterosalpingography). After the contrast has reached the organ, they begin tracking its progress (fluoroscopy) or make a series of x-rays.

Ultrasound procedure

  • tuberculosis of the urinary system,
  • genital tuberculosis,
  • mesenteric lymph node tuberculosis,
  • tuberculosis of bones and joints,
  • peripheral lymph node tuberculosis,
  • heart tuberculosis,
  • liver tuberculosis,
  • sarcoidosis.

Ultrasound is based on the ability of ultrasound to “return” (echolocation). The sound sent by the ultrasonic sensor is captured by him. A specialist can observe on the screen the demarcation of tissues that have different densities, that is, they reflect the echo signal differently. Ultrasound is usually performed in the prone position or not on the side.

Radionuclide study of the lungs

  • pulmonary tuberculosis,
  • sarcoidosis.

Radionuclide study allows to evaluate the blood flow and ventilation in different parts of the lungs. For this purpose, a radiopreparation labeled with gamma-emitting particles (radionuclides). Gamma radiation is captured by a gamma camera, which is placed above the lungs after inhalation or intravenous administration of a radiotherapy agent.

CT scan

  • pulmonary tuberculosis,
  • bronchial tuberculosis,
  • tuberculosis of intrathoracic lymph nodes,
  • tuberculous meningitis,
  • tuberculosis of the joints and bones,
  • tuberculosis of the urinary system,
  • genital tuberculosis,
  • mesenteric lymph node tuberculosis,
  • intestinal tuberculosis,
  • sarcoidosis.

CT scan is performed in the position of the patient lying on a special table. The x-ray tube radiating thin beams of rays rotates around the patient. These beams pass at different angles through the organ under study, resulting in thin sections, which also capture the rotating sensors. Sensors send data to a computer. If necessary, a contrast agent can be administered during CT.

Magnetic resonance imaging

  • tuberculous meningitis,
  • tuberculosis of the joints and bones,
  • tuberculosis of the urinary system,
  • sarcoidosis.

During the MRI, the patient lies on the table of a tomograph, which moves into the tunnel. A magnetic field is created around the body, which temporarily changes the direction of the protons. As a result, magnetic resonance is formed, which is converted by the analyzer into a black and white picture. With MRI, there is no radiation load.

Thoracoscopy

(pleuroscopy)

  • pulmonary tuberculosis (with pleural lesions),
  • sarcoidosis.

To study the pleural cavity, video equipment is used, that is, endoscopes (thoracoscopes) having a video camera and illuminator (the picture is transferred to the monitor). Thoracoscopes are inserted into the pleural cavity through trocars, which are guides that pierce the chest wall. In addition to the examination of the pleura, this method allows for other manipulations, such as biopsy (fabric fence) of interest or removal of fluid (for diagnostic and therapeutic purposes).

Mediastinoscopy

  • tuberculosis of the intrathoracic lymph nodes,
  • sarcoidosis.

Mediastinoscopy is a study of the mediastinum (the area between the chest organs) using a video endoscope. The procedure is performed under anesthesia. The mediastinoscope is inserted through a small incision above the sternum jugular notch (fossa between the clavicle in front). In the study, you can make the same manipulations as during thoracoscopy.

Laparoscopy

  • mesenteric lymph node tuberculosis,
  • tuberculosis of the peritoneum.

Laparoscopy is a study of the abdominal cavity. The technique of manipulation is practically no different from the technique of thoracoscopy. The only difference is that carbon dioxide is injected into the abdominal cavity to separate the organs from each other.

Colonoscopy

  • intestinal tuberculosis.

The intestine is examined with a colonoscope. By the principle of action, colonoscopy is similar to bronchoscopy with the only difference that an endoscope is inserted into the rectum.

Pleural cavity puncture

  • pulmonary tuberculosis (with pleural lesions),
  • sarcoidosis.

Puncture of the pleural cavity is its needle puncture in order to obtain fluid for the study, as well as a medical procedure. During the puncture the patient is seated. The rib cage is pierced between the seventh and eighth ribs (on the upper edge of the lower edge) long and thick needle. After entering the pleural cavity, a syringe is attached to the needle and the liquid is sucked off.

Lumbar puncture

  • tuberculous meningitis,
  • sarcoidosis (neurosarcoidosis).

During puncture of the spinal space, the patient sits or lies on his side. The spine should be bent as much as possible. To do this, feet pressed to the chest (fetal position). A needle is inserted between the 3 and 4 or 4 and 5 vertebrae of the lumbar spine.

Biopsy

  • pulmonary tuberculosis,
  • tuberculosis of intrathoracic lymph nodes,
  • peripheral lymph node tuberculosis,
  • mesenteric lymph node tuberculosis,
  • peritoneal tuberculosis,
  • lupus,
  • kidney tuberculosis,
  • liver tuberculosis,
  • intestinal tuberculosis,
  • sarcoidosis.

A biopsy, that is, the collection of tissue from the affected organ for subsequent laboratory tests, is carried out in several ways. Biopsy must be performed during any endoscopic examination (bronchoscopy, thoracoscopy, mediastinoscopy, laparoscopy, colonoscopy), if, of course, there is something found. You can get the material using a catheter (aspiration biopsy), needles and syringe (needle biopsy). Finally, for the sake of biopsy, surgical excision of the desired tissue is performed.

Ophthalmologic examination

(eye biomicroscopy)

  • eye tuberculosis,
  • sarcoidosis.

The study is conducted by an ophthalmologist in a darkened room. Biomicroscopy is an examination of eye tissue using a microscope and a slit lamp. During the study, the patient rests his chin on the microscope stand and rests his forehead on the crossbar parallel to the stand to fix the head.

In addition to diagnostic methods, the phthisiologist uses research on the function of vital organs.

The TB doctor prescribes the following additional research methods:

  • spirometry - method of assessing respiratory function (breathing in the lungs),
  • electrocardiography - registration of the electrical activity of the heart,
  • echocardiography - heart ultrasound to assess the degree of cardiopulmonary failure,
  • pulse oximetry - assessment of blood oxygen saturation.

What laboratory tests does a phthisiologist prescribe?

The TB doctor prescribes tests in order to assess the condition of the body and identify Mycobacterium tuberculosis. In addition, other diseases are very often found in patients with tuberculosis, which facilitate infection or aggravate tuberculosis. Some of the tests can be taken in private laboratories, but in most cases, all studies are conducted in tuberculosis dispensaries. It is important to note that there are samples that are carried out as part of preventive measures and tests, which are appointed to clarify or exclude tuberculosis.

The TB doctor prescribes the following tests:

  • Mantoux test
  • Diaskintest,
  • Kveim's test,
  • tests for the detection of mycobacterium tuberculosis,
  • T-spot test
  • clinical analyzes (blood, urine),
  • immunological blood test.

Mantoux test

The Mantoux test or the tuberculin test is designed to detect the immune response to subcutaneous administration of tuberculin. The immune response occurs on the skin if the body has met with Mycobacterium tuberculosis, and the immune cells are in a state of hypersensitivity to these bacteria (this condition is called sensitization). Tuberculin is a drug containing particles of Mycobacterium tuberculosis (human and bovine types), therefore, he cannot cause the disease, but is able to reveal an immune response (immune cells will take tuberculin for real mycobacteria and start attacking).

Tuberculin is injected under the skin of the inner surface of the forearm. A white-colored “lemon peel” forms at the injection site - this is the place where the meeting of tuberculin and immune cells should occur.

Results are evaluated after 72 hours using a special ruler.

Evaluation of the reaction to Mantu is carried out as follows:

  • negative - the reaction is weak or absent, with the diameter of the infiltrate (seals) at the injection site less than 1 mm (no tuberculosis),
  • doubtful - diameter of infiltrate 2-4 mm or has redness (mild or moderate reaction),
  • positive - diameter of the seal is more than 5 mm (moderate reaction),
  • hyperergic - severe reaction, with the diameter of infiltration or redness more than 17 mm in children and more than 21 mm in adults.

If the Mantoux test is negative, but there are granulomas in the organs and damage to the lymph nodes, then a person may not have tuberculosis, but sarcoidosis. In severe cases of tuberculosis, the Mantoux test can also be negative due to suppression of the immune system. In addition, false positive results are possible (for example, after BCG vaccination).

The test is carried out in the framework of tuberculosis prevention.

Diaskintest

Diaskintest is prescribed with a positive Mantoux test or instead of it in order to clarify the infection with tuberculosis, especially in people with an increased risk of developing tuberculosis. The principle of diaskintest does not differ from the Mantoux test. The difference lies in the fact that instead of tuberculin use the drug "Diaskintest" containing proteins that are present in Mycobacterium tuberculosis of the human type (Koch's wand) and absent in the bovine type of mycobacterium (the bovine type consists of BCG vaccine and tuberculin).

Diaskintest may be positive when infected with mycobacterium leprosy, due to the presence of the same proteins that are part of the diaskintest preparation.

Mycobacterium tuberculosis screening tests

The most important point in the diagnosis of tuberculosis is the detection of bacterial excretion. Bacteria are secretions of Mycobacterium tuberculosis (MBT) into the environment with biological (natural) or pathological fluids. Mycobacteria should be detected in the affected organ, if instrumental methods have revealed changes characteristic of tuberculosis - this is the criterion of active tuberculosis. Otherwise, it is too early to say that it is tuberculosis, it is necessary to repeat the instrumental diagnosis in 2 to 4 weeks. Mycobacterium for tuberculosis should not be allocated only after effective treatment.

Mycobacterium assays

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